525: Basic Counseling Techniques

Both Sides

reflection of feeling
BCT: allows therapist to demonstrate to the client that he is
aware of the emotions the client is feeling and expresses
empathy. RF emphasizes a clients emotion words and
demeanor and may reflect them back to the client using
similar phrasing. RF is a crucial skill bc it shows empathy,
conveys the therapists understanding and makes the client
aware of his own emotions, show that you understand what
they are feeling
Ex: 18 yr old girl reveals that she is having trouble fitting in
and often sits alone in her room, the therapist responds by
saying, "it sounds like you are feeling lonely and isolated
from others"
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34 terms

Terms

Definitions

reflection of feeling

BCT: allows therapist to demonstrate to the client that he is

aware of the emotions the client is feeling and expresses
empathy. RF emphasizes a clients emotion words and
demeanor and may reflect them back to the client using similar
phrasing. RF is a crucial skill bc it shows empathy, conveys the
therapists understanding and makes the client aware of his own
emotions, show that you understand what they are feeling
Ex: 18 yr old girl reveals that she is having trouble fitting in
and often sits alone in her room, the therapist responds by
saying, "it sounds like you are feeling lonely and isolated from
others"

reflection of meaning

Freud, psychoanalysis. BCT: active listening technique.

therapist paraphrases with emphasis on literal meaning
(verbal/nonverbal) and confirms accuracy of RM. utilizing this
technique shows client that you have heard not just the surface
of their story but also the deeper meaning. RM highlights the
clients core beliefs that guide their bx important bc it adds info
to what the client has already said and conveys therapist
understanding
Ex: client explains that it frustrates her when business
associates do not follow through with their work and how it
bothers her when her friends do not call when they say they
will, therapist responds with, "sounds like one your tenets is to
keep your word by doing what you say you will do and that
when others do not follow this guideline it frustrates you."
or
Ex: client, while smiling and happy and sitting up straight, "my
husband killed himself last month"

reframing

BCT: therpaist gives alternate perspective of what client has

said, positive/neg/or neutral. it is a manipulation of data
through altercation of meaning or value that brings awareness
to client and encourages exploration. Ex: the client believes
everyohne who looks at her is making fun of her, the therapist
reframes as admiration by the strangers instead, challenging her
cognitions

open ended ?'s

BCT: important foundation skill to promote greater client

disclosure. unlike closed ?'s, use how and what, avoid why,
OEQ's can not be answered in one word, used to progress the
client from generalizations to specifics, obtain more info, and

for clarification. OEQ are esp useful in the beginning of

therapy bc it allows the client to tell their story in their own
way and to focus on what is important to them
Ex: instead of how many people are in your family, "tell me
about your family"
summarization

tool that brings together the major points of a convo that either
brings about correction or confirmation of the info said. can be
used to close the dialogue of a certain topic, encourage the
client to probe further, or it can be used to bring together a
clients circular points, an imp skill bc it ensures that the
therapist has heard all the correct content and sorts out the main
points w/o disregarding the clients affect. a versatile tool in that
it can be used in the beginning to segue from last session to the
current one , midway to tie together what has been discuess
thus far, or at the end to bring session to a close

termination

final phase of therapy and therapist/client relationship. T can

occur for numerous reasons; the clients goals have been met, no
rapport etc. must be properly times and not abrupt and
explained. make sure client knows it is not final and may
return. handle carefully so client does not feel abandoned.
should be viewed as positive. the process should be addressed
in the IC document so client can expect what will occur.

trustworthiness

crucial characteristic, must believe in order to promote full self

disclosure and yield positive outcomes. a reflection of the
therapists honesty and openness and lends to client feeling
therapist is dependable. vital in establishing rapport and a
working alliance.
teenage girl must believe in trustworthiness of dr that he will
not tell parents

working alliance

BCT: coalition between therapist and client, getting together:

psychoanalytic/client centered. a therapeutic relationship btwn
therapist and client. consists of the client and therapist be active
collaboraters in therapy and agreeing upon goals of tx and how
to achieve goals. needs to be established early in therapy bc it is
related to successful therapy outcomes. developing WA has not
formula but can be achieved through warmth, empathy, and
respect, if not formed in first few sessions, may not form
3 components
agree to tx

agree on task to be achieved

agree on engagement
proxemics

Taber, 1966. distance/space btwn 2 people, office setup, foster a

safe and comfortable environment, should not reveal too much
about therapist personal life, include no physical barriers,
ample seating, door access for therapist, white noise, soft
lighting, consisent with the demographics of your pt pop

core conditions

Carl Rogers, client centered therapy:

3 factors clients must perceive therapists have in order to make
counseling effective.
empathy,
authenticity/congruence,
unconditional positive regard,
stems from Rogers client based therapy, can be achieved
through summarization and minimal encouragers

listening skills

BCT: crucial tool to help establish the core conditions, LS is

actively attending/communicating with client in verbal and non
verbal ways that promote client disclosure. an active process
where it is also imp to be mindful of what is not said, ommision
of content are just as imp, be responsive, w/o judgement,
includes paraphrasing, minimal encouragers, perception checks
Ex: client shakes his head while talking about wife's career,
therapist says, " i notice you are shaking your head, what does
that tell me?"

logical consequence

behaviorism/CBT tool to change bx, discuss the logical

consequence if bx continues without intervention. a behavioral
term that emphasizes the best course of action for altering a
problem bx, may not be traditional punishment but rather a
natural consequence, serves as a wakeup call and is important
for developing understanding of the possible consequences of a
bx and promotes self control
Ex: beth did not show up for her 2nd therapy session and did
not call in advance, therapist billed Beth anyway

paraphrasing

BCT; rephrases what client says, builds on it, blends the clients
words with the therapists understanding. P is essentially giving
the client feedback and should allow the client to further
explore into their thoughts and feelings. good P includes what
the client says and what they haven't directly expressed. p lets

the clients know the therapist is actively listening and gives

them the client opportunity to correct any misperceived info.
Imp: it illustrates how a client thinks of himself and others.
facilitates reflective processing, and identifies what's wrong
positive asset search

id of patients strengths, PAS is an element of bx analysis and is

imp to evaluate bc the positive assets can be used to overcome
bx problems and focus on client assets which may lead to inc
self efficacy in therapy. id assets also facilitates th working
alliance and establishes rapport, may be difficult but crucial to
identify
Ex: pt has extreme social anxiety but has great sense of humor

power dynamics

Rogers. the control and authority relationship btwn client and

therapist, there is a natural power differential btwn therapist
and client bc therapist controls schedule, $, records, and is the
expert. T should always be in control and express
professionalism but lessen the presence of PD through core
conditions and listening skills to maintain therapeutic
homeostatis and promote successful therapy outcomes. PD may
also be influenced by SES, age, gender. use Rogers core
conditions and active listening as well as appropriate self
disclosure, imp to est at beg of relationship
Ex: child comes into office and is afraid to disclose info to
therapist bc he is an "authority figure"

client expectations

must be addressed in IC and in initial interview Imp: client

expectations can be unrealistic. clients overall hope,
anticipation, and assumptions for tx usually verbalized at beg,
involves what they want to get out of tx such as goals and their
rold and the couselors role in achieving goals, ensure clients
expectations are realistic, adaptive, and appropriate. imp to
where they are in their motivation to change to make sure
proper interventions are used, CE are catalyst of therpay and
helps determine direction and objective of therapy. Must
understand IFR.
Ex: client thinks therapy is a waste of money and therapists are
a bunch of quacks, therapist will know how to approach client
and be aware of client's mistrust

confrontation

BCT: calling attention to what you see, addressing

discrepancies, invites client to think about bx of self and others,
demands revelation on part of client, can be embarassing or

painful, if not careful may look like damaging rapport, could

also create power struggle, timing is vital, "client is always
right" so back track bc they may not be ready to explore that
are yet, often used in middle to end of therapy
Ex: jon said he has many girls interested in him, however, when
therapist asked jon why he had not reciprocated interest in one
of the girls jon became defensive as a result therapist
backtracks, apologizes and leaves topic for another time
congruence

Rogerian, client centered therapy, being consistent/genuineness,

one core condition a therapy must possess, harmony in affect
and appropriate observable response to a situation, mood, state,
helps to express therapists genuineness and authenticity,
encourages client to express self and know that they will not be
judged, inner experiences match outer expressions, imp bc it
helps maintain a working alliance by facilitating rapport, imp to
asses bc if not congruent in thoughts, emotions, and bx's it
could represent a conflict
Ex: beth talks about her abortions, therapist says she is
comfortable but avoids eye contact and interupts client

encouraging

BCT: active listening. any action that promotes client

disclosure. verbal and nonverbal. client knows you are
interested and wish to hear more
Ex: teen client describes parents divorce, therapist nods while
client is talking and follows with "go on, tell me more."

engagement

Rogers Client Centered Therapy: process of the therapist and

client becoming involved and commiting to the therapy
process, T focuses on the TFB tha tengage the client to
participate actively in therapy and maintain their interest. the
1st step is to engage in conversation, lack of engagement often
leads to premature termination, E is cultivated through the
therapists expfressions of the core conditions. change,
admisitrative factors, E is imp bc it is nevessary to the proccess
and is th foundation of therapy
Ex: child does not want to engage, therapist sits on floor and
colors with child while they talk

focusing

BCT: redirecting client's attention to one goal at a time, part of

structuring where the therapist can direct and redirect client at
particular times. concentrating on or close/narrow attn to what
is imp and what is currently being discussed, involves attending

to problems/feelings as they arise, ability to focus encourages

the client to work on present problems where there are
attainable goals vs focusing on past unchangeable ones, imp bc
leads to direction in therapy which results in craetion of goals
and plan to achieve
Ex: although client said he wanted to talk about his recent
traumatic combat experiences, the therapist had to maintain and
redirect his attn to the combat encounters instead of small talk
tha the was inclined to do
self disclosure

when a counselor consciously shares personal info about their

lives to a client bc they feel it would benefit the client , utuilize
only when they think it will be beneficial, normalizes the
clients bx, increases rapport, and enhances alliance, hoever
whould be used w caution for the client may feel the therapist
is taking the focus/attn off client, SD should be relevant and
focused
Ex; client in tx for loss of parent, feels no one understands,
therapist discloses losing parent

stages of change

model used that outlines a clients readiness to change,

developed by Prochaska and DeClemente, consists of :
precontemplation, not aware/no desire/no problem
contemplation, aware, not sure if want to change
preparation, aware, talking about possible change
action, takes action
maintenance, made changes and works to prevent relapse
relapse goes back to maladaptive bx
tool to assess the clients level of motivation and helps guide the
counselor to choose the best suited interventions, helps
therapist meet the client where they are
Ex: if an alcoholic can't admit that they have a problem, they
aren't ready to change bx not likely at this point that they will
stop drinking or go to a 12 step program

structuring

provides conceptual framework for therapeutic process

explaining the points as they go along, appts, contact, fees,
process, expectations, emergencies, confidentiality, outcomes,
termination, informed consent is imp aspect of structuring,
begins the foundation of relationship, ensures that client knows
what to expect, creates comfort/safety and facilitates process
and realtionship while providing guidance
use at first session and then first 5 minutes of every session,
summarize from last session, get into meat and potatoes, and

then conclude
Ex: pt knew that although talking about something really
emotional, by the end of the session she would be better bc
that's how all th sessions are structured
basic -id

lazarus 1997, multimodal therapy. 7 areas of consideration in a

mulimodal approach to assessment:
behavior,
affective processes,
sensation,
imagery,
cognition,
interpersonal relationships
drugs bio/chem factors,
supposed to focus on these factors and how they impact the
presenting problem, summarize core human elements,
intervention should follow in response pattern. all significant
signs/syjmptoms of distress can be assessed, might otherwise
be overlooked
Ex; if 1st response to anxiety is sensory (stomach ache) then
relaxation/biofeedback intervention may be used 1st

clarification

foundation skill used to ensure complete understanding of

client communication, used to avoid assumptions, shows client
that they are being heard, C is imp to prevent
misunderstandings which may deter progress
Ex; client been telling therapist about her sons disruptive and
rude bx toward her, she says she doesn't understand where she
went wrong, therapist asks, "so you feel confused about how he
ended up this way?"
Ex: husband calls wife "pig", what does pig mean?

immediacy

Rogers. attending to problems and feelings as they arise,

therapist reflects on an aspect of current feelings, thoughts or tx
in therapy, increases warmth and empathy, Imp: if there is no
response, client may perceive as judgement from therapist
Ex: mary came to therapy to deal with issues in her marriage,
during the initial interview, she began to cry when she was
talking about her family and mentioned her father, the therapist
caught this and asked her to talk more about her father as this
was the immediate issue

interpretation

cognitive therapy. originally from freudian/psychoanalytic,

techinique used to draw an analysis of what the client is telling

you, tell client and they can accept or reject analysis, meaning
therapist gives to unconcscious thoughts and bx's, can be
dangerous bc it can be incredibly inaccurate
Ex: dream analysis, rorschah projective test
orientation
sensorimotor, concrete,
formal operational,
dialectic/systemic

piaget and ivey. concept involving assessmetn of client's

cognitive interpretation of the problem. 4 levels based on
piaget's cognitive developmental stages.
sensorimotor: clients are in the here and now
concrete: client gives multiple examples. therapist is unable to
get a sense of the overall problem and must search for repeating
key words and themes from the client
formal-operational: client discusses patterns of feelings
dialectic-systemic: client is able to predict/hypothesize about tx
and performance
these modes allow client to fluctuate and flow between them
throughout their life process
Ex: the client says, "i just know when i go home, i am going to
have to get drunk because the wife will start nagging me about
something" (dialectic-systemic)

clarification

BCT: used in non-directive therapy. active listening skill. the

therapist provides a summary of what the client says, focusing
on and clarifying its meaning. Imp: reduces the possibility of
miscommunication and shows the client that they are being
heard. Ex: the client says to the therapist that his teenage
daughter is being "impossible", the therapist repeated, "you say
that your daughter is impossible, describe to me what that
means."

verbal tracking

an active listening skill. "parroting" verbally follow the lead of

the client when making reflections or paraphrases. use key
words that the client often uses. this skill is valuable in making
client feel important and relevant and listened too. aids in
therapist taking notes later. builds rapport.
client: my dad hasn't been home lately
therapist: so you said your dad hasn't been home lately

maslow's hierarchy of
needs

a method of classifying human needs and motivations into five

categories in ascending order of importance: physiological,
safety, social, esteem, and self-actualization

spheres of influence

person problem and environment, way to conceptualize what is

going, find out about them, their family, work, school, love life,
morals, illness etc. when assessing an individual make sure you
have understood them on all spheres...assessment technique
Ex: by end of session one make sure you know all basic factual
knowledge

capping

move client along from emotionally intense experience to a

cognitive discussion
pt was crying and crying and silent, so the therapist said this
clearly was very upsetting to you, do you remember what you
were thinking when this happened?
or use humor, but risky

Helping Relationships - Counseling

Techniques/skills

Both Sides

Paraphrasing
Restating the client's message to show or gain
understanding.

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14 terms
Terms

Definitions

Paraphrasing

Restating the client's message to show or gain understanding.

Interpretation

A technique that is used to uncover and suggest the meanings and

relationships that are often underlying the apparent expression.

Restatement

Repeating what the client has stated with an emphaiss on the

cognitive portion of the message.

Reflection

Repeating what the client has stated with an emphasis on the

affective or feeling portion of the message.

Attending

Several behaviors including listening, engaging in eye contact and

being psychologically present.

Immediacy

Dealing with what is going on in the counseling process at the

present time.

Self-disclosure

The counselor shares personal affect and experiences relative to the

client's issues.

Congruence

The counselor is authentic and integrated in session. Agreement

between the client's behavior and his or her values and beliefs.
Genuineness.

Empathic
Understanding

The ability to experience the clien'ts subjective world including

feelings and cognitions.

Silence

Has many meanings including quietly thinking, boredom, hostility,

waiting for the counselor to lead or emotional integration.

Summarizing

The counselor or client brings together several ideas or feelings,

usually following a lengthy interchange.

Confrontation

Occurs when the counselor identifies and presents discrepancies

between the client's verbal and non-verbal behaviors or between the
counselor's and client's perceptions.

Concreteness

Dealing with issues in specific terms rather than in vague

generalities.

Unconditional
Positive Regard

Acceptance: The counselor is caring without condition and is

neither evaluative or judgmental

Key Techniques of Theories

Both Sides

Psychoanalytic
interpretation, dream analysis, free association, access
unconscious conflicts leads to insight and assimilation of
material by the ego

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11 terms
Terms

Definitions

Psychoanalytic

interpretation, dream analysis, free association, access unconscious

conflicts leads to insight and assimilation of material by the ego

Adlerian

use the persons (subjective) experiences over techniques, life history,

data interpretation, encouragement, new possibilities

Existential

gain understanding first, then use techniques pulled from different

approaches (no testing)

Person-Centered Attitude of therapist is important: active listening, reflection of

feelings, clarifying, being there (no testing)
Gestalt

intensify experiences and integrate conflicting feelings,I/Thou

dialogue (no testing)

Behavior

homework assignments, questions, modeling reinforcement

techniques, social skills, self-management

Cognitive
Behavior

socratic seminar, debate beliefs, homework, gather data, coping skills,

thinking patterns, role play, confront faulty beliefs

Reality

evaluate present behavior to see if willing to change, client doesn't like

present behavior then they make plan to change, commit to following
through

Feminist

gender-role analysis, journal writing, challenging beliefs, psychodrama

Postmodern

change talk- time in clients life when problem was not a problem,
scaling questions, narrative stories, write letters

Family Systems genograms, questions, setting boundaries, issuing directives, change in

short tim