Counseling: A Process View

Philip Glessner MFT, LADC

Definition Of Counseling

A supportive and empathic professional relationship that provides a framework for the exploration of emotions, behaviors, and thinking patterns, and the facilitation of healthy changes. Counseling is directed towards people experiencing difficulties as they live through the normal stages of life-span development.

Counseling Functions

Remedial

Functional Impairment
Anticipate and Accommodate Human Potential

Preventive

Enhancement

Counseling And Theory

Negligible differences in effects produced by different therapy types Common elements between theories
Responding to feelings, thoughts and actions of the client Acceptance of clients perceptions and feelings Confidentiality and privacy Awareness of and sensitivity to messages communicated in counseling

Characteristics Of Effective Helpers

Self-awareness and understanding Good psychological health Sensitivity Open-mindedness Objectivity Competence Trustworthiness Interpersonal Attractiveness
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Components Of The Counseling Process

Relationship
Assessment Goal

Building

Setting Intervention Termination and Follow-Up

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What Works in Treatment: A Review of 40 Years of Outcome Research

Extratherapeutic Factors 40% Relationship Factors 30% Hope & Expectancy 15%

Model & Techniques 15%

Relationship Building

Conditions Of An Effective Therapeutic Relationship

Accurate Empathy Genuineness/Congruence Positive Regard/Respect

Clients perception of relationship is what counts!

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Counselor Skills Associated With Facilitative Conditions

Nonverbal and verbal attending behaviors Paraphrasing content of client communications Reflecting client feelings and implicit messages Openness and self-disclosure Immediacy Attending to Client's Theory of Change Interactive vs. Didactic Approach Promoting Hopefulness
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Functions Of A Therapeutic Relationship

Creates an atmosphere of trust and safety Provides a medium or vehicle for intense affect Models a healthy interpersonal relationship Provides motivation for change
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WAYS OF LISTENING
"Are you listening to me?"
People like to be heard. To be heard helps reduce insecurity. It gives us a feeling of peace. And when someone really listens to us, we often discover something about ourselves. Often we solve problems just when we are really listened to and feel heard. In this handout I will explain two ways of listening and encourage you to try to listen better to those around you. ANALYTIC LISTENING: This is the kind of listening we usually do. During Analytic Listening I am evaluating in my mind as I listen to you. I am busy judging and deciding what to say. I am analyzing. As a result, you don't feel heard. You may repeat yourself, or feel annoyed. Maybe I can even repeat back to you what I "heard" but it just doesn't feel like I listened to you. DEEP LISTENING: This is a rare talent. In deep listening, my mind is very quiet when I listen to you. My feeling is peaceful and curious. I don't take anything personally. I don't judge or decide or figure anything out. I don't try to remember anything. My mind is quiet and open. As a result, you find you don't repeat yourself as much. You feel a connection. You are likely to say, "I don't know why, but I really felt you heard me." Your feelings will become more peaceful.
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Session Rating Scale (SRS V.3.0)

Name ________________________ Age (Yrs):____ ID# _____________Sex: M / F Session # __ Date:___________________ Please rate todays session by placing a mark on the line nearest to the description that best fits your experience.

Relationship
I did not feel heard, understood, and respected. I felt heard, understood, and respected. I-------------------------------------------------------------------------I

Goals and Topics

We did not work on or talk about what I wanted to work on and talk about We worked on and talked about what I wanted to work on and talk about.

I------------------------------------------------------------------------I

Approach or Method
The therapists approach is not a good fit for me. The therapists approach is a good fit for me. I-------------------------------------------------------------------------I

Overall
There was something missing in the session today. Overall, todays session was right for me. I------------------------------------------------------------------------I Institute for the Study of Therapeutic Change www.talkingcure.com 2002, Scott D. Miller, Barry L. Duncan, & Lynn Johnson

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Assessment

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Purposes Of Assessment

Systematic way to obtain information about the clients problems, concerns, strengths, resources, and needs. Foundation for goal-setting and treatment planning.

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Assessment Considerations

Assessment is always an ongoing process, changing as you learn more about the client. Who is complaining or alarmed? Who thinks there is a problem? What is the person complaining about? What is the person motivated for? What does he or she want? What does the person do well? (Find contexts of competence.) Skills, hobbies, sports, activities, avocations, life experiences, etc. Exceptions/previous solutions/times when situation was better Best coping moments What are the goals? How will we know when we are done? Get specific about the problem-free future.
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Assessment Considerations (Cont.)

What are the patterns of the problem? How is it performed? Search for regularities of action and interaction, time, place, body behavior, etc. Get specific (so could imagine seeing/hearing the problem on a videotape) Scan for potentially harmful actions of clients or others in clients' lives (e.g., physical violence, drug/alcohol abuse, sexual abuse, self-mutilation, suicidal intentions/attempts, etc.) that may not be obvious or may be minimized during an initial interview.
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Assessment Tools

Intake forms Intake interview

Clinician questions

Formal instruments

ASAM PPC DSM IV DrInc SASSI SOCRATES ..

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Assessment Tool Rules Of Thumb

Never diagnose with a test or screening instrument only. Tests are useful in validating information provided by the client in the subjective interview. Testing tools should only be used by those with training in using that tool. All testing tools have limitations. Never replace the expertise, training, and experience of the clinician with a test.
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Stages of Change (Meeting the client where they are)

Precontemplation - "I really don't want to change. Contemplation- I'll consider it."

Preparation- "I'm making a plan for it."

Action- "I'm doing it, but not regularly." Maintenance- "I'm doing it."

Termination- "I have no desire to go back to my own ways."

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Extratherapeutic Factors
These factors exist prior to and are independent of participation in treatment Client factors
Strengths Resources Areas of Competence

Chance factors

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Goal-Setting

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Goal Functions

Define desired outcomes Give direction to the counseling process Specify what can and cannot be accomplished in counseling Client motivation Evaluate effectiveness of counseling Measure client progress
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Seven Qualities Of Well Formed Treatment Goals*

Saliency to the Client/Collaborative Small Concrete, Specific, and Behavioral

The Presence Rather Than the Absence of Something

A Beginning Rather Than an End Realistic and Achievable Within the Context of the Clients Life Perceived as Involving Hard Work

* Berg and Miller (1992). Working with the problem drinker.

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Interventions

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Categories Of Counseling Interventions

Affective Cognitive Behavioral Interpersonal/Systemic

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Affective Models

Person-centered therapy Gestalt Therapy Body awareness therapies Psychodynamic therapies Experiential therapies

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Cognitive Models

Rational-emotive therapy Information-giving Problem-solving and decision-making Transactional Analysis

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Behavioral Models

Behavior therapy Reality therapy Cognitive-behavioral therapy

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Systemic Models

Structural therapy Strategic therapy Intergenerational systems

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Collaborative Therapy
A collaborative therapy is one in which: The expertise of clients is given at least as much weight as the expertise of therapists. Clients are regularly part of the treatment planning process. Clients are consulted about goals, directions and responses to the process and methods of therapy. The therapist asks questions and makes speculations in a nonauthoritarian way, giving the client ample room and permission to disagree or correct the therapist. Therapists give clients many options and let them coach the therapist on the next step or the right direction. Client status is elevated from passive needy recipients to active expert contributors.
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The art of therapy revolves around helping clients to bow out of their symptoms gracefully - Milton Erickson
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Termination and Follow-Up

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Indicators Of Counseling Success

Clients own their problems and solutions Clients develop more useful insight into problems and issues Clients acquire new responses to old issues Clients learn to develop more effective relationships

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Accountability For Mental Health Professionals

Continuing education Paying attention to relevant research findings Applying research findings to clinical practice Validating efficacy of our work
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Outcome Rating Scale (ORS)

Name ________________________Age (Yrs):____ Sex: M / F Session #____Date:_______________________ Who is filling out this form? Please check one: Self _______Other_______ If other, what is your relationship to this person? ____________________________ Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life, where marks to the left represent low levels and marks to the right indicate high levels. If you are filling out this form for another person, please fill out according to how you think he or she is doing. Individually (Personal well-being) I----------------------------------------------------------------------I Interpersonally (Family, close relationships) I----------------------------------------------------------------------I Socially (Work, school, friendships) I----------------------------------------------------------------------I Overall (General sense of well-being) I----------------------------------------------------------------------I

Institute for the Study of Therapeutic Change www.talkingcure.com 2000, Scott D. Miller and Barry L. Duncan

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I Realize I Have Not Answered All Your Questions And In Most Cases My Answers Have Only Served To Produce New Questions For Which I Have No Answers Leaving You (and me) As Confused As Before. However, I Believe We Are Now Confused On A Much Higher Level And About Much More Important Things Than Before.
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