Bob Shebib: Interviewing and Counselling Skills For Canadians

•
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INTERVIEWING AND COUNSELLING SKILLS
FOR CANADIANS
SEVENTH EDITION
BOB SHEBIB
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Seventh Canadian Edition
Choices
Interviewing and Counselling Skills for Canadians
Bob Sh ebib
Facull)' Emerit11s
Douglas College
@ Pearson
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ISBN 13: 9?S..0..ll-484248,6
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Libr.uy :md Archive, C-1nad.:i Cat:alOJUinar in Public:ation
She-bib , Bob, author

Choice, : intt'r,•it'wins and coun,c-lli"i, s:kill:1 for Can.;tdian,
/Bob She-bib . - Se\'C'nth edition.
ISBN 9?S..0..ll-4842.fs..6 (,oftrn,·t'r)
1. Coun$C'linJ"'Textboob. 2. lntt'rYic-•·inJ"'T t'xtbook,.

3. Textbook,. I. Tide.
8F636.6 .S48 2019 158.3 C201S..90364S.I
@ Pearson
For my children and grandchildren.,
Ke•vin, Jodie, Eli, and Audrey.
iii
Chapter Professional Identity: Ethics, Values, and Self.Awareness
Chapter 2 The Skills, Process, and Pitfalls of Counselling 33

Chapter 3 Relationship: The Foundation for Change 66
Chapter 4 Listening & Responding: The Basis for Understanding 95
Chapter 5 Asking Questions: The Search for Meaning 126
Chapter 6 Empathic Coonectioos 161
Chapter 7 Supporting Empowerment and Change 192
Chapter 8 Difficult Situations: Engaging with Hard. to-Reach Clients 235
Chapter 9 Mental Disorders and Substance Misuse 271
Chapter 10 Cultural Intelligence 310
Chapter 11 Neuroscience and Counselling 342
•
Preface xiii Trauma-lnfo1med Practice 38
Acknou-iedgme-nu xxiii BRAIN BYTE Trauma 39
BRAIN BYTE Strqths·Based Counselling 40
Professional Identity: Ethics, Values, and
Relationship Issue!? 40
Self-Awareness 1
Counselling Ski lls and S1ra1eglH 41
LEARNING OBJECTIVES 1
Relationship,BuiJdu~ Skills 43
Professional Couns.ello,s In Canada Explorin~ and Probi~ Skills 45
Soc:ial Work and Soda! Justice 2 Ernpowerina Skills 46
Ethics 3 Promotma Chaf1¥e Skills 2nd Str:ue.:ies 46
Dual Rebtionship!l 5 The Phases of Counselling 47

Pro(es!lional Bound2de!l 5 The PrelimiMr)' Phase 50
ConOdent iality 6 CONVERSATION 2.2 ~ ul Friends and Counsellors SO
ValuH fo, Profeulonal Practice 8 CONVERSATION 2.3 Should I Read the File? 53
The 8¢innin~ Phase 53
Belie( in the Oiiflhy and Worth o( People 8
The Aetion Phase 56
Client Sel(,Detenninaoon 9
The End in¥ Phase 57
CONVERSATION l.l G~Hu mour 11
R~ts o( ChiJdren 11 COunselllng Ptualls.: Banlers to Success 57
Ethical Dilemmas 11 Client ¼riab1es 58

Counsellor V2riables 58
BRAIN BYTE Ett.cal and Moral Oecisi:)n Maq 11
Common ?l.•Hstakes 59
Tn~so( EthicaJ 01lenunas 12
CONVERSATION 2.4 Resruiog and Supporting 62
Reso1vina Ethkal Dile.nunas 12
BRAIN em Ett.cs and Neuoscience 13 Sunun:l.r)' 64
Exerd.ses 64
Ob,eet ivity 15
Weblinks 65
CONVERSATION 1.2 Personal Feel~Ge'li'llheWa,; 16
CONVERSATION 1.3 Personal lrr.dvement 'Mlh Clents 18
3 Relationship: The Foundation for Change 66
The Compttent Counseuo, 18
CONVERSATION 1.4 I'm Just a Be.gimer 20
The Counselling Relatfonsblp 66
Selt-Awa,eness 20
The lmpor121l«' o( SeJ(,Aware1lt".$$ 20 BRAIN BYTE The Brainoo Rela1ionship 67
lnere:asina Sel(,Aw:1reness 2 1 De:Onition 67
BRAIN BYTE Oxylocin 68
Who A1n I! How Do O ther!? See Me-! 22
Penonal Needs 23 Relationship and the Phases o( Counsellina 68
Penonal and C uh ural V2lue!l 25 Cart Roge,s and the Core Conditions 69
Professional Survival 26 CONVERSATION 3.1 Uncondi!ional PosiM Regard 71
Sumtn2r)' 28 Core Condit ions: ltnplieat.Ons for Counse1lors 72
Exereises 29 CONVERSATION 3.2 Genuineness 73
Weblinb 32 Counselling Contracts 73
2 The Skills, Process, and Pitfalls Purpose o( Contraeth1¥ 73
of Counselling 33 Relationship Contr2Cts 74
Antieip,:nory Contr3ets 76
LEARNING OBJECTIVES 33 Work Contr3ets I f
Whal Is Couns.ellfna? 3·3 INTERVIEW 3.1 Conlractiog 79
BRAIN em 34
Counselling and the Brain Ena,aain¥ with Seniors 81
CONVERSATION 2.1 Cooosellingand Psychotherapy 3S Sustaining the Counselling Relatfonsblp 82
Choices: The Need fo1 Versatlllty 36 l mmed1ae)' 82
BRAIN em Music 36 T r.u,slerenee and Countertr.u,slerenee 84
Brie( Eneounter!l 3S I NTERVIEW 3.2 Immediacy 84
vii
BRAIN BYTE Transference 86 5 Asking Questions: The Search
BRAIN BYTE Childhood Abuse and Intimate
for Meaning 126
Rela!ionships 87
CONVERSATIOH 3.3 Counsea:>r Self-Oisclosixe 8·7 LEARNING OBJECTIVES 126
Endln& the Couns.ellfn& Relationship 88 The Art of Aski n& Questions 126
BRAIN BYTE En:Ungs. 89 Quest ions Support Counsellina
Oe:alu,i with End1~ 90 Godil!i 126
INTERVIEW 3.3 Emings. 9 1 T)•peso(Quesiions 127
Sum m::ary 9 2 BRAIN BYTE Memory 127
E.xerdses 92 Essential Queitlon.s: Some Options 130
\Veblinh 94
Quest ions for Establlshmi Purpose 13 1
Quest ions to Def'lne the Counsellifl¥
4 Listening & Responding: The Basis Rel::at ionship !JI
for Understanding 95 Quest ions for E.xpl<>rinK and
U nde-rstandinK 13 1
Quest ion!? for Problem Sol"ina 133
Listening for Understandi ng 95 Quest ion!? for Ev2lu:.tini 134
BRAIN BYTE The Impact of Questions 135
TI,e Power o( UsteninK 96
Listening Barriers 97 Questlonlnc Pitfalls 135
Le:.dina(Biased) Quest ions 135
BRAIN BYTE Listeni"€ 97
E>:eessh,e Quest ionlfl¥ 136
O,.,e~om inK Lis teninK BarrierS 98
CONVERSATIOH 5.1 Alternatives to ()Jestions 137
BRAIN BYTE The Auci!ory A1atm System 98
BRAIN BYTE The Righi Ear Advan.iage 100
Multiple Q uestions 138
lrreLe\+::tnt 2nd Poorly Timed Quest ions 139
Active Listeni ng 102 Wh)' Questions 140
Anendlnc 103 Taflorlnc tile Interview 10 tile Client 140
Selective Attention 104 \\'he:!, Clients Do Kot AnS\\~r

BRAIN BYTE Multitasq lOS Quest ions 140
Honverbal Communication 106 Man:1.:mi the Ramblh,i lnter\+iew 1-12
lnt ervie"'ina Yo uth 143
Meanina o( Nom~rbo.l Conununic:uion 107 BRAIN BYTE The Adolescent Brain 143
CONVERSATIOH 4.1 Problems with Lis.1eningand
lnt ervie"''11'{t and Counselli1'{t Se:niorS 145
Responding 107
Senior Abuse 14 5
BRAIN BYTE Nonvetbal Processing: 109
Coss.Cuh ural lnt(".fviewinK 1-17
\ \1o rkl'l,i with Nom,erba! Communie:u.On 110
Met~mmuniea11on 11 1 Beyond tile Surface: lnterwlewlnc to,
Conereteneu 147
SIience 111
TI,e Keed lor Conereu•ness 147
TI,e Person.31 ?l.•1eanlfl¥ o( SUen« 111
BRAIN BYTE Neu-al Development and
Sileo« in Counsellina 112 Marginalzation 14 7
BRAIN BYTE Sienoe 112
Str.u~ies for Aehie,•i1'{t Conereceness 150
Nom,erba! Q.es and Sllenee 116
Mald1'{t Cl,oiees 152
Eneour.¢ina Sllenee 116
CONVERSATIOH 4.2 Leam~ to Oeal"1th Sienoe 116 Interview Transitions 153
Paraphra.sln& 117 Natur2I T r2nsition!l 153
Str.u~ie Tr3n!lit ions 154
Par.1phraSinK2nd Empoth)' 119
Control Tr2nsit ions 154
Summarizi ng 119 Phase T r2nsitions 155
CONVERSATIOH 4.3 Effective Paraph'asing 119 CONVERSATIOH S.2 Note-Taq 156
INTERVIEW 4.1 Listen~ Silence, and Summarizing Conneet (Linkh,K) T r2nsit ions 156
Skills 122 INTERVIEW 5.1 lnterviewing: Skills 156
Sum m::ary 123 Sum m3r)' 158
E.xerdses 12-1 E.xerd.ses 158
\Veblinh 125 \Veblinh 160
viii Con1en1s
6 Empathic Connections 161 De"eloph,i OtSerepcancy 201
"Rollina with Resistanee" 202
LEARNI NG OBJECTIVES 161
Support Sel(-E(t"te:1er 203
The Emotional Domain 161 Stages ot Change 203
BRAIN em Emotional Memories 162 Risk T2kinK203
BRAIN BYTE Mi'ra Neurons 163
CONVERSATION 7.1 Worq with "t..aJY Clients 203
The Un¥U3~ o( Emotions 164
Cog·nltlve Behavioural Counselling 207
Individual D1((ere:nces and C ultu~I Context 166
Ambi\':lle:i,ee 166 HelpinK Clients Reeoani:e ThinkinK P::attenu 209
A((.., 16S Unhelp(ul ThinkinK P::atterns 210
BRAIN BYTE The Emcdonal Brain 210
Empathy 168
Per(ectionism 211
Emp::ath)' Oeflned 169 HelpinK Clients Jnere:3se Helpfol 11,inkh,K 212
The lmpor121l«' o( Emp:lth)' 169 Re(r3mll1i 214
BRAINBYTE LocationofEmpathy 171 BRAIN BYTE Mindfulness 21S
BRAIN BYTE Selective Empathy 171 BRAIN BYTE Creating New Neu-al Patt,,.,ays 21S
Client Reactions t'O Empcuhy I i l BRAIN BYTE Cognitive Behavicual Counselling 217
CONVERSATION 6.1 Increasing Empathic Vocabula,y 173 INTERVIEW 7.1 Cognitive Behavicual Tech,..,.es 217
Types of Empathy 173 CONVERSATION 7.2 When BunonsarePushed 219
lnvita11on::'1 Empoth)' IH Helping Cllt11S Make Bellavlolnl Changes 219

B:ask Empothy 175 Goal Sett ina 219
Jn(ern>d Emp,uhy 176 De"eloph,i Effecth~ God!! Stuemenu 220
Pre-por.uor)' Emp:tth)' I 77 INTERVIEW 7.2 Goal Setting 223
CONVERSATION 6.2 When Net 10 Use Empathy 178
The Problem•SolVlng Proces.s 225
Four Gene,allzatlons about Empathy 179
St ep I: ldent i(r Alternath'i's 225
Emp::athk Response Leads 181 St ep 2: Choose :m Action Strate-a)' 225
Whr Achievin¥ Emp::athk Underu2ndu)¥ Is So St ep J : De"elop and Implement Pl.:ms 226
Oi(t"trult 181 St ep 4: Ev:ilu::ue Outeon~ 227
Poor Substitutes for Empcuhy 182 CONVERSATION 7.3 l'\-e Tried Everything 228
INTERVIEW 6.1 Poor Substitutes for Empathy 183
Brief Counselling 228
Touah Emp:uhr 184
CONVERSATION 6.3 How Can I Be Empathic If I Have Nol Had Se.lected Brie( CounsellinK Techniques 228
the Same Experience? 18S Sumtiurr 233
INTERVIEW 6.2 Effecti-.<e Useof Empathy 186 Exerdses 2 33
Sumtiurr 187 Weblmb 23-1
Exereises I88
Weblinb 191 8 Difficult Situations: Engaging with
Hard-to-Reach Clients 235
7 Supporting Empowerment and Change 192 LEARNI NG OBJECTIVES 235
LEARNI NG OBJECTIVES 192
Resistance 235
Empowerment: Mobilizi ng Suengtti.s for Slans o( Resim1n« 236
Chante 192 UnderSC:ind10i and Respond10i to
Hoo• Counsellina Promotes Em?O">ennent 193 Reslsc:inee 237
AntU)ppressiv~ Praettee 194 BRAIN BYTE Resis:iance 241
Reslruu,ce and Counsellor Sel(,Aw:ireness 241
The S1rengU1.s Approach 194
CONVERSATION 8.1 Worq with "ll'l'YCbltary"
BRAIN BYTE Stress and Crisis 196 Clients 242
Empowerment and Seniors 197 INTERVIEW 8.1 Oealing"'11h Resis:1ance 243
Crisi s Intervention and Confrontation: Proceed with Caution 244

Empowerment 197 CONVERSATION 8.2 Sa.)ing No 245
Tn,es o( Conlront3tion 245
Motivati onal Interviewing (Ml) 199 The Misuse o( Confront::nion 24-6
Emp::ath)' 201 Principles for E((enh'i' Conlront3t ion H7
Contents ix
Argresslon and Vi olence 249 BRAIN BYTE Pleasure Pathway 299
Risk Assessment for Violenee 251 Co-oeturrin& Oisorde-rS JOI
Violenee and Mental Illness 253 Suicide Counselling 302
BRAIN BYTE Head Trauma and Vdenoe 254
Warnin& Sl,ans a.nd Risk A!lse-ss-ment 302
Violenee Risk Assessment: Ker Quest ions 254 Sutnm3r)' 307
Man:1.:u-1¥ An&r)' :and Potent ially Violent E.xerd.ses 307
Beha\+iOUr 255 Weblinlcs 309
BRAIN BYTE ~sion 255
BRAIN BYTE Fligl,t « F'€11t 2S6 10 Cultural Intelligence 310
TI,e Phases o( V1olenee 25 7
CA-i1kal lnddent Oebrie01'{t 263
INTERVIEW 8.2 Violent Incident Follow-up 264 Cultural Intelligence and Diversi ty: Working wllh
CONVERSATIOH 8.3 HON to Handle an Assault 265 Competence 310
Counselling Angry and Violent Clients 266 TI,e ltnporta.nee o( M ulttruhural lnvol,'ement 3 12
Pre,'e11t.On 266 The tanadlan C - CulttJre :.-.I Dl,.r>ly 312
Assertiveness Trainin.: 266 BRAIN BYTE Cultural Neuroscience 313
Co.:nit h'e Beh:wiou rat Counsellu,i (Ther2p)') 267
CaMdia.n l nuni&r,nion 315
An~r ?1-faM~'\"lnent 267 Problems F:ieed by Jn,ml,ir3nt'S ::and
Substanee Misuse lnten'i":111.0ns 267 Refu{ti'e!l 316
Psrthi.atrk lnu·n'ent ion 26 7
Sodopo.Jitieal R~bt ie!l 318
Reduet ion o( Streuors 267
Counsellifl¥ Vietims 267 Key Elements of Cullural Understanding 319
BRAIN BYTE Children and Abuse 268 \\'orkJview 3 19
Surnm::ary 269 Personal Priorities. Values. and Belie(s 321
E.xerdses 269 Identity: lndwklu::dism ,'erSUS Collectivism 32 1
\Veblinh 2i0 BRAIN BYTE Culture and the Pleasure Centre 321
BRAIN BYTE Individualism and Collec!Msm 323
9 Mental Disorders and Substance Misuse 271 Verbal a.nd Emotion:111 Expressiveness 3H
LEARNING OBJECTIVES 271 CommunK"21tion St)1le 325
L311iu~e 325
Mental Health In Canada 272 Rel:1tionship E.xpea:1tions 326
Mental He,ihh Asses!lment 272 Belie(s about How People Sho uld Aet 327
TI,e 01;::1.:oosuc and Smistical Mani.di o( Mental Time Onentation 317
D1sorderS (DSM) 274 Counselling Immigrants and Mulllcullural
~fa,or Men1~I Oisorde-rs 277 Clients 328
CONVERSATIOH 9.1 Paranoia 281
BRAIN BYTE Neurotransmitters and Mental lloess 282 BarnerS to C ultu~ll)' lntell.i~-e:in Practice 328
CONVERSATIOH 9.2 How to Respond 10 Hallucinations 283 Cont rollu,i 1he- Tendency to Stereot)'Pf' 329
Respeet i1'{t Oiver!lity and lndwkll.dl
BRAIN BYTE Depression 284
BRAIN BYTE Attentbn-OeficitJHyperaaivity Oisotder
D1(lerences 330
CAOHO) 289 L~minK from Oienu 330
Ould ::and Youth Mental Health 289 Counsellif)¥ Senior!? 332
TI,e ltnporta.nee o( Counsellor
BRAIN BYTE Adolesa!nl Marijuana Use 289
BRAIN BYTE Adolesa!nl Drug Use 291
Sel(,Awareness 332
Counsellifl¥ a.nd Workh,i with People W ho Ha,~ Indigenous Clients 3-3-3
Mental D1sorderS 291 lnd¢eoous Value!l 3nd World-.•iew!l 333
BRAIN BYTE Psychotropic Medication 293 WorkinK with lnd1~nous People 335
CONVERSATIOH 9.3 When Clients Don't Take Their Tradition31 H~bfl¥ Pr3ctkes 336
Medcation 294
Splrft1tallty and Counselling 336
Substance Use DlsordeJS 295
CONVERSATIOH 10.1 Praying 'Mlh Clients 339
Wlthdr.tw31frorn Dru~ Detoxif'.e2tion 296 Sutnm3r)' 339
Substanee U se Disorders and the DSM 298 E.xerd.ses 3.W
Bra.in Pbstkity 3nd Addtetion 298 Weblinlcs 341
SupportinK Recover)' from Addiction 199
x Con1en1s
11 Neuroscience and Counselling 342 BRAIN BYTE Endorphins 370
BRAIN BYTE Dopamine 371
Mirror Neurons 3H
The Remarkable and M·ys1erlous Brain 342 Glial Cells 374
BRAIN em The NorH.;op B<ain 344
Rew:tr<I PathW3)' 374
BRAIN BYTE The Amazing: B<ain 344 B1aln Problems 375
Neuroscience: An Emerging Force In Counselling 344 Ment3I Oison:lerS 375
CONVERSATION 11. 1 Mind and Stain 344 Meninttitis 375
Eneepha!itis 375
Six Key Forces in Counsellin& 345
Br3in Tumours 376
Why Neuroscience Is Important for Coun.sello,s 346 A1nyotrophie fater.l! sclerosis (ALS o r Lou Ge.hriK'S
Neuroscience Endorses Counsellu,i 3-16 d1se::3se) 376
Studying the Brain 351 Cerebral pllsy 376
Epilepsr 376
Br3in lnu¥U1i 35 1
Huntin~1.on'sdise:ase 376
BRAIN BYTE Types ol Oepces.sicn 353
M ultiple sclerosis (MS) 376
Neuroplastl city: An Empowering Discovery 353 Parkinson's d1se::3se 377
How to Stilnul.:ue Neuropbstkity 354 Tourette srndrome 377
Structure of the Brain 355 Dementi.:1 377
BRAIN BYTE Sundowning 378
INTERVIEW 11. 1 Helping Clients Harness BRAIN BYTE Is it No-mal or Dementia? 379
NeuroJ:Mstay 3 56 CONVERSATION 11.3 CoullSeq People with
Hemispheres 358 Dementia 380
BRAIN BYTE Ri5,flt Braivl.eft Brain 359
St roke 3SO
Br3in Lobes 359 Tr.-unutie Br.I.in lnJUr )' (TB)) and Acquired Brain
BRAIN BYTE While and Grey Matter 359 Injuries (ABI) 382
BRAIN BYTE Broca's and Wernidle's Areas 361
Sumnurr 383
Br3in Lobes 2nd Counsellini 361 Exerdses 384
The Limbk S)·Stem 362 Weblmks 384
CONVERSATION 11.2 Male and Female Brains 363
BRAIN em Psychopathic B<ains 364
Cr3nfaJ Nen't:S 365 Gl•=r, 385
References 392
The Endocrine System 365
BRAIN BYTE Endocrine System versus Nervous Sys'lem 36S Tables. Figures. Contoe1StUions. huenrietvs,
and Brain B1res Index 408
Neuron,: Tile Brain' s Information System 366 .A.urhor Index 410
Major Keurotransrnitters 370 Subjecr Index 414
Contents xi
"There is a crack in et,-erything,
rhar's how the light gets in"
uonmd Cohen (1968)
Cohen's iconic words arc a messa,;c of hope reminding us that hardship, setbacks., and
obstacles arc opportunities for growth, change, and learning. His poetic insight inspires
us to believe that we need not fear our imperfections because resilience and empower-
ment can grow from obstacles and hardships.
"Cracks" in Choices have enabled the evolution of seven editions and left me with
the inescapable conclusion chat it will forever remain a work in progress.. (n cu.h new
edition, user feedback, cmc.r,;ent research, and practice experience have helped me to
re-examine my beliefs., discard outmoded ideas, and replace them with fresh pc.rspectives.
The seventh edition of Choices maintains its basic format and its objective as an
introductory textbook for students in counselling training programs and a practice
reference for professionals in social work, criminology, nursing, child and youth care,
addictions, psychology as well as professionaJs and voluntec.rs in other professions
whose work involves interviewing and counselling. A continuing bcst.-scJler in Canada,
Choices combines theory, practice examples with sample interviews, and challenging
self-awareness c.xc.rcises in a comprehensive, yet readable format. Jt is aimed at profes-
sionals aspiring to gain a wide ran,;e of skills based on supported theory and evidence-
based best practices. Although framed in the Canndian ethical and cultural context,
the content of the book is designed to appeal to a broad international audience of
professionaJs.
This book aims to contribute to the development of professional competence in
five \\--U)'S:
t. lnmxlucing basic concepts and models to hcJp learners understand the theory and
philosophy of effective counselling intervention skills.
2. Providing rc3Jistic examples to illustrate concepts in action.
3. Offering challenging exercises that prom(){C skill development, conceptual under-
standing, and self-awareness.
4. Promoting the importance of a range of skill choices for interviewing. rather than
rules and recipes.
5. Presenting connections to relewm neuroscience research.
In the seventh edition of Choices., all chapters have been rewritten to improve clarity
and include current research, with updated references and wcblinks. This edition
continues my commitment to producing a readable and practical text. As muc.h as
possible, J have avoided the use of unnecessary jargon, and I have tried to be trans-
parent and explicit regarding m'>' assumptions, a practice chat para.Jlels my approach
to counselling.
xrn
Signif,cant changes and enhancements to the seventh OOition include:
■ A new Chapter 11 exploring neuroscience and counselling

■ Significant new content in many chapters related to understanding and working
with seniors
■ Updated rderences and content in all chapters
■ New and/or updated success tips
■ New and/or revised conversations., BRAIN BYTES. and sample interviews indud-
ing the addition of a "reflections" section
■ New material on counsellor burnout, vicarious tTil.uma, and wcJlness
■ AdditionaJ content on substance misuse including drug withdraw·a.1, detox, and the
opioid crisis
■ Content related to understanding and working with paranoia
■ R«onfigurcd Chapter 10: Cultura.J Intelligence
THEORY AND PHILOSOPHY

Choice-5 promotes an eclectic approoch that encourai;es counsellors to draw techniques
and ideas from various theoretical models depending on the spccif,c needs of the diem
and situation, not the comfort level of the counsellor. Counselling is a complex blend
of skill, attitude, and creativity, with the work based on bcst.-practice tcdmiques that
a.re supported by research. Core skills can be learned and practi~. but they arc not
recipes. Based on individual diem need and context, high.-level professionals create,
adapt, and cusromi!c skills and strategics, thus a.voiding any "one-site-fits-a.JI" approach.
Among the modcJs that have hC11.vil-.• influenced this book's content are the following:
■ Person<cntred counseJling, pioneered by Carl Rogers
■ T rauma, informed practice
■ Cognitive behavioural therapy/counselling (CB1)
■ Motivational interviewing
■ Short-term and solution-focused counselling
■ Emergent insights from neuroscience
The term "cognitive reserve" describes the brain's capacity to creative],.• find Wtt)'S to
cope with life's chaJlenges. Socia.1 workers and other counsellors who have high level of
cognitive reserve om "switch gears" when one way of solving a. problem does not
work. Put simply, they have choices and they arc not disc.oura,;ed or defeated when one
approach to working with clients fails. They can vary their approach to meet the unique
needs of different diem~ cultures., and situations. Over a lifetime of a professional
career, through reflection, education and practice experience that builds on success and
learns from failure, they can grow their counscJling skills and cognitive reserve.
Every interview requires an intcJligent choice of skHls and stnnegies. To make
wise choices, counseJlors need to develop a wide range of practice skills based on sup.-
ported theory (science) and proven practice (cvidcncc.-bnsed best practice). When
counsellors have a rcpenoire of skills, they can make knowledgeable choices based on
the unique needs of clients and situations., rather than their own personal comfon
levels or established routines. In simplest terms, the more choices counsellors have,
the grcnter their ability to match their work to the needs and wants of their clients, and
the less their need to repeatedly use the same skill. Effective counsellors a.re wise
enough to know when to-and when not ttruse pa.rriculnr skills. Similarly, the goal of
)UV Preface
counseJling is to help diems achieve ve.rsatility in their capacity to solve problems and
achieve goals.
Slcill and to::hnique can be impressive, but n1one thq•arc insufficient. Compassion, car•
ing, empathy, an ability to suspend judgment, objectivity, professionalism, sclfowarcncss,
and sufficient psychologicnJ health arc some of the personal qualities and commitments
that must operate in tandem with knowlo:Jge and skill. Counscllors need to be genuine,
maintain warm and caring rqprd for the.ir clients, and rccogni:e the inhe.rent worth of
people Kadushin (1990) discusses the impormnt mix of skill and feeling:
?I.fan)' midit s::1y th:u i( they h::.d to choose between (eelinK and technique they
would choose (ee1m~ as the more important pre-requisite. Perh::tps so. but i( one has
to make a choice between these qu2lif"teations. an injustke has 2lre::.dr been done 10
the client. It shouJd be p<,SSlble to offer the client an inter\'iev.'er who is both 3ttitu,
dinally oorreet and ttthnk3lly prot"teient. (p. xii)
Respect for Diversity and Culture

Diversity includes differences in such major va.riablcs as race, religion, 3ge, sex, se>.."Ual
oriem3tion, physical and mental ability, economic capacity, language, culrurc, vaJues.,
belief~ prcfc.renccs, and ways of think in a and behaving. The diversity of today's coun-
selling cascloods requires th3t counscJlors develop a ranae of interviewing and counsel-
lina skills. Competent counsellors arc able to vary their style dependina on the unique
culture and ,vorldviews of their clients.
Choices cmphasi:es culrural competence. Since everyone is unique, each with
his or her own mix of values and belief~ culture is a varinble for work with all cli-
ents. \Vhen working with clients from visible minorities and those who arc margin-
akcd by poverty or discrimination, counsellors must examine the sociopolitical
realities that frame the clients' circumstances. They also need to develop sufficient
sclf-aw3renes.s to escape or manage any tendency to be culrurc-bound-thc assump-
tion that aJI clients share their values, perspectives, and ambitions or, worse still,
that client differences represent deficiencies. By sust3ining a multiculturaJ perspec-
tive that rccogni!es and prizes diversity, counsellors can avoid the pitfalls of ethno-
centrism (the belief thu one's own views and culture are superior). Culturally
competent counsellors view cultur3J differences as opportunities to widen their
horizons and deepen their vers3tility. They remember to be humble enough to learn
from their clients.
Phases of Counselling
This book divides the counsellina rclntionship into four phases: prcliminnry, beain-
ning, action, and cndina. E3ch phase involves common as weJI as unique tasks and
skills. For example, the beginning phase focuses on rclntionship development and
problem exploration. Predict3bl)•, skills for devclopina relationships, like active listen-
ina, arc most useful in the beginning phase, whereas skills such as confrontation arc
not recommended. But the subsequent action ph3sc focuses on helping clients develop
new perspectives, set goal~ nnd implement change strategics; thu~ skills such as refram-
ina and confronting 3re used extensively in this ph3sc.
The four phases 3re devclopmcntaJ, with success u one ph3sc dependent in part
on success at previous phases. For example, clients arc more willing to accept confron-
t3tion in the 3ction phase if a solid rcl3tionship or trust has already been established in
the beainnina phase. In genera], reference to the four~phasc model nJlows counseJlors
to mnke some predictions about the climate of the interview and to determine which
Preface xv
skills and casks will be needed. However, practitioners must be cautious in applying the
modcJ too rii;orously to every counselling intc.rvicw because there arc ah\-"n)'S circum,.
stances for which the sequence of events will differ sharply from the model
Values and Ethics

Edtics are principles of acceptable conduct. Professional associations sud,. as the Cann,.
dian Association of Soc:iaJ Workc.rs and the Canadian Counselling and Psychotherapy
Association Juve formal statements tlut define cc.hies and standards of practice for thc.ir
members. Similarl'>', mfues arc ideas and principles that individunJs and groups considc.r
import:mtor worthwhile. In counselling, cc.rtain core wlucs arc of pnnicula.r importance:
I . BcJief in the dignity and worth of people
2. Respect for the client's right to self-determination (i.e., for freedom of choice and
the right to control one's own life)
3. Commitment to work for social justice
The Counselling Relationship

All editions, including this one, have prioriti!cd the importance of the client/counsel..
lor relationship as a major dcterminam of success. The counselling relationship is
something very special. lt's negotiated. It's non..rcciprocaJ. lt has a purpose. lt is
dcsianed to rccogni!c and mobili:e srrengths. 1t requires counsellors to abandon their
biases and suspend any tendency to give advice in order to listen and respond in a man..
nc.r that crcn.tcs the conditions for trust, growth, and change.
Counselling should empower clients and strengthen their self-esteem. It has very
little to do with giving "good advice," but it might involve providing information and
assisting clients to evaluate alternatives in ordc.r to support them to make informed and
scJf-Octcrmincd choices. Best-practice counselling draws on the expertise of clients to
participate in decisions related to the goals and process of counscJling, For this reason,
counsellors should demystify their worlc through open discussion of their methodolo-
gies, assumptions, and intentions. Moreover, commitment to client scJf-Octenninntion
restrains counsellors from abuse of power or control. In promoting client self-Octcrmi..
nation, counsellors use a strcngrhs approach that empowers clients by assuming their
capacity to cope and change.
The counselling relationship crcn.tes the conditions for c.hani;c to occur and the
motivation for change to proceed. The counscJling relationship nurtures the natural
need that everyone has to grow and change. The cornerstone of this is empathy, a
unique and powerful way of listening chat alone is sufficient to help many people. 1t
is nor a technique that we nctiv:nc when counselling, bur rathc.r an empathic approach
to life that Roger's describes as a ",'",.'>' of being,"
Counsellor Self-Awareness
Effective counsellors arc scJf.awarc, open to feedback, and willing to learn. As counsel..
tors become deeply involved in a relationship with their clients, they need to control
their own biases, and constantly monitor thc.ir feelings and thoughts so that they are
able to separate their cxpc.ricnces and feelings from those of their clients.
Knowlcdi;c of self, including consciousness of one's values and bcJicfs and the
impact of one's behaviour on others, is a prerequisite for effective counselling. Coun..
sellors who lack scJf-awarcncss may confuse their clients' feelings with their own.
\Vhcn counsellors are unaware of their own needs, including those that are unmet,
ll.Yi Preface
they risk unconsciously using thc.ir counscJling relationships to meet ~rsonal goaJs
instC3d of client goals. In addition, without sclf-awarenes~ counsellors will be ignorant
of those arc3s of practice in which they arc competent and those in whic.h it will be
difficult for them to ,vork with objectivity.
Competent professionals know thcmscJvcs, and they ensure that their vnJucs and
beliefs do not become a burden to thc.ir clients. They acc:cJX that exploring and rdlcct-
ing on one's competence and the limits of one's role and expertise are fundamental to
professionaJ practice. For counscJlors, this process of self-examination continues
throughout their oi.rcc.rs.
Neuroscience and Counselling

In r«cnt years, neuroscience has emerged as an important new force in counselling.
Since the 1990s new technologies have spawned an explosive interest in the brain.
These imaging technologies have resulted in enormous progress in our understanding
of the brain. One of the most rclevant and exciting findings is the discovery that our
brains arc "plastic" and in a constant state of change. lifcexpc.ricnce, adversity, trauma,
risk taking, and learning shape and reshape the brain in ways that help us co~ with the
chaJlenges in our lives. Or. alternatively, they ma)' drive us to depression, anxiety, and
substance abuse.
A growing body of neuroscience research has confirmed the validity of counsel-
ling by demonstrating in dramatic ways how counselling changes the brain. Counsel-
ling works! Now, we have the science to prove it. \\:le have IC3rncd how counselling
basics such as listening, empathy, asking questions, and the establishment of relation-
ship counselling harness brain plasticity and promote positive brain growth. It's aJrcady
exciting, even thouWl we arc still at the beginning stages of what is certain to be an
avalanche of profound dcvcJopmcnts in coming years. Neuroscience is providing
answers to the question, "How can counscJling help create conditions that promote
positive, empowering brain growth or repair?" As a result, I think that in the near
future college and university counscJling programs will require courses on the brain
and neuroscience.
Social Justice and Advocacy

Although the topic is beyond the scope of this te>..'t, counsellors should also consider
their responsibility to extend beyond thc.ir role as counsellors to social and politicaJ
action. As advocates for sociaJ justice, they should strive to reduce gender, cultural,
and other forms of discrimination. They should aJso promote changes in social policy
as well as modification in the functioning of formaJ org:inimtions and institutions to
meet the needs of clients.
STRUCTURE OF THE BOOK

The book is divided into 11 chapters.
Chapter I explores professional identity and introduces readers to the basic con-
cepts of ethics, values, and self-awareness.
Chapter 2 explores the basic nature of counselling skills and strategies. Jn this
chapter, four major skill dusters arc introduced: relationship building. explorinw'prob-
ing, empowering, and challenging. The four-phase model of counselling (preliminary,
beginning, action, and ending) is proposed as a model for understanding the evolution
of the counselling relationship. As well, the important components of a traumn,-
infonncd approach are introduced and discussed.
Preface xvii
Chapter 3 examines the heJping relationship and considers the core conditions
of effective counseJling. Scs.sional and reJacionship contracting arc featured in this
chapter.
Chapters 4, 5, and 6 explore the active listening skills of attending. silence,
paraphrasing, and summari! ing (Chapter 4), questioning (Chapter 5), and empa.-
thy (Chapter 6). Specific ideas for interviewing and working with )'OUth arc discussed
in these chapters.
Chapter 7 is concerned with action-phase skills chat motivate clients to think dif,.
fercndy and make changes in their lives. Two important theoretical model~ cognitive
behavioural counselling and motivational interviewing, are fenrurcd.
Chapter 8 presents information on working in difficult situation~ such as when
clients arc resistant or potcntia11)• violent.
Chapter 9 looks at concepts for working with various populations, including those
who arc dealing with mental disorders., contemplating suicide, or who have addictions.
Chapter 10 explores important concepts and is.sues rcJatcd to counselling clients
from different cultures. This chapter includes a discussion of spirituality and counsel.-
ling, reflecting a growing interest in and acceptance of spiritual issues in counselling. In
this chapter, multiculrural competencies for Canadian counsellors arc introduced.
Chapter 11 , new to chis edition, explores issues related to neuroscience and coun.-
scJling including a discussion of brain problems.
Features
People learn in different ways, so this book includes a range of features designed to
assist learners in understanding at the cognitive, emotional, and behavioural lcvcls.
Each chapter contains the following clements:
■ Lcarnini Objectives: key concepts that will be addressed in the chapter

■ Summary: a short review at the end of each chapter chat summari:es important
ideas
■ Conversations: a unique feature presenting teacher- student dialogues about
frequently asked questions
■ Sample Interviews: annotated interview excerpts chat illustrate and explain
chapter concepts
■ Success T ips: short, practical ideas for counselling success
■ Illustrative Figures: diagrams that support or embellish chapter concepts
■ Brain Bytes: short links to interesting and relcwnt neuroscience
■ Exerci,;;es: end-of-c.hapte.r rdlcctivc questions to give readers practice developing
self-awareness, practice skills, and conceptual knowledge
■ Weblinks: links to websites related to the chapter's material
■ Glossary: definitions of key terms
SUGGESTIONS FOR STUDEN TS

If you are studying this book as part of a course on counselling skills, you will probn.-
bly have the opportunity to develop skill competence in a number of different ways:
■ Watching instructor demonstrations

■ Conducting practice interviews using role-played or (preferably) real-life .scenarios
■ Completing the chapter exe.rciscs
x,,m Preface
■ Rcce.iving fcedb3ck and evaluation from instructors and student colleagues who
obse.rve your work
■ Using audio and video recordings to understand and assess your verbal and non-
verb3J responses
■ \Vorbng with clients in practicum fie.Id settings
ln most counselling skills courses, learning groups are u~ to practise skills. Usu-
ally, these learning groups use classroom simulations and practice interviews in which
you assume the roles of dient, counsellor, and observer. Each of these roles offers
unique chnJlenges and opportunities for learning.
Practice Interviewing: When You Are the Client

The client's role offers a powerful opportunity for you to understand diem feelings
and expectations. You may find that your rc3ctions arc similnr to those that clients you
will worlc with in the field experience:
■ Ambivalence about sharing fceJings or details about pe.rsonaJ issues

■ Feelings of vulnerability and fear of be.ing judged, cmba.rras~. or ridiculed
As a dicnt, it will be up to you to control how much you wish to disclose; how-
ever, by taking reasonable risks, you can enhance your learning opportunities and
insights. However, )'OU should remember that a training environment docs not pro\tidc
the time or setting to address complex problems.
Practice Interviewing: When You Are the Counsellor

When you are asked to practise )'Our newly lc3rncd skills as a counsellor, you may
fee] dumsy and insecure as you take risks to chani;c established communication pat-
terns or experiment with new skills and strategics. As a student with limited training.
you may be reluctant to ask questions that seem to invade the privacy of your col-
leagues. Moreover, when dealing with sensitive issues you may fear that your lack of
experience will damai;c your clients. You may aJso fear that your colleagues will judge
you as inept. As weJI, when you arc being observed by others, the intense focus on
your worlc can be unsenling and anxiety-provoking. But all these reactions a.re com-
mon, and you will probably find that your colleagues fed the same wa't'· Most profcs-
sionaJ counsellors take many yc3rs of practice and stud,., to become competent and
comfortable using a full range of skills. What is important is that you persist and
avoid the natural temptation to stick with familiar patterns of communicating. Skills
that are awkward in the beginning will, with practice, become part of your natural
and preferred style.
SUCCESS TIP
If you ere-ate the right conditions, othe-rs wiU help you wrth foodbaek that w,II support the-
dieve-bpment of you, skits and self-awareness.
Practice Interviewing: When You Are the Observer

Student observers are responsible for watching the interview and providing feedback
to student colleagues who are practising their counseJling skills. At first, you may be
reluctant to offer feedback, perhaps ,vorrying that your remarks will generate anger or
Preface xix
hurt fcdings. But keep in mind that the obsc.rvcr's role gives 't'OU an exceJlcnt opportu-
nity to develop the skill of giving feedback 3nd practise this skill.
Helpful focdb3ck is energizing and does not detract from 3nothcr person's se.lf-
e.steem. As people lc3rn and practise interviewing and counselling skills. they may feel
vulnerable and awkw3.rd. Hence, it is important to re.main sensitive to their emotional
and psychologicaJ needs, while balancing their needs for inform3tion 3nd correction.
Obscrve.r feedback ma't' be of two types: supportive or corrective.
■ Supporth-c feedback reoogni:cs screngcM. Consider how you respond diffcre.ndy whm
your st~hs arc 3ckno\\'lo:Jge;J rather than when your \\"t'3knesscs 3re targcto:J. Yet
despite how obvious this idea seems, m3ny srudents and professional counsellors are
very problem,oricnted 3nd fail to ocknowlooge client or colleague ~ h s . Supponive
fttdback m~t be ,;cnuinc (rruc) and dclivem:J without rescuing or patronizing. If you lie
to others to 3Void hutting them, your credibility 3S a source of feedbade will diminish.
■ Corrective feedbac k challenges others to ex3mine or change behaviour. But
before giving corrective feedback, consider your rel3tionship with the othe.r per-
son. If 't'OUr relationship is based on trust and caring, corrective feedb3c.k has the.
potenti31 to be effective. Ho\\'evcr, if your relationship has unresolved conflict,
corrective feedback is more likely to be: perceived 3S an attack. lf people think
your feedback is h3rsh, demanding, or cont·rolling. there is a higher probability
that they will resist. Here arc some general feo:lbock guidelines:
■ Be sp«ific. Avoid generalities such 3S. "Your interview was gre3t." Anchor
your assessment by identifying the specific beh3viours and responses that 't'OU
observed that contributed to the success of the interview.
■ Don't use corrective feedb3c.k as a means to control, impress., or punish. Pay
3ttemion to your tone of voice and other nonverbal behaviour. N13ke sure
that you avoid lecturing and pointing fingers.
■ Timing and P3cing 3rc important vari3ble.s. Supportive feo:lbac:.k is more use-
ful when self-esteem is low. In 3ddition, feedback is most effective when given
3S soon as possible, but ensure th3t you protect personal privacy.
■ Avoid ove.rwhelming student counsellors by providing too much feedback.
Watch for nonverbal cues or 3sk them to let you know when they would like
to stop the process.
■ Ask people to self-evaluate. before offering your opinions. You may be sur-
prised to find that they already h3vc insight into the problem are.as; thereby
reducing the number of are3s in which 't'OU h3ve to provide direct feedb3ck.
■ Feedback has the most potential for success if it is invited or tari;:cccd to per-
ceived areas of need. Contract with others to deliver feedback. Ask questions
such 3s "\Vould 't'OU like me to offer my ideas on wh3t h3ppene.d!" or ''Are
there specific issues that 't'ou're concerned about?"
■ Everyone is different. Some people pre.for feedb3ck to be direct and to the
point. Orhe.rs may prefer it "sandwiched" between positives. Orhe.rs need time
to re.fleet before responding, or they may profit from visual and written illusmv
tions. Discuss preferences with student counsellors, then respond 3ccordingi)•.
Some people h3vc an immediate reu:tion to feedback that will differ from their
reaction once they h3ve h3d time to ponder wh3t you have said. For example, 3 person
who responds defensively or C'Ven with 3nger may, on reflection, come to 3ccept your
input and see things differently. The opposite can 3Jso be true-people who rc3ct
favourably may later develop other feelings, such 3S resentment or confusion. Checking
b3ck during future encounters is one strategy for keeping abreast of others' re3ctions.
a Preface
Remember thnt giving helpful nnd caring feo:lback is one way of developing and
strengthening relationships. 1f you are honest and supportive with others, you greatly
incrc3sc the probability they will be honest and supportive with you when you ask for
their helpful feedback.
Developing an Effective Learning Group

When you worlc with student collcngucs in each of the three roles, discuss 't'Our
fears 3S well as 't'Our expectations of one another. You will need to work to develop
3 contract or agreement on how 't'OU will work together. Practice interviews arc
powerful Je3rning opportunities when they are based on rcnl rather th3n role-pfoycd
feelings 3nd issues. Consequently, it will be important to est3blish a climate of
safety, where confidentinlity will be respected. Some important principles to
remember:
■ Colleagues who nrc in the client's role are disdosina pe.rson3l is.sues and foclina~
so it is essential to respect their dignity and right to privacy.
■ Everyone h3s different cnpncities for intim3cy. Do not expect that all members of
a learning group will disclose 3t the same level. Accept individunl differences.
■ Learning the skills of counscJling requires a willinaness to aive up familiar pat-
terns of communication and attempt new npproaches. Expand your limits by mk.-
ing appropriate risks to try new skills 3nd be tolerant of collcngucs who 3rc
engaged in similar risk~taking.
■ Fccdbaclc from others is nn import3nt pnrt of IC3rning. Therefore. try to make it
easy for others to give you focdb3ck by consistently responding nondcfensivcJy.
Hdp others give specific focdbaclc by 3slcina targ,eted questions.
SUCCESS TIP
Ext,ec1 that lhe ptocess of learning and experimenting wrth new Slull:S WIii res.un i"I a petiod
of awkwardness and self<onsdousooss. FOr' a lime, ,t may seem as though your capaoly
to counsel othet'S is rewessing.
Keeping a Personal Journal

A personal "for your eyes ont,.," jour03l can be 3 signific3m adjunct to 't'OUr learning.
The journal is a tool for introspection th3t provides a private means for documenting
3nd exploring your thouahts and fodings related to the development of your counsd-
lina skills. There are no rules for journnl writing other th3n the need to make entries on
3 regular basis and to try to avoid sclf<ensorship.
Using This Book

If you arc using this book as P3rt of a course on counselling, your instructor will pro-
pose 3 su~cstcd rending schedule that srructurcs your reading over the semester, and he
or she will assign or 3d3pt the ch3ptcr exercises to fit your learning needs. Another way
to use the book is on 3n "as you need it" basis. using the index or ch3ptcr hC3dings to
locate specific content. As wcll, you 3rc encourag,ed to use other books, journals, 3nd
tools. such as lnte.rnct research, to supplement your learning. However, you should rend
this boolc (or any boolc) critic3lly and sce.k to undcrsmnd and explore the kfe3s and try
them out.
Preface ai
Counselling Skills as a Way of Life
You m3y be surprised to discover that the skills of counselling are also the skills of
dfcctivc cvef)tdny communication, and that the process of developing your counscJ.-
ling competence ma'>' begin to influence )'Our pc.rsonaJ relationships. As counscJling:
skills become part of your style, 't'OU may find '>'ourself becoming a linle more inquisi.-
tivc and more sensitive to the feelings of others. However, you may find that others in
)'Our life do not welcome the changes in 't'OUr manner and St)•le. When you change,
others around you have to accommodate '>'our changes. ff you become more probing in
'>'our questions. they must be forthcoming: with their answers. \Vhcn you become more
empathic, their feelings become more transP3rcm. These changes move rhc relation.-
ship to a deeper level of intimacy, which ma'>' be friWltcning for some, particularly if
the pace is too fast for their comfon level.
an Preface
I have appreciated the help offered by the editorial and production staff at Pearson
Canad3, who have been very helpful in guiding this book through the m3ny steps
required to bring the manuscript to publication:
■ Portfolio l\•fanage.r: Keriann McGoogan
■ Marketing Manager: Euan \Vhite
■ Content Developer: Eileen Magill
■ Content Manager: Madhu Ranadive
■ Project Man3ger: Susan Johnson
■ Copyeditor: Susan Adlam
■ Cover Designer: SPI GlobaJ
Thank you to Venkat Perl3 R3mesh 3nd Aishwary3 P3nday for their terrifc copy
edit of this edition. A special thanks to Collen Murphy and John Fox from Dougl3s
College 3nd Joyce Shebib for their comprehensive review of the new Chapter 11.
An adapted version of Chapter 11 was published in the online journal, The Neuro-
psychotherapist (2017), and I am grateful to its' editiors, Manhew Dahliu. and Rich-
ard Hill for their assistance in m3king this happen.
All editions of this book have benefited from the feedback provided by review-
e.r~ reader~ colleagues, clients, and students. Over the year~ students from Dougl3s
College, have offered candid and helpful feedback, and profession3f collengues who
have contributed ideas and suggestions th3t I have assisted me. Thanks to Andrew
Buntin, Barbara Picton, Irene Carter, Jason C3rte.r, Michelle Gibbs, Winnie Benton,
Irene C3rter, Susan Davis, Karen Marr, Sheri McConnell, Sar3 Memel, K3ren
Moreau, Neil Madu, Robert Owen~ Alyson Quinn, Melissa Medjuck, John Fox,
Doug Este.rgaard, Bruce Hardy, Lawrence Becker, Elizabeth Jones, Colleen Murphy,
3nd Tabitha Brown.
Each edition of Choices h3s included reviews from professionals in the field. In
this seventh edition, 10 reviewers, each of who was intimately familiar with the con-
tent of the book, offered their perspectives on how the book could be improved.
Their invaluable 3nd intelligent suggestions helped to shape this 3ddition. Thank )'OU
to these colleagues who reviewed the seventh edition:
Alana Abramson, Kmmden Pol)redmic Unitff.Sit1
Andrew Buntin, George Brown College
Barbara Picton, Vancout'ff Communiry College
Irene Caner, Uniomi1y of \Vind.sor
Jason C3rter, Fleming College
Michelle Gibb~ Mohawk College
P3trici3 Miller, Mounr RO'J(ll Unit'ffSi1y
Sue Davis-Mendelow, Humber College
As 31ways, a special thanks to my wife, Joyce Shebib, who continues to offer support
and very helpful critical comments.
Readc.r comments and critical fccdb3c.k arc always welcomed. Please email me at
shebib@tdus.ca.
Bob Shebib
f21C'ult)' En~ritus
0ou{tla$ ColLes:e
Kew \Vestrninst~r. BC
Customi:~ workshops and staff training based on this boolc arc available. Contact the
author at shcbibb@tdus.net for details.
niv Acknowledgments
Stuart Miesfl23RF
■ Identify the Canadian professionals thnt provide counsellina services.

■ Identify how counsellors can work within the limits of their competence.
■ Define and describe professional ethics, indudina standards related to duaJ rela,
tionships and confidentiaJity.
■ List and describe- the core va.Jues of counsdlina.

■ Identify principles for underst:mdina and resolvina ethical dilemmas.
■ Understand the importance of counsellor objectivity :md self-awareness.
■ Understand and manage personal needs and values in counsdlina.
■ Recoani:e and address burnout and vicarious trnuma as W'Orkplace hn:ards.
PROFESSIONAL COUNSELLORS IN CANADA

Many professional~ such as social workers, child and youth care workers, ps)•chologist~
psychiatrists, nurse~ and psychiatric nurse~ do counsdlina work. Most are members
of professionaJ associations like the Canadian Association of Social \\:1orke.rs (CAS\\:' )
and the Canadian Counselling and Psychotherapy Association (CCPA: see Table 1. 1).
TABLE 1.1 Professional Associations in Canada
canae1ian Addi:tioo Counseuors Ce-rtification fedemtion w.-.w.caccf.ca
C3nadian Art Ther.1py Association w.-.w.catas"lto.ca
C3nadian Assoc:ial:ioo of Music The-rapists w.-.w.musiclher'aP'f.ca
canae1ian Assoc:ialioo of Rehabilitation PtofessionalS w.-.w.carpoational.Of'g
tanadian Assoc:ialioo of Soda! WorM-rs w.-.w.casw..acts.ca
C3nadian Counse-t.ling and Psychotherapy Associatbn w.-.w.ccpa-accp.ca
canae1ian C(.-ninal Justice Association w.-.w.ccja..acjp.ca
tanadian Indigenous Nurses Association w.-.w.anac.on.ca
C3nadian NurSeS Association w.-.w.cna-a6c.ca
C3nadian Psychiattic Association w.-.w.cpa-apc.org
canae1ian PsychOlogical Association w.-.w.cpa.ca
C3nadian Thetape:utic Recmatbn Association w.-.w.canadian-lt.org
CouOOI ot canadian Chad and Youth care- Associations w.-.w.cyceanada.ca
PsychOsocial Rehabilitation canada w.-.w.ps«pscanada.com
As members, they are subject to codes of ethics governing acceptable professionaJ

behaviour. Membership in these associations usually requires a university degree and,
in some cases, a maste.r's degree or Ph.D.
Social ,vorke.rs gene.raJ)y have university training with a bachelor's degree in social
work (BS'W) or a master's degree in social ,vork (MS\\:r). (n addition, they may have spe-
ciali.!cd training in are3s such as family the.rapy or group ,vork. Social workers might work
in private practice or be employed in hospitals, prisons, schools, or community social
service agencies. Many social workers also ,vork for government agencies invcstig:iting
incidents of child abuse and neglect. Social ,vorke.rs arc the largest profossionaJ group
providing support and counseJling to people with psychiatric disorde.rs. lncrcasingly, with
the aging of the Canadian population, social workers are deployed to work with seniors.
CounseJling psychologists are usuaJly qualified at the Ph.D. lcvcl, but some jurisdic-
tions allow registration for those with a master's degree. They may ,vork as counsellors
or may spcciaJi.!e in other are3s, such as in administering and interpreting psychological
tests. Psychologists arc often employed in private practice, but they ma,., also work in
settings such as prisons, hospitals, schools. and private industry.
In contrast, psychiatrists arc mcdicnl doctors with advanced training in psyc.hiatf')t
They are specialists in the treatment of people with menral disorders. Ps,.•chiatrists are the
only counselling professionaJs licensed to prescribe medication. Psychiatric nurses gener-
ally have two to four years of training. Historical!,.,, they worked in psychiatric hospitals and
wards., but today. increasingly, they arc working in community based mental health settings.
Community college graduates with one to two years of college training aJso provide
counselling services in senings such as transition homes, addiction centres, employment
counselling agencies, and community mental he~dth. The nonprofit social service sec•
tor also uses volunteers to deliver services in settings such as crisis phone lines, where
people in distress call for assistance or referral. In addition, the professionaJ counselling
community is often supported or replaced b\• an array of sclf-hclp support groups, such
as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
Social Work and Social Justice

Like other professionals in the helping professions, social workers counsel clients to
help them develop insight, solve problems, deal with emotionaJ p3in, and enhance
2 Chap1er 1
rcJationships. They may also suppondients by providing information, social skills trnin-
ing, or resources. One speci3l feature that d istinguishes social work counselling from that
performed by other professionals is itsdunJ focus on W'Orking with individuals as well as
the.ir sociaJ environment (DaJe, Smith, Norlin, & Chess., 2009). SociaJ W'Orkers assume
that an individuaJ can be u nderstood only in the context of his o r her environment;
thus, they pay particular attention to the interaction of the person and the environment.
Unique to social W'Ork is the important professional responsibility to promote social
justice or "fairness and moraJ riahtness in how social institutions such as government,
co rporations, and powerful groups rccogni!c and support the basic human rights o f all
people" (Shcafor & Horcjsi, 2008, p. 6). Social justice commitment involves advocacy
to promote human rights and more equitable income redistribution, political action to
change oppressive legislation o r policy, public education to shnpe public opinion, and
efforts to build community. Social workers recognize that social problems arise, at least
in pan, from ineffective socinJ systems.
\Vhile counselling is important in helping individunJs cope, it is insufficient in deaL-
ing completdy with these great cha.Jlenges. Thus, because this boolc explores onh• the
counselling component of social work practice, practitioners arc autioncd to approach
this taslc with the broader mission of social ,vork in mind. Valu e 2 of the Code of Edtia
of the Canadian Association of SociaJ ·workers (2005) o udincs the obligations o f social
workers to advoc:ne for social change:
Purjult of Soci::ll Justice

All 2 result. !lod:lJ workers belie--.-e in the obii¥"3tion of people. individual!)' and eol,
!ttth-e1y. to provide resour«.s. services and opportunities for the over111l benef'h of
humanity and l'O a(ford them procect.On from h::arm. Soefa1 workers promote social
fairncss and the equitable discribut.On of reSOurees. and take ::.et.On to redu~ barri.erS
2nd eicpc:md eho-iee for all persons. with !ipecM R1t3rd for those who 3re marttln::ii:ed.,
di~dv:tnta~d, vulnerable. and/or h::1:\'e e,:eeption::111 nee<k Soei::111 workers oppose prt'Ju.-
diee and d1serimination 21.'.ainsc any person or aroup o( persons on ::ti1)' arounds. and
spedf"te:!111)' eh:t!Len~-e views and aet ion!l that stereotype p.,rtkular persons or $tr0u pi.
Prindples.:
■ Soeial workers uphold the ril.'.111 of people to h:t,-e ae«ss to resourees to meet lxlsk
hunun needs.
■ Soda! Yi'Orkers 2dl.'Oc."21te for l2ir and equitable~ l'O pu blk servieesand bene:flu.
■ Soeial workerS ac.h'()("3te for equal t re::atment and proteetion under the law and ehal~
le~e injustiees,. especially inJuStkes that 2(fect the vulncr.ible and d1S:ld\'an1a~-ed.
■ Soeial workerS promote soc:ial de,'1?1opment 2nd e,wironment:lJ mai1::1:~1ne:i1t in the
intereru o( all people. (p. 5)
ETHICS
Ethics arc the p rinciples and rules o f acceptable o r proper conduct. All professions hnvc ethics: Ouidelilies that define the limits
ethical guidelines, desianed to protect both clients and members. Ethical codes define d pennissible behariour.
the limits of pe.rmissiblc behaviour and the sanctions o r remedies for member violations
of ethicaJ standards. Codes of ethics serve the following b ro3d purposes:
■ Professionals can use their codes to assist them with d ecision m31cing and as a refer-
ence for the.ir practice.
■ Ethical codes help shdtcr clients from incompetent and unethical practice by mcm.-
be.rs of the p ro fession. Ethical codes r«ogni:e that clients may be vulnerable and
subject to manipulntion and abuse o f power by profossiona]s, so thq• constrain
professionals from taking 3dvantage of clients.
Protesslonal Identity: Ethics, Values , and Self-Awareness 3

■ Ethical codes nlso provide guidance on how counscJlors can dc3l fairly with col.-
leagues and their cmplO)'Crs, including the responsibility to address the unethical
conduct of colleagues.
■ Codes outline the philosophical and vnluc principles of the profession. For exam,.
pie, the code of the Canadian Association of Social \\:1otkers has six core social
wotk values:
Value I: Respect for the Inherent Dignity and \Vorth of Persons
Value 2: Pursuit of Socinl Justice
Value 3: Service to Humanity
Value 4: lntea:rity of Professional Practice
Value 5: Confidcntinlit)• in Professional Practice
Value 6: Competence in Professional Practice (CAS\\:I, 2005, p. 4)
These ideals arc echoed by the Canadian Counsellina: and Psrchothcrapy
Association, which articulates the following fundamental principles as the b3sis
for cthicnJ conduct:
a. Bendiccnce: be.ina: pro3ctivc in promoting clients' best interests
b. Fidelity: honouring commitments to clients and maintaining integrity in
counsellina: rcJationships
c. Nonmalefkence: not willfully harming clients and refraining from actions that
risk harm
d. Autonom)•: respecting the rights of clients to self-determination
c. Justice: respecting the dignity and just treatment of all persons
f. Societal interest: respecting the need to be responsible to society (CCPA, 2007, p. 2)
Unethical behaviour typicaJly arises from issues related to one or more of the
following: brcakina: confidentiality; misreprescntina: or worldna: beyond one's level of
expertise; conducting improper relationships. including scxuaJ activity with clients; and
causing conflicts of interest, such as emerina: into business or other dual relationships
with clients.
ProfessionaJ associations arc responsible for monitoring their mvn policies and for
investigating and resolving violations of cthicnJ conduct. The CAS\\:I and CCPA arc
examples of professionaJ bodies that can formnll)• discipline members who violate their
codes of ethics. As weJI, counsellors who are 00( members of professional assocuttions
may work with agencies that provide guidelines for ethical behaviour and decision makina:.
In addition, legislation defines and restricts the use of certain tide~ such as social
worker, psychologist, and psychiatrist, to those who have the appropriate degree or
training. The clients of these professionals can report misconduct or concerns to the
appropriate professional association: however, the.re may be no legislation preventing
people from offering counselling services under 3 wide nma:e of other title~ such as
counsellor, personal therapist, family and marital counsellor, and personal growth con,.
sulmnt. These practitioners ma)' not have had formal preparation or training, and clients
should be cautious when they seek their services.
Although the codes arc the primary source for professional decision makina:, coun.-
seJlors should also consider relevant theory, research, laws, regulation~ and agency
policy. \Vhcn faced with ethicaJ dilemma~ they should consider consultation with
collc3gucs, supervisors, professional associations, and lea:al counsel In addition, the
CCPA has published an ethics casebook (Shuh, 2000) designed to assist counsellors in
clarifying ethics and standards of practice, and the CAS\V has published Guidelines for
Ethical Practice (2005) as a reference point for social workers on cthicaJ practice.
4 Chap1er 1
Dual Relationships
A dual re.larion.,;hip is a rcJationship in which the.re is both 3 counselling relationship and Cl.Iii relatiooship: Aieb.~iooslip ii
another type of relationship. such as a business relationship. a friendship, or one of scxu:.d *h thEfe is bot!I aauasellillg ieb.~i>Rship
-6 anctte ~ of retr.i>nship, sud! u
intimacy. The essential purpose of counsclling is to meet dlC' needs of client~ but dual rein,. ~«sa:aal ir.imacy.
tionships IC3d to the risk th.nt counsellors could misuse (or be pc.rceivcd to be misusing)
thc.ir professional relationships for pc.rsonaJ gain. In duaJ relationships, the counsellor has
a persona] interest th.nt may con6ict with the client's interests. This may lead to intended
or unintended exploitation, harm, manipulnrion, or coercion of clients. To prevent these
problems and an,.•conflict of interest, dual rcJationships must be 3voidcd because of their
potcntiru hnrm to clients and the risk of damage to rhe image of the profession.
Not surprising),.,, the codes of ethics for the various counselling professions strictly
prohibit certain types of dual rel.ntionships., especially those of scxunJ involvement.
Generally, they also prohibit sexual intimacies with former clients for a specified period
after terminating the counseJling relationship, but this injunction ma'>' extend indcfi-
nitdy "if the client is dearly vulnerable, by reason of emotionnJ or cognitive disorder, to
exploitative influence by the counseJlor. Counsellor~ in nJI such circumstances, clearly
bear the burden to ensure that no such exploitative influence has occurred and to seek
consultative assistance" (CCPA, 2007, p. Bil).
Professional Boundaries
Despite ethical guideline~ boundary \•iolations and abuses do occur. Reviewing the
available research, (Thoreson and colleagues 1993) found thal the incidence of se>..'Ual
contact between counsellors and clients ranges from 3.6 to 12.1 percent. Conducting
their own srud'>', the researchers found after surveying 1000 randomly seJectcd male
members of the American CounseJing Association (ACA) that 1.7 percent of the
respondents reported engaging in sexual contact with a client during a professional
reJationship. and 7 percent reported engaging in sexual contact after a professional rela-
tionship (Thoreson ct al., 1993).
Physical Contact The CAS\\:l's Guidelines {qr Eihical Pmaice (2005) offers this guid~
ancc on the issue of physical contact with clients:
Sodd1I v.'Ork.ers a"oid e0$:aaina in ph)'Sical cont::.ct with cl1enu whe:i, there is a possibility
of harm to the client as a result of tilt contact. Soeial Yi'Orkn'l who e0$:a~ in approprldlte
physical contact with dients21re rttponSlbLe for settina dear, appropriate and cuhura.lJy
sensitive bound:u-ieii to '-•oven, iiudi cont~. (p. 12)
\Vhile the CASW guidelines do not de.fine appropriate physical contact, common
sense neo:ls to prevail. Fear of the impliations and repercussions of touching has led
some settings to become "no touch" environments; however, this practice may negate
the needs of some clients, particular!'>' children who need physical conmct. In an edito-
rial on the importance of touching in child and youth care sertings., Tom Garfat (2008)
emphasi!ed the importance of touch when working with youth, but he also stressed
that workers need to learn when not to touch. He distinguishes "between those who
would touch youth in the most normnJ and healthy of ways; a pat on the back, a touch
on the shoulder, a comforting hug when the world is a difficult place, a hand held in a
moment of crisis, and those who use the opportunity to touch a young person as an
opportunity to satisfy their °"'n needs and desires" (p. iii). Garfat strongly endorses the
elimination of inappropriate touching, but urges us to remember that "touch is P3rt of
human nature, touch is dcvclopmentnJI'>' necessary, touch is part of healing, touch is a
form of communication, and touch builds bridi;cs" (p. x).
Protesslonal Identity: Ethics, Values, and Self-Awareness 5

While sexual intimacy is de~uly unethical, the appropriate boundaries of other
relationships may be less dear. As Reamer (2002) observe~
Other dual 3nd 1nuhiple refationships3re more 31nb~uous and require e2reful an:11lysis
and eonsuh:nion. Examples include $0Cla! v.-·orkers in rural communities who cannot
3\'0id cont~ with dienu in social settin~s. soeial workers who ue in\'hed br clients
to attend an important li(e e"ent, soek.11 v.-·orkers' rebtionships with forn~rclients, and
soeial workerS' unantidpcatc-d e:ncounterS with cbe:nts 3t 3n Aleoho!ics Anonymous
n~tinK when both parties 3R' in rttO\>ery. (p. 66)
Miller (2007)discusses the chaJlenges that profossionaJs who work in rural or smaJI
towns face when applying and interpreting ethical standards such as "the need to main.-
tain professional boundaries and at the same time achieve a sense of personal belonging
in the community" (p. 168). She aJso notes the vulnerability that workers foci, due to their
high visibility, when their actions are scrutini!cd by members of the community.
Pierce and Schmidt (2012) sugi;est that rural dynamics and culture affect how pro-
fessional boundaries are de.fined:
For example, over time. the pro(essional m3)' be invited to 001nmunity e"\>ents. 3 we'd,
din¥, or a eelebr.uion for "-hkh attend3nce is viewed 3S SiKnif'lcant by the community.
Not attendina m3)' cause disharmony <>r barderS between the practitioner and the
community. (p. HS)
Confidentiality
The rules rq:ardingconfidentialit)• are integral co every code of ethics. EthicaJ guidelines
stress that the confidentiality of clients must be protected. Indeed, most clients enter
counselling with an expectation that what they S3Y will be kept private. For the most
part, counsellors can assure clients that they will keep their disclosures confidenriaJ;
absolute confidentiality: ,. hO\\tC\-er, often it is not so simple. Absolute confidentiality mC3ns that client disclosures
assur•e that dient disclosures are not are not shared with anyone. Rclati\'e confidentiality means that information is shared
shared 'llih an)1)fle.
within the a,;ency with supervisors or colleagues, outside the agency with the client's
~&alive confidentiality: The permission, or in courts of law owing to legal requirement~ such as child abuse legisla.-
assumpti)n that client disctlsures my be
tion. UsuaJI)•, clients can be assured only of relative confidentiality.
shared 'llihin the ,.ency • idl supervisors
or ailleapes. Clllsi:\e the ,.ency -.idl To provide optimum service to clients., counseJlors must share information about
client peraissia.. or _., odlers bec-.-se them within the agency. To monitor the quality of ,vork and help counsellors improve
of lea..ahequiremeaa. s.a::h as those their skills, supervisors need to review client files or consult with counsellors by review~
contailed .ithin ctid abuse legisbtica.
ing audio and video recordings of their interviews. Other counseJlors within the agency
also have access to files.
Many people believe that counsellors and other professionals enjoy "privileged
communication," that is, thq• are lega]ly protected from having to share information
that they have obtain~ while exercising their professional duties. Ho\\'e\'er, the courts
can subpoena counseJlors' records because Canada has no legislative protection for
licensed or unlicensed psychotherapists.
There are valid reason~ including some legal requirements, for sharing informa,.
tion. For example, aJI jurisdictions in Canada have legislation that rttauires counseJ.-
lors to report suspicions of child abuse and neglect to the appropriate authorities.
Similarly, counseJlors might have to break confidentiality when thq• believe that clients
might harm themseJves or others. Counsellors need to become familiar with the pre.-
cise wording of relevant statutes in their area since laws may vary significantly among
jurisdictions.
One often-quoted legal precroent is the 1976 Tarasoff case, in which the client told
his counsellor of his intent to lcill his girlfriend, Tatiana Tarasoff. The counseJlor cold
the campus police of the threat, but he did not warn his diem's girlfriend or her family.
6 Chap1er 1
The client, a student at the school, subsequent!)• carried out his thrcnt and killed the
young woman. The young woman's parents brought a successful lawsuit against the
counsellor and the university. This litigation established that, when counsellors believe
that a client represents "a serious danj;er of violence to another," they have a duty to duty to warn: The profmional
warn potential victims (cited in Nesbitt, 2017.). responsibility that uunsellors haw to
infora P!(lple . , . they baiew a di.-
may harm.
SUCCESS TIP
Become familiar wdh the legj:slatbn in you( a(ea that (eQuires you to (eport suspected cases
of child abuse Or' neglect but remember it is not you(job to conduct an k\vestigation unless
you are legally assigned thi:s (de.
Since the Tarasoff decision, there have been numerous Canadian applications and
legal precedents that address the duty to warn issue. The CASW's G11idelines for Ethiail
Pmcrice (2005) allows for disclosure when "necessary to prevent serious, foreseeable, and
imminent harm to a client or others" (p. 6). The guideJines also obligate social workers
in such circumstances to notify "both the person who ma'>' be at risk (if possible) as
weJI as the police" (p. 8). The CCPA Code of Ethics (2007) has a similar duty to w-arn
obligation that requires counsellors to "use reasonable care to give threatened ~rsons
such warnings as arc essential to avert foreseeable dangers" (p. 7).
Clients have a right to be fully informed regarding the limits of confidemiality,
including any legal or ethical responsibilities that require counsellors to share informa•
tion. Through discussions rq:ardingconfidentiality. counsdlors can reassure clients that
computer and file records arc safe.
Counsellors can take a number of steps to protect client confidentiaJity. They
should discipline themselves not to discuss clients in public plnc:cs and at parties or
other social events. Counselling work is demanding, and an important part of dealing
with the stress of the job is to unwind by talking about difficult cases and ~rsonal
reactions with colleagues and supervisors. This is a healthy and necessary component
of professional wellness. Unfortunately, time pressures and large caseloads may leave
little or no time for this process during the working day, so it is easy to fall into the trap
of discussing clients over lunch or in other settings where confidemiality cannot be
ensured. The obvious risk is that the conversation will be overheard. Even when names
are not used, accidentaJ listeners may think that they know the person being discussed.
In addition, they ma'>' decide that they will never go for counseJling because what they
Sil)' would soon be spread all over town.
Although it is tempting for counsellors to discuss clients with family and friends
because they arc awilable as supportive listeners, they should avoid doing so. Family and
friends are not bound by the same ethics as counsclling profcssionaJs. They could easily
disclose what they have heard, perhaps with a seemingly innocent observation or comment.
Sometimes counsellors breach confidentiality b\• failing to take simple precautions.
For example, taking phonecaJls during a counselling session can lead to careless breaches
of confidentiality and suggest to clients that the counsellor treats their private matters
casuaJly. In addition, counsellors should remove all case records, phone message~ and
notes from their desk. This prevents clients from seeing the names of oth~r clients and
reinforces the fact that the counsellor will not leave private r«ords in public plnces.
SUCCESS TIP
Yv'hen leaving phOOO messages fOr' d ients, give jusa your firsa name and say nothing abOut
the nature of lhe call. Clients may 001 have informed room-mates or famity members that
they are seeing a counselb.
Protesslortal Identity: Ethics, Values, and Self-Awareness 7

TABLE 1.2 Confidentiality Guidelines
Review ptofessional guidelines such as lhe C/JSWs Guidelines lot £1/'Jk:al Practice and 100
CCPA's COde of £tNcs.
l.nveive clients. Keep lhem infol'rned and seek lhei( permissio.n to retease information.
Remembef' 1hat freeoom of rntotmatio.n sa.ah.ies may give cliMts 1he ~ t to access you( files.
Become familiar with televant legal statutes (e.g., chtk1 abuSe or mental health legislation)
that defW'le and limit conftdentiality. OisclOSe onfy lhe information that is (e.::iuir'ed.
Pr·Olec:I dient (ec:ords Mh secure filing systems. Do not leave flies, notes. or poon,e messages
aOOUt dients out vd'lem they may be read by others. Ensure tr.at etectronicaly stored data is
protected.
• Etls...-e lhat consultatio.ns with others concet'ni~ clients are legitimate and conducted in
a private and ptofessional manner. This ptecludes co.nverSatioos abOut clients at soda!
gatherings ot k'I public places such as resta...-ants.
Etls...-e that interviews are private and free from inte(tuprio.ns.
Discuss dieots only with supervisors and use only support staff for ptocessi~ necessary
paperwor'k and documentation.
Nevet use client names., k'llials, or identifying data in emails Or' text messages.
E.xceprio.ns to the rules may, and sometimes must be made when thet'e a(e suspicions of
child abuse or negtect when re.::iuited b-f law (such as a subpoena), and wtlen them is a
risk to self Or' others (suicide lhmat or thteat of vidence).
Nevet use soda! media to discuss dieots, even if you change names and identifying
infor"mation.
T he inte.rview it.self should be conducted in priwte, 00( whereothe.r sroff o r clients

m3y overhear. \Vhen greeting a diem in the w3iting room, counsellors should rdrain
from using surnames; however, they need to be sensitive to the fact th.nt many seniors
and people from some cultures are insulted by the casu3l use of their fi rst names.
Sometimes counseJlors meet clients by chance in public places. \\:'hen this h3p,-
pens, counsellors should ensure that they maintain conftdentiality, even when the client
appears unconcc.rned. They should gently shift the conwrsation to 3 neutral topic or
SllfiCSt a private time and place to continue the discussion. At th.nt time, counsellors
can explain why they avoided a public discussion.
Tab le 1. 2 outlines some important conftdemiality guidelines.
VALUES FOR PROFESSIONAL PRACTICE

Talues: 'MaM individuals and g,oups Values arc principles or qualities that individuals 3nd groups consider important or
consider iapcrual or 11uth.tlile. worthwhile. Ethics are de.rived from values. Values represent beliefs about what is desir~
able and good. Personal values describe what individuals consider desirable and what
they believe is riWlt and wrong. Professional values describe fundnmemal beliefs that
the profession holds about people nnd Wtt)'S the worlc of rhc profession ought to be
conducted. Clc3rly, professional values (as reflected in ethical codes of conduct) and
personal wlues have a major impact on shaping the practice of counselling profession.-
als. T,vo key vaJucs of counselling 3re the belief in the dignit)• 3nd worth of people and
the diem's riaht to self.-dete.rmination.
Belief in the Dignity and Worth of People

Belief in the dignity and wonh of people is the core vaJuc of counselling. This value
commits counsellors to ensuring that their clients nrc t:rC1tted with rcgnrd for their rights.
lt obligates counsellors to demonstrate accept3nce of the individuaJ and to uphold
8 Chap1er 1
confidentiality. Counsellors who wJuc the dignity of their clients apprccintc diversity
3nd reject stcrtt>typing, labelling, and other dehum3ni! ing practices.
Counsellors must treat clients fnirl't', regardless of pcrson3l feelings to\\'ard them. For
example, counsellors must resist the nnturaJ temptation to spend more time with clients
they favour nnd less rime with those whom they find difficult. Counscllors arc expected
to npply their skills and lcnm\-·ledge 3t 3n optimum levcl for eadl client, regardless of their
personal rcaction townrd 3n)' client. Clients may hnvc behaved in \\'ays that counsellors pc.r-
ceivc to be offensive, but this belief does not give counscllors licence to be disrespectful or
to withhold services. Discriminatory practices arc srricdy prohibited by both mnjor codes:
■ Counsellors actively work to undc.rstand the diverse c.ulturaJ bnckground of the
clients with whom they work, and do not condone or engage in discrimination
b3sed on 3ge, colour, culture, ethnicity, dis3bility, gender, religion, scxunl oricma,
tion, mnrit3l, or socioeconomic status. (CCPA, 2007, p. 9)
■ Social workers recogni.!c and respect the diversity of C3nadinn society, taking into
nc.c.ount the breadth of differences that exist among individunJs, families, groups
nnd communities. (CAS\X~ 2005, p. 4)
These ethic.al guidelines underscore the need for professionals to le3m 3bout other
cultures. Such le3ming increases sensitivity nnd 3w3rencss of how values, beliefs, and
worldview define one's behaviour 3nd thinking. This topic will be explor~ in more
depth in Chnpter I0.
Counsellors, espcci31l)• tho.sc who \\'Orie with high-risk clients (such 3S those with
chronic nddic.tion problems) nttd to be careful that their view of, 3nd attitudes toward,
clients do not b«omc jnded. Jad~ counsellors often hnvc 3 cynic.al and pessimistic.
perspective on the willingness 3nd otpacity of their clients to c.h3nJ;e 3nd grow. Coun-
sellors who believe thnt clients arc inapablc of grmvth nrc likely to invest less energy in
supporting c.h3nJ;c. Moreover, they m3y be more prone to using controlling responses
because of their expectation that the "clients c3nnot do it on their mvn." \Vh.nt would
you pr~ict to be the likcJ,.•outcome of 3 counselling session when the counsellor labels
the client "3 hopeless nkoholic''! Conversely, belief in the dignit)• and \\'Orth of people
is expressed through positive practices:
■ involving clients in decision making, g<>3l setting, and problem solving

■ ndopting n strengths appro3ch
■ m3intaining an optimistic view of human n3turc, including the belief that people
nrc c3pable of change nnd growth
Client Self-Determination
Self-determination is the principle thnt clients h3vc 3 right to autonomy and freedom self-detennNtion: De pri~
t!l.i'! promffl the rill's ol dients to hM
of choice to make thc.ir own decisions, insofar ns is possible. Counsellors h3ve 3 duty
auton-, and freedom al choice.
to respect nnd promote this right even when they disagree with the decisions of their
clients. Moreover, choice is 3n integraJ part of client self-dcterminnrion. \Xfhen clients
h.nve no choices, or believe th.nt they have none, self-determination is not possible;
however, adherence to the principle docs not pre-.'Cnt counsellors from hcJping clients
understand how their 3ctions might violnte the rights of others. Nor docs it prevent
counsellors from helping clients 3pprccinte the potentiaJ consequences of their actions.
Some clients, such as p«>ple with mental disabilities and young children, mny be unnble
to make competent choices. (f so, counsellors m3y need to prevent them from acting in
ways that nrc potentiaJJ,., harmful to themselves or othc.rs.
Sometimes beginning counsellors 3re misinformed about the n3ture of counselling.
They believe th3t their role is to listen to their clients' problems nnd then offer helpful
Protesslortal lden111y: Ethics, Values, and Self-Awareness 9

control
& Informed Kno~ge&
lnfOl'l'l'lation
coo....
ltWOl~rMnt in
Acuuto
DecisiOn
Resources
Mak»g
Figure 1.1 Essential Elements of Self.Determination
advice or solutions. The principle of sdf~focermination oblig3tes counsellors co avoid

behaviours that control and manipulate clients. lnstead, they must employ strategies
that empo\\'er clients to make independent and informed decisions. The counsellor 's
expertise lies n()( in knowing what is best for the diem, but in being able co manage
the process through which problems arc solved, feelings are managed, o r decisions are
m3de. Empower ment is the process of assisting clients to discover personal strengths
and capacities. In oche.r \\'Ords, through empowerment, counsellors seek to help clients
take control of their lives and rcnli.!e that thq• can improve their situ3tion through their
actions. (&e Figure 1. 1 and Table 1.3.)
Effective counsellors accept chat clients have a r ight to be involved in
counsdling decision making. They have d"K" right to be tre3ted as active pan-ncrs in the coun--
sclling process and to participate in decisions affecting their lives. This right is underscored
in the CCPA's Code of &hics(2007}.
C lients' Ritch.ts and l nfor-m~ Con:l:ent. When counsetlu)¥ is initiated, and throu~,.
out the oounsellin¥ pro«>ss as necess:arr, counsellorS inform clients o( the purposes.
¥°"ls. tttbntques. pro«dures. limit3tions. potential risks and btneflts of SeF\+keS t'O be
performed, and other s ueh pertinent in(onnation. CounselLorS m.:tl:e sure that clients
underStand the imphc::uions of di3¥00SiS, (~s and fee. collection arf30$:ements,. record
TABLE 1.3 Strategy Choices for Promoting Cl ient Self-Determination

Use advOCaey skills to help clients access reSOU""ces Or' remove ba(rie<s to existi~ options.
Avoid pfe-scriptive advice and other contr·oiI.-ig responses.
Help clients identify, access. and explOr'e options.
Encou(age clients to make thei( own decisions based on infOfmed chOices of the costs and
benefits ot any cou(se of actbn.
Assist clients in evaluati~ the conseciuences ot thei( actions on others.
Fuly infOfm clients abOut counsel.ling Sltategjes and 100 JX)tential (ISkS. P(omOle
couatx>rative deeision making on goats. Whooeve( possible, pfovide acooss to (ecorcts..
Invite clients to evaluate the progess of counsem~ and the counse!Mog (elatiooship.
When unde< eowt Or'de< or simila, nonvoluntary conditions, provide information on the
client's right to decline semce, as well as 100 JX)SSible conseciuences ot such denial
Whenevef JX)SSible, em(X)wet d ients with chOices.
Adopt a minctset 1r.a1 (ecogni?es the client as the ·ex.pe<r on his or her own problems.
feelings. and ptefet(ed solutions.
Avoid dependency-promoting behaviours, such as dOing fOr' d ients Vtt'lat they can do fo(
themselves, e.xcessive involvement, and indisc(iminate advice givi~.
Encou,age optimism and fostet a relationship of safety to help clients lake (is.ks.
Honou( client lifestyle chcices.
10 Chap1er 1
" ~ • CONVERSATION 1.1
STUDENT: I have just started my field placement, and I am Quit.· Such Mg.allows humou'. is one of the ways many ~
disturbed by wtlat is happe-ni~. When the team goes for pie deal with 100 e-nOfmous sttess of their jobS. Jokes abOut
coffee, ever)()(le jOkeS and makes fun of the clients. If they tr~ ENents 0t client misfortunes help counsellors sustain
koow how their counseuors talked about them, they would tnell emotional wet-being. It ooes n01 mean that they have
never come back. I did 001 know lhat professionalS could be beeorne hardened°' uncari~ towatd lheit clients; mthet ii is
so Cdd-hearted. ts tnell behaviout unethic:ar? a W:¥f of unwiOOingand relievi~ consrant pressu-e. As you\.e
discovered. one of the dangers of gallows humour is lhat oth-
TEACHER, Just before t,;sexecutial by haogj~. a c:oodetMed ers wdl over-hear ii and draw conclusions abOut the person's
man is offered a cigatette. MNo thanks,.· hes.a~ M1•m trying to attituOOS. ts it uoothi:.al? What dO you think.?
keepifl$:. 21nd limit'S o( ronf"tdentiality. Chenu h::n,e the ri$:ht t'O pc:uuc:ipote in the on~-o-
in~ counsellin& phms. re(use 2111)' reeommended servke!l. 3nd to be 3dvi.sed o( the
t'O
consequence!? o( soch refuS3.L (pp. 7~)
Rights of Children
As a rule, "cnpable" children arc entitled to confidentiaJity unless there is n reason
to suspect that the child might harm himself or herself or others. As wcll, situations
involving child abuse or neglect must be reported. In this respect, a child can rccejvc
medical treatment or consultation on is.sues such as binh control/abortion, mental
health problems, and addictions counselling Ousticc Education Society, 2015).
In 1991, Cannda signed the United Nations Oeclnration of the Rights of the Child,
which oblig3tes it to enforce children's rights as outlined in the Declaration. Neverthe-
less., United Nations officials hnvc criticized the country for its failure to adequately
address the needs of Aboriginal.disabled, and immigramchildren asweJI as those living
in poverty (ScoffieJd, 2008).
ETHICAL DILEMMAS
An ethical dilemma exists when a choice must be mndc between competing wJucs and ethical dilemma: Asiluati>n invdving
potcntl31 courses of action. A decision to remove a child from a home where there is a,mpeting « ccaHictilc values or
prilciples.
ob-.•ious nnd significant abuse is 00( an ethical dilemmn since the gravity of the situation
gives no room for choice. On the other hand, removing a child when the home situa,
tion is marginal requires weighing the risks of potential abuse against the drawbacks of
separating a child from his parents.
By virtue of their role, counsellors may have simultaneous obligations to different
people and groups., including the agency that employs them, their clients, the com-
munity at large, and the lcg3J system. When oblig3tions conflict, an ethical dilemma is
created with risks and benefits to ench potential solution.
)}t) BRAIN BYTE

functional magnetic f&S003r')C8 imagk'lg <fMRO has enabled study re(X)fted by Riddle (2013) in ScientifJC: American con-
researchers to identify afeas of the brain that are active when cluded lhat "out pfofessed mOr'al principleS can be shifted
pooJje addmss m0tal and ethical dilemmas. The msu1ts by subtle differences in mOOd and how a question is JX)Sed.•
sho.-.ed that amas of the brain associated with etnations tend These findings underscOr'e the value of counsellors consulting
to predOminate. particulatly when the-re is a more perSOoal with others and avoiding iinplJSive actions when confronted
involvement in 100 dtk>mtna (Science Dail'j, 2001). Aoothef with diffreult ethical decisions.

While ethical codes that are based on the vnJucs of the profession attempt to define
acceptable behaviour, they usually do not offor answers about specific situations that
arise for counselling profossionnls. Even though they do 00( provide precise guidelines
for resolving aJI dilemma~ codes arc an important reference aid for decision making.
Types of Ethical Dilemmas

I . Distribution of scarce resources (rime, money, and opportunity to participate
in a pros:ram)
■ An agency has limited funds available to assist clients with retraining. \Vho
should get the money- the client with the greatest potential for success or the
diem who needs it most?
2. Professional competence and e thical bcha,four of colleas:ues
■ A student on internship (fidd placement) becomes a"'"Urc that her supervisor is
attending an AA meeting with one of he.r clients.
■ One of the staff informs you of his intemion to phone in side to extend his
vacation a few more da)'S.
3. Policies and procedures of the as:cncy setting that appear oppr~sh'e or inscnsith<e
to the cultural/dh·ersity needs of the clients it ser,-es
■ A worker has information about a client that, if made known to the ai;cncy,
would make her ineligible for services that she badly needs.
■ You become aware that your client, a single mothe.r on wdfare srrus.,tling to care
for her four children on a meagre budg,et, received a cheque from her mothe.r to
hclp with expenses. Legally, she is obligated to declare this income, which will
be fully deducted from her next welfare P3yment, thus, depriving her and he.r
children of much•nccded assistance.
4 . Behaviour of clients
■ A 17-year-old girl asks for your help to obtain an abortion without involving
her pnrcnts.
■ Your client informs you that he has tested positive for HIV, but he hasn't
informed his parcne.r.
■ A 16-year-old boy tc11s you that he is working as a p~titute.
■ Your client casually mentions that he robbed a bank several months ago but was
not caught.
5. Competing values, needs, procedures, or leRal requirements
■ A IS..)'C3r-0ld girl discloses that her father has been abusive, but in recent wedcs, he
seems to have changed. She asks that you do not make a report to the authorities.
She says she knows her father will retaliate if he finds out that she has told anyone.
■ A young J6.ycar-old Jehovah's \Virncss as.sens her belief that she should not be
given a blood transfusion to deal with a terminaJ illness.
■ An abused child S3YS he will 00( cooperate with removal from his parents and
that he will run away from any foster home.
Resolving Ethical Dilemmas

Erford (2010) describes five ethic.al rules or principles that can be used to help resolve
ethicaJ dilemmas:
I. Amonomy: Honour clients' self-determination and the.ir frttdom to make their own
decisions.
2. Beneficence: Pursue the welfare and benefit of others.
3. Nonmalef,cf!'nu: In simple term~ do no harm to others.
12 Chap1er 1
4. )1urice: Strive for an equal distribution of resources and equitable effort among
p3rticipants.
5. Fideliry: Be loyal 3nd honest and keep promises.
Under idea] conditions, counsellors c3n honour all five principles, but ethic3l dile.m-
mas by nature represent competing principle~ 3nd C3ch choice involves unique conse-
quences. Ethic31 decision making involves identifying 3nd we.ighing which of the five
principles ought to take priority in any given situ3tion.
The application of any modcJ for ethical decision making docs not mC3n that reso-
lution of ethical dilemm3s will be easy. When values and ethics compete, deciding which
one should h3\'C priority c3n be painfully diff1euk Consider 3 case where an individu3l
in remission from cance.r stipulates th3t if his cancer rerurns he docs not want further
surge.ry or other invasive tre3tment. Suppose yc3.rs later, he devcJops dementia and
his cancer returns. He now asserts that he wants trc3nncnt. \\:fhich "pc.rson 's" wishes
should a c3regivcr honour, the one with sound mind from the past or the current one
with diminished capacity! (Adapt~ from Locke, 2014.)
lntimate knowledge of cthic3J principles and legal guidelines can make the decision.-
making process dearer, albe.it no less difficult. For example, 3 client's right mconfidenti-
3fity 3nd self-determin3tion must be given up when that client discloses child abuse, 3nd
the duty to warn principle means that profcssion3fs must brc3k conftdentiality to warn
potential \•ictim.s. However, it is not a1wa\'S dear when a client's bch3viour constitutes
dange.r to the safety of others.
The principle of sdf-determin3tion protects the right of people to make errors and
c3rry out 3ctions that others might consider wrong. Counsellors must consider when
the applic3tion of this principle must be abandoned because the individu3f 's behaviour
might result in death, such 3s in a case where 3 client threatens suicide. \\:lhile counsel-
lors have a clear legal and ethical responsibility to inte.rvcnc to prevent suicide, their
responsibilities arc not as dear for other ch3llen,;cs. For example, the lifestyles of home-
less persons m3y reach the point where their h\'gicne, living, and C3ting h3bits become
dangc.rous for them. The point 3t which their right to self..dete.rmin3tion should )tield
to their right to health and well-being is not easy to establish. An ethic3J dilemma exists.
There 3re four steps counsellors c3n take to resolve ethical dilemmas(scc Figure 1.2).
Step 1: Gather Fads During this stage, it is important to controJ 3ny tendency
to act impulsively. Remembe.r that assumptions 3nd hears3y 3re not the s3mc 3S facts.
Most ethic3J codes require that profcssion3ls s«k resolution with colleagues before
procttding. For e.x3mplc, the CCPA code advises a counsellor who has concerns 3bout
the ethical beh3viour of another counsellor "to s«k an informal resolution with the
counsellor, when fe3sible 3nd appropriate" (2007, p. 6). In many case~ frank discussion
with colleagues revc3fs additional information or results in a S3tisfactory solution.
Step 2: Identify Ethical Issues and Potential Violations At this point, r<fer
to the appropriate code of ethics (CASW, CCPA, etc.) to identify whether the mat-
ter unde.r question is addressed in the code. If the person in question is not govc.rn~
by 3 professional code, then 3gency policies and procedures or local legislation m3y
))t) BRAIN BYTE [ lI , ,, I 1 .• · JI, , · · I ,_
Curr'ent and emerging oour'oimagi~ techniques raise 100 already being used. This raises rn'lportant ethical Questions:
possibility that one day lhese lOOIS could be used to (83d to what ex.tant migt\t neuroscience be used in le-gal settings to
minds. perhaps to deternine if a per-son is tying 0r harbOur'· determine guilt 0t whether 0r not a person ShOulcl be gr'anted
ing prejudicial views. In fact, rudimeniary toolS to do lhis are paroo CSmm,. 201311

l.Galher
FaclS
...
2 . Identify
Ethical Issues
Pocential
V.outions
3. Identify
and Evaluate
Options and
Strategjes
Figure 12 Model for Resolving Ethical Dilemmas
provide important reference points. For example, m3tte.rs of discrimination in Canada

are 3ddressed under the Canadian Human Righu Acr (1985).
Step 3: Identify and Evaluate Options and Strategies Here the goal is to list the
potential action strategies. \Vhere appropriate, consulting with colleague~ professional
ori:ani.z3tions, 3nd supervisors c3n assist in generating altern3tives.
Reflective questions help you consider the merits and ramifte3tions of any action
pl3n. He.re are some S3mple questions:
■ What 3re the 3dvant3ges and dis3dvant3ges of not taking action?

■ What 3re the 3dvant3ges and dis3dvant3ges of taking 3ction?
■ What are the potenti31 consequences (short-term and long-term) of 3ction or
inaction!
■ Who might gain or lose?
■ What other individuals or org:.mi:rations 3re likely to be affected?
■ To what extent might other factors be influencing my judgment (e.g., unresolved
relationship problem~ bias, and hidden agendas)?
■ Wh3t values 3nd principles have priority? Boyle and colle:igues (2006) suggest 3 rank
order of echicaJ principles (s« Figure 1.3). They identify seven ethicaJ principles,
Figure 1..3 Ethical Princip les Hierarchy

Adapt@d r,om so-,,1e e1 at. 2006. p. 97.
14 Chap1er 1
-- - Ceetr,.._
-
..,_
-
..,_
No
Figure 1.4 Matrix Oecision•Making Chart for Ethical Dilemmas
giving the highest priority to protection of life, which su~rsedcs 3JI of the other
rights. The equality nnd inequality principle entitles people to be treated equaJly,
and this right supersedes an individual's right to autonomy and freedom. The least
harm principle aims to minimi:c the advc.rsc consequences of any course of action.
The quaJity of life principle SUjlRCSts that counsellors should choose aJtc.rnativcs
that enhance quality of life over those that diminish it. Privacy and confidc:ntin1it)•,
while important, arc given lesser priority than those rights higher on the hierarchy.
Similarly, truthfulness and full disclosure arc important ethical principles, but they
may be compromised if overridden by other, higher-mt~ principles.
A matrix chart, such as that illustrated in Figure 1.4, can be used as a tool to compile
and compare the bcndits and risks of the a1tc.rnatives. A ~parate anaJ,.•sis should be
done for each choice. Entries should consider both the short.- and long-term costs and
benefits of a given cour~ of action. Consult with experts and others when completing
this task.
Step 4: Take Action A ~ action plan should include details of the intended out-
come. a list of the people who neo:I to be involved, required resources (e.g., information,
mttt:ing space, and cxte.rnal facilitator), and the JittlUCnce of events that must be accom-
plished. A concrete timetable with dearly defined steps ensures that you will not lose time
wondering what to do next. The action plan should also anticipate obstacles and identify
strategies for addressing them. For example, if )'OU are confronting a colleague on a breach
of ethical behaviour, it would be wise to consider what you might do if the colleague
■ launches a counteranac.k.
■ reacts with feelings such as anger, remorse, or shame.
■ denies that the behaviour occurred.
■ asks that you keep your lcnO'l.\rledge of the breach confidential between the two of you.
SUCCESS TIP
Resolution of ethical dilemmas is lntellectualy challenging and emotionaly &axing,. Seek
appcopri".ate consultation and supervision for ~noing and debriefing.
Objectivity
Effective counseJlors ma)' become intimardy familiar with the lives of their diem~ )'et objectivity: ne ability to understad
ree.p, thoclpas. and bdt.lriour without
they arc required to remain objective. O bjectivity is defined as the capacity to under- al~ penonal values, belit.ls. •d
stand situations and people without bias or distortion. \Vhcn counsellors are objective, bias.es to interfere.
Protesslonal Identity: Ethic s, Values, and Self-Awareness 15

they understand their clients' fccJings. thoughts, and behaviours without aJlowing their
pc.rsonal values, belief~ and biases to contaminate that understanding. They aJso do not
directly or subtly cry to impose their prefcrr~ solutions on clients.
CounseJlors can fail to be objective in a number of ways. The first is to make
assumptions: Oistottions oc lalst c:ica- assumptions. Assumptions arc distortions or false conclusions based on simplistic rc3,.
dusicm bas!d on siapliv.ic teasoning. soning, incomplete information, or bias. Counsellors who have had similar experiences
ilcomp~e inforaution. • bias. to their clients' may assume that the.ir clients' problems and fttlings arc the same as their
own. Conscquendy, they don()( take the time to investigate the distinctive viewpoints of
their clients. Counsellors aJso may make assumptions about the meaning of words, but
this danger cnn be avoided if counscJlors remain alert to the need to probe for individuaJ
client definition and meaning, as in the following example:
Client (spe:a.kina tet a Fir;;t N3detns <:eturuellor): I moved here :.bout (h~ )'l":arS ~o.
I Kuess you know how t'O~ it is (m- an Indian in this dty.
CetunseUor (Choke I): I sure do. PreJudiee i.!l e\'e:r)•where.
CetunseUor (Choke?): As you say. it is not e:3Sy. But it's di((erent for e\'eryone. I need
your help to understand better what it' s be<en like (or )Ou.
CONVERSATION 1.2
ST\JDENT: I know vd'lat I'm supposed to do, but I'm wOfrted thing?'" S0tnetime-s suctl cases bri~ up untesolved issues
abOut hO'N Ican conttol my personal feelings vd'len I'm intet- from our O'Nf'I past that need to be te-e-.Karnined 01' p t ~
viewing SOO"MlOOO who haS done sornethi~ te(tible. sud'I as flXthe-r. Sometime-s we simpty need toacknowtedg,e that the-re
tape a ctltk:1 ot beat up his wife. How do you Slay objective in are certain practice a(e.as tr.at are not the be-sl fit• foe us
8
situations •ke those? individually as ptaCbtioners. The value of supervision in suctl

clfcumstances rS Clea(.
SUPERVISOR: Tel me a bit about what you think you a(e sup.
posed todo. STUDENT: Do I have to like my clients W'I orde( to wOr'k wilh
ST\JDENT: 1need to make SU(e that I am obj,e,ctive and that I them?
do not let my personal feelings interle-re. COUNSEllOR: The-re will always be clients who rub us the
wrong way. Some a(e demanding. insuting, Or' threatening.
SUPERVISOR: Sure, that is the ovetaU goal. Ho-.veve-r, au of
and it's a challe-nge to fe-e-1 any (e-al empathy. If that's part
us wdl have some pel"S0031 feelings about \\tlat die-nts have
of the c~nt's usual style (and it oft.en is), then this pt'O\lide-s
done. Your fears a(e very normal fOr' someone just saarti~ in
impor&ant information that can be addtessed in counse-tliog.
the field. usuatty, with a bit of expe(aence, most people a(e
If a client Mpushe-s our buttons_· some-time-s a lltue introspec-
able to manage their footings.
tion is in Ol'de(. Do OU( (e-actions ttlgge( memorie-s of Othe-r
ST\JDENT: What if the client's behaviou( iovotve-s 1r.iogs that unresdved issues 01' experiences in our lives?
do not allow me to get past my initial (eYulsion?
STUDENT: Transfe-rence?
SUPERVISOR: If that happened to me. I would have to ask
COUNSULOR: Yes, it sure could be. We atsoneed to deal wilh
myse-if, ·can I be sufficiently in conttol of my own feeli~
a range of olhet fee-tings that can a(.se such as feellngs of
to wOl'k effectivety with this person?'" In some case-s, I can
overp(otectivene-ss toward a client. Ct, when we have strong
compensate fOI' a bias, and in Olhet cases, 1ptObably should
positive fee-tings. These tesponses may need to be managed
nol be iOVOl\l&d in the the-rapeutic (elationship. However, I am
just as much as. \\tle-n we wol'k with clients. \\tlo aro~ our
no1 sure tr.at anyone is at,e tosaay truly objective in situations
disgust, a•(· 01' frusuation.
whete they are iovotved with someooo who has pe(petrated
a violent c,irne or hatmed a young chlld. The big questions STUDENT: from what you've been saying, in au cases, the
fOI' me are, "How do I maintain an awareness and openne-ss goal is the same. Be aware of out personal teactions, 100n
abOut my personal feeli~r and "HON dO I mitigate those manage the-m. If this isn'I possible, (,efe, the Client Ol se-ek
footings W'he-n deali~ with a pe(S()O \\tlo has done such a s.upel"Vision and support f0t youn;e-lf.
16 Chap1er 1
(n this examp le, C hoice I cuts o ff th e discussion, and the counseJlor loses a vnJuable
o pponunit)' to ap preciate the client's exper ie nce. Choice 2, on the o ther hand, o ffers
gen tle e mpathy and then p robes for m ore detail. This second response reduces the risk
that the cou nscllo r will make e.rrors o f assumption.
A second way chat cou nscllo rs can lose objectiv ity is by over -ide ntify ing with cli-
en ts. Whe n ove.r-ide ncification occurs, counsellors lose their capacity to keep sufficie nt
emotio nal d istance fro m th eir clients. Their o"'n feelings a nd reactions become mixed
up with those of their clients, cloud ing che.ir jud gment. C ounsellors who fin d th em-
selves in this position ma)' find chat persona] cou nsclling or consultation with a su per•
visor is sufficient to help the m regain objectivity, or they may condude th at referral to
another co unsellor is necessary.
A third Wtt)' chat counsellors can lose objectivity is by becoming ove.rly involved
with clients. This over-involvem ent includes duaJ relationships prohibited by ethical
codes, as wdl as relationships in which cou nscllo rs rdy on clients to meet their social
and psychological needs. To prevent chis from happening, cou nsello rs n eo:I to make sure
that th ey are meeting the.ir personal needs in other W'n)' S. As weJI, co u nsellors should be
alert to signs th at they ma y be ove r-involved with particular clients.
SUCCESS TIP
Waming signs of O\let◄nvotvement: Interviews that consistently run O\let lime, tefief when a
client misses an appointment, excessive worry abOut clients, teluc&ance 10 end a counsel-
ling tetationship that haS reached a point of tennination, M~ttons• being pushed, 0t strong
feelings (negative 0t positive) toNard the client evOk.ed.
Tab le 1.4 summ ari!es p rotective strategies counseJlo rs ca n u se co avoid loss of

objectivity.
TABLE 1.4 Mai ntaining Objectivity

Loss of Objectivity Pto1ective Stratery Choices
Making assump(ions • Attempt to understand and monit0r you- prejudices. preferences.,
and biases (e.g., cullural, gender, and teli~us).
• Develop setf-awareooss regarding personal needS and values.
• Listen to but do not be contrOlled by the opinions of otherS.
• Be k'lquisilive. Uptore ead'I client's situation to discover his 0t
het unique perspective.
• 8tainstOl'm 0t seek infotmation frOO'l all perspectives.
• Check your conclusions with clients 10 see if they match lheil's-
seek definition. detail, and examples.
Over-identification • Monit0r reactions and discover areas of vufnietability; be alert to
strong negative Or positive reactions 10 clients.
• Refer d ients vd'len you are not impartial ot able to conttol )'OIX
leeti~
• Know why you want to be a eounsettor- underStand your needs.
• use COiieagues to analyie your reactions and give you feedbaek.
• use toots sud'I as video rec0tdi~ to review interviews lot
inappropriate attemprs to influence or contror.
• Avdd promoting d ient dependency.
• Develop a wellness program to ensure that you are not rel'jing
on youf clients to meet )'OIX needs f0r social and psychOlogical
i.nvolvement and acceptance.
• Recognize wani ng signs of over◄nVOlvement.
Prot esslortal Identity: Ethic s, Values, a nd Self-Awareness 17

CONVERSATION 1.3
ST\JOENT: ts it ever- Okay to be sexualty intimate with clients? b1Xden to ensure that no such explodati\'e influence has
occu«ed" (2007, p. 9). A review of the liter-ature concludes
TEACHER: No! Uni"8(S31Iy, ethical Coeles ot behaviou( PfO• that harm to clients does occur when p(ofessiooalS have
hibil sexual intimacies 'Mth clients. for example, 100 CASN's sexual contact wtlh clients.,. including "denial, guilt Shame,
Guide/it)es for £Jflical Ptactic.e (2005) succinctly states that
isolation, a•(· deptession, impaired ability to trust, loss of
•social WOr'k.ers dO not engage in romantic relations.lips. sex- self-esteem, difficulty ex.ptessing anger, emotional liabtlily,
ual activities 0t sexual contact with clients. even if such con- psycMsomalic disorders, sexual confusion, and increased
1ac1 is sougt\t by dients· (p. 12). A similar iniunction ex,:ilic:itty risk of suk:;oo· (Beckman et al., 2000, p. 223).
stated i"I the CCPA's Code of Ethics (2007) prOhibits any type
of sexual relationship with clients aoo any counsem.ng rela- STUDENT: What about Other- types of involvement? If you are
tionship with clients with whOm they ha\18 had prior sexual a counse!IOr' in a s.mal to-M'I, it's impossible to avoid social
relationstips. contact wtth clients.. Your client migf\t be the owner ot the onl'j
grocery store in town.
STUDENT: That seems str-aightiorward. What about beCOming
involved with f0tme-r clients? TUCH£R: COdes of ethics fo( the various counselling pro-
fessions (e.g., psycholOgy or social wo,k) frown upon dual
TUCH£R: That's a mOl'e diffieult question. My opinion is that relationships when there is a possibility that counsenors wil
you never Should. but you ShOuld consult indi\lidual cOdes of lose obfe(::tMty or where there is potential fOr' client exploita-
ethics fOr' specific guidelines.. For example, 100 CCPA code tion. In large cities, it's usualty easy to refer clients to avoid the
reciutes a minimum of 1r.ree years between the end of the conflict of i"lteresl of dual relationships.. As you point out it's
counselling relationShip and the begjnn.-ig of a sexual rela- much more difficult in a small town, and some dual relatiol\-
tionship. The petiod is ex.1e-nded indefinitely if 100 client is Shiparra~ments may be inevitable. Howe\18r, relationships
cl8ar1y vlJnerable. In any case, counseUOrs Mcl8ar1y bear the Should oover include sexual intimacy wtth cu«ent clients.
THE COMPETENT COUNSELLOR

A high level of sc]f.3wareness enables counsellors to make important decisions regarding
arc3s in which they arc competent 3nd those in which reforraJ to other professionaJs is
warranted. Counsellors must practise only within the range of their competence, and
they should not misrepresent their training o r c:xpc.ricncc. This helps to ensure that
they do no harm to clients. T he following guidcJines provide reference for working
with competence:
I. \Vork within rhe limiu of competence. Counsellors should offer counselling services
that arc within the limits of thc.ir professional competence, as measured by edu.-
cation and professional standards. Competent counsellors use only chose cc-ch.-
niquc-s and strategies that they have been adequately trained to appl)•. They know
that the support and assistance- of other professionals is necessary for issu es that
exceed their expertise. Until counsellors have received the necessary training and
supervised practice, they should not work in specialized arC3s of practice, such
as interviewing children in abuse situations o r administering or interpreting pS)•,.
chological tests. For example, re3ding a boolc or attending a ,vo rkshop on mcmal
health does not qualify untrained counsellors to make psychiatric diagnoses, nor
would attendance at a short seminar on hypnosis qualify them to use hypnosis in
their work. Such speci3Ji!ed interventions usually require certification b)• their
professional body.
CounscJling requires skilled interviewing but includes the additional goal of
helping clients with such activities as problem solving, dealing with p3inful fee],.
ings., and de-vcJoping new skills. Psychotherapy involves intensive counselling with
emphasis on persona1it)• change o r the treatment of more severe mental disorders.
18 Chap1er 1
2. Pursm~ professional rraining and detelopment. CounseJlors should monitor their w-ork
and scclc supervision, training, or consultation to evaluate their effectiveness. They
should pursue continued profession:.d development to increase the.ir competence
and kttp their knowledge current. This helps to ensure that their work is based on
evidence-based best practice derived from accepted theory supported b)• empirical
research. People would not want to Stt a doctor whose most r«ent training was
decades ago in medical school. Similarly, clients should not be expected to work
with counsellors who are not current in their ficld.
Professional counsellors need a core lcnowledi;c base, which typicall)• requires
nvo or more years of academic training:, including supervised clinical o:pcrie.ncc in a
recognized counselling or social service serting. Moreover, throughout their career~
counsellors should expect to spend time in reading books and journals to increase
their knowledge. As well, regular attendance at courses, seminar~ and conferences
should be a part of everyone's professional career.
By keeping the.ir knowledge base current, counsellors arc better able to be
empathic because they arc more aware of the issues and feelings that their clients
face. Moreover, keeping up to date helps counsellors avoid judgmental responses
based on only their O\\•n frames of reference. The range of knowledge that counsel-
lors need to pursue includes the following:
■ Specific is.sues, problems, and c.halleni;cs that the.ir clients arc facing. For exam-
ple, counseJlors ,vorking: in corrections need to know something about finding a
job if one has a criminal r«ord and coping with the stigma of a criminal record.
As another o:amplc, many clients arc dealing: with poverty, and counsellors nttd
to be aware of its social and psychological effects.
■ Relevant medical and psychiarric conditions (e.g., attention deficit disorder, multiple
sclerosis, schi:ophrcnia, bipolar disorder, and autism). Counsellors credibility and
competence is greatly enhanced if their lcnO\\•ledge of these conditions is current.
■ Lifcst)•le wriations(c.g.., same-sex relationships, single P3rents, extended families,
and blended families).
■ Cultural awareness about the values, belief~ and customs of others.
■ Lifespan development (i.e., developmental chani;cs and milestones from birth to
death). Life experience can greatly increase a counsellor's capacity for empathy
and understanding. Of course, life experience may also cloud judgment and
objectivity, so it is important that counsellors scclc training and consultation to
increase their understanding of others' experiences.
■ Monitoring: emerging trends in neuroscience.
3. Be self-au,areof personal reactions and 1mresolt\!d issues. CounseJlors need to be aw-nrc
of situations where their clients' problems parallel unresolved issues in the.ir O\\•n
lives. This awareness is important to help counsellors lcnow when to scclc consul-
tation or supervision, when to refer clients to other ,vorkers, and when to enter
counselling to address their own needs. Clients have a right to expect that their
counsellors are objective about the is.sues being discussed and that their judgment is
not imP3ired by bias. unresolved personal problems, or ph)•sical illness. If counsel-
lors have emotional or physical problems that affect the.ir ability to give competent
se.rviccs., thq• should discontinue se.rvicc to the client.
In addition, large caseloads and the emotional demands of counselling: worlc may
result in emotional and ph)•sical fatigue, the.reby weakening: a counsellor's competence.
Competent counsellors monitor their emotional health: by setting limits on their
amount of worlc, they arc able to leave time to pursue personal wellness and balance
in their lives. Familiar with the dangers of burnout and vicarious trauma, they de,.•c-lop
strategics to prevent these career threatening reactions.

CONVERSATION 1.4
ST\JOENT: I'm just a begj.nnet. So, if I am supposed to work modelli~ for clients. One goal of ttaini~ is fOr' you to ~ d
withrl the limits of my competence, I ShOt.ldn't do anything. your r'af'@e ot d'IOices so lhat you can respond based on the
needS ot your clients and thes situations. Remember', leami~ to
TUCH£R: Like many counseltors whO a(e just starting. you
be an effeclMl c:ounseno, Isa lilOIOngproooss. At this Sfall!!. you,
may feel a bit overwhelmed.
professional responsibility is to make effectf\18 use d supervisors
ST\JOENT: I cSon't want to say or do the wro~ thi~. What if to monitor' )(IU' \\O'k. use them to oovelOp you Skits. Make it
I doni know the right answers. Or' I oon·1 say the right thing easy f0t them 10 flve you feedback. Seek 1t out. an:S then try 10
to clients? be noroefensM>. l.OOk fat oppcrl\Jntties 10 •Pl'IY you, deYelopir'e
k ~ base b'f &aki~ some risks 10 k>am re1t Skins.
TEACHER: flrst lhe(e is rarety a single rigt\t way to respond. wren I first srarted k'I the flel:j_ I aaso feared sayk'lg some-
Most often, them is a range of d'IOices ot thires to say Or' oo in
thing that would damage my client When I shated this feeling
any situation. Second, no one kroNS all lhe rigl\t answers. Be
with one ot my prolessors. he put 1t in perspective by saying.
hOoost with diants abOut the fact that you are stll a Sh.dent and
"What makeS you think you're so important to the d ient?·
oon1 be afraid to adnil )(II.I' limitations, as this i:,ovi:Ses we.at
In general, interviewing is 3 process of gathering inform3tion without any expec-

tation of influencing or changing clients. Competent interviewing rttauir-cs an 3bility
to explore 3nd understand clients' attitudes, fttlings, nnd perspectives. The basis for
this competence is 3 nonjudgmental attitude 3nd intelligent application of the 3ctivc
listen in a: sic ills of attending. using silence, paraphrasing, summ3rizing, and asking ques..-
tions (sec Ch3ptc.rs 4 to 6). Although the principal goal of interviewing is information
gathering, the process of interviewing ma)' IC3d clients to rcJcasc P3inful or forgotten
fttlings. Thus, adept interviewers 3re capable of dealing with unpredictable re3ctions
th:.n the interview elicits or of referring clients to 3pproprinte altern3tivc resources.
Moreover. they know when and how to probe effective!)•.
SELF-AWARENESS
Everything rhat irritares us a.bow others can lead us to an under.ttanding
of ourselt.1es.
--Ca,f )uns (publ lcdoma en)
The Importance of Self-Awareness

Compctent counscJlors need to acquire a high level of 3Wareness of who they arc. Until
counsellors develop self-awareness of their own needs, fccJings. thoughts, 3nd behav-
iours, including their personaJ problems and their 3reas of vulnerability, they will be
unable to respond to their clients with objectivity. T3ble 1.5 contrasts the characteristics
of counsellors who h3ve high levels of self-awareness with those who have low Jc,.'Cls
of self-awareness.
CounscJlors who lack self-aw-arcness and 3re not motivat~ to pursue it arc destined
to rem3in un3ware of the ways they influence clients. For c.x3mple, they may be un3ware
of how their nonvcrbaJ reactions to controversial topics betra)' their biases 3nd dis-
comfort. Capuzzi 3nd Gross (2009) highlight the importance of counsellors developing
awareness of thc.ir own spiritu3I and religious beliefs to 3ppropriatcly engage with their
clients' spiritual issues: "Counsellors m3y not pick up on their clients' concerns because
of their own bi3s or may piclc up on these themes too rc1ldily to the exclusion of other
issues" (p. 304). They m3y avoid pnrricul3r topics, or they may behave in cenain wa)'S to
m3slc their in~uritie.s. As another o:3mple, counsc-llors with personal needs for control
m3y meet this need through excessive and inappropriate advice giving.
20 Chap1er 1
TABLE 1.5 Self-Awareness
counsellors with Setf-Awarei,e:ss CounsellOrs without Selt-Awarenes.s
• Recog.-.ze and underslancl their emotional (eactioos. • Avoid ot ate unaware of theit feeli~.
• Accept tr.at everyone's experience is different • Assume clients wi• resJX)nd ot f/MII the same as lhem
• Know where tneil' foof~ end and those ot theit clients begin. • Project pe-rsonal feelings onto d ients.
• Recog.-.ze and accepa a(eas ot vulnerability and un(&SOl\ied • R&SJX>nd inappropriately because unresolved prot,ems
issues. inte-rfete with theit capacity to be ot:;ective.
• Unde<staOCI pe-rsonal vah.Jes and their inftue~ on the • React emotionally to tnelr clients but don't uOClerStand
counselling telationst-.p. why or how.
• Recog.-.ze and manage internal diatogue. • uncoosciousty use cliMts to WOr'k out looir o,m personal
difficulties.
• Unde<staOCI and conttOI personal defence mechanisms. • Remain blind to defensive reactions.
• Know hOw they influence clients and counselling outcomes. • Remain una-Nar"e ot how their behaviour inft~oces Olhers.
• MOClify beha'Jiout baSed on teactioos of clients.. • Behave based oo personal needs and styte rather tr.an in
response to the needS and feacl:.ions of clients.
• Set prolessional goats based oo knowledge ot perSOoal and • Avoid Of limit goal setting beeause they are unaware of
skill SlrMgthS and limitati:)ns. personal and protessi::>nal needs.
• Accutatety identify and apptaise counselling skill competence. • Overestimate Or' underestimate eounseni~ Slul
competence.
• Know those areas that are llk.ely to lrigger unhelpflA feelings • Are reactive without i.nsigt\t.
0t responses.
Increasing Self-Awareness
Counsellors who 3rc serious about dcvcJoping their self.awareness are secure enough
to rislc exploring their strengths and limitations. Self.awareness means becoming
3Jcrt and lcnowlcdgcable 3bout personal W3)'S of thinking. acting, and feeling.
ScJf.3w3re counscJlors arc strong enough to be open to discovering 3spccts of
themselves that they might prefer to keep hidden. This is 3 continuing, c3reer•long
process that requires courage as counsellors loolc at thcmscJves and their ability to
relate to others.
Colleague~ supervisor~ and clients can be extreme!)• hcJpful sources of informa,
tion, but their feedback needs to be cultivated. Generally, people 3re reluctant to deliver
critic31 feedback, hO\\•e-vcr hcJpful it ma,., be. Therefore, it is important that counscJ.-
lors create the conditions th3t encourage feedback. They can invite input from others
through a number of srrntegics.
The first strategy is to create a safe climate. People balk at giving feedback to other~
because they fear how it will be rccejvcd. One concern is the rislc of retaliation: "If 1 SU)'
something, will I be annckcd or m3dc to foci guilty?" Another common worry is th3t
feedback will damage the relationship. The major conce.rn also might be that feedback
will cripple the other person's sclf•cstecm.
Therefore, counsellors must demonstrate th3l they arc read)•, willing, and able to
respond nondefcnsivcly to focdbaclc. They have a responsibility to consider feedback
3nd, when 3ppropriate, to nct on it. They don't h3VC to 3grcc unconditionally with what
has been s3id to them, but they must listen 3nd give nonaggrcs.sive responses-in other
words, without blame or excuses. Sometimes such control can be difficult to sustain,
pnrticula.rly if feedback is delivered in an uncaring 3nd hostile m3nne.r. A gencrnJ rule
when denJing with clients is that, no m3ttcr what clients say or do, counsellors must
maintain a professional role. Of course, this docs not preclude setting appropr13tc limits,
nor docs it mean th3t counseJlors have to tolerate personaJ or physical abuse. lt means
Protesslonal Identity: Ethics, Values, and Selt•Awareneu 21

stayina calm, beina nondcfensivc, and rcfrainina from rctaJiatory responses, such as
name callina or makina punishing statements.
The second StTil.teay is to use active listening skills to ensure that feedback is con.-
crctc or spccifte. CounscJlors can ask questions to J;Ct derails, definitions, examples, and
clarification. Summari!ing and paraphrasina can also be u~ to confirm underst:mdina.
Who Am I? How Do Others See Me?

Self.awareness for counsellors involves answerina nvo basic questions: Who nm I! and
How do o the.rs see me! These questions require co unseJlors to explore and understand
their pe.rsonal feelings, thoughts, and behaviour.
Feelings Effective counsellors arc comfortable discussina a wide range of emotions.
They do not avoid feelings; in fact, they recognize that, for many clients, understand·
ing and mannging painful emotions is the greatest o utcome o f counselling. To under•
stand client emotions, co unseJlors must be in rune with their own emotional reactions.
Empathy, the basic tool for unde.rstandina the feelings of o thers, will be contaminated
unless counsellors are fully in touch with their own feeJings. This includes knowing
whe.re their feelings end and those of their clients begin.
Work and personal srress may also ncg3tively affect a counsellor's capacity to relate
effectively to clients. Counsellors must be aware of stressful situations and understand
how they react to them. Self.aware counseJlors avoid o r reduce strcs.sors b\• developing
pe.rsonal wellness plans for coping with the inevitable demands of the job.
Thoughts Counsellors need to be aware of their own inte.rnal d ialogue-the inner
voices that evaluate their actions. Counsellors with low self.worth t)tpically find that
the inner voice is c ritical, issuing mes.sages such as "J'm no good." Negative seJf-talk can
lead to emotional d istress and interfere with co unseJling performance in several ways:
■ Counsellors may be reluctant to be assertive with clients and may be excessively
gentle o r nonconfrontational.
■ Counsellors mn't' be unable to assess counselling relationship outcomes objectively
if they tend to interpret problems as personal failures and to discount positive
feedback or o utcomes.
Counsellors need to become watchful of negative seJf-talk as a crucial first step in
developing a program to combat its effects. Subscqucndy, systematic techniques such
as tho ugln•stoppina can be used to replace depreciating self-talk with affirmations o r
positive st:nemcnts.
Behaviour Counsellors need to take time to discover how clients arc reacting to them.
Personal needs and defence mechanisms may lead counsellors to assume blindly that
problems in thecounsclling relationship arise from their clients' inndequades or failings.
Although effective counsello rs have confidence in their own abilities, they have to accept
that occasionally they may say or do the wrong thing. Counscllors neo:I to be m:nure and
open enough to evaluate their work and to cake responsibility for their errors and insen.-
sitivitics. For example, o pen minded counseJlorsconsider the possibility that clients may
be angry for J;ood reason, perhaps because of o ppressive agency routines.
Counsello rs who lack seJf awareness m3y foil to understand or accept the needs
defence mechani sms: Mealal process
o f their clients and are more likeJy to take their clients' behaviour too personally. UJti,.
or teadion t!lat shields a Pff'S• ffOffl
~ble orunaa:•able thCtlgllts, mntcl't', counsellors need to be se.lf aware enough to know which client reactions are
feelings. or COlldssioa t!lat. ii a«:ep:fd, reactions to their behaviour o r personalities and which arc the result of other variables
'Mlllkl aeate allliety•dlallerips toone's beyond their control.
s.e of sfff. Coaaon deieace media•
lisms ilclude deaial displaa!fflffll. tati> Sigmund Freud first described defence mechanisms in 1894. A defence mechani-.m
ama~ioo. StWtSsion, and ie,pession. is a mental process or reaction that shields a person from undesirable or unacceptable
22 Chap1er 1
thought~ feelings. or conclusions that, if ncccpccd, would crcnte nnxicty or dnmnac
one's seJf-cstecm. Defence mechanism~ which arc unconsciou~ distort reality and serve
to protect people from perceived threats. S imple defences include bfomina ochers or
making excuses for the.ir own failures. For example, counscllors might take credit for
counselling successes but blame failure on their clients. Common defence mechanisms
used by counscllors include the followina:
■ Denial: Rdusina to acknowledge the existence of feclinas or problems. \Vhen coun-

seJlors use denial, they fail to conside.r that their actions might be the reason for
their clients' inapproprinte behaviour.
■ Displacement: Shift of emotions o r desires from one person or object to another
person or object. For uamplc, counseJlors deal with their own work stress b\•
behnvina aagressivdy with clients.
■ Rarionalhation: Developing excuses or explnn:nions to protect their self image. For
exnmple, counscllors justify their inability to confront clients b\• concluding that it
is best to offer only positive feedback.
■ Suppression; Averting stressful thoughts by not thinking about them. For example,
counsello rs refuse to conside.r that personal biases might be affecting the.ir decisions.
■ Regression: Dealing with conflict o r stress by rcturnina to behaviour from an enrlier
stage of life. For example, counseJlors deaJ with aggressive clients by becoming
overly compliant or ove.rl)• pleasing.
Counsellors should be alert to circumstances where they use defence mechanisms

instead of confronting reality. Facing reality requires courage and mking risks because
givina up one's defences means sacrificing safety. Moreover, feedback from oche.rs can
be threatening because it challenges counsellors to let down the.ir defences by addressing
aspects o f their situations that they might prefer to avoid.
\Vhen counsellors unde.rstand themselve~ they r«ogni:e when their defences are
up and can ta.kc steps to chanae the.ir reactions nnd behaviour. They know when and
wlu~re they are vulnerable; then, they use this knowledge to cue or trigge.r noodefensive
alternatives. For example, when clients are angry o r hostile, rather than yielding to the
natural impulse to fight back, counsellors can d iscipline themselves to cake time to
empathi!e and encourage clients to ventilate.
&If awarecounscllors know their skill strengths nnd limitations. This se]f n\\--areness
enables them to avoid overusing particular skills simpl)• because they arc strengths, and
it helps them to know when it is appropriate to refer clients to other counsellors. Jt also
helps them to set goals for professional skill development. Knowing the limits of one's
ab ility is a measure of competence.
Personal Needs
Counsellors have the same basic nttds as ewryone dse, including the nttd to be loved,
respected, nnd wlued b\• others. This is natural; however, counsellors must understand
how their personal needs can adversely affect counselling outcomes. Lacie of sdfowarcness
rcgnrding: personal needs can lead to unconscious structurina of the session to meet the
counsellor's nttds instead of the client's. One srudent was told b\• her supervisor that
her clients really liked her as a pe.rson, but when they had a problem, they would go to
someone clse beotuse thq• did not believe she was apnble of dealing with tough issues o r
giving critical feedback. Throuah supervision and rc.flection this srudent learned how her
need to be: liked left he.r vulnerable and ovc.rh• sensitive to client reactions. As a defence,
she avoided doing anything that might arouse anxiety.
Protesslortal Identity: Ethics, Values, and Self-Awareness 23

SUCCESS TIP
Even positive feedback frOO'l clients must be interpreted cautiously. Clients may lty to pla 4
cate counsenors ot use k'lgratiating 1actk::s to manipl.Aate, Or' ,t may be theit way of t elating
to authOrity.
A range of counscJlor needs m3y interfere with counscJling, inclu ding the need to
be liked: the need to achieve status or prestige, control, and perfection; and the need
to cultiwtc soci3l relationships. Table 1.6 summari!cs the major wnrning signs and risks
of these needs.
Need to Be Liked In Cluptc:r 3, we will explore the importance of a w·arm and trust-
ing counselling relationship. lnrgcl'>'• counselling depends on c.smblishing and maintaining a
safe cnvironn'litm, one in which dicnts feel safe enough to take risks. Obviously. this is ca~
ier if clients lilce thc.ir counsellors: hm, -e\-er, counsellors need to remembc.r that h.nving di,.
ent:s like them is not the p rimary goa1 of counselling. The aim of counselling is to support
dimt change o r problem mana~ment. This mC3ns th3t counsellors have to be nssc.rtive
enough to risk makina rc3sonable dem3nds on their clients, which, in rum, may generate
tension and anxiety. Otherwise, clients c3n ClSil)• sray locko:J imo established but unhealthy
pancrns. The need to be- liked becomes problem:nic when it becomes more important dun
ndiieving the goals of counscllina. One beginning counscllo r, 3 )-OUng m3Jc, wrote in h is
;ourn:.ll: "\\:rhen 3 client S3ys something negative o r bcluwes in a sclf-Ocscructive way, I real,.
i.!e I hold b3ck. I don't S3Y anythina because I want to be liked. J want the client to like me,
00( ~meas an authority figure. I'd rathe.r be- seen as a pal or a friend." This journnl encry
hiahliahts the dangers of this counsellor's need to be liked and sianal.s an important insiaht
that will help him question some of his assumptions 3bout counselling. He will need to
rc-cvalunte how his behavio ur may be saboroging client progress.
TABLE 1.6 Managing Personal Needs in Counsel! ing

Personal Need Warnlna Signs and Risks
To be liked and to • WithhOICli~ potentially helpful but critical feedbaek
be helplul • lnapptoprlately a\lOidlng controversy Or' conffict
• Trying to ingratiate (e.g.• excessivety praistng. tem~ clie-nts wtlat
lhey wan1 IO hear)
• Acti~ w'ilh rescuing behaviour
• Expecting or re-act-.~ for compliments from clients
Status or prestige • Trying to imptess with "exotic• ted'lnklues or t'.:l'iltiant interpmtations
• Taking credit for client success
• Na~roppiog
• Stagging abOut successes
Control • Advice givlflg
• lnterfe-ri~ with client se-tf~ete(minatioo (e.g., unnecessarily using
authority, manipulating. and dominating)
• lmposs"lg per'SOoal values
• Stefe-otyping clients as needy and inadequate (which ere-ates a tde
f0t someone to be "helpful")
Perlect;on;sm • focusi~ on mistakes
• Pushi~ d ie-nts toward unrealistic goats
• Re-sJX)ndlng with self-deprecation to mistakes (e.g., ..,,ma failure")
Social relationst-.ps • Becoming OYef-involved with clients (e.g., mee-1ing clients socialy,
contS\uing counselling relationships beyond the nonnal point ot
ctosure)
• Indiscriminate setf-disclos...-e-
24 Chap1er 1
Need for Status or Prestige Counsellors who have an excessive need to impress
others. perhaps bcotuse of insecurity, may b«omc technique-centred instead of client-
centred. \Vith this switch in prioritic~ the nttds of the client ma'>' be overlooked as
counsellors net to impress clients or others. The priority of counselling should be to
bolster the self-esteem of clients.
Need for Control Codes of ethics recogni!e that clients are vulnerable to exploita,
tion. Consequently, counsellors need to pay substantial attention to refraining from
behaviours that result in undue control of clients. The principle of self-dete.rmination
(inmxluced earlier in this chapter) is a basic value that upholds the right of clients to
make independent decisions. Counsellors interfere with this right when they attempt to
take over clients' problems and orchcsrrate their solutions.
ln some setting~ such as government agencie~ counsellors may have the legal man-
date to impose their services. This siruation requires counsellors to be especially \'lgi-
lam. As Brammer and MacDonald (1999) obse.rve, helpers in these settings "must be
wary of identifying too closely with the power of the agency under the guise of carry-
ing out the ai;cncy's mission. Often the helpec becomes lost in such settings, and the
helping services tend to suppon the power of the organization. The result may be an
exagg,erared emphasis on adjustment or pacification rather than on ac:rualization and
liberation" (p. 40).
Perfectionism Perfectionism, an unrealistic pursuit of exceJlence, can negatively
affect counselling. Counsellors who are pe.rfectionists ma'>' be unable to appraise their
work accurateJ'>', and they may have an unjustified tendency to blame thcmseJvcs for
client failures. Sometimes counsellors who are perfectionists push clients toward unre-
alistic ,;oaJs or challen,;c them to move at too fast a pace.
Need for Social Relationships Counsellors with unmet social needs risk over-
involvement with clicnts. Jf counsellors do not have outlets in their own lives for social
interaction, they may misuse the counselling relationship for that purpose.
Personal and Cultural Values

Counsellor seJf-knowledi;c of personal values and preferences is indispensable for cff~
tive counselling. Values constitute a frame of reference for understanding and assessing
clients and for making decisions and choices.
Self-awareness of personal values is an important element of competence. All coun-
sellors have personaJ values, and it is crucial that they understand what these values arc
to avoid imposing them on clients. Self-awareness of personal values is a first step for
counsellors to take to manage the bias that comes from inte.rprcting clients' behaviour
from their own perspectives or cultures rather than from the clients'.
Cultural self-awareness refers to knowled,;c of the custom~ traditions, role o:pccta,
tion~ and values of one's culture of origin. Language is a particularly important vari-
able. The word aurhorir1 will have a ve.ry different meaning for individuals who come
from totalitarian countries and for those who come from egalitarian societies. Cultural
self-awareness prepares counsellors to recognize and value the diversity of other cuL-
tures. Such awareness needs to be accompanied b)• a belief that one's own ethnic group
is only one of many and that there are othe.r appropriate beliefs and behaviours.
(ncvicably, the personaJ values of counsellors influence the way they assess client~
the tedmiques and procedures they use, and the goals that they deem reasonable, includ~
ing which topics will get more or less attention. Moreover, ce.rcain topics arc more value-
charged (e.g., abortion, assisted suicide, sexual orientation, religion, and abuse), and the
beliefs of counsellors may bias their work in these areas. For example, counsellors who
find that they never discuss sexua1it)• in their counselling work need to dete.rmine why.

TABLE 1.7 Values, Bel iefs, and Attit udes That Help and Hi nder Counsellors'
Effectiveness
Unhelpful Yali,es & Beliefs Helpful Values & Beliefs
To accept help from 01oors is a sign ot To accepa help is a sign of stte~.
weakooss.
Some people are jUSI not d&Sef'Ving of OU( Everyone haS intrinsic worth and lhe capacity
respect or cari~. kl be P,Oductive.
People are inherently evil. Unless you a(e People are essential~ gpOd.
ca(eful, they wil take advantage of you.
I ktlow what is best fot my clients. People a(e capable of finding their o-,m
answers and making decisions.
It is essential that my clients llk.e me. The pu(pose of counselling is to help clients
exe(cise d'loice, not to make clients ti.ke me.
I've been there myself, so I kOowwhat my I can'I koow wtlat my clients are feelW'lg untJ
clients are leeli~. I take the Ume to let them teach me.
People are incapable of cha~iog, People can and dO cha~.
My religjoo/cult...-elviewpoint is lhe besl I can accept a wide variety of cultures.,
refigfons. and viewpoints.
In this wOr'ld, it is survival of the fittest We depend on one anOlhe(, and we have a
respoosibiity to help Olhers.
CounsetJors have a rigt\t to impose service Wrth some exceptions. clients can eho:>se to
wtlen it is in their clients' beSt interest refuse service.
Are they avoiding this topic because of pc.rsonal inhib itions? Are they unconsciously
judging the sexual behaviour of their clients?
One W'U)' for counscllors to address this problem is to disclose their values to their
clients; however, they should do this in such a way that clients do not feel pressured to
adopt similar values. Clients should feel free to maintain their own values without fear
that they are in some way disappointing their counsellors.
A counsellor's value S)'Stem is an important variable that influences the methods
and outcomes of counselling. In general, counsellors are most effective when their wJ,.
ues reflect an optimistic and nonjudgmental view of peoplc. lntcllectuaJly and emotion-
ally, they accept and treasure the widest possible variations in lifestyle. They believe in
the inherent strength and capacity of people and in their intrinsic right to freedom of
choice. Table 1.7 examines some of the values that might impede or enhance counseJ,.
lors' cffoctivcncs.s. \Vhcn counsellors have values that hinder effcctivencs~ they are
more lilccly to find themselves behaving contrary to the ethics of the field , such as acting
in wa)•s that inhib it self-determination or failing to respect the dignity of their clients.
Conversely, counsellors who have w1ucs chat enhance che.ir ability arc more naturally
inclined to support the ethics of the profession and arc more likeJy to behave in ways
that empower che.ir cliems.
PROFESSIONAL SURVIVAL
\Vorking as a counsellor can be immenscly stressful and, for some, emotionaJly danger-
ous, p3.rticularly for chose who arc working with clients who have experienced trauma
and abuse. People who work in hospitals and mental hc3lth settings. as well as those who
work with children are P3.rticularly vulnerable. Continued exposure to client troubles
can leave counsellors with little patience and resilience for deaJing with their own issues.
Some experience burnout or vicarious rrauma.
Burnout: A state of emational, ment,l
•d p~al aba11stion tut reduces • Burnout is a state of emotional, mcnml, and ph)•sical exhaustion that hinders or
pew:nts peqi:le froa pe,fo,aing tlleir ;co. prevents people from performing their jobs. Burnout may affect people in different
26 Chap1er 1
wa)'s, but certain symptoms arc typical T he stress of burnout may show itself as a
genera] state of physical exhau stion, includina signs o f diminished health, such as
headache~ sleep d isruptions, and d iacst ive upset . Emotional and mental burnout
may reveaJ itself as increased anxiety, inability to cope with the normal demands
of worlc, depression, excessive worry, discouraaement, pessimism toward clients,
loss of a sense of purpose, general irritab ility, and an inability to find joy in one's
career o r life.
Vicarious trauma is a risk for anyone in the helping professions who wo rks with vicarious trauma: An oa:upalional
people who have been traumati:ed. Shea for and Horejsi (2008) offer this caution: hazard for people in the llelpint prvles-
sions. ii wbQ they dMlop the same
After repe::ued exposures to clients who ha"e been tr.aum::ui:ed and 21re i.n areat distress. s,wrp:cai as llieir dents llflo haw beea
sod:)) worke-rs and o ther helperS 11\3)' de...elop symptoms o( tr.au ma themselve!l. sueh as traumatiHd.
intruSi\'e thou~,u and im~e!l. s leeplessness,. brstander auilt, (eelin,iS o( vuJner21bility,
helplessnes!l. sel(.-doubt, 21nd r3~'C'. Workers who (eel especially 01:erwheln~ b)' d1sas-
ter, those who have h::.d a prior b:perience o( severe emotional tr.auma, 21nd those who
21re inexperien.e«I in di~ster,related work 21re espedall)' vulner:lhle to devtfopin& these
S)•mptoms. (p. 57 I)
Counsello rs who suspect that they suffer from burnout or vicarious trauma should
first consult a physician to rule out any medical condition that might be a factor. Obvi•
ousl)•, the best way to deal with burnout is to prevent it from happening. For counsel•
lors, this means balancing the demands of the.ir worlc life b\• taking care of thcmscJvcs.
CounseJlors need to d evelop personaJ wellness pl.nns that address their own emotional,
physical, and spiritual needs. An essemial part o f this p lan is time away from the job.
Counsellors need to avoid b«omingovcr~involved by ,vorking unreasonably long hours
and weekends or by skipping wcations. They need to make intelligent decisions about
the limits of what they can do.
CounseJlo rs can also prevent burnout by setting up and using a support system
of fam ily, friend~ supervisor~ and colleagues. By doina so, they ensure that they have
people to whom they can turn for assistance a nd emotionaJ support. \\:1o rk collea,iues
and supervisors arc essential for hclpina counsellors manage their emotional reactions
to clients. such as fear and anae.r. Counsellors nttd to r«ogni!e that being ab le co ncccJX
help from others is a sian of strength and that they should model this bcJief in the.ir
O\\•n behaviour. TaJking to others reduces isolation and allows for team participation
and support with difficult decisions or situations. Jc is particularly important for co un-
se.llors to have someone to debrief with after stressful inter views, such as those with
angry or abusive clients.
Continued profcssionaJ d evelopment is another important strnteay for prcvcntina
burnout. Seminar~ co urses, and conferences expose co unseJlors to new ideas and the
latest research and can help them renew their enthusiasm and c reativity.
SUCCESS TIP
Preventin& Workplace Burnout
Am:>ng the many p(oven strategj,es foe p(eventing btXnout a(&: a,Nareness and eatly inte(.
vention to deal with symptOO'ls, exercise, nutrition, healthy personal relationsi-.ps, lifestyle
balance, laughtet/having fun, mindful b(eathi.ng, mindh.Aness, debriefing wtth trusted COi·
leagues and supervisors, use of a mentor or r·01e model. distancing oneself from negative
cow0tkers, sleep, rec,eation, spirituality, taking a vacation, ensuring wofk.Jjace bl"eakS,
maintaining teasonable office hours, scheduling chent interviews to mini.mile sustained
perkx:ls of stress, wor1dng wtthin the limits ot one's cotnpetence, and accepting 1001 you
can'I help everyone.
Protesslonal Identity: Ethics, Values, and Self-Awareness 2·7

Cynicism •
.........nt
&
......
...
._..,
pe,sonal life
Figure 1.5 Common Symptoms of Workplace Burnout
SUMMARY
■ CounscJling sc.rvices arc provided by a wide range of diffe.rent professional~ indud..
ing soci:.d workc.rs., nurses, psychologists., and others.
■ Professiona.1 codes of ethics define the acceptable limits of behaviour for profcs.-
sionals who provide counseJling services. They aim to protect clients from misuse
of position and pcm"er by profcssiona.Js. and they strictly prohibit dunJ relationships
that arc sexual or exploitive.
■ Ethics, derived from vn.Jucs., arc the principles and rules of acceptable conduct. The
values of the counselling profession arc rooted in a few basic principles: belief in
the dignity and worth of people, respect for divc.rsity, and respect for the client's
right to self-determination.
■ An ethicaJ dilemma exists when a choice must be made between competing values.
Five principles can help resolve ethical dilemmas: autonomy, beneficence, non..
maleficence, justice, and ftdcliry. EthicaJ decision making involves weighing the five
principles and deciding which ought to have priority in a given situation.
■ Objectivity is the oi.paciry to undcrsmnd situations and people without bias or
distortion. CounseJlors can lose their objectivity by making assumptions., ove.r..
identifying with clients, or becoming overly involved with their clients.
■ Sclf-:n\--nrcncss is esscmial for counsellors to work with objectivity. Self-aware coun.-
scllors know rhemsclv~heir feelings. thoughts, behaviour, personal needs, and
areas of vulnerability. They understand how they affect clients, and they know the
limits of their competence. They can answer the question, "Who am If'
28 Chap1er 1
■ Burnout and vicarious trauma. arc workplace ha: nrds that can b e addressed using
a. variety of strategics such as lifcst)•le balance, nutrition, exercise, and effective
use of trusti.XI colleagues and supervisors.
EXERCISES
Sett-Awareness 4. ExptOr'e yout perSOOal sttengths and limitations. Use lhe
I. What strong beliefs do memberS of youf clJturaVethnic
foHO\\;~ topi,'.:;s to structure your assessment:
g(OUJ) hcjd? • capacity to be assertive (as opposed to Shy or agwessive)
2. Use the ciuestions and situations belOW to ex.-amioo your • degfee of self-confidence
values in (elation to sexual orientation issues. • comforl dealing wilh a fflde range ot emotions
a. If a client of yourS i:S gay Of lesbian, how might it inftu. • need to control ot be i"I Chafg,e
ence the way you WOrk with him or her?
• capacity to (elate to drverse populations (age, gender,
b. What would you do if a friend told you an anti-homosex- cllture. fetigjon, etc.)
ual joke or sto,y? What if the pe,-son teting the joke was
• ability to give and feceive fOOClbaek (positive and c,iticaO
a dient Or' a COiieague?
• need to be helJ)fLI
c. Do you have gay Or' tesbian friends?
• anxieties and fearS
d. Do you think ho.inosexuality is an illness? How do the
teachi~ of your religion mesh 'lfith youf pe,-son.al val- • competance in initiating (elations.hips (beginnings)
ues and beliefs? • ability to deal with conflicl
e. YotX daugf\tef discloses lhat She is lesbian. Pfedid hOw • self-awareness fegatding how Others see you
you might feel, think, and behave. • overau awafeness of pel'SOOal strengths and limitations
f. YotX best friend confides lhat he feels he is lhe Wf'~ • values and attitudes that will help Or' hindef yotX WOrk
gender- and that he is in the early stages ot transitioning,. as a counseltor
How do you r'e'SJX)nd?
• caJ)aCity and willingness to cha~
g. What afe your views on same--sex. marriage?
Based on yout answers, identify what you coosi:Jer your five
3. Write an essay lhat explores yout values and beliefs. Explore major stfengthS and yout five major limitations to be.
issues and ci uestions such as: 5. Evaluate your capacity for handlrlg feedback from Others..
Why dO you want to oocome a counseltor'? Ate you geneta:lly open and nondefensive when Others criti-
What ~ s dO you expect to meet through your work? In caly evab.Jate your behaviout or perfOr'mance? Do you tend
vd'lat w:¥yS might your personal needs be an impechment? to avdd asking fot leedbaek? Do you acrivefy SOlkit feed-
back? lntef'Jiew friends and coneagues for theit opinions.
Ate people inherantty good or bad?
6. Ate you excessively dependent on your clients? Rate )'Ouf•
What is youf understanding of the meaning ot life?
self fof ead'I statement below using lhe folto.vi~ scale:
Should people have the right to take theit own lives?
4 = always
ShotAcl immigrants be required to speak one ot Canada's
3 = frequentty
two official languages?
2 = sometimes
What are the char'3cieristics of lhe dient you \\()ul(I most
and least want to w0tk with? (Be spe,cifac regarding as 1 = rarely
many variables as possible. such as age, gender, p(lf'· 0 = never-
sonatity, cllture. and religion.) Why would you choose I feel (esponsible for lhe feelings, lhOughts, and
these characte-tistics? behaviouf ot my clients.
What topics Or' issues afe tikely to evoke strong personal I get ang,y when my help is ,ejected.
reactions from you? I feel worthle'Ss or depressed when dients dOn'I
What does authority mean to you? How dO you behave d'lange.
and feel when you are relating to people in authority? _ _ _ I feel compeUed to help people SOive problems by
Whefe do you draw )'Ouf strength? offering unwanted ad\lice.
When you die. what do you most want to be remembered I want to lake cate of my dients and pr·otect them
fa<? from painful feermgs.
Protesslonat Identity: Ethics, Values, and Seit-Awareness 29

_ _ _ When clients don't like me, I feel rejected or c. A ll>year-0k:I mate client roasts lhat if hisgjrtfriend tries
inacl«:iuate. to leave him, he 'liill kill her.
___ I do lhings to make my clients like me, even if d. A client from a counselling relationship that terminated
wtlat I do is 001 helpful. six months ago phOOOS to ask you f0t a date.
I a\'Oid confronting 0t ehafleogi.ng clients.. e. YOIX client leaves your office in a~t. determined to
___ I tell clients wtiat they want to hear. ~teach my ~fe a lesson tot the way She treated me.·
_ _ _ I fOOI most safe when I'm gjving to Olher'S. f. Kno-/Mg that you ace in the macket fOt a new car, yout
client, a used-car saleSperson, otters to help you buy a
_ _ _ When clients fail. I take it personally.
car at the whOleSate price.
___ I spend too much time proving to myself and my
g. Yout clWlnt is a young woman (age 17) who is question-
dients that I'm good enough.
ing her sexual identity. She .-iqlires abOUt yout sex.ual
I tend to be very contrOIJiog with dients. orientation.
___ I tolerate abuse from dients to eosl.l'e lhey like me. II. Yout dient ask.S for yout email address so that he can
___ I feel responsible f0t soM~ my dients· prOblems. keep in touch
caretulty retJiew any siatements wtle-re you sc0ted 4 or 3. I. Yout client, a bisexual male, has tested HIV-positive, but
use your awareness of problem areas to develop a program he informs you that he ooes not wish to tel his wife. He
ol self-dlange. says that he wll practise safe sex.
7. Imagine that you are a dient What migr\t your counsetlOr' j. You receive a catl fromi a client's wife. She says She is
need to knON abOut you (e.g., values, needs, and preJer. concemed abOut het husband and asks wtlether you
ences) to wot'k effeclM!ly 'lfith you? lhink her hUSbar\CI migtll be gay.
8. Take an inventOcy of )'OIX frienclShip clfcte. To what extent k. Yout cOleagues begin to &atkabOut a dient. You are~th
dO your Mends come from lhe same cultural group and lhem at a local restaumnL
have the same values baSe as your own? Predkt what might I. One of yout colleagues tells you that she has just
haPPM if you broadened your circle to include mor'e diver- re1urned from a one--day works.hop on hypoosis. She
sity. DIM!lop a plan to learn abOut the cultures and warld says that She can hardly wait to tty it oo some clients.
religions in yolM' community.
m. You encounter one ot yout COiieagues having lunctl with
9. What pel'SOOal and religious values do you have that would a client. You notice lhat they are drinking a tx>ttte of wine.
gener-ate ethical dilemmas?
n. You have an erotic dream abOut one of your clients.
Skill Practice o. While you are counselling a student (in yout role as
school counselbr), he discloses that he is selling mari-
1. Interview one 0t m::,re colleagues who deltiemtety introduce
juana to ctassmates. (Would your response be different
issues, leeli~. 0t behaviours that represent "tf.gg.ers• fOr'
if you were a counsetlOt in a community agency uncon-
you. What did you learn from this interview?
nected to the schOOr?>
2. Imagine that )<Ill are addressing a situation wher-e you believe
p. You are a counselbr wocking with a you~ gay client in
a COiieague haS acted uoethi:.ally, for example. by breaching
dawn.town Toronto. He has been socialy isolated and is
confidentiality Or' speaking rudely to a client. Assume that
you have decided to approach 100 colleague informally to slow to trust anyone, but ovet time, you have managed
to form a stro~ WOtklflg relationship. Imagine lhat he
shate yout obServation.. Rol&-play what you migt\t say.
appr·oaches you with a request that you walk with him
Concepts in Toronto's aMual gay pride parade. What variables
would you consider in makW'lg your decision? What are
1. can we promise our clients abSOlute confidentiality? Why
lhe implicatbnsof going 'ldth him?Whatare the implica-
0t wtly not?
tions of not gc::i~?
2. What are some advantages and disadvantages to atlowing
q. Yout client is do-.-m to her- last two dOltars. She offers to
clients access to files?
buy you a coffee.
3. Under- what conditions wouk:I you make exceptions to the
r. YOIX car is btoken and tequites an ex.pensive repair.
principle of self~etermination?
Yout dient has been struggling to set up a mobile repait
4. use the concepts in this chapter to explore ethical issues service. but business has been SIOw. He otfel'S to fix yout
and s1mtegies for each ot the fallowing situations: car fOr' a discounted price.
a. AA elderly, frail woman sufferi~ from inoperable cancer 5. A gOOO friand invites you to a small dinnet party. When
decides to lull herself. you arfrve, you are intrOduced to lhe Other- guests, includ-
b. A client deddes to give his other life's savi~ to his Or' i~ a mar'ital<0unsem~ dient wtlom you have been WOrk-
her church. ing with foc the past year. You oote lhat her companion
30 Chap1er 1
fof the eve-nlng i:S not her' husband. F'rom obSeNing lheir ___ te11W'€; a dienl's partMt that he Or'She is HIVi'.X)Sithie
behaviour', lhere i:S no dOubt that this i:S a roman.tic telation- ___ advising a client 10 le-ave an abusive marriage
Ship. She has oevef mentioned this telationship in the past.
_ _ _ oyi~ in the pfe-sence of a client
What would you dO lot the rest of the evening? Shouk:1 you
disclOSe lhis relationship to lhe \\()man's husband? If she °'
___ counsem~ a friend ~igt\bOur at your agency
aSkS you to keep youf knowledge of this relationship from (adapted from Shebib, 1997)
her husband, couk:I you continue to see the-m for marital 7. Give ex.amJje-s of appfopri:ate physical con.tact between
counselling? counse-tlOr'S and clients. How might clJttXal, age. Of genclef
6. Assess lhe ex.tent 10 which you bel~e that each of the lol~ variableS affect your an.swe-t'?
lawing counse-lOr' behaviourS night be acce-p&able usi~ the 8. The case be-tow is baSed on a case fe-cor'd completed by
fOllo-lMg tating scale: a sodal \\()rk student. Use the- CCPA and CASW c:odes to
S = alway< evaluate the apptopriate-ne-ss of the language used.
4 = often I visited lhe Smith hOme to investigate atJegations of chik:I
~ . I was met at the dOO( by Mrs.. Smith, a single pa(.
3 = sometimes
ent. I was s....-prise-d by hef size; she was m0tbid ly obese
2 = seldom
and smelted as if She had not Sho-.ve-red in weekS. Roll:S of
1 = oevef fat hung out of MtS. Smith's Shirt, and portions of he-r le-gs
Be prepafed tode-fe-od you, answe,. How migN your answer were covered with dirt. Mrs. Smith's SIOven.ly appea,ance
vary depencli~ on lhe citcumstan.ces? suggests She is unable to care fOr' he-t'setf, much less he-r
___ see-i~ a client afte, having had one alCOholic children (Reamef, 1998, p. 93).
drink 9. Expl0<e the issues involved in discussing clients with
___ accepting an invitation fof din.oo, at a client's Mends and relatives. Is it acceptable to discuss clients if
home you change the-it names and Other' identifyi~ data? Defend
___ hugging a client your answet.
___ inviting a fo«nef client to a party at yotX home 1O. Shouk:1 some clients be fOr'ced to attend counse-ttiog?
___ dating a formef client 11. Do you think gaUo-hS humour i:S ethical? Defend youf
___ havi~ se-x with a client answer.
___ driving yotX client hOme 12. Review the cooes of ethics for three o, fou( diffe-ren.t cana-
dian ptofessional Or'gan.izat.ions. What common and uniique
___ discussi~ you, dient with a supervisor featufe-s can you identify?
___ assistrlg a client to e-nd his o, her life
13. W0tk in a small g(oup to d8V't'IOI) confidentiality guidelines
___ accepting a client's decision. to commit suicide fOr' electr•onic stOr"agE! and Shari~ of data. What are the risks
___ a!IOwing you, teen.age( to babySit fOr' your client of Sharing infOr'rnation with othef ptofessionalS usa"lg email?
buyrlg a car from yout client 14. Social Media
lending money to a client a. Discuss the ethics of using Google or other se.atch
reporting you, die-nt to the po6ce (after the client e~ioos to ftnd posted information abOUt a client without
tell$ you lhat he Of She committed a crime) the-.' consent. Supi:ose a sea,d'I fe-Yea~ infOf'mation that
is contradictory to discussions he-Id during a counseling
reporting suspected chtld abuSe by you, die-nt
session. Of, 'lff'lat if a se.a,ch ftnds posted inf0tmation
Sharing pel'SOnal expe(~n.ces., fe-etings, ptot,ems, crH.ic:al of the counse-tlOr?
and so oo with youf client
b. What personal infotmation abOut themselves is
- - - ge-nrlg angry with yOU( Client approptlate and inappfopti:ate to, counseltor'S to post
___ discussing a client with youf famity Of Mends on.line?
('Mthout mentionlng names) c. Explore the approptiateoess of counse-tlOtS conn.,e,cting
___ giving a present to a client or receiving a pfe-se-nt with Clients on Face-bOOk. What abOUt fO«ne( Clients?
from a client
15. Imagine lhat you afe directof of a social service agency.
___ shating in.f0<mation. abOut clients with other With limited funding. you have to make a difficult deei:Sion
counse-llOr'S to fund on.,e pr·c ~am and te:fminate another'. Both programs
___ wamlng a person lhat your client has threatened have been successful. Discuss how you might approad'I the
to harm himself Or' he-t'se-lf resolution of this ethical Challenge.
Protesslonat Identity: Ethics, Values, and Seit-Awareness 31

WEBLINKS
The Canadian Counselling and Psychotherapy Association The Markkula Cent~ fOr Applied Ethics at Santa Clara Uni ~ty
webSite has links to notes on ethics, leg.al issues,. and standards website p,ovides articles and links on the toplc of ethics
for counsenors www.stu.edu!ethics
www.ccpa-accp.ca/eth1cs/ This website has links to resources.. articles, and discussions
The canadian Association of Social Wor'ke:rs website has links on the topic of dual relationships and bounda,y issues
and infoimation fOt social WOfkers http://kspope.comlduaVindex.ph p
www.casw-acts.ca
32 Chap1er 1
&ives sped.Pie
covnsel
Oiuiin/Shunerstod(
■ Define what is meant by counselling,

■ Describe the n«cs.sary range of skill versatility for counscJlors.
■ Describe the csscmial clements of 3 trauma.-informed 3pprooch to counscJling,
■ Identify and classify the skills and strategics of counsdlina
■ Summari!c the dcvclopmcmaJ objectives of rhc four phases of counscJling.

■ Describe counscllina pitfalls.
WHAT IS COUN SELLING?

Coun....eUins: is a time-limited relationship in which counsellors hclp clients increase counselli,_-; MempOlleffflent prixess
their ability to deal with the demands of life. Typically, people arc rcfc.rrcd to or seek d ~gdients to lea,. skills.deal rib
counselling because of an unmanaacablc crisi~ such as the loss of a job, rcfationship
ree.,s, and aana,e pntil.tns.
problems, or feelings of disrress.. The immediate goa.1 of counsclling is to provide assis-
tance so that people seeking help (clients) c:m g3in some control over chc.ir problems.
The long-tc.rm gooJ of counselling is to restore or devdop a client's 3bility to cope with
the changing dem3nds of their lives (empowerment).
33
Recen1 researd'I and developments in oouroscience confirm the centrality of 100 d ienvcounseuor relations.hip as a basis
that counsetling has the potential to change client brains in for d'laoge. Counselling enhances neurogenesis (the ptOCluc-
ry positive ways. This research sup(X)rts the value of core tion of new netXons in the bt'ain) and it takeS advantage of 100
ounsefling skill$ such as listening and empathy. Research bfain's neuropfastidty (the capacity ot the brain to change)
ISO enclorSeS placi~ an emphasis on client stre~s and (Mly, tv,)y, & Zalaquett 2010).
T he Canadian Counselling and PsychotheraJ)\' Association (CCPA, 2012) offers

this pe.rspcctive:
CounselIin¥ is the s.ki!Led and p rindpled useo( rel.:ttionship l'O hieiliuu, sel(, Jmowled~
ernotional :)C'Co?p-tanee and ¥r0w1h and the optinul de,'eloprnent o( personal resources.
The overall aim o( eounsellors is 10 provide an opportunity (or people 10 v.'Ork toward
livi1'{t more sat id)·i~)' 2nd resoureelully. Counsellin¥ relat ionships w1II ,'3ry aeeord,
i1'{t to nn'.'d but ,nay be ooneerncd with de\'t:loprnent~I issue~ addressh,i 2nd resol\'i.n~
specJf"K" problems. makinK decisions. oopi1'{t with erisis. de\'t:lopinK person:11I insi¥1u..s
and kno,1;,led~-e, workinK throu,ah (eeli1l{tS o( inner contliet or improvi1'{t relationships
with otherS..
Counselling is de.fined b\• three var iables: the needs and wnnts of the client, the
mandate of the counsellina setting:, and the expertise o r competence of the counsellor.
As discussed in Chapter I, profos.sionaJ counsellors a.re aware of the limits of their
competence and know when to refer the.ir clients to other appropriate services. They are
also aware of their own needs and unresolved issues and they r~fer clients to othe.r pro-
fessionals when they cannot worlc with reasonable objectivity. In addition, they acc~pt
that no one counsellor is qualified to work with all clients. Table 2. 1 summarizes how
counselling: knowledge and skills e,.•o lve from beginning to advanced Jc,.'Cls.
The work of counselling may entail a brood range of octivicics., indudina the followina:
■ hclpina clients cope with painful feelings
■ tC3ching clients new problem-solvina skills
TABLE 2.1 Counselling Skill Levels

Beglnnina Level COunullors Advanced Level COunullo.-s
Bask:: use of core listening and Exemplary use of a t:t"oad range of listening and
reSJX)ndS'lg Skills counsem~ skills and strategies.; capacity to be creative
to meet the unique needs ot indMClual clients
Sensitivity to cwert Responsiveness to subtle nonverbal cues and themes
nonverbal cues
Basic content knowledge ot ln<lepth knoldedge of evidence-oosed best practices;
field of practice abiity to analyZe and adapt published material
Rudimentary unclerStanding Sophisl:ic:ated kr10\\tedge of setf and cultural world'Jiew,
of self one's in1pac1oo others, and one's abiity to selectM!ly use
aspects of self to influence OlherS
Tendency to •mimic" mentors capacity to eustOO'li?e tnetr apptoach; devetopment of
and textbOOk responses individual Styles
Slt'uggte to manage biases. "Second nature· capacity to stay appropriately detached
personal reactbns and in contrOI of self even wtlen Mtested" by d ients
Selkonscious F'oeus on d ients
Tendency to want to fix., rescue. Acceptance of the d ient as ·expert;- locus on client
or solve client prOblerns em(X)werment
34 Chap1er 2
■ mediating relationship communication difficulties
■ aiding clients in identifying and accessing resources
■ helping clients make decisions and implement action plans
■ supporting or motivating clients
Interviewing skills are indispensable to effective counselling. The goal of

imerviewins: is to acquire and organize rcJevant information through timely listening interviewing: A•irint -.:J«ganiling
and responding skilJs. The primary goal is information gathering: however, clients relMnl inforlUlion u~ a«ive listen-
ing sliHs. inct.il:g al.1eading. sieooe.
may foe] rcJicf from sharing and organi!ing their thoughts in response to systematic
parapnsing. s.marizitg. questionini,
interviewing. and eafatlly.
Good interviewers are comfortable with silence and know when to listen without
interrupting. CounscJlors who listen to their clients give them a chance to air their
foding~ and this step can be therapeutic in itself. Patient listening shows clients that
counsellors arc willing to accept them without judgment and without burdening them
with quick.fix solutions to complex problems and feelings.
At the beginning of counsclling sessions or inte.rview~ silent listening may also give
counsellors valuable dues about the potential focus of the interview. Listening also helps
counseJlors IC3rn about their clients' priorities; it reve3Js which methods clients ma'>'
have used and not used to try to solve their problems.
SUCCESS TIP
However self-defeating ,t may appear, au human social behaviour has a purpose.
Good listeners nJso know when and how to respond. Paraphrasing, summari!ing,
questioning, and showing empathy constitute the foundation of effective listening.
These skills enable counscllors to focus and deepen the interview. Good listeners usc
questions to cfarify meaning and seek details and examples; whereas they pnraphra.sc and
summari:e respon.scs to confirm understanding and highlight important information.
A good interview involves methodical questioning and exploration of issue~ a process
psychotherapy: Ad\'af!Ctd CCllaselilg
that can help dientsclarify and org:ini!e their thoughts. Finally, counscllors usc empathy tatgtting S!'Me emotilflal or behaviCIJral
skills to confirm their understanding of the client's feelings. diffltlllies « lisortlers.
CONVERSATION 2.1
STUDENT: What is 100 difference between counselling and is that psychotherapy tends to be more long. term 1rian coun-
psychotherapy? selling, with an emphasis on severe em01ional and behav-
blxal difftl.Aties or disorders. On 1he 01oor hand, counse:m.ng
TEACHER: The te-tms psychotherapy and counselling are
is targeted at assisting dients in managing siluational prob-
often used interchangeabty, and the-re is no accepted dis.
~ms. Whde psychotherapy can weatty assist people. 1t can
tinct.ion between 100m. 801h counselling and psych01oorapy
be harmful if undertaken withoul appropriate araining, ex.pe-ri-
a,e used to help clients learn Slulls, deal wilh fee:U~.
ence, 0t supervision. Attending a short wOr'kShop 0t reading
and manage prot,ems. In counselling and psychotherapy,
a bOOk is tnsufftdent preparation.
appcoprt.ate relationslips with dients are the crucial success
Currentfy, there are hundreds of different 1oorapeutic
medtum that establishes a foundation of safety and securily
approaches., such as Gesa.at. transactional anatysis, psyc~
for clients to undertake the d'lange process.
drama, rational emottve. Roge:rtan or person-centred, motrva.
Although there is nociea, d,vi:iing Nne between the two terms.
tional intervie-.ttng, cognitive behavioural. music therapy, art
the major difference between counse:m.ngand psyd'IOIOOrapy
therapy, and Adle:rt.an.
The Skills, Process, and Pitfalls 01 Counselling 35

CHOICES : THE NEED FOR VERSATILITY
diversity: Vari,a~icm in wmuf The typical counselling cascJoad is ch3ractcri.!cd by its d iversity. Culture, gender, a,;c,
ilestyle.. culture, bSl\lour, semal rdiaion, sc>.."Ual orientation, language, education, economic abilit)•, and intcllectual capac-
orialtati>n, ag_e, a ~ility, religion. and a!her
!actors. ity, as wcJI as beliefs, value~ prcfc.renccs, and personal style, malcc every client different.
Skill versatility mC3ns that counsellors have choices that give them the freedom to adapt
wersatility: TlleneedlorcoaseUcn to individual diffe.renccs--vcrsatilit)• enables counsellors to customize their approach.
to deYetop a broad range GI slills so For example, although most clients respond favourably to empathy, some clients see
theyca adapt ttlEli a~h to frt the
listin«ive ccmpt!liti.s GI each itdNidual empathy 3S intrusive and respond with dcfonsivcncs~ preferring to k«p their feelings
•dCORtell. private. Effective counsellors are aJert to such re3ctions and h3ve the 3bility to use sic ills
other th3n empathy with these clients.
Brill and Le..,ine (2005) stress the importance of the counsellor's pe.rson3J in6uence
in the counselling process. Counsellors "must consider the.ir weaknesses as well as their
capacities and strengths in seJecring methods, technique~ 3nd procedures. Bec3use each
individual is different, aJI workers must develop their °"'n styles 3nd che.ir own w3ys of
handling the tools of the trade. This is the element of artistry chal is a vital pan of such
work" (p. 175). Successful counsellors model high congruence between who they 3re
and how they act. They are sincere and real in the way they relate to diems.
In order to work effectivcly with diversity. the following key principles 3re essential:
I . There is no "one-si:._e-{iu,,all" model of counselling. Respect for diem diversity requires
counsellors to be ve.rS3tile in adapting their methods to fit the needs of ench diem
or context. They may worlc from a modcl or process for exploring problems and
helping clients build solutions. but they adapt that model to each dient situation.
Most counsellors now accept that no single counselling appronc.h is best, and they
are willing to draw ideas from different thtt>rctical schools. In the proces~ they learn
to use an assortment of counselling cool~ including drnm3, role pin)•, toy~ music,
3rt, films. \•isunl ch3rts such ns geneaJogicaJ diagram~ personality tests, and audio
or visu3l r«ordings.
2. Experr cott1UtllON draw on ellidence-ba.sed beSL pracrice5 and experience a.s g11ides in deter-
mining uihich skills and procedures tdll besL meer rheir dienu' needs. Evidence-based
empirical dam can heJp counsellors predict which skills and approaches have the
highest likelihood of success with particular problems.
3. Adapration of skills for individual clients and cirmmsrances i.s required. Counsellors
who persist in using the same strategy for 31) clients, without regard to individual
difference~ will never become effective. Skill versatility gives counsellors choices
and the freedom to adapt to individual differences. \\:fhen one strategy foils or
is inappropriate, another can be utilized. Culnm; spiritual values, gender, devcl.-
opmentaJ level, the presence of mental disorders or addiction, the narure of the
problem, and the capacity of the diem are some of the variables to be considered
when 3dapting skills.
))t) BRAIN BYTE

By using a range ot counselling sttategies. counseuors can parts of the brain to go with Alzheimer's), physical and em::>-
activate different afeas of lheit clients· bl'ains and stimulate lional connections with the person are made possible that
the development ot oow neut'3I pathways 0r even the wowth would 001 be available thfough 1alk alone. Music can atso
of new neur'Ons. fot e.xample, feseatch has demonsuated be used to •Shift mood. manage stfes.s-incluced agitation.
thal using music. dance, and &efcise with Alzheimef's stimulate positive interactions, factlftate cognitive fuoction
patients helps them to mcatl memories and em::>tions. Draw- and c00tdinate mot0r movements· (Allheimer's Foundation
ing on a different part of the brain (music tS one ot the last of America, 2015).
36 Chap1er 2
Versatility means bc.ing flexible rcgardina vari3blcs such as the location of
the interview, the duration, the pace, the fee~ and the people involved. Although
some counscllors work in office settings with scheduled 4S•minute or hour•long
interviews, many work in settings where counscJling interviews arc less structured.
Process vc.rsntiliry aivcs counsellors choices rcgardina the sequence and pace of
counselling activities. \Vich most clients, the bejpnning ph3Sc is concerned with
explorina problems and fcelina~ but with other diem~ counsellors may move
immediately to action and prob lem sohtina. \\:lith some client~ counscJlors spend
a great deaJ of time helping them explore their fcelinas, but with other~ counscJlors
spend little or no time in this activity.
Vc.rsntilit)' also extends to other facto.rs, such as the amount of expected or
desired eye contact, the seating arrangements, and the physic.a] distance. Some
clients are comfortable in an office serrina. but others prefer to work in thc.ir °"'n
home or to meet in a neutral scttina. Adolescent boy~ for example, might prove
more approachable if counsclling interventions arc combined with some activit)•.
Some clients favour an open seating arrani;cment with no desk or obstacle between
them and their counsellors. Others prefer to work over the corner of a desk.
4. Adaprilie counsellO'N know how and u,hen rouse skills, and rhey know tt--hen ro refrain
frc,m using rhem. This rttauircs intelligent consideration of a wide range of variables.,
including setting, prob lem, client capacity and receptivity, time available, and so
on. For example, at the beginning of a counsellina relationship. counscJlo.rs usually
want to use skills chat promote the development of the working alliance, so they
avoid more demandina stratejpes such as confrontation. Once th~• have estab lished
a firm working relncionship. counsellors will want to use skills that hclp clients g3in
new perspectives, so confrontation ma'>' be warranttXI. As another example, empa•
thy often encouraaes clients to share deeper feelings. Therefore, counsellors who
use empathy should be willing to invest the time that this sharina requires; how•
ever, if the interview is nenr an end, the counscJlor might decide to avoid cmP3thic
responses that stimulate emotions that cannot be dealt with in the time avail3ble.
5. Clienu a.re at diffnem sragesof morilYUion and each srage s,,uesr.s unique counsellor skills
and strategies. For example, clients who are prccontcmplntivc (not thinking about
change in their behaviour) will not respond to approaches that might work very well
with clients who arc in the midst of chan,;c.
6. Effenil'e coun.sellmsare "m,drifinguaf." They adnpt their use of lanaunge and idiom
to match the lanauage of thc.ir clients. Careful listening helps counscJlors learn their
clients' communicative languai;c and metaphors, which helps counscJlors modify
their language to fit thnt of thc.ir clients. Counsellors will find it easier to establish
rapport and build crust when they match their clients' words with similar language.
The following examples illustrate:
Client I: ?l.·1'>' \'iew o( the problem is . . .
Coun.seltor I: I( I~~ the pkture oorrectl)·, the war rou see it is . .
Client 2: When I listen to m)•sel(. I know what I h::t\'e to do.
Coun.se.U.or 2: Teti me more about what )'Ou are S3)'i"¥ l'O )OurSelf.
Counsellors need to p3y attention to variables such as voice tone, volume, and
tempo and then respond appropriately. To a depressed client, a high,-cnergy, fast•
taJking counsellor might be annoyina. Similnrly, the counscllor who responds in a
monotone to a client who is ecstatic about find in a a job might come across as cold
and indifferent. There arc constraints on this principle, thouah: Counsellors should
not yell at clients who yell at them, nor is it necessary for counscllo.rs to use vulgar
language to march their clients.
The Skills, Ptocess, and Pitfalls 01 Counselling 37

The challen,;es of tod3y's diverse c3seload m3y require 3 counsellor to inte.ract
in one interview with a client who has 3 sophistic3tcd and 3rticulate command of
English, then meet with 3 client whose lnngua,;e skills 3re rudimentary. For each, a
different \'OC3bul3ry is appropri3te 3nd necessary.
SUCCESS TIP
Although counseling s.kill:S and strategies a(e to be adapted to meet iOCIMClual needs and
d (cumsrance-s, p(ofessionat ethics, attitudes, value-s, and behaviou( must remain constant
Brief Encounters
Some counseJlors worlc in settings where they are able to schOOule clients with pr(){ected
time over a period of many months; however, in m3ny soci3J service and community
centres, inter3ctions are brief, limited to a single encounter or even a few minutes.
NevenhcJes.s, the potenti3l impact of this work, however brief, should not be dis-
counted (Presbury, Ecluerling, & McKee, 2008: Carpeno, 2008). Among the possible
positive outcomes are the following:
■ When clients 3re 3mbivalent 3bout change, support from the relationship c3n tip
the sc3Jcs in favour of change by creating an 3tmosphere of rrust and s3foty.
■ Counsellors can m(){ivate by conveying optimism th3t change can occur, particu.-
larly when they focus on client strength~ not weaknesses.
■ Short sessions can provide an outlet for clients to vemil3te feelings.
■ CounseJlor empathy and nonjudgmental responses help clients accept the.ir feelings
3S normal.
■ Questions 3nd reflective responses can help clients organi!e ideas and plan for sys-
tematic change.
■ A client's way of thinking about a problem and its resolution can shift when coun.-
sdlors offer fresh ideas or re.framed reffections (i.e., looking 3t a problem from a
new perspective).
■ Counsellors c3n help remove barriers to change through information or the pro\tj,.
sion of resources.
TRAUMA- INFORMED PRACTICE

Traum3tic experiences can include single events such as violence/rape or n3tural
disaster~ as well as those that arise from ongoing abuse or neglect. A person can also
experience trauma from witnessing, reading, or hearing about the experiences of others.
(n foct. counsellors m3y experience vic3rious traum3 from exposure to the stories of
traum3 from their clients.
People respond in unique ways to traum3. Some continue their lives with linle
or no emotional disruptions while others experience "anxiety, terror, shock, sh3.me,
emotion3l numbness, disconnection, intrusive thoughts, helplessness and powerless-
ness" (BC Provincial Mental Hea.Jth and Substance Use Pl3nning Council, 2013, p. I I).
Counsellors c3n expect that a significant proportion of their client caseJoad h3s expe-
rienced traum3, as 76 percent of C3nadians h3ve experienced trauma at some point in
their lives. Moreover. up to 90 percent of women in treatment for substance abuse h3ve
been subject to 3buse-refatcd trauma (BC Pro\tinci3l Mental Health 3nd Substance Use.
Pl3nning Council, 2013), for which their use of substances is a w3y of coping.
38 Chap1er 2
After trauma or oog0rng suess. the ~ppoc.ampus, a part of oocomes larger and mOl'e sensitive. which helps explain 100
IM btain associated with memory, may be damaged and hypersensitivity and paraooia lhat develOps after trauma.
become smaller, which leads to more difficulty in prOblem Damage to the prefrontex. cortex. after trauma may impair lhe
solving. Al the same lime, tne amygdata, a part of the limbic individual's abtfity to plan and make apptopriate decisions
system mspoosible f0r emol.ioos such as danger and fear. (Bremner-, 2006).
The BC Provincial Mental Health and Substance Use Planning Council (2013) has
identified four essentiaJ clements of a trauma.-informed approach: trauma awareness,
emphasis on safety and trustworthiness. opporrunity for choice, collaboration and
conn«tion, and strengths-based skill building.
t. Trauma Awareness
Here, the focus is on building both client and counsellor knowledge about trauma and
how it can affect one's life (mental, emotional, and behavioural), including chronic
pain, slttp difficulties, depression, anxiety, e.motional numbnes~ memory problems,
loss of life meaning, feelings of shamc/sclf-hate, inab ility to trust in relntionship~
difficulty sening boundaries, substance misuse, self-harm, high,-rislc sexual behav-
iour, suicide, isolation, and criminaJ behaviour (sec BC Provincial Mental Health and
Substance Use Planning Council (2013, p. 22) for a complete list). The N-ational Child
Traumatic Stress Network (2015) n()(CS that children may respond to trauma with
a wide range of reactions. including difficult)• artaching, increased vulnerab ility to
stress, relationship problems (e.g., friends and teachers), trouble with authority fiJ;-
ures (police), and problems expressing or managing emotions. Post-traumatic stress
disorder (PTSD) is one common result of the rmuma of experiencing or witnessing
a traumatic event. Jts symptoms may include a wide range of symptoms, including
uncontrollab le flashbacks. distressing thoughts and nighnnares about the event, a
need to avoid people and plnces associated with the mtuma, severe anxict)•, emotional
numbnes~ inability to form trusting relationship~ slttp problem~ substance misuse,
guilt, sham,; and anJ;cr (Mayo Clinic, 2017b; American Psyd1.iatric Association, 2013).
2. Emphasis on Safety and Trustworthiness
The immediate focus follo"•ing any traumatic experience is to make sure that
the person is safe, that basic needs are met, and that he or she is able to connect
with supportive people and resources. Trauma upsets one's sense of physical and
emotional security so it is esscntiaJ that the counselling environment be structured
in a way that contributes to the restoration of safe()•. Establishing a wekoming
environment from reception to physical space to service delivery that involves
and keeps clients informed is important. CounseJlors need to be predictab le and
reliable with consistent follow throuJ;h. The S ubstance Abuse and Mental Health
Services Administration (2014) emphasi!es the importance of offering cultural and
gender responsive service, including utilizing cultural connections and rccogni.!ing
and addressing historical trauma. An important part of this practice is to use, or
support clients to use, culturally appropriate healing practices.
3. Opportunit)' for Choice., Collaboration, and Connection
Trauma dise.mpowers people. Trauma.-informed practice aims to restore client
power and control in their lives and as participants in the counseJling reJation-
ship. Open communication, freedom for clients to express opinions and feeling~
nonjudgmental counsellor attitude~ support of diem choice~ and collaborative
work with clients all contribute to this clement.

Focusing on strengths helps to change the foctJS of the pessimistic thought pattems. Counsem~ from a sttengths
prefronlal C<><tex (tne part oflhe btain responsible lo< judw,,er,, perspective takes advantage of 100 btain's neufoi::i)sticity to
~nning. aoo decision mak.i~) from negative to J)OSitive enhanice imJX)rtant determinants of cha~, such as capacity
thinlung (tvey, 1\/ey, & Zalaquett. 2010). Tlis find-,g has huge to take appropriate risks, optimism abOut one's ability, and
implications fOr' counselling clients with IOw seff.image and resiience to handle obSlaeles wiloout damage to self.esteem.
4. Strengths-Based Counscllina and Skill Buildina

Strengrhs.-based practice shifts the focus from problems to opportu nities a nd sofu,.
tions. Counsellors "hold the bclief that children, youth, and their families have
strengths, rc:sourcc:s and the ab ility to recover from adversity (as opposc:d mempha-
si!ing problem~ vulnerab ilitic:s, a nd deficits)" (Hammond, 2010, p. 4). Clients and
counsellors work as partners, and the "expertise" o f clients to make their o"'n
decisions is rc:sp«t~.
Relationsh i p Issues
People "'ho have been traumatl!c:d often have difficulties in their per sonal and fam ily
rc:lationships. Sensitive counsellors who utili.!e a trauma-informc:d approach r«ogni:e
that some of thc:sc same d ifft eulties may emerge in the client/counsellor relationship.
Some of thc:se problems indude the following:
■ difficulties trusting others and a. rclucmnce to share foc:lings
■ generoJ loss of interest in establishing intimate rc:lationships
■ hypersensitivity and a tendency to be suspicious about the motives of others
■ tendency to bc:come easily frustrated and tro uble managing ani;er
It is critical chat co u nseJlors manng:e the.ir own fc:c:lings when working "'ith people
who have bc:en traumati!c:d to ensure chat they do not respond defensivdy to d iem
behaviours that arc provocative. They need to communicate to their clients chat the
counselling relationship is safe and that counseJling will not exacerbate their trauma➔
Consequ ently, patience, empathy, honesty, and procttding at an appropriate p3ce for
each client are particularly important when working with clients who have been trau.-
mnti!c:d. Fully involving clients and rcsp«ting their rights to self..dctermination and
decision making will hc:Jp to restore a sense of control, so crucial to recover y from
trauma➔ As a result, clients who achieve intimacy and find suppo rt in a counseJling rcJa,.
tionship find that they arc also more able tocommunicnte in their persona.J relationships.
Counsello rs "'ho have their own history of trauma. nttd to ensure chat this docs not
ncgntivc:J,., impact their ability to counsel clients who have been tmumnti!c:d. Utilizing
supervision as a tool to increase self-awareness of their behavio ur, emotion~ and impnct
on clients is recommended.
SUCCESS TIP
With a trauma-infofmed app(oach, counsellors uooerstancl that lheir clients' behaviour,
thO~IS and emotions, ho-.-.evet troubling. misguided, or confusi.ng, are copi~ sttategjes
that enable them to deal with and sur'Vive lhe impact of lheif trauma. Counseth.ng can help
dients deV80I) more effective chOie:es-for ex.ample, healthy communication s.kill:S, anxiety
or an.get management, assertiveness, aoo inter-personal fetationshi!Y"uUimacy skills.
40 Chap1er 2
Treating Post•Traumatic Stress Disorder The ,;03J of post-traum3tic stress d isor-
der trcntmc nt is to help clients rcgnin control b)•dealing with those emotion~ behaviour,
3nd thoughts that 3re intcrfc.ring with thc.ir qua.Jit)• of life. Counselling (psychotherapy)
is the primary trc3tmc nt. but this m3y be suppleme nted with 3ntideprcsS3m or 3nti•
3n.xiet)• medication. Medication, b)• itself, is insufficient. Comb ining medication with
meditation and wellness initiatives such as exercise and nutrition will h elp with recov-
c.ry. The principles of traumn.-informed cou nscJling d iscu ssed in this section a re the
foundation fo r 3ny intervention. A number of d ifferent counselling strategics have
proven effective, in cluding the following:
■ Cos:n itive behaviou raJ chera~• (CBn to hcJp clients deal with unhelpful thinking
p3ttcrns. (Sec Chapter 7.)
■ Exposure therapy, wh ic.h involves revisiting trauma.tic eve nts until they 3rc no
lon,;cr troublesome.
■ Eye movement d esensitizatio n a nd r eprocessing (EMOR) a ver y spcci3Ji!ed
nppro 3ch designed to help d icms process trau matic memories. (Shapiro, 200 1).
■ Use of s:roups fo r support and sharing o f coping skills.
COUNSELLING SKILLS AND STRATEGIES

T here is no stand3rdi!cd met.hod for cl3ssifying counselling skills 3nd strategics.
Nevertheless, it is usefu l to think 3bou t skills and strategics in ter ms of their function
o r intended purpose. Jn this book, four major skill and strategy d uste rs a.re d iscu ssed s.kill and strategy
(sec Tab les 2.2, 2.3, 2.4, and 2.5), d us.ters.: Catepes of ~ and
strl'teffes based on tileir intendei:f purpose
t. Relationship build ing « ~ . aNiliy.
2. Exploring & p ro b ing
3. Empowc.ring & strength b uilding
4. Promoting change
Some skills achieve multiple purposes. Sensitive active listening, for cx3mplc,
contributes to the development of the rcl3tionship because it commu nicates acceptance
3nd the since.re desire to understand. At the same rime, 3ctivc liste ning is essenti31 for
getting inform3tion, so this skill c3n a.Jso be cl3ssificd as an exploring and probing skill.
Re.framing is both an empowc.ring 3nd a challe nging: skill. It serves to empower when
it shifts a client's attention to something positive (emotion, perception, o r expc.ric nce)
th3t has been overlooked o r never interp reted 3S such, but it challenges by influencing
the clie nt to enter tain n ew interpretations that generate new behaviours o r changes in
TABLE 2.2 Relationship Building

Goal: EstabliSh a productive and professionally intimate relationship, sustain trust
Sklll-S Stratt(IH
• Active Uste-ntng: Altendiog. silence, • Maintain a safe, confidential, and
paraphtasing, summartzrng. empathy, and professional envirorunent
asklrlg questions • F'oc:us on collabO<atioo
• Core Conditions: Congruence. positive regard, • Be ltust\\()rthy, relia ble, a nd consistent
and warmth • Help c~nts Mtetl their stones· without
• Oeftne and Sustain Relationship; Conttaetiog. judgment
ln-.nediacy, and Retatioos.hip PrOblem • Re-member im(X)rtant details
SoMog
• Appfoptiate counsell0t self~iSdOsufe
• Hurnou(
The Skills, Proc ess, and Pitfalls 01 Counselling 41

TABLE 2.3 Explori ng & Probing
Goal: Acquire and deepe:n understanding and motivate clients to "tell their stories.··
Skills Stratet1es
• Active Listening; Attending, silence, • Maintain focus oo key issues
par.1phrasiog. summarizing. empathy, and • Manage interview transitions
as.king <i u&Stioos (Cllange of 1opk:)
Seek e.ampleS • MonitOr' padng to flt individual client
Oifectives needS
Simple encourage<s
0,::.M-ended sentence completbn state~nts
Pay attentbn to nonverbal channel of
communication
TABLE 2.4 Empoweri ng & Strengt h Building

Goal: lnc,ease client choice, conhol, and opportunity.
Skills Stratet1es
• Recogriize and sea,ch b client strengths • Prioritize coltatx,ration
• Refr'aming fOr' new pe:r'Speclive such as • foster optimism
viewing prOblems as op(X)ftunities for cha• • focus on growth and potential
Identify (&SOufces to assist client (rete«an tot d'lange
Provide inf0tmatbn • Advocate oo behalf of dieot
Teaching; tole playing, modemng • UtJize s.Jults training progr'arns
Positive feinforcement: pt'3ise, reassurance, • use ot mentors
and tewatd
TABLE 2.5 Promoting Change

Goal: Focus on solution and the PoSSibtlities for feeling and problem man.a@ement
Skills Stratet1es
• Challe~~: confronti~ and corr'ecti~ • focusi~ on helping clients change:
distortions goal se-tting. e-xplOr"mg/evaluating
Providing feedback alterr\atives., and implementing action
• Using mftami~ to add oow pe-rspectives on plans b cha•
problems and Sdutions • UtJizing client strengths
• Aclbn Plannu,g; defring dear goals, exp!Oring
alte«la!M!: chanfJ!: c¥itbns.. aoo maki~ char'@eS
Hetpi~ die-nts i:1entify and modify unhelpful
thiO!u~ patterns (see Chapter 7)
Hetpi~ die-nts manage- problematic fee-lings:
relax.at.ion and mindfulness
Using JX)wer and authority
emotional pe.rspective (see Chal){cr 7 for an in-depth discussion of this skill). CounseJ,.
lors do not use skills compulsively. They have the knowledi;c, ability, and assertiveness
to use a skill when necessary, but they a.Jso use selfoestraint to avoid using a skill when
it is not in the client's best interest. Counsellor self.-disc:losure, for example, is an option,
not a requirement.
SUCCESS TIP
A tr-auma inf0fmed approach features core conditions, tel3tionship building SkillS, and
4 4
empowerment skJls as lhis combination of skillS and attJtudes \\()rk$ beSI to provide safe-ty
and ensure coltabOtation with die-nts.
42 Chap1er 2
Practitioners need to be versatile, building skill competence based on knowledge
of the following:
t. Skills and strategics and their intended purpose
2. Best methods and situations for using each skill
3. Self-awareness of personaJ strengths and limitations with each skill
4. Acquired understanding of each client's caP3Cit)•, need, and willingness
Relationship-Building Ski 11s

Relarionship-buildini skills and strau.• iies arc the basic tools for engaging clients. develop- relationship-buildirc skills and
ing crust. and defining the purpooc of the counselling. A strong counselling relationship is strategies: lids for enppig dents
and dM.iop.g trust.
universally accepted as essential for counselling success. The relationship establishes and sus-
tnins the ncccsS3ry 53fecy, trust, and intimacy for clients to explore their issues and feelings,
then deal with the challenges and emotions associated with change. The strength and sup-
port of the relationship provides a base for clients to risk engagement in chc change process.
Relationship-building worlc is of central importance during the beginning phase
of hcJping. b ut effective counseJling requires chat the rcJationship be sustained and
dttpened through all phases of helping.
Core Cond itions Rogers ( 1951 , 1961 , 1980) and others have written cxtensivdy about
the core condition.'> necesS3ry for forming a helping rclntionship--namdy, congruence core conditions: W.wmtt.. anpathy,
or genuineness, empathy, and positive regard. Rogoers believed chat people are essentiaJly posiweiegard.and ~ m.
good, self-deterministic (able to make the.ir O\\•n decisions), and goaklirccted. Thu~ he
coogruence: ne capaciytobe real
believed that these core conditions are necessary for establishing the rapport and ther- and consist• .ith clients; m.l~dling
apeutic alliance needed in a purposeful counselling relationship. Central to his theory bebl'iour. ~ s . .tacticm.
was the notion that the core conditions create the emtironmcm within which change and
growth will occur with the client seen as "the cxpen on his or her own life ... responsible genuM!ess: Aaeasure al ho"•
allllientic or teal me is ii a ielati>nship.
for the direction of change and growth within counselling" (Erford, 2010, p. 16).
Cons:rucncc, or jtenuincn~s, is the capocity to be real and consistent with clients. Con, empathy: The po:ess ol accurately
gruent counsellors arc open with their reactions and feelings and demonstrate consistency in undefs!and-i the emoti>nal perspecth-e
d anather persca, and die ccmllllicatica
what they believe, say, and do. Congruency also requires counsellors to be "tTIUl.Sparent"- d tiis understaading ■itklll imposing
\\tithout hidden agendas or false dcmc.mours. Rog:c.rs believed that the more counsellors arc me's Otlll feelings• readions.
:.n\--are of the.ir feelings and the more they genuinely express these feelings in the counselling
pos.itire regard: Theabilityof
relationship, the more effective their counselling will become. An important part of congru-
uunsellors to ~ lite inlleienl ~
ence is counsellor self-disclosure, patticularly with their "here and now'' feelings. d people.
Empathy is the most important core condition. ln simple terms, it means being
acti're listeni,.-.: Atn descliling a
ab le to sec the world through the eyes of the client. Essential to empathic understanding dvster of skills that are uS!d to ilcrease
is the ab ilit)• to understand feelings without imposing one's own fttlings or reactions. tile accuracy of • ndentanding.. Attendi-,..
Counsellor experiences have the potential to increase emP3thic understanding, providing usilc silefltf. paraphrasing. summarilina.
counsellors arc on guard to ensure that they do n()( become prescriptive of hCM• the client questioning.a. sha• ing empatt,,aie die
basi:: stills GI adi,,,e istening..
must feel. Positive re-,:ard, or respect for clients, is the ability to recogni!e the inherent
worth of people, rcg:irdlcss of their behaviour. attending: Atera used to descril:e
tile •ar that caselkn communicate to
Active Listening Active lisccn ini is crucial for building rclntionships and for under- tlleir clients tut they an te:ady. Milling.
standing. If counsellors arc preoccupied with what to S3Y in reply, they cannot truly listen. and a~le to listta. Vefba:1. ncaverbal. a.
Until they listen the.re is no way for them to understand the complexities and uniqueness attitmal nes aie die esv.ece of effec.
ti...e attend-,.
of their clients' situations. Active listening is an interactive process involving six slcms:
attending, using silence, paraphrasing, summari! ing, questioning, and showing empathy: silence: Ato:il used in a.selling
whel the dent is thin~. tile client is
■ Anendini is the manner in whidi. counsellors communicate that they are physically a,nfssed and unsuie GI l'lflat to say«
and psychologically interested in what their clients arc S3ying or doing. di. or the dent It.as entOUntffl'd paint.I
ree.p. Because ii is c11l11111t, defined.
■ Appropriate silence gives clients time to think and respond. Effective counsel- silence can also signal trust iss.a!'s «
lors understand the multiple meanings of silence. Is the client confused! Have d...._
The Skills, Ptocess, and Pitfalls 01 Counselling 43

we renched the end of the topid ls the client thinlcing! Slcillcd counsellors know
when to intcrruJ)( 3 silence and when to allow it to continue.
paraphrasing:: Atonjudg_•ntal ■ Paraphrasing involves restating (usu3Jly in shortened form) the client's thoughts to
mtatemeat of the client's ..on:ls and clnrify the essence of wh:.n he or she has said.
Gas in lie ~Elor's 0111n w.ords.
■ Summari::ina mC3ns condensing the csscmial content and identifying important
sunvnarizing: A•ar of ccadensing themes and ideas.
content (See also CIXtMt SamMJtY•d
TlwttSamM~ ■ Questioning involves probing for information to confirm understanding and seek
(J.teStioning: An actm lis,~ clnrific3tion, such 3S by saying, "Do you mc3n that . .. ?" \\:fhen combined with
skill tu inYdvtS probing I• infcma• nonjudgmental counsellor responses that confirm understanding. questioning
tion to confinn ~ rstanding_ and seek provides an opportunity for clients to "tell their stories," 3 process which is often
clari!icati>n.
cathartic and therapeutic.
• EmP3thy is "the process of nccuratd)• understanding the emotional pe.rspectivc of

3nothtr person and dlC' communiattion of this understanding" (Shfflib, 1997, p. 177).
Active listening is the psychologic3l incentive for clients to open up with further
disclosure. \Vhen clients sense deeply that they have been heard, th3t the.ir ideas are
not judged or rejected, that the.ir feelings 3rc accepted 3nd validated, trust develops.
Active listening makes it safe for clients to explore ideas and feelings. Together with the
core conditions, 3ctive listening says to the client, "I have heard you,'' "( am willing to
understand 't'our feelings 3nd problems without judgment," and "I accept you." Active
listening is a powerful tool for est3blishing rapport and undcrst3nding. the basis for
strong working relationships.
Defining and Sustaining the Relationship Roge.rs (1961) emph3si!es the impor-
tance of a.voiding moral judgment of the diem. He vividly C3prurcs the signific3nce of
nonjudgmental exploration to the development of the rcfotionship:
It is only as I undersu.nd the (eelin¥S 2nd thoud,ts whieh seem so horrible to )Ou. or
so weak, or so sentiment31. or so bi:a.rre-it is onlr 2s I see them as )'Ou se,e them. and
~ept them and you, th::u rou (eel really ( ~ to ~pl ore all the h.icklen nooks and lr~t•
enin~crannie!l o( )'Our inner 2nd often buried ~rience. (p. 34)
Two major skills 3rc associated with defining and sustaining the rcfotionship:
contracting 3nd immediacy. Counselling contracts ma)' ch3nge, sometimes frequently,
as the ,vork proceeds.
relationship contracting:: ■ Relation.,;hip contracting involves negoti3tingthc intended purpose of the counsel,.
Hegcti~ the intended purpost of ling relationship. including agrtting on the expected roles of both counsellor and
the uunselling Rbtion- ildu-,:
a i ~ on the apa:ted des« both client.
counsell« and cli.-. ■ Sessional contracting is concerned with setting the purpose of an individual
session. Scssional contracting defines a work plan th3t is individu3li!ed to meet
session.al contract._-; An agree.Mt
between counS!lor and client rega'-t the needs of the client. Consider, for example, three women who seek counselling
the topic •d exieued ClllkOme GI for the s3mc problem-a relationship brc3kdown. Bcc3use of contrncting, the first
• intervit'# « session. ('See also client may conclude that she needs help in m3na.ging her stress and P3in. The second
Ctx,;rx.tiRg.)
client may wam to focus on developing her 3ssenive communication slcills for dC3l•
ing with an 3busivc spouse. The third diem might want hclp with decision ma.king
in choosing between leaving the rcfationship 3nd remaining in hopes of solving the
relationship problems. (See Chapter 3 for a det3iled discussion of refotionship and
scssion31 contracts.)
anticipatory contracting:: Al~
• nl bE1~ ODaSellon-1 dients that ■ Anticipatory contracrina focuses on planning strategics and responses for events
plans kif predictable ew:nts. Antqii.;orr that ma)' occur during counselling, such as how co give fecdbaclc or how to respond
contracts prom!! g_uidance ICJ ~ • s
•d ansv.er the questioo. '"M.at shNld I to a drug use relapse. Clients 3rc often able to give counsellors valuable input and
doif .. !"' 3cfvice on how they (counseJlors) can best de3l with these events.
44 Chap1er 2
Immediacy (Eg:in & Schroeder, 2009) is a tool for examining and deepening the immediacy: Atool t« exiforing,
counselling relationship. It involves a process of evaluation that addresses the qmllity walualing. and deE1)erting CC11asEting
ielati>nships.
of the relationship in terms of its conmtcted objectives. The skill of immediacy can be
used to troubleshoot rcJationship prob lems. 1t promotes candid discussion rcg:irding
ways the reJationship might be changed to fulfill its objectives. \\:'Ith immediacy, rela-
tionship problems and feelings are addressed before they have a chance to have a lasting
destructive impact. (Sec Chapter 3 for an extensive discussion of this skill.)
Exploring and Probing Skills

Explorini a nd probini skills arc basic tools of interviewing that counsellors use to &ploring and probing: skills: S~
g:ithc.r information, clarify definitions, seek examples, and obtain necessary detail. uunsellors us.e to pth« inf«mali>n,
d Mify definiti>n, S£ek w mples. •d
These skills enable counsellors to avoid making assumptions. Active listening skills arc dltain necessary dftail.
the primary tools of exploration and prob ing. ~ausc they communicate counsellor
willingness to listen nonjudgmentally, they motivate and encourage dicms to tcll thc.ir
stories. When clients arc helped to explore their problem~ they often g:iin insight from
questions that provoke thinking in areas that may have been overlooked. As wcJI, reflec•
tive responses such as empathy help them g:iin perspective on emotions.
Directives, such as "Tell me more" or " Please expand on )'Our feeling~" control directives: Sllott state.nts that
the direction and pace of the interview. Directives can also be used to focus the client °'
promi!' directi>n to tlieals • s .
inforaution. and pace (e.g.•"Tell me
on reJcvam priorities. Directives arc the " road signs" of the interview. _,.I
Simple encouragers are short verbal and nonvcrbaJ cues that motivate clients to
continue. Verba] stntemcms such as "Uh.-huh" or " Yes" and short directives such as simple encouragers: Short phrases
and gestuiessuch as •1e1 me Ml!:
" Please continue." a]ong with nonvcrbaJ signals such as head nods and an attentive
"Co on: 'Uh-huh: and head nods that
posture, make up this skill set. enocuage dients to ocaiinue widl their
Counsellor self-disclosure, used sparingly, can be a useful tool that models appro- stclfies.
priate sharing of feelings. Counsellor self-disclosure ma)' reduce the clients' sense that
counsellor self-disclosure: Whal
their experiences or feelings are strange or abnormal. Subsequent],.•, when experiences uunsellors disclose personal opinions.
are "normalized," clients arc more apt to open up and share. Jn this way, counsellor ree.p, or aae<dctes, it can be a usfful
self.-disclosurc acts as an exploring/probing skill.
Humour, if timcJy, can be used to r~ucc tension or encourage clients to take a
it..-
toct that med.ls appropriite wring. ud
norauite the clients· feelilgs oc
~noes. CounS!lor self-di!dlsure
lighter view of their situation, but humour must be used cnutioust,., so that it docs 00( shooId be used spari. ,solety to Met
offend clients or trivia.kc their problems. tile needsoldientsiu way tu does IIOl
shift the foc.s to the a.selkll
Opcn.-cnded sentence completion statements give clicms an opportunity to "fill
in the blanks." The counsellor presents an incomplete statement, then pauses to allow humour: a uunselling tool that 'lltlen
the diem to complete the thought. Almost a.Jwa)'S, clients will finish the statement with appropriate and ~ II tiaed, ffl..l)' SU~
thc.ir own content. This is a p0\\terful strategy that gives clients full control of the answer PM the dewl>pment ol the relati>nship,
iedlltf taasia.. encc.age tile dient to
while the counscJlor controls the focus area. Here arc some examples: talle a lght.erviewol tilleir problem, or
How might you finish this statement? prom! an at.ernate perspective • tlleir
si1Ualion.
■ The one thing I need most from my husband is .
■ You're feeling .. .
■ So, the options 't'ou'vc considered arc .. .
■ Finish this statement. The one thing I nttd most is .
■ The next step is .
By responding to nonverbaJ cues, counsellors pay attention to such things as voice
tone, posture, eye contact, and facial expressions. Sometimes the content expressed
by a client's words is sufficient for undc.rstanding. But not infrequently, the major mean-
ing or intent of a client's message comes through the nonverbal channel CounscJlors
should never ignore the nonverbaJ channel, which enhance~ contradict~ or embellishes
verbal messages.
The Skills, Pt oc:es.s, a nd Pitfalls 01 Counselling 45

Managing transitions involves paying attention to or suggesting shifts between
phases or topics. This skill can be used to organi:e the flow of the intc.rvicw or to link
themes and ideas (see Chapter 5 for an e>..'tensivc discussion.)
Empowering Skills
empowering skills: S~ us!dto~p Empowerins: skilJs help clients mobili.!cconfidcnce, self-esteem, and control over their
clients mobilile ocafidefltf, self-esteEa. lives. Counsellors who arc committed to empowering their clients must start with a
•d contnf c,,,e, tileir lires..
basic be.lief that their clients arc capable of managing their own lives. They must relin.-
quish the mistaken notion that clients depend on them for advice, decision making,
and problem solving. Clients are empowc.red when they participate in decisions about
counselling goals and procedures.
The principle of sclf--dctcrmination introduced in Chapter I promotes empower-
ment by helping clients recognize choices and encouraging them to make independent
decisions. To avoid promoting unhcaJthy client dependency, counscJlors should not
do for clients what clients can, and should, do for themselves. CounscJlors should
acknowledge and give clients credit for their success. When clients arc successful and
they "own" their success, their confidence and self-esteem increase.
Four skill sub clusters are the essence of empowering: teaching, giving information,
supporting, and above all searching for strengths.
Teaching Teaching may be used in counselling as a way to assist clients in develop-
ing strengths. Skills training, rolc.-playing, and other tools can be used to hcJp clients
develop their capacities.
Giving Information lnformation giving empowers clients with knowledge of altc.r-
nativc courses of action, including resources that might assist them in dealing with
their problems. Counsellors may also offer suggestions and advice regarding problem
management.
Supporting Supporting is used to bolster clients' energy and optimism. To some
e:r...'tent, all counselling skills are supportive. Supporting reduces clients' feelings of
isolation and provides them with incentives to address their problems, express their
feelings. and begin a process of change. Supporting can also be used to tell clients
that they arc on the right track and that their feelings and reactions arc normal. As
well, supporting hcJps clients manage anxiety and stress, thus, incrc3sing their enc.rgy,
scJf<onfidencc, and capacity for problem solving.
Searching for Strengths Clients arc often besieged by debilitating problems and
chaos. Counsellors cannot ignore rc3l problems, but in the process, they should not
focus all their attention on problem situations and what is d't•sfunctional in their clients'
streng_ths approach.: Acounselilc lives. The strens:ths approach assumes the inherent capacity of peoplc. Jndividuals and
perspe«iw that asSllmes tile inherent communities arc seen to have assets and resources that can be mobili!cd for problem
capacity of people. lldimaals and
communities are seen to haw assets solving(Shcafor & Horcjsi, 2008; SaJceby, 2009: Glicken, 2004). Empowering skills and
•d iesoun:es that can be mobililed tw principles will be explored in more detail in Chapter 7.
poblea scf\ing.
Promoting Change Skills and Strategies
chal~ng skills: S~ us!dto Challenjpng s k ills arc used to encourage clients to e\laluate their behaviour and ideas.
e11CC1Jrageclients to critic-.a9/ e,aluate They push clients toward change and growth to fulfill the fundamental reason for the
their beha\tCIUr and ideas.
counselling relationship; hO\\•evcr, excessive or premature reliance on challenging skills
may strain the counselling relationship.
confrontation: Counstllint iliiiatiws Confrontation prods clients to critically examine thc.ir actions or consider other
that <Wlenp dients to criicall1 ex..ine
their acti>ns andfor consiier other viewpoints. CounscJlors may need to provide critical or corrective feedback, identify
vitr11pciills. overlooked strength~ correct distortion~ suggest other viewpoints (rdraming), or
46 Chap1er 2
request that clients assume responsibility. Confrontation skills arc: most c:ffoctive when
there: is a strong relationship of trust and when clients understand and accc:J)( the va.Juc:
of their use. Brill and Levine: (2005) offer this perspective on the challenging skill of
confrontation:
?l.·1isuse of oonfront2tion c:u, be de\'astat intt, dest ro,.,i,l{t all previous e(foru.. \Vorke-rS
must assess the 3tnount and quality o( eonfrontation the elient is willin& or able to use,
2nd they rnust be 2ble to Ki"e- support if the re:U1ty is overwheltnini.::. Worke-rS must
noc use confrontation l'O express their own an~-e-r and frustr2t.On. 2hhou,ah these 3re
etrt,iinl)' 2 part of the re:U1ty with whieh both workers 2nd dienu 1nust deal. (p. 186)
Ideally. confronrotion skills incre3sc: clients' motiwtion for change. The counselling
relationship provides the necessary base for confrontation. Clients are more likeJy to
accept confrontation as credible when counscllors have: first listened and folly under-
stood them. Clients may be appropriately confronted when they:
■ are working from false assumptions or incomplete information.
■ misread the actions of others.
• lack self~awarenes.,;; regarding the: impact of their actions (e.g., when they blame
others for the.ir problems rather than examining their own responsibility).
self-awareness: The pocesso! be::om-
ing atfrt and ~ 1edgeatle atout one's
~ WJ// d ttilling. acc.,. and feeling.
• demonstrate contradictions in their behaviour, thoughts, and feelings.
■ den)' or do not recognize their personal strengths, capacities, or resources.
Ac.rion p la n nini is a wa't' of helping clients bring about changes in the.ir lives. action ptanning: flelping cli• s make
These changes may include: finding new ways of managing feelings, forming strategies dl.-ges in tilleir liws.: ll'lolws setting
for modifying ways of thinking, or developing new skills or behaviours. Action planning
fOib, identi!Jing strategies t.Wn,e..
and dmlopilc ,.aans kif ieathing goals.
helps clients define dear and measurable targets for change(Koals), identify and evaluate
alternative: strntegies, and select and develop plans for reaching these goals.
Use of Power and Authority Counsellors derive or are given power by virtue:
of their position. Such pO\\•er comes from man)' sources: competence, knowledge,
education, control of resources, position in the: agency or status in the community, or
simply the fact that the: client is the one who is in the: position of needing or seeking
help. Counsellors are also rc:prc:sc:ntntivcs of agencies that wield power. For example,
child protection social ,vorkc:rs frequently make decisions and judgments that have:
a large impact on clients' lives. However gentle and caring counsellors arc:, clients
may perceive them as pe.rsons with power and influence:, and often as people: to be:
feared. Comp(on and GnJaway (2004) note: that families may have "negative expec:ro•
tions, lack of trust, and fear of commitment" (p. 152) because of experiences where:
they perceived professional authority to have been misused. Miller (2007) advocates
the importance of an anti-oppressive model of practice that recognizes the inher-
ent imbalance: of powe.r between clients and professionals. She promotes the use of
methods such as the: strengths approach, transferring power to clients, and involving
them in decisions (i.e., an anti-oppressive approach). As well, she invites dialogue:
on the important issue: of what professionaJs "can or should do in the presence of
organi!ationnJ and societal policies that do not support practising according to the:
frame,vork" (p. 132).
THE PHASES OF COUNSELLING

Counselling relationships can vary gre3tl)• in te.rms of time. Some evolve: over a long
period, but others may be limited to a few or even a single session while some may
last for only a few minutes. Counselling inte.rventions usually move through a planned
change: process involving sequentinJ steps or phases, each characte.rized b\•unique: as wcll
The Skills, Pt ocess, and Pitfalls 01 Counselling 47

phases of comselling: SEqtential as common objectives and skills. For our purposes, four ph a.«?s of counselling will be
steps tk(qh whi~ uuns.elling teads to
discussed: (I) preliminary, (2) beginning, (3) action, and (4) ending. This model builds on
begin-.g. act•
eYOl\'e. The four ,US.es are peliminary.
ending. similar modcls present~ by others such as Eg3n and Shroeder (2009), Shulman (2009),
and Young (1998).
Each phase is distinguished by its focus on different activities. The preliminary
phase is essentially for planning. Proper planning increases the likelihood that clients
will perceive chat their nttds can be met through counselling. The beginning phase is
a time of engagement, when both the client and the counseJlor make decisions about
whether they will work togcthe.r and, if so, under what structure. The beginning phase
is also a time for exploring problems and feelings. Although clients ma'>' begin to change
their behaviour or manage che.ir feeJings more effectively during the beginning ph3Sc,
the action phase is more concerned with initiating change. During the ending phase, the
working rclationship is brought to a close, perhaps with a referral to another resource
or counsellor.
SUCCESS TIP
£very counselling relat.ionship wiU have many begiMings and endings and lhe presence
and dynamics of each ShOuld be consider-eel. The most significant beginning is the start of
the rel3tionship, bul each session Or' encounte( also has a beginning. When the focus of
discussion Shifts to a diffemn1 topi:, lhis is at:so a beginning. Sirnilatly, ead'I encounte( also
has an ending and as each topic draws to a ctose, thi:s is also an ending. The end of lhe
relationshiJ) is a inJ)Ortanl enchng that deserves the hJI attention of the counsellOt.
One common objective of each phase is forming and sustaining a working relation.-
ship. Thiscounsclling relationship is the vehicle for change and pro\tidcs a base of safety
and security for clients to explore and understand their emotions and difficulties. The
counseJling contract, an agreement on the goals and roles of the participants, is the
reference point for the relationship. lt is continunJI)• reviewed and revised as the work
progresses.
A second common objective of aJI phases is to establish open, honest, and produc-
tive communication. Effective communication enables counseJlors to learn about their
clients' needs and feelings. As well, it empowers clients to learn new ways of handling
old problems.
The third common objective of 31) phases is evaluation. Ongoing cvaJuation can
review the esscntin1 eJements of the counselling plan (goals and methods), the ,vorking
relationship, or the overall satisfaction of aJI particip3nts with the P3Ce of the work and
its results. By using a problem.solving approach, counsellors and clients can explore
ways to ensure that the work is relevant and efficient.
Skill dusters heJp organize skills based on function. Since each ph3se of counselling
supports different acti\'ltics, each ph3se 3lso favours different skills. For example, dur•
ing the beginning phase of counseJling, relationship-building skills are the priority, and
ch3llenging skills arc usu31Jy avoided, al IC3st until a foundation of crust and safety h3s
been established. Exploration/probing skills arc also \•ital during the beginning ph3se.
They enable counsellors to acquire information for understanding. thu~ heJping them
avoid assumptions. Challenging and directing/te3ching skills tend to be more effective
in the action phase, when a strong relationship and a solid b3sc of understanding have
been established. T3blc 2.6 summa.ri:es the principal activities and priority skills of
each ph3sc.
Counselling tends to move through the phases sequentially, with success at
each ph3sc depending, in pa.rt, on the success of preceding phases. For example, the
48 Chap1er 2
TABLE 2.6 Counsel! ing Activities and Skills
Pbase P1lnclpal AtdwitlH Prlodty Skills
Preliminary • lntefView pre~Mtng • Planning
• Reviewi~ files and othef infOl'mation • Establishi~ Self-awareness
sources
• P(eparing the interview setttng
Begj.nning • Establishi~ a eollabOtative, • Active listening
professional worktng relationship • P(ornoting c0te cooelitioos
• lntefVieNi~ for understanding • Defini~ the relationsl-.p
• Evab.Jating (comracli~)
• Searching fot St(engthS
Action • Goal setting • Te.act-.~
• Action ~nni~ • lnfOl'mation giving
• Helping clients change behaviow', • Sup(X)rting
manage f/Mlfiogs, and cha~ • Confronting
unhelphA think.i~ pattems • Action planni~
• Revi:ss"lg lhe contract deepeni~
the relationship, and managi~
communication difficulties
• Evab.Jating goal progress and lhe
o~ing (elations.hip
£tiding • Ending the helping relationship • Giving information
• Referri~ client to other fesotJfOOS • Sup(X)rting
• Evaluating goal achievement
preliminary phase is designed to support the w-ork of the be-ginning phase. Jt allows the
counsellor to complete the prcp3rations th3t will help welcome chcdicnt to the ai;ency.
As wcll, it works as a lcind of warm,-up, so counsellors can be ready and sensitive to the
needs of their clients. Wc31c planning results in weak beginnings. Similarly, dfoctivc
work in the action phase is C3sicr when the beginning phase has be-en successful. A solid
base of understanding permits counsellors and clients to set more goals, and a founda-
tion of trust allows counscJlors to be more challenging in chc.ir approach. (n contrast,
counsellors who attempt to chaJlcngc dicms from a thin b3sc of trust arc likely to meet
with resistance or rejection. Even in the action phase, it is important to cry to sequence
the steps. Jf clients cry to dcvcJop action plans before they have set dear goal~ their
action plans are more likcJy to be vague and dircctionlcss.
Although counselling work tends to evolve sequentially through the four phase~
usuaJt,., it docs not move fonvard in a neat and ordcrt,., manner:
The loaiC:U Pf"OKn'SSion of these ph:lSt'S makes the p ~ appear to be 21 linear, step,by,
step Seto( 3Ctivities. In reality. chai,~-e, rarelr proceeds in ai, orded)• fashion~ r.tthe-r. it is
more o( 21 spi~I, with frequent return!? l'O pr.Or phases for cl::adf'.e2tion or 2 rev.>0rki1'{t
o( \':l.riOU!l tasks and ::.etwitie!l. (Shea(or &. Horej!li. 200S. p. 126)
The phases of counselling also provide a systematic and useful checklist of the key
activities and logical steps chat arc p3rt of the change or problem-solving process. By
referring to the phases of counselling, counsellors and clients can remain dear on where
they are in the counselling process, what has be-en done, what remains to be accom-
plished, and what options re.main open. However, as 30)' experienced counsellor will
attest, "cu.h counselling encounter is different, C3ch relationship is uniquely complex,
and the work may evolve in unpredictable ways" (Shebib, 1997, p. 71).
Sometimes dc3r dh•isions between the phases of counselling arc app3rcnt. But
more frequently, the.re arc overlaps between the phases and shifts forward and backward

between one phase and another, and, in some cases, phases may be skipped altogethe.r.
Some typical counselling scenarios arc provided here:
■ Jessica, a very private pe.rson, was distraught ove.r the breakup of her marriage.
Aw-arc of her inability to cope and 00( knowing what to do, she attended scve.ral
sessions with a counsellor. He.r counsellor proceeded slowly, gently encouraging
Jessica to mlk about her fccJings. Jessica was surprised that during the second coun-
selling session, she began to weep. Afte.rward, she remarked that she felt as if a great
weight had been lifted from her shoulders. She never felt the need to rerurn for a
third session.
■ Be.rt was n()( interested in exploring his problem beyond a superficial level. Anxious
to effect change in his life, he wanted to brainstorm ideas for dealing with his prob-
lems. Counselling worlc focused on helping him set goaJs. As this work progressed,
client became more trusting, and the sessions began to focus on exploring his
feelings.
■ When )O)'Ce was challenged by her counseJlor to examine how she might be
contributing to the problems she blamed on her boss, she became angry and
stormed out the office, never returning. A year later, a series of events caused
her to recall her shore-lived counselling experience, and she decided to cake some
responsibility for he.r difficulties. The counsellor never lcnew about the ultimate
positive outcome of the relationship that appeared to end so badly.
■ As Fernando mJked about his problem, he suddenly realized chat his siruation was
not as hopeless as he thought. Discovering another way to look at his problem
allowed him to identify several new ways to solve it.
■ After a single session, Bob remarked to his counsellor, "My problem is the same as
when I came in here, but somehow it doesn't seem to bother me as much."
The Preliminary Phase

The preliminary phase of counselling is essentially a time of planning with a focus on
nvo central casks. First, the agency setting is made attractive for clients so they are mori.-
vatcd to eng3ge and remain with the agency. Second, counsellors prepare themselves
for the interview.
CONVERSATION 2.2
STUDENT: What is the difference between a conversation with STUDENT: You're rigt\t. I find my famtfy can'I sepatate their
a helpful friend and a counsem~ interview? feelings from mine, and they atways end up givi~ me weU-
intentiooed but not very helpful advice.
TEACHER: The goat of a ftiendShip is to meet the needs
of bolh people. Frtends (and fanity) are important. If they TEACHER: Effective counsetors are comiortable d1scussi~
feeti~. and they dOn't tell c~nts. hoN they ShOl.,jj feet Goad
are undetstanding. caring. and supportive, they can be an
counselb"S are excellent listeners_ and they .West time to make
effective source ot help. As With a cour\Selll.ng felationslip,
just taik.i~ to a Mend can be cathartic to IM indrvidual. SUfe they accurately understaoo clients' feeli~ and concerns.
Counsellors know hOw to sys.tematicalty expl0te ptoblems.
TM fe.ality is that lhefe a,e lim,ts. to what Mends can
set goal~ and develOp plans f0t action. They assisl dients: in
offer. Sometimes friends. and famtly dOn't have speciali:zed
knowledge, Ot lhey may OOI know what (esotJ(ceS Ol se!'Vioos identifyi~ and evaluati~ altef'natives. 'llf'tile recognlzklg that
are available to deal with specific pfoblems. F' riends and the clients must cooose f0t themselves. Thefef0te, counsel-
lors do no1 impose advi:e or by to rescue dients: btf taklng on
famity may alSO be so emotionalty involved With you that it is
theif problems. Unltke friendstips. counselling retationslips
hard f0t them to be obi('ctive.
am dttected to meet 1rie needs of one person only-the dienl.
50 Chap1er 2
The Agency Setting Jdcally, the 3gency is set up to appc3J to the client groups that it
serves. A drop,-in counselling centre for teens should look different from 3 d3y program
centre for seniors. Dim lighting 3nd be3nbag chairs meet the needs of tee.ns but present
3 safet)• hazard for seniors. TC3 is 3ppropriatc for senior~ but a soft drink m3kcs more
sense when the clients 3re tttns. ldea.Jly, the agency should:
■ h3ve uncrowded waiting rooms.

■ allow for reception and interview space that is private and confidential.
■ greet clients in a w3rm and friendly manner.
■ provide for the needs of children (e.g., by supplying a pin)• are3 with agc-appropri3tc
tO)'S).
■ allow for wheelchair access.
■ h3ve posters and other art th3t do not violnte the value~ religion, or culture of the
ai;cnq's clients (generally, they should also be politically neutral).
■ h3ve up-to-date rc3ding m3tcrial in the waiting room.
But often counseJlors fail to ensure that their interviews arc protected from phone
calls 3nd other interruptions that impede the flow of conversation. When interruptions
3re allowed, the mcss3ge to clients is, "I have other concerns that arc more important
th3n you. Hurry up and finish."
Moreover, flexible office arrani;cmcnts arc best. Some clients and m3ny counsel,.
!ors prefor 3n unobstructed arrangement without 3 desk between the p3rticipants, but
others favour working over the desk. The office needs to be 3rranged with c3rcful
consideration to the mcsS3ges that the design communicates. Chairs 3nd desks should
be arr3ngcd so that no psychological advantage or power is given to the counsellor.
Seating 3rrang:cments should allow for adequate personal sp3ce between counscllors 3nd
clients. A comfort zone of about I to 2 metres (4 to 7 feet) is 3dcquatc for most client~
but other factors might result in 3 nttd for more or less distance.
CounseJlors also need to be c3rcful in choosing personal items to displa)•. Picrurcs
3nd memorabilia that punctuate differences between counsellors and their clients
should be avoided. Of course, clients may have different reactions. For example,
some clients expect and appreciate seeing their counsellor's degrees or diplom3s hung
on the wall. For these client~ knowing something about the tr3ining and crcdcnti3Js
of their counsellors helps to establish confidence and credibility. Other clients, how-
ever, may react negatively to such a display. For them, the display sets up soci3J and
inteJlcc:tual b3rricrs. GeneraJly, counsellors should structure their offices with the
needs 3nd background of their clients in mind. Jn this respect, clients can be an
invaluable source of consultation. Their opinions on office decor and (3yout should
be solicited.
Figure 2.1

Interview Preparation Counsellors can use the preliminary phase to predict how
the interview time will be used and to make decisions related to the time, place, and
structure of the interview. As well, counsellors can think about specific questions and
responses for working with particular clients, without setting up a script or rigid agenda.
Shulman (2009) suggests that for a variety of reasons, clients often do not share
feelings and concerns directly. They may be ambivalent about sharing, or they may
hold back because of socictaJ and cultural taboos about talking about sex, authority, or
money. As a result, clients may raise these concerns indirectly, and counsellors must be
alert to recogni!e dues about their clients' concerns. For example, a single parent who
asks her welfare worker if he has ever been on weJfare may be indirecth• expressing her
fear that the worker will be insensitive to the stress she faces in trying to cope with a
limited budget. Sometimes questions regarding personal background or circumst:mces
may be indirect ways for clients to explore concerns about trust.
Shulman (2009) recommends the preliminary phase skill of nming fn as a tool for
anticipating the feelings and concerns that clients might bring to the interview. By runing
in, counsellors can think about what clients might express and how they will do so. The
preliminary phase is also a time when counsellors examine their own readiness. For
example, counsellors should take a few moments prior to each interview to self-examine
through questions such as the following:
■ Am 1 dealing with persona] stress or problems that might make me less effective or
more vulnerable?
■ Am 1 sufficiently disengaged from my last client to be open and objective!
■ What personal biases do I need to mana,;e to work effectively with this client!
■ What reservations do J have about meeting this diem?
■ Do J have unfinished business with this client that J have not addressed!
■ What feelings do I have toward the client that might impo:le my objectivit)•!
Client Files The preliminary phase is aJso a time for fact-finding to hclp understand a
client's situation. For example, a counsellor could research Tourene's syndrome in prep-
aration for meeting a client with a child who has been diagnosed with this condition.
TypicaJly, most agencies have files on eac.h client that may contain considerable
information regarding the client's age, place of birth, address, marital status, work
history, educational background, prior experiences with counselling, and assessments
of personality, values, past problems, ability to handle stress, communication pane.rns,
and so on. Cliem files can also alert counsellors to any past incidents of violence and
point out any neo:l to take special precautions.
A review of client files can gready speed the intake process, but it is important to
maintain an open mind and avoid prejudgment, particularly with respect to the assess-
ments other counsellors have made regarding the client's manner and personality. Client
reactions are influenced in part (and occasionally) by the personality and behaviour of
their counsellors, as shown in the following example:
Russ waited for his counsellor, who was h:U( an hour l.:ue for the scheduled inter\'iiew.
Russ wu sc res.std bee1use o( pe-rsona! problems 2nd w3:S anxious l'O ~et home l'O ea.re for
his sick cluldren. Estelle. his counse1lor, was also stressed bec3use o( a di((kult v.--eek o(
work. Durin& her inter\+iev.> with Russ she wu 2lso 2w::are that her next 2ppointmen1 was
already w::aitina for her l'O l'rnish with Russ. Determined l'O c::atd, up. she ,newed quid.I)'
with questions 10 complete her assessment o( Russ·s situ:u.On. Russ, uiken aooek b),
Estelle·s ::abrupt style. proceeded cautiously. hesit2tin¥ 10 share person:U in(orm::ation
qukl.1,·. Later, when rompletif)¥ her Ole notes on the interview. Estelle: wrote: "Client
was defe:nslve and. ¥u:trded. He ::appeared unusl.l211)' reslrumt 10 ~plorinK his (ee11~"
52 Chap1er 2
_ CONVERSATION 2.3
STUDE:NT: If lhem's already a file on lhe clW!nl. ShOuld I read ST\J0ENT: I think anOlhet drawback is that If you do OOI IOOk
it be:fom seeing the client fOr' 100 first lime? at the ftle, you wtU miss out on 11.nc:,m~ what's bee-n done,
'llf\at wol'ked, wt1a1 issues are key, and so lorth. ts the-re a W:¥f
TEACHER: Thete are ptos and cons to reading clie-nt flleS in
of teading a file- withOut be-i~ in.fh.Jenced by othe-t writers?
ad\tance. It's important to be awate of the risks of either route.
Some counselt)rs pre-fe-r toconducl lheil' first interviews wtth- TEACH£R: Being awafe of the potential fof in.fl~n:e rS cru-
out reacfi~ lheil' clients' flleS. They argue that by not re.acfi~ cial. II is important to f&mind ourselves that opinions in ftles
the flies, they are prevented from being unduly influenced are not the clients' opinions but those of 100 pe-rson writing
(biased) by prior in.format.ion. After a fU'St k'lte-rview, they feel the rec0td. Ideally, fe-co<dS ShOuld be shelfed with clients and
mote able to evaluate 100 validity ot previous rec0r'dS. I.n add~ the conclusions pn.ttysupported. Of course, thi.s is n01 at.vays
lion, they argue that clients can cha~, and approachi~ the poss,i:.e.
interview with a freSh perspective makes it easier to relate to
ST\J0ENT: Could I share- the- file with lhe client to ge-t his Or'
the dient's present condition.
he-t reactions?
STUDENT: But suppose 100 client has a histOf')' ot violance
TEACH£R: Probably 001, at least nOI wdhOUI the- pe-rmission
that rS reported in the file. How wolld I be able to get that
of the- pe-rson W'ho wrote- 100 fecOtd. De-pe-nding on whefe-
inf0tmation to protect myself wtltle stil keepU'lg an open
you live, freedom of access to infofmation legislation may
mind? Is there a w.ry of getti~ onty the pertinent information
give dients the- rigf\t to petition for access to 100 file. Usu-
from the flle that would allow me to identify 1oose prOblems?
ally, the- onus rS on the agency 0t govemment department
TEACHER, Tharsane ol the d,a-NbaCkSof not madir,g the file. to pcovide a reason fOr' wtthhOlding in.formation. Counsellors
I like your idea of setting up some ldncl of pfocess fOr' ide-nt~ need to be famtfiat wtth 100 regulations in theit area.
fying clients whO might be dangefous. Clients wtlo pfe-sent
safety concerns could be "fed-flagged'" in SCll'ne way.
The Beginning Phase

Successful prdiminnry phase work establishes a base for the first mnjor cask of the
beginning phasc--namet,.,, developing n safe and trusting helping relationship through
which clients can work toward their ,;oaJs. This relationship between counsellors and
their clients influences whether clients will be willing to risk disclosure and is n signifi•
cant variable that determines whcthe.r clients will continue with counselling. The coon•
selling relationship is time~limitcd nnd based on a contract that outlines the objectives
and terms of the relationship.
Some clients come willingly to counselling, perhaps because of an unresolved
crisis or because they hnve been persundcd by others to seek help. Other clients arc
involuntary and, in some case~ overtly nntagonisric to the counsellor. They may also
be coming because of n current crisis or pressure from others. An employer, for
exnmple, may insist thnt a staff member seek counselling to nddres.s attitudinal or
addiction problems.
Many clients are also under considerable stress, and this stress is intensified if
the clients perceive counsellors neg:itivcly. Predictabt,.,, clients' experiences with other
agencies and counsellors shape their perceptions nnd expectations. Clients who have
had bad experiences with counsellors will understnndnbly be guarded ag:iinst further
disappointment. In addition, because counsellors arc often in n position of authority,
or clients Stt them in such a position, clients' experiences with ochers in nuthorit)• will
come into play. Most clients, however strongly they mn't' be mociwt~, will have some
degree of resistance or ambivaJence to change. Involuntary clients may be especially
resistant and, in some cases, hostile. They may perceive any initiative by their counsel-
lors as a hostile act, however, weJI mC3ning it w·a.s.

SUCCESS TIP
The clie-nl's reason f0t corning to counseling may 001 reveal itself until much later-. fear,
emba(rassment, trust issues, and ocher factors can impede irrwnedi:.ate intrOduction of lhe
problem. In lhe beginning, it is the counsellor"s job to engage with the Mpresenting prOblem.•
Successful engagement wilh this d'lalleoge helps to c,eate the conditions f0t mor'e intimate
discussion ot ocher issues.
The counselling relationship is fundamental to counscJling success. Even in short,

one-session encounters., when a high lcvcJ of intimacy is 00( crucial, clients will be more
apt to engage 3nd share when the counscllor gives some attention to dcvdoping the
relationship. Ch.nptcr 3 more fully explores the importance of the helping relationship
and specific skills for developing and maintaining it.
A second major task of the beginning phase is to acquire and deepen an under~
standing of the client's situntion or problem. ln rhe beginning phase, clients arc asked
to teJI their stories, describe their feelings. and explore their problems and dilemmas.
For their P3.rt, counsellors must be prepared to listen, and this mC3ns be.ing prepared
to learn. Preliminary phase worlc ma,., help counseJlors predict possible theme~ and
experience may tC3ch counsellors a g.rent dC3l about common needs and issues; however,
in the beginning phase, counsellors need to put aside all assumptions as they attempt
to appreciate the unique nature of ench client. The active listening skills of attend-
ing, using silence, summarizing, paraphrasing, questioning, and showing emP3thy are
the basic tools for this exploration. These skills tend to motivate clients to graduaJt,.,
open up, organi!e their thoughts, and identify their feelings. They move the relationship
beyond superficiality and hcJp both the counsdlor and the diem achieve shared under-
standing. Active listening also enables counscJlors to probe for detail~ definition~ and
examplcs--information that is essential for preventing assumptions.
The Therapeutic Value of the Beginning Phase The therapeutic value of coun.-
seJlors listening without judgment c3n be enormous. Active listening enables what is
often the most important pan of any counselling encounter- the opportunity to tcll
one's story and express feelings without interference. Since incense listening is rare in
eve.ryday encounters, clients ma)' be visibly moved when they fed heard. Moreover,
when counscJlors accept clients without judgment, clients become better able to accept
themselves. Effective counsellors aJso encourage clients to explore the emotional com.-
ponents of the.ir lives. \Vhen clients share emotion~ counsellors need to be c3reful not
to sabot:.lge this sharing by rescuing, telling clients not to fed as they do, changing the
subject, or conveying discomfort or judgment. In addition, as clients ta1k, they may
rdC3se a flood of emotions. A client might remark, "I've told )'OU things that no one
Figure 2.2
54 Chap1er 2
else knows." As clients open up, they may begin to fed unburdened, a process that is
known as catharsis or ventilation. catharsis: An eaotiooJI tell!'aS! of
Effective: counsellors probe: for detail by askina questions systematicaJly. They ~ about put «wrMI experifflces
t!l.i'! iesults in a po-«ml telei.se ol peal·
identify fodings and mirror them with empathic statements. This work enables clients up feelilgs su~ as aaiiety« ang$.
to organize: the.ir thinking and to explore: and accept their feelings. \Vhen clients are
confused or indecisive, orderly questioning helps them cateaorize information and
pinpoint details or is.sues that they may have ove.rlooked.
Cautions For some clients, a sinale session may be sufficient to meet their need~
and they may not return for the next scheduled interview. Sometimes they decide 00(
to return because they feel they do not need to. The cathartic release of emotions in a
single session empowers them enough to dC31 with their problems.
Other clients may quickly respond to the pO\\•er of the: counselling relationship
and disclose at a level they would 00( have predicted. Later, they ma't' fed embarrassed,
fearing that they have gone: too far, or they may resent their counsellors for probina into
areas they would have preferred to keep private. ln response, clients may cut off the:
counsellina reJationship prematurely, or they may come to the: next session but remain
distant and guarded to protect themselves from over...disclosina.
One: way to prevent problems is to be sensitive to individual pacing needs. Clients
may give dues that the session is moving too quickly. The counsellor should watch for
indicators such as hesitation, questioning why the: counsellor w-ants to know something,
or st:ne.mc:nts that the client would rather not discuss particular issues.
Another strategy is to discuss with clients how they fed about the session. The
following excerpt illustrates this technique::
CounseU.or: Later h'.)n.i~u, when )'Ou think about our time tOiether. how do )'Ou think
)'Ou ·u (eel?
Client: I think I w1II have mixed (eel in~ It was reall't' ~-ood to talk, but I wonder 1( I told
)'Ou mo much. I hope you will not think less o( me.
Counsellor: You took a real risk "'1th me in s~rinK your pri\'ate thou,ahu a.nd (~lu~j.
I think it's reason:able to worry about how I re:l.l!ted. Would )'Ou like to know!
Client: Ye~ verr much.
Coun.~ellor : Do you trust me enou,ah to belie"e th::u I will not he to you or tell )'Ou
somethin& Just t'O m.:tl:.e you (eel better!
(f the client SU)'S 't'CS. the counseJlor might candidly share: his or her reaction to the:
client disclosure:
Counsello r: I admire your coura~-t to Nice such painful issues.. As 2 result, I (e,el closer
to )'Ou 2nd beuer ::ible to underS12nd )'Our stru~e. Ko,. I don't think less o( )'Ou.
(f the client s3ys no, the counsellor initiates discussion of wh3t work nttds to be
done: to establish trust:
Counsellor: Perhaps w~ could ~lk. 2 bit about w~t needs to happen betwttn you and
me in order for )'Ou to trust me.
ln the pre-.•ious example, the: counsellor helps the client anticipate feelings that
miW't 3risc after the session. By doing so, thecounscllor can help pre-.•c:nt the client from
renching false: conclusions or making erroneous assumptions about wh3l happened.
For counsellors to h3vc: such discussions with clients, 3 hiah level o( counsellor sel{-
3w3reness is crucial. Counsellors need to be willina to examine: how they are refatina
to their clients. They should be adept at identifying any pc:rson3J biases (positive or
neaative) th3t they nttd to manage to work effcctiw.ly with their clients.

The Action Phase
(n the beginning phase, counscJlors work to understand their clients' perspectives,
and clients organize their thinking and express their feelings. The action phase
focuses on soh•ing problems, managing fttling.s, setting goals. and exploring altcrna.-
tivc strategics.
In practice, action•phasc work ma'>' happen simultaneously with beginning-phase
work, as clients ma'>' make discovc.rics or achieve insiaht from o:ploring issues, feelings,
and problems. Slcillcd interviewers ask questions systematically, probing for detail 3S
approprhne. This process aJone hcJps clients organi:e their thoughts on complex issues.
As wdl, summari! ing. paraphrasing, and responding with cmP3thy provide an impor•
tant mirror for reflecting clients' feelings and ideas. As a result, clients may Stt their
problems in a different light, or they ma.'>' discover choices for nction that they had
overlooked.
In the action phase, counseJlors pin)• a. key role by providing new information,
ideas, or perspectives. This involves challenging distortions of problems and encour-
aging clients to consider issues they may have overlooked. As well, counsellors need
to encourage the worlc of change b)• ensuring that clients set dear and specific goals,
which form the basis for the development of realistic action plans. Subsequently, coun.-
sellors may assist clients in implementing their plans. This assist:mcc includes hclping
them anticipate and address potentiaJ problems, as wd) as supporting them through the
struggles of the change process.. Counsellors aJso help clients develop new strategics for
coping through skill acquisition strategies such as role-playing or techniques for manag-
ing self-defeating thought patterns.
When clients experience the core conditions of congruence, empathy, and positive
regard, they become better able to accept themsdve~ less defensive, and more open to
expe.ricncing and accepting their feelings. Client attitudes and feelings change as coun.-
selling progresses successfully. Some of the important signals that clients are changing
and growing include the following:
■ cues that they feel less apprehensive about counselling and the counseJling
relationship
■ increased acceptance of feelings and more honest expression of previously denied
foclings
■ diminished negativism, seJf<loubt, and blaming of others, and increased optimism
and sdf-accepmnce
■ increased acceptance of responsibility for behaviours or choices
■ reduced sense of responsibility for the actions and choices of others
■ increased empathy for others (Gilliland & James, 1998, p. 115)
Figure 2 ..3
56 Chap1er 2
Figure 2.4
As noted earlier, bcginning•phase and action.-phasc activities can happen simul,.

taneously. Shifts between bcginning•phase and action-phase work arc also common.
For example, clients may explore a problem in depth, begin a change program, and
then revert to beginning-phase work to rocklc another problem area. Some common
scenarios include the following:
AO$;elo's counsellor ene<)U~e<l him to deseribe his situ::ation. As he ~lk.ed. he disrov..
ere<! :lSpttt.S o( his problem th:u he h::.d overlooked :md that su~sted new possibilities
for immediate ::.etion.
P2ri,·ash tended to keep her (ee:11~ so v.--ell hklden th::u she w:u unav.>2re o( their effet!t
or intensity. \(i ith iti>ntle encour2~-e.ment from her counsellor. she be~a.n t'O open up.
Talki0$: about her (eeli0$;$ represented a dramatic s.hi(t in her beh::tviour. The therapeutic
value o( this than,Ki' was enonnous, as she unburdened hel"Sel( from a lifetime o(
pent-up emotions..
Chapter 7 will explore how to assist clients through the worlc o( the action phase.
The Ending Phase

Successful termination starts in the beginning phase, when the nature and limits o( the
counselling contract are defined. When counsellors and clients agree on the 3ctivities
3nd goals o( counseJling, they have defined a point of termination. This point becomes
the target o( 31) counselling work. Although the target may change as client needs and
progress arc rc-evalu3tcd, counsellors should reinforce that termination is 3 reality o(
the counseJling relationship.
Although evnlu3tion is 3 component of all phases of counselling, the ending phase
is 3 major opportunity to 3ssess what h3s been accomplished and what remains to be
done. 1t is a time to help clients make the step to independence and to consider new
directions 3nd goals. It may 3fso occ3sion3lly be a point of transition. such as when a
counsellor refers 3 client to another service. The ending phase is also a time to cvaJuatc
the counselling rc1ationship. This e\laluation ma)' involve addressing any unresolved
concerns and expressing feelings 3bout the ending o( the rel3tionship. See Chapter 3
for a more complete discussion of endings.
COUNSELLING PITFALLS: BARRIERS

TO SUCCESS
CounseJling rcJationships 3re formed to 3ssist people to reach goals such as making a
decision, dealing with painful feeling~ improving interpcrson31 skills, or man3ging an
3ddiction. Outcome success is easy to define: lt is measured by the extent th3t goaJs
3re reached. Me3suring the success of an interview or communic3tion momem in the
The Skills, Pt ocess, and Pitfalls 01 Counselling S7

interview is more difficult since much of the ch.nnac w-ork happens outside the interview.
An example illustnnes:
Jerome stom~ out of the inten•iew when hii counsie1lor21sked him to consider how his
drinkh,i n,iaJu be afftttifl¥ his family. His 3.11i r)' w<>n:ls 21s he sl.:unmed the door left the
eounsellorleelinK r21ttlOO: "You're just hke ::.11 the rest. I thou~t '>·ou v.--ere on my side.
but it's dear my wife hasp to )'Ou... Six months later, Jerome' s situ:uion deteriorated
10 the point where he was re::.clr to re6eet on his ::.cldietion. The counsellor's ehallen{ti'
bee.me an important p3rt of his ri'(".(J\~ry.
NevcrcheJess, counselling can and docs fail, so counscJlors neo:I to develop their
capacity to S)'Stcmatically investig3te and review failure. They need to be able to distin.-
guish between failures thal arc beyond their control and those aused by their own mis.-
takes. Failure may originate with the client; it ma'>' arise from pcrsonaJ issues associated
with the counscJlor, such as faulty technique or lade of skill; or it may stem from factors
that arc outside both the client's and the counsellor's control. Eg3n and Schroeder
(2CX>9) put it bluntly when they described what they call the shadow side of helping:
Helph,i mode.ls ::are fb,,,,.ed~ helpeTS are sometimes selAsh and e\'en predator'>' and the,.,
::are prone 10 burnout. Clients ::are sometimes se!Osh. la:r, and pred::amry. e\'e n in the
helpina rel::ationship. (p. JI)
Client Variables
Substance abuse or menta1 disorders may make it difficult or impossible for clients to
enga,;c with the work of counselling. Clients may resist or undermine counselling because
of secondary g3in, whe.re the payoffs from maintaining the problem outweigh the benefits
of change Or clients may resist change because of an unconscious foar of success, because
they expect to fail, or because the risks of chan,;c arc too frightening to face.
Counsellor Variables
lntdlectually and emotionally secure counscJlors are willing to examine their methods
and attitude~ and they are willing to take their share of responsibility for poor counscJ-
ling outcomes. Counsellor variables include mental attitudes, mood~ and behaviours,
all of which an dramaricaJly affect how counsellors relate to and assess their clients.
Some counsellor variables that affect counselling outcomes arc burnout and vicarious
trauma, personal problems, and loss of objectivity.
Burnout and Vicarious Trauma A career working with people in crisis may be
intenscJy satisfying, but it can also be emotionaJly srressful and draining. Counsellors
may experience unrelenting pressure in worlcplace demands, including high caselo3ds,
limited resources, and crushing paperwork. Counsellors can become depleted from
trying to respond to the needs of their clients and the organization. ln addition, coun.-
seJlors arc subject to the.ir own famil)• and economic stress and trauma. Counsellors
may be resilient, but even the sturdiest person can become debilitated by stress.
Personal P·roblems Counsellors are subject to the same stresses in lifo as other
people. They can become depressed, their children an become ill, their marriages can
foil, or they can become responsible for caring for ailing or elderly parents. Responsible
counsellors accept that there ma'>' be times when they need help too. They recognize the
importance of having people in the.ir lives to whom they an ask for assistance. \\:fhen
counsellors have healthy reciprocal relationships with others, they arc less likely to use
(subconsciously) the.ir clients to meet these needs.
During acute periods of stress, counsellors need to recogni!e their vulnerability
and take steps to protect their clients. These steps might include taking a temporary
58 Chap1er 2
reduction in workload, shifting to a less demanding caseload, caking a "mentaJ health"
break, or s«king increa~ supervis ion or consultation to monitor their worlc. Jn
extreme circumstances, they may choose to take an extended IC3ve or switch careers.
SUCCESS TIP
Asking for help is a sign of strength, nor weakness. This rS true foe d ients, and it is alSO 1rue
to( counsetlOl's..
Loss of Objectivity Objectivity is a measure of counseJlors' capacity to relate

to clients without allowing their °"'n feelings and biases to distort their judgment
(see Chapter I for a detailed d iscussion). A number of facto rs can lead to a loss of
objectivity, including unresolved persona] problems. difficulty dC3Jing with panicu•
Jar emotions or topics, attraction or revulsion to clients, over-identification with di•
ent~ and excessive or unrealistic fear of particular clients.
Counsellors who are not aware of their values and beliefs and the impact of their
behaviour on o thers are limited in their ability to monitor their levcl of objectivity.
CounseJlors who are committed to increasing the.ir objectiv ity make themselves avail•
ab le for foedbaclc o r supervision. Moreover, they recogni:e their personal limitations
and their inab ility to wo rlc objectively with every client. They know when to refer clients
to other professionals.
Common Mistakes
CounseJlors are constantly ma.king choices. They must decide which of the three
domains to exp lore (feeJing, thinking. or behaviour). They must choose which skills to
use, how much to probe and cha.Henge, how fast to move the process forward, and which
materiaJ is relevant to pursue. A ll of this happens in an environment (reJationship) that
is often ambiguou~ o ccasionally hostile, frequent!)• complex, and constantly changing.
Tab le 2. 7 o utlines the top 10 most common counselling errors.
Pseudo-Counselling: The Illusion of Work The goal of every counselling rela-
tionship is to improve the q uality of life for the client. Achieving this goal may invo lve
problem resolution, assistance with decision making, or management of painful feel-
ings. Counsellors nttd to screen their responses and activities to ensure that the.ir work
supports the objectives of counselling.
Pseudo-counselling involves what Shu lman (2009) describes as the illusion of p ~ l i n g {illusion of
work-co unselling sessions are animated a nd active, but they are essentially empty and WOltc): Apoces.s ifl .tlith tile w.o!Mf and
tile ciefll ~ ifl a ccaversati>n that
is empty and tut has no teal me.ing.
TABLE 2.7 Top 10 Counselling Errors Counselling -.,1Nskrelevan1e,:ilorati:in
d is.sues. use ol diches and p;r.roniliflt
1. Rigidity and use of a "one-si:ze-fits-a11· apptoach platiudes. iMelectu.al esploratio. ol
2. Insufficient attention to the counseflOl'~lient relationship is.sues, and a-,Odaf!Cf ol subf.d.S or
~ lhat-.,oh~ paifl ifl fl\'Otlr d
3. A<Mce givk\g '"safe·1opits.
4. Absence of com conditions---empathy, unconditional positive fegar'd, and genuriooess
5. Missing the opportunities offered b-f paying attention to the nonverbal channel
6. Loss of Ol>jectM1y and judg,nenlal responses
7. Pad~ ptoblems (too fast, too stow. and i.napproptiate timing of resJX)nses)
8. lnapptoptiate use of self~isclOSure (too mud'I. too little, and poor1y lmt:?d)
9. Rescui~. fatse re.assurance, and minimi:zing prOble-ms
10. Cultural insensitivity

without rcaJ me3ning. Shulman makes this important observation: "For the illusion to
take place, however, two must engage in the ritual. The worker must be willing to allow
the illusion to be created, thus, participating in its maintenance" (p. I 54). The illusion
of work can be Crc3tcd through the following:
■ interesting but irrelevant exploration of is.sues that do not contribute to problem

sohting. including an excessive focus on finding the root causes of problems
■ use of dichi:s and patroni! ing platitudes
■ overly intellectual exploration of is.sues
■ avoidance of subjects or ftt.lings that involve pain in favour of S3fc topics. Of course,
it is sometimes appropriate to shift the focus to S3fc arc.ls of discussion (e.g., if the
interview is almost over, or if clients are dearly unable to handle additionaJ stress).
Inappropriate Advice Giving Society conditions us to seek advice from expert~ so

it's not surprising that many clients come to counsellors expecting "expert advice" on
how to mana,;e their lives and solve their problems. Students and beginning counsellors
often believe that counselling rttauires them to listen P3tiemi)• to their clients' problems
and then offer advice on what they should do. However, they nttd to learn that this
approach is rare]y helpful and is sometimes harmful to clients. p3rticularly when such
acktice is based on vaJues that arc inconsistent with the client's lifestyle or culture.
Clients often s«k advice even when they know what to do to m3na,;e the.ir problems.
Sec.king advice cnn be a way of expressing dependency or transferring responsibility for
decisions and outcomes to someone cJsc. This dependency inhibits the riWlt of clients
to make choices, and it may le3ve clients fccJing resentful or frustrated, particularly if
the advice was unsolicit~.
Advice giving ma'>' incrc3se counsellors' self-esteem by underscoring their ability
to be resourceful and helpful, but it may also undermine clients' self-esteem, leaving
them feeling inadequate bee.awe they have been unable to figure out their problems
for themscJves or bc-c.ausc they lade the will or resources to act on the "good advice."
Counscllors who tend to give advice can become overly concerned about whether clients
follow their advice, and if so, whethe.r the advice is successful. They can also become
disappointed when clients do not follow advice.
As Compton and GaJaway (2004)condude: "it is n()( your job to 'fix' clients. Rather,
)'OU help them set and work toward goals. You assist them to recognize and use person.-
in-situation strengths and resources for problem solving and go3l atminment" (p. 82). \\:le
arc in a better position to empower and promote client scJf-Oetennination if we refrain
from giving advice and if we honour what clients bring to the rcJationship:
■ knowledge regarding themsc]ves and the siruation

■ knowledge about the origin and devcJopment of the problem
■ expectations about how you can hcJp
■ a network of social rcJationships
■ views about what they would like to accomplish
■ strengths for use in pursuing goals (Compton & G31away, 2004, p. 82)
This injunction ag3inst ad,tice giving does not me3n that counsellors should with.-
hold information or ideas that might benefit their clients. Herc are some examples of
information or ad,tice that counsellors might provide:
■ tentative suggestions regarding alternative courses of action that the client has
overlooked: however, "when counscllors are unwilling or unable to present and
explore all ,tiable alternatives neutrally, they have an ethical responsibility to refer
60 Chap1er 2
the diem to another counsellor, or at the very least, to make their biases or limita,
tions explicit" (Shebib, 1997, p. 33)
■ ex-pert information based on resC3rch or knowledge (e.g., job-sC3rch techniques and
child-rearing principles)
■ ideas for improving communication or problem solving
■ sugi;estions regarding the process of problem resolution
■ opinions and information that will help clients avoid unforeseen consequences
(dangers) to themsdves or impulsive or poorly considered action
\Vhere there is a range of individual choices, such as decisions related to marriage
or career, advice giving is inappropriate. In such circumstances, the role of counsellors is
to assist clients in identifying alternative courses of action, then to help them weigh the
advantages and disadvantages of each alternative. Counsellors may suggest alternatives,
but they should do this in such a way that clients feel frtt to reject their suggestions. As
a rule, counsellors should probe for client ideas first with questions such as "\Vhat are
your thouRJus on what to do?" "\\:fhat arc your choices?'' "\\:'hat advice could you give
yourself?" "\Vhat idC3s have you considered but rejected!"
Rescuing R escuing, or "band-aiding," involves actions that prevent or pr()(ect rescu~ Alsoc-.iled ~ aiding, dlis
clients from dealing with issues or feelings. Rescuing arises from the counseJlor's need irm:ilws acounsellor's adionsthat pre•
wnt or piotea diffl1s from dealing Mith
to avoid tension and keep the session cheerful, but it is misguided because rescuing issues or ffflings. Rescuing arises frcm
diverts clients from addressing important though difficult issues in their lives. Rescu- tile counS!lor's need to a-,oid tensioo ud
ing is therefore a misuse of the support function of helping. Counsellors may become keep the sessicadleeml
so preoccupied with avoiding or reducing tension that they interfere with their clients'
ability to cope or to solve problems. Jf problem situations arc to be worked through
successfully, clients must be allowed to experience and express painful emotions. For
their part, counsellors must develop their ability to be present for such work without
their °"'n needs and anxiety interfering or becoming a burden to their clients.
SUCCESS TIP
Advice giving and tescui.ng arise more from the counsellOf's ooed to be helpful, intelligent,
Or' powerful lhan thQ client's nQQdto receive ad\lk::e o, be mscued.
There are three major types of rescue bdi.aviour:

t. Ten.sion reducer.s: Avoiding cough but otherwise timely and important topics and
feelings by changing the subject, using humour to cut off discussion, or suggesting
a coffee break.
Rodney MIS On:11Ur willina to ::.ddress his sadness O\'er the death o( his l2theT. As
he ~ n to talk. he cried so(tly. As he d,d so. his counsellor reached out and put
her hands on his shouJden. reassurinSt him that his ariel would P3SS.
Par hcsi121td lor 2 1noment as he stru~ed to collect his thol¢hts. ScnsinSt t~t
tl,is miaht be a p.,inful moment for him. his counse.lJor s~ested that he miaht
prefer to ~lk about somethina else.
CounscJlor responses such as these impede the work of counselling b\• prevent-
ing or discouraging clients from dealing with their feelings. For clients to learn to
manaae their emotion~ they must be allowed to experience the.ir pain. If counsel-
lors communicate discomfort or disapproval with expressed em()(ions, important
opportunities for work may be lost.

2. Placaring: \Vithholding potentinJly helpful but criticaJ confrontation or offering
false feo:lback and empty reassurance.
T::u·a expresud fear 3bout c:on1,iC'tin~ her l:1the-r, with whom she h:td not ~d
oon1:v!t for llve )'e3rs. Her oounsellor offered support: "Everythll,i is it(>ina to
work out v.--ell. J'n, sure )'Our father will be tts:t3tk 10 see you...
Shirtq· decided oot 10 oonlront herd1e:n1 O\'e-r an obvious h)'pe:ne problem. She
oonduded that it would be be-st not to upset he-r die:nt 3nd jeop:u-di:e- a stroll¥
rel::n ions.I, i p.
3. Beh.a,.,iours rMr impede independence: Speaking for clients and doing for clients what
they are able to do for rhemsdvcs.
Jessie's C'OunselLor w3nted to be seen :u helpful and resourceful. She offered to
rewrite her d1e:n1's r&:unW, 3nd pkk up :lpplk::nion lonns from ~ I emplO)-e-rS.
Jolie was h::1:vh1i t rouble- unde-rstandini 2 school :usi~nrne:nt. His C'hild C'are-
oounsellor phoned his te-::iC'her to ,isk lor c:13ri(k3tion. e\'e:n thoud, Jose w3s
C':2EX'ble o( talkina to the te-::id,er himsel(
For clients to become independent. they need to dcvdop the skills and srrength to
dcaJ with their lives on the.ir own. This ma)' be a difficult process for diem~ requiring
counsellors to be supportive without stifling their clients' growth. Counsellors must
avoid unduly protecting their clients by inte.rforing with their opportunities and capnc:it)•
to face their diffteultics. This requires counsellors to be full)• aware of their own need
for power and control and to accept th:.n successful counselling requires clients to be
their own problem solvers. Furthermore, counsellors must rid themselves of an)' fnnmsy
that only they can save their clients.
Communication Stoppers Some responses tend to bring communication to a hair.

Rescuing and advice giving arc two prime examples, but others th:.n have the same
effect include name cnJling, "pln)ting psychologist" by offering clever but unsolicited
assessments, commanding, morali!ing, minimi!ing the fcdings or concerns of others,
using platitudes or clichCS, and excessive use of interrogating question~ cspcciaJly urhy
questions that tend to aslc for justification or communicate subtle judgment. Abrupt
subject changes are aJso communication stoppers. They may communicate that the
counsellor is uncomfortable with the topic or feelings expressed.
Faulty Technique Some of the problems that a.rise in counselling can be attributed
to counsdlors' inept use of skills. Poor technique can lend to missed opportunities
-
CONVERSATION 2.4
ST\JOENT: What rS the diffetence between supporting clients the begk\niog of a relationslip, and it may be hazardous to
and f&Seuiog them? expt)fe highty em::>t.ional topics ne.af the end ot an interview.
AA imporiant quest.ion fof counsetl0ts to considef is ·Whose
TEACHER: Rescuitlg robS c~nts of legtt.imate opportunities
needs are being met, mine or the client's?· Rescuing behav-
f0t gro-.,h. Support;~ promotes self-ooterminauon by prov;d-
iour moots counsenors' ooeds undef IM guise of helping
itlg encoufagen-.ent 0t resoufces to motivate clients toward
clients, but supportive behavio1S helps clients realile IMir
growth and cha~. Tuning is atso a factOr'. Rescuing OCCU(S
objecti\les. In the loog run, thefe are limes when it rS m0te
when clients have the srre~ to deal with difficult areas Of
supporti\ie to anow clients to face lheir struggtes and experi-
°'
feelings, but theif counseuors avoid the wor'k paitl that this ence tnek parl. Effective counsetlors afe courageous en~
woukS entail. On the othef hand, if clients are overwhelmed,
to alloN clients to express their paitl and accept the feality
some direc1 assistance by counsenor-s to leSSen their bu(den
that they cannot pfovide solutions to al problems.
rS supportive. It may be wise to avoid excessive intimacy in
62 Chap1er 2
and, in c:xtrc:mc: cases, can be: harmful to dic:nts. For example:, counsc:llors might foil to
respond to individual diffc:rc:ncc:s (c:.g., gendc:r and culture), or thc:y may ding to a rigid
"one: style fits all" approach to counselling. They may also be: poor listcnc:rs, or they
may lack empathy. They might push clients too quid:J,.,, or they might allow them to
stagnate by neglecting to motivate them to make: changes.
Uncontrollable Variables largecasc:loods may precludc:counseJlors from spend-
ing sufficient time: with thc.ir dicms. Resources may 00( be: available: to support
clients in thc:ir change process, such as at a detox facility. ln addition, unexpected
evc:nts and crisc:s such as illness, dc:ath, or job loss may frustrate progress. (n some:
cases, clic:nt changes ma't' be subverted by family and friends who are unprepared to
support change.
Defence Mechanisms Sigmund Frc:ud (185~1939) first used the: tc:rm defence defencunechanisms: ._.al
mech a n ism to describe how people protect thc:mseJvc:s from aru:ic:ty, unpleasant pnnss or teaeli>n that shields a P£fSOfl
frca•O.Sirable or.acceptable
thoughts, and persona] threat. To some c:xtc:nt, the: use of defence mechanisms is
t!loughts. f.eelings. • to11tlusi:ins
normal and healthy; it nJlows us to cope with the demands of life. But dc:fc:nce mecha, tll.tt. if acoeptei 'llcd:I create _,.ty
nisms are problematic when they are overused or when they prevent us from dealing « euleng_es toone·s s-.eet self.
Common de.ieace m.chanisms ilclude
with problems that should be addressed. Herc: are some: common dc:fc:nce mechanisms dellial dispbc-=at. r;11ionalilatiln,
that counscJlors are likc:ly to see in their clients. suppessia..-6 regrmion.
■ Acting Om. Expressing emotionnJ distress behaviourally. Example: A 't'oung child

deals with hc:.r frustration by breaking her doll.
■ Denial. Refusing to accept or admowlcdi;c: what may be dc:arl't' c:vidcm to others.
Example: A man with a drug addiction will not admit he: has a problem despite:
considerable evidence: and feedback from othc:rs.
■ Displacement. Transfer.ring fc:c:lings to a less thrc:atc:ning person or object. Example::
A man who is angry at himsclf for losing his monc:y at the casino talcc:s his anger
out on his wife.
■ Diuociacion. Separating or disconnecting from reality. Example: Amnesia as a reac-
tion to a trauma.; daydreaming.
■ Humour. Avoiding c:motionaJ conflict by looking at the humorous aspects of the
situation.
■ lncdlecmalitacion. Avoiding fc:c:lings through excessive abstract thinking. such as
focusing on the details of an event, while losing touch with the: associated feelings.
■ Passit-e Aggre.uion. lndirccth• expressing aggression. Example:: Withholding hc:lpful
ideas or information from someone you dislike.
■ Projection. FnJsdy assigning our own unacceptable fccJings to othc:rs. Example: An
ajlR'..ressivc: person sees othc:rs as hostile and angry.
■ Rarionalitacion. Using sclf/4crving but incorrect explanations to avoid emotional
rurmoil. Example: A woman who did not get a job promotion rationali:es that she:
did not want the job anyway.
■ Reaction Formation. Substituting behaviour, thoughts, or feelings that arc the oppo-
site of those that are unaccc:ptablc:. Example:: Being overly friendly or hc:lpful co
someone you dislike.
■ RegTeuion. Reverting to an c:a.rlic:r form of coping.. Example: An adult sulks rather
than using problem solving to dc:al with a diffteult situation.
■ R$ression. Keeping fc:c:lings and mc:moric:s out of conscious awareness (but they
still continue: to influence: behaviour). Example: A ,voman who was sexually abused
as a child may have: no memory of the: c:vcnt, but she: re.mains uncomfortable with
physicaJ touch as an adult.

■ Spliuing. Stting or experiencing things only as polar opposites. Example: Seeing
others as either perfect or totally inadequate. This defence: prevents people: from
considering more balanced views and expectations of self and others.
■ Sublimation. Involves converting unacceptable feelings or impulses into more acceptable
behaviour. Example:: Dealing with anger through involvement in martial arts.
■ Suppreuion. Dc:liberatc:ly avoiding thinking about feelings or thoughts that provoke
anxiety.
(Smm't': A1ne-rica.n Pi<)~.hfatrie A$$0Cfa.tion. 2COO. Grohol, 2015. Mcleod, 2008)
SUMMARY
■ Counselling involves a tim~limitc:d relationship designed to hcJp clients increase
their capacity todea.1 with the demands of life such as dcnJing with fcdings, learning
new skills, making decision~ and accessing resources.
■ Counselling case.loads arc: characte.ri:cd by diversity in culture, gender, age:. religion,
sexual orientation, language. education, economic ability, and so on. \\:forking with
diversity requires counseJlors to be: adaptive and to be able to use: rcsc:arch throry
and experience: as guides to determine which skills and procedures best meet the
needs of their clients.
■ There: arc: four essc:ntia.1 clements of a trauma~informc:d approach: trauma aware~
ness., emphasis on safety and trustworthiness, opportunity for choice, collaboration
and connection, and srrengths-baS(Xf counselling and skill building.
■ Four major skill and strategy dusters define the: range of necessary skills for coun~
sc:llors are ( I) rc:lationship~building, (2) exploring/probing. (3) empowering and
strength building, (4) promoting change.
■ The: four counseJling phases arc: (I) preliminary, (2) beginning. (3) action, and
(4) ending. Each phase: is charactc:rizc:d by unique tasks and skills. During different
phases of the relationship. different skill dusters assume priority.
■ Many variables can lead to poor outcomes in counselling. C lient variables include
unrealistic expectations and poor motivation. Counsellor factors such as burn~
out, pc:rsona.J problems, and loss of objectivity can also lead to failure:. Process
or faulty techniques, including pseudo-counselling, advice giving, and rescuing, can
contribute: to failure. Finally, failure may arise from factors outside the: control of
counseJlors and clients.
EXERCISES
Self-Awareness 3. Desctibe a situation in which you gave advice to or rescued
1. Think of a recent o, current prObtem that you are fac~g. someone. Do you have a tendency to give advice 0t rescue
Oescr'ibe the ways lhat counselling might be used to assist others? Seek feedback from Olhe:r'S who know you to see if
you rn addressrng this prOblem. Usi~ concepts from this theit perceptions agree with your setf-evatuation.
chapter, identify what mighl be the maj0t activities lot ead'I
Skill Practice
phase of counselling.
I. Imagine thal you are teSJX)ncling to lhe foUo-Ning dient
2. Review the taskS of ead'I of the phases ot helping. With whi:::tl
questions: What is counselling? HON does ii WOrk?
phase oo you feel most comfortable? Least comforta~?
64 Chap1er 2
2. lnter'View cOleagues or counseltorS fonn the field. Explore _ _ _ The counselling ptocess evOfves sequentially
the.' answel'S to lhe fellowing question: What are some of through a number of phases, ~th each phase having spe-
yout bigg&St counselling mistakes.? What did you leam from cifte taskS an.d te,ciuiring specific skills..
the-m? ___ Effective counsenors are consistent. They use the
same Skills in lhe same way throughout the counselling
Concepts
process.
1. Rate 100 extent that you think each of the fOflowk'lg srate--
___ If the pr1n.dples of counselling are applied effec-
ments is ttue usi~ lhe foltowing scale (be ptepared to
tively, all clients wil be helped.
defend yout answel'S):
___ Eve,ything that happens in the counselling inter-
4 = always
view muSI be treated as confidential and Shared with no
3 = fre,ciuently one. Thi:S is the law in C3nada.
2 = sometimes ___ Effective counsetling invdveS bleoeli~ the client's
1 = tarely OOeds with tt'IOse of the counsellor so that everyone invcived
0 = never is satisf~.
_ _ _ It is important for counsetor'Stodevelo,:, a personal ___ The Skills of counselling are also the skills of effec-
Sl)te so that they 1reat all clients the same way. tive ev«yday communication.
___ The counsem~ process has a IOt in. common. with 2. Write a Short essay supporting lhe follo-/Mg atgument: The
the processes used by other professionalS, such as doctorS capacity to accepa help from an01her- person is a sign of
an.d lawyerS; lhus, competent counseltors gather- informa- sueogth.
tion, diagoose the problem, and offer- SOiutions or advice 3. In 'lff'lat ways might advice giving di:Semi»NEr clients?
to their clients on the beSt tesdution. 4. What do you think are the advantages and disadvantages of
_ _ _ Usualty, clients W'ho seek help are in ctisis, and wot'Jd~ from a fout-phase mo:Jel of counsem~
theit ability to make decisions is significantly impaited. 5. Identify and ex.ptore clients' legal rights to access fde infor-
Ther-efO(e, it is im(X)l'&ant lhat counsellOrS are comfortable mation in your jurisdiction.
with maklrlg Ul1portant decisions on behalf of theit clients.
6. List the pros an.d coos of displaying ead'I of the tonowing
_ _ _ The application of sktlls or techniques deltacts in yout office:
from spontaootty.
a. famlly phOtos
Prolessional counsellors sttive to be free of biases
b. motivational JX)Stel'S
___ CounsellOl'S wM have perSOl'lal expe-rieoce wilh the
ptoblem or issues that their c~n.ts are experiend~ 'liifl be
more effective.
WEBLINKS
This site offM links to a wide range of resou1ces on a variety Article that ext,IOres 15 Common Defence Mechan isms
of psychOlogy topics http://psychcentral.com/
www.psywww.com/resource/bytOPfC.htm lib/ 15-common~efense-mechanismsl
Government of Manitoba manual on trauma-info,med p,actice Rep,int of a classic article by Cati Rogers, the founder of
http:/lltauma-tn fo,med.catwp..contenVuploads/'2013/ 10/ Person-Centred Counselling..
Trauma-tnf01med_Toolkit.pdf http://psychclassiC$.yorku.ca1RogerSltherapy.htm
l he Skills, Process, a nd Pitfalls ol Counselling 65

Designer49 I/Shutte,s;o:k
■ Explore the features of a counselling relationship.

■ Explain the importance of the core conditions of warmth, empathy, and
genuineness..
■ Oemonstr:ne ability to negotiate relationship. anticiP3tory, and work contracts.

■ Demonstrate skills for maintainina the counscJling relationship.
■ Examine relationship endings.
THE COUNSELLING RELATIONSHIP

One of the most well-documented findina in counsellina is the fact that devclopina and
sustainina an effective counselling relationship is widely accepted as critical to success
(Cochran & Cochran, 2015; C ozolino & Santos. 2014; Heinonen & Spenrman, 2010;
Nystul, 201 I; Rogers, 1980; and Shulman, 2CX>9). In fact, the rcJntionship itself is often
the central reason for client chan,;e, and it can be " more important than any informa.-
tion aiven, rderrals made, or practice approaches used . . ." (He.inonen & Spearman,
2010, p. IOI). Research by Kivliahan, Celso, Ain, Hummel, and Markin, (2015)demon.-
stratcd that counsellors with better relationships have clients who make better progress.
66
Having a sttong relationship can activate lhe brain's pleasute and feeling good. Conver'Sety, the loss of lhe
tewatd system in the same way as a dtug by teleasing tel3tionship can lead 10 dep,-ession and anxiely (Jantz,
lhe oourotr'ansmittet dOS)amine, which is associated with 2015).
Capuz! i and Gross (2009) conclude, "specific proc~urcs and techniques arc much less
important than the alliance between counsellor and diem" (p. 65). Significant]}•, "even
clients whose lives have predisposed them to distrust and suspicion often remain :.de rt
to dues that this professional relationship may hold promise" (Miley, O'Melia, &
Dubois, 2004, p. 130).
Rather than focus on technique, wise counsellors make the helping relationship the
centre of their ,vork. Over 50 rears ago. Rogers ( 1961) emphasized that a counsellor's
attitudes and feeJing.s are more important than technique and noted that the client's
perception of the counsellor's attitudes is what is most crucial. Re0ecting on this he
wrote, "In my early professionaJ rears 1 was asking the question: How can I treat. or
cure, or change this person? Now J would phrase the question in this way: How can I
provide a refotionship which this person ma'>' use for his own personaJ growth!" (p. 32).
The expertise that counsellors bring to the relationship lies less in the.ir ability to solve
problems than in their capacity to recoanizc and mobili.!c diem strengths and resources.
When strenai:hs are revealed and resources identified, clients become empowered with
new choices and rcvitali!ed optimism.
Definition
A coun....ellin,: relationship is a time-limited period of consultation between a counsel- c:ounselli,_ relationsh.,: Ali, .
limited peri>d al coosultation bE1~
lor and one or more clients for assisting the client in achieving a defined goal.
a toonsfflor W a dient dedicated to
Counselling refotionships have some of the same components of intimacy, caring. lldliMlg a de.fined f(lal
and support that characteri:e deep personal relationships. High-level communication
skills are as important to friendships as they are to counselling. Moreover, many of the
skills of counselling arc aJso the skills of effective everydaycommuniation. Friendships
grow out of mutual attraction and common interests., whereas counselling relationships
focus on heJping clients achieve goaJs such as resolving crises, making decisions. and
learning new skills. Counselling relationships are structured for the primary purpose of
reuhing these goals, and once the clients have achieved them, the counseJling relation•
ship is terminated. There is no expectation of reciprocity.
Personal relationships can be terminated for personal reasons. Counsellors, how•
ever, arc expected to persist in their efforts on behalf of clients even when they arc
frustrated by l.ac:k of progress or client resistance. Counselling may be ended when there
is little likelihood of reu.hing its goals, but not simply because the counsellor prefers
other diems. One measure of professionalism is the capacity of the practitioner to
sustain commitment. patience, and caring despite frusrrating obstacles. Many clients
come to counselling with impaired ability to form or sustain health)• relationships.,
so counseJlors must remain sensitive to this fact and not allow their own emotions or
"bunons to be pushed."
Rogcrs's counselling classic, Cliem.-Cenrered Therapy (1951), describes the expe-
rience of a client who successfully completed counselling following an unsuccessful
experience with another counsellor. The second counsellor asked the diem wh'>' he had
been able to work through his problems on his second attempt. The client responded,
"You did about the same things he did, but you seemed reaJly interest~ in me" (p. 69).
Relationship: The Foundation lor Change 67

))t) BRAIN BYTE n,, '. , 11
Oxytocin is a hormone and a ne-urotransmittef that plays a strengthen relations.hips. Oxytocin gets released duri~ light
sigrlifacant tole in telationship t:X>ndi~. Both sex. and bitth caresses. sex., wtlen someone ShO'hS they trust you. and
inctease levets ot ox.ytoc:in, and it appears that strong tela- sometimes even simi;::iywith talking. When released, ox.ytocin
lionships atso increase ox.ytodn lew!ls. There is evidence increases feelings ot attachment for another- perSOO, as well
that increased ox.ytocin levels reduce stress, anxiety, depres- as feelings ot trUSI. It also decreases feelings of stress. fear
sion, and also increase empathy and one's geooral abtfity and pain· (Korb, 2014: onlioo). These findi~ undetscore
to communicate emotions (Gravotta, 2013; Simon-Dack & 100 importance of payingattantion to the counsem~ r'ela~
Marmarosh, 2014). 0ur brain/bOdy releases ox.ytocin to
8
ship and avoiding a strict taSk or prOble-m-sol\'ing orientation.
The heJping relationship provides rhe necessary security for clients to disclose the.ir
fttling.s and ideas. As rrust develops in refationship~ so docs the caP3cit)• of clients to
become increasing),., open to revealing themseJves. Drawing from the srrength of their
relationships with counsellor~ clients may rislc new ways of thinking and behaving, and
in this way, the relationship becomes the medium for chanae. In positive counselling
relationship~ clients perceive their counsellors as a.Hies. They become increasingly will.-
ing to disclose because they do not fear that they will be rejected, judi;cd, or c~rced to
change in ways that they find unacceptable. Jn its purest form, the counselling reJntion.-
ship becomes a collaborative endeavour.
CounseJling sessions a.re not always comfortable or pleasant. The process may
involve exploration of painful feelings or o:pe.riences. Personal change involves risk
and modification of one's usual way of thinking or behaving, and this can be stressful.
Counsellors who a.re intent on kttping the counselling rclntionship pleasant ma,., com,.
municate reluct:mce to deal with sensitive issue~ or they may withdraw at the first sign
of difficulty by changing the topic or rescuing.
SUCCESS TIP
If you want to inftuence sotneone, fifSl pay anent.ion to the relatiotlsi-.p.
Relationship and the Phases of Counselling

Each of the four phases of counseJling-prcliminary, beginning, action, and ending-
has associated relationship tasks and cha.Jlenges (Shcbib, 1997). In all phases, counseJlors
need todcvclop effective skills and attitudes for engaging and retaining clients, including
sincerity, perceptivencs~ honesty, respect for dive.rsit)', capncity to initiate conversa.,.
tions, ability to be a good listene.r, comfon with discussing feelings, emP3th't', ability to
communicate confidence without conceit, and warmth. The essential clements of the
counselling relationship include core condition~ contract~ goals, and immediacy, with
the worlc conducted within professional boundaries and time limits (Figure 3.1).
Preliminary Phase The gool of the preJiminary phase is to create the necessary
physical and pS)'Chological conditions for the relationship to begin. The counselling
environment (e.g., ni;ency setting, office ln)'OUt, and reception procedures) can have
a dramatic impact on the client's mood and expcctntions even before the interview
begins (Knapp & Hall, 2006; Shebib, 1997). Preliminary phase work attempts to create
first impressions that say to clients, "You will be respected here. You a.re important.
This is a place where you will be supponed."
68 Chap1er 3
Co<e
Conditions
Immediacy Contrac1s
Sooodaries Goals
& Time
limits
Figure 3.1 The Essential Elements of a Counselling Relationship
SUCCESS TIP
The stage for the relationship is set long befom you moot your client. Upe-riences wdh past
counsetJors, ext,ectations abOut lhe pcocess, factOr'S such as tM waiting room, hOw the cli-
ent is greeted, and waiting time mean lhe relationship has already started befOr'e )'Our fllSt
encounte-r. TM relatiotlsi-.p is further predefined by issues such as culture, gender, sexual
Orientatbn, reactions to autnority, and the presence ot mental disor'dets.
Beginning Phase The relationship g,c,al in the beginning ph3sc is co dcvcJop rap-
port, trust, and a working contract or agreement reg3rding the purpose of the work
and the roles of rhc participants. The relationship at this phase must provide enough
safety for clients that they will engage and continue with counselling. Counsellors cre-
ate this c:nvironmcm of safety b)• communicating that they do 00( judge the diem and
that change can occur. The relationship enables clients to fee] sufficientJ,., free to take on
the first risks of counselling-sharing their feelings and concerns. Neverthcles~ some
clients are poorly equipped to do this. and they may remain guarded or suspicious
throughout the whole process.
Action Phase Ideally, in the action phase, the reJationship continues to dcvdop and
strengthen. Clients take new risks as they find the courage and strength to examine and
change their wa)'S of thinking, feeling, and behaving. During this phase, reJationship
work may need to focus on addressing communication problems including. at time~
tension or conflict.
Ending P hase Termination of the counselling relationship comes when counsel-
ling has ~rved its purpose and clients have reached their goa.Js. Termination focuses
on reviewing the work accomplished, helping clients consolidate learning. and SU)ting
goodbye. Ending phase work will be discussed in more depth later in this chapter.
CARL ROGERS AND THE CORE CONDITIONS

Carl Rogers (1902- 1987). the founder of dicnt<entred therapy (later known as person•
centred therapy), has exerted an enormous in6ucncc on the counseJling profession for
the last 65 't'ears.
Rogers (I 951, 1961 , and 1980) asserted the importance of s«ing others as "becom-
ing." This notion underscores a fundamental belief in the capacity of people to change.
Clients arc not bound b)• their past, and counsellors should not use diagnosis and das•
sification as tools for depersonalizing clients and treating them as objects. In counseJling,
Relationship: Tile Foundation lor Change 69

clients need to be seen for their potcntiru, strength, inner p0\\'Ct, and ai.pacity to change.
Rogcrs's nondircctivc methods are based on the premise that if core conditions are
present, then change is possible. The core conditions act to speed the natural process
of healing or recovery from psychologicaJ pain or problems.
The essential core conditions arc unconditionaJ positive regard, empathy, and
genuineness. Core conditions arc aspects of attitude that are prerequisites to forming
and maintaining effective hclping relationships. Although counsellors can use certain
behnviours and skills to demonstrate core conditions. the conditions must represent
the authentic values and attitudes of counseJlors. \Vhen counseJlors exhibit these core
conditions. the potentinJ for chnnge and positive relationships with clients is incre3scd.
However, there is no guarantee that clients will interpret warmth, aenuinenes~ and
empathy (or any communication) in the way that they were intended. Prior cxperi.-
ences and expectations, as wdl as cultural and individunJ differences, can easily lead
to discrepancies in the way communication is perceived. Counsellors can expect to
be rejected at least some of the time, despite their best cffons. Moreover, a client may
perceive empathy as an intrusive attempt to "get into my head" and may interpret caring
attitudes as manipulation. Secure professionals accept this re3lity, knowing that consid-
erable resistance may be encountered as they work to develop the heJping relationship.
Unconditional Positive Regard UnconditionnJ positive rcg3.rd accepts the diem as

a person of wonh and dignity. This acceptance is felt and communicated by counsel.-
tors without condition, judgment, or expectation. Rogoers beJieved that such uncon.-
ditionaJ rcg3rd creates the very best conditions for client growth to occur. Essential
components of unconditional positive regard include caring., respect, warmth, and
compassion.
Rogers (1961) urged counsellors to shun any tendency to keep clients at a distance
by tre3ting them as objects with detailed diagnostic labels. Instead, he ari:ued thnt coun•
warmth: M espressi>n of 10npomssitt sellors neo:I to learn that it is safe to express their warmth and to let clients know th.nt
caring tut reqlllies genuin•n-.:J they care.
• olwm•, the acoeptafltf of the equal
YIOrt!I of oeks.. a IOflju~ntal attihlde,
Warmth is difficult to define; yet its presence or absence can be fclt immediatdy.
•d avoidance of tuaing. \Varmth communicates comfort and trust, and it is a precursor to trust. It attracts
clients to take risks because it indicates the goodwill and motivation of the.ir counseJ,.
lors. In the beginning, clients often come to counselling reluctantly, perhaps driven by
external pres.sure or by the weight of their problems. Counsellors need to engage or
connect with clients to hdp them find enough acceptance so that they return and suf,.
ficient safety so that they can take appropriate risks. Warmth say~ "I'm approachnblc.
You do 00( need to be afraid of me. I won't take advantage of your vulnerability. J'm
a kind person." As a result, warmth is particularly important during the formative or
beginning stage of the relationship. Warmth is also crucial for supporting clients dur.-
ing a crisis, and it is a necessary partner to ai.ring confrontation. Clients will be more
receptive to feedback if it originates from a warm and caring attitude.
Although warmth can to some extent be defined behaviouraJly, it must arise from
genuine fodings of caring for the client. Otherwise, the counsellor's actions will appear
lacking in genuineness. ·warmth is demonstrated by smiling appropriatdy and by show.-
ing since.re interest in the comfort of the diem. Counsellors show warmth when they
communicate nonverbally that they are totaJly focused on their clients. Simple coune.-
sies, such as eliminating distractions from the interview, asking clients if they are physi.-
cally comfortable, offering them a beverage, and making e)'C contact all convey warmth.
\VelL-timed humour can nJso add a warm touch to the interview.
Counsellors need to be flexib le with their lcvcl of expressed warmth and caring.
Highly suspicious clients may interpret warmth as manipulative, and some clients are not
comfortable with a high levd of expressed emotion. As \\'di, gender may be a variable.
70 Chap1er 3
Being warm docs not prec.ludedC3ling with difficult topics; in foct, w-amnh provides
the neccss3ry found3tion for such ta1k. Nor docs it imply that a grc3t deaJ of the inter-
view needs to be spent making small mlk, 3S one might do during a social visit.
Sometimes in busy social service aJ;encic~ c3sdoads become unmanagC3ble and the
pace of the work frantic. Constant crises and unrelenting papcnvork exhaust even the
most energetic and caring workers, who m3y begin to lose the "spark" they h3d when
they first entered the field. Unless controlled, the office routine can begin to feel more
like an 3ssembly line th3n a counseJling service, as clients become numbers and the
worlc becomes increasing),., m.sk.-oriented. How docs one continue to focl and express
warmth under such conditions! The answer must be discovered individually, but we
c3n learn something from the observations of one worker, a senior caseworker with
over 25 years' experience:
What works for me is to remind 1n)'SeJ( that no matter how overwhelmed I feel. it's
worse lor in)' clienu. O(ten. they're broke. in crisis and not sure wbethe-r they w;,int to
live or die. Tih~)' don't need me to be p::arc o( the problem. \V~c doesn·c work lor 1ne
is to s.et cau¥ht up in oo(fee room neK"3ti\'ism. You know what it's like-the ones who
ne\'er h::a"e ::anythina '--ood co 53)' ::and ::always expect thina,i co s.et worse. It :Uso helps if
I take a few moments. sornecirnes precious se«>nds. between interviews to rned1t2te.
When I n~t mr chent. I tr)' to spend some time just heh,¥ (riendl)·.
Empathy Empath)• describes the capnc:it)• to understand the feelings 3nd \'lews of
3nothe.r person. Emp3thic 3ttitudes and skills can generntc powerful bonds of trust 3nd
rapport. Emp3thy communicates understanding and acceptance. An cmpuhic artitudc
is ch3rncteri:ed by one's willingness to IC3rn about the world of another and begins with
suspending judgment. To be nonjudgmcntn1 rttauircs considerable discipline in control-
ling personal bi3sc~ assumptions, and reactions thu might contaminate understanding.
CONVERSATION 3.1
COUNSEllOR 1: Maybe C3fl Rogers COUkS do ii, but I find 1t met anyone who is pufe evil. 31th~ some psyd'lopaths can
difficult, somethnes impossible, to have fespect and cari~ come clOSe.
fof someone whO has oon,e something h0tfend0us, such as
COUNSELLOR 3: We have a professional t'de to play, and it's
raping a Child.
n01 out job to condemn Of put.Sh, but the feality is that we
P1108ATION OFFICER: Even Rogers admitted to bei~ chal- won'I •ke or tespect eitety dient we moot; howevet, we have a
lenged. Sotnelimes he'd Share his oogative teactions ot much better d'lance of helping the client cha• if we have a
feelings with his clients-maybe that's why he identified WOl'kiog felationSl'lip. This increases the poss,ibiity that clients
genllneness as a core condition. 'Ifill trust us so that they can ex,:ife-ss and discuss important
feelings and ideas. The bouom Ii~ fot me is this: fes,)ecl the
COUNS£UOR 2: Eyen if I have strong negati\le feelings toward dient, but reject the behaviout. When you do that the client
my client, I can stil controt my behaviour. I can listen; I can has a safe relationslip, and often that alOne can generate
~ my active listeni~ skill$ to try to undersaand. I can empa 4
movement to consttucli've change. If the client ex.pcesses
thize, which doesni mt.an I awee with the client Of sanction remofSe ot self~oubt about his behaviout 0t if he hints at
the behaviouf. some de-sil'e to d'lange, we can buitd m::,mentum tot change
with encOU'agi~ questions and feflections sud'I as ·Sou nets
P1108ATION OFFICER: One of 100 fitst people I wOt'ked with
•ke there's a part ot you that WOlJd 1tke to be different,· Of
was a man whO was so abusive and he put his wife in the
"Suppose you wefe to make a change in the difection you
hospital. I dtShked him befor'e I even met him. But as I gOI to
describe. How WOUid you do if?•
know him, 1found myself softeni~ a bit. I still was fepu~d
by what he did, but I also came to understand his depression, COUNS£UOR 2: Hefe's anolhef thought. I think 1t rS jUSI as
his inabiity to get a job, and his own abuse asa chitd. He was important to unders&and and controt out strong pos,tive feel-
much mofe complicated than I imagined. NON, I've wOt'ked i ~ oocause lhese have the same potential to clOud ouf
in the Alber&a correctional system tot 1S years, and I've~ ObjeclMly.
Relationshi p: Tile Foundation lor Change 71

In addition, counscllors need co be able to enter the emotional world of their di.-
ents without fear of b«oming crapped in their pain. CounseJlors who arc secure with
themselves and their feelings have the capacity to enter their clients' worlds without
fear of losing their own identity. Brill and Levine (2005) note that when a counscllor
communicates acceptance. there is the "freedom to be oneself--to express one's fears,
angers, joy, rage, to grow, develop. and change--without conce.rn that doing so will
jcopardi:e the refationship" (p. I 18).
Empathy has cwo components. First, counsellors must be able to perceive their di.-
ents' feelings and pc.rspecrivcs. This rcquircscounscllors to have abundant S(".lf•awarencss
and emotional maturity so that they do not contaminate their clients' cxpe.ricnce with
their own. The second component of empathy is to make an empathic response. This
involves putting in words the feelings thnt the client has expressed. This task cnn be par-
ticularly difficult, since clients often communicate their feelings in abstract, ambiguous,
or nonverbal ,.,,.,._,.,s. Empathic responses rttauirc a vocabulary of w-ords and phrases that
can be used to define feelings. At a basic level, empathic responses adcnowlcdge obvious
and dearly expressed feelings. At a more advanced or inferred level, e.mP3thic responses
are framed from hints and nonverbnJ cues. An empathic response proves to clients that
they have been hcard, unde.rstood, and accepted. Chapter 6 focuses on this critical skill.
Genuineness Being genuine mcans being authentic and real in a relationship. Coun.-
sellors who arc ,;cnuine show high consistency between what they think and do, and
between what they feel and express. Rogers ( 1961) used the term congmenr to describe
this quality and emphasi:ed the importance of self-awareness to unambiguous com.-
munication. To avoid giving contradictory messages., counscllors need to be aware of
how they arc feeling and how they are transmitting their feelings.
Genuine counscllors are also hight,., trustwonhy. Thq•do noc lie to dien~ and they arc
willing to provide feedback that is cimel'>' and helpfuJ. They sho,,v respect for clients ~• bc.ing
open and honest while maintaining warmth and emP3thy in the relationship. They do not
w-orlc from hidden a,;cndas., nor do they put on "masks" or play roles to hide their true feel,.
ings. As weJI, ,;cnuine counscllors arc reliable. They do what thq• say they arc going to do.
Core Conditions: Implications for Counsellors

Rog,ers's philosophy suggests a number of introspective questions for counsellors to
consider rcg:irding che.ir attitudes and behaviour in hcJping relationships:
■ Houican I acr so that dienu will perceil't' me as rmsru,onhy! This means counscllors do
what they say they will do and net in a way that is consistent with how they feel. It
requires counsellors to communicate without ambiguity and contradiction.
■ Can I permir m,"$e'lf ro experience positive arrirude:s of u,armrh, caring, liking, intereSL,
and re:spec.r rOlmrd clienu!
■ Can I be :srrong enough a:s a per.son to be :sepamte from my clients! This requires a high
level of maturity, self.awareness. and courage. Ro,;crs summarizes this chaJlenge:
''Am J strong enough in my own ~parnccness that I will not be downcast by his
depression, frightened by his fear, nor engulfed by his dependency! Is my inner sclf
hard'>' enough to rcali.!e that I am not destroyed by his ang~r, taken over by his need
for dependence, nor enslaved by his love, but thnt 1 exist scP3rate from him with
feelings and rights of my own?" ( 1961, p. 52)
■ Am I :secure enough ro permit clienu their separarene:s.s! Clients are not under their
counscJlor's control, nor are they to be molded as modcJs of what counsellors feel
they should be.
■ Can I le, mysclf fully emparhhe urirh my dienu' feelings and world per:spenil'eS without
e,ialuaring c,,- j1Klging!
72 Chap1er 3
CONVERSATION 3.2
STUDE:NT: How far ShOuld I go With genuiooooss? What if I'm I can'I see hoN sharing thal information would sel'\le any pur.
a~ry with my client? Should I say so? Or suppose I find my pose. On 100 other hand. it may be useful 10 the client if you
client disgustk"lg. Shouk1 1ex.press that too? explored the specific behaviou's or attttudes that gave rise to
thOse feelings. With sensitive feedbaek, your client can have
TEACHER: You've identified an impoftant dilemma. On the
the benefit of leamk'lg abOut his or her impac1on others. Once
one hand, the need for genuineness suggests that we ShOuld
you put 1t on the &able foe discussion., you no ~ ( have to
be open and hooost with our clients. We Shouldn't put on
hide )'OU' reactions. One final poi.nl: Strong react.ions toward
false fronts, lie to clients. Or' fake OU( feelings. Al the same
our clients may hi.I'll at OU( own vlJnerabirrties. If you find a
time, ethical principres dear1y prOhibit us ftom dc::i~ hafm.
d ient disgusti~. I'd want to ask you. MWhem does that feel-
Being genuine ooesn1 entitle counsetors to "dump· on tnell
ing come from? Are you sure 1t is related onfy to the d ient?·
clients. Genuioo counsellors are truthful, but they ate alSO
timely. They share personal petceptions and footings in an ST\J0ENT: Maybe the client Mpushes my buttons" the same
asserti\18 way to meet their clients' neoos. They night ex.press way my pa(ents did.
theit anger, but they dO so withOut intending to punish, rid~
cute, or trap the.' clients. As f0t feeli~ diSgtJSl toward a client, TEACHER, Exactly.
COUNSELLING CONTRACTS
A contract is n negotint~ agreement between the counsellor and the client reg3rding c:ontr~t: Aneiomted agieemeai
important variables that define the worlc. Counsellors typicaJl't' begin contracting enrly bE1•een coaselCl'i . t clients ieprding
tile purpose of the 'llllfk. their ,espectiw
in the first interview; however, contracting is continuous throughout the life of the soles, and the •Uiojs and f'Clllllines that
helping relationship. Rigid adherence to ne,;otiatcd conrracts is hazardous. Counselling • ill be 11sed to ieat h tileir agreed-on
contracts nttd to be pcriodicaJl't' revisited and updated, sometimes even severnJ times ct;e«ive. ('Seealso sessitxtJIGMlflt:t
and wri GMtnct)
during a single session. The reasons for amending contracts include the following:
■ Exploration of problems nnd feelings ma,., promote insight. and this may lead to
changed expectations and revised goals.

■ (ncrcascd rrust may enable clients to address more difficult topics and feelings that
they were unwilling to consider at the beginning of the relationship.
■ New problems and issues may emerge because of changing circumstances.
SUCCESS TIP
Variables suctl as clJtu(e, level of t(uS'l, timlflg, mood, and stress can affecl a client's wfling-
ness and capacity to address topics. Similarly, unresdved conftkl .-i 100 client~setlOr'
(elat.ionship can dramatically affect the contract. Unless these variables are considered and
until conflicl is resolved, the client may not cooperate or fulty participate.
Purpose of Contracting
Contracting ensures that clients and counsellors arc on the same page with respect
to the goals of the w-ork and the counselling methods that will be used. Contracting
3fso involves discussion that defines the counscJlor~ lient relationship, including role~
right~ and responsibilities. Good counscJlors adjust their style to meet the need~ cul-
ture, and personality of their clients. They consult and negotiate with their clients to
identify and understand these variables. Effective contracting respects clients' freedom
to choose, and it gives them knowledge and control of the helping process. \Vhen
counsellors and their clients are ,vorking toward agreed-upon objectives, it is much
Relationship: Tile Fo undation lor Change 73

more liket,., that clients will "own" the ,vork rather th3n see it as somethina th3t h3s
been imposed on them. Contractina reduces suspicions that counsellors may have hid•
den ai;endas.
Contrnctina directly addresses the reality that there may be (and often an~) sharp
differences among the follO\\•ing:
■ the problem as perceived by 3ny referring source (e.g., another aaency, family,
employer, etc.)
■ the problem as perceived b)• the client
■ your perception (as counscJlor) of the problem
The contract is like a road map that provides i;enerol directions on how to get
from A to B. Jr confirms that all parries are ,vorking tow3rd the same end. A counscJ.-
ling contract also predicts an end to the relationship. Defining tasks and goals makes it
dear when the relationship should be ended. Jo this Wtt)', the counselling relationship is
deart,., distinauished from a friendship. whidi may last for 3 lifetime.
SUCCESS TIP
ContracUng may change ave( the life of lhe relationship Or' even during a single session.
Client insigrlt, changed priOl"ities, moo:J, ttust k!WI. capacity, and eme(gent issues arQ
variables that drfvQ changes in tM contr'3Ct.
Contracts may be formal and sianed by both the counsellor and the client, but more
frequent])• they are informal and ratified with verbal agreement or a handshake. The.re
are three types of contracts: relationship, 3nticipatory, 3nd work.
Relationsh i p Contracts
~lationship contract: ANftotulion The relation.,;hip contract outlines how the counsellor and the client will work together.
of tbe intended purp>S! of the uunselling lt results in a cusromi:ed relationship th3t is uniquely respectful and responsive to the
telationsllii>. inc:Wiig an ag,ee~ •
client's expectations, W3nts, and needs. The process involves candid discussion and
the ~Ed soles al bo1' counselklf and
dient exploration of client issues, such 3S the followina:
■ communication style (e.g., prefe.rred ways to communicate, problem solve, resolve
conflict, and give and rcce.ive feedback)
■ personal wlues, worldview, and culture
■ exploration of how differences (e.g., gender, aae, race, and sexual orientation) might
help or hinder the counselling work
■ past experiences with counselling
The relationship contract, b)• its nature, honours diversity and individual differ-
ences in communication styles and patterns. The process signals to clients that their
needs and wants will be respected and th3t counsellors are willing to adjust the.ir st)•le
to accommodate clients.
Pan of the relationship contractina process is discus.sing the methods 3nd process
of counsellina. Counsellors should be open about what they are doina and not work
from 3 sec.ret script with myste.rious techniques that they hide from clients. They should
be willing 3nd able to describe their worlc in simple, non-jargonistic langu3ge. (n this
way, clients can know something about what is happening, the direction of the work,
and wh3t remains to be done.
Shulman (2009) emphasi!es the need for workers to provide dear, non-ja.rgonistic
st3tements th3t describe the rani;e of services available. This is particul3.rly important
74 Chap1er 3
in settings where the counseJlor ma.'>' be the one who initiates first contact. \Vhen the
purpose of the mcetina is explicit, clients do not have to ,vort)• a.bout workers' hidden
agendas, and they a.re in a. more informed position to cake advantage of assistance. ln
the example below, a school counsellor is ma.Icing an excellent attempt to engage with
an 11-yenM>ld boy who has transferred to the school in the middle of the a.endemic yenr
and Sttms depressed and alone:
Coun.seltor: My name is ?l.·1r. S1nith. I'm here bec3usie your te::.cher thou$:ht I mi$:ht be
:1ble t'O help you with Sm»e of the problems you 're havinK :.t sehool. I know that ii ean
be tou~, to be the new kkL Sometimes it's just not mueh (un. Maybe we rouJd 1~t
:.nd see i( we ean O~-ure o ut 3 way to mW 1hi~ better. \Vh::u do )'Ou thin.kt
Past Experiences with Counselling Many clients have considerable experience
working with counsellors, and they have learned what works and what docs not ,vork.
CounscJlors can learn from chis and adapt their approach nccordinaly. A sample probe
illustrates as follows:
Coun.seltor: I'd like )'Our help. I know )'Ou\~ bet>n oomin& to this 3~ncy for 3 while,
:.nd you have a lot o( ~perienu as 3 user. h would help me i( )'Ou could tell me a bit
:1bou1 )'Our ~perience~1ke. wh3t did )'Ou f'lnd helpful and not help(ul? TI,en we ean
t3lk about how )'Ou and I t21n best v.-'Ork t~ther.
\Vhile diems ma.'>' have had satisfying and empowerina expe.rience~ the reality is
that many have fclt discmpowe.red by counsellors and other socia.J service providers.
Open discussion about this can provide valuable cues for structuring the current rel3,
tionship. Moreover, the process can help clients who have had a b3d expe.rience reach
some closure on unresolved fcclinas. Ac the same time, the process dearly communi•
cates chat chis relationship has the potentia.J to be diffe.rent.
Discussion of the Roles and Expectations of the Participants Counsellors
should know somethina about what clients want from chem. Do clients expect them to
provide 3dvice on how to manage che.ir problems! Do they want to be challenged with
new information and new perspectives? Are they looking for someone who is warm,
gentle, and supportive, or someone who will just listen? Similarly, counsellors need to
tdl clients a.bout an'>' exptttations they have. Role discussion may also address is.sues
such as how the participants might 3ddrcssconflict, and how they can provide feedback
to e3ch other.
Clients may be a.ware of the.ir pain and may rccogni!e and accept the need for
change and help, but they may have no idea what form this help might take. In such
situations, counsellors need to be able to hdp them unde.rstand the potential assistance
that counseJling can provide.
Somedients also have unrealistic expectations of their counsellors and the process.
They may believe that counsellors will tell chem what to do and solve all their problems.
Or they ma.'>' have no faith in the process whatsocwr. According to Wicks and Parsons
(I 984), when people enter counselling they often anticipate "either a. miracle or complete
failure" (p. 175). Contracting is a significant opportunity for demystifying the process
and for challenging unreasonable positive or negative expectations.
The followina example is taken from the midpoint of a. second inte.rview. le illus-
trates how the counsellor gen th• encoura,;es the client to re-examine some self-imposed
restrictions on the relationship:
Client: Let's l:ttp rny feeli1l{tS out o( thil. I simpl'>' want 10 look at ways to improve rny
relationship with my son. I( you could teieh rne some tt"<':hniques. I'd be rnosc Kr:l.teful.
Coun.sell.or: Of eourSe you're entitled t'O privacy on issues <>r (e,eli~ that )'Ou don't
want 10 share with me. At the ~rne time. I wonder i( )'Ou miiht be too hasty in rescriet-
h1K wh:lt v.--e t21n discuss.

Client: I don't i et it. What do )'OU mean?
CounS(>IJOr. \Veil, you·ve bee!, throu$:h a lot. \\11th your son' s arrest 21nd his dis:1ppear,
antt (or over a month. I'd be surprised i( rou weren' t (ee1m~ stress.
CUent: \Vho ..vouk.ln·e
CounseUor. That' s exxtly my point. When I don't ~lk about (ee.lin{t:l th:u are bother,
ina me, I have to keep them inside or pretend they're not there. I've (ound that doesn' t
work. Sooner or bter. I h:i,'t, to (21ee my (eelin~s.
Client: I'm Just 21(r3id that i{ I start er)•i1l{t. I won't be :lbte l'O Sl'Op.
CounS(>IJOr. Th:it tells 1fie that the pain must be ,'t,r)' deep. (Slknte as tht- clitnt tc>ars up.)
CounS(>IJOr. I Yi·on't push )'Ou, but I hope our rel:u.Onship ean beco1fie a 5::11(e pl.:1ee for
you. 1t·sobrwith me i( )'Ou ery.
Many clients arc slow to develop trust, perhaps for good reason. They may have
lifelong experiences o( betrayal or abuse by people they trusted. \\:fhy should it be
any different with a counsellor? As a result, it is understandable that they approach
counselling with a degree o( mistrust. Wides and Parsons ( 1984) provide a compel.-
ling observation: "Though there may seem to be a great distance between counseJ,.
lors and their clients during the beginning phase o( counselling, they should not be
discourai;cd because at that point their clients ma)' be closer to them than anyone
dsc" (p. 168).
Client: I really don't see the point in be.in¥ hen:-. ?l.·f)• sit"uation ishopeless. J','t, ~n l'O
other oounsellorS and nothina worked. 1'1n onl)• here because mr wi(e insisted. She
thou~,t rou mi~u be 3b1e to help.
CounS(>IJOr (Choice I): You eer~inl)• do sound diseoul"3~-td. but I think you should
Kive eounsellu~ another chanee. Marbe b)' talli~ about )'Our problems, we c=n discover
some solutions you've O\~rlook.ed.
CounS(>IJOr (Choke 2): Given rour past experie:nees,. I ean see wh)· you' re pessi1nistie.
You're wise to be skeptical until )'Ou Ond out i( you can trust me. In the end, the results
will be the most important thi~
In this example, Choice I is well-meaning but ill.-timed and may lead to n powe.r
struggle i( the client fods compelled to defend his position. Choice 2 is not condcsccnd.-
ing, it avoids the power struggle trap, and it docs not promise success.
Anticipatory Contracts
antidpatoty contract: An ag,eement Anticipatory contracts enable counsellors and their clients to plan for predictable
between couns!lots and clieus tu'! events. Jf you know something has been problematic in the past, ask your client for heJp
plans kif predictlble ew:nts. Antqii.;ory
contracts pnrme g_uidance ICJ coasElcn
on how )'OU might respond if the same situntion arises in the future. Some examples o(
•d ans•111.r tbe questioo. '"M.at shodd I what counsellors might say are as follows:
d) jf .. !"'
CounS(>IJOr (to .:1 client with a hl;;tory of \iolenc.e): "I need your help. I( I see that )'Ou
are :u,irY. what would be a ~-ood thlfl¥ (or me to do that rou would And useful? ..
CounS(>IJOr (to .:1 client iW.rtina a job search): "Suppose three or lour w~k.!l inl'O )'Our
job seareh )'Ou 21re ~ttina diseoul"3~-ed. Give 1fie some ::.dviee on wh::u I miaht do l'O help
you r«.3pture some o( the positive ene"iy you (eel todar. ·•
Homebuilders usuaJI)• prewire n~w homes so that future instaJlation of services

like cable television will be easy. In the same way, reJationships can be "prewired" to
mnke resolution o( communication difficulties easier. Conrracting smnegics, such as
discussing in advance how conflict will be addressed and working to develop and refine
open communication, are the tools for prewiring relationships. )( conflicts occur, a
76 Chap1er 3
mechanism is aJrendy in pince for resolvina them. Herc arc some examples that illustrate
the options:
Counsellor: Suppose th::u I h::r\'e some (eedbr:lck for you. How would )'Ou hk.e me IO
2pprooch )'Ou?
Coun.seltor: let's talk about wh::u e::.ch o( us tan do i( there's 2 problem be1ween us.
l m~ne th::u I sar or do somethinK t~1 offends rou or you don' t like.
All o f us h.nve preferences about how we like to give and rece.ivc feedback. Some
o( us want it straight and to the point; some respond better to a "S3ndwich Sl)•le," com-
binina critical feedback with suppon and positive affirmation. Others need visual or
behavioural illustTiltions. Anticipatory contractina identifies these preferences.
SUCCESS TIP
TM onus is on the counsellOf to adjust his Or' het styte of giving feeelbaek to moot 100 style
of the client. Clearty, this fe<::iuites counsetlo, fkoobllily. Anticipatory eootrac1s tel the coun-
sellOI" how to be flexit:,e.
Work Contracts
Whereas the relationship contract focuses on the respective roles and expecr:ntions of
the participants and how they will communicate, the work contract defines the focus for WOltc contr-ac:t: An ag,eemea1 di.at
the current session and the overall objective of the participants' ,vo rk toJ;cther. Sheafor specifies the iMended to3ls• «r.OCdle ol
uunselling..
and Horcjsi (2008) identify the following basic components of the wo rk contract:
■ problems o r concerns to be addressed
■ goals and objectives of the intervention
■ activities Iactions) the client will undertake
■ tasks to be per formed by the worker
■ expected duration
■ schedule of rime and place for interviews
■ idemification of other persons, agencies, or o rg3nizations expected to participate
(p. 322)
As well, ethical issue~ including the limitations of confidentiality, arc also pan of
the work contract.
Sessional Focus The scs.sional contTilct answers the question, "\Vhat are we hopina
to talk about a nd accomplish toda,.•!" Althouah the importance of defining sessional
focus seems seJf-evidcnt, it is surprising how often counsellors procttd without a clear
sense of direction or purpose. Or they assume that the.ir clients undersr:nnd and arc
working with the same purpose in mind. \\:'hen clients are involved in negotiating the
contract, they arc respected and empowered as active partners, not passive recipients
of service. W ith clarity and agreement reaard ina purpose, clients arc more likely to
support and participate in the work. Sometimes what counsellors sec as client resis•
tance is better understood as legitimate client defence against something (i.e., goals o r
processes) they experience as imposed.
Sessional contracts can direct anemion to one o r more of the three major domains:
behaviour, thinking, and feeling, SessionnJ contracts based on beh.nviour target objec•
tives such as skill d evelopment, problem solution (what to do or say), decision making,
Relationshi p: Tile Foundation lor Change 77

TABLE 3.1 Contract ing l eads
What are you hopi~ to acc:ompis.h as a (eslAt of our \\()rk IOday?
Whete do you feel most comtortable ssartl~
What brings you hefe?
What oo you need to get out of tOday?
What dO you need from me-?
Lei's talk abOut hO'N we can use ouf time here.
Flnis.h this sente~: When I leave he-re tOday, I hope tr.at .
Several limes you've hinted at . .. Perhaps it migt\t be important to focus on this a bit
( To art il'tYOlunta,y dienO You feel forced to come-. Neve-rtheless. you could have chosen
not to. So I wondet if we could talk aOOut hOw you couk1 make the beSI use ot the Ume we
have together.
The- e-xami:,es belOW are chOice options when you wish to intrOduce clients to the services
available at tne age-ncy, wtle-n c~nts a(e stuck, and when d ie-nts have limited understand-
ing of the possibilities of counseling.
If you wis.h. we could ex.ptore . .
Here's an idea of wtlete we might go from here.
In my e-xpede-~. I have found that it is very helpful, sometimes crucial. to talk abOut feel-
ings befOl'e \\()rkj~ on problem solutions. Ooos this make sense to you or not?
Let me tell you a bit abOut the prawams here. Then we can discuss which ones. if any,
you wish to use.
He-re are two choices: Eithef we could wol'k now oo fiOOi~ a SOiution. ot pe-rhaps it might
be be-tte-t to just spend time talking about how you fool.
I wonde-t if it makes sense 10 talk a bit abOut . . .
exploring options, 3nd goal setting. SessionaJ contracts ba~ on thinking arc concerned
with hcJping clients explore vnJue~ assumption~ beliefs(induding spiritunJ beliefs), and
scJf-csteem is.sues. \Vhen feeling is the focus of the comrnct, the work concentrates on
clients' emotions.
Counsellors 3re sometimes too quick to 3ssume that clients need to worlc on sofu,.
tions when the.ir primary need may be to "unwind" with a sympathetic listener. Through
sessionnJ contracting, counseJlors ensure that whal is done in the interview is explicit
and relevant.
Work Focus Jf there is no agreement on the purpose of counselling, the work is
apt to be direc:tionless. 'W ithout an agreed-upon purpose, counseJlors tend to make
assumptions 3bout the needs and wants of their clients-which arc frequently wrong.
Sec T3ble 3. 1 for examples of leads th3t c3n be used to initiate contracting.
Every counseJling a,;ency has a purpose chal defines and limits its service. Specialty
a,;encie~ such as employment counselling cenrres, m3y focus on c3reer testing and job
search skills, while a transition home may provide crisis counseJling and shelter. A
community centre might provide a broad ran,;e of counselling, education, 3nd group
suppon services. The multiple purposes of counselling can indude helping clients with
problem soh•ing, decision making, and managing feelings. It can also provide suppon,
give information, and foster skill acquisition.
Counsellors define and limit their role based on their position in the agency and
their training, An intake worker, for ex3mple, may be restricted to inirinJ screening and
assessment~ while a community outreach worker ma'>' spcci31i:e in reaching clients who
do not \'oluntarily seek service.
But clients may have specific wants and needs that do not mesh with the mandate
of the agency or its workers. Abrah3m Maslow's (1954) famous hierarchy of needs
(Figure 3.2) can be a useful wa'>' of understanding client priorities. Maslow suggested
that people normally seek to fulfill their basic survivnJ needs before pursuing higher
order needs. As one counsellor put it, "You can't counsel a client who hasn't eaten."
78 Chap1er 3
~
actualizailon
Safely
a.1cs...1va1
Figure 3.2 Maslow"s Hierarchy of Needs
Contracting needs to con.sider three variables: client need, ai;cncy mtmdau; and
counsellor expertise. Contracting ,vorks wd) when the client's needs matc.h the agency's
mandate and the counscJlor's competence, but when the service the client needs is
beyond the mandate of the agenq• or the competence of the counscJlor, rcfc.rral to
another counscllor or a,;cncy is appropriate. lntcrview 3.1 illustrates how contracting
is used to eng3gc and map out a plan with the parent of a teen who is abusing drugs.
})!} INTERVIEW 3.1

This interview is exc:e-pted from the IS-minute mark of the first session with a parent of a teen who is abusing drugs.
Counsellor: Let's take a few minutes to talk abOut hO'N we Analysis: A simple. flot1-ja.rgo,,lstic statement initiates tfle con-
mighl \\()rk togetnet. Then we·u bOth have a Shared sense tracting process. CCl'ltracting is presented as a col/at>txatlve
of direction. process.
Cllent: Great i:lea. I was \\()ndeMgwhere we go from here.
Counsellor: Pethaps you have some idoos on what you'd Analysis: By seeking input, the counsellor communicates
like to achieve. I'd like to hoor lhem. Then. if you wish. I respect for lhe client's needs at'ld signal$ that lhe counseNor is
can add some ot my own. t'10/ going 10 take control and make all the dedsJoos. Tfl;s helps
Client: As I tOld you. my big goal is to keep my son alive. &:, empower the clknt and minimae any tet1de.ncy for the clknt
I don't want to (eceive a cau from the hOSpital saying he w become overly dependent.
has overdosed.
CounsellOr: Whether you( son uses drugs is n01 under you( Analysis: The counsel/Or gently attempts to contain tfle M'Of'k
control. If you ,.;st,, we could talk abOt.C some of tne ways you within areas that the client can COf'lttOI, namely her behaviour..
could deal 'Mth his behaviot.Jf, sl.d'I as how to handle it Vi'f'lef'I Thedienrs reactictl COt'lf,rms ut'lderStat'ld1ngat'ld ptr,vides agree.
he b<eakS curlew 01wt1a1 todowMO you think he's high. mer1t 00 000 latget fotM'Of'k.
Client: That would be g(eat.! Those are rwo of my biggest
problems.
Counsellor: Obviousty. this i:S a time of sttess for' you. One Analysis: Counsellors can suggest addJYiona/ Ideas to hel(J diet'lts
of the ways I may be able to work with you is to help you make the be.SI use of the setVlces available. In this Slatement. t/'Je
deal with your feelings. Sometimes you might feel OYe(· counsellor attempts to lntrOduce feelings as Ofle of the areas on
wool med by evefythi~ that's happenmg, and I'd be happy which COUl'tSel/klg rnigftt focus.
just to listen o, to help you sort out you- feeli~.
Client: You have no idea how tough this has been fOr' me Analysis: The client's willingness &:, begin to share SOfl1e of her
as a single parent. My fathe(was addicted to alCOhOI. and feelings signals to the counsellot ll'lat She has accepted ll'le offer
my son brings back ail those memories.. we,p/ofe feelings.

>» INTERVIEW 3 .1 Contracting (continue}
Counsellor: So, you're no str'an.ger to the pain lhat is Analysis: Empathy Is the f)(eferred resp()(tS(J to srrong feelings.
caused b-f addiction.
(Five minutes /all!r.) Anaty1l1: This work sets the sttJge fot feedback. It giWJs the
Counsellor: Whal do you ooed and want from our COU!tSellor a dear picture of the c/J'enrs p,efetred style. KnM11g
relationship? this, the counsellor ctJn tailot any feedback to fit the Client's
ex,:,ectat!Ctls.
Cl5ent: I want you to be honest with me.
Counsellor: What do you mean by Mbe honest?· Anaty,ls: The cout'ISeJIOr avoids assumpUoos of meaning atld
Cllent: Don't try to spare my feelings. If you ltlink I'm asks tile cfietll to define tile word •hOf)(!St. • Wolds ctJn have ver'y
wrong, say so. Don't sugarcoat the truth. differer,t meatllngs to ifldividuai'S... Later. if the cout1sell0t wishes
to challenge tile ctier,t, he or she can use an ;ntroductOr'y state-
Counsellor: So, if I have some ideas abOut how you might
ment such as I/le fo/l(}v;iflg to rem;nd the Clklnt of the C-Ot'ltract:
dO thi~ differentty or another way of looking at thi~.
~Remember' whert we agreed that if I had some kieas that were
I'll jusa tel you.
different from youtS I should be hotle.st?" Because there has
Client, Eliac:lly. been f)(iot agreement, the cliertt Is l'l'l()re likely to support the
Counsellor: can I expect the same from you? f)((>Ce'SS and to be open to feedback or challenges.
Client, (Hes/tall!~) Iguess so.

Coun.sellor: You seem unsure. Would it be tough to con- Anatys/1: &me clients have trouble de:Jllflg with persoos in
front me if you thought I was wro~ autflOtlty. Even tflOugfl the clietll agrees. it Is im,:,orttJnt to pick
ClitM: I'm the kind of perSOn who likes to keep those kinds up on the he.sitab'ot1. Others are simply Shy and have habitual
ot thi~ inside. pattert'IS of taJd11g a passive apptOOCh to re/ab'ooship ptoblems.
The cout1sellit1g relat!Ctlshjp c.an be an opporrut'llty to e,q:,erlmertt
Counsellor: Sometimes it makeS sense to hold back, and
with new way$ ofrelating. WIie{) couttSe/lors create condltioos of
that's a s1rength. Uke with your son, you need to pick your
safety for rislc-lakJflg, c/J'er,ts Catt Jeam Skills that they can ttattSfer
battles. Overall. it's beltet to have Choices. In OIX refa~
to otflet relatiot1Sh;ps.. In 111;s excerpt, the cout1se/Jor also finds a
ship, I'd like to invite you to risk telti~ the truth to me.
way to hOr'IOU( strengths.
(A few minutes later.)
Cl5ent: AbOut a yeat ago. I we-nt to a family counsenor for
help. That was a disaster.
Counsellor: You might be wOt'ried that ttlis will turn out the Analysis: The purpose ofasking clients about experiences ;s tlOl
samew.ry. to engage the client ifl a gossip ses'Slctl abOut the mistakes ofcoJ.
Client, Yes. leagues. Gandld dl'Scus'Slor'ls about what ~s effective at'ld inef-
fectlW! Pf(JVide Important lt1fO(matiot1 oo the cliet'lt'S e.xpectatiot'IS
Counsellor: Now I'm worried too.
attd feats lot the curroot re/atiooship. Th;s gives the COU!tSel/or
(Cout1sel/or and client laugh.) Tell me what went w(ong; a chance to customize cout1selling to meet the needS attd ~nts
1r.en, we can talk aoout how we can avoid 100 same ptOb· of the client.
tems here. Just tell me what happened. but don't tell me A little shared humour adds watmlfl to the reliJt/Mship.
whO your counseltor was.
Cl5ent: Well, fOt' one lhiog. he never gave me any informa- Rev;ewlng the client's counselling Mstory flel,:,s avo;d the
tion. If I as.keel for a brOd'lure or something on heroin, he'd mistakes of the past. Of course. tflls dfscusslotl must be con-
a~Nays say sure, and then he'd forget. ducted in a professional maMet that does not invc/tle maflgning
Counsellor: I wonder if it migt\t be useful if we kept a few COiieagues.
notes.
Client, Okay.
<A few minutes later.) Analysis: o;scusslon regarding the limits of coofidentlality
Counsellor: Oo you have any questions? attd any other ethictJI concem-s that the clioot has cart oow be
addressed.
Cl5ent: WhO gets to see my file?
Reflections:
■ How does the counsenor in this interview promote collaboration?
■ How would you have answered the counsellor's que,stion, MWhat do you need and want from our relationShip"?
80 Chap1er 3
Relationships with Youth Establishing a relationship with youth involves all of the
same clements of success thnt are involved in relationship building with adults. \\:'Ith
youth, it is important to establish relationships with dear boundaries. It is desirable to
hnve warm and friendly cncountc.rs where the convc.rsation ftt.ls nntural and spontane-
ous; however, conditions diffo:rcm from friendship arc present. For one, the.re arc limits
to confidentiality and these should be discussed. Insofar as possible, the youth's right to
privacy can be respected, but lcgn] and a,;ency responsibilities need also be considered. ln
this sense, it is important not to compromise the role of other professionals by withhold~
ing information to whkh they are cntidcd, or by undermining thc.ir authority or compe-
tence throuWl collusion with youth. 1t is also essential for counsellors to avoid assuming
a parental role. Unsolicited advice or attempts to control will likely meet resistance.
Many youths who come to counselling have histories of abuse and neglect. Some
may still be living in abusive or dangerous situations where fear and caution arc con-
stants. Counsellors can expect that these youths will bring these same feelings to the
counselling relationship. and initial attempts to connect with 't'Ouths may be difficult.
If they expect that the counseJlor cannot be trusted, then whatever defences they use to
cope with rejection will come into play. Thus, initiatives to establish counsellor trust,
rcliabilit)', and predictability arc crucial. A tr..mmn.-informed approach should be used,
which features the core conditions. r«ognition of the client's strengths, and collabora-
tion as the foundation for relationship eng3gemcm and development.
Adolescence is a time when there arc enormous physical, emotional, and social
developmental challenges. During this period, anxiety, depression, moodiness, and inde-
cision are common experiences. When the.re arc also issues involving substance abuse,
poverty, the criminal justice system, mental health, marginalization, abuse, and neglect,
the chaJlcngcs arc multiplied and new barriers cmcri;:c which ma,., bring youths to coun-
selling. Jf a warm and trusting counselling relationship can be ncgotiat~. much-needed
stability and structure is inmxluc~ into their otherwise chaotic lives. Chapter S will
explore in more detail the skills and attirudcs n«essary for establishing this relationship.
Engaging with Seniors

Life Stories Counsellors who work with older adults should become familiar with
the values and issues that have defined thc.ir lives. Just as the rise of terrorism and
the events of 9/11 have left an indcJiblc imprint on current generations, seniors were
impacted b\• world events such as the Vietnam \Var and the cultural changes of the
1960s. As part of relationship building with seniors, counsellors should ask them to
share details of significant life events and influences. Some of these will be highly per-
sonal such as the birth of their children, death of their spouse, or significant travels.
Others will be intimatel't' conn«ted to significant experiences like war (e.g., World
War II, the Korean \\:far), the Cuban Missile Crisis. the Scarles, or the fall of the ~rlin
Wall. One senior related how air raid sirens used in Cannda in the 1950s as a drill for
nuclear war, left hc.r so tc.rrified that even today, sounds such as the siren from an ambu-
lance rekindle her fc3.r. Hearing such stories will provide counseJlors with context for
a grcatc.r understanding and empathy for lives that have evolved very differently than
their °"'n. He.re arc some sample questions that might be used:
■ \Vhat were the most significant memories or moments from your life?
■ \Vhere have you lived (or travelled) during your lifd Hou.•did this clungc or affect you?
■ \Vhat were your happiest moments (or saddest)! \Vhat lasting ~ffcct did they have!
■ \Vhat changes in the world have affect~ you the most?
■ \Vhat arc the things about your life that arc important for me to understand?

Age Differences Signific:mt differences in a,;c berwttn counsellors and their clients
is a factor th.nt can be discussed openly. Some seniors ma'>' be reluctant co share, fc~uing
that a youn,;cr counsellor will not be able to understand thc.ir problems. Others may
wckomc the idC3 of working with someone '>'oun,;cr as a chnnce to ,;ct fresh ideas and a
"youth" pe.rspective. A simple lead can be used to initiate the conversation. For exam,.
pie, "How do you think the fact th.nt I am much younge.r than you might help or hinder
our ,vork tog,ethcr"! Counscllor IC3ds can also honour the experience and wisdom of
their senior clients. Using a srrengths approach, a counsellor might say, "I'm betting that
'>'ou've learned a lot in )'Our life that you can use to deal with your current problems."
Relationship Dynamics Transference and countcrtransfercncc arc often at play.
Some seniors may adopt a pnrcntnJ and protective role toward the counsellor. For their
pan, counseJlors need to be aware of their own feelings (positive or negative) when
working with seniors. For example, interaction with an aging client facing declining
hC31th might trigger the counseJlor's own fears about death and dying. ln response, the
counsellor might withdraw or become overly prot«tive.
Counsellors need to be ready to examine their own assumptions regn.rding aging.
Seniors arc a very diverse group. and there are vast differences among them with respect
to health, cognitive ability, capacity for autonomy, lifestyles, and income. Counsellors
must be willing to re-.•isit any negative assumptions they might harbour such as the
notion that seniors arc rigid or not capable of making their own decisions due to cog•
nitivc decline. \Vhile many seniors have hC3ring los~ this should not be confused with
loss of mental ability.
SUSTAINING THE COUNSELLING

RELATIONSHIP
Immediacy
immediacy: Atool f o r ~ . I mm ediacy is a tool for exploring, evaluating, and deepening counselling reJntionships
evaluar.&. and deepening coun~ (Eg3n & &hrocde.r, 2009). All rdationship~ including counselling relationship~ are
nlation~ s.
subject to periodic conflict. This may arise from communiai.tion problems, strong emo-
tion~ misconceptions, failed expectations, power struggle~ value conflict, and many
other re3sons. Such conflict has the potential to be destructive, but it also presents a
great opportunity for further development of the relationship.
The~al of immediacy is to strengthen the counscJling reJationship by evaluating the
gene.ml working di.mate of the counscllor- diem relationship. "The reJationship is cwlu,.
ated or reviewed, and relationship strengths and weaknesses are examined by exploring
the respective feelings, hopes, and frustrations of the parties involved" (She.bib, 1997,
p. 114). All relationship~ including the counselling relationship. arc occasionally tested
with minor or serious personn1it)• conflicts and communication breakdowns. Counscl.-
ling involves rislc..taking, whidi. can lead to stress and anxiety. This process of change
means that the reJationship is not always plC3sant. Handled wisch•, these conflicts have
the potentiaJ to deepen rather than impair reJntionships.
When problems arc identified, they can be resolved through discussion, compro-
mise, conflict resolution, or renegotiation of the relationship. Jmmcdiacy can address
fttlings such as anger, rescntmem, or resistance that are adversel'>' affecting the reJntion.-
ship. Similarly, positive feelings of liking or attraction miaht also need to be addressed
if these feelings are clouding objectivity or progress. The example below illusrrntes how
a counsellor might initiate relationship immediacy:
CounS(>IJOr. I want to put ,iskle what v.--e\'t, been ~!kin¥ about ,ind ~ke a look at wh::u's
h::appeninK betv.--een us. I think we have ,i ¥ R':at r::apport, and Yi't, both seem relaxed when
82 Chap1er 3
we're h'.)~ther, but I believe l\ee betome reluctant t'O be totallr hones«. ?l.fa)'be it's
because I don't want the rel3tionship to become unple:aS3.nt. I( I'm not mistaken. you
seem to hold back too.
Immediacy is a pO\\rc.rful tool for preventing communication brc~llcdowns and build~

ing rrust. By addressing relationship difficulties as they arise, problems that are more
serious are prevented from deveJoping because of the buildup of unresolved feelings.
This does not imply that every relationship issue must be explored. With immffliacy,
counsellors can address significant feelings and issues that affect the reJationship as they
occur. but it is important for counsellors to be sensitive to timing and pacing. Gene.ra.11)•,
immediacy should nor be introduced when a session is ending if there is insufficient
time to resolve issues. 1t may also be wise to delay immediacy discussions if clients are
unduly stressed with other is.sues. As well, avoid initiating immediacy discussion too
C3rly in the relationship before a base of trust is developed. Counscllors can ensure the
appropriateness of using immediacy by asking: Would immediacy be useful for the di-
end Does the client have the capacity (personal strength and resources) to profit from
immediacy at this time? Immediacy is a way to get closer to clients.
A dependent relationship arises when clients become overly reliant on their coon• dependent relationship: A
sellors for decision making. Common indic3tors that a dependent relationship exists uunselling Rb1ion~ ii wbQ dients
tieoc. ow,t, teliant on lktr counsfflors
include excessive permission seeking, frequent phone calls or offKe visits for informa, for decision maliing. lndicitors indDde
tion, and an inability to make simple decisions or take action without consulting the a:cesswt pe,mission seeting. frequent
counsellor. A dependent relationship undermines the principle of self-dne.rmination b\• ptic. calls « office visiis rorillcrmat•
and a11 inabiityto m..W simple de:isioa
shifting power away from clients and preventing them from deveJoping independence.
A well-timed immediacy discussion can address dependency issues and lead to a new
« Lale act• 11ihout c.sulting .ith tile
uunsellor firsl
contract that favours client autonomy.
(n the following example, the counsellor uses immediacy to identify a sharp change
in the mood of the interview:
Counsellor: You ~m to h:t,'t, become S<HnN·~t quiet. \\'hen I ~,sk:. question, you
i-1\'t, me one. ort\\'0-Yi'i>rd 2ns"eers. Usual!)' you're q uite expressive. Is somethifl¥ wroni!
Client: Now that you mention it, res. I'm just noc sure !'loo.\• 1m.ch I'm willina to trust
)'Ou. At first it was okay. but now you ~m intent on pushina me to deal with thin¥,$
I'd rather keep pd\'ate.
Couruellor : Perhaps l'1n movina too fast or brU,i.ina up issues v.--e h:l\'en't :!ir~d 10
talk about.
Client: Mostly )'Ou don't take no lor an an5\\-e-r. When I s::I)' I don't want to ~lk about
somethintt, I mean it.
CounseUo r: Like earlier today. when I kept oomlfl¥ back to how )'Ou (elt when )'Ou broke
up with )'Our wife.
Client: That ·s 2 perl'ttt ex2mpte.
Coun.se.ltor: I ttuess I was push)'. I knN• )'Ou would rather ::t\'Oid the topie. At the s::m~
t ime. I could see t~t there wu so much poin in\'olved ch:tt I thou{tlu it m~t be useful
to talk 2bout your (~hn~.
Client: You're probably ri$:ht. I should face it, but r,n :i(r2id.
\Vhen responding with immediacy, it is important to use I -statements to under• I-statements: Clear asserti>ns abo-JI
score responsibility and ownership of feelings. (n genera], the emphasis should be on penonal feelings« reaaions that de not
blame or judge others.
statements such as "I'm uncomfortab le," not "You make me feel uncomfortable."
Coun!l('Uo r: Let's stop (or:. 1no111ent. r,n feel1fl¥COn(us«I, and r,n oot sure where v.--e're
he~ed. What's happenina for you!
Client: We do seem to be K()lna in circles.. I'm lost too.
Coun.se.U.o r: All ri~u, let's talk 2bout how \ \'e can ~-et ix.cl. on track.
Relationship: Tile Foundation lor C hange 83

In Interview 3.2, the counsellor uses immediacy to address concerns that his client has
become dependent. Initially. the client is reluctant to discuss this issue, but the coun.sdlor's
persistence sets the stage for the client to emerge with some important feedback. Changes
in the relationship can then be negotiated. Morcovc.r, the process models communication
and relationship problem-solving skills that are transferable to other situations.
Transference and Countertransference

transferenc:e: The tfadffl(J al tlieals Transference is a concept that ,.,,.,..s first introduced by Freud to describe the tendency
toa,mmunicate ■idl, t!leir couns.elkn in of clients to communicate with their counsellors in the same Wtt)' that they commu-
the sa• •.tr that theycommunicated to
signific,• people in the pisl nicat~ with significant people in the past. Transference can include reactions of both
attraction and aversion. \\:'hen transference is strong. clients have intense feelings and
reactions that arc unconnected to experiences with their counsellors. Transference is
))l} INTERVIEW 3.2

counsellor: Oo you remembet that when we fil'SI met, we Analysis: The counse/10t signal$ an interest In l()()l(ing at the
agreed that from time to time we'd stop to evaluate hOw relationship and P,OY!des a link to earlier relationship contract-
thi~ ate going? If it's okay with you, I'd like to talk abOut ing. so the ,:,,ocess should not come as a surprise to the client.
out rel3tionshi~O'N we're communic.ating, as well as
what's wOr'kiog ar\CI what's not wOl'kiog.
Client: I lhink it's been great. You always seem to know Ana/y1/s: Many clients are uncomfortable with immediacy
what to say. I don't know if I COlJCI cope if it we-ren't lot you. discussions, perhaps because of past failures. The client's
praise of the counsellor may be justified, or it may be an
attempt to avoid any controve,sfal topics.
counsellor: ThankS. To be hOOeSt, I have mix.ed reactions Analysis: The counsel/Or self-discloses feelings and concerns.
to what you're saying. It's nice to be appreciated, but I'm This alSo models fo, the clfent.
alSO concetned. I wondet if by telyin.gon me so mud'l, il's
bee:Omi~ harder fOI' you to do it on )'OU' own.
Client: I can'I do it on my own.
Counsellor: Okay, so you need help. 8Qt~ a~e to seek Ana/y1/s: Without attempting to argue with the client, the
and accept help is a sign of strength. My concern is that I counse/10t gently perSfsts In encouraging the client to look at
may be dcin.g things fOr' you that you need to do yourself. the issue..
Client: Now you sound like my father. He's always saying Analysis: The client ;s able to k:Jentffy an important parallel to
that I ShOlJd stand on my own two feet more and not rely her relationship with her father (transference).
on him so much, but every rime I try to be independent.
he intederes.
counsellor: Does that happen between you ar\CI me?
Client: <Hesitates.> A rime.
counsellor: Can you efatx)rate? Analysis: The counsellor uses a simple probe to make su,e that
Client: Don'I get me wro~. I really want you( help, but he understands.
sometimes it seems like you've already decided what I
Shouts do. I figufe that you probably kOOw what's best, so
I just go atong 'Mth )'OIX ~n.
counsellor: 11 sounds as though you have mixed feelings. Analy:sls: An empathic response recognizes the client's ambiv-
On lhe one hand, you value my help. but on the olhet I alence Of mixed feelfngs.
alSO sense some retuctanice, maybe a bit of a~r at me. I
wonder if part of you knows it isn'I good fOI' you if you don'I
have 100 freedom to make youf oNn deeisions.
Client: That's right
84 Chap1er 3
~JI) INTERVIEW 3 .2 Immediacy {cMtinue)
Counsellor: can you think of a recent example? I want to Analysis: Asking for an e.KAmp/e ensu,es that bOlh the coun-
make sure I undel'$tancl. sellOt and client have the same understanding. As well, the
Client: Earlier tOday when I mentioned lhat I wanted to go enmple adds necessary detail and clarity to the Issue.
back to schOOI, you were really supJX)ftive, and I appreci-
ated that, bul it seemed like you were buldozing me to take
art. I like to paint, but it's a hObby. not somett'li"lg I want to
purs:ue as a career-.
Counsellor: That's a g()()j point Thar\kS f0t the feedback. Analysis: The Immediacy d/scU$slon deepens the relationship
Let's talk abOut hO'N we can change ouf relationship to and enables the counse.llor and the client to negotiate neces-
avoid similar ptOblems in the future. fOr' my part, l'U try to sary changes.
be m::>fe sensitive to interfering. What abOut you?
Client: I guess I should be mofe assertive.
Counsellor: Meaning?
Client: If I think you're pushi~. I wtl you tel you.
Counsellor: And. when I sound like youdather . . .
Client Watch ou~ (Both laUf/fl.)
ReHectJons:
■ What might be the outcome if this conversation never happens?
■ Suppose the client insists that ..all is well." Suggest options for the counsello,.
■ The success tip below sugge:sts that relationship patters and p,oblems for bOth clients and counsell0rs tend to be
duplicated in their relationship with each other. Expl0re how this might be hue in this relationship.
liket,., present when the.re arc strong feelings of liking or disliking another person based
on first impressions (Young, 1998). For example, a client might relate to the authority
of a counsellor with the same withdrawal and inner anger that charactcri.!ed an earlier
rcJationship with parents. In addition, as Egan and Schroeder (2009) note, "Some of the
difficulties clients hnvc in their da)'•to-dtt)' relationships are reOected in their relation-
ships to helpers. For instance, when they are compliant with authority figures in the.ir
everyday lives, they may be compliant with their heJpcrs. Or they may move to the
opposite pole and become aggressive and angry" (pp. 20 5- 106).
SUCCESS TIP
Relationship pattems and problems that clients have .-i theil' everyday lives tend to be dupli-
cated in thei( relationships Vitth counsetlOr'S. Similarfy, counselbs may bring relationship
patterns and ptOblems frotn their everyday lives to lhe counselling relationship.
Examples of transforence:
■ Kevin despe.rately w-ants to be liked. He gives his counscllor unsolicited praise and
gifts. Increasingly, he begins to act and talk in the same,.,,.,.,,., as his counsellor.
■ Claire suffered ab use from her father and both of her brothers. In the first session
with a male counseJlor, she immediately begins to cry, despite the fact that she felt
optimistic and self<onfidcnt before she entered his office.
■ Amar has n strong need for npproval. He withholds information that he thinks
might provoke the counsellor's disagreement.
Relationshi p: Tile Foundation lor C hange 85

■ Jamie, a sb:•'>'C3r.-old who has been abused, behaves in a sexually provocative way.
■ Toby, age 18, has had a very strained relationship with his father. His coon•
sellor notes how easily he becomes angry during the interview at the slightest
provocation.
With transference, unresolved is.sues result in distortions in the way that others
are perce.ived. Consequemi)•, the successful examination and resolution of counsellor-
diem relationship difficulties heJps clients develop communiation and problem resolu•
tion skills that will be useful to them in their daily lives. Jt is important that counsellors
distinguish client reactions and feelings that arise in the currem relationship from those
that arise from transference. Counsellors should not be too quick to rationali:e clients'
feelings and behaviours as transference. Their clients' responses may be valid reactions
to what has transpired in the counselling session.
Transference happens to some degree in aJI relationships. but it is much more likely
to occur in relationships in which authority is present. Of signifiance is the fact that
to some extent all counselling reJationships involve J)O\\'er and authority. Counsellors
such as probation and parole officers ma'>' have formal roles of authority. Counsellors
may also have power because clients perceive them as having su~rior or expert knO\\•l.-
edge. Some counsellor~ such as those in weJfare setting~ have control over services and
benefits that diems are seeking. Clients also may react to other variables, such as a,;e,
socioeconomic status, position, gender, marital smrus., appearance, size, intelligence. and
social deme3nour.
countertran.sferenc:e: -ne positive • Countcruansfcrencc is defined b\• Gladding (201 I) as "the positive or negative
•ptiw •fahes. f•tasies, and feelings wishes. fomasie~ and feelings that a counsellor unconsciousJy directs or transfers to a
that acounsfflor •onsciom.ly dEts or
transfen to adent. steaail:g frca tis or client, stemming from his or her O\\'ll unresolved conflicts" (p. 42). The risks of coun.-
lier tni.nsoh,ed cooflicu"' (Cl~. tertnmsforc.nce underscore the importance of counsellor self.awareness and the respon,.
2011,p. 42). sibilit)• of supervisors to pro\tide opportunities for them to " monitor the tendency to
be too helpful, and to deal with feeJings of sexual attraction as well as anger, fear, and
insecurity" (Young, 1998, p. 169).
Countertransfercnce is.sues are emotional reactions to diems whereby counsellors
come to see clients as project~ sexuaJ objects., friends., or even extensions of themselves
(Young., 1998). Below are some signs for counseJlors that countertransference is happen,.
ing or that a risk for countercransference is present:
■ h3:Ving intense feelings (e.g., irritation, an,;er, boredom, and sexuaJ attraction) for
clients '>'OU hardly know
■ feeling attraction or repulsion
■ being reluctant to confront or rending to avoid sensitive issues or feelings
))t) BRAIN BYTE
Neural networks, f0<med by loaming and experience, afe experien:e. This conoeclion ot association is nor available to
ac1ivated by explicit Or' implicit memory. Explicit mem0<y conscious awafeness. (Gabbatd, 2006). Transferen:e occurs
activates the frontal COftex. and the hippocampus to fecal in counsem~ when implicit memories stimulate emotiooal
ex.petiences, in.formation, Or' ideas. Implicit memocy ir'WOl\'es and behavioural responses associated with other felatioo•
diffefenl parts of the brain, the basal ganglia, and the cer. ships such as wilh one's father. A clien.t who feared the harsh
ebellum. It encompasses m::>tof memo,y skills suctl as how discipline of his father and kept his feelings to himself may
to drive a car. as well as associative mecno,y, W'hid'I includes do lhe same tt'ling with his counseltof, unawate that there
defences. emotions, and behaviours lhat emerge from trig• are aspects of his counsel.lOt's appeatance Of behaviour that
gers 01 associations. F'0c example, hearing a particular~ temind him of his father and have set off the same guatded
may evoke sadness that i:S connected to a past unpleasant response.
86 Chap1er 3
Adults who wefe abused 0r ooglected as children may may feel unworthy of love and Mremain in dySfuncrional pat-
develop bl'al'ls It.at are JXX)rty eciuipped to fOl'm healthy feta• terns of behaviof, hOtd on to failed str'ategSes, and temain in
tionships.. TM amygdala, a part ot the brain that is fespon- destructive felarionships• (Co2olino & Santos, 2014, p.163).
sible fOr' pfOCessing fear, can be damaged btf abuse. A person A unk:lue opportunity to altef these patterns i:S possible if a
may entet adulthOOd with ex.eessive feaf of raking risks, a strong and Irusting counsem~ relatiooslip can be negoti-
necessary part of reaming and k'lfunacy. In tess lhan one-half ated using a ttauma-based approad'I. Cozolino and Santos
a second and outside ot consdous awareness. a damaged (2014) discuss the ne-1.Xoscience: "A positive emotional con-
amygdala may triggef feaf and 100 ..flight 0c figru· fesponse nection sthn ulates fewardi~ metabOlic pfoc:esses that acli-
befOr'e the mofe tational pre-frontal cortex can ascertal'I that vate neuroptasticily, and secure relationships pfotect against
a felationship is potentially safe. 1n lhis way, the amygdala sttess. wtlid'I inhibits pfotein synthesis and othet biotogjcal
erects bar(aers and gener'ates negative emotions that pte- processes necessary fOr' brain gfoNth.· This is furthef evi-
vent the formal.ion of meani~ul and intimate relationships. dence of the centrality ot the eounsetling telations.hip as a
(Cozolino, 2010; CozOlioo & Santos, 2014). Abused children Pf81'8'Cluisite fOr' client groNth and d'lange.
■ continually running ove.rtime with certain clients and wishing that others would
not show up for scheduled appointments
■ adopting rescuing behaviour, such as wanting to lend money, adopt abu~ children,
or protect clients
■ thinking about client similarities to other p«>ple
- --
' - ' CONVERSATION 3.3
STUDENT: I think thal many counselt)rs mi:sund81'Sland self- STUDENT: As I see ii. the most impoc&anl principle is that
diSCIOSufe. Some of my COiieagues make a point of telli~ self~iSC:IOSure shouk:I be an oprion, not a compulsion. Coun-
theif clients about thes' past whereas others Share little Or' sellOrs ooed to be able to self-disclose, but they al!.O should
nothing abOUt their private LiveS. be able to consttain lhemsetves from always disclOSing. If the
session is m::,ving smoothly withOut self-disclOSufe, then it's
TEACHt:R: CounseUOr' self~isclOs.ufe can be an impoftant
ptObably unnecessary. Self~isdosure must stfengthen the
para of effective counselling.. The problem is knowing W'hal to
relationship or other'Wise contribute to lhe v.()rk. The primary
Share, hON muctl to Share, and when to Shafe 1t.
goal is to meet 100 client's needS.
STUDENT: I agree. I lhink some disclOSum conveys that the
TtACHER: Thal's ~ht fot me, the most important principle
counsellor is warm and human, and 1t helps clients OYet'COO".e
is to avoid letting counsellOC' setf-disdosure Shift the focus of
the common mistaken belief that they are the onl'j ones with
the intel'View from clients to eounsenors. That leads to role
problems.
reversal, with clients counseui~ counselOrs. As I sai:1 eartief,
TEACHER: Self~iSC:l::>Su(e modets apptOptiate sharing of lool- too much setf-diSdOSure leads clients to see counsellors as
ings and gives clients the courage to open uJ). Some clients incapable and lose confidence in the ptocess and the capac-
may feel reassufed knowing that theit counsellOts have faced ity of their counsellors to help. The counselling relationship is
similar problems. but unless it's haOOled carefulty, clients not mutual, with each person taki~ rums Shari~ a problem.
may see their counsellors as~. What's often forgotten is the fad that setf-disct>sum inwlves
IT'IO(e than sharklg details of )'OU' past Or' youf per-sonal prob-
STUDENT: Back to your earlier statement Whal do you share?
lems. Sharing your feelings wilh clients abOul the r'elationslip
HON muctl? When?
or the "-«k i:S al!.O self-diSC:IOSu'e and a key eternent of the skill
TEACHER: The a~rs vary depencfi~ on the client and the of immediacy. Rogers (1961 and 19Sl), a centr'al figure in
situation. 1.n gener'al, a moder'ate level of setf-disclOSufe is counselling and too found81' of client~ntred <~ntred)
appropriate (Sheafo, & Horejsi, =>. Howellel, some sUua- ther'apy, em,:tlasized the lf11portanice of bei~ tr'ansparenl and
1.bns maywa«anI a great deal ot self-disctosure and some oone real in the felationShip by Sharing m::,ment-to-momenI feel-
at au. Oependi~ on the siluatklo, too muct'I self-diSd::ISl.l'e may ings that am relevant to the relationship. Aftef all. if we can't
be as bad as too little. be open abOut OUf fee6~. hON can we expect dients to be?
Relationship: Tile Foundation lor C hange s·7

TABLE 3.2 Guidelines for Counsellor Self-Disclosure
Self-disclOSure should 001 Shift the focus from client to counsetlo,.
Self-disclOSure should be used only to meet the needs of the d ients.
Counsetlors need to be able to self~ isclOSe as wel as able to 001self-disclose.
Too much can be as rnapp(Ol)(aate as too Htle.
RevealW'lg current feelings, concerns, and ideas is usually more useflA than revealing past
~ IO<y.
If the work is prcxooeliog smooltlly without it. then it probabl'f is not necessary.
■ dealing with clients who have problems or personal histories similar to your own
■ employing unncccsS3ry o r excessive self-disclosure (see Table 3.2)
■ fccling rductant to end the cou nselling relationship
ENDING THE COUNSELLING RELATIONSHIP

Counselling relationships wry in length from a single interview o r a short e ncoun-
ter to many years. Some are super ficial, with minimal e motional investment by the
participants, wh ile others result in conside.rablc intimacy and emotional involvement.
Counsellors need to make intelligent decisions about when to terminate the reJation.-
ship. Term ination of counselling relationships may happen fo r a number of reasons:
I . T he reJationship may be ended when the ,;oats of co u nscJling have bee n rcnc.hcd .
Counselling relationships arc time-limited, so when clients have developed a
sufficient ai.pacity to work on their own, it is time to end the relationship.
2 . Counsello rs may end the relationship if they do not have the tim e o r competence
to fulfill their clients' n eeds. In su c.h cases, the ending will include refc.rraJ to other
co u nscJlors o r agencies.
3 . Counsellors ma y d etermine that they are u nable to work with sufficient objectivity.
Herc again, refc.rraJ is the preferred a1ternativc.
4 . Siruationa.J factors such as illness, mo\ting, o r the end o f a practicu m may necessitate
ter m ination o r refer ral
5 . If evidence shows that cou nselling has not worked and that the re is lin le potential
fo r success, it is tim e to term inate o r refe r.
SUCCESS TIP
Clients may decide to opt out of future service and fal to show up for scheduled appoint-
ments. However, lhis does oot necessarily mean that the work has been unsuccessflA
because "as many as twi>thU"dS of dropouts reJX1r1 considerable progress• (Fortune, 2002,
p. 459).
T he Canadian Cou nscJling and Psychotherapy Association's Code of Erhic.s (2007)

offers this guidance on term ination:
CounsellorS tertnin:lte «Junsellina rElauonships. with dien1 ~ree.me:n1 whenc,'er po,$$ible.
wtlt:I, it is reasonably dc.l.r th::n: the '--oc3ls o( rounsellirl{t h::t\'e b..>ei, met, thedient ii no Ion,
~er benef'ht irl{t from eounselhn$:, when clienu do not P3)' fees cha~ed. when p revious!)•
d1sclosed 3'~11('.)• or inst itution:11l lunits do not allow lor the provision o( fu rther eounsel,
lifl¥ serviees. HOYi'e\'t:r. counsellorS make re::tSonable e«ort.s to l::.ciJ1tate the eontinu:ltion
o( eounsellifl¥ sen •kes when sefVi~s are inter-rup ted b)• such (:k't<>rS as counsellor illnes:s,.
client or eounsellor rek1<'::ltion. client llna.nd:d d1((ku1ties. :md so forth . (p. 818)
88 Chap1er 3
The end of a counsetli~ relationship may t(.gge-r some of a~ fite when tr1ggered by cues associated with 100 ended
100 same feeli~ as those ex.perienced in any relations.hip telationship. In addition, research also found tnal the tewatd
breakup. The psyd'lotogjcal distress thal people feel can noN system of the brain e ~ i"I a waysi'nilar to the~ perSOns
be (partialy) explaiood by funcrional magnetic tesonance with addiciions c1'3Vedrugs(Greenbefg. 2011). This research
unaging (fMRI) of Ille btain. Imaging shows Iha! parlS of Ille suppocts the imJ)Orlance ot spending ritne addressing the loss
btain 1hat typically ftte when people ex~ience physical pain associ'.ated with the encl ot the counselling relationship.
Endings can evoke painful feeJings. All relationships, regardless of their length,
have the potential to be intimate. The counselling rdncionship is not designed to be
permanent, but owing to its intimacy the ending of the relationship may trigger power-
ful feelings nnd behaviours in both clients and counsellors. For some clients, intense
satisfaction and feelings of accomplishment punctuate their success, but ochers may
fed abandoned and dese.rced. The ending may remind chem of the pa.in and sadness of
other endings. so they may need help dealing with che.ir loss and grief (Brill & Levine,
2005; Shcbib, 1997, ond Shulmon, 2009).
The ending of a strong counsclling relationship brings anention to the fact that all
rc1ationships are temporary. Pending termination may generate a variety of emotions
and reactions including anxiety, anger, nnd denial of the ending. Counsellors need to be
sensitive to signals chat clients are having trouble with endings. Some clients who have
shown progress miaht regress to previous ways of coping, or they may present new and
complex concerns that seem to say, "I'm not read,., for this to end." Gladding (2011)
emphasizes the importance of mutual agreement to end the relationship, although for
a variety of reasons this may not always be possible.
Other clients might express their pa.in about the ending by expressing unfounded
anger nnd resentment (in dfect, avoiding the pa.in of the ending or denying the impor-
tance of the relationship). Still others fail to show up for the final meeting as another
way to avoid dealing with the pain of the ending.
Young (I 998) suggests that "a helper's feeJings of loss at termination may also be
due to a reliance on helping relationships to meet needs for intimacy (friendship) as well
as a conscious or unconscious sexual attraction" (p. 286). The termination may also
remind counsellors of other losses in their lives. When these losses remain unresolved,
the.re is a risk that counsellors may be unable to handle termination with the dient. They
ma't' feel guilty for leaving the dient, and they might dcla't' or avoid termination to dude
their own feelings of pa.in. Counscllors who have invested heavily in the reJationship
have to deal with the.ir own fedings about the ending. This may result in a variety of
denial renctions:
■ Denial of the ending b)• allowing or encouraging clients to remain in counselling
loni;er than necessary. The counseJling relationship is not designed to be lifelong,
and the counselling contrac.t should set an end point to the relationship. As wcll,
individunl interviews should be structured within n time frame. A defined time
frame helps to focus and contain the worlc. Excessively long interviews without time
controls can lead to fatigue, unnecessary repetition, and inattention.
■ Denial of the ending by making false or unrealistic concessions or promises (e.g.,
by promising to visit or correspond with clients)
■ Denial of feelings by behaving apathetic:.llly or avoiding discussion of feelings about
the ending
■ Denial of feelings b)• abruptly ending without warning

SUCCESS TIP
C(edit the client for success ln counselh.ng. If, lot exami:,e, tM client says, "You am 1he
only one that listens to me,· you might say, ·"What have you been dc::ing differently lhat has
tnade it easy f0t me to listen?"
Dealing with Endings

The ending phase can also be a time of continuing growth for clients, so it is important
to involve clients in the process. As Brill and Levine (2005) suggest:
In termin::uion. as in the other step!? o( the probJem.-$0,JvinK proces!l. the d1e:nt's p.,r1ki,
p3tion ill o( maxilnum import:mtt. I( the helpin~ rel::uionship is at 311 si~nif"lC3.nt. the
way it ends will be import21nt for the d!ll'nt's sel(,im~e and C3p.1C'Jt)' for future rel.:uion,
ships,. The re:ason (or termination should be dear in the minds o( both client and work.er
and. whene,~r possible. (eeli1l{tS about it ~pressed and und.e.-scood. (pp. l~l~I)
The ending ph3se, when h3ndlcd effective],.•, offers rich potenti31 for work. Sur-
prisingly, many books on counselling do not e.x3mine the thera~utic possibilities of
the ending phase. With trust firmly established in the reJntionship and the urgency
of the end approaching, clients ma'>' b roach signific:.m t themes and topics in the end-
doorknob commt.nieation: A ing phase (Shulman, 2009). Shulman (2009) describes the phenomenon of doorknob
pkiloffl!IIOII descli:led tdlerein tli.-s
communication, whereby clients bring up important issues 3t the end of the interview/
twing - ~ issues at the end al
the intervie,,,hebtimsll,f) 'lltlen then is rcfotionship when the.re is linle or no time to 3ddrcss them. Clients are typicnJI,., amb iv-
iitle or• time to addres.s lliem. alent about dealing with the is.sue~ but their need to address them finally overcomes
their need to 3void them.
Tc.rmination or transfer should not be 3brupt but 3nticipnted 3S 3n outcome during
all phases of counscJling, It should be "discussed during the planning and contracting
phase of the helping process and the client should be reminded from the beginning
that intervention is goal oriented 3nd time limited" (Shcnfor & Horcjsi, 2008, p. 479).
Generally. termination of the counselling relntionship should focus on the following:
■ review of the e>,,'tent to which worlc contract goals have been realized
■ procedures for further conroct or services from the agency, if needed
■ rderral to other services, if necessary
■ relationship closure, including discussion of feelings regarding the ending- for
e.x3mplc, unresolved feelings 3nd rcgrcts~ .dong with unfinished business
■ next steps
The ending might also include some culturally appropri3te ritu3l such as the offer-
ing of a sm3ll gift, but generally, there is no expectation of counsellor reciprocity. One
uception might be the end of a long rcl3tionship with a youth, in which case the worker
might present 3 token of remembrance.
It is appropriate for counsellors to express chc.ir feelings about the termination of
the relationship. This models 3ppropriatc sharing for diem~ and it stimulates them to
risk sh3ring their reactions and feelings. Of course, this discussion requires counsel-
lors to be open to strong feelings that clients ma'>' express, such as s3dncss and anger.
Shulman (2009) underscores the importance of counsellors sharing their O\\•n feelings,
but he acknO\\•IOOgcs that this is a difficult skill to develop. In part, this difficulty arises
from the fact th3t counsellors may be struggling with their own sense of loss as they
prepare to cod the relntionship with a vaJucd client. Continued sclf-e.x3mination can
help counsellors develop self-awareness 3bout their own behaviours 3nd feelings regard-
ing endings and separations.
90 Chap1er 3
lntervicw 3.3 illust:raccs how the ending process can be used to address focling:s. The
client is a young adolescent about to bc-dischari;ed from a residential rreacmem centre.
For the last six weeks, he and his counsellor have bttn actively planning for his rctum
home. The client has been looking forward to more freedom and release from the rules
and restrictions of the centre. As part of his pre-release planning, he has spent two
weekends with his famil)•.
))!} INTERVIEW 3.3

In this interview, the client. i 16-ye.ar-old youth. is abOut to be released from a heatment centie endiog a six-month
relationship with the cOull$ellOI. During his time at the centie. the youth has g1own vey close to his counsenor.
Client: How long are we gotng to be hem? I have thi~ I Analysis: The counsello,- risks empathy by picking up on
need to do. n<Jnverbal cues from the client. The counse/10t suspects that
CounsellOI: If I'm not mistaken. you IOOk a little glum tOday. the client's overt anger may be connected to the ending of
the relationship and the more Important feeling Is sadness.
not anger.
Client: can't you tl\let let anythi~ pass? Why don't you just Analysis: TM client's first reaction is to deny his painful feel-
get off my back? ings about tM ending by expressing mote anger. The counsel!Ot
Counsellor: Tomon'ON you11be leaving the centfe to feturn is careful not to get hooked. 1h(J counsel/Or o,:,ts to keep the
hOme. Maybe we could talk atx>ut that. I'm wondering hoN conversation active in the feeling domain.
you feel abOut it. I \\()lJCl.n1 be sufprised if you had mix.ed
feelings of betng happy to be leavi~ but atso sad to be
leavi~ youf friends hefe.
Client: It's no big deal. but why should you cafe?
Counsellor: I feel sad k.nowing you're leaving. We've Analysis: By sharing her own feelings. the counsel/Or commu-
become very close, and l'I miss OU' time togethef. nicates her willingness to deal wlth emotions. He,- disclosure
Client: It's been all rigt\l. I guess you'fe Okay. undersc0t&S that the relationship had meaning. This acts as
a model for the client. Of course, any feelings tM counselk:Jr
shares must be genuine.
Counsellor: ThankS. and you·,e Okay with me too. ( Ten Analysis: AlthOugh his anger softens. he Is still reluctant to
seco(l(}S of silence.> How do you feel abOul us not seetng acknowledge his feelings. The counselk:Jr persists.
each Other- anym::>m?
Client: I can handle it.
Counsellor: I know you can. You've featly ShOwn a rot of
courage dealt~ you( pfoblems.
Client: I wish it wasn't happentng. I don't k.now if I'm ,eady Analysis: Although tM client has trouble labelling his feelings.
togo. M begins to open up. The counse.llor uses empathy to acknowl-
Counsellor: It's very sca,y lhinking abOut ~~. edge the feelings suggested by the client's remark.
ClleM: I want to go home, but my mother and I always Analysis: The client risks talking about his feelings abOut going
seem to end up fighti~. You and I can talk and not fight. hOme. 1h(J counse/10t tries to get tM client to accept credit f0t
Why can't it be that way with my m01oor? success in the counselling relationship. She challenges him
Counsellor: Maybe you have more conuOI than you think. to cons/de,- how he can transfer some of his behaviour from
What dO )'OU dO dlffetentlywith me than with )'OIX mother? the client--counsellOt relationship to Ms relationship wlth his
motMr.
Reflections:
■ What might happen if this client is not able to resolve his feelings regarding leaving the centie and the end of his
close relationship with the counsellor?
■ Explore the importance of cOull$ellOt self~isclosure in this encounter.
■ What impo,ctant p,inciples regarding endings are evident in this excerpt?

SUMMARY
■ Developing and sustaining an effective counselling rcJntionship is widcJy accepted
as critical to success in counselling.
■ Throughout aJI ph3Scs, the core conditions of counscJlor warmth, empathy, and
genuineness arc csscntfal.
■ Counselling contracts arc important tools for defining roles, purpose. and for antici•
paring issues that might arise during the life of the counselling relationship.
■ Over the four phases of counsclling-prclimin:.uy, beginning, 3ction, and ending-
the counselling relationship needs to be developed, sustained, and then ended.
Understanding the concepts of transference and countcrtransfercnce, the imcJligent
use of counsellor self-disclosure, and immediacy for dealing with relationship issues
is cruciaJ for maintaining the working dim:.ue of the rcfarion.ship.
■ The inC\•imblc ending of the counselling relationship may trigger J)O\\'erful fodings
in both clients and counsellors. The ending phase, when handled cffoctivdy, offers
rich potential for work.
EXERCISES
Self-Awareness 5. This exercise is desigoed to expand your self-awareness
1. What were (or are) the auributes of your most positive regardi~ issues that might affect your counsem~ relation-
telationship with another person? The most negative? Ships. Complete each sentence Qlkkty, without attempti~
How can you use this information to be a more effective to edit your thoughts.
counsetlOt? The one thing I have to have from other people is .
2. Pay attention to lhe people you see and meet over the nex.t What's missing k'I my personal life is . ..
week. Who evOkes str~ emotbnal reactions? Who seems Somethi~ that people dO that bathers me i:S ..
most similar to your parents or other authority figures?
The one type of person I'd hate to \\()rk wilh is .
Now ex.amine your feelings and try to identify transference
reactions-feeli~ that you carry over from prior relation- Retatiooshil)s would be better if .
ships and that ace not baSed on ot:;ective teacfions to the What I like most abOut people is ..
current relationship. What I dislike most aOOUI people i:S .
3. Most of us tend to repeat established patterns when we 6. Think abOut significant relations.hips in your life that have
begin new mtationsrtips. Seek feedbaek from others W'ho ended beeause of separation, death, or Other reasons. How
know you and ex.ptore Questions such as the folto'M~: did you res,:x,nd emotionally and behaWOU'all'j 10 lheSe end-
• What first impressions are you likely to leave with others? i~? In retrospect, are them thrlgs you wish you had said
• How do their perceptions compare with your intentions or 001 said? What ramains unresol\ied in 1hese relations.hips?
or k'lner feelings? (Suggestion: If thi:S ex.erdse evokes strong emotions, you
may find it useful to debrief 'Mth a friend 0t colleague.>
Now consider the fonowiog ciuestions:
7. In your answer to the pmvious Question, vd'lat behatJioural
• What am your typical feelings, thoughts, and behaviours
patterns am eviden1? What a,e lhe imi:lications of you,
as you begin teN relationships?
insights for your WOrk as a counsenor?
• How ace beginnings the same 0t different f0r you when
8. Rate the extent to which you think it would be apprOl)riate
you are relating to differant inclM:lualS or groups (e.g.,
for you to disctose the infofmatioo listed belOw. Use the
clients, colleagues, 0t supervisars)?
fallowing scale:
• What WOt'kS tor you?
S = a~N3yS appropriate
• What ooesn't? 4 = usually appropriate
4. b.amine your own needs with respect to keeping the coun-
3 = sometimes appropriate
sem~ relationship warm and pleaSanL How far would you
go to ensure this as an outcome? Under what conditions 2 = usually n01 appropriate
migt\t you ooecl to sac,iflce pteasantoess? 1 = never approp(aate
92 Chap1er 3
Be ptepar'ed to defend your answet'S with examples. Periodic.ally, Share hO'N you are feeling using a statement
___ Details of you( education and training such as MRight no-N I'm feeling . . .• You are free to add
other- significant lhemes in your retationShip that afe n01
_ _ Your phlosophy of counselli~
sugg,asted in lhe at:x>ve list. When you are finished, discuss
___ Information abOut youf age. marital status, and what d'langes you would like to make in youf relationship.
number of childmn
4. On the baSis of your Obsel'Vations and insights from lhe
Your sexual orientation pfevious question, begJ'I the process of develo,:iing a range
___ ParUcutars abOut your life. such as pe-fsonal of different Skills and s1tategjes for beginni~ relationships..
ptot,ems lhat you have faced This will help you avoid beeomi~ locked into estabis.hed
___ Details abOut youf eve-ryday life, such as your patterns. Oeflne pet'SOOal goals fof development in relation
hobbies, reading pfeferences, and vac.ation plans to hOw you handle begk'lnings. As par1 of thi.s, detail three
diffefent begj.nning styles you wish to add to your Skill rep.
___ Intimate details abOut youf personal life, such as
eftoi,e. Desctibe when and how you will experiment with
marital problems and recovery from addictions
these three appfoaches.. What prOble-ms do you anticipate
___ F'eelings soch as anger, bOredom, confusion, or migr\t interfere Vdth actlkNement of lhese goats?
sexual attraction lhat afe influencing the interview
5. Simulate a retatbnship contracti~ session with a coueague
To what ex.tent wefe your answers influenced by your com- in the role of client. Choose youf own issue and setting,
forl level with each of the categories?
6. Imagine you are interviewing a cl~t who believes Mcounsel-
9 . Evaluate your general comfort with self~isdos.ure and inti- ling is a waste of time.· Suggest several approaches.
macy. What areas ot your life are you feluctant or uowilti~
to talk aoout? To what extent wouk1 your friends and col- Concepts
leagues describe you as open or clOsed? O::> you tend to
1. Under what conditions do you thrlk it WOlJd be wise for a
be guarded aoout sharing in.formation, Or' do you generally
counsellor to avoid self~i:sctosure?
disct>se a great deal to Others? How does your comf0r1 with
disclosufe vary depending on wtlom you are talking with 2. Evaluate the JX)tential appro,:iriateness of eactl of the lolbw-
(e.g., family, friencts, authority figures., clients, COiieagues, ing counsenor self+di:Sctosufes (the counseltof is speaking
and strangers)? What afe the imp6c:ations of your answers to a client):
for your work as a counsenor? a. Youf situation fetniOds me of my own ptoblems. Maybe
10. Imagine you afe a client with liffle knowtedge of counsel- we can poo OU( energies and find a SOiution that WOr'kS
ling going for youf first intel'View. Assume you are seeld~ fof bOth of US.
help managing deptession. What are some of the thi~ you b. I'm SOtry to say that it's none ot youf business whethef
wouk1 want to know abOut the counselling pfocess and your I have children.
pending relationship with the counseltor1 c. When my huSband abuSed me fOr' lhe firSt time, I knew
the marriage was ovef and I left.
Skill Practice
d. (In an addict/Otis t,eatment ce.nt,e, meeting a client
1. Interview friends and coueagues on the to,:iics of warm1h,
lo, the fi,st time) Hi, I'm JOhn, and I'm a recovering
empathy, and genuineness. Ask them to describe how they
alcOhOlic. so I kt'IOw what you're going thl'ough.
kOON vd'len someone exhitits lheSe iMer qualities.
e. I'm feeling confUSed. 1think we need to stop fOr' a minute
2 . Talk to people wtlO are hapP'f in lheif wol'k. Ask them to
and decide where we'fe gci~.
describe hoN lhey sustain lheil' energy and enthusiasm.
f. YOU' i:toblems are realty getti'lg to me. They remin:S me so
3. Otcoostrate an immediacy enicounter-. Conttaet with a col-
much d my own struggles. They brklg back all my pain.
league to spend one hOUf evatuati'lg and stre~ni~ your
relationship. use the fOllo-Ni~ ope-n-encled statements to a:.You have the most beautiful eyes.
devetop lhemes f0( youf discussion, but be sure to explore b. I like what you're weari~ tOOay. It's really sexy.
your ideas and resJX)nses: I. Genierally, I like to lty to eslablish open communication
The thi~ I value mosa in this relationship is . . in my fetations.hips, so I push myself to be open with my
The ooo thing that is mi:Ssi~ in our relationship is . feelings even when it's difficult.
When I fr'SI met you, my feaction was . J. Your attitude really makeS me want to juSI give up on you.
You are most like . k. This has been a bad day lor me. The(e have been $0.IT'le
cutback.Sat the agency, and I'm "«ried abOut losi~ my
When I lhink aoout sharing foof~ with you . . jOb, so if I seem a little ptOOCCupied today I hope you11
F'or us to oocome dOSef, 1WOUid have to . undel'Sland.
What I want most from you is . I. What a weekend! We partied all night. I could hafdly
When I lhink of the future of OU' relationship. I . make it to work tOday.
Rel ationship: The Foundation lor Change 93

3. Oescr'ibe hOw counseltor setf~isclosure might be appropri- 4. What are the is.sues (pros and cons) involved in counselli~
ate in response to each of the fOllowk'lg client statements Or' friends?
questions. Suggest a response. 5. What themes trigr\t emerge as important and unique when
a. Have you ever felt so angry that you wanted to kill devetoptng counselling relationships in different fields of
someone-? practice Or' settings, such as woddng 'lfith seniors, group
b. My mother n.evet gives me the support I need. hOrnes fo, youth, fostet hOmes, addictions settings, immi-
want clients, COr'rectional facifrties, rtXal settings, hOspitals
c. I began using drugs when I was 11.
and hospice settings, work in the LGBTQ (lesbian, gay,
d. Are you gay? bisexual, transgender, ciue-stiooing) community?
e. I'm te«ified abOut gci~ back to SChOOI. I don't think I 6. Explore how a counseltof's age might be a factor wtlen
can handle it It's been so many years since- I wrOle an working 'Mth youth, such as counse-llot'S wM are-vety you~
essay Or' read a bOOk. and those whO are much older.
t My teenage son is d(rving me crazy.
r.. 1think lhis counseli~ session is a waste of time.
h. I realy Wke you.
I. 1dOO't think anyone hasevet been as depressed as I am.
WEBLINKS
An overview of the basics of Person-Centered Therapy .. The This site contains an article explo,ing juvenile offenders'
Foundation of Pe-son-Centered Therap(' by Jerold O. Bozarth perception of the counseHing relationship
www.pet"soncentered.com/theraplst.html www.jtpcrim.org/August_2011/Juvenile-Offenders-
Percepbons-Joh n-Ryals.pdf
This site contains links to major personality theo,ists, includ-
ing Carl Roge-s This site contains YouTube video links where clients discuss
their experiences with counselling
www.Sh1p.edu/-cgboeree/pe,se:ontents.html
www.youtube.com/ - ~ rch for Experiences of Counselling
This Counselling Today article examines technology and the Part 2: Developing the Counselhng Relationship
c-aunselling relationship
http:J/ctcounseling.org/2011/10/finding-technolOgys..
role-in-the-counseling-relationShip
94 Chap1er 3
iQ:)noep1'ShuttetS':ock
■ Define the components of listening for understanding.

■ Identify and describe strategics for overcoming listening barriers.
■ Ex-plain the importance of active listening.
■ Describe nonverbaJ communication.
■ List and explain the multiple meanings of silence in counseJling.
■ Define and demonstrate paraphrasing skills.
■ Define and demonstrate summari: ing skills.
LISTENING FOR UNDERSTANDING

When yoH ralk, you are only repenting what )'OH already
know, bur if you listen you ma)' learn something new
(Dafai Ulma)
Proficient counsellors are dynamic and responsive listeners. They arc persistent and
curious Je3rners committed to understanding. They strive to hear, not just the words of
the.ir clients, but also the nonvcrbaJ channel of inform3tion where variables such as voice
tone, posture, and gestures act to support, repe3t, enhance, or contradict vcrbaJ mesS3ges.
95
Effective listening, not only includes silence, but also involves the components
of hearing, observing, interpreting, 3nd responding through 3 complex process that
requires sensory, mental, and bch3vioural competence. As a mcntaJ proces~ listening
involves separating rdcwnc information from irrelevant information, 3ssigning meaning
to words 3nd experiences, and remembering and linking related data. High~levd listening
regards emotional unde.rst3nding 3S 3 prerequisite for fully comprehending the words
and content of wh3t the speaker has said. Put simply, listening is making sense of what
h3s been heard from the perspcctive of the other person.
Counsellors ma'>' use questions to obtain cl3rification, definition~ and ex3mples.
They use silence to reflect and communic3te respect for the risks that clients have taken
to share the.ir stories. Summarizing, paraphrasing, 3nd cmP3thy 3re, in pan, listening
c.heclcs to ensure the 3ccuracy of the.ir observations 3nd conclusions.
Effcctive listening as a counscllor requires man3gement of or diseng3gemem from
b3rricrs such as personal problems. boredom, lack of interest, or competing dem3nds
to folly focus-both psrchologic.ally 3nd physicallr~n the mess3gc. Counsellors need
to be self.aware 3nd constand'>' on the aJert to ensure that their own perspective docs not
detract from or contaminate their capacity to understand the words and fttlings of the.ir
clients. The listening process is oudined in Figure 4 .1. Since the challenge to effectively
listen is demanding and potentially cxh3usting, it is not surprising th3t failure to listen
dfcctivdy is a primary reason for relationship breakdO\\•n.
The Power of Listeni ng

Listening is a cornerstone of counselling 3nd is essential to understanding and reJation.-
ship development. Often clients come to counsclling with considerable experience of
not be.ing he-3rd. They may have turned to family and friends for help but found that
their concerns were discounted or were met with simplistic 3dvice by people who we.re
so 3ru:ious to heJp that they failed to listen with attention. In contrast, effective counseJ-
lors 3nd interviewers h3VC' a cultivated ability to listen.
As a fundament3l building block for the counsclling relationship, listening com.-
munic.aces to clients chat their ideas and fodings 3re important. Our natural inclination
is to interpret meaning to words 3nd behaviour based on our own experiences. This c3n
easily lead to assumptions that 3re very different from those intended or experienced
by others. Listening educ3tes counsellors 3bout the uniqueness of their clients, thu~
minimizing 3ny tendency to make erroneous assumptions. Moreover, listening encour•
ai;cs clients to tell their stories and disc.lose che.ir feelings. In the proces~ they m3y gain
enormous therapeutic value from rdc-3sing pent-up emotions. Also, when counsellors
listen to clients, clients become better 3ble to listen to themsclves. In genera], S)'Stem3tic
Hearir,g and Selecting and

Rememberir,g Somog Understanding
Verbal and lnfarmation, Meaning and
Nomabal Ideas. and Emotions
M._.. Feelings
Figure 4.1 The listening Process
96 Chap1er 4
listc:ning, punctuated with appropriate probes, clarifiai.tion rc:sponscs, and summaric:~
helps clic:nts ori;:ani!c: confusing and contradictory thoughts.
Listening is an act of accc:pt:mcc: and caring that says, "Your feelings arc: precious
and unique:. 1 ,von't insult you by assuming that I kno"' "'hat you're going to sa)' before:
you S3Y it. I w-on't judge or ridicule whnt you say. I ,von't try to change you to fit my
idc:a of "'hat )'OU should be." Listening is an active attempt to undc:rstand our clic:nts'
perceptions and fc:ding~ "'hid,. may be different from our own.
Ironically, "'hilc: listening rc:quires counsellors to be silc:nt, rc:maining silc:nt doc:s
not necc:ssarily mean that one is listc:ning. A silem person may hear the words and c:ven
be able: to rc:peat vc:rbatim what has bc:en said, but a tape rccordc:r or a dc:ver parrot
can do the: same thing. Good listening is an active procc:s.s that requires hearing the:
contc:nt. c:motional tone, and context of "'hat is bc.ing said while controlling listening
obstacles and using skills such as summari.!ing, paraphrasing, and empathy to confirm
understanding. 'W ithout attention and self-control, learning obscadc:s can contaminate:
mc:ssagc:s with unintended distortion, selective attention, and inte.rprctation. Thu~ good
bstc:ning requirc:s that we: opc:n ourscJves up to learning.
Listening is not a passive act---cffc:ctive listenc:rs arc busy "'ith the task of trying to
comprehend what is happc:ning for their diems. Somctimc:s counscJlors arc patiently
quiet as they respectfully yicJd the right to spc:ak to their clients. At othc:r times, they
are vocal, with questions and directives for more derail, example~ or darification. At all
time:~ they should ai.rcfully observe and try to understand nonverba.1 bdi.aviour. Active:
listening, a collection of skills discussed in this and subsequent chapters, is the way
that counsellors sho"' their dients that they are listening. This is possible because they
are, in fact, mc:ntaJly and ph)•sically committed to the msk of listening. \\:lith so much
at stake and so much to do, listening is hnrd work. 1t requires counsellors to focus all
their intc:llcctual and physical anc:ntion on clients so that clic:nts hnve the counsc:llors'
un"'avering commitment. Listening is the diem's re,.\--ard for talking.
SUCCESS TIP
To be heafd and deei;:iy underStOOCI by anothe-r pel'SOO rS a rare-and profoundly e-mpo.-.eri'lg
ex.pe-tie-oce-. Consequently, an lhe he-Ip that some- clients need is the opportundy to shafe-
the-if problems Viith a patient, non;udgmental listene-t who ooesn-'t butden them with advice-.
LISTENING BARRIERS
Communiai.tion is a process involving a sender and a r«eiver (for two-person communi,-
cation). In its purest form, the communication loop begins "'hen one-person frames and
sends a mes.sage using verbaJ or nonverbal channds (frequently both); the receiver must
hear and intc:rpret the: message, then pro,•ide fc:c:d bac.k that confirms undc:rstanding.
))l) BRAINBYTE L,t,_1 1,;

Barth (2011) re-pofted on a study by Prioce-ton neufosci- pfocess aoo add to a pe-rson's capacity to be- e-mpathic.
e-ntist tauten Silbe-rl who demoosttated that fMRI scans On the othet hand, inacc.urate anticipation has pitfalls and
of good listene-rs showed thell brain activity patalle-led that can cle-arly le-ad to misunde-r'Slanding and communication
of those to whom they wete listening. In addition. the bfeakdown. To p,-e-ve-nt lhis miscommunication, counsel 4
scans showed lhat key b<ain ate-as lit up befofe wofdS lorS must temain ve-ry aue-ntive to ensufe that their clie-nts·
wefe spoken. suggesting anticipation of what was abOut to mess.ages are in sync with any mess.ages 0c feelings they
be- said. On the one haOO, this might suppotl lhe- listening anticipated.
listening & Responding: The Basis t or Unders1andlng 97

TABLE 4.1 Common Listening Barriers
seooina Mes.sace:s Receiving Mes.safH
• Not havi~ the wOl"ds to ex.press feelings • Assumptions, bias, and judgment
and ideas. • E«ors inte(preti~ messages
Lack of i.nsigt\t o( awa,eness • Selective attention
Contradictory vet'bal and nonverbal • Heari~ words., but 001 emotions
messages • Em::>1.iooal reaction
Bias • failure to attend to oonve-rbal channets
Un(esolved trust issues • Unwlling to heat content or feelings
Pet'specrive (eun.u,al/wortcMew) • Distract.ions sud'I as fatigue, ooreoom,
Unwillingness to communicate and preoccupation with personal issues
(self-ceOSO(S,,ip) • Ptanni~ wtlat to say instead of listening
Information gapslincomi:,&te • lnte«upring. rushi~. or finishing 100
communicatio.n speaket''s sentences
• Resislance • Resista~
ln counsclling, this fttdb3ck, usually in the form of summaries, paraphrases, or emP3thic

responses., acts as a po\\'e.rful incentive for the client to continue. Questions(as discussed
in Chapte.r 5) are nJso an important tool in communication. They provide a W'll)' to get
missing information, example~ and definition.
Typically, the.re are a hui;e number of b3rrie.rs to listening (see Table 4. 1). Some
originate with the sender, others with the receiver. These can interfere with cffoctive
communication such that high-levcJ communication is often the exception, not the rule.
Closed-minded listeners respect onl)• those who agree with them. Since they nlready
have the "right" answ·ers, the.re is neither need to conside.r new thoughts and ideas, nor is
there any reason to seek additionaJ information. ln contrast, opcn.-minded listeners are will-
ing to explore new ideas and arc secure enough to he3r difforcnt opinions without distortion..
Overcoming Listening Barriers

Be Patient To make themselves unde.rstood, people need to be able to frame their
ideas. Clients who lack the ability to express themseJve~ perhaps because they have a
limited vocabulary or capacity to articulate in precise terms, use words that are vague,
ambiguous, or conrradictory. Others ma)' not have sufficient awareness or insight to
describe their feelings. In such circumstances., counsellors can become impatient, and
this becomes an obstacle to listening. They ma,., try to hurry the process b\• finishing
sentences for clients who are struggling to express themselves. Or they can become lazy
and assign their own mC3nings to words and phrases.
Active listening heJps to minimi.!e the risks of misinterpretation. Summaries and
p3raphrascs hclp confirm understanding, and they provide a re.flective mirror for clients
to hear the.ir own ideas from a different but undistorted perspective. Targeted and sys..-
temaric questioning encourai;es exploration and specificity, and it helps clients orgnni:e
their thinking and engage in problem solving.
))}) BRAIN BYTE ~I· Ai.1 '. ,., Al,111·1 S,,'.• ·1
Ten times faster than a visual image or a lhought can be irrelevant, while others, like a fingin,g phone, demand our
processed. lhe auditOty cifcuits of the bfain respond to immediate attention. But Horowitz wams of lhe dangefs in
sound. (Horowitz, 2012). Neufoscientist Seth Horowitz a new digital wOJkl, where effeclive listening beeomes dif-
(2012) depicts lhis auditory circuit as an alarm system ficult as ouf brains afe being seduced by constant noise.
in a constant state of readiooss to respond 10 sounds that As a safeguafd, counsellors ne&d to soundproof their
signal danger or attraction. Most sounds a,e ignored as sessions.
98 Chap1er 4
Focus on Trust Client messages can be incomplete or missing inform3tion because
of trust issue~ particulnrly in the beginning phase of the counselling relationship when
the client ma'>' be reluctant to share. This is understandable since the counselling rela,
tionship has yet to be tested. Consequently, the client may hold back information or
feelings that a.re ultimate!)• vitaJ for understanding 3ocf instead present "safe'' issues to
test the relationship or only hint 3t conce.rns th3t are more important. ldeaJI,.,, as coun-
selling: progresses, clients learn th3t they can depend on their counsellors to respond
with respect 3nd understanding. Unforrunaccly, in some cases, they m3y learn that the.ir
counsellor cannot be trusted with feelings.
Control Distractions and Stay Focused Once mcss3ges 3rc sent, they must be
received and interpreted accurately- hence the importance of a counseJling environ-
ment that is free from distraction and inte.rruption. Counsellors should never discon-
tinue an inte.rvicw to 3nswer the phone since th3t m3y brc3ch confidentiality, impede
relntionship rapport, and stop the flow of information. Similarly, pager~ fax machine~
cdl phone~ and even an unanswered ringing phone c3n destroy the ambience of a
meeting. Ideally, a.II such equipment should be turned off.
Good listening is difficult work that requires effort to stay focused. Since we can
think many times faster th3n others can talk, it's easy co allow our thoughts to wander.
The trick is to keep our minds busy with listening. Active involvement in listening,
through summarizing, p3raphrasing, 3nd 3slcing question~ helps counsellors stay 3Jert
3nd focused. Mental involvement helps counseJlors concentrate on and understand
what's being s3id. For example, as they listen, they can ask thcmsdvc~ "\Vhat does the
client mean by chat? Wh3t arc the key points in th3t explanation!" However, counsellors
should avoid trying to figure out what clients are going to say next since chis will only
dive.rt che.ir attention from listening.
lmcrn31 noise can 3Jso interfere with listening. Counsellors might be pr«>ccupied
with che.ir own needs or ideas. They could be looking fonvard to their vacation and
im3gining their break. They ma'>' be unde.r pe.rsonal stress. suffering: from fatigue or
thinking about other clients. A tired counscJlor might ddiberatdy neglect to explore or
define important idC3s.
Stop Assuming Jf counsellors believe that they a.lrc3d'>' know what others arc going
to SU)' and arc not open to new information, then listening is not possible. App3rent
patient 3ttention and silence could give the illusion of listening, but assumptions and
preconceptions quickly become obvious to asnue clients. Typical I'>', clients are guarded
3nd defensive with people who h3VC opinions different from their own. ln the follow-
ing ex3mple, a high school student h3s just told her counsellor th3t she has been offered
3 scholarship at a prestigious university.
Student: h's one o( the flnest unh'i'"rsities in the 2rea. It is an honour l'O h:ave been
chosen from :ill the 2pplicants. Mr fad,e-r, who never h:ld a chance to ¥0 l'O univerSity,
isecstatk.
Coun.se.ltor (Choke I): Wow! TI,::u is ternfle. You must be so proud o( )'Oursel(. TI,is
is re:tll'>' an ouutandin¥ opportunity.
Coun.se.ltor (Choke 2): How do rou (eeJ about it!
The counsellor in Choice I in this example assumes feelings 3nd mc3ning. As a

result, further exploration is discouraged or cut off. Choice 2 is 3 listening: response that
encoura,;cs more information. It 3Jlows for the possibilit)• that the client might say, "I'm
depres~ 3bout it. I've been ,;oing to school for 12 years, 3nd I really wanted to t31cc a
year off." Choice 2 illustrates 3 basic principle of effective listening: Good listeners arc
open to learning.
listening & Responding: The BasfS t or Unders1andlng 99

Personal Re.actions \Vhnt clients sa'>' and how they say it may arouse a counscl.-
lor's tension and anxiety. Emotions in the client c:m trigger emotions in the counsellor,
which, if unchecked, can lessen the counsellor's capacity to listen. For example, an
angry diem might stimulate fear in a counsellor, who, preoccupied with fe3r or insecu.-
rity, then might act defonsivcJ'>'· A depressed client might have a contagious effect and
cause a counsellor to become similarly despondent. Certain words or messages might
act as emotional triggers for counseJlors and lead to faulty listening and understanding.
Many beginning counsellors react strongly to clients who have been abusive, and
they erect listening barriers. They ,;ct so trapped in their own neo:I to condemn the abhor•
rent behaviour that they have no room left to become aware of their clients' frames of
reference. Consequently. they fail to establish any base for understanding and any crcd.-
ib ilit)' to promote chan,;c. Entering into the private w-orid of clients whose behaviour and
artitudcs differ sharpl)• from one's own requires emotionaJ maturit)', skill, and, often,
abundant courage. Such apacitics distinguish and define competent counseJlors.
Sometimes counsellors become bored (e.g.., when dealing with clients who spC31c in
a monotone or clients who arc repetitious and long-winded), even to the point of falling
aslttp during the interview. To stay alert during an interview, counseJlors must arrive
alert. They should get enough sleep and exercise and avoid heavy lunches that might
lead to drowsiness. Short breaks to take a walk, stretch, or dear the mind are important
ways of sustaining energy.
When clients share difficult feelings and topic~ some counsellors handle their own
discomfort by becoming inappropriardy quiet or silent, becoming excessively talkative,
changing the subject, or offering premature advice or reassurance. Such responses may
communicate that the counsellor does not understand or is not listening or, in the case
of inappropriate silence, that the counsdlor does not care. Counsellors need to become
confident in their skills and abilities so that they can tolerate clients' feelings, rcoctions,
and even verbal assaults with a minimum of defensive reactions, which obscure listcn.-
ing and understanding.
Listening Does Not Me.an Agreeing A common misconception occurs when people
confuse listening with agrtting.. One new counseJlor remarked, "ff I listen to someone
who abuses children, am J not condoning it?" Another person remarks, "J told him what
I want. \\:rhy doesn't he listen to me!" In fact, the other pe.rson may have listened and
hC3rd, but has chosen not to comply. In this example, failure to comply is interpreted as
e\!idcnce that the other person isn't listening.. This is a common error in thinking..
Exemplary counsellors are vigilant when they are dC3ling with clients who test the.ir
values and beliefs. They discipline themselves by taking extra precautions tom.sure they arc
listening accunndy. They also try to become alert to any inte.rnal noise that might impair
their capocit)' to hcnr. They know they arc vulnerable, and they take preventive measures.
Self.Awareness Since everyone's frame of reference is different, we can never per•
focth• understand how other people arc experiencing their world. Our understanding
is aJwa)'S clouded to some e>..'tent by the mC3nings we as.sign to events and by our own
thoughts and feelings. Counsellors may have unrccogni!cd or unresolved prob lems
))t) BRAIN BYTE

Reseatd'I has s00-1«'1 that when people feel ovetloaOOCI, they ;,, prC>OOSSlng 1ar-euage. nti,e ywr head., allow mom SOI.Wld to
Mat better' with theit right eat. Tris is beCauSe the rigl\t eat COO· the rigtlt ear miNf impt(We: listeni~ an:S mamory frOO'l 8pereent
Mets to the lefU::irain hemispf'e'e which ~ a doninant tde to as much as 40 percent in some individuals. (Starr, 2017)
100 Chap1er 4
parallel to those of their clients. Fo r example, o ne counsello r experienced unusual d is-
co mfort whe n trying to work with a client who was dealing with a n unw-nnted prcJ;-
nancy. Ten years before, the co u nsellor had placed her own ch ild up for adoption, but
she had never addressed the emotions she felt over the d ecision. \V henever her clie nt
focused o n her o ption~ the co u nsellor's o wn feelings made it tough for her to separate
he r feelings fro m those o f the client.
Table 4.2 summari!cs strategies for ove.rco ming co mmon liste ning p roblems. These
strategics are presented as ideas rather than as recipes for responding. E.nch intervie w
situation requires indiv id unli!ed and Crc3tive responses.
TABLE 4.2 Overcoming Listening Barriers

Ptoblem COunsello.- Choices
The dient has prObtems with language Ask questions to clarify meani~ .
(e.g., nisleading WOrd chOice and Pay careful attention to noovet'bal
difficulty verbalizi~ ideas). communication f0t dues to meaning,
Messages are incomplete, ambiguous. ot Probe fOt detail and examples.
undeat Pataphtase to confllm underStandlng.
Ask for definition.
Relationship ptot,ems/b'ust issues ate Sho-N empathy.
resulting in client cenSOr'St.p of feelings Have a candid discussion abOUt the ttust Or
and ideas. relations.hip issues.
Go at a sto.ver pace and reduce questions.
Communicate openness thraugh nondeteosive
'"'-·
There is outside i'\terletence (e.g., noise HOid phone calts and move interviews to a
and laek ol p<ivacy). ptivate setting.
There is intemal interference Start a personal wellness plan.
(e.g., COU-IOt fatigue, difficulty Improve rme management Skins.
concentrating, bOtedom. and hearing
impairment). Defer the interview.
Use self-discipline to increase concentration
(e.g.• mentally sum.mari?e key det.a'ils).
Summarize, paraphrase, and empathize.
The counseltor has a IOSs of ot;ectivity Use supel'\lision ot consultation to address
when dealt~ with ideas that are contrary perSOnal issues that ctoud objectivity.
to his Ol her values.. Discipline yourself to ext,IOte different ideas.
There are cuttutal barriers between Etllist the client's help to understand cultutal
counsetot and client. values and issues; lhen adaPI the interview style
to fit.
Use translators ot refer 100 client to a counsetlOt
of the same culture.
Oew!lop cuttufe-spe,cifllC kno-ldedg,e.
Content is o...el'Wtletming f0t the Summarize to identify themes and priorities.
counsetot (e.g., wtlen the client rambles Seleclivety intertuPI to contrOI the Oo-N ot the
Ot is long-winded). interview.
The dient is inappropriatety silent. Attempa to unders1anc1 the meaning of the
slence; then respond apptoptlatety.
The dient has speech prot,ems (e.g.• Remembet lhat problems may decrease as
mumtling, stuttering, and wtlisperlng). the counseltor becomes more familiat 'Mth the
client's style.
Ask the client to speak up.
list ening & Res ponding: The BasfS t or Under s1and lng 101
ACTIVE LISTENING
Understanding is alwa)'S tentative- hence the importance of aJlowing clients to confirm
or correct our understanding. Active listening describes a duster of skills used to incrc3se
the accuracy of meaning. Attending, being silent, summari!ing, paraphrasing, questioning,
and empnrhi!ing are the essential skills of active listening (sec Figure 4 .2). They b renthe
life into listening so rhnt it becomes a continuous process of paying attention, hearing,
exploring, and d~pcning. Active listening involves hC3ring what is said as well as what is
left unsaid. Counscllors need to use both their e\•cs and enrs to asce.rroin meaning. Careful
anenrion to sud,. cues as word choice, voice tone, posture, and verbal hesitations is nee~
sary to discover confirming or conflicting messages in the verbal and nonverbal mcssa,;cs.
Subtle changes in voice tone o r sudden shifts in the topic may signal important areas
for the counsellor to explore:. In one case, a 28-'>'C3r-old woman who w·as describing her
career goals happened to mention her sister. As she d id so. the counsellor noticed that she
avoided eye contact and her voice dipped slightly. He asked ho"' she felt about her sister.
The woman beaan cryina as she related how her sister had alwa'>'S been the favoured one
in the family and how she had felt rejected by her mother. Subsequently, this relationship
became a central issue during counscllina, and the client developed insiaht into how she
was using her career as a desperate: attempt to gain her mother's acceptance:.
Active listc:nina skills defuse c ritical incidents. The FBI, for example, has rccogni!ed
active listenina skills as essential competencies for resolving crises, including hosmi;c-
tn.king incidents, and it has replaced using force "'ith active listc:nina as the preferred
strategy (Van Hassclt et al., 2006; Royce, 2005). Research has shown that active listc:n.-
ing, particularly the skills of paraphrasina. empathizing, and open..ended q uestioning,
helps subjects (i.e., hoscage takers) release frustration, despair. anger, and other p,m,-erful
foelings, with the result that they rerurn to a more normal level of arousaJ a nd rational
thinking. One reason active listening is so effective: is because it docs n()( threaten people
with an overt attempt to change them. Active listenina builds rapport because it sho"'s
that the listener is nonjudgmemal and is interested in understanding. Individuals in
SIience
Att.ndlng
• Asking
Quest,ons
Pa,iphraslng
Figure 42 The Skills of Active Listening
102 Chap1er 4
crisis may erect he3vy psychologicaJ defences, but "bec3use active listening poses no
threat to an individual's self-image, it can help a subject become less defensive" (Nocsner
& \Vcbster, 1997, p. 16). Active listening is a powerful tool for dcvcJoping a relationship,
which becomes a basis for negotiation.
Anending. nonverbal communication, using silence, P3rnphrnsing. and summariz-
ing will be explored in the following sections. Subsequent chapters will address the skills
of questioning and empathy.
ATTENDING
Attendini is a term used to describe- the way that counsellors communicate to their attending: Atera used to descriie
clients that they are rc3d)•, willing, and able to listen. When coupled with understand- tile •ar that c•selkn communicate to
t!leir clients tu'! they an teady. 11illing.
ing and appropriate verbnJ response~ attending promotes exploration. As a basic active and able to liMta. Vefba:1. ncaverbal.
listening sic ill, attending conveys physical and psychological commitment and openness and attitudinal CIIES are 1M es.seaceClf
to the helping intcrviN•. Anending sa\'S to clients, "l'm here for you. You have my undi- effeaiw attending.
vided attention. I'm not afraid of your feelings and what you have to say."
Certain core attending skills are univcrS3lly applicable, and counsellors can use them
with confidence. First, counsellors need to ensure that their ftt.lings, attitude~ and com-
mitment to clients are genuine. Jf a counscllor has negative feelings about a p3rticular
client, then refc.rral to another counsellor may be warranted. On the other hand, if such
negative ftt.lings permeate a counsellor's attitude toward many client~ then additional
remedies may be necessary, such as personal counselling, assistance to deal with burn-
out, consultation and supervision to manage feelings, or a career chanJ;c. Sometimes a
counsellor's personal rc3Ctions can be a valuable clue regarding how a particular client
imP3cts other people. The key conside.rntion here is whether the counsellor's feelings
are unique to him or her, or whether they arc indicative of a client's general demeanor.
Second, pro\•iding a safe and private space is an incentive for clients to open up.
This includes efforts by counsellors to control distracting noise and curb the.ir own
imcrnnJ distractions. ScJf,<fiscipline to suspend hasty assumptions and judgments is
also essential. Counsellors need to avoid rc3cting with verbal or nonve.rb3l mes.sages
that express imp3tience, disagrttment, or judgment. As noted earlier in this chapter,
this may be difficult when clients present ideas that are offensive or conflict with the
counsellor's values and beliefs.
Third, counsellors can show that they are attending b)• being on time for the inter-
view, remembering important detail~ and following through with agreed-on plans. A
ce.rmin ph)•sical and verbal presence conveys comminnent. Verbal and nonverbal behav-
iours such as hC3d nods and encouraging probes convey interest. Counsellors need to
bring warmth to the interview, which is communicated through appropriate smiling.
changes in voice tone, and expressions of caring and support. An unemployed client
who rcpons with glee to his counsellor that he has found work has a riWlt to expect
more than a monotone, "That's grc3t."
There may be cultural and individual differences that require adapting how )'OU
attend to clients. For example, some clients arc notcomformblc with sustained eye con-
tact, and others may be suspicious of warmth and humour. This rc3lity underscores the
importance of continual work to devcJop cultural understanding and competence. As
alway~ it is important to remember thal individuals vary in the extent they subscribe
to the values of their culture of origin.
There is general agreement that the following behaviours convey appropriate
attending:
■ keeping an open posture (i.e., turning towards the diem, arms and legs uncrossed)
■ maintaining eye contact
listening & Responding: The Basis tor Unders1andlng 103

■ leaning fonvard
■ using responsive facial expressions like approprhne smiling
■ encouraging comments and head nods
■ speaking in a warm and pleasant voice
As with any counselling skill or procedure, attending must be applied intelligently
relative to diversity and cukuraJ variables. For example, among many Middle Eastcm.-
ers, six to tweJvc inches is a comfortable conversational distance; but an "arm's lcngrh"
is more comfortable for most \\:festerncrs (Hockney & Cormier, 2005). Counsellors
should also avoid rigid adherence to one style of attending. For example, the needs of
a client who is embarrassed may be best served by avcned or less.-intcnse eye contact
until more trust and comfort develops.
Careful attention to words, phrase~ and nonverbal communic3tion opens counsel.-
lors up to lc3ming. Counsellors need to hear what is said, as weJI as what is not said.
They need to rcffcct on how ideas arc communicated through cone of voice, posture,
and other due~ and listen careful!)• for confirming or conflicting messages. As well,
they need to sift through what ma,., be complex and sometimes confusing information
to identify P3ttcms, priorities, and areas of relevance. This work may involve the major
senses of hearing, sight. smell, and touch. Although counselling work gene.roJly centres
on hearing and sight, significant information can be gleaned from our other senses. For
example, alcohol and some other drug use may be detected by smell.
When counsellors are patient, they give clients space to confront painful emotions
and to gather their thoughts. \\:f'hen counsellors sit still, mainmin culturally appropriate eye
contact, and avoid nco:lless questions they do much to convey to the.ir clients their unwav.-
ering attention. These actions focus the attention of the interview completely on clients.
To accomplish thi~ counsellors must develop their ability to be comfortable with silence.
SUCCESS TIP
The pitfaus of listen.-ig include saying too much as weu as too liltle. SIience is important, bul
ultimatety k\suffdent b effective listening.
Selective Attention
selectiw perception (selective Selective perception or selec,th•c attention is a term u~ to describe the natural ten-
attention): Atera 11Sed to desuibe dency to screen out ir-relc\lant information to avoid being overwhelmed. Of necessity,
the natwal taidency to avoid being
counsellors must ignore some parts of a client's communication and selectivdy attend
OYM1helllied by illcrmat• by screaaing
out material t!I.M is irrtlev•. to othe.rs. It is not possible (nor desirable) to attend to everything a client says; however,
communication breakdown can easily occur if a counsellor ignores issues or feelings that
arc important to a client. This underscores the importance of the contTilcting process
(see Chal){er 3) as a tool for ensuring that counsellors and clients are on the S3me P3ge.
What a person pays attention to is likdy to be influenced by one's frame of refer..
ence, which is uniqueJ,., defined through influences such as past experiences, personal
value~ current mood, interests, concerns, fear~ prejudice~ health, culture, and context.
A tow truck driver looks very different depending on whether you have a flat tire on
SUCCESS TIP
Oients atso selectivety attend. FOr' example, lhOSe whO a(e O\ler1y anxious are more likely to
pay attention to anxiety-prO't'Oking stimuli, and those who ate suspicious WIii be more sensi-
tive 10 cues that the eounselOt cannot be trusted.
104 Chap1er 4
TOO brain is una~ to pay attentbn to l\\() thi~ at the same greater risk of m$Si.ng important cues and no1 rememberi~
time. In Or'der to divert our attentkln to a different &ask, the t:tain what clients have said (Taylar, 2011). This realily uooerscor·es
must Shut cbNn an:S shift its focus from tne fW'SI task (Medna, the importaoce ot counsetbrS atk!Oeling to their diants' corrwnu-
20'.)8). Research also SOONS that shifts rn attention resul in a ricatkln Viitrout beeoni~ ,:reoccupied Mh what to say next.
a dark and stormy night, or you are being to\\'ed for illega] parking. The word moiher
may caJI up images of love and support or memories of abuse and pain.
Recognizing and Managing the Pitfalls of Selective Attention Mnnng;ng rhc
pitfalls begins with self-awareness about how our point of \tiew and life experiences
influence our perceptions and interpretations. Counsellors need to re.fleet on their O\\'n
listening habits to identify areas of vulnerability. Counsellors need to be alert to the
dangers of selective perception in their own thinking and responses. They must be
vigilant to make sure they understand how and when prior learning, va.Jucs, and current
expectations influence where they focus. They need to be careful that they don't impose
their own sense of what's important, which can easily lead to loss of objectivity as well
as missed information and opportunities. Viewing scssional recordings and seeking
feedback from informed observers is an important part of this process. Herc are some
typicaJ counsellor seJective perception errors to consider:
t. Egpcemricity. Hearing only messages that support established opinions and beliefs.
\Ve need to remember that whal \\'e know is subject to change.
2. Role bias. Counsellors will pa)' more attention to cues that arc consistent with the.ir
professional focus, training, and responsibility. An employment counsellor will be
interested in career and vocationaJ data, whereas a marriage counsellor will be more
alen to information on familial communication. This is necessary and appropriate;
however, attending to one issue runs the risk that other important areas for inquiry
are overlooked. For example, an employment counsellor who docs not recognize
the S)•mptoms of a mental disorder or substance abuse will have limited effective-
ness when dealing with clients who have these issues.
3. Disengaging. \\:'hen this happens, counsellors have simply stopped listening and their
anention is focused elsewhere. This may occur for a variety of rc3sons, including
boredom, disinterest, fatigue, or preoccupation with their own issues. As well, coun-
sellors might deliberately discni;pge when they arc uncomfortable with the topic.
4. Preoccuparicm tdrh problems. When counsellors arc too fixated on problems, they
miss the opportunity that comes from a strengrhs appro3c.h. Rec:ogniiing client
strengths heJps to buikl confidence and self-esteem, and it mobili:es resources for
problem solving.
It is also important to pay aucntion to the counseJling relationship. Over the
life of the counsellor-c.licnt relationship, various priorities will emerge related to
beginnings, conrracting, problem solving, and endings. The vitality of the relation-
ship is a strong predictor of a successful outcome in counselling, so this important
wriable should never be ignored.
5. NOl. auending ro rhe emotional domain. By focusing on behaviour, counsellors ignore
the emotions of their clients, which are often more important to problem resolu-
tion than finding behavioural solutions. Emotions can sustain problems, interfere
with decision making, and crente stress that pre-vents problem solving. When clients
express emotions, active listening, particularly empathy, is crucial For example,
listening & Responding: The BasfS tor Unders1andlng 105

Miller, Forcehimcs, and Zwcben (2011) reported that "one of the strongest prcdic~
tors of a counseJlor's effectiveness in treating substance use disorders is cmpa,.
thy" (p. 49). CounseJlors should also monitor and deal with the emotions that they
bring to an inte.rvicw or that arise during an interview.
6. Nor co,uidering the nom't"'rbal channel. Listening to words without considering non.-
verbal communication ma'>' result in counsellors he~uing only a small pa.rt of what
their clients arc communicating.
7. Snap judgmenu. Good listeners are curious, patient, and cautious in the pursuit of
understanding. Medina (2008), a molec:ula.r biologist, n()(CS., "\Vhat we pay attcn~
tion to is often profoundly influenced by memory. ln eve.ryday life, we use pre..,i~
ous experience to predict whether we should pay attention" (p. 75). This suggests
a major pitfall that has profound implications for counsellors. \Vhen our clients
share stories., their stories may stir our own mcmorie~ and we may begin to "fill in
the blanks" based on our experience. This shoncut to understanding can result in
erroneous assumptions and mis~ information. \Vhile past cxpc.riencc with the
same issues as our clients may give us an empathic advantage, this is only true if we
remain viailant to ensure that we do not contaminate our clients stories with those
of our own. Perhaps we are safer when clients present unfamiliar issues and prob-
lems because our lack of lcnowledi;c makes it easier to explore for understanding.
8. Muhira.sking. Neuroscience has demonstrated that the human mind is incapable
of multirasking with respect to paying attention (Medina, 2008). Here's the most
common problem in counselling: While clients arc talking. counsellors are thinking
ahead, planning what to say. ln order to think ahead, their minds must disen,;pg,e
from listening. Active listening skills can hdp counsellors maintain focus on what
their clients arc communicating.
SUCCESS TIP
Too much time ex.plOring content comes at the expense of ptOblem solving and feeling
management. Whtie some detail is necessa,y for uooerstandi.ng. excessive attention to all
the de&aits rS neithet neoossa,y not ptOductive. NOr' rS it generally usehA to d1ted the wock
of counselling to ftnd the ·(oor causes ot prObrems.
Remember that listening is hard work, and you nttd to be physically and psycho.-
logically ready for the interview. One essential component of this readiness is to address
)'Our psychological nco:ls by dealing with your own is.sues that might make it difficult
to hear clients. If you have unresolved difficultic~ cspcciaJly if they mirror those of
'>'our client. it will be paniculnrly difficult to listen effectively. A second component is
to malcc sure you fully disengai;c from )'OUr last client before engaging with the next.
Finally, make sure you understand before you move on. Summarize, paraphrase, and
ask defining questions to enhance and confirm )'OUr understanding. As a rule, the more
)'OU occupy '>'ourself with the active demands of listening, the less you will be tempted
to let your thoughts ,\--under.
NONVERBAL COMMUNICATION
Most people are familiar with the physiological reactions that occur in moments of
great fcnr. Powered by increased adrenal secretion~ our bodies respond automatically
with eJcvared heart rate, rapid breathing, dry mouth, and ()(her symptoms. Many of
these reactions arc dearly ,risible to any observer, even before any verbal declaration
of fear. Nonverbal behaviour is usually outside our conscious control and is less likely
106 Chap1er 4
TABLE 4 .3 Nonverbal Behaviour: What to Observe
Eyes Eye contact movement, tears, dilated pupils
Facial cues and expmssions Frowning, Shaking the Mad, smilWlg. clenched m::>uth, blushtng
Vocal Tone, volume, use of silence, hesitation, pace, mood
Use of space Seati~ dislance. movement, bOdy position
Appearance/Dress Grooming. hygl,ene, dress, tattoos. t.'ancli~. scars
Body language Posture, gestures, pacing behaviour, arm and hand m::,vements
Toudl HandShake (e.g., Ump, aggressMl), hugging, hand on Shouldet
Distractions Playing with a rtng 0t pen. touchi~ hair
Affecl Blunted, flat, inapptopriate, labile, mstricted (see gtossaJY)
to be censored. Consequently, counseJlors can often trust nonverbal communication

as a more reliable indicator of feelings than ve.rbal communication. Sue and Sue (2008)
found that "studies support the conclusion that nonverbaJ cues operate primarily on an
unawareness level, that they tend to be more spontaneous and more difficult to censor
o r falsify, and that they arc more trusted than words" (p. 171). Table 4.3 includes some
of the key things to look for in your clients' nonverbal behaviour.
(n ,;cneral, research has shown that often 55 to 65 percent or more of the meaning
of a message is conveyed nonverbally (Shcafor & Horejsi, 2008). Sometimes aJI signifi•
cant communication comes from the nonverbal channel; for example, people's emotions
may be conveyed much more accurate!)• by their body posture and eye contact than b\•
their words. Counsellors who rely only on words will be limited and ineffective by 00(
integrating that part of the interaction that contains the meaning.
Knapp and Hall (2006) offer these condusions:
KonverbaJ eornmunie::uion should not be stud100 as an isolate-cl phenomenon bu1 :lS an
inseparable pore o( the total eommunbtion p ~ . . . Nom'e'rbal eonununie::uion is
import=nt beeluse o( its role in the t'Ot:il 001nmunk21tion system. the tremendous quan-
t ity o( in(orm::uion:11I cues it ah,es in 20)' p3rtkubr situation. :ind its uSc in (und3mcntal
2re:lS o( our d3ily li(c. (p. H)
Meaning of Nonverbal Communication

CounscJlors can learn a great deal more about their clients' ideas and feelings if they
cardull't' observe and try to unde.rst:md the nonverbal channel GenemJly, nonverbal
communication serves one or more of four purposes:
■ Confirming OT repeating: Nonverbal mes.sages are consistent with messa,;cs that arc
spoken. Alternativcl't', nonverbaJ cues embellish the intensity of the client's ideas
or feelings. Example: thumbs up with a smile while saying yes.
CONVERSATION 4.1
STUDE:NT: I find that I'm so busy ltying to lhink of what to say said witoout some thought of wtlat kl do next. but with ptae-
next that I miss what the client is sayi~. tice it can be done. One ttick is to lhink about \\flat is being
said before thinking about what to say. As you reflect on
TEACHER: Yes, 1t is tough. That is a eotnmon problem. even 'llf'lat is bei~ sakl, try to identify majoc themes and footings.
for ext,erienced counsellors. TM brain canno1 ml.dtitask Its. Often, )'OU' response will emerge naturally out of lhis effOr'l.
tening and planning. One tas.k must stop for the 01t1er to DeYelOp your comf0tt with silence. If you need a moment to
occur. Of course, it is hard to stay focused on what is bei~ think, ask for it

■ Comradicring: Disp3rities between the verbal and nonverbal mesS3ges arc apparent.
Example: Cliem might say, "I'm «static," but in a sarcastic manner that conveys
the opposite. Another common example occurs when people say, "l'm interested
in what you have to say," but at the same rime, they continue with another activity,
betraying their lnck of interest.
■ Subsriuaing: Ideas and feelings arc communicated only in the nonverbal channel.
Examples: shaking or nodding the head to say no or yes; shrugging the shoulders,
expressing confusion or indecision. Nonve.rb3l communication such 3S vocal into.-
nation~ pauses, and hand gestures can aJso be used to regulate the flow of conver-
sation (e.g., turn-taking). Yawning might unconsciousJy signal to your guests that
it is time to go home.
■ Expressing emorion: The client's emotions are suggested through nonverbal mc3ns.
For example, crying might signify sadness, fc3r, or jO\' ; a mi~ voice might suggest
anger or frustration.
Counsellors need to interpret nonverbal behaviour cautious!)•. NonvcrbnJ behav-
iour can have many mc3ning.s, C11C.h of which can vary according to culrurc, context,
and individual comfort level. For example, people from some cultures interact at very
dose personaJ distances, but others experience the same personal distance as intrusive
or even aggressive. Some people consider direct ere contact rude, while others view
avoidance of ere contact as cold or as e-.•idcncc that people are lying. Jn fact, in some
cultural groups averring one's eyes is a sign of respect and courtesy. Hays and Erford
(2010) offer this perspective on Native Americans:
To subd)' ,natch this Je...el o( ere eon12et is respectful and shovi·s an underst2ndinK of the
dient's way o( bein&, Tilt eyt:s 3re oor,skler«I to be the p.,tJ1w-3y to the spirit: therefore.
tooonsiscentl)' look someone in tl,e i')'e is to show 2 Level of e:ntitle.ment or 3iKl'dSM'>n.
It isi ood to Kl.:11l« 31 someone e\'erronce in a whi.le, but hstenh,K in tl,e tl"3d1tion.3I W2)'
is sornetl,ina tl,::u happens with tl,e e3rs and the heart. (p. 320)
kinesics: Tliestudyolbcd7l-,:ua,e. Body Language Kinesics is the study of body language, including such variables
such u p)sture. lacial expessioos. as posture, facial expression~ gestures, and eye motion. Sometimes body language is
pstu,es, and qe aotica
easily interpret~. such as when ~pie use gestures that have dir«t verbal equivaJcms.
For example, people might point to indicate direction or use their fingers and hands
to signify size or numbers. At other rimes, body language is ambiguous and more dif-
ficult to interpret, particularly when people communic3tc contradictory mesS3ges. For
example, a person miWlt appear to be listening intently and making appropri3tc eye
concac:t, but if these actions are accompanied by fidgeting and rapid finger tapping,
then the rc3l mcs.s3ge is "l'm bor~."
Even a simple smile may have multiple meaning~ including warmth, amusement,
or ner\'ousness. Te,us ma)' convey sadness, amusement, embarrassment, or fear. Conse-
quently, counsellors should look for multiple indicators of meaning rather than a single
explan3tion. Factors such as context, culrurc, relntionship, power dynamics, and gender
may be loosely or intimately connected to the me3ning of any nonvcrb3l mes.sage.
In some situations where ve.rb3l and nonverbal messages appC3r contradictory, the
client may be 3mbivalent and both messages may be corr«t. For example, a mother
might SO)' how proud and happy she is th3t her son is leaving home to attend college,
but at the same time be crying. In this example, it is dear she has mixed feeling~ and an
appropriate empathic counsellor response might be, "Even though )'OU'rc proud to see
)'Our son taking this important step, it still hurts btt3usc he will no longer be at home."
Voice VocnJ nonverbal cues include tone, \'olume, pitch, and rate of speech. These
variables can reveal if clients arc depressed, euphoric, angry, or sad. For example,
Kadushin (1990) concluded that anger tends to be expressed with sptte.h that is more
108 Chap1er 4
Ema'il aoo text messaging communication is often misintef. a(e invol\led. Generally, nonverbal communk:ation is p,-o-
p(eted beeause lhe(e is no access to lhe non-verbal channel cessed in IM rigt\l hemisphere of the b(ain. Damage to
which signalS the subtle meanings. emotions aoo in1en- the (ight side of the b(ain can lead to a vatiety of social
1ions of the sender. To fully process meaning, Ou( bfains communication difficulties, including understanding non-
need to access and intefpret bOth the vefbal and the non- vefbal cues and oar.er subtleties of communication such as
verbal channel. Note thal IM nonverbal channel is often humour Of metaphors (Ame(ican Speech t.a~uage Hear-
more impoftant aoo reliable, parlicular1y when emotions ing Association, 201 S).
rapid 3nd loud, whcrc..ls sadness is ch3rac:terizcd by more pauses and slowness of
speech. Silence is 3fso an important component of nonve.rb3l communication. Coun•
sellors need to be 3ble to rc..ld nonverbal cues to decide how, when, 3nd if they should
interrupt a silent moment.
Spatial Oistance/Proxemics Proxemics describes how people use space and dis• proxemics: Alelmusei:Jtod.scribe
tancc. Hall's modcl ( 1959) is still widely used to describe the four m3in distances (for how people sse space -6 diManoe in
social bala'lioia
Weste.rn.-born C3nadians):
t. lntim3tc distance is a :one of up to0.5 merrcs (l feet), rcse.rved for private exchanges
of intimate thoughts 3nd feelings.
2. Pcrso03l distance is 3 zone of about 0.5 to I mctre(l to 4 feet), used for less intense
uchanges with friends and family.
3. Social distance is 3 zone of approximately I to 3.5 metres (4 to 12 feet), used for
more impersonaJ meetings and social contact.
4. Public distance beyond 3.5 metres (J 2 feet) is used for casu3l cxch3ngcs, such as
giving a speech or lecture.
How an individu3J uses space is influenced by many wri3blcs, including gender, 3g,c",
culture, ph)•sic3J characteristics. smru~ various personality trait~ and the narure of the
rcfationship. Thus, counsellors should 3dapt their se3ting to mttt the nttds of individual
clients 3nd siruations 3nd remember th3t angry clients usuaJI)• need more space. More-
over, in such situation~ counsellors need more space for safety reasons. Counsellors
should 3fso be mindful of spatial shifts during the inte.rvicw. Often these changes arc
subtle, such 3S when a client shifts his or her chair back, 3S if to say, "I'm not comfort•
3ble with what we're taJking 3bout." Simil3rly, as clients le3n in and move toward them,
counsellors can conclude that imim3cy and trust 3re increasing. When clients physically
withdraw, counsellors might want to avoid confrontation or sensitive topics.
Counsellor Self~Aware-ness of Nonverbal Behaviour Counsellors neo:I to be
3w3re of the.ir own nonve.rb31 behaviour and the subtle ways it might influence the.ir
clients. Counsellors may inndve.rtcnrly communicate displeasure by frowning, rurning
3w3y from clients, or increasing the physic31 distance from clients. Altcrn3tively, they
communic3te interest by smiling, using a pleasant tone of voice, inc.reasing eye contact,
3nd lC3ning toward clients.
SUCCESS TIP
Clients can be very adepa at notic::i~ nonverbal cues lt'lal might betray thei( counsetlol"S'
judgmen1, bias, deception, disinte-rest, anxiety, o, lack of genuineness.
listening & Responding: The BasfS tor Unders1andlng 109

Some counsellors might laugh nervously when they are anxious or scared, thereby
confusing their clients. Counscllors can review videotapes of rcaJ or mock counselling
sessions to increase their sensitivity to appropriate and inappropriate nonverbal com,.
munication habits.
Culture and Nonverbal Communication All cultures have unique nonwrbal lan-
guages. In the deaf culture, for example, nonverbal communication is an e>..'tTemely
important adjunct to ASL (Ame.rican Sign Languag,e). Gestures and fucinJ expressions
may be emphasi:ed to define meaning. One Canadian study supported the conclusion
that the French speak more often with their hands and rypicnJI)• use more gestures in their
interactions (Adler, Towne, & Rolls, 2001). Spatial dismnce also differs among cultures.
Mid die Easterners stand and communicate much closer than most Westerne.rs ,vould be
comfortable doing, With respect to eye contact, Adle.r et al. (2001) make this observation:
Like-di.ruul«', potterns o( ere eont:w!t vary around the world. A d1reet ~a:e is eonsidc--red
3ppn>pri:ue (m- speakers in Lat in Arneriea.. the Arab world. :md southern Europe-. On
the other hand. Asfaf)$. Indians,. P2kist3nis,. and northern Europe:ms K"3:e at a listener
peripher.tll't' or noc 2t 2ll. In either ease, deviations from the norm are likelr to make 2
liste,~r u1lM-lnlortabLe. (p. 231)
Some nonverbnl communications such as smiling, laughing, and fro\\•ning have the
same meaning everywhere; hO\\•e-ve.r, some cultures put more emphasis on controlling
the expression of personal feelings., which sometimes makes it difficult to g:iuge the
intensity of the client's feelings. An example illustrates how a counsellor might use
cultural knowledge:
CounS(>IJOr. (S/Ji!aklng ,o a mi.ddlt,a,ged Ad.an u.OO!Mn.J How 3re rou (eelina!
C lient: (Ulitl, a ~rtght nn/Je.) I'm f'me. I'm doina okay.
CounS(>IJOr. On a ~le from I to 10. with JO bein& the best you ~,~ e"\>er (elt. wl~re
would rou put )'Ourseln
C lient: (H~taus.) ?l.·bybe 3 or a -t.
In the preceding example, the counsellor knew that the Asian woman might (as pan
of her culturaJ learning) hide and suppress her feeling~ perhaps not wanting to burden
he.r counscJlor with her pain. The scnling question provides a face~saving way for her
to reveal he.r emotions.
SUCCESS TIP
Client nonvetbal cues will tell )(lu when you have spoken too much, when the client wants
to 131.k, and when lhe moo:1 of the interview has shifted. TrUSI these cues mor'e lhan lhe
WOtdS you Mar.
Working with Nonverbal Communication

Nonve.rb3l communication needs to be considered as P3rt of the toml communication
process that includes verbal behaviour and context. Herc arc four ways to respond to
client nonve.rb3l communication:
I . Use it as a basis for under.standing. By paying attention to the nonverbal channcJ,
counscJlors can greatly increase. their knowledge of those are11.S that are important
or sensitive for the dient.
2. lgnO'fe. lnconsequential nonverbal behaviour (e.g., a small shift in body position or
scratching one's nose) docs not need to be addressed.
110 Chap1er 4
3. Defer. Sometimes nonverbal behaviour is potenti31l)• signif,canc, but a sufficient
levcl of rrust has not yet bttn established. PotentiaJly significant nonverbal mes-
sages may come at the end of the interview when there is no time to address their
meaning. In such circumstances, it ma)' be wise to defer, but a mental note can
remind the counsellor to deal with it later when there is more time.
4. Acknowledge in the t~bal channel. Use responses such a~ "Your tears really say how
much this means to you." Responding to nonverbal cues communicates a dttp
sensitivity to the client's experience and (in this example) a willingness to worlc in
the emotional domain.
M etacomm uni cation

Metacommunication is the message that is heard (inte.rpreted), which may differ metacommunkation: The messaie
sharpl)• from the ,vords spoken or the intended message of the speake.r. Factors such t!l.i'! is Mard (illerp«:fd), lldli::h mar
diffef fromdie ..onls sp,k£ft or the
as nonverba.1 cues (especiaJly voice cone, volume, and inflection), context, history, rela-
intended messaie of the speaker.
tionship trust lcveJ (espcciaJl't' regarding unresolved conflict), mood, and many others
all influence how someone interprets a message. So, it is important that we stay ale.re
for signs that a different meaning has been ascribed. For example, the seeming),., simple
offer, "Can I heJp?" might be understood (heard) by different people as:
■ You don't trust me.
■ You don't thinlc I'm capable of doing it on my own.
■ You need heJp, and J'm the one who can solve your problem.
■ You want the credit for what I'm doing.
■ You think J am doing a lousy job.
■ You are willing to do it for me.
■ You are angry because I didn't ask )'OU to hclp.
The following example illustrates what some clients might "hear:"
Coun.seltor I: Wh't' don't you tell hlln how you (eeJ!
Mronll"l8 of the mts:soge fe,, du• client: You Yi~re not smart enou,ah 10 think of th::u on
)'Our own.
Coun.se.U.o r 2: Do you aaree with wh::lt I S3kl!

MNmf1.8 of du• me~ for 11.t- clit'nl: Do not disaaree.
SILENCE
The Personal Meaning of Silence
Another major active listening skill is silence. One distinguishing quality of effective
counseJlors is their mastery of language to communicate ideas and promote change;
however, language fluency a.Jone is insufficient. Counsellors aJso need to understand the
importance of silence in communication. They need to balance their verbal agility with
an tttua11y strong capacity for silence. Sometimes the most effective and appropriate
counselling response is to say nothing.
Individuals and cultural groups sh<:M• considerable differences in their comfort with
silm.cc ln some cultures, silence is a sign of respect. For many counsellors, silence is unnat-
ural and if pauses occur in the conversation they become anxious and fear that their clients
will Stt them as incompetent. They also often burden themselves with pressure to fill the
silent ,roid with words. A silent pause, even as short as a few second~ may lead to inner
panic. Almost on reflex, they act to fill silent moments with questions and interprrtations.

Some p«>ple judae silence hnrshly. They sec quieter people as unmotivated, unin.-
terested, aloof, rejecting. and ianoram. In n discussion with a group of srudents in a
counselling class, I asked members who rated themselves as "more verbal" to ta.Jk to
"less verbal" members nbout their typical reactions to silence. The verbal members
made statements such as "I feel judged," "I don't think you're very interested," "I'm
boring you," and"( wonder if you care about what we're doing?" Their comments
deart,., indicated that they felt threatened by silence or viewed it as evidence of judg-
ment or lack of interest.
In contrast, the members who rated themselves as quieter noted that they often did
not have enough time to respond and revealed thnt they were fearful or felt inadequate.
Sample comments from this group we.re: "You don't give me enough time to speak,"
"I'm scared to ta.Jk," "I ,vorry about makina n fool of m)•sclf," and "By the rime, I think
of what to say, someone else has already said it."
Silence in Counselling
As noted above, counsellors can have the same anxieties about silence as other people
have. Silence mtt)' heighten their sense of inndcquacy as counsellors and lead to unccr-
tninty in the interview. As a result, counsellors may become impulsive and try to fill
silences too quickly.
However, disciplined counsellors who nJlow silence in their interviews may find that
their relnrionships mkc on nn cmireh• different tone, with thc.ir clients answering their
own questions nnd discovering their own solutions. A repe.rtoire of skills position coun-
scJlors for dealing with silence in nn interview. CounseJlors should become comfortable
permitting silence as wcll as knowing when to interrupt silences appropriately. Knowing
when to speak nnd when not to requires some understanding of the vnrious meanings
of silence. A survey of the use of silence in counselling suggested that counsellors
use. silence "primnril't' to facilirote reflection, encoura,;e responsibility, focilitntc expres-
sion of feelings, not interrupt session flow, and convey empathy" (Hill, Thompson, &
Ladany, 2003, p. 513). Silence may be ill-advised, however, with clients who are ps\•choric
or with those who are likeJy to view the silence as punishment.
During silence, counsellors need to do more than just keep quiet; they also need
attended silence: Atleaded sil!llce to attend to the silence. Attended silence is characteri!ed by e\•e contact, physical nnd
is tharacteriled t,, •ali-, eye «intact. psychologicnJ focus on the client, and self-discipline to minimi!c internal nnd external
~ al and psycb:dogic-M locus c. the
distraction. Silence is not golden if it communicates lade of interest or preoccupa.-
dient.-.:J self-drsC.,line to • inimite
illemJl-.:J Memal disuauion. tion, or if it snys, "I'm not listening." This means refraining from fidgeting and other
digressions, such ns raking notes or nnswering the phone. At the snmc time, counsellors
should not sta.re or turn the silence into a contest to sec who breaks it first. Counsellors
should 00( nutomatically assume that silence means failure, nor should thq• think that n
few moments of silence means that the work of counselling has stopped. Passive clients
may be busy with thought, or they mny be seeking to gain control or understnnding of
p3inful and forgotten feelings.
))t) BRAIN BYTE S · ·1 ,_
Co20fino (2010) suggests that some clients find silence in fot some, ·defences to escape negative feelings come
counselli~ difncult and they imagine that the eounseu0r 10 tequite constant action and distraclion to keep us
Mthinks they ate bOting, stupid. a waste of lime, ot a from becoming frightened ot overwhelmed• (p. 88). In
bad client· (p. 88). He suggests that lheit teactions ate contrast, CozOfino identifies anothet group of clients who
activated by implicit memories (unconscious) lhat mitrOr ftnd silence supportive and a bl"eak ftom lhe ptessutes of
difficult telationShips with theit parents. It seems that communication.
112 Chap1er 4
Every silent interlude: h3s a different meaning, and counsellors need to be 3stute
to discover the signific3ncc: of each quiet momem and the most appropriate response.
Understanding different types of silence: hclps counsellors look for cues 3nd consider
3ppropriate responses. Herc 3re the six common meanings of silence: in counselling:
t. The dient is thinkina.

Although all clients need time to process information 3nd frame their response:~
some need more time than others do. Some clients talk with only a momentary
p3use to catch their brc:3th, but others punctu3te their speech with periods of
re.flection. If counseJlors do not allow this time for contemplation, their clients
m3y fee] disc:mpowerc:d or inadcqu3te. Clients may be formulating their thoughts
or feelings. onh• to be prc:marurcJy cut off by counsellors whose own anxiety with
silence docs not permit them to wait.
When clients need time to reflect, counsellors c3n simply rcm3in anemive and
nonverbally show their interest 3nd involvement through eye contact, open posture,
and so on. Thc:yc3n 3lso verbally indicate their willingness to listen by using simple
phrases, such 3S "I sense )'OU nttd some time to think. That is oka't'· I'll wait" 3nd
"h's ok3y with me if you just need to think without speaking."
2. The dient is confused and un.,;ure o f what to say or do.

Sometimes questions arc undC3r, the focus of the interview is ambiguous, or clients
do not know what is expected of them. Cliems may sit in silence, shifting uncom-
fortably 3nd 3ttc:mpting to sort out what to do next.
When cliems become quiet because they 3re confused, 3llowing the silence to
continue sustains or increases the clients' anxiety. These circumstances w3rrant
intenupting the silence to cforify meaning, direction, or c:xpcct3tions. Rephrasing.
summari! ing, paraphrasing, 3nd even repetition can help in such situ3tions.
Coun.se.U.or: Perhaps )'Ou' re confused.
Client: V,..1ods.)
Counsello r (Choke 1): t think t mi~t h::n't' confused )'OU with tn)' !:1st q uestion. It didn't
make sense to rne either. Let me reword it.
Counsellor (Choice?): let's s.loo• down:. bit. Help me to underst.:1nd "-hat is unclear or
eonfusi1l{t.
In addition, clients may have diffteulty expressing their idea~ or language: prob-
lems ma,., be a barrier. Sometimes clients just need 3 littJe more time to find the
right word or phrase. At other times, counscJlors need to tentative!,., sugi;c:st idC3s
or help clients label feelings.
Clients 3re more likely to be silent during the beginning ph3sc: of counselling
and during first interviews. This is norm3J 3nd usually indicates that clients arc
unsure of what to say or do. Consequently, they depend on the counsellor to t31cc:
the IC3d to cl3rify role and direction.
3. The dient is encounce rins: painful feelinas.

lntc:rviewing 3nd counselling can stimulate powerful feelings 3nd memories. Coun-
scJlors who can tolerate: silence give space to their clients so that they can o:peri-
ence and deal with pain or anxiety. (n some c3ses, clients may be ambivalent 3bout
facing thc.ir fceJings. They ma,., be afraid of their intensity, or they m3y be unwilling
to face thc.ir feeling~ at lc:3st at this time. Silence is 3 chance for clients to examine:
the merits of continuing further or rctrenting to safet)•. Usu3Jly, such moments arc
obvious because the discussion is intense immediatcJ't' before the silence.
When clients arc struagling with powerful feelings. counsellors m3y need to use
multiple responses. First. you C3n 3llow this type of silence to continue. Responding

with :.ntentivc silence can be very thcmpc:utic and supportive. 1t says, "I am here. J
understand. 1 have the courage to be with you as )'OU dc:aJ with your P3in."
S«ond, you can suppon silence with empathy when dc:aJing with powe.rful
client feelings. Othe.rwise, clients might fcc:l ignorc:d o r misunde.rstood. Empathy
confirms that fcc:lings have been hc:ard, and subsequent silence gives the client time
to p rocess. Empa thy might be u~ to let clients know chat they have been u nder-
stood. As well, empath)• tells clients that they have not been abandoned and that
their counsellors arc ready, willing. and able to be with them while they consider
their feelings. Once the co unsellor has expressed empa thy, silence may be appropri,.
ate. ln the following example, empathy frames nvo long, silent moments:
CounseUor. As I hsten to )'Ou. I am bei.innin¥ to sense your (eelinK o( resentment that
your mother cont inWIII)' t ries to run )'Our life.
( I 5 ~ d J of Ji.ftnte)
Client: (fMrs m NT eyes.) Resentment! That's only port of it. I don't think I could ever
li"e up to her expectations..
(CounklfOJ ,n.aintahu eye Mntat1. far:n dknt.)
(IO~dsof slftnte)
Client: But it's K'()ina to be okay. I reali:e that I h::t\'e m)' oo•n eicpectations to n~t. It's 1ne I
h::t\'e t'O face in tll(' 1nirror.
Counsellor: Sounds like )'Ou are be.:i.nnina to ::.ccept that your mother is not ¥Oifi¥ to than~-e
and. th::u onlr )'Ou ha"e oontrol over who you are and how you act.
4. The client is dealin~ with issues o( trust.

Before crust develops in the counselling relationship. clients may be hesit:mt to share
personal information, and they may communicate this reluctance through silence.
T h is is a normaJ and self-protective way for people to avoid rejection and main-
tain a sense of control over private matters. A different trust issu e may arise with
involu ntary clients who use sile nce as a W'll)' to control o r sabotai;c the interview o r
demonstrate hostility. The.ir silence says what the client may want to express: "I'm
here, but you can't make me talk." Silence becomes a way of retaining d ignity and
control in a siruacion in which thq• feel d isempowercd.
GencraJly, counsellors will want to move the interview genth• toward more
openness and intimacy. One way to proceed is to acknowledge the risk in sharing
a nd to d iscuss issues of trust. You can open the door with a comment like this:
" ( know it's not easy to share your feelings with a stranger. You don't know me
rec, and you can't be sure how 1 might respond." Another strategy is to move at
the client's pace and discuss less threatening content until rrust in the relationship
dcve]ops.
Sometimes it is preferable to put trust issues on the cable rather than try to pro-
ceo:I when the.re is ob-.•ious resistance. Consider using a lc:ad such as the following:
CounseUor. I'd hke to share a per«ption with )'Ou. 1',..e not iced that whenever I ask 2
question. you answer me quickly. :lnd then )'Ou beconl(' rathe-r silent. I'm v.-'Orried that
there mi$:ht be so1ne problems betw~n you and me th::u w~ should dis.cus!l. OT perhaps
you ~ it differently. In any case, I think it v.--ould help i( we could discuss it. I'm ce-r,
tainl't' w1ll1n& to ltSten to anr o( )'Our concerns or fttlin~s.
(Oknt luJknt.)
Coun!l(>IJOr. I'm not )'Ou, 2nd without )'Our help I c::rn't underStand how you (eel, but I Sus.
pen )'Ou 'd r.uher not be here. Th::rt ·s how I'd (eel in the same drtumstance.
ln the preceding example, the counsellor's invitations do not guarantee chat the
client will open up to d iscuss feelings about being forced to attend the interview;
114 Chap1er 4
however, such openness to discuss rhe issue frequently works. ln any c3sc, clients
will have heard the invitation, and it ma,., help to build trust.
5. Silence L-. the client's usual way.

Some clients arc quiet by nature. They arc unu~ to giving long or spontan«>us
response~ and they may be more comfortable keeping their ideas to themsdvcs.
Silence is not a sign of counsdling failure, so counsellors should avoid the tempt3•
tion to end it prcm3turcly. Sometimes counseJlors need to modify their own expec-
tations and W'tl)'S of rcfoting to nJlow for the extended silences of some individuals.
As we will sec in the next chapter, there arc interview techniques th3t arc effec-
tive in drawing out quieter clients. For example, opcn..ended questions that cannot
easily be answered with a simple yes or no ma,., help overcome P3ttcrns of contin-
ued silence. Another technique is to discuss with clients how silence is affecting the
counselling work and then to explore ways for them to become more expressive.
Sometimes clients don't understand the expectations of theircounscllors, but once
they do they arc willing to cooperate. Professionals should re.fleet on the foc:t that
whereas they have had training in the skills and process of counselling, their clients
have not. Clients may be inaccurately seen as resistant when they are just unsure
of what to SU)'. This underscores the importance of counseJlors keeping clients
full,., informed by taking advantage of opportunities to explain their intent and
procedures. Simple stnteme.nts such as the following hcJp dcm)'Stify the counsel,.
ling process:
Cou n.se.U.o r: l 'rn sure there's tn<n-e th:u you ean tell me. It will help rne t'O understand better
i( you tell me more det,i1ls 3nd perhaps s:_l\'e me a few ex3mple~
Counsellors can also adapt the.ir methods by using strategics that require less
verbal inte.rnction. Children, for example, may respond better to play, art, music,
and drama. Adolescent males may be more motivnt~ to talk if the interview is
conduct~ in conjunction with an 3Ctivity, such as a walk in the park or a game of
pool. Counsellors arc wise to remember that while they tend to be most comfort-
able with verbal intcrnc:tion, their clients might favour other methods. For example,
some clients like to write in a journal, which gives them a chance to think inrrospcc-
tivcJy without time pressures. With thesedicnt.s, counsellors might seek agreement
to use rdC\.nnt journal entries as reference for discussion. (n the following C3.SC. a
counsellor relates how poetry was used:
The dient was 3 20.rear-old Yi'Om3n who se,tn~. at f'irst. n>1uttant to ulk 3bout
her depre$$iOn. Her usl.dl responses wen> one•Yi'Ord or short ansv;-erS.. I remern,
bered th3t she h::.d mentioned th3t she liked poetry. so I asked her i( she would
be willina to brin¥ some o( it to our meecini, She was wi.llin¥ 3nd in (::.ei e~er to
sh3n> her ..vork. She brou¥Iu a short poem t'O the next session. wh.id, she re:3d to
me. TI,e poein m,e3Jed her deep depression 2nd her preottup3tion with death.
A(terw3rd. we talked about her tonnent at a Le\'t:I t~t ..vould not h2,'e bee!, other~
wise possible. fa,d, ..veek, she brou¥ht 3 new poem. 3nd these poems bec=in~ our
startina point. As she be¥aJ1 to (eel better 3bout herSeU. her po.:-rns be<-3tne more
buorant and optirnistk, 3nd. the,., beeame one n~sure o( her pqress..
6. The client has reached closure.

Silence happens when there is nothing more to say about a parriculnr topic or idea.
Silence is a way of saying, " l'm finished. Let's talk about something else."
When counselling topics reach natural and appropriate closure, counsellors
need to move on to a new subject. They ma)' break such silence by seeking con-
firmation that an end point has indeed been reached. One strategy for prevent•
ing premature closure is to nd:nO\\rledge the possibility of closure, as wd) as the

possibility that the client may need time to formulate more idC3s. A comment such
as the following acknowledges both aJtc.rnatives:
CounS(>JIOr: I'm think in¥ th::rt we miilu h:t\'e K(Jne as far :u we e,n with that ide:3. O r perh3ps
there is tn<n-e )'Ou would like to S3y.
Subsequently, a transition to a new topic is appropriatc.1t may also be valuable

to take a few moments to summari:e before moving to a new area of discussion.
Nonverbal Cues and Silence

Sometimes nonverbal cues can rcveaJ the meaning of silence. Presenting the open palms
o f one's hands ma'>' SU)', " \Vait. I neo:I time." Looking awa'>' and clenching a fist ma'>'
signal an angry silence. At other time~ the meaning of silence is unclear. Jn such situa.-
tion.s, counsellors may choose to let the silence continue for a while to sec if its meaning
becomes apparent, or they ma'>' wish to see.k help from their clients to understand it.
Following ::are some sample responses th3t counsellors can use:
■ You've (We've) become very quiet. I'm ,vond cring wh3t that means.
■ HcJp me understand the meaning of your silence.
■ Perhaps you arc hesitant to tcll me, or maybe )'OU just need some rime to think.
Although silence is often ambiguou~ and understanding its meaning is difficult,

some dues can help counsellors inter p ret silence. Tab le 4.4 presents some of the mes.-
sages of client silence. The table includes a range of nonverbal cues and idC3s about
how to respond to each; however, all nonverbnJ behaviour neo:ls to be inte.rpreted with
e>..'trcme caution. The same behaviour may have multiple meanings. C rossed arms may
SUfiest defensiveness but may also signal that the client is physically cold, or the client
may be both defensive and cold. You need to interpret all nonverbaJ behaviour by con-
sidering the individuaJ client and the overall context in which the behaviour occur~ and
then check with the client to confirm accur3cy.
Encouraging Silence
S ilence can serve a number of useful purposes in counselling. It provides rime to cxpc.-
rience fcclings and contemplate. lnsight may emerge from moments of uninterrupted
thought. Therefore, it makes sense for counsellors to promote periodic silence in their
interviews with clients. This may be panicularh• useful when working with clients who
CONVERSATION 4.2
ST\JOENT: How IOOg is a feasooable amount of time to allow TEACHER: Try paying anent.ion to 'llf'lat you're saying to your.
a silence to continue? setf during silent ll"IOt'l'M?nts. Watd'I for depfedating se•-talk.
s.ud'I as Mlf I d0n1 say something, the client will think I'm
TUCH£R: Without knowi~ the context, I can'I answef )'Ouf
incompetent.· Counter- this by reminding yourself that sdence
question. Somethn es aftet a few seconds of sdence, it's
has its place W'I counsetti~. If you inter-rupt too soon, you rob
appropriate 10 bfeak in and say scwnethi~. In othet cifeum-
clients of important opportunities to reflect. Remember that
stan:es. an extended silence of several mrtutes is okay. Ead'I
comfort wtth sileoce can be learned, but as with au Slults.
situation must be IOOked at indi\lidually.
leafl'liing feQLifes practice. It may help 10 have a gtass of water
STUDENT: I agree, but my pl'Oblem is that I get uncomfortable so that you can take a long, SIOw sip to pfevent speaking
after- a few seconds. I get so anxious that I usualty rUSl'I to say premahxety. Deep bmathing may atso help. finalty, do 001
something, eyen when I know I sholACI keep quiet. over'Compensate. Some silences sholAd be inter-rupted.
116 Chap1er 4
TABLE 4 .4 Responding to Silence: Nonverbal Cues
Cllenl AttJons Intended Message Counsellor Respon-Se Choices
Palm ol one hand ,.;,,a 90 d,wees, "Please be patienl I need rime Verbalize willingness to wait.
S(juintiog. fur(owed tx-ow, eye m::wement, to thlnk.: Indicate attended s~oce v.;th eye contact and
and smiling (positive 0t pleasing thOUgt\U. Other nonver-bal expressions of support.
Shoulder Shruggi~. raised palms, and "Help--fm confused and Se-t the direction; clarify instructions.
r-apid eye movement. don't ktlow what to do next: Rephrase the last response.
Ignoring°' providi~ inapptopriately shor1 "You can't make me talk: "I Communicate that it's Okay 001 to talk..
answe-rs, movi~ the chair baek. don't want to be hete. • Empathi:ze with resistance.
Describe your feelings wtlen forced to &alk.
Starling lo lalk, ab,upl!y Slopp;og, shak- "I don't know Vtt'lether to &alt Empathi:ze with ambivalence.
ing head, and stutte(mg. or not.· Discuss the risks of Sha(mg and not Sha(.-ig.
Pf¥ieal withdr-awal. averted eye contact "I'm scared of what you might Reassure and convey a nonjudgmental attitude.
carefully measured WOtdS, and whispering. thlnk of me.·
Tears, covering eyes, quivering lips. "I'm overwhelmed w'ilh these Show empathy, use attended silence. and tneo
flUShed face, loold~ at the ft()()(, and feeUngs. • reveal further empathy.
trembling.
Low vdce tone, a pattern of short ;,This is the way I am. I 000'1 Accept it as a cultur"al or lndividual norm.
answe-rs. say much: Gentty encour-age w'ilh open-ended questions.
ExJ:jain lhe importance of sharing.
Leanrng baek, smiling. saying, .. That's it· "I'm finished.• Summarize.
Change the topic and move on.
are impulsive and diems who seem afraid of silence. The followina are examples of
counsellor leads:
■ I thin k it miaht be useful if weeoch rook a q uiet minute or two to think about this
idea.
■ Let's pause for 3 moment.
■ lt's oka,., with me if you wam to thinle 3bout it for a while.
■ \Vhcn you're ready, we can talk about it. In the meantime, I'm comfortable if we
don't say 3nythina.
■ Occasional silence is somcthina that m3y occur during our time together. Some-
times one or both of us will need time co thin k.
SUCCESS TIP
Avoid the imputse to respond irrwnediately to a client's question. Sometimes dients ask a
ciuestion bul after a pause go on to answe-r ,t lhemse-tves, ex.ptessiog their thoughts and
feelings in more depth. This rS another example of hOw silence can be a high-level counsel-
ling response.
PARAPHRASING
Paraphrasini means rest3ting the client's words and ideas in your own words, but pa,aphrasi,_ A IIOlljldgmeau l
1u1atement of the dient"s w.ords and
paraphrasina is not the same 3S r~pe3tina what the client says. Repetition confirms
idei.s in the 00'.llselkw'SOIUl 'Mlf'ds.
mcmoriz3tion, but it docs not mean that the words and ideas h3VC been understood.
Paraphrasing is a way of stating thoughts from a d ifferent angle. The defining feature of
3n accurate p3raphrase is its interchangeability with the client's ideas.

Paraphrasing is an important active listening skill that sc.rves two purposes. First,
paraphrasing confirms that counsellors have been listening and have understood clients.
Second, paraphrasing gives clients an opportunity to correct inaccuracies. Jn the begin.-
ning phase of counseJling, paraphrasing is particularly important b«ausc the counseJ,.
lor is just starting to unde.rst:md how the client thinks and fceJs. Paraphrasing helps
the counseJlor "J;ct on board." Paraphrasing, summari!ing, and empathy arc reflective
skills that are crucial to dcveJoping the counselling relationship. As well, it helps clients
explore their problems in a way thal is less forceful and directive than direct question,.
ing techniques.
Paraphrasing concentrates on immediate client statements. It is presented without
judgment and without an attempt to solve problems. The important point to remem,.
ber is that paraphrasing does not add to or alter the meaning of a client's statement.
(nstend, it promotes more discussion and elaboration. (n the following example, notice
how the counsellor's paraphrased responses otpture the essence of what the diem
has said:
Client: Losin& 111y job was 1ust the start o( a bad )'i'3r. I h:a"e h:ld bia riurri.:1~-e probtems
too. ::and now 111)' d.:1uahter is on the scn:-et.
CounU"Uor. You have h::.d 3 nuinber of serious thin{tS i'°' wronK thii year.
Client: Ri,aht now, the most u~•ent thll,i is t'O Ond some W3)' t'O ~t 111y dauKhter b3cl.
home. I 1ll'('d to know she's s:a(e.
Counsellor: So the (()("us o( )'Our attention ii ~in& t~t )'Our d::al¢hter is out of d.:11~r.
Client: I'd lo"e t'O be able to le:t,'e mr husband ::and move to a new dty. but "-hat would
h::appen to mr d::au~ter! I e2n' t be seJOsh.
Counsellor: I( it were just you, you'd know wh::at t'O do.. but )'Our d.:1u~1ter really is
your priority.
Client: You're ::abso1utelr ri~t. On~ she's ok3r, then I'll uike c::an:- o( mrsel(.
It is always preforablc for counsellors to present paraphrases tentative.I)•. This pro-
vides the opportunity for clients to correct errors, confirm accuracy, or provide more
det::ail. A tentative paraphrase opens discussion for deeper o:plorntion. Statements such
as "Correct me if J'm wrong" and "Would it be foir to Sil)' . . . ?" suggest tem::ativencss.
Table 4.5 provides some other examples of p::araphrasing statements.
Sometimes counsellors move too quickly by doing two things at once. ln the foJ,.
lowing example, the counsellor offers a potcntinll)• useful paraphrase and then abruptly
switches to a question that will move the interview in a different direction:
CounseUor. As I~ it, )'Ou\'e re::.ched .:1 point in )'Our li(e where )·Ou're not ~-oinK t'O
take 2ny rnore abuse. \Vh::at do you see as )'Our opt.Ons!
In this o:amplc, a vocal pause or short silence should have been given to allow the
client the chance to confirm th::at the paraphrase was correct. Client confirmation may
come from both verbal and nonverbal channels.
TABLE 4.5 The l anguage of Paraphrasi ng

Put a different~. you seem to be sayi~ .
As I uOderstand ii .
Is lhis right? You're saying.
In Othet WOfdS • .
It seems as if .
It sounds a bit like .. .
As l heatit .
TM picture I get i:S •
118 Chap1er 4
Paraphrasing and Empathy
Paraphrasing differs from c.mp3thy because it concenmncs on the content of mcss3g~
information, facts, details, and descriptions-whereas empathy focuses on feelings.
Paraphrasing may be less threatening to clients who have trouble discussing feelings. Para,
phrasing can be u~ as a prelude to empathy, with cmP3thy being introduc~ as clients
become more trusting and willing to address their feelings.
(n general, paraphrasing arises from words that the client has actually said, whereas
empathy builds on verbal and nonvcrbnJ cues, responding to feelings that the client
may never have identified. Paraphrasing is more closely rclat~ to summarl!ing. Both
paraphrasing and summari! ing condense content, and both highlight key ideas in the
client's communication.
The following example shows the difference between paraphrasing and empathy:
Client : Noc h:wina a ,ob is~ttu-)¥ me dovm. I know it doesn'c help to sit in front o( the
TV 211 day hopin¥ s<.uneone will call with tn)' dreim job.
Cou nsellor p:l.r.l.phnlSe: You're aw;,ire th::u you have l'O become more :ietive in se::.rehina
(or:. job l'O stop the downward sltde.
CounselJor empath y: You' re ::rware that wishina for a job o((er is ma.kill¥ you depressed.
ln the paraphrase response, the counsellor paid anemion co the key message (con-
tent) in the client's statement and then restated it in different words. ln the empathy
response, the counsellor picked up on the emotion3l component. Counsellors often find
that simple paraphrases such as the prec~ing one have a powerful, positive effect. Para-
phrasing helps clients reali:e that counsellors are listening and that they are interested.
Subsequent]}•, clients who fod heard and understood often release the.ir defensiveness
and fears about sharing. ln turn, the process o( sharing and exploring may generate
new understanding or insight for clients regarding their foeJings and problem situations.
SUMMARIZING
Summarizing is an active interviewing skill that can serve a number o( purposes. First,
summari! ing confirms understanding and checks assumptions. Since client mes.sages
may be complex and ambiguous, it is crucial that counsellors validate their inte.rpreca,
tions. \Vhen they summari: e content, counsellors present a snapshot o( their clients'
main ideas in condensed format for verification.
Cou nsellor: So far, )'OU se,ern to be s:ayin¥ th::u )'OU don't se,e 211)' point in lr)'ifl¥ the
same old scr21~ies. T2lkin¥ l'O he-r didn't see.in to work. ijp,onna her was e\'e:n v."'01"$('.
Kow )'Ou' re not sure wh::u elSie )'Ou t21n do. Does th::n seem like an :)C('ur2te surnm::ary!
CONVERSATION 4.3
STUDENT: If the client has just said something, what's the TEACHER: AA effect ive paraphrase is m::,fe than just mechan-
pcint in testating it? I think that a d ient migt\t find pataphtaS- i:.al festatement Or' pa,rl'Oti~ ot the client's worcts.. Verbatim
iog very imtaling.. restataments may imtate clients because lhey don'I add
TEACHER: You're sayi~ why an.get your client by repeati~ anythi~ to the interview. A useful pataphrase considers cli-
ent ideas ftom a diffefent perspective. Paraphrases ate most
\\tlat's obvious?
potent when they invite ot stimulate further etabOration and
STUDENT, That"s nghl. discussion. Nevertheless, I think it's best to avoid e.KCessive
TEACHER: Notice that I just pataphtaSed what you said, and use of pataphrasi~ 0t any othef Slull. use pataphrasing
you seemed Okay with it. vd'len you ~ to chock yout pefCeptions and when it sootnS
STUDENT, (Nods in agreement.) important to let a client know that you uodet'Sland.

Second, summari!ing is a Wtt)' of o rgani!ing complex data and content by tying
d isjointed but related ideas together. This ma,., help clients look at existing problems
d ifferc:ndy, thu~ permirting new insights. Such summaries can :.dso significant!)• reduce a
client's confu sion by o rde.ring ideas in a more coherent sequence. The following example
is excerpted from the midpoint of an hour-long counselling session. Prior to this point,
the d iem had been ta.Jking a.bout a variety o f ways to manage his d ep ression.
CounS(>IJOr. Let me Stt 1f I can su1n up what ..ve'"e been ~U:.inK ::ibout. Essenti.:11llr, 21s
you ~ it, rou need 10 Yi-Ork on lorl{t~t erm solutions. so-ine refated to improvin& )'Our
fl tncss,. others ta~til,K )'Our social life. As well. rou want t'O look at thin~s rou C21n do
iinmedi.:ue1y t'O reduce rour depression. indudinK s.eui~ a medical 21nd look.in& for
some fun thin,a:<i to do. ls th:u a fair way t'O o utline our discussion?
T he counsellor's summary helps the client systemati!c his o r her action plan. Sum,.
ma.ries such as this help clients and counseJlo rs identify priorities. By summarizing,
counsellors configure their clients' problems and issues in a way that gives precedence
to certain ideas.
T h ird , summari!ing can be helpful in working with clients who are verbose-who
introduce irrelevant mate.ri3I and wnnder from topic to topic. Summari.!ing separates
what is important from what is irrelevant b\•focusing the inter view on particular themes
and content.
CounS(>IJOr. From w~t )'Ou\-e ~n sayil,K, it Sttms th at your problems 21t Yi-Ork with
your supervisor 2re your top priority. Do you aaree.!
Summarizing ma)' focus on a short time within an inter view or it may encompass
a broader pe.riod, induding the whole interview o r the entire helping relationship. Two
content St.nrna,y: As.marythat types of summaries arecontent(or simple) summaries and theme summaries. A content
lccum • content and is• • IIEdi'..d summary focuses on conte nt and is an unedited condensing o f the client's word~!
conoe.sing of the client's •crds.
ideas arc included. A theme summary ed its unnecessary detail and attempts to identify
theme St.ftlmaty: As.taaarythat key patterns and areas of urgency. The fol!O\\•ing example illustrates the two types of
edits-«Ss.wy detail .tatt~s to summaries. The client, a 45-'t•cnr-o ld male, has been describing how unhapJ)\' he has
ii.ntifyley pal.'lerns and areas« urgency. been as a welder.
Client: From the Ars:t d ayor1 tl,e ,ob. I k new th:n weld in¥ wasn'1 for me. E\'en as21 duld. I
alW'3)'S wanted to wo&. with people. As a wi'lder. I spend 11\0St o( rny time on my o vm. La.st
v.--eek was 21 aood example. Frorn ?1.fonday to Timrstl3y, I was in tl,e shop bo.sei1~1t. a.nd
tl,e only time I had :l.11)' h uman interact ion was when I v.--ent to lunch. It's not mud, better
::at home. My wi(e has aone back to 9Choo1. so she's b u sy with homN-ork e\'ery niaht. The
kkls a.re arown. ailCI we don't see them t~t often. AU I seem to do is work 21nd watcl, n.,:
\V1th tl,e junk on TY. th at's not mud, o( 2 li(e. TI,e only thi~ worth w:1td,i1l{t ii ct\.1'.
Content (or simple) s ummilf)·: Frorn the beQ:inninK, )'OU were aware th::lt your weld ins.
career didn '1 meet )'Our lona,s:t::indins. need to work with people. It seems th::lt your
work. with last week as a l't'Pk.:111 ex21mple, lea,-es )Ou on your OYi'n. With your wi(e
s tud yinQ: 21nd your children aone. TV olfer-s little com (Ort.
Them(> summ21f)·: You ·re (eel in¥ 001::ated. Keitl,er ,.·our job nor )'Our home life ah'\"S )'Ou
mud, opportunity 10 S3t isl't' )'Our L<n,~,standh,K need t'O work with people.
Content summar ies make linJe or no ju dgment about rclcwncc. The major ,;oaJ of
the content summary is to organi!e ideas and sum up d3 t3➔ Theme summaries a.re risky.
They require interviewer s to d etermine which information is rcle\.nnt and which is irreL-
evant. In the preceding example, d ifferent interviewers might focus on different theme~
depending on the.ir mandate. A researcher investig:iting u•.le-.•ision p rogramming would
hear this client's statemem d iffcrcml't' from a career co unsello r or a marriage counsello r.
LIVE: An IICfOl'1ffl tu descrbs tile
loure~ial steps in s.aa.riz-,: Good summari!ing involves four csscntia.1 steps that you can remember with the
ista1. ii.ntify, Wfbaliie. m luate. acronym LIVE: listen, identify, ve.rbali:e, evaluate.
120 Chap1er 4
Step 1: Listen In this step. the ta.sic is to listen carefully to verbnJ 3ncJ nonvc.rbal
mes.sages that provide dues to content 3nd meaning. Counsellors must exercise a grc3t
deal of scJf,<Jisciplinc to 3\'0id contaminating clients' idC3.s with personal bi3.s and dcfi•
nition. Counsellors can aslc questions, request example~ and probe for definition as
ways to reduce any rislc of imposing their own biases and assumptions. At the s3mc
time, they need to control distractions, indudingoutside noise, daydreaming, attending
to other activities, or becoming preoccupied with what to say next. In genera], active
involvement in wh3t is being said divens counsellors from any temptation to become
distracted. Another technique to avoid distraction is to silently repeat or review client
mes.sages.
Listening mC3ns pn)•ing attention to the five W's -Who? \Vh.nd Where? \Vhcn?
Why!- plus How? Sample questions co consider arc: \Vhom arc clients t31king 3bout!
What are they S3)'ing? \Vhat arc they feeling! \\:lhat are they thinking? \Vhcn docs this
happen? \Vherc docs it occur! \\:lhy docs it happen! How are clients saying it?
Step 2: Identify and Interpret The prim3ry goal of this step is to make sense
of nJI that has been said and heard. This involves distinguishing import3m informa•
tion from irrelevant inform3tion, identifying underlying themes and P3ttcrn~ and
setting priorities. 1t also means hc3.ring what has been said in context and avoiding a
common pitfaJI in listening: not seeing the forest for the trtts. The counsellor's goal
is to arrive at as similar a meaning as possible to the meaning the diem intended. At
this step. counsellors need to remember th.at their ~rsp«tives 3rc biased. \Vhat they
deem significant 3nd what their clients view 3.S important m3y differ sh3rply. This
reality underscores the importance of discussing these differences openly within the
interview.
One technique that counsellors can use is to listen for keywords in cu.h of the
three domains: behaviour, thinking, and feeling. Some sample reflective questions for
counsellors include the following:
■ \Vhat is my client doing?
■ How docs he make sense of what is happening! What beliefs docs she have about
hc.r problem situ3tion!
■ How is he feeling?
Step 3: Verbalize Your Understanding The goal of this step is to vc.rbali!c ),'Our
understanding of what the dicnt has said in a summarization response, using words
3nd phrases that the client can understand. Undc.rst3nding is 31\\"ll)'S tentative, at least
until clients have 3n opportunity to confirm or ch31lengc counsellors' perceptions. So,
this step is crucial to test the accuracy of comprehension.
The move to a summarizing statement can be flagged by leads sud,, 3S the following:
■ To summ3rize what you've been saying .

■ lf I may offer 3 summary .
■ To be sure I understand .
■ Let's summari:e .
■ Summing up .
■ Let's pause for a moment to recap.
Step 4: Evaluate After summ3ri!ing for clients, the next step is to watch and listen
carefully for signs that the summary is correct. Accurate summaries ma'>' be signaled
nonverbally by the client's head nod~ smile~ and relaxed posture, and vcrbaJly with
short statements, such as "That's right" or "Exactly."

Oisagreemc:nt may be: dirc:c:t, with c:.xpressions lilcc: "No, that's not right," or it
may be nonvc:rba.J, with clients mO\'lng back, hc:sitatina. or looking away. Lulcc:warm
responses, such as "Kind of," are subtle: clues that your summary is incomplete or inac~
curate. In addition, para.Jinguistic cuc:s, such as spcec.h that is drawn out, may indicate:
a lukc:\\"8.rm response:, c:vc:n though the: words may appenr to confirm undc:rscanding.
\Vhc:n dc:aJing with lukewarm responses, counscllors need to use questions and state:~
mc:nts to invite: confirmation. This reinforces the: notion that the dienc's riaht co be
henrd accurateJy will be: respc:c.ted, and it empowers clic:nts to take: an active: role: in
evaluation. Lc:ads such as the following can be: used:
■ Ooc:s my summary capture the: important points!
■ I'm wondering if you agree: with my summary.
■ Is that accurate?
■ How does that sound to you?
■ What have I missed?
))l} INTERVIEW 4.1

The followii,g interview excerpt illustrates some important concepts from this ch.apter. This is the second interview with a
client who is seeking help with anger management The excerpt begins abOut frve minutes into the interview.
counsellor: Lei's feview what we talked aoout laSI week. Analysis: This opening comment sets the stage for a summary
(Three seC011ds of silence. Client smlle.s and oods her revittw of the last interview. This is important for re-ttslabllshing
head.) the contract. It confirms that issues important in the last ses-
sion still remain priorities.
Counsellor: I remembet two pcints. fll'st, you indicated Analysis: After offering a summary. it is important to confirm
that you wanted to find out what youf tr1ggers af&-the its becuracy. In this case, the counsellor uses the brief silence
thi~ that lead you to bse contfel. Second, you wanted to allow for the client to respond. This theme summary foe.uses
to explOr'e some ideas fof staying in contrOI. What have I on what the counsellor cons;ders to have been the priority of
missed? the last session. Checking for client agreement is an imJ)Ortant
component of making su,e the p,ocess is cOl/abOrative.
Client: Yes, that abOut sums it up. But I don't want to Analysis: The client confirms partial accuracy and then adds a
beCOme a pushover". point that the interviewer's summary has missed. This should
alert the interviewer to the client's priorities.
COunsellor: So, a•f manage~nt but not at lhe ex()Mse Analysis: A succinct paraphrase offers another pe,spective.
ol gjviog up your rlghlS. Perhaps the counsellor missed an opportunity to get mo,e clar-
(Ten SSCC(lds of si-e.) ity on the WOrd ..pushover."
Counsellor: vou•ve beCOme very quiet. I'm suuggling to Analysis: There is not enough information fo, the counsellor
under"Stand what that means. to understand the meaning of the client's silenc.e. It might be
(Ten secot'ldS of silence. C/J'ent /coks at Ille flcor, tears Ill tempting to move on with further quest.ions, but the counsellor
her eyes./ suspec.ts that the silence is significant. A gentle statement
invites the client to give meaning to her silence. Nonverbal
counsellor: Pethaps thi:S i:S painful for you to think aoout.
cues (looking away and tea,s) suggest that the client Is
encountering strong feelings. The counsellor then focuses on
feelings.
ClleM: In eitety relationshiJ) I've ever had. I end up being Analysis: The client's comments suggest tha-t she is willing to
the underdog. I do everything to please my partoet, but take a trust risk. This is a critical moment in the interview. The
nothing fOr' me. I a~ysgive in. Inside, ifs a diffetent sto,y. cllent will be watching carefully for signs of ,ejection.
I'm ful of rage and resentment.
122 Chap1er 4
i>» INTERVIEW 4 .1 Listening, Silence, and Summarizing Skills<contn.te)
COunullo,: Teti me mote. Analysis: This directive encourages the client to go on with her
(Leat'IS toward c/J'ent, maintaining eye COflttJct.J story. It confirms direction and Is short enough not to Interfere
with the momentum that the client has established. Attending
behaviour shows that the counsel/Or is Interested and o,:,en to
hearing the client's Ideas and feelings.
Client That's 100 essence of the prOblem. I let things butld Analy:sls: The client continue.s to risk. This signals that trust is
up inside and 1hen I ex,:,IOde. Once, I was even f11ed when growing, but the connection may sJill be very fragile. As we will
I bleN UJ) at my bOSS. see in Chapter 6. It is now impo,tant fo, the counsellor to make
an empathic connection with the client's feellngs.
COunullor: So, your anget is a bit like a time t:ornb, tickl~ Analysis: Here the counsellor paraphrases, using a simile that
away until you explode. is consistent with the client's phrasing.
Cller,, El<aclly. Analysis: This silence m~ be a simple pause that allows the
(Short silence..) client to decide what to talk about next.
Client But, as I think abOut ii. it's not just my a~t. Analysls: The client does not accept the counsellOrs para-
guess what I'm realy afraid of tS nev« having things go phrase as accurate. Secure counsellors need not fear such
myway. mistakes 0r corrections. The client's willingne.ss to correct the
COunsello,: As I hear it, you seem to need to have more counsellor indicates that she has enough trust in the relation-
controt <:Net you, life. ship to feel safe In challenging the counsellor. Ofcourse, some
clients may challenge because they have no trusJ.
Client: No, lhat's no1 it H's not contfol so much as
validation.
Reflections:
■ If you were the counsellOc in this interview. what feelings might you have experienced during the extended silent
moments?
■ Early in the interview, the counsellor asks, MWhat have I missed?" Consider the advantages of this question compared
to an alternative. "Have I missed anything?"
■ Sugge:st le.ads that would enable the c-0unsell0c to follow up on the client's statement, • 1don't want to be a pushover."
SUMMARY
■ Listening is the basis for understanding and a prerequisite for relationship
development.
■ A wide range of problems, such as culturaJ and language barriers, difficulty in
framing idea~ outside noise. ambiguity, loss of objectivity, and spcec.h problem~
can inte.rfere with this listening process. Competent counsellors remain sensitive to
these problems and take steps to overcome them.
■ Active listening (silence, anending, summari! ing, paraphrasing, questioning, and
empathizing) is an essential tool for inc.rc3sing unde.rstanding, communicating inter-
est, and letting clients know that they have been heard. Active listening involves
counseJlors in an ongoing process of pa)•ing attention, listening, exploring. and
deepening.
■ Significant information is communicated through the nonverbaJ channel.
listening & Responding: The Basis tor Unders1andlng 123

■ Silence may have multiple meanings. Effective counsellors are comfortable with
silence, but they :.dso have the wisdom to know how and when to interrupt it.
■ Attending is the way that counsellors communicate that they arc physically and
psychologically committed to the heJping relationship.
■ Paraphrasing is a way of restating someone's words and ideas in your O\\'n words.
Paraphrasing is important in counselling because it confirms to clients that counsel,.
!ors have heard and understood them.
■ Summarizing helps clients o rg:aini:e complex thoughts and is used to focus on rcl.-
evant themes and content.
EXERCISES
Self-Awareness 3. Conducl an. interview with a colleague on an.y topic of inte-r-
1. Describe an encountefyou have had where nOOW!tbal com- est. Practise pataphtaSi~. Watch fOr' vetbal and n.onvetbal
munication was more im(X)rlan.t than the content of lhe vet- in.dic.at0rs that )'OU' par'aphr'ase- was cortecl.
bal messages. 4. Conduct a five- Of ten-minute in.tel'\liew with a coueague
2. list wOr'ds, phtases, an.d siluations that you think are youf on. any topic of in.tefe-st. As interview-er, you should ptac-
e-motiooal triggers that mighl make ii difficult for you to tise summatlzing skill.$. Try to offet bOlh content ar\CI
listen. theme summaries. Al the conclusion of the in.terwew, offet
a complete summary of the session. ASk you( partoet fOr'
3. Ovef the next week Of so, pay attention to the vocal pauses
feedback.
and silences that you and otherS use in evet'yday and pt~
fessional communication.. What in.di::'.atOr'S sugg,asa comfort 5. Conduct practice interviews with a colleague to experiment
wilh slence? Oiscomfor1? with spatial diStance. Oeliberatety increase or decfe-ase the
distance be-tween. lhe r.w of you to learn abOut the e:ffed
4. Oellberately altef yolM' resJX)nse time in a con-..el'Sation. to
of space-. Al what poin.t did yout space- become tJiotated?
experiment with silence.
How did physical distance affecl the quality of youf vetbal
5. Ask a coneague to ObServe yout use of silence dur1~ an exchange-?
intetview (e.g., attanded slence. apprOl)riate in.tet'fuptioos,
6. Attempt to communicate with a COiieague using only non-
and leoglh).
verbal cues and gestures..
6. Videotape an. inteNiew Or' ask a coueague to Observe you(
7. ObServe the n.onvetbal communication. patterns of diffetent
attendi~ behaviout. age woups. What similarities and differences am apparent?
7. Metacommun.ication.. Oesctibe the possible- meaning (fof
8. F'orm a small woup of fouf to five cOlle-agues. Identify on.e
you) of each of the- fOIOwiog:
of you whO is wiling to discuss a eurfent pr•obfematic situ-
a. Youf te-ad'ler askS you to see hef rigr\t after class. ation. Two or lhree people will ObServe the interview, and
b. Youf pal"ttlet forgets yout birthday. r.w will act it out.
c. A Men.d asks if you are free ~ Sat1Xday mor'ning. Counsellor 1: Conduct a 10-minute intel'\liew whtle payi~
d. A client does n.ot soow up fOr' an apJX)intme-nt cafeful attention to lhe detail of the prOblem. Deliber-ately
avoid addfessi~ feelings.
e. Youf client ask.S, "How old afe you?·
Counsellor 2: Conduct the in.tel'\liew while paying cate-
ful attention to em::>tions. Oetibetately avoid expl0ting the
Skill Practice
details of lhe prOble-m.
1. Outing interviews with some colleagues or clients, ftnd
Counsellor 3: Oelibet'ately inctease lhe le~ of counsetlOr'
o,:,por1une moments fOr' bde:f pe(a:xls of reflective- silence-;
pauses (silence).
1hen con.tin.ue lhe inteNiew. Discuss 'Mth your coueague-/
client what the impact of lhe silence was on the in.tel'\liew. Debrief and compare the outcomes of lhe interviews.
2. Work with a cotieague to ~ lore 100 effects of poot listen- Concepts
ing. As an &efcise. delibe,atefy (but subtly) violate lhe
I. Explain how silence can. be- used effectively in counsetling.
prlnciptes of effective listening ar\CI atter\Cli~. FOr' example,
inte-rfupt inappcOl)(aatety, ask unrelated ciue-stions, switd'I 2. Paraphrase e-ad'I of the follO-.-dng dient saatements:
topics pmmatufety, and avoid eye con.tact and othet in.dica- At a party the Othef night I finalty met sorneon.e Mh whOm
tOr"S of intemst. When. you are ftnished, discuss hoN it fee-ts I can cany on. an intelligent conversation. He- seemed
to not have othel"S listen to you. intefested too, but he di:fn.'t ask for my phone- n.umbet.
124 Chap1er 4
It's a dilem.rna. I dOn'I knON whether to ftni:sh lhe SChOOI • I just IOSt it. My anger- bul t up and I hit her. She got so
yeat or dtop out and get a handle on some of my debtS. upset lhat she packed up and left with the kids. I've
My super.to, wanlS 10 see me today. 1kt'Owstie~to talk never- 0000 anything like that in my wtlOle life. I realiZe
10 me beCauSe rvet:JeEo late fOr'v.O'k Oler' the lalSt ie-Nweeks. that I didn'1 SOive any1hing by losing my tempet. Now
I may have tuined my marriage ar\CI hxned my kids
If Sile wanted me toe.all het, wily didn't shesaysometiw,g?
against me.
Rrsa my cat~ OONr\ lhM the fri:2ge. NON it'stOO ,:It.Im~
• I guess I'm goi~ to have to find some way of dealing
,,g, 1shOuld """IY someone wro;,; ~ at fbong tt'ings.
with my dtink.i~ ptOblem. The othet day, I was so sick
I think lhat 'Mth AIDS and all the othet diseases you can from drinking lhat I couldn't even get out of bed. I jUSI
catch, we shoukl all take precautions. You nevet know can'l let bOOZe continue to jeopatdize my WOtk and my
wl'oO migllt be infected. family.
Well, to pu1 it bluntly, I think my partoet haS a lovet. But
I could forgjve that. I jUSI want OU( (elations.hip to be the 3. ln.tef'Jiew people from different cultutes regarding theit use
way it was when we firSt met of nonverbal behaviout (e.g., greetings, saying gOOClbye,
summoning a waiter, eye con.tact ph)'sic.al contact, and
I've tried everything. I have a great r~s~. I've caued
use of space).
ever-yone I kOON. I IOOk fOr' WOrk five to six hOurS a day.
StiU, I can't fand a jOb. 4. Ext,lain wtly counsellot'S might a\lOid paying attention to cet-
Lately, I've been thinking that there has to be more to life tain topics because of their' own needs. Alter'natively, ex.plain
than wOr'k and play. I'm not even sure if I believe in GOd, why counseuors might pay ex.ces.sive attention to cettain
but I need to find some meaning fOr' my life. topics beeause ot theit own needs..
WEBLINKS
Links on listening from the International listening Association: The International Child and Youth Care Network (click on the
"Reading•· tab f0c ac-cess to practice hints. a reforence library,
www.hsten.org
and othier useful connections):
..Tips on Effective Liste:ning." by Larry Alan Nadig: httpdkyt-net0<g
www.drnadig.com/listening.htm
listening & Responding: The Basis t or Unders1andlng 125

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LEARNING OBJECTIVES
■ Describe rhe importance of asking questions.
■ Explore esscntiaJ questions (dosed, open, and indir«t) and hO\\• they might be
used cffectivcJy.
■ Identify and describe common qucstionina pitfalls.
■ Explore strategics for interviewing youth and seniors.

■ Explain how to promote concreteness in counscJling.
■ R«ogni:e the five different types of interview transitions.
THE ART OF ASKING QUESTION S

Questions Support Counselling Goals
No single approach to quesrionina works with every client. Counsellors must consider
numerous fuctors., such as the goals for the session, the comc:x"t in which questions are asko:J,
and the individual needs of dicnts, and then adapt thc.ir questioning t«hniqucs accordingly.
\Vith a rcpcnoirc of techniques, slcillful intc.rviewers use questions to cngnge clients in
hiahtr-ordc:r thinking., kindle rhe.ir curiosity. and prompt them to consider new possibilities.
126
Asking questions is a cornerstone of active listening and counselling. Purpo~ful
3nd well-timed questioning considers variables such as the current interview ph3se,
sessional contract, level of trust, 3nd the c3pacity of the client to handle that level of
questioning. Used appropriate1y, questions support the J;03ls of counselling in a number
of ways:
■ Gmhering infonnmion. Answe.red questions provide counseJlors with detail~ defi-
nitions, 3nd examples. As an adjunct to empathy, questions help clients explore,
clarify, and define emotions. Counsellors who use questions to learn will be less
likdy to make erroneous 3ssumptions.
■ Prmriding /oms. Session3J contracting is used to define the purpose of the inte.rview.
Subsequently, questions control the topic and direction of the interview consistent
with this contract. Focused questions ensure that the interview remains on trade.
■ PromOling in.sighr. Thought-provoking questions stimufote clients to begin a reOec-
tive process that can promote insight. Asking the right questions can promote
aw-areness by leading clients to ex3.mine issue~ ide3s, and fcdings th3t they might
h3ve othe.rwise overlooked. Effective questioning can also help clients m3ke con-
nections 3nd uncover patterns in their thinking 3nd prob lem solving. A ~ries of
questions C3n S)'Stematically lead clients through problem exploration, goal setting,
and prob lem solving.
■ CarMni.s. Stimulating questions in combin3tion with nonjudgmental responses fuel
the cath3rtic process by encouraging clients to tell their stories 3nd explore the.ir
feelings. Often the therapeutic va]ue of this is sufficient to provide the necesS3ry
strength 3nd motivation for clients to address the.ir problems on their own.
Types of Questions
When counsellors wry the W'n)' they ask questions, the interview takes on more vit3lity
3nd the use of time becomes more effective. Effective questioning technique depends
on 3 number of factor~ including timing. the nature of the refationship, the purpose
of the interview, and the mood of the participants. Moreover, questions that 3re
surprising!)• u~ful with one diem m3y generate hostility in another. There is an 3.rt to
3slcing questions th3t precludes 3ny attempt to structure questioning in the same way
for each client.
Closed Questions Closed questions can easily be 3nswered with a yes or a no, 3nd dosed questions: Cluestic.s di.at can
they are u~ful for confirming facts and obt3ining specific information. Since closed easilybe aniv.eied rib a simple ,es• no
(e.g.•"!lid JOU g_o byyca-wlfM.
questions do n()( invite detailed responses, they can effectively bring closure to an
interview or slow the pace of clients who are overly verbose. On the other hand, dosed
questions should be avoided with clients who tend to be succinct. For example, clients
})l) BRAIN BYTE r,l,_1-1 ,1,

Questions can triggef recall of memories long lotgOtten. Ques- a bakery may prOduce a pleasant fecal ot one's t,andrnotl'wl-r.
tions evoke answerS 01 emotional teactions baSed on stoted A IOud noise may instantly take a C3nadian veteran back to
infotmation and expe(I(>~ from the past A simple ciues- his expe-rienc&S in Afghanistan. ~uently, when asking
rion such as Mwhete did you attand Sd'loolr may triggef a ciuestions, counsellors need to considef that their clients may
stmng em::>tional fesponse from an Indigenous per'SOO W'ho interpr'el tne question frOO'l an entirety diffetMI frame of te:fe-r-
endufed the abuSeS of the canadian Residential SchOOI sys. ence. Uoox.pected fesponses and nonvetbal communic.ation
rem. Metnary ir'WOl\'es all five senses. The s.mel of cOOkies in are dues that this may be happenlOg.
Asking Questions: Tile Searcll lor Meaning 127

can ea.sit,., dismiss the question "Do )'OU have anything 't'OU want to taJk about today?"
with the answer "No." Typic:.dly, dosed questions begin with words such as can, did,
are, hal't', is, uiill, u,-otdd, and do, as in the following examples:
■ Can you tcll me whnt )'OU 'vc done about id

■ Did you hnvc an opportunity to call the schooH
■ Are you fodingdcprcsscd?
■ Is my understanding corr«d
■ Do you agree that the most important problem right now is . .. ?
In J;Cncral, when counsellors want a definite )'CS or no answer to an important
question, a dosed question is preferable. In the following example, the client hints that
suicide might be an is.sue. This possibility is too significant to be ignored, so the coun.-
seJlor uses a dosed question to sec if this is a risk.
Client: Lately. I ~,~been so down I wonder, wh::u·!l the point o( ~oi~on!
CounseUor. Have )'Ou been thinldfl¥ about killin& yourself'!
Sometimes oraanizations require an intake interview that requires a great deal of

inform:nion. A series of dosed questions is an dficiem way to gather data quickt,.,.
Unfonunatc1)•, too many dosed questions may irritate clients and leave them feeling
interrogated and restricted. To minimize these effects, counsellors should blend dosed
questions with various interview stratcgic~ in particular, other active listening skills.
SUCCESS TIP
At the beginning of an .-iterview, 1t is usually beltet to mioimi:ze questions and sim~ encout-
age clients to Mtell lheit sto,y.• By ooing so, counsellOrS may fand that they Obtain much of
the infotmation lhat they need without having to question clients.
open questions: Ouestilns tut Open Questions Open question.'> are distinct from dosed questions because they are
promo:eespansive ans-""1. These types
ol quesli>ns ta.at be aasMltd d a
difficult to answer with a simple yes or no. For this reason, open questions arc usu.-
simple yes orno (e.g., •i-ro. doyoa le.I nil,., prefc.rnble to dosed questions. Thq• provide a great deal of freedom for clients to
abclll her!"). ans,.n~r the questions in the way they choose, with 3S much or as little depth as they wish.
Open questions may be used to begin an ime.rview, for example, "\\:fhat brings you he.re
today?" They may also be used to explore thoughts, feelings, or behaviour: "\Vhnt were
you thinking?" "How did you feel?" "How did you respond!"
Open questions begin with urho, tt-h.ar, tt-h.ere, tt•hen, or tt"1.1(thc "five W questions")
or how.
■ Who knows about )'OUT situation besides )'OUT wife?
■ Whnt have )'OU been able to do to cope with this problem?
■ Where do you see this relationship going!
■ When did this begin?
■ Why do you think it has been difficult for 't'OU to copc?(As will be discussed later
in this chapter, wh1 questions should be used cautiousi)•. )
■ How do )'OU see id
■ At whnt point do you think you might be read,., to malcc a decision?
Keep in mind that with some clients both open and dosed questions yield the
same result. \Vith these diem~ the dosed question "Did you have any feelings about
what happened?" and the open alternative "How did you fecl?" will generate the same
128 Chap1er S
response. However, counsellors should avoid using the dosed n1te.rnntive with less verbal
clients. If co unseJlors want an expansive answer. they should avoid using clo~ ques-
tion~ particularly when dealing with clients who tend to provide single-word or short
answers to q u estions. For example, instead of asking. "Did you come he.re for help with
your rCsumC?" a counsellor might ask a q uestion that conveys a greater expectation for
detail, such as " \\:'hat we.re your reasons for coming in today!"
Clo~ questions become leading q uestions when they su~est the "right" or expected
answer to the client. ln the following example, a single mother describes her .situation:
Client: I often think that 11\)' kids do not i-h'e me e:no~ respect. Just once. I'd like
them t'O ~,sk me how mr da)' went. When r,n tired, they rould help out more.
Coun.settor: Do you feej 3n~ry?
Client: Sure I do. \Vho wouldn't?
In this example, the client hints at strong b ut u ndefined feelings. Even though the
client affirms anger, this may not be her main fecJing. The client may indeo:f be angry,
but other fttl ings may be dominant. Yet many clients find it easier to go in the d irection
suggested by the counsellor's q u estion than to shift the answer. A less biased q uestion
miaht be "How do )'OU feel about this?"
Kadushin (1997) suggests that o pen questions can be intimidating for incxpe.ricnc~
clients who are unsure of their expected role: "For .such inte rviewees, open..endcd q ues-
tions provide little structure, little guidance for what they are suppo~ to tn1k about and
how they arc .supposed to talk about it" (p. 24 I). As a rule, clients may remain confused,
resistant, o r threatened by q u estions until clarity is estab lished regard ing the goals and
process of counselling. This underscores the importance of relationship contracting
that establishes counseJling ro utines and expectations, which typically ICOOs to more
client control and colla boration a nd a reduction in client resistance.
SUCCESS TIP
Questions can lead to surprtsi.ng and unexpected client responses (for bOth clients and
cou~). These responses create options for aransitions to new areas ot ioqliry and for
renegotiated agreement on the direction of wOr'k (contracO. When clients respond to ciues-
1:ions with sttong emoti:)ns, empathy is a preferred response.
Indirect Questions Indirect questions, o r embedded question~ arc statements that indirect questions: State.nts that
impt, questicm (e.g.. ·rm curi>usabOIIII
act as q uestions. Indirect questions are a .softer way of .sec.king information. They arc
hc,#)1)1.1 respodd">.
less intimidating than open and dosed questions. Indirect questions are effective for
breaking up the monotony and threat o f constant questioning, particularly when they
are combined with other skills, espcc:in1ly empathy. The following are some examp les
of indirect questions:
■ I w-onder whether you believe that it's possible.
■ Perhaps )'Ou're feeling confused over her response.
■ I'm curious about your opinion.
■ Given what you've said, I wouldn't be surpri~ if you decided to accept the offer.
■ I have no idea what you might be thinking.
■ I w-ould not be surprised to find that you have strong feelings on the maner.
■ You may have already reach~ a conclusion.
■ Your views on this are very important to me.
Table 5.1 summarizes the various types of question~ including their advantages
and disadvantages.
Asking Ques tions: Tile Searcll lor Meaning 129

TABLE 5. 1 Types of Questions
Type Description Advantages Disadvantages Examples
Closed quesUoos Quest.i:)ns that can • Conftrm fadS. • Restrict answers • Wtll you be going to
(do, will can, be answered yes conclusions, or • When asked repeat- the parents' group
are, If) °'no aweements edty, can leave clients tonight?
• Slow the pace of a feeling intefrogated • Did you say everything
l'ambti~ intetview by that you wanted to
limiti~focus say?
• Ate easy f0t clients to
answe(
Allow fOr' an
Open <i u&Stioos
(who, what.
where. when,
Questions that
promOle a mor'e
expansive answe-r
•
unrestrk'ted
responses
l'a• of
• May be more Ume--
consuming process
• Are mor'e d'lalleogjng
• What a(e you( plans
for this evening?
• How are you feeling?
why, oow) • Em po-.ver clients by for clients to answer
g'Ning 100m incr-eased
control of answers
Indirect questions Statements that act • Ate less tt'lreateni~ • May not elicit a I aminterested in
as questions 1r.an traditional response from the kr10\\;~ if you have
questions dieot thought aOOut what
todo.
ESSENTIAL QUESTIONS: SOME OPTIONS

Some interviews arc highly strucrur~ with a series of q u estions to answer, such 3S a
survey o r 3 st3ndardi:~ assessment tool or p rotoco l. For example, 3 suicide risk assess-
ment interview will include targeted questions designed tog,et inform3tion about knO\\rn
ris k factors. A psychi3tr ic interview gnthe.rs data to see whether a client's symptoms
m3tch the criteria for P3rticular mentaJ disorders. Although it is possible (and some~
times desirable) to conduct 3n interview without question~ the ab ility to fo rmul3te
targeted questions is 3n indispens3b le skill for every counsellor.
struc:b.red Interview: An inteMl!'w A structured interview follows 3 d efined sequ ence o f predetermined stand3rd
that fol!Gws a l)ffdet.rmiflfd sequeace d
-·
questions. E.x3mples include inter views th3t require counsellors to complete forms to
establish clients' cJigibilit)' or to m3ke assessments. (n structured inter views, there is
little o r no freedom of choice reg3rd ing the focus 3nd pace of the inter view.
oostruc:tured hrtertiN: An illervi!w An unstruc.tured interview gives interviewers and clients freedom to go in any
that doeitot haw a preset plan that d irection without a predetermined set of q u estions. In this t)·pe o f interview, the tone
mtricts dir!Cli:in, pace.« content
is more conversational, and the pace and style of questioning is less rigid. The conmtct
remains flex ible.
Typically, most interviews will h3ve the following process goals:
I . Establishing purpose (ses.sioMI contract)
2. Defining, strengrhening, or troub le shooting the counselling refotionship (reJntion~
ship contract)
3. Exploring and understanding the client's siruation and p roblems
4 . Problem solving
5. Evaluating the work
T he follO\\ring sections propose s3mp le questions for each of the preceding 3rens. It
is alw3ys p referable to have 3 variety of ideas (choices) for 3ccomplishing the S3me tnsk.
A reperto ire permits ffexibility 3nd contributes to keeping the interview interesting and
individuali:~ . To increase the chances for rnppon, counsellors nttd to modify ques..-
tions and word choice to meet the particular nttds, educational levcJ, 3nd culrure of
130 Chap1er S
C3ch client. Other active listening: skills such as summari! ing and, in particulnr, empathy
are essentiaJ to ensure that the interview does not become an interrogation.
Questions for Establishing Purpose

Contracting was introduced in Chapter 3 as a tool for ensuring that clients and counscl.-
lorsdearh• understand the intended purpose of the relationship. \Vhen clients come for
service, the basic question counsellors need answered is "\\:'hat brings you he.re toda,.•?"
Of course, this does 00( prevent counsellors from introducing: their own ideas, but this
question and its variations ensure that clients are consulted regarding their nttds and
expectations. This is particularly important when working with involuntary or reJuctant
clients. Here arc some sample questions:
■ How would )'OU like to spend our time together!
■ Do you have feelings and concerns from our last session that you want to address!
■ \Vhat would you like to talk about!
■ \Vhat do )'OU think would be a good starting point?
■ \Vhat would you like to accomplish today!
■ \Vhat is '>'our gonH
Questions to Define the Counselling Relationship

Clients may come to counselling: with denr ideas of what they wam from the.ir coun-
sellors, or they may be aware only of their pain and be hopeful that some heJp will
be forthcoming:. In any case, it is important that both clients and counseJlors under-
stand their resp«t:ivc roles in the process. Relationship contracting (see Chapter 3)gives
clients and counsellors an opportunity to define their relationship and how they will
work toj;cther. TypicnJ questions include the following:
■ \Vhat experiences have you had with counseJling? \Vhat did you find heJpful/n()(
helpful?
■ \Vhat are your expectations of me!
■ How do you prefer feedback (e.g., soft, direct, and "sandwic.hcd")l
■ \Vhen you imagined coming he.re today, what were you hoping would happen!
■ How will you know if our time together has been useful?
■ Anticipatory feedback helps to plan for things that might arise in the counselling
relationship. For example:
■ ff I notice that you arc getting discouraged, what should 1 do?
■ \Vhat would be a good way for me to approoc.h you if 1 think there were prob-
lems between us!
Questions for Exploring and Understanding

At the beginning: of an interview, or when a new topic is introduced, an open-ended
question such as "\Vhat do 1 need to know about your situation?" empowers clients
to identify areas of immediate concern or willingness to explore. This question com-
municates to clients that counsellors will respect their needs and wants without making
assumptions. It ~ms to say, "I nm willing to listen and lenrn. I will treat you as a person,
not as a number or a category." At least initially, clients may 00( put forward the.ir most
urgent need. They ma'>' start with a safo topic to test the waters for understanding and
acceptance. Once they fed more trust, they may present matters that are more serious.
Asking Questions: Tile Searell lor Meaning 131

Sample wrintions of this question arc "\Vhat arc the important things I need to
understand about you and your problem?" and "Can you tcJI me the key points we need
to explore!" Concreteness probes are used during all phases of the interview to ensure
clarity and secure examples. They move the interview from superficial understanding
to shared understanding.
Questions designed to learn about a client's situation genc.raJly target three impor-
tant areas or domains:
affective domain: HGwclients feet. I . How the diem {«ls about the problcm-affec,rivc domain
CO,gJ'litiw, dCWt'lain: Koll cliffl1s think 2. How the diem chinks about the problem-cognitive domain
abclul tlleir situati>ns.
3. Whnt the client is doing about the problem- h e.h avioural domain
behavioural domain: 'Mai'! cli!als
andcini, Affective Domain (Feeling) Sometimes solutions to problems nrc obvious to
clients, and they do not need help with decision making or problem solving but still
lack the capacity to cope with their dilemmas. Often this is because their struggles to
deal with painful feelings detract from their power to solve the problem. So, in many
circumstance~ managemcm of emotions is a pre.requisite to problem solving.
Questions thnt explore the feeling or affective domain include the following:
■ How do )'OU fttH

■ Whnt emotions docs this rriggcrr
■ I'm interested in hearing more about your emotions.
■ Whnt feelings best describe your reaction!
■ Are you feeling .. . r
The question "How do you feeJ!" is one way to introduce feelings and co encourage
clients to explore the emotional components of thc.ir problems.
Cognitive Domain (Thinking) How people think about their difficulties is often
more important than the problem itself. An event thnt may be no big deal to one diem
setf-ta.lk: .Mental messages p8l$)1e give may represent a life-threatening crisis to another. Self-talk, or inner dialogue, refers to
to t!lems.elve (e.g., -rm no good1. the mental messages we give oursclves. Ncg3tivc self-talk is associated with inaction and
poor self-image.
In contrast, positive self-talk builds conf,dence and is self-empowering, 1t moves
people away from a victim mcntnlit)• of feeling powc.rlcss. It also enables individuals to
deal with crises realistically, without self-imposed rigid and punishing demands.
By seeking to understand how clients think about problems, counsellors can get
valuable clues rcgnrding important issues, such as sclf-estccm, motivation, and irratio-
nal thinking. Subsequently, counsellors can directly chnllcnge clients' ncg3tivc self-talk.
Sometimes counsellors can achieve quick and dramatic counscJling interventions
by chnllcnging the rationality of the worrier. By offering factSi, challenging assumptions,
and inviting clients to consider the rc3l probabilities of dreaded events. counsellors
introduce much-needed critical thinking that may interrupt the worry cycle (She.bib,
1997. p. 81). This strategy is an esscntl31 clement of cognitive behnvioural counselling,
which will be cxplor~ in Chapter 7.
Herc arc sample questions thnt can prompt exploration of the cognitive area:
■ Whnt arc you thinking!
■ Whnt is the evidence for your belief?
■ How do )'OU know this to be true?
■ Whnt do you say to yourself about this problem?
■ Whnt does your "inner \'oice" say?
132 Chap1er S
■ \Vhat messai;cs do you give yourself th3t are self-defeating!
■ \Vhat arc you tcJling yourself!
Behavioural Domain Although it is important not to move too quid:J,., to work on

problem sohting. an important patt of ,votk in the beginning phase involves interview-
ing clients to le3rn what they arc doing and not doing about their problems. Such infor-
mation is important for assessment. It tells counsellors whether their clients arc active
in seeking and working on solutions or whether they have become withdrawn and have
given up. Some questions for exploring the behavioural area include the following:
■ \Vhat have you done?

■ \Vho cJsc is affected by this problem!
■ Can 't'OU identify what triz:crcd 't'our relapse?
■ How did you respond!
■ \Vhat did you do or say?
■ \Vhcn is the problem worse or better!
■ Has the way )'OU have been h3ndling your problem changed!
SUCCESS TIP
Changes in any of the lh(ee domains-feeling, lhinking, or behaviou(- will stimula te
changes in the other two areas. For ex.ample, when a clien1 is able to alte( negative lhinklflg
patter~ positive changes are mote likely with respect to thei( feelings and lheir behaviou(.
(See Figure S. l).
Questions for Problem Solving

Questions can assist clients to think systematically about the sequenti31 steps involved
in finding remedies to their problems. Questions of this type arc more appropriate
when the problem h3s been fully explored. Some key template questions include the
following:
■ \Vhat do 't'OU see as possible strategics for overcoming this problem?
■ \Vhat arc the costs and benefits of this a1ternativd
■ How would )'OU feel if you took this step? How would you feel if you did 00( act?
Figure 5.1 The Three Domains
Asking Questions: Tile Searc ll lor Meaning 133

■ Wh.nt prevents 't'OU from caking action?
■ How can you overcome this barrier?
■ Wh.nt eJsc do you nttd to make it h3ppcn?
■ Wh.nt do you sec 3s 't'our first step toward ch3ngc?
■ How can you m3kc it (your go3J) happen!
■ Wh.nt strengths or resources will help you achieve 't'Our goal?
■ When will you start!
SUCCESS TIP
Avoid the eotrwnon tendency to move too ciuicidy to prOblem sotving. Make sure that the
prot:,em has been fl.Aly expl0ted firSt and that clients have been given an opportun.ty to
expmss and process their feelings.
Questions for Evaluating

Ongoing evaluation of counseJling outcomes and the counsclling rcl3tionship ensures
that the work rem3ins on track. EwJuation enables counsellors and clients to trouble~
shoot relationship problems before they become cam.strophic. Evaluation also informs
contract negotiation and revision. Some examples of questions th3t might initiate evalu-
ation arc as follows:
■ How has our work met your expectations?
■ Looking back on our session, what were the things that you found helpful!
Unhelpful?
■ How woukl you like things to be the same or different next time we meed
■ Wh.nt remains to be done?
■ Wh.nt ch.nnges would 't'OU like to m3kc with respect to the way we communicate?
■ On 3 scale of 1- 10 how w-ould you rate our time together?
■ How would you evaluate our work!
At the end of 3n interview (or 3s a significant topic ends), the question "Wh.nt
have we missed?" often yields surprisingly rich information. This question provides
a last<hnncc oppommity for clients to t31k 3bout unexpressed issues and feelings. In
addition, when clients have been ambivaJent about sharing some det3il~ this question
m3y tip the scales in favour of sh.nring. 1t 3lso empowers clients by giving them control
over content, and a final chance to make sure their nttds are on the table for discussion.
Some variations of this question include the following:
■ Wh.nt eJsc do we nttd to discuss!
■ Wh.nt's left to explore!
■ H3vc we cove.r~ all that is important?
■ Wh.nt questions haven't 1 asked?
In the following example, the counsdlor prompts the diem to examine the session:
CounS(>IJOr. Our time is almost up. and I want to make sure I ha\'i":n '1 O\'fflool:.ed ~mp
thin¥ t~t is import:uu 10 you. \Vh::u have we 1nissed!
Client: ~e.lJ. v.--e h::n'i'n' t e"en be~-un to talk 3bout hoo• m't' di\'Ortt h:uth:u,~-00 my kids.
In m:u,y W'3't'll. the,., ~,,e be,en the re:al victims.
134 Chap1er S
> : •.
Ne-ufoptasticity means that ouf brains are constantty focus on moving forwatd and change. Questions target-
irwOlved in f0tming new ne-ural pathways as well as pruning ing client str'e-ngths activate areas of the br'ain that stimu-
ones that are no looge-r used. Effective intel"Viewing can help late positive emotions, and increase the oouro1tans.mitter
10 form a Mnew brain.· FOr' e-.xample, questions that focus serotonin, which is essential to a sense of well-being (Ivey,
on selling goats create neural pathways that strengthen the ""Y & Quuk, 2009>.
Coun.se.U.or: I :l¥ret with you. It's verr important th::u Yi't, don't overlook them. Does
it m::d.:e sense IO you 10 make th::u discussion pore o( our next meetin,a! I want to make-
sure tilt-re is eoou~, time.
Client: Yes. that makes Sense.
Coun.seltor: Then let'!? make- th::u number one on our list for next time.
Remember th.nt there are some risks to opening: up new nrca..s of discussion at the end
of an imc.rview, panicularly if the topic involves strong emotions for the client. ln the pre-
ceding example, the counscllor suspected that this was a complex topic, so she ~to:I
deferral to the next session. In such circumstances, thecounscllor might have been tempc:cd
to :.lSlc further questions or to empathize. but these responses miaht have prolonged the
interview bc\nnd the time 3wiJable. 1t is important to end the interview without Je3ving
the client in a state of disrrcss.
SUCCESS TIP
Six Key Questions
1. What beings )(lu here IOday?
2. What a(e you( expectations of me?
3. What do I need to kOON abOul your situation?
4. What do )(lu mean by . . . ?
5. What did we accomplish?
6. What did we miss?
QUESTIONING PITFALLS
Asking questions is a skill. Faulty questioning may b ias answers, antagonize clients, or
keep the interview at 3 superficial level Jn addition, insensitive questions that disregard
clients' feelings or culture can leii.ve them feeling judged or abandoned. Poorly timo:I
questions may rush the interview or frighten clients with demands for disclosure before
trust has been established.
Leading (Biased) Questions

A leadina question suggest the "correct" answer b)• conveying a strong due about the leading CJJtStions: Aquev.ic. t11a1
suigests a preferred a11SWH
3nswer the interviewer would prefor to hear. The following ex3mples illustrate this
(e.g.• ~ on't )1)tl think ourses.sia. W!ftl
pitfaU, realt, ~ II today?").
"Don't you beJieve it's time you toolc care of yourseJf inste3d of putting 't'Our
husband first!"
"You lilce school, don't 't'ou?"

"Do )'OU really want to keep working for a man who trc3ts )'OU that way?"
"You're not thinking of killing yourself, arc you!"
C lients who have a h igh need to be liked, those who tend to be compliant, and those
with dependency n eeds arc especially vulnerable to lC3ding q uestions. These clients are
less likeJ,., to be assertive by disagreeing with their counsellors.
How a question is wo rded can also dramatically change the answer. Asking your
spir itual leader, "Is it a.JI right to smoke while praying?" may get a ver y d ifferent answer
from asking, "Is it a.JI right to pray while smoking?" (Sudman & Bradburn, 1983, p. I).
Counscllors may use lc3ding questions to camouOag:c their own ideas. For example,
the counsellor who a.sics, "Do you think you should be doing that?" is probably sa ying,
"I don't think you should be doing that." Leading q uestions tend to corner client~ as in
the following interview excerpt, in which a co u nseJlor talks to a man about his mother:
CounseUor. Gwi":n wh::u )'Ou\'t, been s:1yin~ it's t ime (or action. \Vouldn't )'OU ai.:re,e
th:u allowina your mo ther to ll\'t, alone 3t home is not in 3n)'One's best interest!
CUent: I su ppose you' re r!iht.
CounseUor. 'Would you prefer to put her in 3 sen.OrS' home!
CUent: I ~ll)•don't want t'O put her in a home. TI,::u v.-,oukln't be ri$:ht.
CounselJor: Don't )'Ou think this mi,aht be easier on )Our family th3n taldni.: on the
enormous probtems involved in movh)¥ her in with )'Ou!
CUent: (Hes&atd.) I suppose )'Ou·re n~ht . But . . .
Coun!l(>IJOr. (lntc·rrnpcm,g.) I h::n'e a list o( possible pl::.eeme:nt!l. Do )'OU w;,int to 1nak.e
some calls no"-!
It's C3SY to sec how the counsellor's agenda in the preceding encoume.r d iscounted
the views and needs of the diem. By selectively emphasizing one aJte.rnntive, the coun.-
seJlor allowed the client little fTttdom of choice. Consider how the outcome might have
been d ifferent had the counsellor used the following lead :
Coun!l(>IJOr. Gwi>:11 wh3t you h::1,'t, bee!, s:iyintt. it seems you\~ re::iehed a point wilt-re
it's t inlt' for action. What do )'Ou se,e as )'Our opt ions!
Such a lead would have a.Jlowed the d iem to identify alternatives, such as arrang~
ing for in.-home care for his mother or inviting her to live with him. The counsellor's
favoured aJte.r nntive docs not cont3minate the discussion. Counsello rs need to remind
themselves that the solution belongs to the client and there may be considerable ambiva,.
lcnce rcg3rd ing the alternatives. The counscllo r's role is to support the management of
this amb ivalence by paying 3ttention to feelings, exploring the problem, and weighing
alternatives.
Excessive Questioning
Although questions can be an important part of most inte.rvic:ws., excessive question,.
ing can quickly leave clients feeling inter rogated and bombarded and, as a result, some
clients fail to return for a sa:ond interview. Others become increasingly defensive and
terse with their response~ particularly if they arc unsure of the purpose of the quc:s.-
tions. Excessive questionin g can overwhelm clients., IC3ving them frustrated, confused,
and exhausted. Questions put co u nseJlors in control, and they remind the client who
has power in the rcJationship.
Some clients simp l)• do not respond well to questions. Counsellors may find that
r3the.r than gcning more information, they arc obtaining less. For example, involuntary
clients may c:xpc.ric:nce questions as an invasion of their privacy. As wcll, clients from
some cultures may TC3Ct unfavourably to questions. In such circumstances, reliance on
136 Chap1er S
CONVERSATION 5.1
STUDENT: Sometimes it leets as if an I do is ask Questions. TEACHER: Yes, there are a number of skill alternatives to
I can't help thinkil'lg that if I were the client, I'd be really Questions fOf' gathe-ri~ k'!foanation and makl~ asseS:StnMts.
irritated. I don't want to le.ave clients fooling intefrogated, but In some cases, pte-rnterview questionnaires can be used to
ciuestioos seem to be 100 only way to get 100 information I gathe-r importanl information. Switching to a nonverbal mode
need. Oo you agJee? btf using tools such as fliJ) charts, J)ictures, J)lay (with d'lil-
dren), Of music can also be effectNe ways to eon~t 'Mth
TEACHER: You're rigt\t to be coocemed. There is a real dange-r
dients. Technk:lues such as ShOwing empathy, summariZing,
that dients will beeome defensive if they feet cross-examined.
usi~ S1:lence. and self~i:sclOS~g may be more effective ways
By paying attention to the needs, feelings. and responses of
of getting details, fac1s, and examptes.
individual dients, you wil be able to see if you are alienat-
Empathy, fof e.xample, is a powerful counseni.ng tool
ing 100m. Sometimes counselling works best if you avoid 0t
that tells clients. that we undefs.tancl Of afe trying to aJ)J)re-
minim.ize questions. for ex.ample, clients who have not yet
ciate lheif feetrngs and perspectives. Empathic tesponses
developed trust in lheir counselJors may r&Sl)OOCI better in
and s.ummafaes create an essential base of tfust btf ShOwing
interviews vd\en questions are minimi:zed.
that counsellors are nonjudgmental and caJ)able of listen-
Another drawback to aSki~ too many questions is that
ing and understanding. In f&Sponse, clients often beeome
too much respons,ibdity foe the d,recti::,n and content of the
mofe courageous and motivated to Shafe and explore.
interview can be left on your ShOuklers. This can be disem-
AJ)J)rOJ)ri.ate use of silence creates SJ)ace fof clients to
powering to, clients and can lead the-m to beCOtne overly
speak. QuestioM are important fof effective interviewing,
dependent.
but you should try to add vaftely to your interviews by using
STUDE:NT: But are there ways to ex.plOfe and get information a range of siuns.
without asking questions?
questions will frustrate the gools of the interview. Counsellors should be 3le.rt to signs
th3t the.ir clients 3re reacting poorly to questions. For example, their clients' 3nswe.rs m3y
become briefer, a dear sign of the.ir intention to be less cooperative. Clients 3fso may com,
muniane their displC3surc nonve.rbally by shifting uncomfortably, grimacing, or 3\-erring
eye contact. Some clients m3y refuse to 3nswe.r by becoming silent, but others ma,., be
more outspoken with the.ir disapproval, saying, for instance, "I don't Stt the point of all
these questions." Jf counsellors continue with questions when it is cJe3.r th3t their clients
3rc rejecting this approndi., se.rious d3mage to the counselling relationship m3y result.
Con5tt1ucndy, it is important that counsellors 3re able to modify their approaches
to reduce or eliminate questions. Sometime~ for example, an empathic response c3n
3chieve the s3me purpose 3S a question:
Client: I just don't know what I'm ~-oinK to do. Slnce she le(t, l'\'e (eh lost 21nd unsure
of what I should do with my l1(e.
Coun.se.U.or (Choke I): \Vh:lt ::are some possib11itiesr
CounS(>JIOr (Choke 2): Sounds 21s 1( )'Ou (eel 31131onc ::and u1ltert21in o( what l'O do next.
Choice I seeks more inform3tion from the client about wh3t a.1te.rnatives he sees for
him.self. This question moves the int~rview away from feelings to problem solving 3nd
decision making. In Choice 2, the counscllor 3Clcnowledges the client's feelings as well
3S his indecision, and the response is much more likcJy to be perceived 3S supportive
3nd sensitive.
Sometimes counsellors have to ask man,., questions. such as in dete.rmining eligibil-
ity for se.rvice or completing an intake (first) interview. One way to lessen the imp3Ct of
excessive questions is to have periodic P3USCS to check how their clients 3re doing. For
example, they might S3\', "I'm asking a lot of questions. How arc )'OU doing? I know it
c3n be a bit overwhelming." Respectful comments such as these empower and involve
clients in the process.

It is important for counscllors to remcmbe.r to balance questions with responses
that confirm u nderstanding (summa.ries) and empathic responses that affirm sensitiv-
ity to feelings. \\:lhen q u estions arc dearly linked to the ngreo:1-upon purpose of the
inte.rvicw (contract), clients are much more likdy to bc-coo~rativc, but if the questions
nppenr meaningless or intrusive to the diem, resistance is likely. Asking questions is
an appropriate way to g,et informa tion. Howeve.r, skilled cou nscllors have the ab ility to
switch ton non-questioning mode when the situation warrants. The foUO\\,ing example
shows some of the different options for exploring a client's an,;cr:
Open Quesdon: \V~t happens when )'Ou ~et 21nar)'!
Cl~ Q uESt.ion: When )'Ou 21re af)¥r)', do you become violent!
lndittet Q uestion: r,n curious about how you handle )'Our 2111~-er.
Self-dl$Clo11:ure: \Vhen l'rn a.ni r)', I :UW3yS wonder " -hat to do with it.
Empathy: Sounds as thou$:h. in 21ddit1on to your anier, )'Ou also~,~ a lot o( poin.
Silence: (Appropri21te si!e,~ 21vokls arousinK the d1ent's de(en«s. It Kives the client
time to e>:preS.$ his or her feeli.n~il.)
Contract: Perhaps we ea.n pause for a moment and dttide whether this is a iood tune
to explore )'Our feel1n,a:-i of af)¥er.
Directh~ : Tell rne rnore.
Sentence completion: Use 2111 ineomplete se:nte:nee (se:ntenee stern) that pauses with 2111
expec12tion that the client will f'l.niilh the Sentence. Usl.dlly the client will f'lll the pause
with his or her thou£;hts or (eelin~s.
Herc are some examples:
■ It seems rhar urhen you become angry, you tend LO •••
■ And you are feeling .
■ The mosi imporranr rhing f« you is ro .
■ If :,ott u-ere LO rell him tt-'har :,ott think, ,ou u,'Otdd .
T h is tool enables counscJlors to control the process by p rO\tiding clients with stimu-
lating prompts while ensuring th:.n the content comes from clients.
Summ21ry: The theme i.n " -hat )'Ou a.re s:ayi1l{t seems l'O be a iltro1l{t (eelin¥ o( 21~r.
P21r.1.phr21se: l.n otherwon:ls. )'Ou're a pe-rson who wi.11deal with )'Our21~r in sorne " 'ay.
A ll of the preceding examples are potential counscllor responses, a nd C3ch has the
potential to achieve the process gonJ o f angc.r exploration. They illustrate the range of
choices that arc always available to skilled, versatile counsellors.
SUCCESS TIP
Consider switching to a no~questioning mode (1) to reduce lhe tone of inte(rogation
and avoid the power s t ~ trap, (2) when client responses are guarded and defensive,
(3) wtlen clients are not responchng to questions, (4) for el.Atural adaptation, and (5) to add
variety to your interviews.
Multiple Questions
Multiple questions nrc two or more questions asked at the same time. ff the questions
arc complementary, they are not problematic. A second q uestion ma)' be asked simul.-
tnnoously that embellishes o r clarifies the first:
Counsellor (Ex21mple I): How did you feel about it! How did )'Ou (eel when he rejected
you!
138 Chap1er S
ln Example I, the second question does not detract from or contradict the first.
Of course, the second question a1one would have sufficed. In contrast, the follo"'ing
example illustrates how multiple questions can be confusing:
Coun.~ellor (Ex::ample 2): How did )'Ou (e,el about it! Did )·OU see any other war of
h::mdlina the !lit"u::ation!
\Vith E.x3mple 2, both questions 3re potenti3lly useful, but n()( when they 3re 3sked
3t the same time. The client has to decide "'hich question to answer. Each "'ill take the
interview in a different dir«tion: the first focuses on feelings while the second moves
the discussion to the behavioural domain. At their worst, multiple questions can inun-
date 3nd assault clients with complex and conflicting: demands. Imagine if you were the
client in the following interview:
Coun.se.U.or: So. is there :l..11)1hifl¥ )'Ou ca.i, do! Do )·Ou think )'Ou mi,.i,t h:a"e mid hei-
how )'Ou (elt! Or 11\3)' be )'Ou see it di(ferentl)'. How lofl¥dO )'Ou think )'Ou ca.i, continue
to h::anion!
The counsellor ma)' be wen-meaning, but responses such 3s these complic3te mat-
ters 3nd m3y add to the client's confusion. As a rule, counseJlors need to curb any
impulse to 3slc more than one question 3t 3 time. When thq• aslc a question, they should
wait for the 3nswer before proceeding: to another question or topic.
Irrelevant and Poorly limed Questions

One way that counseJling inte.rvie"'s are distinguished from everyday conversations is
that interviews have a definite purpose or intem. \Vhcn counsellors know the purpose
of the interview, they are able to frame questions that suppon that purpose. Converse.I)•,
counsellors "'ho are unsure of the purpose 3re more likely to ask random questions.
Counsellors should have a purpose for questioning, and they should be prepared to
share this purpose with their clients. They might offer 3 brief explan3tion, for example,
"lt woukl heJp me to understand your situation better if I asked you some questions.
This "'ill give me an ide3 of ho"' )'OU see things.'' Prc3mbles such as this inform the client
of thecounseJlor's motives and procedures. When clients know what is happening, they
are less like1)• to be defensive and more lilccly to support the process.
Sometimes counsellors 3sk excellent questions but ask them at the wrong time,
which IC3ds to inappropriate topic changes. A common error of this type occurs "'hen
counsellors ask content questions after clients have expressed the.ir feelings:
Client: I wa!l luriou!l with her. I ne\'er im::aained that 11\)' best friend Yi'OuJd be havina an
:affair witl, my husband. 'We' ,..e been married for 10 )'elrS.. and I thou~t I could trust
him. I (eel like a complete loot
Counsellor: How d,d you llnd out the)' were se,ein& e:ich other!
ln the preceding example, the counsellor's question ma)' be valid, but it is timed
insensitively. Since the client has just risked expressing strong feelings, the counsellor
should consider empathy 3S the preforred response. The next chapter addresses the
critic31 skill of emP3thy.
A second common error occurs when counsellors shift the topic "'ithoutexploring:
beyond a superfici3l level This can happen for seve.ra1 re3sons. First, counsellors may
be unskilled 3t probing 3 topic. Second, they may be overly cautious about probing,
perhaps fearing that they will be invading their clients' privacy. Third, they may be fix-
3ted on problem solving, 3S in the following example:
Client: We A,.iit all the time.
Coun.se.U.or: How do you think )'Ou n,i~ht cut down on the O~hti.n~

In this ex3mplc, the counsellor jumps to problem solving far too quickly. A better
choice would have been questions to find meaning 3nd empathy to connect with fcel.-
ing.s. For example, the counsellor needs to learn what the client meant by "fight." Do
they yd) and scream? Do they refuse to taJk to each other! Or is the.re physic.al conflict?
Perhaps the best response choice w-ould be a probe ta~ting feeling~ such 3S "How do
't'OU fed about the constam fighting!"
Why Questions
\Vhy questions should be used C3utiousJ,., since they tend to be more thrc-3tening for
clients if they arc perceived 3S 3slcing for justific3tion, or if the tone of the u1Jt,question
communicates judgment, disapproval, or embedded advice. The question "Why don't
you leave him?" may put a dient on the defensive with the implied mcs.saJ;c "You should
leave." \Vh1questions ask people to explain 3nd justify the.ir bch3viour. Frequently, this
requires a degree of insight th3t they simply do not have. In response, clients may make
up answers or feel exposed and stupid for being unable to answer the question.
Even when judgment is not intended, "when someone asks why you did something,
't'OU might fed she or he is judging you for not being 3ble to handle the situ3tion more
effectively" (Hill, 2004, p. 121). \Vhy questions may provoke defensive rc:.lcrions, includ-
ing 3voidance 3nd attack because "m:.ln't' clients 3ssoci3te u1hy with a past experience of
be.ing grilled" (lvey, Jvey, & Zalaquctt, 2010, p. 103). The following excerpt illustrates:
Client: I e2n't rel.:ue to my father :10,.,rnore. He eannot see that I !"K'ed my independence.
CounS(>IJOr. \\'hy don't you just move out :tnd live on )'Our own!
C lient: Impossible. I h:ave h'i'<> n\On' 't'i':::lrS of rolJe~~. and I ean 't af(ord it.
CounS(>IJOr. \\'hy not just tell him i'lic:M• you (eel!
C lient: h'se:uy for 't'Ou t'O say. but you just don't unders:tand.
K3dushin (1997) suggests asking urhar instead of urh, questions. For c:x3mplc, "What
prevents 't'OU from sharing 't'OUr fttlings?" is more helpful th3n "Why don't you slurc your
feelings?" The first question (what) seems to accept that there arc expl3nations and rt':.lsons
for thedicnt's behaviour, whert'3s the second question (why) sccms to dcm3nd justification.
TAILORING THE INTERVIEW TO THE CLIENT

When Clients Do Not Answer Questions
Sometimes clients do not 3nswer questions, or their answers 3re supe.rficial. To decide
how to proceed in such cases, counsellors need to consider some of the reasons why
clients miaht be reluct:.lnt to respond.
Questions Are Not Understood Clients m3y not understand questions because
they have not heard them. For example, clients may be hard of he:.uing or deaf, or coun.-
seJlors may be speaking too softly, or b3ckground noise interferes. As wdl, clients may
not have been listening. In 3ddition, counscJlors may be using ,vord~ phrase~ meta.-
phors, 3nd expressions that 3re not part of the client's repertoire. Effective counsellors
arc able to 3dapt their idiom3tic language and voice volume to meet their clients' needs
and expectations. They 3\-oid technical terms and jargon, p3rticularh• when communi.-
cating with clients from different cultures. Furthermore, counscJlors are role models
for their clients, and one of the interesting :.lnd positive outcomes of counselling is
that clients may lc-3rn how to listen. \Vhen counsellors demonstrate effective listening
and responding skills. clients tend to imitate them. Alte.rnativdy, counsellors can tC3ch
clients to use listening tools. For example, to encourage clients to summari:e, leads such
140 Chap1er S
as this can be used: "Please tc11 me in your own words what your understanding of our
agreement is. 1 want to make sure we both have the same unde.rstanding."
The Purpose of Questioning Is Unclear Clients have a riaht to lcnow why ques-
tions arc be.ina asked, and they arc more apt to respond when the purpose is clear.
CounseJlors may simply sane the purpose in an explanatory sentence: "The reason I
am asking this question is . .. f' However. if counseJlors do not have a valid reason for
aslcina particular question~ they should not ask them. Questions arc crucial for accom-
plishing the goals of counsellina. but they must be used cautiously, either to obtain
important information or to direct the interview to relevant channels.
The Answers to Questions Are Unknown Some questions are difficult for clients
to answer. For example, the questions may call for insight and explanations that arc
beyond the clients' current lcvcJ of undcrstandina. Sometimes clients are unable to
articulate the.ir ideas and inner feelings. Learnina disabilities arc also a factor for some
clients. \\:'hen clients don't have answer~ "why" questions arc particularly frustratina.
Client Privacy Is an Issue Jf clients arc concerned about the.ir privacy. they may say
(verbally or nonvc.rbally), "That's not an issue 1 care to explore." They may change the
topic abruptly. or they may respond with silence. Some clients resist questions because
of prior expc.ricnccs of beina embarrassed, interrog:itcd, or put on the Spo(. Moreover,
the.ir cultural norms may disc:ourai;c questions of an't' type, or they may restrict the
areas in which questioning is appropriate. In some situations, clients withhold answers
because they fear that their answers will not be understood or that they will be judg~.
At other time~ they arc simpl)• 00( ready or able to address the issues the questions raise.
Unresolved Relationship Issues It will be difficult to proceed with counscllina
if there is outstanding tension or conflict in the relationship. Good question~ insight-
ful emP3thy, accurate summaric~ even warmth and ca.ring may be rejected because
they are filtered through the relationship discord. In such situations, it may be a bener
choice to shift the discussion to address the conflict.
Response Choices When Clients Don't Respond to Questions First, counsel-
lors should honour the rights of clients to control areas of discussion and levcJs of inti•
macy durina any phase of the rcJationship. Using the contractina proccs~ counseJlors
can respect clients' wishes not to explore the particular area and shift the discussion to
less threatening content. Neve.rchcJcs~ some anxiety is normal and po(entially produc-
tive when difficult topics arc being addressed, so counsellors should not automatically
shift the topic when anxiety arises.
Second, counsellors can evaluate whether they have given their clients enough time
to answer. Some clients arc slower to respond, and counsellors ma)' misinterpret the.ir
silence as reluctance to speak.
Third, counseJlors might tactfully ask clients what is preventing them from answcr-
ina. Sometimes trust issues impede candor. Candid discussion of barriers usuaJly
increases trust, if counsellors are nondefcnsivc. Moreover, by remaining nondcfensive,
counsellors demonstrate their capacity to be open and nonjudgmental. They show their
ability to handle tough issues without retaliating. As well, when questions target sensi-
tive or private information, counseJlors can express empath)• regarding how hard it
miaht be to share such personal material.
Fourth, counseJlors can simply stop askingqucstions. Jf they continue to ask ques-
tions even though clients refuse or dismiss them, unfortunate con5tt1uences will likely
result. Moreover, under pc.rsistcnt questioning clients may become increasing!)• frus-
trated, angry, and resistant, or they may feel inadequate because they have been unable
to meet their counsellors' expectations.
Table 5.2 summa.ri:es conditions for using questions appropriately.
Asking Questions: Tile Searcll lor Meaning 14 1

TABLE 5.2 Guideli nes for Questioning
00R't: Do:
Bombard clients with questions. Satance and add variety to lhe interview with
a range of Othe< Skills.
As.k more than one q uestion at a time. Pause aftef ead'I question to gtve clients
time to answet.
use leading questions to control clients and Re~mbef' that summary and empathy
theit answe<s. responses are important to confirm
understanding,
use whyquestions, as they usuatty imply Ask questions ooe at a time.
blame or c,oovey j udgment.
As.k questions unleSS you have a feasoo to Respect eultutal no(ms and individual
need. 0t a right to have. lhe answet. style'S that may make certain Questions
k\approp(aate.
As.k a ~ se-ries of closed questions. Ask questions for a specific pur(X)Se.
Ask dOsecl q uestbns when you need to Ask open questions to gtve clients maximum
confirm spedfi::: facts 0t ideas. COOt(C,.
Managing the Rambl ing Interview

A challen,;e th3t all counsellors face is how to focu s and control ove.rly verbose clients,
who ramble from topic to topic with u nnecessary or ovenvhdming detail. Significant ly,
the thinking patterns th3t lead clients to verbose w3nde.ring in the interview may be the
s3me P3tte.r ns that prevent them from h3ndling their problem siru3tions nppropriatdy.
Consequ ently, it is importnnt that counsellors take some responsibility for m3nnging
the interview p rocess. In this w3y, clients lenrn 3bout sequencing and managing problem
exploration 3nd resolution. He.re are some strntegy choices:
■ Since open questions tend to elicit detailed responses, counsellors can use more
closed questions.
■ Identify the p roblem. For ex3mple, the co unseJlor might make a comment such as,
" You're giving me a lot of inform3tion , and ( ,.,,.,mt to m3ke sure I don't miss an\•~
thing. So, can J h3\-e your permission to focus on one point at a time?"
■ Aslc q u estions that chtdlenge clients to be b rief and focused, such 3S. "ff J asked )'OU
to summar i.!e your siruation inn sente.nce o r two, wh3t would )'OU S3y?"
■ Monitor the use of nonverbal cues that might enco urage wandering, such as an
3ttentive posrure, head nods, 3nd paralinguistic cues (e.g., "Go on," "Yes").
■ Be candid with the client by using a sc:ntement such 3S "Jt seems to me that whenever
we st3.rt to talk about a topic, we end up w3nde.ring off the subject. \\:fh3t do you
think might be hnppeningf'
■ When clients m3ke innppropri3te or premature shifts, immediately refocus on the
topic be.ing 3ddressed. Jt m3y be helpful to let the client know why )'OU 3re doing
this with a comment such as "I'm going to slow )'OU down a bit. I want to m3ke sure
we fully explore the issue of .. . before we move on. If we stay with one is.sue nt n
time, we are less likdy to miss important work."
■ Identify time constraints. Set time limits on the intentiew 3nd remind clients of the
interview time remaining.
Although it may be necess3ry to cut some clients off, it is important th3t this be
done in a way that the client does not feel dewJued o r overpowered. Counsello rs need
142 Chap1er S
to monitor and control their own negative fcclings, such 3S irritation and frustration that
may be e\'oked by their verbose clients. ff this is not done, it will be difficult for them
to communic3te 3 genuinely caring tone and empathic attitude.
SUCCESS TIP
I.n the beginning phase, clients often need an unintefrup(ed opportunity to tell theif stOr'y
and Shafe their feelings. ContfOlling and focusi.ng the intel'\liew too quickly may impede and
negate the cathartic beoofit to( a client that is made possible btf attentive listening.
Interviewing Youth
The period from puberty to young adulthood spans ~12 ye3rs 3nd is ch3racte.ri:ed
by enormous biological, psychologicnl, 3nd S<>cinl development, 3S well as significant
changes in cognitive devdopment and the brain. Even under the best of circumstances,
it is often a trying time with rapidly ftuctu3ting emotions, insecurities, and angst 3S
people confront the challenges of developing an adult identity. These ch3Jlenges 3re
compounded for 't'OUth in the social service system who could bede3ling with 3ddition3J
issues such 3S fnmil't' b reakdown, homelessness, poveny. drug abuse, physical and se>.."Ual
3buse, mental disorders, and conflict with the legal system.
Like nil groups, the.re is no one-size.fits-all script for working with youth. Although
they ma't' be dealing with common problems 3nd challenges, each young person is
unique and the counselling relationship must honour these individual differences. P3y-
ing attention to the counselling relationship m31ces this possible.
The core conditions (uncondition3J positive regard, empathy, and genuineness)
discussed in Chapter 3 of this text are the foundation for this relationship. Youth may
come to counselling with considerable suspicion so counsellors need to be patient,
c3lm, and consistent during wh3t might be a lengthy beginning phase of trust building.
Past rcJntionships where trust has been \'lol3tcd ma,.• leave youth justifiably suspicious
3nd cautious of the motives of others, including wcll.-mcaning counsellors. Counsellor
consistency and predictability provides structure that increases 3 sense of safety for
the youth.
The contracting process C3n be used to explore 3nd understand the youths' neo:ls,
what thq• w3nt from you, 3s well as individual preferences. Open discussion to achieve
cl3rity on the role of the counsellor and the goals of counselling, 3S well ns the limits of
confidemiality, helps to reassure 't'outh th3t there are no hidden agend3s.
Youth may present with behaviours that don't make sense. Intense reactions to
seemingly innocuous triggers, resistance to simple rules, anger, acting-out behaviours,
3nd an in3b ility to make simple decisions in the.ir own best interests m3y signal 3 his-
tory of traum3. Youth who distrust the sincerity or commitment of the.ir counseJlors
))I) BRAIN BYTE

The prefrontal cortex (behind the forehead) is a majof area fesu1t, adolescents are more likely to ac1 imp-.Asivety and to
of the btain responsi~e f0r fegutatrng behaviour, making experiment with drugs and high ri.sk 0r sensation seeking
good judgment chOices, and predicting the outcome of behaviouf <Ashwell, 2012). Compounding the problem is
behaviout It also ptays a paft in fegulating emotions and the fact that dfugs such as aitOhol compcomise the pce--
sexual ufges. It is the last afea of the brain to f-.Aty develop, frontal cortex., fufthef limiti~ its ability to support effective
with full maturation delay&d until earty adullhOOCI. As a decision making.

may test che.ir rcfotionships repetitively by questioning motive~ eng3ging in provocn,.
tive behaviour, and exhibiting outright expressions of hostility tow-ard their workers.
This requires chat workers be exceptionnJly patient and resilient and not cake their
clients' actions personally. A trauma.-informed approach to youth recognizes that these
behaviours and reactions serve a self-protective purpose, and counseJlors need to cake
time to cry to understand these clients in the context of their trauma. This underscores
the importance of giving )'OUth time to "teJI che.ir stories" and the criticaJ importance
of counsellors letting them know chal their stories have been heard. Active listening
skills, in particular empathy, are crucial in this process. On the othe.r hand, excessive
questioning can fed intrusive, and it ma)' unde.rmine the intended collaborative gonJ of
the reJationship. Table 5.3 offers additionaJ tips for interviewing youth.
Indigenous youth may be deaJing with significant issues of marginali!ation,
including a system involving workers who arc typically Caucasian. An anti-racist
approach such as the one described by Hick (2010) demands that workers "change
their own awareness and procedures, and social reJations and systems that operate,
both ove.rtly and covenly, to perpetuate racism" (p. 267). As pan of chis, counseJlors
should activcl't' explore how they can support the use of Indigenous spiritual and
healing practices.
Youth can be an incredibly satisfying population to ,vork with, as there is great
potential for shifts and chani;cs in their lifestyle that could result in major positive
movement. A strcngth~bascd approach shifts the focus from dcfteits, problem~ and
idemifying what is wrong to collaborative relationship where the emphasis is on help-
ing clients take control by utili!ing pc.rsonaJ, community, and family strengths. \Vayne
Hammond (2015), President of Resiliency Initiatives Canada, emphasizes that children
can be resilient and grow, even thrive, when faced with adve.rsity and that our approach
should cmphasi: e hope, solutions, and possibilities. He Sll)'S that "those who embrace a
strength-based perspective hold the bcJief that children, youth, and the.ir families have
strengths, resources, and the ability to recover from adversity (as opposed to emphash.-
ing problem~ vulnerabilities, and deficits)."
TABLE 5.3 Success Tips for Interviewi ng Youth

Don't get drawn into powet str'uggleS.
Maintain self-.awar'eness and a nol'lfudgmental attitude rega,di~ is.sues such as dr'&SS,
hair, and txxly piercings.
Avoid pmssuriog youth to make d'langes they are not ready fOI", as lhis is Wkety to evoke
r'esistance.
Pay close attention to d'langes in baseline (established pattems of behaviour) as lhey may
sigoal increased stress Or' suicide risk.
Seek youth input in goal setting and decision making to rnc,ease the likelihood 1r.at they
will engage in and susiai"I cha~.
Be friendly and wa,m. but ramember you are oot their' perSOoal Mend.
Avoid ltyi"lg to be "with ir b-f adopting 100 language, maMerisms, and dr'ess of lhis group.
It's 001 expected; it may 001 be respected.
Remember that what may seem to be "no big deai- to )'Ou may be a majot c,isis to 100
youth. What is important is how they see and define the problem.
Don't assume heterosexuality.
Support and eoltabOtate with Other prolessionalS whO may be invclved with you( d ient.
Social media is a big part ot most teens· lives. lOOk for op(X)rtunilies to discuss safety
issues (e.g., the dangets ot ·sextiog·). Etlcoutage clients to utilize apptopriate online
r'&SOur'ces to assist them to undersaand is.sues rn 1t1eir lives.
144 Chap1er S
Interviewing and Counselling Seniors
Canadn's 6 million seniors are a very diverse population. lntc.rvicwing and counselling
with this group requires consideration of a large number of variables. In addition to the
usuaJ cultural and personality difforcnccs that define any group. counsellors will w-nnt
to consider factors that are significant for seniors, including ph)•sicaJ health, cognitive
ability, economic status, famih•, and community supports.
?l.•fason and Paul 3n' lifeJonK friends in their early se,'i":lnies.. ?l.•fason is physically ::.etl\'t,
2nd enjo)'!I spend!~ time with his wife 2nd six $tr3.ndchildren. Paul uses 2 walk«. lwd
in a l<,r1~,term c:ire facilit)·, 2nd is dependent on medk2tion for a vuiet)' o( llt::31th
i$$UCS indudinads:tbetes,. Parkinson' sdi:sease, and depress.On. P2ul in"~ed wiselr and
is AMneidilly independent wtule ?l.•fason continues to \\'Ork pc:ut,tin~ in orde-r t'O ,~t
his basic needs.
Ch:.dlenges and problems fucOO b)• seniors can be discmpowcring. As with any grout;
the gooJ of counseJling is to assist them to restore or sustain elements essential to an
empowered life including independence, freedom of choice, and an opportunity to pur-
sue ,;oaJs and dreams.
All of the principle~ values, and counsclling strategies discussed in this book arc
still appropriate when working with seniors. As always., flexibility in the choice of skills
is cs.sentiaJ in order to accommodate individuaJ difference.
Counsellors who work with seniors need to be exceptionally empathic. They need
to invest considerable effort to understand life issues that they have not 't'et faced. For
example, the neo:I for a senior to move to assisted living ma)', in the face of diminishOO
capacity and failing health, seem seJf-evident and necessary, yet it is met with consider-
able resistance. This resistance must be understood from the perspective of the client's
emotions which have been aroused by the implications of the multiple losses associate
with the prospect of mO\'lng. Empathy and patience provide an opportunity for the
client to express and process these emotions. Table 5.4 provides further success tips for
interviewing and counseJling seniors.
Senior Abuse
When interviewing seniors, counseJlors should be alert to the possibility of abuse.
Senior (dder) abuse includes a wide range of problematic issues induding: physical
assault, sexual abuse, over/under medication, neglect, denial of personal rights such
as the right to practice one's religion, threats., emotionaJ abuse, and harassment. It may
come from stran,;crs who target seniors, caregiver~ or in any setting providing service,
but it is most likdy to come from someone known to the senior, usuaJly a family mem-
ber. Neglect in care facilities may occur as a result of inadequate staffing or training. ln
recent years, onlinc predators have targeted seniors and have successfully duped many
of them out of their life SU\tings.
Counsellors need to be fully familiar with the.ir legaJ and professional responsibili-
ties with respect to elder abuse. Sometimes the abuse is a criminal offence (e.g., assault,
theft, and uttering threats) and protection and invcstig3tion arc subjcct to the jurisdiction
of the criminal code. The Canadian CMrrer of Righu and Freedoms offers protection
ag3inst discrimination. There is no spccifte legisJation in Canada that deaJs \\'lth the rights
of seniors but each province has enacted its own laws regarding issues such as guard~
ianship (sec Canadian Centre for Elder Law, 2017) for details on provinciaJ legislation.
Counsellors should look for dues that suggest abuse such as:
■ Signs of neglect: shaggy appearance, malnourishment, lack of personal hygiene,
and be.ing left unbath~
■ Injury: unexplained or untreated W'Ouods, blade eye~ or bruises

TABLE 5.4 Success Tips for Interviewing and Counselli ng Seniors
• Adapt fot hearing problems. Minimize noise, and if you need to talk IOudet, take ex.tta precautions to insure confidentiality.
• MOdify the k'lte-rview as necessary to accotM1odate vision and m::>bility ptoblems.. for' e.xample, ptovicle any written material in
a larger font. Ens.ufe that off.ce fumitufe is n01 a ba«iet or an obsiacle to the client.
• Be careful with physical contact FOr' example, a firm hands.hake may injure someone with fragile bOOes.
• If your client has cognitive impairment, keep ii simple, speak slO/dy, summarize, use repetition, and simple and focused
questioos.
• Altow time f0t the client to reflect and ptocess. Pictures can be used as memo,y cues.
• Focus on empowennent. Adopt counsem~ strategies that gtve clients conuOI and cOllabOr'ative in\(ll\letnent in decision
maki~.
• Adopt a strengttrs-based approad'l lhat assumes capacity, not incapacity. A client may have vision impairment, but this does
not mean that he Or' She is unable to make independent decisions.
• Ext,l0te and understand the events and life experiences lhat have shaped lhe values and WOtld view of dients.
• Adapt counsem~ strategies to tne cultural n0tms, values, and beliefs of 100 client
Facilitate life revie~ that help seniors make sense of their lives.
Be open to discussioos tr.at invcive spirituality.
Use Mr.: Miss.; or ·Mrs.: unle'Ss you are k'lvited to use first names.
8 8
Be sensitive to gender-r'elatect issues..

Eliminate age inapprop(aate jargon or unfamiliar acronyms.
• When \\()rking 'Mth fanilies. talk directly to the Older person, 001 tlvough other faintly membe-rs. Similarly, wtlen using a
translatOr', maintain eye contact with 100 client and speak to lhem, 001 about lhem.
• Remember, some seniors may be meeting social/emotional needs llvough their retationShip with a counsetot. This factOr' may
add tnOr'e ti.me to the interwew. However, oldet dients may have le'Ss energy, so avoid lengthy sessions that cause fatigue.
Use empathy to convey unclerStanding, but be careflA that empathy does 001 invade the clients' need fOr' privacy as they may
not be comfortable 'Mth excessive intm3cy with a stranget.
Be sensitive to clues (e.g., bruising or unexplained injury, changes in baseline behaviolX in mood Or' social involvement. lack
of hygj,ene) that 100 client may be a 'Jictim of negtecl, Or' physical, emotional, sexual, and financial abuse.
Be alert to 100 facl that depression, soci'.al a~ty. and multiple IOSSes may trigger thoughts of suicide. Ooo'I be afraid to ask
the •intent question· (see Chaptet 9).
Listen. There i:S much to learn frOO'l the acquired wisdOO'l of seniors.
See Chapter 11 f0t strategies for WOrki~ with seniors who have dementia.
■ Behavioural changes: withdrawal, depressio n, defensiveness. and pcrsonaJity changes

■ FinanciaJ changes: altering a will o r power of attorney, large cash withd rawal~ and
exploitation by unscrupulous business
■ Unsafe living conditions
Seniors, even when asked, may be very reluctant or unable to disc.lose that they are
vie.rims o f abuse. This ma'>' occur because of shame, o r fear of the consequences, o r a
desire to protect family members from legal con.sequences. ln the following example, a
social worker notices that her client, age 8 I , has a blade eye.
Socbl \Vorker. I ean ~ th::u yo ur eye is sv.'OIJen.
Client: It' s no thin&-
Socbl Worker. Ho w d,d it happen!
Client: I must h:3,ee bumped into a door o r sornethi1l{t. I re:311)' don' t reme.mbe-r.
Soci31 \Vorker. \Vas your h usband with )'Ou when it h::lppened!
Client: Like I 53,.,J, it's nothinK co v.'Orr)' about.
Soci31 \Vorker. I'm wo nderina i( )'Ou (eel s:.(e when )'Ou 2re 2lone with him.
Client: The l2sc ft'\\•yeu s h::t\'e no t bee., easr for him . He really is a 1t(JO(I nun. But. since
his stroke. tilt-re are times when . . . . (Long prawe.)
Soci31 \Vorker: You care for your h usband, and it sounds like )'Ou do n't w:mt l'O cause
hitn an'>' trouble.
146 Chap1er S
Client: I don't know wh:u I'd do without him.
Soda] \Vorker: Sure, but it's also important that )Our nt<tds are rnet. You need to be
2ble to (eel sa(e in ourov,m home. Marbe, "~•re 211 a point where both o( )Ou could use
some extr:i support.
(n the example, the social worker proceeds with considerable p3tience and tact while
gently maintaining the trust that will set the stage for a referral to appropriate follow-up
and support se.rviccs. Each province and city will have its own resources chat can be
accessed by seniors for support and protection including police, social se.rvice a,;cncies,
hea.Jth authorities, shelters, community care facilities, and other ori:anizations chat offer
spccia.1i!cd se.rviccs for seniors.
Cross-Cultural Interviewing
CounscJlors nttd to be careful chat their counseJling and questioning methods arc 00(
cukura.11)• biased. For example, cukura.J groups diffe.r profoundly in the way they react
to questions. When attempting to relate effective!)• to members of other culture~ coun,-
se.llors need to avoid stereotyping and ovcri;:cnerali!ing. 'W ithin a culture, an individual
may subscribe to all, some, or none of the cultural norms. Following are some points
to consider:
■ Clients with histories of oppression may tend to be overly compliant during the
interview. Consequemly, closed questions such as "Do )'OU understand!" may
be answe.red "yes," when in fact the client docs not understand. Open questions
arc preferable.
■ Use sea.ff or interpreters who spc3lc the immigrant client's language. \Vhen using an
inte.rprcccr, look at the client when the inte.rprcccr is translating.
■ \Vhcn langua,;c skills are limited, pay careful anemion co nonverbal cues.
■ Some cultures may react neg3tivcly to question~ or they miW't find some questions
on parciculnr topics intrusive.
■ Speak slowly, repeat or summari!e often, and allow frttauem pauses. Sometimes
\•isua.J or written cues will assist communication. Use simple langua,;c and minimi!e
jargon and idioms. Spc3king louder will not hcJp.
BEYOND THE SURFACE: INTERVIEWING FOR

CONCRETENESS
The Need for Concreteness
Concreteness is a te.rm used to me3sure the clarity and spccifteity of communication. concreteness: Atermused to
le is "a way to ensure chat general and common experiences and feelings such as depres- musuf! the clarity ud spetifdy
d communflli>n.
sion, anxiety, an,;cr, and so on arc defined idiosyncratically for each diem" (Cormier
& Cormier, 1985, p. 48). \Vhen communic3tion is concrete, aJI participants share an
Ivey, Ivey, 2.alaqueu. and Quirk (2009) teported lhat neu- and memory. This unde-rscofes the im(X)rtance of counse~
toscientists have found that 100 stmss of poverly, oppres- IOr's sup(X)rting social action initiatives to combat oppression.
sion, sexism, and racism can create unhealthy and damaging Counselling can atso assist clients to explOr'e ways that they
lew!IS ot COr'lisd in the brain, which negal.M!ly impac1 netXal can mitigate 100 tc»6c darnarge from mafginalization. including
developtnent in areas of the brain associ".ated with language ways to de.al with oppressive systams.

understanding of words, phrase~ idC3s, feelings. and behaviours. 'W ith sclecto:I probing
skills. counsdlors assist clients to provide necessary definition and detail. Counsellors
also need to model concreteness b)• ensuring that their ex-pres~ ideas and feelings are
dear and specific. (n addition, they need to remain aJert to signs (verbal and nonverbaJ)
that their clients may be assigning different meanings from tho.sc intended. When client
communication lacks concretenes~ counsellors can use interviewing skills to raise it to
the desired level Figure 5.2 outlines various strategies counsellors can use to achieve
concreteness..
Probing for concreteness is necessary for the following reasons:
■ People see and experience et-enu differemt,. \\:'hen someone describes a problem or
shares a feeling, there is a natural tendency to make assumptions based on our own
prior learning and experience. \Vhcn a client asks a counsellor if he knows how
she feels, the counsellor may automatically answer "yes" without funhcr inquiry or
clarification. Even though personal experience can hdp them appreciate the prob-
lems and feelings of client~ counsellors risk communication breakdowns if they
neglect to explore their assumptions for accuracy. Active listening enables them to
understand the experiences of others with less risk of contamination.
■ The meaning of urords and ideas is •~Y much influenced 17:, factors such as culture or
history. Although people may have links and similarities in their experiences and
common human need~ everyone is unique. All people have different frames of
rdercnce based on their learning and experience. Consider the images that a word
such as anger miWlt evoke for various people. One person might vividly rccaJI an
abusive childhood, in which anger always led to someone getting hun. Another
might visuali:e screaming and hurtful words, while someone dse thinks of with-
drawing and saying nothing. To a 12.-year-old, 30 might seem like old age, but to a
man in his late 80~ 70 is young, Similarly, a joke may be pe.rccivcd as humorous by
some p«>ple but provocative, insulting. or sexist by others.
•
Clitnt
Statement/
Respanse
c-
Quesljc)ns
•
- Explore
......
Figure 52 Strategies for Achieving Concreteness
148 Chap1er S
■ Jargon and idiom ma,
cc,nfu.se dienu. Questions must be dC3.r and understandable
to the diem. Like many other profcssionaJs, counsellors 3nd their work settings
h3ve their jargon, consisting of abbrcvi3tions, distinctive ,vord~ and phrases th3t
arc commonly understood by the people who work in the ficld. This jargon allows
for a quick shorthand flow of communication and helps to define activities and
routines precisely. Unfortunately, jargon is often used inappropri3tc1y with clients
who do not undc.rstand it, 3S in the following example:
Coun.seltor: I'm assuminK th::u this ii the flrst time th::u you\'t, K(Jne throuah the intake
process. A(ter we eomple1e your app, I ean refer you to an appropri::ue oonununily
resource.
A new client may h3vc no ide3 wh3t is mC3nt by the terms inrake process and co~
muniry re.source or the 3bbrc-.•iation app. Too cmb3.rrasscd to 3sk, such a diem m3y
be left feeling demoralized, stupid, and incaP3blc. Non.assertive clients frequently
respond to jargon by acquiescing or pretending that they undcrst3nd when they
h3ve no idC3 what h3s been S3id.
■ Messages are ofr.en unclear, incomplete, or ambiguous. Important information ma)' be
mis.sing. Sh3.rcd understanding between two people is possible onh• when c3ch
p3rticipant understands a message in the w3y th3t the sender intended.
■ People may lack ,he tocabulary 10 express ,heir ideas preci.sefy. \\:fhen langu3ge abilities
arc limited, it is difficult to communicate idC11.S 3nd feelings.
■ People may be unatmre of ,heir feelings. Questions c3n stimulnte thinking 3nd bring
clients' 3ttcntion to areas and feeJings that they m3y not h3ve considered.
■ Communication may be .superficial. \Vhen counscJlors move too quickly without
exploration of key ideas and feelings, the interview is likely to remain on a surface
level, and it m3y quickly run out of ste3m. He.re's 3n example:
Client: I lee.I stron{tly about ii.
Coun.~ellor: I'm not Surprised. From wh::u )OU h::t,'t, be<en ~yin&. who wouldn't (eel
that W:l.)'?
The counseJlor is supportive but docs not explore further to find out how the
client is feeling. This client hints at feeJings but gives no information about their
precise narurc. Unless the counsellor probes further, assumptions 3nd misunder-
standing arc the likely outcomes.
Probes for concreteness propel the interview from 3 superftei31 level of discus-
sion to 30 intimate lcvcl that requires a deeper investment from eve.ryone involved
in the inte.rview. Chapte.r 2 defined the illusion of work concept as a kind of implicit
p3rmership between counsellors and clients. In this 3.rrangemcnt, counscllors per-
mit clients to avoid the P3in and struggle that 3rc often associated with growth,
while counsellors 3Void the risk that purposeful challenge cnt3ils:
\Ve h3VC all developed thec3pac:it)• to engage in convcrs3tions which arc empty 3nd
which h3vc no mc3ning ... \\:lorkers h3\-e reported helping relationships with cli-
ents that have SP3nncd months, even years, in which the worker 3fways knew, dttp
inside, th3t it was all illusion. (Shulman 2009, p. 154)
■ Content alone does nor full1 communica,e meaning. A counscJlor can casil't' miss impor-
tant information by failing to notice the underlying emotional or personal content
in the words.
Counsellor Reluctance to Probe One distinguishing characteristic of cxcmpl3ry
profcssion31 interviewers 3nd counselJors is their c3pac:it)• to be comfortable with any
topic. Effective interviewers and counscJlors arc learners, 3nd they recognize that the
best te3chcrs 3rc their clients. This means having the courage 3nd assertiveness to ask

diff,cult questions about private matters. If counsellors have personnJ needs to avoid
certain topics o r if they are fearful that the discussion miWlt unleash strong diem
emotion~ they miaht hold bade to meet the.ir own neo:ls to keep the interview pleas.-
ant. At the same time, co unseJlors need to lcnow when to back off and respect their
clients' right to declare some topics off limits. Probing too deeply o r movina too fast
may result in clients revealing a grc3t dC31, but having done so. they may react adversely.
They might foci violated and not return to future session~ or they miWlt put up barriers
to protect against further unwanted inquiries. To be ethical, counsellors must question
wisely, explorina onh• those maners that are rcJevant to the work and fit their compe-
tence and rrnining, Thu~ asking clients for more concreteness requires that counsellors
arc willina to invest time and energy to listen.
Client Reluctance Some thoughts may be private, and lack of relationship rrust
may preclude full disclosure. For example, people fearing judgment or ridicule may tcll
others what they thinle thq• want to hear, or what they believe will result in accept:mce.
lndividunJs may also distort or exngi;erate messai;es because of experiences. Emb3rrass..-
mem, fear, uncertainty, taboos about taking help, and simple mistrust of the interview
process, including suspicion about the motives of the interviewer, present natural b3r-
riers to shnrina information. For some people, talcina hcJp from someone else suggests
dependency and we3Jcnes.s, which may result in feelings of inadequacy. None of this
means that the interview relationship is dysfunctional. In relationships, everyone must
decide how much, when, and with whom they are willina to reve3J persona] thouahts
and feeJings. Everyone differs in the degree to whidi. they are comfortable with disdos..-
ing intimate thouahts and feelings. Restraint and self-censorship of some ideas and
feelings are normal and necessary. Some people prefer to remain private, sharina linle
o r nothing. Others open up very slowly and only with people whom they deepl)• trust.
C ulrural norms may aJso influence what individuals arc willing to share. Clients often
view co unseJlors and intervie,.nrs as authority figures, and they tend to relate to them
b3scd on their prior experiences and imaaes of people in power. Even though thecoun.-
seJlor may have very little real authority, what is important is the perception o f the
client that the counsellor has power. Probes for concreteness arc invitations to clients
to trust their counsellors by revealing thoughts that they miaht prefer to keep hidden.
Shulman (2009) suggests that the same sodct:.d taboos that inhibit open discussion
o f sensitive topics also affect helpina relationships. Among the taboos that Shulman
identifies is reluctance to tn1k about sex, money, dependency, loss., and authority. To
Shulman's list of common tabooscould be added discussions about spiritual issues and
hC31th, as wcll as others that vary between people and between c ultures.
SUCCESS TIP
Compete-nt intervievdng requires cu(iOSity and a willingness to learn. This beeomes even
more important when counsellors have personal and prolessional experience with the issue
on the table. Unless c o u ~ monitOr' and control their assumptions, they are vurter-at:,e
to assuming they kOOw thei( client's situation without needl"lg to be told.
Strategies for Ach ievi ng Concreteness

Let Clients Know the Purpose Counsellors should probe for understanding only
in those arc3s that support the purpose o f the counselling relationship (contract).
\Vithout a dear contTilCt, the counsdlina interview is more likely to be haphazard
and random. However, in the beginning, it ma)' be necessary to give clients some time
to tell their story. When counsellors have a nttd for information o r if they wish to
150 Chap1er S
explore a particulnr area, they should consider sharing their objective, as in the follow-
ing example:
Counsellor: You h:t,'t, not 13lk00 much about )'Our (eelu~ l 'rn wonderin¥ i( it rni"1u be
uselul lor us to spend a little bit o( time ~orll1¥ thii important 2rea. TI,::rt mi$;11t help us
undersc2nd S<H»e o( the pressure you \'t, ~n under 2nd how l'Ough it is l'O tnO\'t, lorw2rd.
Wh:lt do you thll,k?
\Vhcn clients understand and support the purpose, they arc much more likely to
respond positively to probes for concreteness.
Respect Timing Herc are some brood ,;cneral guidelines:
■ During the beginning phase of n relationship. probe more cautiously until trust is
developed, or you gee a sense of the client's capacity for more in-depth exploration.
■ \Vhcn there arc relationship conflict issue~ consider the wisdom of dealing with
this reality first.
■ Probes for concreteness may stir up ftt.l ings that clients nttd time to process; there-
fore, during the ending phase of an interview probe more selective!)•.
Use Simple Encouragers and Directives The simplest way to probe for more
information is to use short phrases and ,;csturcs thnt cncoura,;c clients to continue
with their stories. Nonverbal gestures, such as head nods, sustained eye contact, and
:mended silence, convey such support and interest.
Directives arc short statements chat provide direction to clients. Using directives directives: Sllot'I stateaents that
is nnothcr way o f gathering informntion. They can also be used to control the pace and °'
promi!' directi>n to tlieals • s .
infor1Ution, and pace (e.g., "Tell me
flow of an interview, and in cognitive behavioural counselling (discussed in Chapter 7), _,.I
they are used to nssign homework to clients. Directives such as "Describe- your feelings,"
"List your main reasons,'' "Give me an example," "Tell me what 't'OU did," "Share your
thoughts," "Tell me more," "Expand on that," "Don't move too q uickly," "Describe
your feelings," and "Put it in your own words" nJI help nc.hicvc concreteness.
S ince overuse of directives may leave clients feeling controlled, they should be used
sparingl)•. A softer tone and open body lnngua,;c can lessen the command nspect of the
directive. Short statements and directives, such ns "Tell me more," "Yes, ,;o on," "\\:fhat
else?" "Please expand on that," and simple encourage.rs such as "Uh-huh, hmm," c.nn
be used to sustain client sharing without interrupting the flow of the interview. A short
example will illustrate-:
Client: I ¥m'SS rm prett't' an{tr)·.
Coun.seltor: Meanil,K!
Client: O ur refationship is on the rot.ks.
Coun.seltor: Tell me more.
Client: M)· brother always puts me dov,m . It's '--ot to the point where I don't want to
be a.round hitn.
Coun.seltor: (Nods: aurnt/t\' sifentrJ
Client: We used to be so dose. \Ve were insepa~ble, but in the fast year. it's bero1ne
so eompetitive.
Questions Questions nrc the primary tool for seeking information. lnteJligcnt ques-
tioning can be used to get example~ define te.rms, o r probe for detail. The following
interview excerpt demonstrates chis process:
CounseUor: I want to nuke s ure I unders12nd. \Vh::u do you me:2n when you ~y
eOfn/~ltlu~!
Client: It's somethh-)¥ ualy. Not just wantll,i to wll, but al,so needina to win. h's as i(
ever,.•thil1¥ rides on winnll1i,

CounseUor. Is th::u true for both o( )Ou!
C lien t: At first, it wu Just him. Kow I'm JUSt :u but.
Coun!l(>IJOr. \\'h::u's:. typie:d ex::ample!
Counsellors can use ~rics of questions to explore vague statements beyond a supe.r~
ficinJ level. The following excerpt illustrates:
Clien t: I know there are m3n)' times wben I let my (ee.li1'{tS ~ the better o( me.
Coun!l(>IJOr. \\'h::at kinds o( (eelin,iS,!
C lien t: Son~unes I let my an~-er build to the point where I'm read)' l'O explode.
Coun!l(>IJOr. "Ready to eicplode"-wh::at does that mean!

C lien t: I would never become ph)•Sie:U and hurt someone. I'm JUSt a(r3id o( ~-ettin¥
re:Ul)' mean ::and s::arh,i hurt(ul thi~
Coun!l(>IJOr. H:u t~t happened!
C lien t: Yes. (Heslt.ata) A lot.
Coun!l(>IJOr. C::an you think o( a ~ ex:imple!
C lien t: ?l.·ty mother. She's alwars tryin¥ to eontrol m)' li(e. Most o( the tune. I just Ir)'
to iifi()re he.reonstant n:ij$in~ but l::atelr it seems th:u e\'e-rr s«ond. d3)' she pho!"K's with
::.dv iee. I don't w::ant it. and I don't !"K'ed it. Ye.sterd::ar I blew up 31 her.
Coun!l(>IJOr. \\'h::at did you do or say?
C lien t: I told her in no uneert:.in tenns to buu out o( my life. She started toer,·. Then
I felt ~-uiJty.
Empathy Although it is n()( usunJI,• thought of as a probing tool, empathy in foct
Cre3tcs a powerful incentive for clients to open up. Although the.re arc exceptions, suc-
cessful empathy builds trust and safety for clients to reveal and explore their feelings.
\Vithout empathy, clients are more likcl,• to kttp their feelings private.
Follow Cl ues Often clients hint at a concern, which provides counsellors with a
natural opportunity to probe for more detail nnd to open the discussion to a gre3ter
levcl of intimacy.
C lien t: (Aoorldmg eye oontact.) h's not e3S)' to open up to 3 stra.n~-er.
Coun!l(>IJOr. It is tou~,. You mi~ht wonder hoo• I ::am it()in& to re::iet or whether I w1II
hold wh::at you S3)' ::t:it'3inst you.
C lien t: It' s just so emba.rl"'3ssina.
Coun!l(>IJOr. One wa,· tOO\~reome tJ131 is to t::t:ke a eh::aniee on me I'm open to a.nythin~
you have to s::ar. I flnd that when I avoid talki~ :.bout 3 tou~, area. it becomes e,.•en
more dirAeult to de:U with later.
C lien t: L2tel,·, l cannot sJe.ep :it nidlt bec::ause I'm wonderi~ i( I midlt be ipy.
SUCCESS TIP
"To helJ) a client. discuss &abOO feelings and concerns, the worke-r has to create a unique
'culture' in lhe helJ)ing interview. In this cultu(e, 1t is acceptable to discuss feelings and
concerns 1ha1 the client may ex.pe-rience as tabOO elsewhere'" (Shulman, 2009, J). 156). To
create lhis culture, IOOk fo( clues that tabOO-r'elated btOCks are present, b(.-ig discussion of
the blOek 10 the open, and 1hen renegolr.ate a new aweement that allows fo( opan d.rscussion
of lhe labOO area (Shulman, 2009).
Making Choices
A theme throughout this book is that effective counseJlors have a broad range o(
alternatives for responding. When they have choices, counsellors are not locked into
152 Chap1er S
repetitive panern~ nnd interviews are more interesting and \tibram for both clients and
counsellors. The follo"'ing example demonstrates some of the many "'ays that a coun-
sellor might respond to a client:
Client: I suppose I should ha\'e ~peeled it. Mr Kirlfriend said she needed time to
think to "re-ev.llu::ue our rel:1tionship, .. 3S she put it. It was tol¢h, but I s.a ...e her some
t ime alone.
Counsellor (Choice I): How d,d )'Ou feel :lbout what W'3S happenin~ (an open question
that focuses the di$CuSS.ion on the dient·s feelinKS]
Coun.seltor (Choice?): What was )'Our plan! la.n open question coneentr:ltina on the
client's behaviour a.nd thol¢htsl
Coun.se.U.or (Choke 3): Tell me wh:lt )·Ou pbnned t'O do. fd1rtttive]
CounselJor (Ch.o k.e 4): Sounds M:.e th.is wu a painful lime for you. [empathic response
dirttted t'O the client's (~li~I
Coun:1;eUor (Choice 5): I'd be interested in knoo•ins. how you h:1ndled it. lindireet
question]
Coun:1;eUor (Choice 6): (Sifen«.) fsdenee used to {th'i' the d1e:nt 3n opportunity to
continue sharil,K]
Counsello r (Choice 7): It was hard. but )'Ou v.--ere able t'O Kh'i' her time to reaS!le$$ )'OUr
relat1onsh.ip. (poraphr3seJ
SUCCESS TIP
Choices fot ptomoring etabOtation (concteteness) ioclude combining each of lhe six.
bas.ic open ciuestion stems (who. what, when, whete, why, and how) wdh ead'I of the thfoo
baSic domains (behaviout, feeling, and thinking). Simple encotXagers: such as ·Teu me
more· and F'0t ex.ample ... • p(omote fwthe( depth and ctarity.
8
INTERVIEW TRANSITIONS
An interview transition occurs when the topic of conve.rsnrion shifts from one subject interview tran$ition: bhifl in the
to anothe.r. Such shifts ma.)' occur spontaneously in the course of the interview, or they topicolthe interviea
may be orchestrated to further the objectives of the interview. The need for a. transition
a.rises in the following situations:
t. Discussion of n pn.rticular issue is finished, and it is time to move on.
2. Discussion triage.rs ideas in another area or links to earlier areas of discussion.
3. The topic is too threatening or painful, and a topic change is needed to reduce
tension.
4. The subject has limited relevance or hns lost its relevance to the goals of the
inte.rview.
5. A change from one phase of the interview to anothe.r is necessary (Shebib, 1997,
p. I 56).
There are five types of transitions: narural, strategic, control, phase, and connect
or linking (Shebib, 1997, p. 156).
Natural Transitions
Natural transitions a.rise as the discussion Bows seamlessly from one topic co another,
with dear links between the two topics. The most common natural transition occurs

when clients mention new themes as part of the interview, and counseJlors use this
information to jump to the new topic.
Client: All I ~lk about my di~tisfaction with 11\)' job. I rdh:e that the s::m~ could also
be sakl about mr marri~e.
CounseUor. Pert\:tpS we could addrtSS th:u new.•. Tell me wb:u·s h::appenb-w in )'Our tn.:trrb~
Clients arc unlikdy to resist natural transitions since the interview moves clC3rly
in the direction they have SUstRCStcd. The topic chanae is not abrupt, and transition
responses indiate that counsellors have heard what their clients have just stated.
Strategic Transit ions

Strategic transitions arise when counsellors make choices among topic :.dternatives.
Imagine that a client makes a statement such as the following:
Client: This h:as been the: worSt year on record for me. Mr f'lnanees were: a d1saster
an)•w:ay. 2nd now that J\,e lost my job I think I'll KO under. Ke,edless 10 ~)', this hasn' t
been i ood for 11\)' marria~ I can se:,e how h:anl it is on mr kkls. ?l.·1y eldest dau~ter
see.ms to avoid 1ne entirely. 2nd I'm sure mr son ii on dru~. h :all becomes too mueh.
How should a counscJlor respond to this revelation? Should he or she select finances
as a priority for follow-up? Or go with one of the other problems: marriaae, rcJation.-
ships with children, drug abuse, or unemployment! Should the counsellor focus on
problems or fccJing.s or both? How a counsellor responds is a strategic decision that
affects the direction of the interview, at least for the moment. As much as possible,
clients should be involved in decisions to make a strategic transition.
Control Transitions
Because counsellors have to orchestrate the flow of the interview, they sometimes use
control transitions to manaJ;e the interview's direction. Redirecting the flow of an inter-
view is warranted when the discussion topic is irrelevant or when it prevents diaJogue
on more important is.sues. Preventing pre.mature subject changes is crucial for ensuring
concreteness or full exploration of content and feelings. Moving too quickly from topic
to topic results in a rambling and superficial interview where many things are discussed,
but few are unde.rstood.
Control transitions are used not to dominate clients, but rather to exercise profes..-
sionaJ duty to ensure that the interview rime is productive. (n practice, counsdlors and
their clients should share control, with counscJlors giving clients as much po\\'e.r as pos-
sible to set the course of counselling based on their needs. For the.ir pan, counsellors
hdp by monitoring the process and pace of the interview to ensure that discussions have
sufficient intimacy and stimulation. Skilled counsellors are sensitive to the following
elements of the interview that arc open to control:
I . Specific topics that are the subject of focus
2. The e>..'tent that the interview focuses on each of the three domains: feelings (indud.-
ing control on lcvcJ of emotionality), behaviour, and thinking
3. Sequences in which topics are discussed, including decisions to move the interview
from one ph3se to another
4 . Use of time, induding depth of discussion as wcll as interview start and end times
5. The following example illustrates a control transition:
Counsellor. I think we m"-'u be mo..,ina 100 quickly here. ~e havm ' t h3tl 21 th:utee to talk a.bout
yo ur (e,eibl{t.t. I wonder 1( )-OU'd ~ree that v.--e should do th:n before v.--e mO\'i' on to a di Ire-rent
topk. It miaht help us both to understand wb)• it's been sod1(t".e-uJt (or )'Ou to tn.:tke:2 decision.
154 Chap1er S
(n this o:3mplc, the counscJlor gives a brief rc3son for slowing down the interview
3nd focusing on feelings. Clients who understand what is happening: are much more
likcl)• to support the process.
But clients thcmscJvcs may suddenly change the subject of the interview for a vari•
cty of rc3sons. For o:amplc, perhaps they were rC'\•caling too much, or the materinJ was
too painful or persona] to discuss. Because of issues of client rrust and rcadines~ coon•
sellors need to use control transitions wiscJy and be mindful of the underlying feelings
that client-initiated shifts signal One way for counsellors to deal with a topic shift is to
openly acknowledge the shift, then gently explore its meaning.
Coun.se.U.or: Arn I n~n in think in¥ th:u you seemed un«unfort2ble talkina about ,.·our
relationship with your father!
Client: It'll not somethin~ I want to s.e1 into ri¥ht now.
Coun.se.Uor: Th:u's okay. I w1II not force )'Ou. On the othe-r h:md. )'Ou mi,aht deeide later
that )OU ~ue ready.
Counsellors can use summaries as a way to introduce control transitions. As the
following example illustrate~ summari!ing makes the topic switch seem less abrupt.
This is important because abrupt transitions ma,., appear harsh to clients and accentuate
their feelings of being cros.s-ex:.lmined.
Coun.~ellor. So. as I understand it, dru¥ abuse h:u h:ld a SiiJ1i0can1 imp::.et on )'Our
work. Your boss h:ls re:.1ehed a point where he w1II support )'Ou. but only i( )'Ou e:nte-r
rehab. Let' s sluft our forus for a minute and talk 2bou1 problems with )'Our family.
Phase Transitions
CounscJlors also use topic changes to help move the counscJling process into the next
phase. For example, in the beginning phase relationship building and problem explora•
tion arc paramount. However, at some point, it becomes dear that sufficient time has
been spent on problem exploration, and it is time to move on to the chaJlenges of the
action phase, where the activity shifts to problem solving: and scssionaJ contTact work on
feeling:~ thinking, or behaviour. Thus, phase transitions are needed to bridge the work
of one phase to another, as illustnncd by the following: o:amplc:
Counsellor: I wonder if v.--e have reached a point where it makes sense to ~ n talldna
2bou1 the ehan~ you W'3nt to make. ~e could b¢in to discus!? some o( )'Our ¥°"Ill and
then think about how to ::.chie..-e the-m.
(n the following o:ample, the counsellor uses a phase transition to end the int~rvicw
and to establish a linlc to the next session:
Counsellor: I'm impressed with )'Our ins¢1sabout how )'Ou tend l'O put )'Ourself down.
It ~m!l to me th::u the next lo$:.ieaJ step 1ni,ah1 be to explore hoo• 10 combat this ten-
dency. I( )'Ou 2~~. we can start "'1th th::u nb:t t ime.
Pacing Generally. inte.rviewcrs should proc~ at a pace that their clients can manage.
This docs not mean that clients must aJways be 100 percent comfortable with the intensity
of the interview. lndccd, the work of interviewing and counselling can be demanding, and
exploring difficult topks can be exhausting. He.re are some genemJ guidelines for pacing:
■ Move more slowl)• in new relationships and first encounters.
■ Expect diffc.renccs among clients.
■ Don't expect to maintain the same intensity or an ever-increasing intensity through-
out the interview. Periodic "rest" periods with nonthreatening or less demanding
topics c3n energize clients.
■ End interviews with less demanding: questions and responses.

CONVERSATION 5.2
ST\JOENT: What are your looughts on takl~ nOles duri~ an TEACHER: AU clients have a right to that information. They
interview? may n01 ask but, as a rule-, you Should tell them. You rarSed
a gOOCI point earlier abOut how nOle--takiog can dettaet from
TUCH£R: You fl'SI.
rapport in 100 inteiview. I agree. I think it's partkular1y impor-
ST\JDE:NT: 1have mix.eel footings. On the one hand, I don't tant to put 100 pen oown when clients are 1aUd~ abOut leel-
want to forget anythi~. On the other hand, it seems so COid iogs 0t Olher private matters. On the other hand, most clients
and dinical to be writing wtlen die-nts are talking, It seems to ex.pec:t that you'll write oown informatbn such as phone num-
lake .r14y from the intimacy ot the relationship. bers and add fesses.
TEACHER: Suppose you were IM client. and I were takltlg STUDENT: I'd preiet not to take notes at au during the inter-
nOles. view and just Wl'ite up a summary aftef the client leaves.
ST\JOENT: I'd wonder about what you wete W(itiogabOut me. TEACHER: That v.()uld be ideal. Of courstt that's 001 atways
I'd be really scared that someone else might see the notes. possible. There may be fofms ot computetlzed question-
I'd probably be really careflJ abOut what I said. naires to complete that can'I be delayed until afte-r the inter-
view. Or you may have other clients warli~. so there may be
TUCH£R: What if I tOld you that you could see the nOles?
no time after the interview.
ST\J0ENT: That would help. Then I'd be able to COtr'ed any
mistakes. 1-'d re-ally want to know wM would have access to
100 file.
Mortt>ver, counseJlors need to m3na,;e interview transitions between one topic and
another. As well, they should avoid r igid agendas such as might be followed in a formal
meeting and instC3d allow some freedom of movement bcrnf'C(.'n topics. Counsellors also
need to be careful not to sprint from one topic to 3nother without adequate exploration
o r completion.
Connect {Linki ng) Transitions

Connect or linking transitions arc used to join or blend ideas from recurrent themes.
For e.x3mplc, a client m3y m31cc continuaJ subtle rcfc.renccs to 3 need to have everything
just right. The counsellor might use a connect transition to bring this theme to the
foreground:
Counsellor: ln~ll )'Ourex::unples, )'Ou t:llk about how you make- Sure' th::u you pay 3UC'n•
1.0n t'O C'\eery little deuul. Then )'Ou sec-m t'O ber:ue your:W'I( i( e,eer)•thin¥ isn't pc-rfttt.
))l} INTERVIEW 5. 1
The followiog excerpt illustrates selected interview skills. This is the first int~iew with the client, a single mother on
welfare. The counsellor w01ks in a C-Ommunity service centre that offers a variety of programs.
(During the first five minutes of the interview, the cout1sel- Analysis: lt1lervkw c,pet1fngs t!Stabllsh first lmpressJOfls. A few
/cr at1d the client engage ;,, small talk.) minutes spet1t on small talk helps clients relax. and it should
t1ot be considered time wasted.
counsellor: Per'haps you can tetl me what bt'ings you here Analysis: A simple phase trat1sition begins the process of estab-
tOday. You did not tell me much on the phone, but I had lishing the purpose of the Interview. By making a llt1k to the
the impression that you fett some ufgency. ifltake phone call, the counselk:Jr demOflstrates that thectkt1t's
ClleM: I've been on wetfare f0t year'S, and I just can't make sense of emergency was heard. This Jets the client know that
ends meet. the counsel/Or Is a good listener at1d sensitive to feelings.
156 Chap1er S
i>» INTERVIEW 5 .1 Interviewing Skills (continue)
Counsellor: Sounds (OUgtl. Tefl me more. Analysis: A supportive and sympathetic reaction communi-
Client: Ifs not just 100 money-ifs what il's dci~ to my cates warmth and concern. The counsellor uses a directive
kids. to seek more detail and concreteness. As well, it creates an
apportunlty for the client to tell her story.
Counsellor: What do you mean? Analysis: It would be easy to assume what the client is talking
Client: My oldest is 18. He doeso'I seem to have any moti- abOut. Instead. the counsellor probes for definition. An open
vation. He says he can ha(dtywait until he is 19 so he can question gives the client full freedom to speak freely.
go on wetfare too.
Counsellor: I wondet if it seems to you that being on wel- Analysis: This Indirect question offe,s an interesting ,eframe
fare somehOw conne<:ts with yout son's attilude. for the client to consider.
Client: Good i:dnt. I hadn't thought of lhat, but it makeS
sense. It's all we've ktlown fo( the last five years.
(A ftrN minutes later.) Analysis: Here the counsel/or- might have asked an open
Counsellor: I need )'OIX help to undet'SlaOCI what you we(e question to initiate the working contract. However, an
hoping would happen when you came here today. Indirect question ;s substituted. This adds some v.vlety to the
interviewers style and helps to /WOid leaving the client feeling
Client: I need to gel into some sort of mtrainiog, My skillS
Interrogated.
are way out of date.
Client: I'm willi~ toWOr"k anywhete, but eventually, I want Analysis: The counsellor's response accents a key word using
to frnd something that frts. a questioning tone. This is yet another way to seek info,mation
Counsellor: Fils? that ls more concrete. The counsello,-'s Interest stimulates the
client to say mare. Humour lightens the tone, but provides an
Client: I'd mally like to WOrk with people. I'd like )'Ou( job.
apportunity to probe further.
(Ba/h laugh.)
Counsellor: I noticed eatlie( lhat as you described you( Analysis: A linking transition connects two parts of the
voluntee( wOt'k with ldds. you seemed happy. lntel"llew. Good counsel!Ots try to remember a blt of Information
Client: 1-'d IOYe to do it full time, but the(e's no way. that might be relevant o,- useful later-a kind of '"mem0ry
Post-It note. N
Counsellor: What prevents you? Analysis: An open question to identify barriers.
Client: I need to earn a li'o'I~. Veiunteet'Saren'I pai:S. To get
hired ful lime, I'd need to get a diploma.
Counsellor: But .. . ? Analysis: Here, a simple unfinished res,:,onse is a useful
Client: But .. . That takes money, and I ha\18: no idea hO'N prompt for the client to identify ba"lers.
I'd pay for it. Plus, 1-'venever been a g()()j student sogotng
back at my ag,e may be a recipe fOt' disaste(.
Counsellor: Sounds as if you've al(eady looked into it.
Although you sound like you'd lave todo it, you'(e wOt'ried
abOUt au the ObStades.
Client: Yes. As I said ear1iet, I'm detefmined to gel out of
lhis rut. I suppose I sholJCI do somethtng abOUt it.
Reflections:
■ What is the lmpo,ctance of the client telling her story?
■ How d,oe,s the counsell0r in this interview communicate empathy?

■ Suggest what the counsellor migJ,t say or do next.
Asking Questions: Tile Searcll lor Mea ning 157

SUMMARY
■ Questions are an important interviewing tool for g3thering information, pro\tiding
focus to rhc interview, promoting client insight, and supporting catharsis. Good
questioning can systematically lead clients through problem solving and can heJp
clients examine arc3s th.nt they might otherwise ovcrlook. Jt is important to balance
questions with responses that confirm understanding (summaries and paraphrases)
and empathic responses that confirm sensitivity to fccJings. So experienced counscJ-
lors use a broad rc~rtoire of skills all the time.
■ Questions can be either dosed or open. C losed questions can be c3sily answered
yes or no. Open questions are difficult to answer with a simple 't'CS or no. The vast
majority of open questions will be "five~, ., questions (who, what, where, when,
why, and how). Another effective questioning tool is the use of indirect questions,
which are statements that function as questions.
■ Faulty, insensitive, and poorly timed questioning may bias clients' answer~ antago-
ni:e them, or keep the interview at a superficial level. Common errors include lead -
ing question~ excessive questioning, multiple question~ irrelevant or poorly timed
question~ and urhy questions. A lternative options to questions arc always available
for use by skilled counsellors.
■ Interviewing youth and seniors involves paying attention to individual differences
as well as cognitive ability.
■ Concreteness concerns the extent to which the discussion conveys dear and specific
meaning. When communication is concrete, all participants share understanding of
langungc, ideas. and feelings. Strategics for promoting concreteness include using
simple encouragc:rs, probing for detail with questions and dirtttivcs.
■ Interview transitions occur when the topic of the interview shifts from one subject
to another. Such shifts may occur spontaneously in the course of the interview, or
counsdlors ma)' orchestrate them to further the objectives of the interview. There
are five different rypcs of transitions: natural, strategic, control, phase, and connect
(or linking).
EXERCISES
Self-Awareness 4. Conclucl an i'\ter'viewwith a coneague. Use questions k'la~
1. Pick an issue that you have wry stt~ footings abOut (e.g., ptopriately (e.g., ask irrelevant questions, change the topic
abOrtion, capital punishment. Or' canadian politics). Con- freciuantty, bOmbard with questions, and ask leading ques.
duct a 5- to 10-minute inter'view with a colleague to ex.plOm tbns). After the inter'view is completed, discuss how it fett
his Or' her' viehS oo the same 10pic. Howevttt", do not reveal to be k'I tx>th the rnter'vie.ver and the client ,·ote. What did
any of you, feellngs or th~ts on the topic. Afte, the intet- you learn atx>ut yourself from this ex.perieoce?
view is ovet, discuss the experience. To what ex.tent we,e 5. Reflect on the variables that might make it difficlAt lor you to
you able to keep you, oNn views separate? se•~isclose 10 a counsell01. What issues rn your lile would
2. Think abOUt an expe(aence where you had a sliong reaction )<Ill be A!luc&art 01 uf'Mili(€ to discuss? How dO )<Ill think )<Ill
to being questioned. What were you, thOu.ghts and leeli~ migt\t react if a counsellor pursued these topics?
durk'lg the enicountet? How did you react? 6. Think abOut some of your pel'Sonal and WO(k relation.
3. Ask a friend 0t COiieague to monitor your interactions over Ships. Ate you mofe likely to be the one asking questions 01
lhe nex.t week 01 so regarding your use of questions. Seek the one answering questions? In what w:¥yS does this impact
feedbaek. the powet dynamics of the relatbnship?
158 Chap1er S
7. On a scale of 1- 10 (1 =easy; 10 =tougtt), rate hO'Ndiff!CIJt c. It's been a long time.
it might be for you 10 conduct a d ient interview Ydth the 101- d. I knO'N e-xactty what she me-ans.
IOwing themes or topics:
e. You have no idea hOw I fool.
Oealll
f. I'm realty angry with you.
Spiritual issues
a:. The-re are some significant thi~ happening in my lile
Sex and intimacy right now.
Mental heallh issues b. I'm 001 sure I can handle this pfoblem. I need he-Ip.
1-tyijeoe
4. Each of lhe fonowi~ client slate-men.ts has ooo or m0te
Aging problems with concreteness. F'ust, identify lhe concre-t&-
YOIS relationstlip with him/her ooss problem. Second, suggest a possible counselloc
What can you learn aoout )'OU'self from your answerS? response to promote concfe-te-ne-ss.
a. 1stitJ have lee-Ii~ fOI' he-r.
Skill Practice
b. IW ftlen tt a lot of lhOugl\l.
I . Coo:foct a 10-mW'lt.lte locused interview with a Cdleaigue. YOU'
c. I hardly sleep at nigr\l.
task is to explore one topic in as much depth as JX)Ssible.
However', in this interview, you are n.ot allowed to ask ciues- d. I've tried to control my kids, but nothrlg seems to WOrk.
tbns. Use a range of Skits other than quesl.bnir'lg,. (Note to e. She's an elder1y person.
the client: Keep yots answers very brief. Try n01 to be overl'j I. I f... bad.
cooperative.) After the i'\teM8W is O'iet, discuss the expari-
ence. See 00W many diffefenl strategies you can identify fOI' 5. Each of lhe- fallowing counsellor statements contains
getti~ ir'D'matioo c.-. addil.ioo toOl)(!l'I and ct)Sed questions). phrases or jargon that may be unfamiliaf to d ie-nts. Reword
each using everyday language.
2. As a conditioning &efcise fOI' interviewi~ ciuiel clients,
conduct an in.tef'Jiewwith a COIie-ague-. Set up the in.te-rview a. It seems as 1h0u.gh youf son has a 101 of inte-rpe:ISOl\3I
so that your colleague- does not resJX)nd verball'y. use a difficllty, and ii is gene-rating acring~ behaWOuf.
variety of ted'lni::lues Other than questions. b. Cognilive-ly, he see-ms we-II within the- mean.
3 . Videotape an extended intel'View with a celleague. Classify c. It appears 10 me that you are feeli~ ambivalent.
each response that the counse-tlOr' makeS in tem'ls of ly~ d. After intake it seems appropriate to make a refe«al to
open ciue-stion, closed Question, summary, and so on. Iden- one of our community resources.
tify patterns. Ate the-re Skills that are overused 01' underused?
e. Youf aflect is euthymk::.
Concepts 6. Work in a small group to brains.tofm jargon that is used
I . ClaSsify each of the foltowing questions as open, closed, in a setting that you knON. Next, reoor'd these tefms and
Of indirect. phrases so that lhey are easity unde-rsaaodable.
a. How do you feel aoout your brOthe-t? 7. Watd'I a talk Sl'IOw. See if you can identify the interviewing
b. I'm pUZlled aoout yotX mact.ioo. Skills that are ~d. LOOk for e-viden.ice of improper interview-
ing techni(lue.
c. Do you have time to see me oex.t week?
8. Identify six or mo(@ different chOices for obtaining lhe
d. I'd like to kn.ow somethi~ aoout your sttategy.
folk)\\;~:
2. Rew0r'd the fOflowing clOSed questions as (a) open ci~ • The- p(~ of a oottte of socsa
I.ions and (b) i"ldirecl ciuestioos..
• l.nfOl'matbn abOUt your client's feelings
a. Are you enrolled in the seo-etarial PfO!Jam?
• Youf client's reason fOI' se-eki~ help
b. Did the principal refef you?
9. Imagine that you are a counse-uor preplaMing an interview
c. Are you feeling sad? with each of the follo-lMg d ients. What in.formation do you
d. Do you want 10 talk abOUt your feelings? think you might need? Identify Questions and directives that
e. Did you tell hef hOw you lel? you migttt use.
• A patient who has been physically fe-strained in a hOspi.
3. lmagk'le that you am responch~ to the lolto.-dng d ient state-
tal e~rgency wafd aftef a dfug OYefdose.
ments. Suggest fOflow-up responses that are- open ciues-
tions, closed ciue-stions, indirect ciuestions, and d1fe-ctives. • AA elder1y woman vd'I0 is going blind.
a. I have mixed feelings. • A man whO seeks he-Ip tor ang« management.
b. The~ step is to Sdve the blOOdy prOblem. • A pafe-nt of a child who has been taken into cus.to:Jy.
Asking Questions: The Searc tl lor Mea ning 159

IO. Interview Aerobics must ask a clOSed question, even if that migr\t 001 be the
11. Prepare l'las.h caros \\1th the names of various Skills oo each beSt response. (Note: Do n01 IOOk at the card until lhe client
cafd (e.g., open question, ck>Sed question, paraphrase-. has finished speaking,)
summary, empathy, iOClirecl question, direclive, silence-. Exercise 2: WOr"k in a group of three (counsellor, client,
wild card (any Skill), self-di!.clOSufe. and contractl"lg). Then and coach). Dufing the interview, lhe coach coooses an
use them in an inter'View with a COiieague. appropriate ski\J cafd fOr' lhe counsetor to use.
Note: The foUo-Ni~ exercises are desigr\ed to help you Exercise 3: Conduct an interview using the cans in any
develOp a range of SkillS. The mofe comfortable you are ordef that you choose. Continue interviewing until all of the
wilh a 'hide afr'ily of responses.. the mor'e you wUI be able to cafdS are used. ca,ds may be used more than one time.
respond based on the oeedS of the client and the situation. Exercise 4: Conduct an interview using the ca,cts in any
Uerdse 1: Shuffie the cafds. The counsellOf istens care- ordef that you wish. Howevef, you can use each card only
full'f to what the client says aOCI then setects the fil'SI card in once.
lhe stack and fol tows the dk"ections on that card. For exam- Exercise 5: OeV1!IOp your o-.m strategy for using lhe cards.
ple-. if lhe next cacd reads "closed question,· the counsenor (Adapted ftom Sneb;b, 1997, p. 161)
WEBLINKS
Article on investigative intervi~ing of childieo. Basie: counseling skills for wo,king with teens (Center f0t
"Guidelines on lnyestig~to,y Interviewing of Children: Wh.at AdOlescent Studies)
Is the Consensus in the Scientific Community?.. by Hollida https:l/centerforadolesce:ntstud1es.coml3-b.asic<0unseling-
Wakefield (2006). American Jourt1al of Fo,e11sic PsychO!Ogy, ski Ils-working-teens/
24 (3), 57- 74.
www.i pt.forensics..com/hbr.ary/.ajfp 1.him
160 Chap1er S
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■ Explain the impormncc of emotions in counselling.

■ Define what is meant by empathy.
■ Identify the types of empathic responses, including when and how to use them.
■ Explore lccy principles (g:cncrali:ations) for using empathy.
THE EMOTIONAL DOMAIN

At any moment in a counselling interview, counscJlors can choose to focus on one of
three brood areas: behaviour, thought. or fcdings (emotions). All thrtt are potentially
important and necessary for problem mtmai;cmcnt and change. Of significance is that
change in any one domain will have impact upon and trigger change in the others.
\Vhcn the emphasis is on behaviour, counscJlor questions and responses tarj;ct what
the client is doing or S3ying. Responses such as, "\\:' hat did 't'OU say?" "How did you
handle the situation!" and "\Vh.nt do you Stt as the next logical step!" 3re dominant.
If the focus shifts to the thinlcina (coanitive domain), responses such a~ "How did you
make sense of what happened!" and "\Vh3t were )'OU thinkina?'' 3re evident. Work
in the feeling or affective dom3in will involve counsellors in responses and questions
th3t explore emotions. Questions such 3S. "How do you fecH" 3S weJI as empathy will
161
dominate the ,vork. The bruancc of this chapter will explore concepts and strategics for
working in the important emotionaJ domain. Chapter 7 will explore how counsellors
can work in the behaviouroJ and cognitive domains.
Emotions define and shape the course of our lives. They remind us that we are
alive, but sometimes they make us long for death. Some cmotions--such as joy at the
birth of a child-demand to be expressed. Some that are too frightening to acknowledge
are destined to remain forever hidden, perhaps e,.,cn from ourselves. Carl W Buechner
underscored the importance of emotional connections: "they may forget what you said,
but they will never forget how you made them foci" (public domain). Shared emotions
are the cornerstone of intimacy. One's emotionaJ reaction, while not always mtionaJ,
dear, or understandable, often controls the finaJ judgment on communicative meaning.
EmotionaJ responses trifler unique physiologicaJ responses in our bodies such as
nausea or headadie~ and they can have a profound impact on our health and well-being
(Seligman & Reichenberg. 20 I0). In fact, "Emotions experienced as positive can activate
the inner pharmacopeia, those chemicals that reJax, help fight infection, and restore"
(Solccl,y, 2009, p. 17).
Historically, emotional responses have helped humans respond to important
situations:
■ Anger: The hands swell with blood, making it easier to use weapons or strike back;
increased heart rate and adrcnaJin serve to increase energy and power.
■ Fear: Blood Bow to the legs increases, making it easier to escape; the body may freeze
for a moment, giving time to gauge whether hiding is a better response.
■ Happiness: Brain activity inhibits negative thoughts and fosters increased energy.
■ L01.-e: General bodil't' responses promote well-being and a ,;cneral state of calm and
contentment.
■ Surprise: Raising the eyebrows cxP3nds the field of vision, thu~ making it easier to
figure out what is going on and to plan the best course of action.
■ Sadness: A general drop in energy and enthusiasm creates an opportunity to mourn.
(Golcmon, 2005)
Jones (2006) makes this interesting observation: "Emotions are clever design solu.-
tions to the problem of making fast decisions in response to significant practical prob-
lems posed by the natural and sociaJ worlds: we percejvc a danger and fear immediately
primes us to take protective action" (p. 3). But she aJso comments on the way that emo-
tions can cause us to act inappropriate!)•: "They prepare us to embrace motivationally
actions we should shun and leave us in physical turmoil when we would be better served
by calm" (p. 8). Murdock (2009) identifies how problems miaht arise from emotional
reasoning: "Because of the emotional investment in an idea, it is seen as true, reg3rdless
of discrcP3m information" (p. 329).
))t) BRAIN BYTE

Emotional reactions are also linked to our emotional memi> neural alarms· that cause us to feact with outdated ot ioof-
rtes. TM human brain compcues current expe:ftence with fective fesponses. Mofeovet, emotions can be partkul3r1y
past events f0t similarities. and it may command us to •feact baffling beeause Mthey often date from a time earty in OUf
to the present in ways that wefe impcinted IOog ago, with lives when things were bewildeting and we did no1 have
thoughts, emotions, teactions reamed in msponse to events w0tds foe compfe-hending events. We may have the d'laotic
perhaps only dimly similar· (Goleman, 2005, p. 21). This feeli~. but not lhe WOfdS fot the memories that fonned
may tesult in what Goleman (2005) desctibes as Mout-of~ate lhem" (p. 22).
162 Chap1er 6
Because the human expe.rience is so closely connected with emotions (feelings), we
c3n upect co unselling work to frequ ently focus on heJping clients identify, explo re,
man3g,e, o r accept their emotions. CounseJlors engng:c with clients' emotions in a n um-
ber of ways. The co unselling relationship provides safety for clients to explore and
understand their feelings. Friends and family may be well-meaning but poorly equipped
to deal with complex emotions. T hey ma,., be prone to simplistic advice giving, o r they
may try to chani;c the subject when painful feelings are revealed. CounseJlors, on the
other hand, are able to deal with feelings. They do not tell clients how they should feel,
nor do they insult or frustrate clients with quick.-fix solutions. Instead, they allow cli-
ents to express emotions without nco:ling to censor what they reve3J. Nonju dgmental
responses and pe.rmissive encouragement from counsellors can be enormousl't' thera-
peutic for those clients who have struggled on the.ir own to cope with their emotions.
The pursuit of empathic understanding opens up an avenue for communication and
insight that is seldom accessible in everyday communication.
Golema n (2005) sus:i;csts that the ability to rccogni!e feelings as they happen is the
cornerstone of emotional intdligc ncc, and that people who are more in touch with
their feelings arc better able to navigate the.ir lives a nd are more competent decision
makers. G ladding and Newsome (20 10) suggest that "people who are unaware of the.ir
emotions o ften exper ience problems in relationships" (p. 154). Prcsbury, Echte rling.
and McKee (2008) conceptualized emotional intelligence in two C3teg<>ries: skills related
to understanding the seJf and skills related to understanding others. Self-skills include
ab ilities such as recogni!ing., monitoring, managing, and remaining open to our own
emotions; being congruent in what we feel and how we behave; and u sing emotions
as part o f problem management and creativity. Emotional intelligence when relating
to othe.rs requires empathic ab ility, including the capacity to unde.rstand, manage, and
navigate emotions in others that may be complex and ambivaJem. As well, we need to
be ab le to rccogni.!c incongruence; that i~ inconsiste ncies between what people feel and
what they sa y o r do. Seligman and Reichenberg (2010) give an ex:.lmplc:
A pe-rsoi, ~press.in¥ words o( lo"e w1II spe-.l.k $0(dy. 111::aintain K()od ere cont~ , ::and
h::1:,,e 211 open ::and ..vtJrominKposture. HOYi'e\'tr, i( that person ,>erbr:1111:es 101:e but has
poore)>e contact. an :l.11$tr)' tone o( voice, or 2 ten,sie 2nd dosed poscure. conflict in¥ ::and
con(usii,K emotions are co1nn1unk::rted. The receiver ,nay not know "-h:u t'O belu.'•,,e. only
IX''t' 2tten1.0n to part o( the mess~e. m isinterpret the mess~e. or discredi1 the n~~-e
because o( its delivery. (p. JJ2)
Howeve.r, communication d ifficulties and problems ofte n occur, since there arc
wide variations in the extent to which individuals value and express emotions. Many
factors impact this, including ::age, cultural norms, i;cnder, setting, mental disorders,
and soc:ialimtion. For example, people from Asian cultures value emotional restraint,
whereas \Vesterncrs tend to be more boisterous in expressing feelings. (ndividuaJs may
openly ~xpress emotions when they are with peers o r friend~ but be guarded or mute
with pe.rsons in positions of authority (induding counsellors).
Counsellors need to be alert to the impact of these variables, and they must also
monitor their own emotional reactions and mood to m::ake sure that the.ir feelings do not
))I) BRAIN BYTE

Recent ne-ufdOgic:31discoveries may help explain the foots of as tr'IOse of OU( clients. Put simi;::iy, when we heaf abOut 0r
e-mpathy as well as the (ISkS ot ,.;cafious ttauma foe those- in witness an event OUf bralfls respond in the same way as if we
the hefpi~ pfofessions. When we listen to 0t obServe others, expe-rienced the event directly. As a res.ult.. OU( fee-tings tend
•mifl'Of neufons• in our btains tend to fire in the same way to mimic our clients' feelings.
Empathic Connec tions 163

ncgntivdy impact the work. Grancllo and Young (2012) cmphasi:e that "clients in coun-
seling must be nJlowcd to work through their own issues without regard to the changing
emotional state of the counselor" (p. 119).
Counsellors can hcJp clients consider how their emotions might be intcrfe.ring with
decision making or eve.ryday life. Decision making, for example, may be difficult when
clients' emotions pull them in different directions; however, many unhappy feelings.
such as sadness, anger, grief, and disappointment, are part of everyone's life. (n fact,
feelings like grief are healing responses., and they arc not usuaJly pathologicnJ or in need
of treatment.
The Language of Emotions

Our language has wisely sensed the tivo sides of being alone. It has
created the ulOrd "loneliness" ro express the pain of being alone. And
it has creared the u:ord "solitude" ro express the glory of being alone.
- Paul Tillldi (TM Etn-naJ Nou,. 1952)
Much of counselling involves gening in touch with the subjective experience of cli.-
ents, particularly in the emotional domain. CounscJlors are constantly chnllcngcd to
understand and respond to the range of subtle feelings that clients express in language
that they can unde.rstand and accept. Despite the fact that there are hundreds of words
for emotions in the English language, words alone often fail to communicate precise
information about client fee.lings. A client who says, "I'd kill for a chocolate ice cream,"
is dca.rly exaggerating. Another might minimi!e a problem, saying, "It doesn't bother
me," but context and other cues might reveal evidence of profound pain.
Table 6.1 presents a feeling inventory of the most common families of emo-
tions. lt is self-e-.•ident that cmotionaJ intensity varies among people depending on
the circumstances. Sometimes., word modifiers (e.g., t'ff)', exr.remely, .somewhat, mosdy,
and lirrle) serve to limit, quantify, and add further precision to the levcJ and type of
emotion expressed. For example, we can expect some difference in emotional levcJ
between people who describe themselves as somewhat happy and others who say they
arc incredibly happy.
Metaphors Metaphors describe a state by using a symbol in a direct comparison.
For example, a diem who says he is "going around in circles" is using a metaphor to
describe his fedings of confusion.
Herc arc some metaphors with the possible fccJing that cnc.h one su~ests:
■ tied up in knots. in a pres.sure cooker (stressed)
■ about to blow up, bent out of shape (furious and angry)
■ on a sinking ship, down in the dumps (hopeless)
■ tearing my hair out (s\\--ampcd)
■ in a sticky situation (vulnerable)
■ between a rock and a hard pince (helpless., confused, and ambivalent)
■ butterflies in m't' stomach (fear and excitement)
■ on top of the ,vorld, on cloud nine (happy and ecstatic)
■ taken for granted (dcva.Jucd and put down)
■ going around in circles, feding pulled apart (confused and ambivalent)
■ Cfi on face. lilcc cw'O cents (embarrassed and shamed)
In addition, sometimes people use metaphoric phrases to describe ways of dealing

with emotions, such as "rising above it."
164 Chap1er 6
TABLE 6.1 Feeling Inventory
Intensity
tateao,y ot Emodon tow Level Medltn levet Hieb level
Ana,e, annoyed. il'filated, miffed, angry, mad, hOstile. hatefu l, outtaged, fu(ioUS, ve~hA,
olfencled, resenthA, ptOVOked. disgusted, inflamed, in a tiff, repulsed, bOili~. in a fage-.
disi:,eased. aggravated. put off, fed up. sore. agttated, and seettlS'lg irate, and infufiated
licked, upset and disturbed
fur alarmed, net'VO!Js, anxious, frightaned. scared. WOr'ried, ShOC:ked. hottified, pa.ntked,
teased, uneasy, timid, distressed. fearful, jumpy, and terl'ifted, mortified, terrorized,
bOthered. apprehensive. uptlgl\t and c()lj sweat
intimidated, and butte-rflies
Ellll)Owerment adequate, up to the d'lalleoge. confodent, capai:.e, adepL healthy, irwulnetable, in conttol. OOld,
able to cope, and stable quaHfied, whole. ene~oo. potent. couragoous. and
dynamic, tough, suong, brave, unbeatable
detefmined, and secufe
Vulnerability OO!k.ate, insecufe, Umk:1, Shy, weak, vulnerable, falling apart. burnt defenseless, impotent,
small. ftagne, tifed. weary, out, eowafdty, helpless. usetess, worthless. no good, po-Net'less,
emba(tassed, Sl)O()ked. sick, i.ncompetent, i.nadequate, and ex.r.austed. lifetes.s. useless,
appfe-heosive, and concemed unptotected, frail and petnfM!d
Joy~leasure saUsfM!d, i,ad, good, pleaSed, happy, contented. joy!IA, loY<d, euphOric, jubilant, ecstatic:,
and eotnfortable excited. optimistic, and cheerful thrilled, delighted. passionate-.
elated, mal'W!IOuS., fu!I ot life,
terrifoe, and o,e,joy,!d
Saidness disappcinted. hurt, trout:,oo, unhappy, glum. sad. depressed. agonized, dejected,
cSowncast, upset and bOlhefed melanchOly, blue, lonely, dismal, de<pairi~. de<pandent.
and pessimistic: hopetess, and miserable
focus distracted. muddled, u~rtain, confused. baffled, per~oo. (_.. a state oO pandemonium
OOUbtful, hesitant, mixed up, puzzled, ambivalent. stumped. O( chaos, mystified, and
unsure, and indeeisive jumbled, disjointed. and frustrated swamped
Shame embartassed, humbled, and belittled, diSCfedited. guilty, Shamed, disgraced, scanda~.
regretful femorseful, and ashamed huniliated, and mortified
Surprise startled. and puzzled surprised, stuMed, and shocked astonished, astounded,
flabbergasted, amazed,
overwhelmed. anct in a-.ve
love atttaeted, and friendly ctose, intimate, wa(m, tendet, IOvecl, adOl'ed, entaptured,
Cherished. smitten v.;th, craiy abOut, wild aoout, flip
anddoti~on over, idOliZe. and worship
Nonverbal Communication of Emotions One key to successful communication

is monitoring a nd understanding the nonverbal channcJ of communication. Body lan-
gun,;e (especially facial expression): voe.al c ues such as tone, intensity, rate of spe«h;
and affect are essenti3l components of emotions that confirm, embellish, or comm-
diet verbal statements. All cues should be interpreted cautiousJy, including these com-
mon ones: tears, forced smiles, grimaces, covering clenched fist. shaking, becoming
silent, smiling, shaking he1ld, pacing. looking at the floor, turning away, and 't·elling.
For example, lack of eye contact may be culturally appropriate in some Indigenous
groups in Canada, and so non-Indigenous helpers should 00( inte.rp ret it as a sign of
disrespect. Counsellors need to remember that their O\\'n nonverbal communication is
not always under che.ir control, and it may be outside their lcvcJ of awareness. As Sue
and Sue (2008) note, a counsellor "who has not adequatel't' dealt with his o r her O\\'n
biases and racist attitudes may unwitting),., communicate them to a culturally diffe.rent
client" (p. 171). Despite their words and seated intentions, their nonverbal communica-
tions express an uncensored meaning.
Empathic Connections 165

Individual Differences and Cultural Context
All feelings can be c:xpcricnc~ as positive or negative 3t wrying lcvcls of intensity, but
this subjective determination is individunJt,., defined. For some ~pie, anxiety c:m be
debilitating, serious!'>' affecting: the quality of thc.ir lives; however, for an athlete the same
emotion may arouse a competitive spirit and the individu:.d might thrive on its physi.-
ologicaJ consequences. CounscJlors need to remember that their clients ma'>' respond
with emotional reactions very different from their own- with similar fccJings, sharply
different feeling:~ without significant cmotionaJ reactions, or with markedly increased
or decreased intensity; therefore, counscllors should a,-oid using: thc.ir own mC3suring:
criteria to interpret the emotions of others. For example, if they expect rhal people in
crisis will be verb3J 3nd ded3re their pain, then they might miss the fact th3t the quiet
child is much ncedie.r th3n the one who is 3cting out.
But circumstances and context 3re not 31\\"ll)'S good predictors of feelings. One per-
son miaht be anxious about public spC31cing but find the experience exhilarating, while
another pe.rson is terrified by the prospect. One individu3l might enjoy parties 3nd be
stimulnted by the ch3nee to meet new people, but a second person looks for any excuse
to avoid the p3nic brought on by c.rowdcd social events. Consequently, when the mean,.
ing is notobviou~ counsellors should aslc clients to explain the.ir emotional experiences.
In the following example, the counsellor m31ces erroneous assumptions 3nd then,
sensitive to the client's nonverbal mess3gc, ,vorks to correct the error. This models
openness to the diem 3nd serves to reinforce the rea1it)• that counsellors arc not pc.rfcct.
Client: Mr mother isrominato visit me ,~t wttk.
CounS(>IJOr. Oh, th::u'!i nice. h'!i alwa)'!i $trt:::II when you h::n,e:. chance to see ,.·our (olh.
Client: (H~tatmg.) I ttuess so.
CounseUor. (Pk ldng up on tht- clit'flt'f htutadan.) Perh::aps I was mo h:lSt't' in assu mh)¥
you Yi'Ould be happ)' th:u she was cornini, I should h::a"e waited un1i.1 you told me how
you (elt. How do ,.·ou foe.I :iliout her \ti.Sit!
Client: I dre::.d it. ?l.·1y mother :dw3)'S w::ants to tell rne hoo• to run my li(e.
lndh•iduals arc also often governed by cultural norms, and there 3re wide vari.-
ances in the e>..'tent and manner to which they express emotions. Some cultures value
emotionnJ expression, whereas others favour emotional restraint. CulrurnJ empathy
(Connie.r & H3c.kncy, 2008) requires counsellors to pay 3ttention to both cukurnJ 3S
well as contextunJ considerations. Note th3t emp3thic responses should be culturally
appropriate with consideration of issues of pride and shame. For some dientSi, empathic
responses m3y le3d to embarrassment and "loss of (acc." Thu Si, diem receptivity to
empathic responses should be conside.red.
Ambivalence
Clients interpret their own problems and expc.riences and find them frequendy compli.-
catcd by multiple and seemingl,.•contradictory feelinas from two or more emotional famj,.
lies(sce Table 6.2). A great deal of stress and confusion can 3risc from the pushes and pulls
of competing fcdings that, if unm3naged, C3n disrupt a client's life. The tenns ambi1~lence
and of tu'O minds are often used. Ambivalence is normal, and although it can kttp people
stuck, identifteation, exploration, and resolution of ambivalence can be a wlunble P3rt
of decision making, Four key questions can be used to systematicaJly ewlu3te options:
I . What 3re the 3dvant3ges o( m3intaining the status quo!
2. What 3re the 3dvant3ges o( changing!
3. What 3re the diS3dvantages of the status quo?
4 . What 3re the diS3dvantages of ch3nging?
166 Chap1er 6
TABLE 6.2 Common Mixed Feelings
Happy and This olten arises in coojul'd.ion with a lifestyle change (e.g., getti~ ma«ied,
scared retumtng to Sd'IOOI, starting a MN job. sending child(en to daycare, and
experienctng the "emp1:y nesr when children le.ave hOme).
Happy and sad Some transilional life events, such as leava"lg one job lot anotner or seeing
a chik:I off to COilege (or kinde(garten, etc.), elicit these leeli~. A sense o(
IOSs as well as gain is olten present.
Depressed and These feelings suggest that the person has "bOttOO'led out.· Significantly,
fed up 100 feeling of be.-ig led up may be used as a st(ong morivatOr' for change
(e.g., deckli~ to change a self~estrucrive drug habit).
An&ry and fear i:S often the n'IOr'e significant emorioo, but anger is m::>re c0tM1ooly
afraid expressed (e.g.., a pa(ent fad~ a teenage!' wM is 1wo hours late fOr' curlew).
Hopeful and Many clients fluctuate between believing tr.at cha~ is possit:,e with the
despairing potential for lite to get bette( and that nothi~ Viill knprove and further effort
i:S futje. Oe\ltllOping and susiaintng motivation is crucial in such situations
(e.g., a pe(son cop.-ig with a life-threatening i!Joess).
Attracted Many people who am consideri~ changes in thei( lives experience tnese
and repelled footi~. Part of them wants thi~ to be diffetent, and part wants the
<•Pt>roaclll security of thei( p(esent situation. however, distressflA (e.g.• a perSOn
avoid) contemplating leav.-ig an abusive (elatioos.hip).
Love and hate This usually arises in the face of conttadictory evidence (e.g., a friend
whOSe behaviour i:S ooatic-sometimes IOvi~. sometimes abuSive).
This method adcnowlcdgcs thnt there arc costs nnd benefits to each co urse of
action. lt aJso presents a nonjudgmental way to honour the fact that clients ma,., resist
chnnae for good reason, even when they P3Y a henvy price for doing so. For example, a
client may continue to abuse su bstances despite enormous persona] and financial costs
because it provides relief from h is severe d ep ression.
SUCCESS TIP
Counsetors need to remember that dients are lhe ex.pe(ts on theif own lives and tr.al they
have made the best chc::ice frOO'l what they consider to be thei( available options. Counsel-
ling empowers dients by hell)lng them identify add1t.ional ctu::ices and by helpi.ng them to
address or remove barrie-rs to options that were not seen as viable.
Motivational Jnterviewing (Miller & Rollnick, 2013) was developed as a collnb-

o rativc communication style specifically for assisting clients co resolve ambivalence.
Empathy, a ccncraJ feature of Motivational lnterviewing "normalizes ambivaJence
and demonsmttes that the counsellor unconditionally accepts the client" (Capu:i.zi &
Stauffor, 20 16, p. I 53). This popular, evidence~bascd approach will be~xplored in derail
in Chnpter 7. Example:
A wonun dest:ribes the j~• she felt when her son ielt home l'O b¢in trainiO¥ as a counsel~
lor. but as she c~lb, her ~-es well u p with tears. C learly. she is expe-riendn&:. scrona sense
o( los!l. despite the fact t~t words speak to her prkle and happiness.. More accur.nely.
both (eelin~ exist sl1nultaneo usly.
SUCCESS TIP
When responding to clients who express mixed foolt.ngs, say and instead of but. This rS less
confrontational and fully honours the presence of bOth feelings.
Empathic Connec tions 167

People also have feelings about the emotions they experience. Sometimes they are
very aware of these mixed fccJings. sometimes not. Try this simple experiment. C lose
't'our eyes and r«all a r« cnt strong emotion, such as anger o r joy. Take a moment to
get in touch with 't'OUr feelings. Now try to complete this sentence, "l feel about feeling
(your recent strong emotion)." Many readers will find that this simple exercise leads
to a deeper unde.rst:.mding of the.ir emotions. Some may find guilt behind their joy;
others fear.
Mixed fttlings arc often associated with anxiety and stress, especially when the
fttlings require opposing responses. Jf a person is both attracted to and repelled by
a particular choice. anxiety is likely to continue until he o r she resolves the dilemma.
Affect
affect: A tera t!lat counS!lors uS! to Affect is a term co u nsellors use to describe how people express emotions like sadness,
desuibe hlw~ tiprm emo:ioa. excitement, and anger. C ulrurc and context help to define what is considered within the
"normal range" of affect. Moreover, affect is communicated through voice tone and
quality, posture. facial expressions. a nd other nonverbal cues. These terms arc o fte n
used to describe affect:
blunted: Eaotiouespressi>n is less
than one aight eapa:t.
• Blunte& EmotionaJ expression is less than one might expect.
flat: Ttie,e is an absellce« ne.- abS!IICe

• Flat: There is an absence o r near absence of any signs of emotional expression.
ol any s.ps of emational expessica • Inappropriate·: The per son's manner and mood contradict what one might expect.
For example. a dicnt might laugh while describing the d eath of his mother.
inappropriate: TIie perso.'s manner
w_.,
• d mood cootr,dict what one might
espe«. For a clieal migflt laugll
• Labile: There is abnormal variability in affect, with repeated, rapid, and abrupt
shifts in affective expression.
,...ile describing die deatl of • is MIiier.
labile: Tliere is abncmal variability ii

• Restric.ted or constric.ted: There is a mild reduction in the range a nd intensity of
emotionaJ expression. (For more information, sec Amer ican Psychiatric Associa.-
affect. wiih rti)eated, rapid, and atwupt
shifts in affective e,:pressica
tion, Diagnostic and StmisticaJ Manual of McntaJ Disorders., 4th ed., 2000.)
restricted or constricted: Tllereis a Psychologists and other mental health professionals use the terms affective
aild reduuion in die range • d intensiy disorders o r mood dic;;orders to describe a variety of disturbances in mood. T he most
ol emoti>nal tipression. common mood disorders are major depression, d't•sthymia, a nd bipolar disorder. Cfi,.
affective disorders: Distarbaaces in ents with major depression arc likely to experience many of the following symptoms:
aood. indllding d~ss• • d mania. depressed mood; inab ility to experience p leasure: loss o f energy and interest in life
and wo rk; changes in appetite; sleep d istur bances (especially insomnia)~ decrease in
mood disorders: See also affective
d;SIXders. sexual energy; feelings of ,vo rthlcssncss, helplessness., guilt, anxiety, or pessimism; and
thoughts of d eath o r suicide. Oysthymia is a chronic condition with symptoms similar
dysthym.ia: Achronic tonditi>n 11ith
S)fflptom similar to depfessi>n bell duit
to d ep ression but that arc less intense. 'W ith b ipo lar d isorder, clients have alternating
an less sMre. depressive and manic episodes. Manic episodes inclu de these symptoms: abnormally
elc..,ated mood, irritability, hostility, grandiosity, ovcractivit)', flight of ideas., decreased
need for sleep. a nd buying sprees or other indicators of poor judgment (Da..,is, 2006;
American Psychiatric Association, 2000). In these situations, refc.rral to a physician
should be considered as an adjunct to counselling (see Chapter 9 for 3 more in-depth
d iscussion).
EMPATHY
It is the mind which create-s the world about us, and euen though
u:e srand side b:>· side in the same meadou\ nt)' eyes will never see
whar is beheld by )'Ours, ID)' heart will never stir to the e-morions
with which yours is rouched.
~or~-t Gissina (1857- 19.13)
168 Chap1er 6
Empathy Defined
In cveryda'>' terms, emparh1 means seeing the world through someone clsc's eyes. For
the purposes of counselling. though, cmp3thy is defined as "the process of accuratdy
understanding the emotional pc.rspcctivc of 3nother ~rson and the communication
of this understanding" (Shcbib, 1997, p. 177). The primary objective of empathy is
to understand and respond to feeling~ but there is 3Jso a cognitive component. Reiter
(2008) defines cognitive cmP3thy as "an understanding of the values, worldvicw, and
intentions of the client" (p. I09). Cognitive empnthy is an cs.sc:nti3l component of appre-
ciating how emotions arc experienced and understood from the client's perspective.
But as Baron.-Cohcn (2003) note~ "empathi!ing does not entail just the cold caku-
13rion of what someone else thinks and feels. . . . EmP3thi!ing occurs when we fee] an
appropriate emotionnJ reoccion, nn emotion trigge.red by the other person's emotion,
and it is done in order to unde.rstand another person, to predict their behavior, and to
conn«t or resonate with them emotionally" (p. 2). To be dfective, empathi!ing needs
to come from n position of compassion and caring. Rogers ( 1980) outlined what he
considered to be the essential clements of empathy:
■ Entering the private perceptual w-orld of the other and becoming thoroughl)• at
home in it.
■ Being sensitive, moment to moment, to the changing felt meanings that flow in chis
other person.
■ Temporarily living in his or her life, moving about in it deJic:ately without making
judgments.
■ Sensing meanings of which he or she is scarcet,., aware.
■ Not crying to uncover feelings of which the person is totally unaware, since this
would be coo threatening. (p. 142)
SUCCESS TIP
Empathy needs to be expfessed to be effective. The empathic process rS not complete until
clients have an opportun.ty to confirm, correct. or embelli:sh lheit feell.ngs, and they know
that U'leit feelings am understOOCI and appreci'.ated.
The Importance of Empathy

Carl Rogers (1902- 1987), one of the most influential psychologists of the twentieth
century, wrote and lectured extensively on the importance of empathy in counsel-
ling. He conceptunli!ed empathy as one of the core conditions of helping (along with
unconditionaJ positive regard and congruence) that determine the outcome of counsel-
ling. In fact, Rogers argued that the core conditions we.re not onh• necessary but also
suff1eient co effect change. Near the end of his life, he offered this comment on the
importance of empathy: "To my mind, empathy is in itseJf a healing agent. 1t is one of
the most potent aspects of therapy, b«ause it releases, it confirm~ it brings even the
most frightened client into the human race. If a person can be understood, he or she
b.-loTIJ:S"(l981, p. 181).
Empathy is a fundamental building block for the helping relationship nnd is clearly
connected to positive outcomes in counselling(Table 6.3 outlines some of the ways that
emP3thy hclps clients). le is widet,., nmlced as among the highest qualities that a counsel-
lor can possess (Cla.rk, 2007, 201 0; Egan & Shroeder, 2009; Reiter, 2008; Roge.r~ 1980;

TABLE 6.3 How Empathy Helps
Encoufages ex.pressioo of emotions. which is cathartic
Normalizes and validates feelings, reduces isolation, and contributes to 100 develOpme-nt
of the counselling relationship
ll'k:l"eases awareness ot emotions, including ambivalent feelings
Stimulates furthe( explOr'ation of clients' sut,ective ex.pe-riences
Helps clients (ecogrwle the impact of emotions oo themselves and others
Assists d ieots to uooerstand how emotions influence decision maid~ Of hOw they can
impede action
Provides a starting JX)int b managi~ and expressing emotions in constr'ucrive ways (e.g.,
r'e cogoiZi~ triggers)
and Shulman, 2009). Emp3thy is a powerful hdping tool nnd a core condition for nJI
hcJping rcJationships, reg3rdlcss of the counselling or therapeutic model adopted.
Among clients who abuse substance~ research shows that empathy is one of the
strongest predictors of success in reducing relapse (Miller, Forccchime~ & Zwcbcn,
201 I). Appropriate empathy communicates understanding, builds trust, and assists in
establishing the counsellor's credibility. Miller and Rollnid: (2002) conclude that the
degree of empathy expressed by counsellors is a signifteant determinant of the success
of clients in addictions treatment, whereas confrontationaJ counseJling leads to high
dropout rates and poor outcomes. P«>plc tend to protect thcmsdvcs from judgment
and rejection through defensive reactions or by e\lading disclosure; howeve.r, as Clark
(2007) obse.rves, empathic responses reduce ps,.·chologicaJ threat. Effective empathy is
nonjudgmental and it is non prescriptive (i.e., it docs not suggest that the client's feelings
need to be changed or "treated"). The counsellor's manner and cone convey acceptance,
comfort, and capacity co listen.
When counsellors arc empathic, they arc less likely to oversimplify complex prob-
lems. Because they understand more, they are aJso less prone to insult their clients with
wcll~mcnning but unusab le and premature advice. A common counselling error is to
move too quiclcl)• to problem solving when, for many clients, their difficulty is primaril)•
emotional. They may al'l"COOy have ready solutions to their problems, but emotional tur•
moil or ambivalence is a barrier preventing action. As a result, they arc unab le to engage
in taking action until the.ir emotionaJ needs are unde.rstood and managed. By assisting
clients to understand and manai;c feeling~ energy is freed up for problem solving and
clients ma)' be able to move ahead without further counsellor involvement.
Counsellors who accept the feelings of their clients help them accept themselves and
their feelings. Effective empathy honours the fact that clients have real and rational rt':lsons
for feeling as they do. Roi;crs (1980) note~ "True empathy is always free of any evaluative
or diagnrucic qualit)t The recipient perceives this with some surprise: 'If I am not being
juds;cd, pc.rhnps I am nm so evil or abnormal as I Juve thought. Perhaps I don't have to Jud~
myself so harshly.' Thus, the possibilit)• of sclf..acccptance is graduaJly increased" (p. 154).
Rogers further suggests that empathy is more than just a skill- it is a Wtt)' of
be.ing with another pe.rson. As he succinctly put it, "The ideal therapist is, first of aJI,
empathic" (1980, p. 146). As important as empathy is, it should not prcdude efforts
to understand other parts of clients' experience~ such as their thoughts, experiences,
behaviour, and the context in which they live the.ir lives.
Empathy aJso assists clients in identifying and labelling feelings, which allows them
to deal with thrue feelings. Moreover, with strong and supportive counsellor~ clients
can find the courage to den] with feelings that may have been too painful or overwhelm,.
ing to address on the.ir own. In this sense, empathy conrributcs to therapeutic chan,;c.
170 Chap1er 6
))I) BRAIN BYTE
Recent f&Seatch at the Mount Sinai Medical Center (2012) has huge futute implications foe conditions suctl as autis.m,
has found lhat an ate-a of the brain known as the antef10t dementia. and some perSOnality disol"derS whete a laek of
insular cortex is wtle-re empathy is p(ocesSed. This frnding empathy is a centtal feature.
Furthermore, clients often adopt the communication patterns of their counsellors.

Thus, counscllors who use empathic communication nnd other active listening skills
arc modelling skills that clients can use to improve their rcJationships with others.
CounscJlor empathy modcls a healthy and effective way of communiating.
To cmpathi.!e cffectivel't', counsellors need to be able to demonstrate comfon with
a wide range of feelings. For instance, they need to be able to talk openly about painful
feelings such as grief. Just as doctors and nurses need to be able to dea.1 with catastrophic
injury without losing control or running away, counscllors must develop their capacity
to w-ork with intense feelings without neo:ling to change the subject, intcllccruali!e, or
offer quid: fixes. Sometimes counsellors misinterpret this capacity as meaning that they
nttd to be emotionaJly detached nnd coldly indifferent. ln fact, empathic counseJlors
are deeply involved with the.ir clients. They put aside or suspend the.ir own reactions to
their clients' fccJings and adopt an accepting and nonjudgmental attitude.
Rogers (1961) emphasi!cs the neo:I to "sense the client's private world ns if it were
your own, but without ever losing the 'as if' qua1it)• . .. To sense the client's anger, fear,
or confusion as if it were your own, yet without your own anger, fear, or confusion
getting bound up in it" (p. 284). Rogers aJso provides this important observation about
emP3thy:
You 13)' aside your own "iews and "alueii in order t'O enter aiu>the-r'ii ",orld without
preJudiee. In some se~, it means that you lay aside )·Our self: thiii can only be done
by persons who are secure eoou~, in themselves that ther k°""• they will noc iet loiit
in what tlU)' tum out to be the !ltr.ln,ii' or bi:arre \\'Oddo( the other. ai,d th::u ther can
comfortablr return t'O their OYi'n world when ther wi.iih. (1980. p. 143)
An empathic connection does not mean that we endorse our clients' \'lews or
behaviour. As Miller nnd Rollnick (2002) note, "It is possible to accept and understand
a person's perspective while not agreeing with or endorsing it. Neither does an attitude
of acceptance prohibit the counselor from differing with the client's views nnd express-
ing that dive.ri;cncc" (p. 37). In extreme cases, clients may present with attirudcs and
behaviour that we find abhorrent- a man who has ab used his partner, for example.
Understanding this client's inner world in such a case may even be vitaJ, as it establishes
the counscllor's credibility for understanding and, subsequent!)•, as a potential influence
to help the client move toward non-violent responses. ln such situation~ empathic
efforts often help counsellors to become less reactive with their O\\•n feelings after they
learn about the complexities of their clients' lives.
> : •.
Gwen Oewaf (2015) reviewed fecent research on empathy fesearch suggests that we afe less sensitive to lhe pain and
and the bt'ain and re(X)rted a numbef ot significant findings. em::>tions of others when they are str-angers, members ot a
She found that ex(X)Sure to medta violanee can blunt ou, differ'ent race or subgroup, Or' individuals who am subject to
ability to be empathic to other'S. She also reported that the social stigma.

Client Reactions to Empathy
ClicnL,;; may respond to empathy differently. Posit ive reactions include:
■ ROOuction of pain through the rclensc of feelings (catharsis):
■ Increased insight as feelings arc rccogniz~, 13bellcd, and managed; and
Increased trust and rapport with the counscJlor.
Nc,zath·e reac.rions include:
■ Anger at the counsellor for crenting rhc conditions that led co their feelings being
exposed;
■ Embarrassment arising from fear of being judg,ed as wcalc;
■ A sense of intrusion if empathy violates pcrsonnJ, familial, or cukuroJ vaJucs that
preclude sharing feelings with others; and
■ Fear of continuing the counselling work if empathy pushes the client to deal with
feelings before they arc rc3dy.
Consequent!)•, in sessions where powerful feelings are reve3Jcd, counsellors should
leave time to process thedicms' rcoctions. This might uncover any feelings or concerns
that should be addressed before moving on, or it may prevent clients from dropping
out of counselling. Example-:
CounseUor. \Vhen you 1.-0 home toni~u and retlect about wh:u you shared rn,b)•. "-hat
do )'Ou think you m~t say to )'OurSelf!
Client: I think I'll beembr:lfr.l:;$$('d that I eriied. You must think I'm really w~k and (r.11i:Ut.
CounseUor. \VouJd )'Ou like to know how I (eel!
Client: Sure!
CounseUor. I'll tell you, but first I W'3nt to know i( )'Ou will belie,'t, rne.
Client: You\'t, always been up front with me. I'll believe )'Ou.
CounseUor. I think it took 2 lot o( ooura~ for )'Ou to be open with )'Our (eelin~s. and
I respect )'OU for takina th:u step. For me. it was 2 sian o( stren,tth.
In some e,ses, the di31o~ue mi$:ht take a different route sucl-i 2s the (olJowina:
Coun!l(>IJOr. I'll tell you, but first I W'3nt to know i( )'Ou will belie,'t, me.
Client: You·n probably just 5::1)' somethi11K to m.:11ke me (~I better.
CounseUor. So. let's talk about what needs t'O h:tppen before you ea.n trust me.
Sometimes clients who have shar~ dee-ply come to the next session dcte.rmined to
exercise more control over their emotions. They may appc3r defensive or withdrawn.
A lead such as, "\Vhat are )'OUr thoughts and feelings about the last rime we met?"
can be used to debrief the Inst meeting. On the other hand, it may be healthy to avoid
confronting this apparent resistance; instead, see it as a healthy W'n)' for the client to feel
safe and g:iin composure.
Angus and Greenberg (2011) su~cst that some clients have developed problematic
emotional responses that often originate from trauma. For example, if a client learned as
a child that closeness and kindness was followed by sexual abuse, then, as an adult, she
may respond to empathy and requests for intimacy as an impending violation. As a result,
counsellor empathy may be- met with anger and rejection, particularly in the early develop-
mental scages of the relationship. On the other hand, sensitive and weJl-timcd (measured)
empathy can provide an opponunity for he.r to begin to address how prior learning, while
protective at one time, now prevents her from dcvcJoping deep and meaningful relation.-
ships. Exploring emotions associated with the trauma can help her become unstuck from
automatic emotionaJ reocrions and ncrions that arc no longc.r useful or appropriate.
172 Chap1er 6
_ CONVERSATION 6.1
STUDE:NT: I WOtAd realty like 10 incfe-ase my empathy Slults. help se-nsitize you to their unique \'OCabulary. By adopting an
but my \'OCabulary is so limited. I seem to k.nO'N only a few attitude ot inte-test and curiosity and focus~ on feelf'lgs, you
fooling v.()fdS, such as happy, sad, scafed, and angry. How can dramaticaly k'letease your vocabulary. AnOlher suategy
can I increase my feeling WOtd d'loice? 'llf'len listening to clients is to lty to recall footings that you
migt.l have had in similar d r'Cumstances. This might give you
TEACH£R: It's not necessary to have an eocyctopedic \'OCabu-
la,y, but you should have eoough WOr'd ctu:ice to capture a
some ten1ati\ie: ideas abOul what yolM' dien1 could be fooling.
tx"oad range ot feelings. Study Table 6.1 (which appeared STUDE:NT: What abOut the danger ot imposing my feeli~
earlier in thi:S chapter) for new feeling v.«ds: 100n take advan- on them?
tage ot every opportunity to practice empathy and use U'lese
v.()rdS. The lnte-r~t has many s,tes 1001 feature leeli~ word TEACHER: Yes, lhat is atways a tisk. Hence the need to be
inventOl'ies and these can be usehA, but remember that feel- tentative, remembering that people may respond to IM
ings are often mixed. Try reading books and watching TV same situation in widety different ways. NevertheleSs, there
with a special ear for discemiog how people are feeling. One are often SCll'M comrn:::,n aoo predic1able emotions fot most
of the t>est ways is to use invtlational empathy to as.k others people in a given situation. It's also important to w0tk on
hoN they feel. then to listen carefully to their WOtds. This wil beeoming aware of yout own lee6~.
TYPES OF EMPATHY
The three types of empnrhy arc invitational cmp3thy, basic cmP3thy, 3nd inferred cmpa,
thy. \\:'Ith invirotionaJ empnthy, a counsellor uses strategies to encourage clients to rolk
about thc.ir fcclings. With basic empath)•, a counsellor mirrors what the client has explic-
itly said. And with inferr~ empathy, a counsellor reaches empathic undc.rst:mding b)•
interpreting subtle dues. At 30)' point in an interview, counsellors can use empnthy to
explore a client's bdi.aviour, thinking, or feelings. \\:'hen counscllors focus on behaviour,
they explore what clients arc doing or saying or they shift anemion to problem solving.
When they pursue thinking, they are interested in their clients' bcliefs and assumption~
including their inner dialogue and self-esteem. Empnthy enables counsellors to pay pri-
mary anention to the third area-feelings (Figure 6.1). Frequently, counsellors are too
anxious to solve prob lems, and they move the interview focus prematurely to prob lem
Thinking
Feelings
Figure 6.1 Empathy Focuses the Work of Counselling on the Feeling Domain

solving, ignoring, or discounting whnt may be more important thnn solution~ their
clients' feelings.
Invitational Empathy
invitational empathy: Ato:il a
counsel!« uses to ..,ur;aie clieali to I m •itational empathy encouragesdients to explore emotions. It signals intent (or an invi,.
esi,:lore eaotioa.
tntion) to move the interview 3'\-,t)' from one of the other domains (behaviour/problem
solving or thinking) to a focus on emotions. lnvitationaJ empathy is initiated with a simple
question such a~ "How do you feel?" Another choice is to say something like, "It might
be helpful if we put solving this problem aside for a moment to explore how you feel."
lf appropriate, counsellors can make further process comments about the importance of
addressing feelings as an integral part of problem management. lnvirotional empathy SO)'S
to the diem that the counsellor is re3dy and able to ta1k about difficult feelings.
Todo this, counsellors can draw on their knowledge of human growth and devclop-
mcm, such as ways thnt people tend to deal with particular life evcms and crises. Some
clients are reluctant to share their feelings for fear of judgment, or they ma,., believe
that they shouldn't feel a particular way. Others may think they arc the "only one" or
that they are "crazy," "evil," or "abnormal." For example, it is common to feel some
relief, even happiness (as well as grief) when a loved one who has been struggling with a
painful illness dies, but a diem may feel guilty for feeling this''",.)'· Invitational empathy
normalizes the expc.ricncc, making it easier for the client to talk about it and accept it:
"h's normal at a time like this to struggle with mixed foeli~rief, pain, comfort, and
perhaps joy that her suffering is at an end."
By encouraging clients to talk about feelings and then responding nonjudgmentally,
the counsellor is saying, "It's olcny to fee] this way." In the following example, the coun.-
scJlor uses invitational empathy to "give permission" to a client who might othenvise
suppress or ignore his pain to experience and verbali.!c his emotions:
Client: I ttuess it's no biide3L So. wh:lt i( the)' know the scoop on my m::arit::il problems.!
CounS(>IJOr. A lot o( people in the S3me situation 1ni~t (eel emb::ar~ a.nd perhaps
di~ppointed or :l..11ir)' that a (rie:nd oouJd be so indiscreet about son~hi1'{t ~id in
eonf",denee.
In the following example, the counsellor uses nonverbal cues as a basis for invirn,.
tionnl empathy to encourage the client to explore a difficult topic:
CounS(>IJOr. \VouJd )'Ou mind i( I shared 2n obser\'ation with rou! I ,nay be wron~. so
I'd like your opin.On.
Client: Sure. 1.-0 ahead. 53,., it.
CounS(>IJOr. I notiee that wbene,'er mention o( )'Our l2ther eomes up. you seem keen
10 ehan~ the topie.
(Lon,g s1lmce; dknt starts a, tht- jloorJ
CounseUor. Some memories are p.,infol- maybe e"en too painful to talk 2bout.
Client: (So/d,. tears ln hiseyd..) h's just th3t his death wu so unexptteed. ~e h:ld 2 fl$:ht
th:11 mornilli, 2nd I didn't e"en i.~t a eh:1..1,ee to sar ~b)'e.
Invitational empathy begins with questions and responses tnrgctcd at encouraging
clients to express feelings. The choice o( strategy is influenced by the usual variables,
including the amount of trust in the relationship. time constraint~ culture, and the
counsellor's role. Timing is one o( the most important variables. Since the exploration
o( feelings can be time.consuming, it is important for counsellors to make sure that
they have enough time to complete the process. Intelligent use of silence is another
important variable. Clients may need thc.ir counsellors to patiendy listen and restrain
themselves from filling evc.ry silent moment with words.
174 Chap1er 6
One w3y to brid,;c the inte.rvicw into 3 discussion of feelings is to use invitational
statements, such 3S "I don't know how you fed, but if you're feeling pain or lonelines~
I'm f'COOy to listen." Comments such as "I need 't'our hdp in understanding: your feel-
ings" c3n also move the interview into the 3ffcctive-or feding--area.
Frequently, clients pro\•ide n3tural opportunities when thq• give hints about how
they are feeling:. Then the counsellor can use questions to encourage further sharing.
Open questions promote clients to sh3re feelings: "How 3re you feeling?" "\Vhat feel-
ings best describe how 't'OU reacted!" Closed questions t3Jl:Ct spccifte information 3bout
feelings: "Did you fed angry?" "ls this something: you feel strongly 3bout!"
Helping clients understand the importance of 3ddressing feelings is 3n important
step th3t keeps clients involved in decision m3king (contracting). \Vhcn counsellors
inform cliems and solicit their support for the proces~ clients' motivation is higher.
He.re are some sample lc3ds:
■ I think it might hdp if we shift our focus and talk 3 bit about how you feel. This
might hclp us both to understand why your decision is so difficult.
■ \Ve haven't yet talked about your feelings. In my experience, feelings often present
one of the biggest b3rricrs.
■ Umil feelings arc unde.rstood 3nd 3Ccepted, they can distort our thinking: 3nd even
reduce the 3mount of control we have ove.r our behaviour. So 't'OU might find it
useful if we spend some time exploring how you feel
In addition, directives c3n be used to move the interview into the feeJing are3: "Tell
me how you feel." "let's switch our focus and talk about your feelings.'' Directives arc
one w3y to man3g,e the flow and focus of the interview.
Moreover, with some clients, counsellor sclf-disdosure is 3 Pffi\'Crful tool if used
sparingl,.•: "I don't know how it is for you, but I know that for m3ny months 3ftcr my
marri3g,eended, I was in a state of shock."
Another tool for exploring fcding.s is the sentence completion statement. Sentence
completion statements give counsellors a way to focus feelings on a particular arc3, and
they give freedom to clients to control the 3nswer.
■ \Y./hen I think about 31) my problems., I feel . ..
■ If I could use one feeling to describe my situ3tion, it ,vould be .
■ \Y./hen I first came for counselling., 1 fclt .
■ The feelings th3t 1 most nttd to deal with arc . .
But invit3tion3l cmp3thy should 3fways respect the clients' rights to privacy. Many
variables., especially trust, imp3Ct the e>..'tent that any client is willing to open up and
discuss fceJings. In addition, vari3bles such as gender, past experience, socializ3tion,
mood, 3nd power issues can also influence how much individuals 3re willing to share.
Basic Empathy
'With basic empathy, counsellors perceive 3nd respond to feeJings that 3rc explicitly basic empathy: AtounS!lor's
communic3ted. Basic cmP3th't' ma't' involve labelling feelings or summ3ri! ing expressed actnCMtedg_•nt d adienrs cleafty
a,mmunicated feelings.
feelings. Frequently, clients W3nt to talk about feelings. particular!,.• those closely rclated
to their problem situations. \Vhcn they take the initiative to introduce feeJing.s, it is
relatively easy and nonthreatening for counsellors to respond with b3sic empathy. &sic
e.mP3thy simply Sll't'S. ") have heard how you foe], 3nd 1 accept your feeJings without
judgment." \Vith b3sic cmp3thy, no anempt is made to interpret, judge. or promote
greater 3Warcness or insight beyond that which the client h3s alre3d't' 3rticulatcd.
Despite its apparent simplicity, basic empathy c3n be a powerful heJping tool. \Y./hcn
people express feelings in evcl)•tfoy communication, they may be blocked or discouraged

when others react by judging. ignoring, or giving advice. For example, one common but
o:trc.mel,., unhelpful response is "You shouldn't ftt.l that way." ln contrast, basic c.mpGthy
crc3tcs a clim:.nc in which clients do not have to defend or hide the.ir feelings. For m3ny
people, basic e.mP3th)• responses arc an unusual and satisfying cxpe.ricnce. As one client
described it, "For the first time, I felt safe. Someone had finally listen~ and heard me."
Furthermore, counsellors who puncruatc their work with frequent empathy are
more likely to build rapport and evoke further information from clients. Simple logic
suggests that when people bclicve that they are accepted and understood, they are more
likely to feel secure and less likcly to raise defences. As a result, clients are more inclined
to share and o:plore at a deeper level of intimacy than they would under more threaten-
ing conditions. The following example illustrates basic empathy:
Clien t: I wu ready to ki.11 her. How eouJd she embarr"3SS me in front of all those people!
CounseUor. So )'Ou' n:- a.n¥rY th:n she d,dn't h::r\'e e:nouah sense to ke"('p quiet.
Clien t: Anary. but ~lso hurt. After all. she w;,is supposed to be In)' be!it friend . How
eould !ihe double<ro!i!i me!
CounseUor. Sounds as if )'Ou fe"('I betr.tyed.
But empathic responses also need to be presented with an air of tentativeness to

give clients an opportunity to offe.r corrections. A simple pause or a question such as
"Have I j;O( it right?" can be used to this end.
SUCCESS TIP
To make simple, yet effective, empathic r e s ~ use lhis format:
~vou fool . .. (add tee1,n g wotd) because .. . (add contMtT
Inferred Empathy
inferred empathy: IN ificatia.ol a I nferred empathy, sometimes called ad,~nced empathy (Egan & Schroeder, 2009),
clients"feEfings based • IOIIYttbal 00.S involves identifying clients' feelings b3scd on nonverbal cue~ theme~ and hints. Coun,-
•d indited cca.aicatica
sellors should also pay careful attention to what their clients do 00( say, including topics
they ::rvoid and sudden shifts in focus. lnforr~ empathy is a pO\\•erful counselling tool
that enables clients to dC3l with feelings at a level deeper than expressed emotions.
Some clients find that their trust level incrc3scs when counsellors identify their hid.-
den feelings: "M 't' counsellor seemed to know how I felt without my saying so. Finally,
I felt understood. In fact, I began to understand myself better." Moreover, inferred
empathy may be P3rticulnrly useful with clients who lack feeling vocnbula.ry or arc unac-
customed to expressing feelings. lnfe.rred empath)• s«ms to say, "I have thecouraae and
the ability to hC3.r your feelings."
Clien t: It was a tou~, !iitu::ttion. Here I W3$ in front o( ~ll those people with 11\)' prh'3te
life hl1id lxtre.
CounseUor. From the tea.rS in )'Our eyes. I suspect this w;,is a painful ::tnd emb::trraS.Sll1i
moment for )'Ou.
In the pr«eding o:ample, the client sec.ms willing co explore her experience, yet she
stops short of wrbally identifying her feelings. The counsellor takes a mild empathic risk
and considers context and nonverbal cues to infer empathy. lnfcrr~ empathy should
always be present~ tentatively to allow room for correction and further exploration.
With inferred empathy, some speculation based on the evidence of feelings is nec-
essary. Consequently, there is more risk involved than with basic empathy. There are
two significant risks. First. because the information b3sc for infc.rrcd cmp3thy is more
ambiauou~ more errors arc likcl)t Hence, counsellors should be especially tentative with
176 Chap1er 6
inferred empathy. As wcll, counseJlors should nvoid becoming overly speculative to the
point where they arc simpl)• guessing at their clients' feelings. Second, inferred emp3thy
may be met with resistance from clients who are unwilling or unable to acknowlcd,;e
their feeJings. Inferred empathy notices subtle cues, and clients ma)' be surprised to
henr that their ftt.lings h.nve been communicated. They may renc:t with anger and resent-
ment that their feelings have been uncovered. In addition, some clients are afraid of the
intensity of the.ir feelings, whereas others have strong needs for privacy. Thu~ inferred
emP3thy must be timed appropriately. The counselling rcJntionship should have a rea,
son.able level of trust, and the counselling session should h.nve sufficient time left to
process any renctions. Otherwise, it is best to defer inferred empathic responses till later.
Since inferred empnthy involves "reading" the client, counsellors need to de,.'Clop
skills in this aren. First, clients provide clues to their feelings in a number of ways. They
might be emb3rrassed about shnring their feelings or reluctant to ask for help, so they
talk about a "friend who has n problem." Second, as stressed earlier, understanding
nonverbal behaviour is crucial. Astute counsellors learn a great deal about the.ir clients'
feelings b\• carefully observing: changes in voice tone, sudden shifts in posture, nervous
behaviour, ten.rs, grimace~ clenched fist~ finger tapping, and smiling. As \\'CII, certain
behaviours can suggest feeJings. For example, a boy who runs away from a group home
just before a visit from his mother may be saying something about his fe3r or anger. A
client who arrives late, refuses to take his co3t off, and sits with arms folded across his
chest might be saying, "I don't want to be here."
SUCCESS TIP
Yv'hen lhefe afe time pfess.ures, counsellOrS tend to locus more on task at the expense of
felationship. Appfopriate and pfoportional empathy, even when time is limited, helps che-nts
to manage beltet than if the interview Of encountef addressed only task.
People often express emotions using analogies. For example, a client who comp3res
his life to a speeding train may be expressing his fears of be.ing out of control. Some
clients hint at the.ir feelings by asking questions, such as "Do )'OU worry about your kids
when they arc out late at night?" ln addition, clients who minimize problem~ as in "I
h.nve a bit of a problem. Do you have a minute?" or "This is probably not impormnt,"
may be signaling: that they have sianificant issues and feelings that they need to discuss.
Preparatory Empathy
Tuning: in, or preparatory empathy (Shulman, 2009), is another useful way to prcpnre preparato,y empathy: Atounsfflor's
for inferred empathy. Prep3ratory empathy is n prcJiminary phase skill that involves 11netJf1 to a.sider (in advafltf al the
interviewJ the feelings and CCIC'fflS t!l.i'!
trying to anticip3te the feelings and concerns that clients might bring up in the inter- tile client may commllicate ida::tly.
view. Since clients often do not directly revenJ their feelings, tuning in helps counseJlors
anticiP3te how clients might communicate feelings indirectly. Shulman (2CX>9) illustrates
tuning in with a common exnmple involving an e.ncounter between a ll•ye3r-old coun-
sclling novice and a 38-year-old mother of seven children. The mother asked the worker,
"Do you have any children!" The worker responded defonsivdy by talking nbout her
training: in child psychology. Shulman sugi;ests th.nt the worker missed the implicit feel-
ings expressed by the mother- the fear that the worker will not understand her. Had
she used the tuning-in skill, the worker might have been able to consider in advance the
range of feelings that a mother of seven kids miWlt have when meeting with a young
counsellor who has nochildrcn. With such advance prcpnration, the worker might have
been more sensitive to the mother's real question, perhaps responding, "No, J don't have
any children. \\:rhy do 't'OU ask? Are you wondering if J'm going to be able to understand
what it's like for you having to raise so many? J'm concerned about that as well. If I'm

to help you, J'm goina to have to understand, and you are going to have to hdp me to
understand" (Shulman, 2009, p. 57). This response is an excdlent illustration of genu.-
inenes~ which in this case provides an opportunity for a discussion of the mother's
feelings about w-orkcrs and gives the ,vorker a chance to share her own feelings. Similar
counsellor strategies might be appropriate for diem question~ such as, "Have 't'OU ever
been to jail!" "Do you know what it's like to live on the srreed" and "How old are you?"
Table 6.4 summarizes the three types of empathy.
TABLE 6.4 Types of Empathy

Type OescrfptJon Maj<M" Use Comments
Invitational E~agtng dients to To stimulate discussion of Invitational empathy undet'scores the ll11portance
&alk. abOul feelings emotions of emotions. It counter'S any tendency to m::we too
To oonnalile feelings quickly to problem solving without fully considering
the role that emotions ~y.
Basie ResJX)ndl"lg to clearly To encoufage continued Basic empathy contributes to the 00Vt>lopmen1 ot
aflkulated feelings expmssioo of feelings trust It signats to clients that counsellors are wifli~
To connrm capacity to hear and able to deal with feedngs.
feelings
Inferred ResJX)ndl"lg to To move feelW'lgs into lnte«ed empathy may genel'ate tnOr'e anxiety in some
oonve-rbal cues and the verbal chanool ot clients if feelings that they avoided, suppressed, Or'
other indicators of communi::ation wanted to keep hidden are made visible.
feeti~ lnte«ed empathy may ptOO'lote dien1 insight.
))) CONVERSATION 6.2
SllJDENT: I don, think empathy is always such a good thing. Other clients W'ho may 001 be ready lor empathy are lhOse
1watd'led one taped interview of car1 Rogers and two olhe:f who are so caught up in their own talking lhat they do 001
lherapists interviewing the same client, GIOria. If I had been even hear empathic statements. As Shea (1998) suggests,
Roger'S's client, I wolld have been irtitated. He seemed to attemprs to empathi:ze with this woup may adualy be coun-
continualy regtXgitate what the dient had just said. terproductive because empathy interferes with what lhey
want most-an audience to listen.
TEACHIR: You've l'aised a good point. Too much empathy,
particl.Aar1y wtlen you get stuek at a basic level. migt\t leave STUDENT: I lhink one way to handle that is to test y()U( client's
you and )'OIX client going in circtes.. It's alSO true that If you capacity fOr' empathy with a few bask empathic Slaternents.
move too fast With empathy, your dients can lee! lhr-eataned If lhey a(e not well received, you can baek off by switching to
and put up lhell defences. This is particularly tfue with cli- less demancfi~ content or more basic empathy.
ents W'ho have stfong needs for privacy. They may view your
TEACHER: t ag,-ee, back off, but not fore.....! As kust - p s ,
empathic statements as an unwanted intrusion into their
the dient may welcome that same empathic response Iha!
feelings. Empathy invites greater relationslip intimacy, and
he Or' she at fir'Sl rejected. To continue 100 lisl of times 'llf'len
some clients are 001 ready lor the (isks that this entaits. As
empathy may not be a good idea, I'd add the lollOwi~:
Clark (2007) noted, Msome fand the emotional closeooss
of 100 therapeutic retationShip threatening and invasrve· • YOIX clients reject empathy.
(p. 37). Some clients open up to empathic responses only to • It's dear1y time to move on to ptoblem Sdving Or' another
tater regret having revealed too much. They may ·ciam up· activity.
in future sessions, nevef return to counselli~. or they may
• Empathy is continuousty misinterpteted by the client
(esent their counsellors f0t allov.i~ that to happen.
(e.g., as conttolling or intrusive).
But~ trough you migt\t have been irritated. it's s'lteresti~ to
note that, years late(, Rogers's client Gtoria described OOH he( We Should always remember that counselling techniques
Sim time Vfilh Rogers was lite~hangj~ for het. This reo'lindS will not work the same way wtth al clients. Cultul'al norms,
us that cliants respond diffet'antly to the same techl'lique. Be tlUSI IM!I, mOOd, and personal resiliency are au vartableS that
cam/'-' lhal )W' P<!(Cei:,ion of !he Rcgers tape doesn1 dO!e( )<lU influence how empathy is received.
from using empathy. It may be e""'-1Jy wt,at )<lU' cloot . - s.
178 Chap1er 6
FOUR GENERALIZATIONS ABOUT EMPATHY
Generalization One \'(Ihm dienu share feelings, empathy is (more often th.an nO() che
preferred response. A positive reinforcer "prescmcd immediately following n bch.nviour
C3uscs the bch3viour to increase in frttiuency" (M3rtin & Pear, 201 I). Clients talcc
an intcrpc.rsonaJ risk when they share their fccJings. EmP3thy acknowledges this risk
by conveying recognition and acccpcancc of the client's fccJings. Empathic responses
are a reward for sharing that conveys the mem-messaj;c: "This is a safe place to bring
your feelings." ln this way, it rc.inforccs the wisdom of the risk and motivates clients to
continue sharing feelings. On the other hand, when clients share feelings and they arc
not rc\\'tlrded (or reinforced) with cmpnrhy, rhc:n they tend to keep their feelings more
private. Non-empathic responses to expressed feelings carry the mct3•message, "Your
feelings 3rc not important." or " I'm not comfortable miking about wh3t you're feel.
ing." This underscores the importance of ex-pressing cmp3thy C3rly in the rcl3tionship.
When dealing with reluctant or mandated client~ empathy provides a w3y to acknowl•
edge and validate their strong emotions. Subsequently, as these clients feel understood
3nd listened to, their reluctance will often lessen.
Generalization Two Risk expre.ssing emparh1 eart, in rhe relarioru.hip. Norms, once
esmblishcd, arc difficult to alter. E3rly cmp3thy helps form the norm th3t the counsel-
ling relationship is 3 safe place to express feelings. To become comfort3ble with empa•
thy, counsellors need to overcome their own fenrs about bringing emotions into the
foreground. Many counsellors fear that by encouraging clients to express emotions,
they might trigger extreme reactions, p3rticularly suicide, but this fear is not substami•
3tcd by research. ln fact, it takes energy to suppress emotions; therefore, by helping
clients express 3nd get in touch with their feelings, counsellors can help them decrc3sc
the ncg:itivc effects of these feelings.
(nvimtional empathy is useful for working with clients who arc reluctant or unable
to articulnte feelings. Counsellor timing is criticnl, and counsellors should present invi•
tational cmp3thy in a gentle and tentative m3nne.r.
Early in the counsclling relntionship, counsellors should give priority to acquiring,
maintaining, 3nd deepening empathic undcrst3nding by rcm3ining alert to emp3thic
opponunitics. One obvious opponunity arises whenever clients vcrbali:e feelings. ln
such moments, counsellors can use basic empathy to confirm understanding. Some•
times clients rcve3J feelings nonvcrb31Jy, and counsellors c3n use inferred empathy.
When clients h3\'C not sh3red their feelings, counsellors c3n 3dopt invitation3f empathy
to encourage them to share their emotions.
Generalization Three Netff as.Rime rhar U't' ain know anorher penon's emorions in rite
way char rhcyknoui them. People often try to be understanding 3nd comp3ssionatc by say-
ing, "I know just how 't'OU feel." \\:fhilc this response h3s the potential to be supportive,
it is more likely that it will sabotage further opportunity for exploration and IC3rning. h
docs not honour the fact that each of us emotion:.dly processes experiences in our O\\•n
way. The fact that we h3ve h3d a similar experience does not give us C3SY access to instant
understanding. Our own cxpc.ricnce, with 311 of its assocfatcd memories, emotions, 3nd
outcomes, m3y 3ctu3Jly be a b3rricr to empathizing. Empathy requires th3t we ,vork to
see the world from the client's perspective. This means th3t we must carefully gu3rd
3g3inst bi3~hc n3tural tendency to 3ssumc that how we feel or have felt under like cir•
cumsta.nccs is how the client is feeling. High-le\'CI sclf-awarencss, he3lthy curiosity, 3nd
humility about our limited capacity to appreciate the client's emotions arc prerequisites.
Active listening. P3rticularly empathy, will help us to get closer to this go3I.
"I know just how 't'OU feel" also discourages people from the C3tharric benefit of
telling their storr~nc of the most therapeutic outcomes of active listening. Jc hij3cks

any opporrunity for the counscJlor to learn. Since we aJrc:ady "lcnow" what the person
foe.ls, what point is the.re in discus.sing it?
Counsellors should express empathy tentatively. Thu~ it is important to chc:c:k
with clients to confirm empathic understanding. Counsellors need to refrain from
using empathy as a wc:apon by insisting that their clients must feel a particular way.
Counsellors should also look for indicators that clients have accepted their empathy
and that it is accurate:. Clients provide confirmation through head nods, smiles, mani.-
festing rcduc~ anxiety, and verbal confirmation (e.g., "That's right" or "You seem to
know exactly how I'm feeling even before I tcll you"). Clients also implicitly confirm
willingness to accept empathy when they continue: to sh.arc feelings at a deeper level.
Conversely, clients may verbally signal that empathy has missed the mark (e.g., by saying
"No" or "That's not right")or with subtler nonverbal and paraverbaJ messages. Some
clients who are reluctant to challenge: may agree with empathy that is off the mark, so
it is important to remain aJcrt for contradictory nonverbaJ messages such as tentative
voice tone (e.g., "I guess so") or hesitation in their responses.
Sometime~ empathy misses the target and clients offer corrections. This is good
news and should be view~ as an important and positive: outcome: of empathic rislc.
Empathy is a devcJopmc:ntal process rttiuiring counsellors to remain open to adjusting
and refining their understanding until they reach a point of shared meaning with their
clients. Moreover, when clients correct their counsellors, counsellors know that they
can trust them 00( to capitulate.
Generalization Four Empachy requires flexibility in its use. induding che abilicy to refrain
from using ic. Empathy is an important and powerful skill, but counsellors need to use it
intcJligc:ndy. \\:fhcn clients arc willing to address feeling~ empathic responses are dfcc,.
tivc (sec Table 6.5 for sugi;c:stions). \Vith some client~ empathic statements result in
the opposite of what was intended. lnstead of deepening trust and encouraging clients
to open up. empathy arouses defences. This may happen when empathy targets feelings
that clients would prefer to hide, or when clients experience empathy as invading their
personal space. When clients resist empathy by withdrawing or becoming defensive,
counsellors should discontinue: using it for a while.
SUCCESS TIP
If clients exl)f&SSfeeling. respond wrth empathy. Risk ex.pressing empathy early in lhe rela-
tionshiJ). Be tentative-we can nevef fully ktlO'N how othet'S fool. Oew!loJ) ftexibifily (hO'N,
when, and when n01 to use empathy).
Moreover, situationaJ difforc:ncc:s influence how the work of empathy unfolds.

Some clients arc verba.1 and open with their feelings. They arc likely to respond posi.-
tivcJy to empathy. Others need gentle encouragement to tallc about feelings. and they
open up discussion of feelings gradually and in a very controlled manner. Counsellors
will gc:nc.raJJ,., find that they encounter less resistance: when they match their clients' pace.
TABLE 6.5 The Empathic Communication Process

Decide if it is an app,q:iriate tme to exi;:b'e emciions (coosider' cootext,. limi.-.i aoo 1e-..e1 of trusa).
Use invitat.iooal empathy to initiate discussion of feelings.
Pay attentbn to vefbal and nonvetbal inclkators of emotion.
ExplOl'e feelings fOr' detail, deflnition, and ex:amJ)le.
Forml.Jate a tentative empathic msponse.
Wait b Or' encour"3ge the d ienl to con.firm Or' COtr'ect your' empathic: perception.
COl'r'OCt 01' offer a doope:f empathic r'es:i:x:>nse baSed on the clien1's r'&S,:)Onse.
180 Chap1er 6
Empathic Response Leads
Using 3 range of different responses adds interest and variety to the interview. Using the
same words and phrases too often can irritate clients and reduce the interview's energy
3nd vitality. Having 3 ran,;c of leads for empathic response prevents the interview from
sounding artificial or robotic. The following list sugi;csts some variations.
I m •itational Empathy
■ How/\Vh.nt do you fed? (open question)

■ Do you want to tallc about your feelings! (do.scd question)
■ I'm wondering how you are feeling. (indirect question)
■ Tell me how you feel (directive)
■ Any thoughts on how thnt made you foci! (dosed question)
Basic Empathy
■ You foel .
■ My sense is that 't'OU might be feeling ...
■ From your point of view .
■ As you sec it . .
■ I w-ondcr if what you' re S3ying/fcding is .
■ You appcar to be feeling .
I nferred Empathy
■ Your tears suggest chat you might be feeling .
■ You've become very quiet. Perhaps )'OU are feeling .. .
■ One the.me th3t keeps coming up in what )'OU are saying is . .
■ \Vhen you taJk about .. . 1 sense you feel .
■ \Vhat 1 understand from wh3t you have said is .
SUCCESS TIP
A tMtative tone and a pause fof further dient input or correction is an important part of any
empathic tesponse.
Why Achieving Empathic Understanding Is So Difficult

Empathic errors are ,;enernJly unlikely when counsellors are simil3r to their clients
(in a,;e, gender, race, etc.) 3nd when they have had simil3r problems 3nd experiences;
however, even in these situations., empathic errors C3n happen if counsellors do 00(
separate their own experiences from those of their clients. CounseJlors need to reme.m-
ber to nJlow for individu3l differences by remembering th3t, however, simifor their O\\' n
experiences might be. they c3n never fully understand how their clients feel. Through
emP3thy, they can ,;et 3 sense of their clients' feelings 3nd rise 3bove imposing the.ir own
interprct3tions., feeling~ and judgment~ but this understanding will never be perfect.
Empath)• is perhaps the most difficult counselling skill to master. Empathy demands
a lot of mentaJ energy from counsellors. First. they must man3g,e their own emotioMI
and judgmemal reactions. Then they h3ve to find meaning and discover feelings from
their clients' verbal and nonve.rbal communication. This can be exceptionally demand•
ing since clients m3y keep fccJings hidden or suppressed, or l3ck underst3nding and

nwarcncss of their emotions. Relationship issues, including lade of trust, cmb3rrass-
mcm, and fear of being judged, can inhibit clients from disclosing. For example, there
may be societal, cultural, or personaJ norms thnt prohibit sharing of feelings. Or clients
may not have the ability (language) to communicate their emotions.
Further complicating theempnthic process is the fact that counsellors must respond
right away. Jn nn interview, there is no time to use a thesaurus or a dictionary and no
opportunity to consult others, rehearse the.ir empathy, or ponder the feeling state of
their clients. Empathic risk means daring to share percejvcd understanding with clients
using concrete words and phrases that are accessible in the siruation.
Poor Substitutes for Empathy

\Vhen counseJlors express empathy, they adcnowlcdgc the feelings that cliems have
expressed (verbally and/or nonverbally). They might include a brief "because" clnuse
that summari!es content. ln most siruation~ they will stop there. This gives clients a
chance to process what they have hc3rd, to offer correction~ or possibly to share at n
deeper level. At this point, counsellors should avoid cutoff responses, subject changes,
empty responses, sympathy, or any other response thnt divens attention nwn't' from
empathy.
Cutoffs Cutoffs are phrases thnt inhibit the further expression of feeling. Counsd-
lors who make statements such n~ "Don't fed ... " and "You should feel ... " aredem.-
onstrating a low level of understanding nnd acceptance of how their clients feel. Such
statements are not supportive. They force clients to defend their feelings. Similnrly,
when counseJlors nsk clients questions such as "Why do you feel like that!" n judgmcn,-
ta1 tone is present that can leave clients feeling defensive (sec Chapter S).
Another response that may inhibit clients is silence. \Vhcn clients risk sharing
feelings, empnthy is bener than silence. \Vhcn counseJlors fnil to aclcnowledi;c feelings,
they mn't' be saying, "This is 00( important" or "I'm 00( capnblc of dealing with your
emotions.'' ln response, clients might fee] abnndoned, embarrassed, or judg,ed.
CounseJlors can also make the mistake of cutting clients off by changing the subject
or offering advice. A subject change gives the mem,-messagc "Let's not talk about that."
C lient: Sometimes when he speaks t'O me that way. I Just want to '--o hide in 2 corner.
CounS(>JIOr I (appropriate empath)'): It sounds like m.:1ybe you're (~lu~ emb,urassed.
Counsellor 2 (in2pproprb1te empathr ~ubject jhift): It sounds like ma)·be ,..ou're
(eel in¥ embarrassed. Would you hk.e
t'O talk about ways o( O\~roomlfl¥ it?
Empty Responses Empty responses arc de-void of content. Phrases such as "I hear
what )'OU'rc S3ying" and "I understand what )'OU mean" convey no confirmation that
the counsellor has understood. Another empty response is P3rroting, or repeating
what the client has said. Egan and Schroeder (2009) describe p3rroting as "a parody
of emP3thy" (p. 145). ln contrast, empnthy communicates the counseJlor's cffon to go
beyond merely he~uing the words to understanding the client's feelings and perspec-
tives. Using empathy, the counseJlor rephrases the client's statements and nssigns labels
to feelings that the client has expressed but not named.
Be aware that diches and platitudes, such as "Everybody has to have a little pain
in their life," pntroni!e and reject clients' feelings. As Egan and Schroeder (2009) put
it, dic.hcd responses say, "You don't really have a problem at all, at least not a serious
one" (p. 145).
Sympathy Sympnthy and empnthy are frcqucnth• confused, and many people view
them as idcnticaJ; however, there arc important and signif,cant differences between the
nvo concepts. Sympathy refers to concern for other people's problems and emotions
182 Chap1er 6
))!} INTERVIEW 6.1
The following excerpt illustrates some of the itMpProprldte responses that counseuors som~imes use instead of empathy.
lgno,ing feelings and offeting empty resPonses, simplistic advice, and sympathy are inadequate substitutes fOI empathy.
Client: (Softly, with tears fr, he( eyes.) I just haven't been Analysl$: /napproprfate to,:,lc shift: TM client Is clearly experi-
lhe same since he left. I Sltl look out lhe dOOr' and ex.peel encing ,:,aln, perhaps grief, and she trusts the counselk:Jt enough
him to come hOme. to share these feellngs. Generally. when clients share feelings,
Counsellor: How old was he when he ran away? particu/.vty feelings that are strong. empathy is the prefe"ed
resp(J('ISe. The counsel/Ors response shifts the foe.us away from
feelings to content. This may subtly signal to the client that the
counse.llor is uncomfortable with feelings. Continual shifts such
as this will ..,,afn" the client not to share feelings.
Client: He was just 16. I still tt'IOu~tof him asmy OOby. NON
I go to Sleep at nighl wondering v.tiethet he's dead or alive.
Counsellor: You thOught of him as you( baby. Now you go Analysis: Parroting. Repetition at this Point sl!M!'S no purpose.
to sloop at ~ t wonderi~ wtlethet he's dead O( alive. Some.times key wo,ds o, phrases can be emphasized as a w.,y to
Silence. focus attention. but this type of parroting ;s inappropriate here.
Counsellor: I unde-rstand hoN you feel. Analysis: Superficial response. The counsellor tries to be sup-
Cllent (Buries her face itt her hands.) Sometimes I just J)Ol'live, but the response is empty. Until the counsellor rls.k.s
don'I ktlow vd'lether I can go on livi~. If something ooe-sn't empathy with specific feeling words and phrases. the client
happen soon. then .. . (Counsel/Or intertuf)ls...) cannot know whether she has. in fact, been heard.
Counsellor: You have to lhink of you( hUSband and you( Analysis: Misguided rescue attempt. Ignoring feelings. It seems
other- chilclreo. Obvious that th;s courrselkJr ls unable to deal with the Powerful
ClleM: Yes, I ktlO'N, but dO you have any ide-a wtlat I'm feelings that the client presents. After an ill-timed interruption,
going th(ough? How tough it is just to get out of bed in the counsellor offers a misguided and simplistic solutkm, while
100 momiog?
Ignoring the emotions the client ex.pressed.
Counsellor: My guess is that you feel vety a~ry at lhe Analysis: Inaccurate empathy. The counsellor-attempts infe"ed
wor1d, maybe- e-ve-n some guilt that you are- someho-N empathy. Unforlunately, there Is insufficient evidenc.e to sup.
,esponsible fot you( son's running away. Port the counsellOrs conclusion that the client feels angry
Client: No! I don't feet guilty. I was atNays a goo:J mothe(. o, guilty. The counsellor may be right, but as suggested it Is
I think if my son we(e here, he'd say that too. When he merely a guess, a JJOOf subs.titute (Or empathy. M0reover, the
became addicted to drugs, it was more than eithe( of us counsellor- is not attending to the feelings that the clfent has
ktle-w hOw to handle-. already ex.pressed.
Counsellor: I heat vd\31 you're saying. Analysis: Superficial rt!SPonse. This res,:,orrse has the same
Client: So, what am I sup(X)Se-(1 to do? I fee-I so empty and problems as her earlier OM, " I understand how )(lu feel."
useless.
Counsellor: H's a ve-ry bad feeling Analysis: Inaccurate empathy, Jack of specificity. The counsel-
(Brief silence.) lor attempts empathy but m;sses the intensity of the client's
feellngs. Then, the counsellor- quickly shifts the foe.us without
giving the client time to ,espond.
Counsellor: You shouldn't lee-I tnat way. One day your son Analysis: The counsellOt''s rt!Sponse violatt!S the im,:,ortant
mighl walk rn the door. You have to go on living. requirement to ac.cept clients' feelings without judgment and
withOut trying to tell them how they should feel.
Client: I sup(X)Se you'(e righl ThankS for istentng. It felt Analysis: Someti mes clients bl!n'1fit from the Tntervl~
gOOd to get It off my chest. when the counselkJt's res{XJ(tSl!s are as ,:,,oor as thOse t1ep;r;ted in
Counsellor: I'm glad I was able to he-Ip. th;s encounter. Sim,:,ly telling one's story and verbalizing feelings
can help people deal with pain or problems; however. it ;s much
more likely that this client ;s ready to dismiss the counsellor.
The coun.sello, may be just as ,ellewd that the interview Is over.
ReHectJons:
■ Suggest alternate approp,i.ate resPonses that the counsello, might h.ave used.
■ What might counsellors do when they r~gnize that their resPonse was inaccu1ate or inappropriate.

and is related to our own emotional and behavioural reactions. SymP3thy is the coun.-
seJlor's personal reaction, and though it is intimatd't' connected to the d iem's foe],.
ing.s, it is not the S3me as empathy. Sympathetic responses arc self-disclosu res., whereas
empathy is a process o f seeking to unde.rstand anothe.r's feelings; however, counsellors
arc human, and it is normaJ for them to have emotionaJ responses when listening to
their clients. In fact, their reactions are the basis for compassion, an indispcnS3ble com,.
ponent of a caring counselling rcJationship. T he.re arc moments when it is appropriate
for co unsellors to express symP3thy by letting clients lcnow that they support them
and that they are moved by their P3in. At the same time, it is cssemial for counsellors
to d evelop the ab ility to separate their emotional reactions (sympathy and comP3ssion)
from those of their clients. Counsellors also need to ensure that their s,.•mpathy docs
not detract from the client's feelings by interfering with their need to express feelings,
tell their stories, and face the reality of their problems.
C lient: l 'rn re:Ul't' v.-'Orried about tellinK my d:.d th:u l'\'e dropped o ut o( oo.Jleiti'. Even
when I was a little 1.::irl. tn)' (:uher kept s:ayi1l{t. "You\•e p to ~'t't an education or ,.·ou'II
ne\'er iti't anr,\-here in li(e.•·
CounS(>JIOr(Ch.o ice l ~·mp:uhetk re3ction): I don't think it wu ,-er)' fair (or him t'O
h::n-e l3kl sueh a he:h')' burden on )'Ou. It alwap1 makes me somewhat a~r)' when I he::ir
about parents push in¥ their kids..
Counsellor(Choice 2---empathk reactlon): So )'<lu (e2r th:u you \-e Let your father down!.
In the preceding example, Choice I is a misguided anempt to offer support. Judg~

memal in tone, it shifts the focus from the client's feelings to those of the counsellor.
Choice 2 expresses basic emP3thy, setting the smge for further explorntion.
C lark (2007) cautions thu ''A counsellor is subject to being ps,.•chologicall't' drawn
into the experiences of a d iem, and the interaction can lead to a distortion of perspcc.-
tivcs" (p. 14). For example, an overt,., sympathetic counsellor might curb discussion of
painful emotions o r might change the topic or avoid funher d iscussion of the area to
"protect" the client from the distress of facing the issue. Too much sympathy might
also cut off an opportunit)• for the client to explore foeling:s and options for action. The
following example illustrates this:
C lient: A(ter 15 )'ears of \\'Orkin¥ for the cornp:mr, they tell me th::u e\'en thou~, 1\-e
done a ¥ ff:at ,ob. I h:a\'e t'O take a par rut and a new job because the)· can' t afford to ha,-e
two supervisors.
CounseUor. That' s so un(air. What do they expect? You desen -e better.
It's eaS)' to speculate how in the p receding example the counsellor's response might
c urtail a more balanced airing of feelings and later exploration of the merits of a pay
c ut as one of the options. He.re is a more appropriate empathic response-:
CounS(>IJOr. Perhaps )'Ou (eel used, bel1evh11i:: that their pr:aise was just empty words..
SUCCESS TIP
Clients a(e often successful in making us feel as lhey do. Use lhis as a baSis for empathy
and as a ~ to monitor, undetsrand, and conuOI yout own emotions.
Tough Empathy
It is easy to feel caring and compassion for most people in pain, such as the aging d iem
who loses his job, the young mother who has had a second miscarriage, and the single
parent who is trying to raise children on a limited income; howcve.r, some clients may
challenge a co unsellor's tolerance. Even the most accepting counsello rs occasionally find
184 Chap1er 6
CONVERSATION 6.3
STUDE:NT: I haven't had a lot ot life e-xperlenice, and I'm wor- feeli~ such as pain 0t IOSS. If we have been thete oursetves,
ried that I won't be able to uOOefSland what IM c lient is we ha\18 some ad\tan~ but only if we are cautious to avdd
feeling. assuming that OU' feelings, perspective, and solutions will be
the same fOr' OIX clients. The best w.ry to do this rS listening
TEACHER: Somethnes counseUOrs do lheit beSI WOr'k when
to out clients' stories, even if we think we know wtlat they ate
they ad inst they don'I unders tand, then take the time to listen.
going to say.
We ate constantly challenged to wor'k 'Mth clients who are
very different from us, so we ~ to be willi~ to le.am and ST\JOENT: Maybe there's an advantage to n01 having had the
wdti~ to let d ie-nts "teach· us abOut their extieriences and satne ex.perience in that I'll be m0te ready to listen, leam,
feelings. While we may not have had the same experience, we and be curious.
can df3W on events in out own lives that have evoked sin-.lar
it difficult to ta,., aside pc.rson:.d reaction, suspend judgment, and respond with cmp3thy
to clients such as the following:
■ Bob, an 3ngry 20-,.•e3r--old who savagely artackcd an cider!,.• woman
■ Perncll, a father who argues for the morality of sex with girls ove.r IS
■ Eileen, an HIV~positive prostitute who ignores the dangers of having unprot«to:I
sex with her customers
■ Ruby, 3 W'Oman who rejects 3nd attacks efforts to help
Counsellors working with clients such 3S these often experience strong emotion31
rcu:tions, and they m3y find it difficult to put aside their personal feelings to feel and
express empathy.
Some criminal psychopaths live with cruel disrcgnrd for the rights and feelings of
others. displaying a complete absence of ability to feel empathy or caring. ln fact, "the
blotting out of emp3thy as these people inflict damage on victims is almost always part
of an emotioMI cycle that precipitates the.ir cruel acts" (Goleman, 2005p. 106). Com-
menting on the research, Goleman offers evidence th3t suggests a biologic.al basis for a
13d: of empathy in psychopaths.
\Vhy then should counsellors respond with empathy to such people? First, empathy
is 3 way for counsellors to understand how their clients think and feel. Second, as noted
C3rlier, empathy is instrumental in forming the helping rel3tionship, the pre.requisite
condition for the contract between client 3nd counsellor➔ One outcome of emp3thy is
that clients come to feel valued and understood. Because of the empathic rcfationship,
cliems begin to rcve3J more, make discoveries 3bout themsclve~ and alter the.ir pcrsp«.-
tives about themselves and others. With clients who lack emp3thy for other~ counsellor
use of empathy obliges them to face their feelings 3nd those of their victims.
(n situations in which it is difficult to respond with empathy, counsellors ma't' need
to work on their own issues. For example, they c.nn ask themselves. "\Vhat is it 3bout
this particular diem that makes it difficult for me to be empathic?" "Does this client
remind me of someone else (e.g., parent and forme.r partner)?" "To what extent do I
have unresolved fttling.s and is.sues th3t this client triggers?"
Another strategy for counsellors is to spend time getting to know the client. Usu-
3lJy, familiarity increases emp3thy, as in the following example:
Carl. an emplo,.•ment counsellor, c3re(ull't' re::.d Anmnio's Ate. Antonio was a 19-,.~r-old
unemplored tn.3!e. From all indk::mons. Antonio W'3S not ve:r't' interested in f'mdil'l.¥ 3 job.
His n\Othercompl.:1ined that he usu.:111)' sle-pc until noon and th3t he rare!,., o?\'i":n read the

nN·spcaper want ads. Antonio arrived (or his appointment 20 minutes fate and a;h'i' out a
dear rness~~ that he d,dn't want t'O be there. ''How Joni will thisuike?" he asked bluntly.
Carl's n::uu~I reaction was an~r and di~ust at Antonio's 21titude. He v.'Ondered to
hitnsel( why he should spe1,d time with this die:nt, who w-as clearly u1ml0t1vated. PuttmK
his personal (e,elinKS askle. Carl dttided to reSpo1,d witl, empatl,y. and he ~-e:i,tlr replied.
"~•1y hunch is that )Ou don't se,e much point in beina here. Marbe )'Ou'reeven a little
anar)' at beina forced to come." Antonio. a bit surprised at C3rl's. percep11,·e:ness. told
him how mud, he resented everyone tryil,K to run his h(e.
Gr.klu3lly. Antonio be~an to Let do-Nn his de(e:ncesa,,d a ve:q• di((erent picture emer~-00.
Antonio talked about the rejection he (elt from countless. emplO)~rS who turned him
::rway. Soon it wu de3r to Carl t~t Antonio was deeply depressed. He slept l3te because
he could not sleep 3t ni~ht. He had stopped lookina for work bec3use it was his best
choice (or deal in¥ with the pain o( rejection.
Sometimes counsellors fo3r expressing empathy because they mistakenly believe

that empathy endorses their diems' beliefs or lifostylc~ but keep in mind that being
emp3thic docs not mean agreeing with the client's fodings or perspectives. Empathy
simply attempts to Sil)', "I understand how )'OU foci and how you see things." ln fact,
clients must fee] understood before they will respond to any efforts to promote change.
Empathy is one of the wars that counsellors csmblish credibility nnd win the trust o(
their clients. \Vhen a trusting relationship exist~ clients may be willing to consider other
pe.rspcctives and look nt the consequences of their choices.
})!} INTERVIEW 6.2
Client: F'o, as loog as I can remember, I've been drinking

~ ly basis. It's no big deal.
counsellor: (Sc/tty, whi.le ma;nttJirlirlg eye COtltact.J Drink- Analysis: The counsello,- trittS to proceed cautiously with b.tt.ic
ing has bee-n part ot yout life, and you don't see a prOblem paraphrasing. Mirroring the client's t1,oughts conveys that he
with it. has been heard. Suspending verbal and nonverbal judgment
(Client nod~) helps to dtNe/op trust.
Counsellor: You mentioned lhat your family gives you a Analysis: An open question encourages the client to talk about
hard time abOul drinking. How do you feel abOut that? his feelings. Such st.atements atso say to the client that the
counsellor is willing to listen.
Client: Yeah. I work hatd all day. If I want to have a dtink.
no one has a rigt\t to tel me to stOI'). Otinking helps me
relax.
counsellor: Sounds as though you resent it wtlen otherS Anaty1l1: Inferred empathy. Although the client doe.s not
interfe,e with somethi~ that gives you pleasuce. diteclly label his fee.lings. based on the wordS. context. and
nonverbal messages. the counselk:Jr speculates that resentment
might be the predominant feeling.
Client: (Loudly.) They should baek off and mind their own Analysis: The client ·s response suggests that he is ,espansive
business. I don't tell them how to live. to the counsellor's empathy. He signals this by continuing to
share at a deeper level. Th;s is a significant event in the inter-
view, which should give the counsellor confidence to COtltinue
to ,;sk empathy.
counsellor: It's tnOr'e than j ust resentment Pethaps you're Analysis: Anger is inferred from the client's n<Jnverbal e.rpres-
angry that they oon·1 respect your tigt\t to Hve your life as sion (volume). By labelling the anger, the counsellor gives the
you see fit. client "permission" to dlscuss h;s anger.
186 Chap1er 6
~JO INTERVIEW 6.2 Effective Use of Empathy<conHn,e>
Cllent: 1guess I shouldn'1 be so ticked off. After au, my Analysl$: Since the counse.1/or accepts h;s anger, the client may
father was an atcohdic, and I know fltst-hand what it's like feel less that he has to defend it.
to live v.ith a drunk.
Counsellor: To some extent, your feeli~ am mixed. You Analysis: The counse.llor picks up on and ldftntifles the client's
feel anger beeause you think they sholJCI mind theit own mixed feelings. Mixed feelings can often be a source of anxiety
busiooss, and you atso see where lhey're coming from. for clients. particularly if they pull their emotions in different
You are sympathetic to lheit fearS. directions.
Client: Well. to be perfectly honest, it's not just their fear.
I dOn't want to drink tnyself 10 death like my father did.
Counsellor: You've oone some thinking aoout hOw you'd Analysis: Inferred empathy. This client was initially guarded
like yout life to be different When yolM' wife confronts you, and de.tensive, quick to de.fend his right to drink. As he flnds
it realty touches a nerve, and you're mminded of fear'S acceptance from the counsellor, he begins to let his guard
you'd rather n01 have. down. In some interviews, such as this one, trust can develop
Client: No way I'm gci~ to let that happen to me. quickly. but more often, the counsello,- requires extended
patience.
Counsellor: You're determined to control your drinking. Analysis: This bask empathic response gives the clfent some
Client: I'm n01 going to be like my father. breathing room. Counse/lOtS shOuld avoid constant pressure on
clients to move to a higher level of intimacy. The counselk:Jr
needs to move deeper, but caution is eritical to avoid moving
too quickly.
Counsellor: Co«ect me if I'm off base, bul as you 1alk, I Analysis: The counsellor uses both confrontation and infe"ed
wonder if a part of you is afraid that youf drinld~ could empathy in this statement. Presenting the ide.as in a tentative
get Dul of hand. manner softens the confrontation.
Reflections:
■ What might have happened if this cOun$tllOr had used a m0re confrontational approach?
■ If you were the counsell0r. what would you want to do in the nex.t half-hour with this client?
SUMMARY
■ Because of the centm1 role that emotions play in our lives, counsellors must give
priority to exploring :md understanding clients' feelings. Emotions are characteri:ed
by physiologicnJ as weJI as psychological and behavioural reactions. Mixed feeling~
including contradictory emotion~ arc common. A great dC3l of client stress and
confusion can arise from the pushl":S and pulls of competing feeling~ which, if
unmanaged, can control a client's life.
■ Empathy is a core skill for all helping reJationships. Empath)• helps build the helping
relationship, assists clients in identifying and labelling feelings, modcls a healthy W'a)'
of reJating to other~ and helps clients accept their own feelings. Although counsel-
lors can neve.r know exact])• how their clients feel, empathy enabll":S them to move
closer to understanding.
■ The three types of empathy are invitational, basic, and inferred. Jnvitational empa,
thy involves strategies to encourage clients to talk about their feelings. Basic empa,
thy mirrors what the diem has explicitly said, while inferred emp:nhy attempts to
reach empathic unde.rstanding from less obvious clues. A variety of strategies can
Empatlllc Connections 187

be used to encourage clients to express feelings. includina invitational statements,
questions targeted at feelings, explan:.uions of rhe importance of addressing fedina~
directives., self-disclosure~ and sentence completion statements.
■ There are four key gcne.ro1i!ations about empath\•: (1) When clients share feelings,
empathy is often the preferred response. (2) Counsellors should risk expressing
empathy early in the relationship. (3) C ounseJlors should express empathy ten.-
tativdy. (4) Empathy requires flexibility in its use, including the ab ility to refrain
from using it.
EXERCISES
Self-Awareness life that involves emorion.s. In response, other members
1. Begin a bg to track your footings. Al periodic intervals (e.g., attempt to identify the predominant feelings exptes.sed.
every hour), rec0td WOr'ds and phrases lhat best deSCribe 2. Practice ln.ter'vie'N: Work in. pairs: wilh one pel'SOn acti'lg as a
hOw you are footi~ at lhat moment. Try to be as precise as dient Shari~ lhe details of something curten.t that in'VOl\ies
possible-. usi~ terms thal captLXe the essence and in.tensity emotions, and the other person acti~ in the counseuor
of hOw you feel. Maintain your IOg lot at least one week. role. AIIO-N abOUt 15 minutes for the interview. As counsel-
a. What patterns or cycleS are apparent? Are there limes lOr', use lhe three types of empathic responses to keep the
of the day Or' week when you are more likel'j to feel par. in.terwew focused on. footings. When the interview is over,
ticular emotions? review the experience with each Other' using the foltoM~
questions as a glJcle:
b. How could you have altered your emotions (e.g., to
inc,ease pleasurable feeli~ and decrease negative ()ient: What was easy and difftellt abOUt s.hating your
feeHngs)? footings? What responses from your partner were help.
ful? UnhelJ)flA?
c. What have you learn.eel abOut yourself from this ex.ercise
that 'liill assisl you in yolM' WOrk as a coun.setor? CounseUOt: What aspects of responding with empathy
d;d you fond most challengµ,g?
2. Recall the 10 families of emorion.s: anger, fear, strength,
3. The purpose of lhis exercise is to dewlap your ability to
weakness, joy, sadness, con.fusion, Shame, surpri.se. and
"ttaek· the flow of an. interview. including identifying the
love. Rate your ability to Show or ex.ptess each one on. a
use of particular interviewing and counsetting skill$. Wot'k
scale of 1 to 5 (5 = suong. 1 = unable to express).
with Sluden.t coneagues. One student wll be the counsellor,
a. What are the emotions that you have m0te difficulty another the client 'Mth the others as obSer'vets.. Videotape a
expressing? Ate 1here feelings you would never- express? 15-minute segment of a counseli~ interview. Classify each
b. How dO your ability and wiUiogoes.s to Share emotions counsellor response (e.g., open. question, closed question,
vary depending on. the person you are with? silence, empathy, self-di:sctosure, Or' mixed msponse). Use
the tonowing table to compile interview statistics. Ptace a
3. Would you flOO it easier' to tel your friandS (your parents, fam.
d'leck each time a partkl.Aar skill i:S uSed. Notice that the
tty, etc.) that you tove them Or' that )(Ill are angry with them?
table is organiled to divide the _..terview into time segments.
4. What d«1 )(Ill learn. abOut expr~ emotions when you were
gro~ up? bt,lom l'ON this migt\t help Or' hinder- your v.<lrk
0-S millUles ~1 0 • i.Us 11- 15 mines
_.. your field d practice. F'Or'examJ:je, if you wewupin a famly
Or' culture wtlere em::,tions were seldom extiressed, consider Open ques1ion
hOw Ui s haiS impacted your curtent 'lfili~ to sOOW your Closed ques1ion
leeliogs or to encourage Otf'lerS to share their emotions.
Indirect question
5. Describe in. detail how you feel, think, and act when you
experience specific emotions. For example, you migt\t write, Sience
·When I feel seated, I want to escape. My breathing is shal• Empathy
low. I tend to IOOk away. I become quiet. I think I might Selk:lisct>sure
vomit.· (Hint: use yolM' imagination to visualiZe situations
Directive
where you might experience the specific emotion.)
&.mma,y
Leaming Group
Paraphrase
1. Work in a smatl group of tour Or' five students. Take turns
Other (spedfy)
mak_..g a brief saatement abOut something current in your
188 Chap1er 6
Aftef the inter'view, discuss these questions: d. Mtf I started ctyi~. 1oon·t think I coukS eve( stop:
a. Did the counsetklr' use a vafiely of diffetent fesponses? e. (An ex-offender to his or her pa.role offlcer.) · Have you
b. To what ex.tent did lhe counsellof vaty his ot her ev« been to jair?·
appfoach as the session ptogressecl? f. (A 16-year-okl bOy.)Ml'd rathef live on the sareet thangp
c. What interview uansitions were appafent? Were lhey to another fostef home. Five foster homes an five years..
appfoptiate? Considet, fOr' example.• whethef the ltans~ IW had enougl>!"
tion occuffed prematufely, befote concr-ete undel'Slaoel- a. (A gay man.) "I dkl.n'l expec1 to live to see 40.•
k'lg or ex.ptoration was com pteted. b. MWhy do you want me to go to see a psyd'li:altist? Ooyou
d. What Skills were ovefused or underused? think I'm ctaiy? You're the one who's crazy.•
e. Which fesponses were productive? Which responses I. (Patient speaking to a paramedic.) · Leave me alO.ne. I
were counterpr·oductive? jusa want to die.·
4 . Interview calleagues Or' friends from diverse ethnic groups to 7. ln.tetwew people from different cultufes. If JX)SSible.. intef-
ex.ptore how different individuals: ex.ptess emotions.. view first-geootation immigrants wtlo have been in lhi:S
5. In a smal group, predict and describe the possible emo- country fof onl'j a shor1 time. Ex,:,l0te their views on emo-
tions that difletent individualS in the following scenarios tional expression, fof e.Kample, the ex.tent that theif per-
might experience. What nOOWl'bal cues might you ObServe sonal. familial, and clJh.-al roots value Wring emotions.
in each case? Remembet that peoples' viewpoints do not niecessarity rep-
resent that of theit culture of or~n.
a. Man whose wife ot 60 year'S haS just died
b. Young teenager on a firSt date Concepts
c. Middle-aged man fired from his job 1. Assume that lhe fOllowtng clients a,e speaking to you
aoel that an empathic response is appropriate. Suggest a
d. 20-yeat-old man told by his doctor that he has
response to each statement
SChiZOphtenia
e. Mothef discove-ring her teenage daughtef is usi~ drugs
a. (Y'outh speaking to a youth }U$t/Ce worker.) "You doo'I
care abOut me. All you guys are the same. You tel me
f. A young \\()man subjected to online hatassment that you want what's best lot me. You' fe just tn this job
g. PerSon wt10 lost his "e savings in the stock market fOf the mo.ney.•
It. Prisooef abOUt to be sentenced b. (Client, smiling.) · Fof the flrst time. lhings am really
I. An3Y dient saafti~ to come togethet lot me. My kids afe an ooing
well in schOOI, my marital ptoblems are o.n the upswing.
j. Oient seeing a counsetklr' fO( the fll'St (or last) time
and I finally put some money aside fOI' a rainy day:
k. Patient in hOspital waiting fO( maj:)f surge,y
c. (Parent to a teacher.) Mf don't know what to do. I know
I. Child en.te-ring a foster home you said I s.houkS try to help my son with his homeNOrk
m. Man who has just abused his wife and ShOw some tnteresa in his \\()rk_ but he comes home
n. Couple on lhe day of theit ma«iage from school and goes straight to his room. When I ask
abOut his h0mew0tk, he a~NayS says that lhere wasn'I
o. Immigrant whO has left his wife and children at home
vd'lile he settles in C3n3Cla any. When I offer to help. he makes it cteaf he'd rathef
do it on his own:
p. Setial killer
d. (Teenage.r, crying.) ·i-m ptegnant. This will kill my dad,
q. Compulsive gamble( afte-r a big win and aftet losing his me:
but first he'll lull
paycheque
e. MEvetyo.ne atways says hOw togeth« I am, but I dOo't
r. ll-year-<lld girl wro haSbOOn sexually abuSed byhe< father feel together. Sometimes I get so wound up that I think
s. 75-yeat-(jj woman remanying thfee yearS after too death I'm gci~ to bur'Sl.•
of he( hUSband. (She was happily maffied for 45 years.> f. (Man. age 57, talking abOut his family problems.) " I
6. Identify teeli~ words and phtases that beSI describe hOw have to make every decision. I can nevef count on my
each of the fonowing clients may be feeling: wife Or' kids fOr' hell:):
a. MEveryone in my life keeps putting me down. Even my a. (Parent to a teacher.) ·My so.n does not have ADHO.
01m childten constantly criticiZe me: I 000·1 cafe what you say. I'm not going to put him o.n
drugs.:
b. (Shakil'lg.) "fifteen hafd year'S with lhe same company
and what do lhey do? They dump me with three weeks' b. (Client shouting.) Mf am calm!•
notice.· I. (Mt)man, age 50-plus, talking to a 23-yea,-old worker.)
c. (A six-year.c,td boy. crying while speaking torecrMtion ..You're pfetly young to be working hefe.•
sJaff.J •Noooo wants to play'lfith me. No one llk.eS me: j. (Patient In an ambulance.) MOo.n'l let me die:

2. Each ot the fOIOwing client statements expfesses mor'e than b. ·I'm not ashamed to admit it. Once in a wtltte, 1hl my
one feeling. Identify feeling \\()fds and phrases that beSt wife. It's no big dea1.·
describe the mixed foof~. Next, fOr'mulate an empathic c. · 1 don't cate what you s:¥f. I won't give up on you untH
response. you eonvett and save you( solJ.•
a. "Thank.S fOr' seeing me tOday. It really felt good to get d. · 1want to die. I've lhOught abOut it fOr' months, and I just
thi~ otf my chest. No one has evef listened to me the d00'1 want to live anymore.•
way you did. I hope you dOO'I think l'm crazyOr'Stupid."
e. ·What's lhe big deal if I have to steal a bit from Safe-
b. (Eyes we/litJg up with tea,s,J-1t'stM'll. I don't care to be way to make sure my kids afe feel? It's oot like it hurts
with him anymOr'e.• anyone.·
c. Ml was bro~t up to believe you should handle your f. (Student to teacher.) · 1 suppose this course is gci~ to
problems oo yotX own. LOOk at me now-sitti~ he-re be like au the Olhers:. LOts of feadlng. a bunch of papers:.
JX)uring my guts out to a counsetlOr'.• I only hope lhere's some relevance to it al ."
d. "lo tel you lhe truth, I'd like to just mard'I rlgN in, 100k g. (Client, 35 years old.) Ml had oo idea she was only 15.
him in the eye. and tell hlm exactl'j whefe to go. I don't She was the ooo vd\owanted to have sex. Ftom the look
know wtiat to dO... in her eyes, I colJCI tel She was begging fOr' it. It's featly
e. "F'lnding out that my fotmef g'i"lfriend had my bab-f was unfait that I'm now charged with rape. Besides, 15 is
totally shocki"lg. After we bfOke up, She didn't even tell Old enougtl fof someone to make up theit own mtnd."
me She was pregnant I'd love to be a fathet, but I don't II. ·This counsetling isn't very helpful."
want a relationship with her. Maybe it wouk:I be beSt if I
I. · 1 reatlydOn'twonytoomuchabOutAIOS. What can I do
just forget thewhOle lhiog. but I want to dowtlat's rigN.•
abOut it? If I'm meant to get it then 111get it. So what?
t MLM~ on your 01m is the pits. Now I doo'1 even knON We all have to die sometime...
where my next meal is c:omi~ from. I used to IOve betng
j . ·I'm 001 stupij. I know that he sholJCl.n't hit me. Bui I
martied. I felt as if life really had meantng. At least, I
guess I desetved ii, lhe way I put him dOl«'I. I sholJCI
don't have towony abOut being beat up b-f my hUSband
learn to keep my mouth Shut. When I see him, I'll
every time he gets drunk. It's just so diffteult. Maybe I
apolOgJze.•
s.houk:I gj\iQ him anothet chance.·
k. (Client. with angry tone.) ·No one is willi~ to 1alk to
r.. (Woman, 79 years old, crying.) "My daughtef keeps
me abOut the fact that I migtlt be dying. I can accept
saying lhat she is coming for a visit. but it has boon
it, but every time I ask lhe big question, people change
weeks sinice I have seen hef. (Wipes away the tea/$.)lt's
lhe topic."
not that important. I realty do not want to bea bOlhef. I'm
just feeing SOtry fof myself this mor'ntng.• I. ·There's no way I'm going to pay for her stupidity. If she
didn't want to get ptegnant, She sholJCI have taken the
h. (A clvll engineer from Syria who Immigrated to
pil . Now she ex.peels: me to sup(X)rl the baby until he's
CatJada.) " I was so ex.cited to begin my new life in
18. I 000·1 care if I am the fathet. NOi a chancer
caoada when I came three years ago. Bui all my dreams
have disappeared. The onty wOr'k I've been able to find What do you think are the advantages ot resJX)ndtng with
is drM~ a cab.· empathy to the pteceding clients?
I. {12-year.oJd girl.) ·1 flashed my breasts on the Internet 4. Each of the follOwing client statements might be a rou-
whle I was in an onlioe chat room. Now my life is ruined. tine tnqliry for in.formation 0t could be an tndirect way of
Everyone at school calS me a Slut. I have no one." ex.ptesstng feelings. Assume that the client is ex.ptesstng
f. ·n,e 2015 te«orisl klllings in Pans realty messed me up. feelings and lormulate an empathic response.
1haven't been able to steep, and I constantly think abOut a. How old afe you?
my kids. I don't travel or even gp to movies anymCl(e. It b. Have you ev« been uoemplOyed?
could happen hefe:
c. Have you ever lived in a fostet home?
3. This exetcise albwS you to apply tough empathy. The foi. d. Oid you use dcugs when you wefe my ag,e?
lowing statements may evoke stfong per'SOOal feactions.
e. Have you ev« taken psychiatric medications?
Assume that the petSOO is speaking to you and that you afe
responding with empathy, even though empathy may n01 5. Record a television pr·awam. Watch l Vfith lhe sound lutned
be the ptefetted response. off. Pay attention to the nonvetbal communic.ation of the
a. MCanada was much beltef when it was white and aetars. Now watch it with the sound lutned on. How suc-
Chfisti:an. With such high unemployment, don't you oossflJ wefe you in correctly reading the nonverbal cues?
think it's time to stop letting every damn lfflmigrant into 6. The fOlloMng is the tr'anscript of a por1ion of a counsel-
the country? No wonder I can't get a job: lOr"s interwew. The wOr'ker is an emptoyment counsetlOr' at
190 Chap1er 6
a Vancouvet social service agency. Ctiticalty evaluate the Clie-nt: Mostly, I've WOrked as a secretary in Toronto. It was
counsetlOr"s tesponses (e.g.• approprt.ateness of questions, okay, but I don't want to dO that anymore. I realtydon1 have
use of empathy, etc.). What attitude do you think lhe coun- a Clue what I'd like.
setot conveys to his dient? Suggest alternative resJX)nses Counsellor: So you know you want to get out of cletical
baSed on empathy. wot'k, but you'te uns1Xe what etse you might dO ot like.
Counsellor: Hey! Are you Leah? I'm Mr. Short. Won't you Cliem: Yes, exactty.
come in to my office? (Brief small talk 111 office.)
Counsellor: Have you considered social services? There are
Counsello1: So wtlat i:S yout ptoblem? How can I help you? lots of gOOCI programs that you couk:I complete in a short
Client: Well, I don't really know wtlere to begin. Ri~t time.
now. my life i:S a mess. I've gotten ato~ well so far, but Cli&nt: No. I don't lhink I'd like that.
latety . .. well. I'm just not coping very well. (Client pauses.
Coun-Sellor: How can you be sure until you give it a try?
wipes tears with a tissue.)
Sometimes votunteet wot'k is a really go:xt way to ftnd out
Counsellor: Okay, cam oown. Try not to er,. Have you been if you like il
to thi:S agency before? By lhe way, hOw old are you?
Cli&nt: Wei .. . I guess so.
Client No, lhis is the fll'SI lime. I wondet if anyone will evet
Counsellor: Actually, I was in the same bOat as you. Then
give me a d'laoce. So~es I lhink, why not g;,.,e up? I feel
I vOlunteetecl. Nex.t thing I knew I was baek in Sd'IOO. Now
so sw:.ared al the time. Oon'l get me wro~I really want
1·m wot1d~futl time and loving it. I have a friendwhoWOrkS
to w0tk, to be independent. to buy my kids all the lhiogs
at the votunteet bureau. Why don't I gjve het a Call and set
I haven't been able to afford. 1just don't koow if I can do
up an ap!X)intment fOr' you?
it. I haven't wOt'ked in 10 years. Plus, there's the problem
of daycare ... the things you read . .. it's hard to koow Cll&nt: Okay ... thanks.
wtlo to trust. Things just seemed so much easier when my Counsellor: No ptoblem. I was glad to be of help. 111phone
husband was alive. her, and then l'l gjve you a call. It'll probabty be next week
Counsello1: You say you haven't w0tked in 10 years. What OtSO.
was lhe last jOb you hek1? What dkl you do? What ate yout
job skills?
WEBLINKS
Roots of Empathy, a p,ogram with Canadian o,igins, to teach Website offering comp,ehensive tOOls and WOrksheets on emo-
empathy skills to child1en tions and a variety of other relevant topics
www.rootsofempathy.org http://www.therapistaid.com/
The Compass OeRose Guide to Emotion Words: A c-0mprehen- Emotional Intelligence Network
sive list of emotions and fe,eling words as well as some links http://www.6seconds.org,'
to other resources and articles on the topic
www.derose.neVsteve/resou1ces/emotionwords/ewords.html
The Association f0c the Development of the Person Centered
At,proach (includes links and articles based oo the teachings
of Carl Rogers)
www.adpca.org

Jacek Oudzinsk.Vl23RF
■ Identify the clements of empowering clients.

■ Explore the srrengths approach.
■ Appreciate the complex and diverse chaJlenges of ,vorking with seniors.
■ Understand the goaJs and skills of crisis intervention.
■ Describe the principles and strntegies of motivational interviewing.
■ Identify and describe the stages of change model.
■ Explore the principles and strategies of cognitive behavioural counselling.
■ Understand the process of problem solving.
■ Understand the principles and techniques of brief counselling.
EMPOWERMENT: MOBILIZING STRENGTHS

Empowerment: TIie prooess o f ~
FOR CHANGE
dients discowr personal stiengths-6
Empowerment that results in clients discovering strengths and taking control of their
capacities so tu'! ...,ate~ to1alle
contrdowr t!leirhes: the elJIE!(ted lives is the expected outcome of successful counselling. There are many clements
outa,me of succtssful counselling. of empowerment that impact all three domains: feelings, thinking. and behaviour
192
.ll
Figure 7.1 The Elements of Empowerment
(sec Figure 7.1). Empowered clients have high self-esteem 3nd confidence, enabling them
to cake appropriate risks without undue anxiety. Able to enjoy success without guilt,
they arc fully aware of their needs and values. They behave assertively, aware of thc.ir
right~ yet respectful of the rights of others. \Vith access to knowledge and resource~
they make their own decisions by using a r:mgc of skills and strategies. Although
empowered clients have the ability to act indcpc:ndc:ndy, they arc also able to draw on
social and community supports. Empowerment is the antidote to oppressive S)' Stcms
that deny people access and opportunity to particiP3tc in decisions that affect their lives.
Empowerment requires self-determination as well 3S the mca.ns. opportunity,
resource~ and freo:lom to exercise choice. Fully exercised, empowerment ensures foll
particip3tion in decisions nffecting clients' lives. Responsible empowerment is founded
on the principle of reciprocity nnd respect for rclntionships and the rights of others. It
is 3ssertive for personal rights 3nd freedoms. but not 3t the expense of the rights 3nd
freedoms of others. In relationship~ responsibleempmnrment commits people, insofur
3S possible, to negotiating, coll3borating:, consensus sec-Icing, and rem3ining occountable.
Responsible empowe.rment is nssertivc, neither passive nor aggressive.
How Counselling Promotes Empowerment

Counsellors do not empower clients; rather they promote the conditions where
empowerment can flourish. Counsellors support diem empowerment with the foun-
dntion3J belief that clients 3rc capable of change and h3ve a right co mnnngc their own
lives. An empowerment 3ttitude focuses on the cap3citics nnd strengths of clients
while forgoing: nny need to control clients by t31cing on an "expert" role that m3kes
them dependent. When empowerment is the priority, clients become the expert~
3nd there is "coll3borntion and sh3rcd decision mnking within the profession3J reJn-
tionship" (Sheafor & Horejsi, 2008, p. 79). CounseJlors dem,.•stify the counselling
process through open and non-jargonistic discussion with clients of their methods
3nd nssumptions.
Sdf..detcrmination, 3n important component of client empowerment, is promoted
by helping clients recogni!e choices nnd by encouraging them to make independent deci-
sions. Counsellors shouJd not do for clients whnt clients can 3nd should do foe themselves.
Supporting Empowerment and Change 193

SUCCESS TIP
PerSOr\3I identity, that sense of kOowm"lg whO you are and how you connec1with Olhel'S, is
an essential part of empowe<ment. CounsellOt'S can help d ients inctease pel'SOl"lal identity
(and se•~oom) b'f helping them ex.ptore and appreciate U'leit roots, in particl.Jat positive
aspects of g(oup hisl0cy, lncluding accompfish~nts, cl.Ahxal and (eligious pr'actices, and
language.
Anti-Oppressive Practice
Often clients come from diS3dvantag~ and marginali:~ groups where they "have been
'beaten down' by oppression, poverty, abuse, and othc.r harmful life experiences. They
want better lives for themsdvcs and their familic~ but they feel powerless to make the
necessary changes. Some clients have a pervasive sense of failure and foci different from
and rejected by other ~pie" (Sheafor & Horejsi, 2008, p. 422).
Sometimes pO\\•erlessncss 3rises from neg3tivc self-evaluation 3nd lo"' sdf-cstcem
or from lade of confidence in one's ability to 3lter one's life, but sometimes the systems
that 3re set up to 3ssist clients are themselves oppressive and contribute to powerless..-
anti-oppressi'lt practice: 'Mien ness. Anti-oppressive practice involves counsellors working for structural changes in
couns.elkn 'llllfk ICJ str~ural dl..-ges organizations or policy, 3nd in promoting equity in the distribution of rcsourcc5i. oppor-
il«ganizatioos. pcicy, -.:Iii promoting
equity in lie disttibutioo of m ouroes, runitie5i. and power (Drolet, Clarie, & Allen, 2012). P3ul Moore (200 I) suggests that 3n
opportunities. and po--. anti-oppressive framework ch3Jlenges workers to examine and challenge the lenses that
may colour our vie"'points on what is "right and acceptable:" racism, sexism, hetero-
se.xism, 3bleism, ageism, and cl3ss oppression. Feminist theory 3ddresses the power
differential th3t allows men to enjoy privilege at the expense of women.
Ben Carniol (2010), 3 C3nadian social work ~uator and 3d\'OC3tc, re.minds heJpcrs
that since racism and other prejudices may deny clients access to jobs and resources
such as 3dcquatc housing, helpers have a responsibility to advocate for a progressive
system 3nd social policy changes.
Since client self-determination is enh3nccd when clients h3\'t". more choices, counscl.-
lors should 3lso be involved in broader 3Ctivitics such 3S working to identify and re.move
gaps and barriers to service and encouraging more hum3nc and accessible policies and
services. The counsdling process itself offers empowerment to clients. The beginning:
phase offers many clients a unique opportunity to explore their situ3tion and their feel.-
ing.s. Active listening skills hdp clients bring: long-forgotten or misunderstood fcdings
to the surface. Ventilation of ftt.lings c3n energize clients, 3nd it can lead co spontan«>us
insight into ne"' "'3YS of h3ndling: problems th3t seemed insurmountable. For some
clients, the work of counselling: is finished 3t this phase.
THE STRENGTHS APPROACH

streng_ths approach.: A counselilc The strcnjtth s approach is 3 perspective that shifts the focus from diem problems
perspe«iw that asS>Jmes tile inherent
and deficits to possibilitie~ c3pacities, and resources th3t can be mobiliz~ in the pur-
capacity of people. lldimaals and
communities are seen to haw assets suit of goals and change. Many clients come to counselling "'ith lo"' self-esteem and
•d iesouttes that can be mctiililed I• confidence. Sdigm3n's (1975) concept of learned helplessness suggests th3t individu.-
probleascf\ing. als can become demoralized through foilure to the point that they give up trying to
learned helplessness: Astate al alter their circumstances, e,-en in situations in which change is possible. Persons "'ith
aind tu'! oa:urs llflen indi\ifualsUle learn~ helplessness c3n be difficult 3nd frustrating to work "'ith bec3use these clients
learrlfd throug) lailure that their effcru do not believe the.ir efforts "'ill make a difference. \\:fhen they 3rc successful, they 3re
¥ill not result i• change.
likdy to attribute it to luck, rather than their efforts or c3pacity. As long: as they hold
these beliefs, they arc unlilcdy to engage in risk.-t31cing to solve problems and achieve
194 Chap1er 7
empowerment. Signif,candy, individuals may in foct be quite capable, but believe they
are not. For others, anxiety about rislc-tnking or failure deters them from action. ln
addition, if clients nre locked into a view of themselves ns victim~ they nre likeJy to
resist change, or they may enter into dependency relationships in whidi they relinquish
power and control to others, including their counsellors. The key is to help them set
small goofs and implement a successful action plan, then accept the conntttion between
their actions and success. Cognitive behavioural techniques are also vaJuable in helping
clients change the way they think about themsdves.
SUCCESS TIP
Counseilol'S need 10 manage lheil' own unmet needs then mighl impede lheit capac,ty to be
helpful. F'o, example, if lhey have a higri r')OOd for' control, they can potentially take power'
from clients, who lot their part may freely g;,.,e it away.
Here are some basic strategies for maintaining a strengths approach:

t. Negoti3te coll3borative relationships with clients where they share responsibility for
identifying priorities, goals, and preferred wnys of proceeding. Accept that they are
the "experts" on the.ir own lives and that with encouragement they can make deci-
sions on what will and will not w-ork. Counsdlors need to be Oexible and accept that
every intervention plnn will be individuali:ed to the unique needs and attributes of
each client. What works with one client may be counterproductive with another.
2. Trust that clients have the capacity to change, and that they can learn to cope with
the.ir problems and challenges. Every experienced counsellor can relate ama!ing
stories of people who have recovered from adversity and overwhelming odds.
3. Stay interested in strengths. Acknowledge clients' skills, resourcefulness, motiva,
tion, and virtues. \Vhen workers value their clients' strengths, clients learn to vnJue
themselves. Discovering overlooked abilities, lcnowledgc, and experience can also
ene.rgi:e counsellors nnd clients.
4. Ask questions or make statements thnt uncover strengths, such ns "Thinle of a time
when )'OU were able to handle problems such as this. \\:fhat skills and resources
enabled you to cope?" Other approaches include these: "\\:'hen you were nble to
manage, what were 't'OU doing that helped )'OU succeed?" "\Vhat are the things in
't'our life thnt you fed good about?" "What's ,vorking well for you!" "\Vhat ,vould
't'our friends say arc your best quaJities?"
5. Help the client identify strengths that come from adve.rsit)' with questions such ns
"In whnt ways have the problems you've faced in 't'OUr lifemnde )'OU stronger!" To a
client who has struggled for six months to find work and get off welfare, you might
say, "I'm impressed with )'Our ability to hang in the.re. Mnny people would have
given up." look for strengths in the way clients have handled adversity with com-
ments and questions such ns "You've been through a 10( in your life. but somehow
't'ou've managed to survive. How have )'OU been able to do this!" Or you might Sil)',
"In what ways have your problems made you stronger?"
6. U se cognitive behavioural techniques to help clients challenge and mann,;e self-
deprecating remarks that reinforce low sclf-esteem.
7. Avoid diagnostic labels ns a way of describing clients. Labels tend to ignore strengths
by focusing on pathology nnd deficits.
8. Focus on problem soh•ing and goal setting rather than on discussions of blame
or on finding the root causes of current behaviour or problems. There may be

cathartic benefit to discus.sing history, but once this purpose is achieved, the focus
of the ,vork should shift to present and future events. Goal setting energizes clients
to action and mobilizes their resources and motivation for change.
9. Use the info rmal resources of fam ilies, neighbourhoods, and communities that
are potentiaJ sources of help and srrength for clients. Use community d irectories
to pinpoint agencies, services, and self-help groups that coukl be supportive. ChaJ,.
lenge clients to ide ntify and discover these resources: "Who do )'OU rrust?" " Who
suppor ts )'OU when you neo:I help!"
Strengths-based counselling shifts the focus from deficits and problems to a process
in which clients' strengths, capacities, and resources are recognized. Strengths are the
resources that e nable clients to overcome prob lems. ln this sense, client as.sessmem
moves beyond identifying obstacles and prob lems to discussion of personal and envi..
ronmental resources.
Helping clients renke their strengths empowers them with the belief that thq• are
capab le of change. For example, helping clients re frame how thq• think about p roblems
can enable them to see their problems as opportunities. SaJCffly (2009), a major propo-
nent of the strengrhs approach, offers these perspectives:
It is a collaborative process .. .. It is an 3ppt"Oach honorh-)¥ the inn.2te wisdom of the
hutiun spirit. the inhe-rent eapad ty for translonnation of even the roost humbted and
::abused .. . . Rally clients· interests,. eapadties. motwations,. resources. and emotions in
the v.'Ork of re::1ehinK their hopes ::and dre::1ms. help them llnd pathways to those "°"ls.
::and the p.,yoff ,nay be ::an enh::ul«d quality of d::ul't' life for them. (p. I)
SUCCESS TIP
"Practicing from a strengths perSpec1ive reqlires lhal we Shift lhe way we lhink abOul.
approach, aoo relate to our dients.. Rather lhan loc:using exclusively or dotninantly on prob-
lems, )'Our eye rums towards pos$,lbiily. In lhe thicket ot trauma, pain, and trouble, you see
blOOms of hope and transfotmatioo.· (Saleeby, 2009, p. 1)
T he strengths approach rW uces some of the power differentiaJ that occurs when
client vulnerabilities and d eficits are given priority over their strengths. G licken (2004)
offers this reminder: "There is usually more a bout clients that is positive and functionaJ
than is neg::ative or d't•sJu nctional" (p. 4). W ith the strengths perspective, the client is
the exper t and the primary author of the change p rocess. "Thus, the worker's ro le is to
listen, help the client process., and facilitate by focusing on positive behaviors that might
be useful to clients for coping with the.ir current life situations" (Glicke n, 2004, p. 6).
Our minds and bOdies react wilh mmarkable speed to deal (prolonged) stress. depression may inc,ease, lhe prOduc-
with C(isis and stress. To divert ils resources 10 fighling tion of oow brain neurons i:S reduced, and the(e is damage
the crisis, the brain Shuts dOwn nonessential actMly such to the Hippocampus, a part of lhe btain associated with
as digestion. Our hearts pump taste( and our b<ealhing memory and learning. Maladaptive attempts to deal with
inc,eases to maximize oxygen to the bOdy. Adrenaline, the srress using d(ugs, overeating, and s.mOking compound lhe
stress hOrmone cortisol. and dozens of 01her hOrmones a(e problem by iner-easing lhe (iSk of suoke, heart anack. liver
released. The bf3in signats the liver to release mo(e sugar disease. and a myriad of olhe( health problems (Ashwell,
C(eating a burst of eootgy. While cortisol, ad(enaline, and 2012; The Franklin Institute, 2015; and University of
01her hOrmones help us cope in the short run, with chronic Maryland, 2015).
196 Chap1er 7
EMPOWERMENT AND SENIORS
On July 1, 2017, there were almost 5.8 million people in Canad3 over 65 't'C3rs of age
representing about 16 percent of the population, and for the first time, the number of
seniors over 65 years of 3ge in Canad3 is grc3tc.r than the number of children under 15
(Srotistics Canad3, 2017).
The first of the baby boomc.rs arc now in their 70s. Thc.ir lives have evolved very dif-
fcrendy than past generation~ and they are rewriting the book on 3ging. \Vith improved
life expectancy, thq• can expect to live 15 to 20 years or more and their cxpcctntions
for 3n 3ctivc and productive retirement are high. As a group. they arc healthier, more
educated, and more financinJI'>' secure than previous generations.
Today's seniors 3rc very adept 3t self-advocating for their rights and needs. Gener-
ally, they have led lives where they we.re active pnrricip,mts in decision making, so there
is linle doubt that they will have an enormous imP3ct on services for this age group.
They will want to be very involved in defining and developing programs and services
that will meet their needs. Since the foundation for empowerment is choice and con-
trol, counseJlors will welcome this proactive stance as one that is very consistent with
strengths and empowerment counseJling philosophy and routines.
Aging offers many opportunities. 1t is a rime when people can have more time to
pursue hobbies, spend rime with family, assist with raising grandchildren, travel and
realize dreams that were not possible in the.ir young,er •fears. Increased attention to
fitness and nutrition along with bener healthcare results in more seniors living longer,
healthier, and independent lives. Financial need, better health, and a ,;eneral desire to
remain active in the labour force has resulted in many seniors ,vorking wdl past the
traditional retirement a,;e of 65.
Aging can also pre.sent with man,., unanticipated challen,;es that lead seniors to seek
counselling (see Table 7. I) For example,. health issues may have imP3cto:J the ability of many
seniors to w-orlc or pnnicipnte in octiviries that have defined their lives. Some, bo::ause of
mobility or hrokh issues. including loss of ~-csight, have become dependent on others for the
6rst rime in their lives. \Vomen live longer than men, so they are more likd)•to face the pros-
pect of living alone without their spouse, sometimes with very limited income or suppon.
Retirement or unanticipated job loss can result in dramatic changes in role and
stnrus that have de.fined a person's life. \Vithout the demands and time commitments
of employment, retirement requires people to find new ways to structure their time
and find meaning in their lives. Otherwise, depression, loneJiness, and despair may
take over. Consequently, helping seniors achieve or maintain a sense of purpose is an
essential empowerment ,;oaJ.
CRISIS INTERVENTION AND EMPOWERMENT

A crisis can take many forms. NarurnJ disasters, terrorist attacks, and w-nr create crises that
impact all members of a country or community. Personal experiences such ns rape, denth,
divorce, loss of income, or incarce.mrion dearJ,., affect individunJs and their families.
Many factors influence how an individual copes with a crisis, including past expe-
riences, overall physical and psychological health, the presence or absence of social
and community supports, substance use, personality factors such as impulse control,
and genetics. Catastrophic disasters, assaults, war, and other traumas can disempower
even the strongest individual~ and people may experience devastating and debilitating
life change~ such as post-traumatic stress disorder. For some, a crisis ma)' stir up pnst
memories of other traumas and the impact may be cumulative, leaving them more vul-
nerable. As a result, the.re is further psychological injury leading to depression, ph)•sical
illnes~ anxiety, hopelessness, suicide, or withdm,.,,.-nl.
Supporting Empowerment and C hange 197

TABLE 7 . 1 Empowering Seniors
Component Potential Issues Suppon Choices
MedicavPsychiatric • Complex health, f0t example. loss of eyesigt\l, • famity sup(X)rt and education
heari~. and physical mot,li1y • Lifestyle counse1Hng-t1ut(rtion and exefcise
• Oep(ession • Appropriate use of medication and the
• Oemtmtia includi~ Alzheimer's Disease heafth system
• Respite care
Flnancial • Po,,el'ly (especially women) • cafe« and job counselling fot those
• Unexpected job IOSS remaini~ in the wor1dofce
• Costs of hOusi~ in IO~tefm ca,e • Community fesouroos f0t financial and
• financial abuSe housi~ support
• Legal ramedies
• Oisc(ntination (ageism) • Wellness counsem~
• Managing time, use of leisure.• and copi~ with • Expt>r-ation of meaninghA social and
retirement recreational opportunities
• Emotbnal and phyS:ical neglecl and abuse • use of advocate groups and 0tganiz.atioos
• ISOiation and fear of abandonment • Empt>yrnent of vOlunteers
• Housing • Police inteiwntion
• Couples who beeome separ-ated in diffefent • LObbyi~ fof systemic: change
care facilities beeause one of them oeects tnOr'e • Pets
complex cafe • Arrangement of traosportat.ioo (famil'j, vOI~
unteers, and seniors' services)
PsychOI. .I • LOss of control, indepe-ndence, and identity and the • Stfengtns-based counselling
need to find pur(X)se in life • Grief counselling
• Oeali~ with death and dyi~ • MaximiZing in'V()l\lement rn decision maka"lg
• LOss of control, identity, and independe~ • Utili:zation ot adlAt day care and droP.,.n
• ISOiation and fear of abandonment progr-ams for seniors
• Grief exacerbated b-f multiple IOSSeS (friends,
family, and spouse)
• Sex.uaity
Neve.rtheles~ many people adapt and may even thrive during a crisis. T hey dis.-
cover their resilience and untapped strengths, including previously unknown resources.
OptimisticaJI)•, the resolution of a crisis is an opportunity fo r growth. Presbury, Ech.-
terling, and McKee (2008) suggest that post-traumatic g rowth (PTG) happens when
people "come away from traum:nic events having gained a new perspective on life and
having achieved important understandings" (p. 212). Supportive crisis intervention by
counsellors and others can increase the probability of post-traumatic growth (lames &
Gilliland, 2013).
A crisis can overwhelm individuaJs and disrupt their ability to cope and function
normally. Persona] crises that may arise from depression, loss of job, or rape mil)' evoke
emotions so intense that action or rational thinking is impossible. Sometime~ as in the
case of a disaster like a flood or tsunami, people are c ut off from the.ir basic physical
needs. Whatever the nature of the c ris is, the p riority goal for counselling is to heJp
clients obtain power and control b\• re-establishing safety and stability. One centra.1 step
is to help and encourage connections with supportive family, friends, and community
resources to restore equilibrium and to reduce psychological trauma➔
SUCCESS TIP
In the immediate aftermath ot a crisis, counsellOts n'lay wish to minimize (but no1 prevent)
expfession of footings rn favouf of l!litiatives that locus on safely aoo coMection with sup.
portive family and community resources.
198 Chap1er 7
The ultimate goal of crisis inte.rvention is diem empowerment, so that wherever
possible counsdlors should collaborate with clients; however, bcc3usc of physicaJ inca,
pacitation or emotional in3bility, there ma)' be times when counsellors need to assume
power and be more dirtttive. For example, if 3 dicnt is suicidal and not responding to
counselling initiatives, the counsellor ma,., need to caJI for emergency se.rviccs and hos-
pita1iz3tion. ff 3 dicnt is emotionally unable to make rational decisions, the counsellor
may be required to take chari;:c. Table 7.2 summa.ri:::cs counsellor skills and strategies
for selected crisis intervention goals.
ln the remainder of this chapter, strategics for motivating clients and helping
them develop and sustain change will be explored. MotivationaJ Interviewing (Miller
& Rollnick, 2002, 2013) is a tool to hdp clients deal with the ambivalence that inhib-
its them from making necessary changes. The stages o f ch ans:e model (Prochaska stages of chance, model: A IMOry of
& Norcross, 2001) is based on the notion that people go through different motiva-
tional stages, C3ch of which requires different counsellor skill choices for success.
st•
mo:rt~ion tut recopil2s liw changes ol
piecontemplat • contemplat •
preparation. auion. and main~.--e:.
Frequently, the stages of change model is reflected in Motivational Jnterviewing. Cog-
nitive behavioural counscJling is a collaborative (counsellor and diem) approach to
helping clients make changes in the three major psychological domains: thinking.
behaviour, and emotions.
MOTIVATIONAL INTERVIEWING (Ml)

Motiv-arionaJ lnterviewina (Ml ) (Mille.r & Rollniclc, 2002, 2013) is an empirically motirational interviewi~ (Ml): A
validated strategy for helping people ove.rcome ambivaJcnce to change. Motivational nocCllfruuati>nal coaseHing approach
t!l31 promotes behavml change by
interviewing requires a collaborative, nonconfrontational relationship. lt assumes that assisting tlieals to recognize: and iescbe
motivation and capacity for change arc within the client. Consequently, it honours the ambi~
client's right to seJf-dcte.rmination regarding whether change is to take place, as well
as the ultimate gooJs of any change process. "MI allows clients, both mandated and
voluntary, to discove.r their own reasons for making change. Ml aJlows the impetus to
change to emerge from within a client, thus honoring the client's unique circumstances
and worldvicw" (Caponi & Stauffer, 2008, p. 145).
TABLE 7.2 Crisis Intervent ion

Intervention Goal Counullot Skill and Strategy CholcH
Pt,ys;cai safety Link to fesouroos f0t fOOCI, sheftef, and medical assislance.
°'
Help d ient move to a physical psychologically safe setting.
Access emergency secvtes (e.g., police and ambulance).
P~hOIOgjcal safety Etlcoutage client to ink with personal supports (famlfy, friends,
and religious leader).
ShoN empathy Catlow clients to ex.press feelings).
Normalize feelings.
carry out 1tauma counsetling.
Empowefment Provkle information.
EtlcotXage decision making.
Promote and reinforce small goals with reaistk time frames.
Mobilize Or' help client coMect wilh sup(X)rt groups.
Restore balance Offer reassurance.
Provi::le sel'Vioos (informat.ion, support, and refenal) to
significant family.
Communicate hope and optimism.
Etlcoutage resumption of normal routines..
Plan f0t follow-up.

Miller 3nd Rollnick's (2013) conception of Ml highlights the following features:
■ The "spirit of motivational interviewing" is more important th3n technique. "The
spirit of motivational interviewing" as conccptuali:~ by Miller and Rollnick (2013)
is primaril)• conce.rned with the 3ttitudc of the counsellor and the counseJling refo,.
tionship. It derives from Roger's person-centered 3pprooch with 3 high cmph3sis on
client sclf-determin3tion and faith in the ability and cap3city of people to change.
They identify " four key interrcl3t~ cJements of the spirit of Ml: p3rtnership.
acceptance, compassion, and evocation" (p. 15). Partnership emphasizes colfob-
orativc conversations to assist people to strengthen their motivation for change.
Acc:cpt3ncc involves the esscntiaJ core conditions described by Rogers (1961) of
unconditional positive regard, empathy, and genuineness (Stt Chnptcr 3 of this
book). Compassion, as defined by Miller 3nd Rollnick, involves a conscious focus
on promoting the best interests of clients by giving their needs priority (p. 20). Evo-
cation focuses on the inherent strengths of clients as opposed to detecting problems
and deficits. As discussed earlie.r in this chapte.r, the strengths approoch assumes that
clients arc experts on the.ir O\\•n lives, and they h3ve within them the experience, wi~
dom, and resources that need to be the focal point for decision making and change.
■ Avoidance of the "righting reflex.-thc desire to fix what seems wrong with people"
(p. 6). This desire to fix might involve confrontation (which tends to promote rcsi~
tance), 3nd advice giving on the best course of 3Ction. It often involves trying to per-
suade clients to change. The righting reflex tends to put clients on the defensive whe.re
they take positions that hnve hisroric3lJy been defin~ 3S resistant. In MI, counsellors
are encouraged to consider how their bdi.aviours and responses might be evoking
resistance. (Sec Chapter 8 for a further discussion of this important perspective.)
■ A belief thnt the resolution of 3mbivalencc is a criticaJ step in supporting change.
Ambivalence Miller & Rollnic.k note that most people who need to change are
ambivalent: they hnvc reasons to change as well as reasons to maintain the status quo,
however, dsyfuntionaJ that might be (2013). Anxiety and indecision can leave people
stuck. Ambivalence is a normal part of the chnngc process. For clients who are not inter-
ested in changing, the emergence of ambivalence would signal movement t0\\'3rd change.
When people are 3mbiwlent, they are drawn in opposite directions at the same
time. People may be ambivalent for a number of reasons, including the following:
I . The aJte.rnatives are cquaJly appealing (Approach/Approach).
2. Neither course of action is appealing (between a "rock and a hard place").
3. Both altcrn3tivcs have features that are both 3ppealing and unappealing.
4 . Conflicted fccling~knowing what is right, but finding one's emotions taking one
in the opposite dir«tion (Hcan/intcllect).
5. Desire to move in one direction, but fear of loss if that direction is chosen.
6. Simply not knowing what is right.
"Change Talk" and "Sustain Talk17 One way counsellors can address ambivalence
change talk Clieal statanents is by listening for "change talk"- dient statements favouring change and "sustain
laYOJring dt.an,e. talk "- dient statements favouring the smrus quo (Mille.r 3nd Rollnick, 2013, p. 7).
sustain talk: Client Mat.ement.s Here are some examples of diem statements that signal change tallc:
laYOJring 1M mtus quo.
■ I wish my life was different.
■ I w3nt to quit drinking.
■ I could ask my family for help.
■ I miaht be able to work pan.-time.
200 Chap1er 7
■ I probably should go back to school.
■ I need to find a W'll)' out of this mess.
■ I will look into it.
■ My intention is to fight this problem.
■ I tried to stop using heroin.
SUCCESS TIP
The fact lhat a che-nt firmly defends a lifestyle that he knows is unwOr'kable is prool that he
is in need of great assistance and suJ)port.. (WickS & Pal'SOOs, 1984)
\Vhcn counsellors hear change talk, cardully targeted responses can increase the
level of change talk and motivation for change.
Client: "I know th:u smokin¥ is Nd and. I !"K'ed to q uit (chan,e talk). but I'm 2(rakl. that
i( I q uit I'll ¥:l.in \\re~t (tlillam talk)."
Coun.seltor (Ml choice~):
■ I( )'OU rn:lde 2 dedsion l'O q uit. how would )'Ou do it!
■ \Vh::lt are )·Our re:asons for wanth1¥ to quit!
■ Hoo• important is it for )'Ou m s:.ive up smokiOi!
A decisional balance sheet lists the benefits and costs of different choices. By
addressing barriers to change, counsellors may help diem to "tip the baJancc" in favour
of change. ln the above example, exploration of the ways one can control weight g3in
ma,., help this client overcome resistance to change.
Empathy
EmP3thy and other active listening skills are now universally recognized as important
to any counsdling relationship. regardless of the choorctical approach of the counsellor.
Ml is no exception and empathy is a central feature of this approach. "\Vithin the Spirit
of Ml," it creates an interview climate where clients are free to explore their value~
perception~ goal~ and the implications of their current situation without judgment.
Conversely, "confrontationaJ counscJling has been associated with a high dropout rate
and rdativet,., poor outcomes" (Miller & Rollnick, 2002, p. 7). Active listening, espe-
cinJly with the use of empathy, increases intrinsic motivation for change.
Developing Discrepancy
The ove.rnJI gonJ of motivational interviewing is to help people get unstuck. The method
is to initiate "change talk" by caking advantage of naturally occurring opportunities in
the interview to embellish diem statements chal suggest differences between the way
their life is and the way they would like their lives to be. Simply focusing on a client's
goals and aspirations can often help people appreciate how the.ir current lifestyle is
inhibiting che.ir ideals. Motivational interviewing uses a number of strategics to evoke
change talk, such as the following:
■ Asking evocative questions about disadvantages of the status quo, advantages of

change. optimism 3bout change, and intention to change.
■ Using scaling questions- for example, "On a sc3Je of to 10, whe.rc are you in
t~rms of satisfaction with )'OUr life?"

■ Exploring the positive and negative consequences of the status quo.
■ Using eJaboration skills (e.g., asking for darifiC3tion, examples, description, and
further infor-m:.nion) to clicit furthe.r change caJk.
■ Querying extremes, such as "Suppose you don't make any changes. \\:lhat do 't'OU
think might be the consequences of this in the worst-case scenario?"
■ Looking back to help clients remember how things were before compared with the
current situation.
■ Looking forward by asking clients to describe their hopes and goals for the future.
■ Exploring goals and vaJucs to target discrepancies between important goals and
current behaviour (Miller & Rollnick, 2002).
■ Helping clients understand their ambiva]cnce to change using the metaphor of
a secsaw- ,vhen the costs of continuing present behaviour and the benc6ts of change
outweigh the costs of change and benefits of continuing present behaviour,
change will occur.
" Roll ing with Res istance"

\\:fhcn counscllorsconfrontdients with arguments for change, they can e3sily find them-
selves in power struggles where they are pressing for change and diems are resisting.
ln Ml, client resistance is seen as a message that the counsellor nttds to do something
different. Power struggles arc likely when counsellors do the following:
■ Offer unsolicited advice from the cxpe.rc role.
■ TeJI clients how they should feel.
■ Aslc excessive questions.
■ Order, direct, w-am, or threaten.
■ Preach, moralize, or shame.
■ Argue for change.
■ Blame, judge, or critici!e.
SUCCESS TIP
"As long as )(lu( clients are goi.ng to (esiSI you, you might as 'm!II encourage it• (Milton
Erickson., sou(ce uokoown).
radical acceptance: A strateg:, Radical acceptance is a strategy that involves encouraging expression of state~
that ifl\'OIWS ..agini espressi:in al mems that you tend to disagree with or philosophically oppose, for example:
statemeais t!latyo, tend to disagree wit!I
or philos-icalJ oppose. C lient: I don't see the point. The onlr reason I C3tne rn,b)• is the fact that 1( I didn't
show up. I'd be cut off wel(:ue.
CounS(>IJOr. I' in Ve?")' $:lad )'Ou bro~t this up. Man)' people s.h3re views soch as )'Ours
but ..von't speak up. so I appred::ue )·Our willin{tness t'O be honest.
ampl.ified reflection: Atethniqll! Amplified reflection is a t«hnique that exaggerates what a dicnt has said with the
that exauerm wtuit a cliea1 has said hope that the diem will present the other side of ambivalence. However, as Mille.r and
Mt!I the llope tu 1M clieal 11ill ,-seat
the ether siJe of aabivalenoe. Rollnick (2002) stress, " (t )his must be done empathically, because any sarcastic tone
or too extreme an overstatement may itself elicit a hostile or otherwise resistant rcac~
tion" (p. IOI).
202 Chap1er 7
Client: I don't se,e what the problem is. \X'h::u 's the harm in havin¥ 2 (e,., drinks a(ter a
h::ard d::ar's v.-·o rk!
Counse.Uo r: So, you're s::ari.n~ th2t drinldn& h::.sn't c::aused 30)' problems or aiven rou
211)' reason (o-r ooncern.
Client: Well. I wouldn' t ao th3t far.
Support Self-Efficacy
To begin and sustain change, clients must bclicve in their np::acity for change. For their
part, counsellors can have an enormous impact on outcome if they believe in their
diem's ability to chanae and when they take steps to enhance diem confidence. One
choice is to heJp clients identify past success. Another is encouraging clients to m:.llce
an inventory of their strengths and resources. \\:forking on small achievable goals often
starts a chanae process that gathers momentum. CounseJlors can also look for oppor-
tunities to affirm their clients' effons. strengths, and successes.
STAGES OF CHANGE
Risk Taking
Change involves risk, and risk creates anxiety. Even when motivation to change is high,
emotions such as fear make it difficult to replace established behaviour with new W'n)'S
of behaving. As a result, there is often tremendous (seJf-imposed) pressure on clients
to maintain the status quo, however, ineffective it might be. Sometimes change involves
a "sdlina" job, but the results are bette.r when clients, not counseJlors, do the selling.
Clients need to convince themseJves that the benefits of chanae outweigh the risks, and
they neo:I to dcvclop positive attitudes and beliefs about their capacity for change. Coun-
sellors with a strengths perspective believe in the capacity of their clients to change, and
this beJief in them can be a powerful motivating factor.
Johnson, McClelland, and Austin (2000) identify three factors important for moti-
vation: "the push of discomfort, the pull of hope that something can be done to relie,.'<'
the problem or accomplish a task. and internaJ pressures and drives coward reaching a
goal" (p. 133). Thus, not on!)• must clients want to change, but they must also believe in
their capacity for change.
The concept of secondary iain is a useful way of understanding why some people Secondary gain: Auseful•arof
resist change despite the obvious pain or losses involved in maintaining their current undefs!and-,.,.,. some people m ist
dl.-ge des.pie the «Nioas pail or lossei
situation. Secondary gain refers co the benefits that people derive from their problems, inrolwd in aailllainilc their curreat
such as increased attention from others, having an a\--nilable rationale for not changing si1ualion.
or participating, financial advantage, or escape from W'Ork or other tasks.
CONVERSATION 7. l
ST\JOEHT: The clients Ihave the most trouble with a(e the laZy as laly, we ShOtJd remember that they may have given up for
ones--the ones whO won'I even get out of bed in the mOO'ling good reason. They may not have IN resCIU'cesor supp:,rt they
to go IOOk for a job 01 100 clients whO nENer fonow through on need tor change or they may have given uJ) k'I Order to protect
commit~nts. themsetves from the furthe( damage to lheir self~eem that
would come from repeated failure. In this way, their behav-
TEACHER: Sure, these clients can be exceptionally diffadt iour may be soon as adaptive. It's normal f0r counselbrs to
and frusuati~ to \\()fk wtth. Sometimes it's hard to do, but lose patience with lhem and give up, but it's important to
we ShOtJCI discipline oursetves to be nonj udgmental regardi~ remember that precisely what they did to lhemsef\ie~
motivation. AJ!hough it might be tempt~ 10 label SOt'ne cl.ants up. That's one of the reasons they need counseling,

transtheoretical model of The stages of change model, nlso known as the transtheorerical model of chans:e
change: A aodel tu identifies fiw
(Prochaska & Norcross, 2001), has rcce.ivcd a great deal of attention in the literature
stages ol dt.ange---piecontemplatio..
contemplatioo, pnq:iaratio.. actio.. . t since its inception in the 1980s. In this modcl, five stages of change arc rccogni!ed: pre~
aa:intenance. 0-Sellof re$p)IIS! choices contemplation, contemplation, prc-P3ration, action, and maintenance. As wdl, change
an difiefat depeaiing • the dierrt's is viewed as progressive development in this modd, with success at any phase depcn,.
stage of chang_e.
dent on the success of previous phases. Figure 7.2 illustrates the five stages of change.
Although this figure implies an orderly progression from one phase to another, in reaJ~
icy, clients may progress through stages and then drop back to an earlier scag:c (relapse)
before starting a.gain.
An essential assumption is that counselling interventions need to be selected to
meet the needs and motivation of the particular stage clients are in. Thus, for example,
it makes no sense to talk to a client who is not ready to change (precontcmplativc) about
change strategies, but this tallc ,vould be wholl)• appropriate for a diem who is preparing
for change.
A client may be at different stages of change for different problems. For example,
a client may be precomemplative (not interested in changing) rei;prding his drinking:,
but ready to cake action with respect to his foiling marriage. Accordingly, discussing
strategies for cuttingdO\\•n his drinking is likeJy to meet with failure; hO\\revcr, exploring:
strategics to improve his marriage is likely to elicit a positive response.
P'recontemplative Stage: " I Don't Have a Problem." Clients at this stage have
no intention of changing. These clients do not pe.rccivc themselves as having a prob-
lem, despite the fact chat their behaviour is problematic for themsc.lvcs or others in
their lives. These clients are not thinking about change, and they may rationnli.!e their
problems. minimi.!e the consequences of their action~ or blame others.
For these clients, empathic and sensitive listening chat encourages them to exam-
ine their situation and its consequences can be very heJpful. Counsellors can provide
information, offer feedback, or encourage reflection with questions such as "ls what
you're doing now working to mttt your needs!" Obviously, for clients to change, they
Contemplati\le
Fl
Actian
•
Figure 7 2 The Stages of Change
204 Chap1er 7
must move beyond the pr«ontcmplative stage. Unforrunatdy, many people, including
some counsellors, believe that confrontation is the remWy for denia.L Denial is a defence
mechanism that enables people to cope, perhaps by protecting themsclves from the risks
of change. As a result, confrontation threatens this protection and it often rri~ers further
and deeper resistance. OiClemcnte and Vclasquez (2002) observe that "Sometimes the
reluctant dient will progress rapidly once he or she ve.rbnJi.!es the reluctance, fttls listened
to, and begins to feel the tension between the reluctance to chani;e and the possibility
of a different future" (p. 205). DiClemente and VaJasque! (2002) offer this perspective:
Clinki::uu o(ten belie-\'e th::u rnore edueat.On. n\Ore intense treatment. or more confron.-
t:ltion will ne«~nl)' produce more chan~'C'. Nowhere is this less true th::m with pre-
contempl:1t·orS. More inteiuit)' will o(ten produce fewer resu!u with this Stroup. (p. 2C6)
Contemplative Stage: "Maybe I Should Do Something About It." A, the con-

templative stage, dients know they have a problem and are thinking about change, but
they have not developed a plan or made a commitment to take action. Contemplative
clients may be ambivalent and may vacillate between wanting to alter their lives and
resisting any shifts in their behaviour or lifost)•le. At this sroi;e, clients ma)' be open to
new information as they self-assess their problems and the advanmi;es and disadvan-
tages of change.
Ex:1rnp1e: A~nes has been in an 2busive rel:1tionship for )~rS. She wishes th:u she could
!e::n,e 2nd s12rt O\'er. In f::.et, she h:u !e(1 her husband twice in the past, but C.l.ch time she
h:u returned " '1th in:. (ew wttks.
Contemplative sroi;e clients like Agnes are "burnt out" from previous unsuccessful
attempts at change. They are often in a state of crisis with considerable associated stress.
Although they desire change, they doubt it will happen, and they believe that if change
is to occur, it will be beyond their control. They aJso lack self-esteem and believe that
they do not have the skill, capacity, or energy to change.
Ex:1mp1e: Peter (.S5) ~s ~n 1.memplO)~ lor alu\OSt t'Yi'O )'e:lrS. but he h:lS nOI looked
(or 2 ,ob in months. He 52yS. "l1lt-re·s no work out there. Besides. who is it0111K 10 hire
2 nun o( rny a~?"
Seligman's (1975) concept of learned helplessness is a useful perspective for under-

standing these clients. Ptt>ple with learned hcJplessncss come to believe that their actions
do not mane.r; as a result, they are unlikely to extend any effort to change since they
believe that thq• have no control over their lives and that what happens to them is a
result of chance. They believe in a "luck ethic" rathe.r than a "work ethic." Their beliefs
are reflected in srotements such as the following:
■ "You have to be in the right place at the riWlt time to succeed."

■ "ff I'm successful, it's because the task ,.,,.,..s C3sy."
■ "It doesn't maner if I work hard."
■ "There's nothing I can do about it."
The key to working with people with learned helplessness-indeed, with most
clients at the contemplation stage-is to assist them "in thinking through the risks of
the behaviour and potentia1 benefits of change and to instill hope that change is pos-
sible" (DiClemente & Velasquez, 2002, p. 209). Many people with low self-esteem and
lcarned helplessness are in fact quite capable; it is the way they think and feel about
themselves that is problematic. Consequently, it is important that counscllors look for
ways to counter the client's self-deprecating remarks (e.g., encourai;e clients to sec the.ir
past failures as deficits in the plan, not deficits in them). As well, counsellors can encour-
age clients to sec clements of success in previous efforts (e.g., P3rtiaJ gooJ achievement,

lessening of problem severity, and short-term achievement). Cognitive behavioural tech-
niques, discussed later in this chapter, have also proven to be effective.
Confrontation should be used cautiously. As a rule, confrontation is most effective
when it is invited in the context of a collaborative relationship-in other words, when
it is invited. Then, it may be useful as a way to help clients understand incongruities
between what they believe and the way they act, and rccogni:e self-defeating ways of
thinking and behaving, behaviour that is harmful to sclf or other~ blind spots, blam.-
ing behaviours, and communication prob lems. As wcJI, confrontation can aJso target
unrecognized or discounted strengths.
Preparation Stage: " I'm Going to Do It Next Week." \Vhen clients rcuh this third
phase, they have made a decision to chani;c and motivating them is no loni;cr the prin-
cipal task; however, counsellors neo:I to sustain the energy for chani;c through support,
encouragement, and empathic caring. The principaJ msk for the counsellor is to assist
the client to dcvcJop concrete goals and action plan strategics. \Vithout concrete, system.-
atic plans, change efforts can be quickly frustrated and abandoned like soon-fo~ncn
New Year's resolutions. The essence of good planning consists of Setting concrete goals,
identifying and evaluating alternative W'tl)'S of reaching goals, selecting an action plan,
and anticipating potential o bstacles. For clients with learned helplessness, Setting smaJI,
achievable goals is crucial for establishing and maintaining a climate of success and hope.
Example: Iris. a 't·OUni siniJe parent. is excited about the po$$ibilit)' o( returnin& t'O
school. She sees a sc.hool counsellor for assistance with enrollment in the hiah schoors
speeial proal"3m for teen 1noms,. but she has not 't~ considered issues like d:t)'C:!Fe.
Using a strengths approoch, counsellors can assist preparation stage clients to draw
from their past experiences (proven success strategics and lessons learned). As well,
clients can learn about strategies that h.nve ,vorked for others. FinaJly, it is very impor-
tant to conch these clients to anticipate potentiaJ obstacles and to plan strategics for
addressing them, including the emotional stress of the ch.nnge process.
Action Stage: " I'm Changing." At this stage, clients are ac.tiveJ,., involved in the
change process. They arc working on the goals and implementing the plans developed
in the prcP3ration stage. DiClemente and Velasquc! (2002) offer this perspective on
counsellor srrategies for this scagc:
Cl1ent'S in action ,nay still h::n,e some oonfhctinK (eelin~s about the tha.n~-e. They ma,.,
Ca.re(ul listeniO¥ 21nd 21mrmina clients t~1 they 21re doiO¥ the ""'t
1niss their old l1festyLe in s<.une w:iys 21nd be struj$1ina t'O llt int'O this new behaviour.
thin¥ are important in
this sta~-e. It is also important to c.hec.k with tilt c.lient to see if he or she has d1SCO\~red
p::aru of the tha.n~-e plan th3t need revision. (p. 212)
When clients encounter anticipated obstacles, counsellors can re.mind them of pre-
viously developed contingency plans. If there are unanticiP3ted obstacles, counsellors
can assist with interventions to support clients as they deal with these potential setbacks.
Maintenance Stage: l'l've Done It. I Need to Keep Doing It." ln the final
stage, the challeni;c for the client is to maintain the changes that have been made and to
deaJ with reJapses, which may occur for a number of reasons (e.g., unexpected tempta.-
tion, personal stres~ triggers, letting down one's guard, and sabotage by others who are
threatened by the chang,c).
Counsellors can heJp clients accept that relapses, while undesired, are pan of the
change proces~ and they can hclp them to reframc the relapse as an opportunity for bet-
ter success ne>..'t time. For example, they can heJp them develop new or rc,.•ised strategies
for dealing with stress points or triggers.
Table 7.3 oudines the stages of change.
206 Chap1er 7
TABLE 7 .3 The Stages of Change
Staao/C4al Strateo Choices
PfecMemptatfwe Slage • Emptoy empathy and Olhet active listaning skits.
Clients with no desire or intent.ion of d'langi~ • Provide information and feedbaek (if invited).
• Counselling goal: JllCfease awarell6$$ of • E~age dients to seek S'lklrmation and feedbaek frOO'l others.
neoo for change. • Help clie-nts beCOme aware of attractive alternatives.
• use lhOught-proYOking questions.
• Avdd dllective and confrontational techniciues.
• use films, brochures, bOOkS. and self-assessment questior\nakes as tOCiS to
increase client insight.
• With irwOluntary clients, extilore feeli~ and concems openly,
self<tisctose your own feelW'lgs aoout being bOOCI, give clients choices,
involve them in decision makl~, and encourage client-initiated goats.
contemplative Stage • Support "change talk:
Clients who afe lhinkiog abOut d'lange • Discuss risks and beoofits of change. but avoid argui~ in favou( ot change.
• Counselling goal: Resolve ambivateoce w • Help clie-nts uOderStand and manage self-deprecating remarks (e.g.,
engage in the change f)(OCess. reframe past failutes as learni~ ex.pel'ieoces).
• Identify elements of success in p(evious d'lange efforts..
• Uptore pmvious relapses emphasizing failure ot ~ns. not failure of dients.
• use support groups.
• Convey hope and belief in the dient's capacity for success.
Preparation State • Setgpats.
Clients who am committed to change • Plan systematic action.
• Counselling goal: Develop C011ctete strate- • Assemble/mobilize tesoutces to support d'lange.
gies lot action. • Make contingency plans (anUdpate obsiacies).
Action Stage • Reward (p,aise, sup(X)rl, and ackno-ldedg,e) change efforts.
Active change effort • Assist client to antidpate and manage JX)tent.ial obStades.
• Counselling goats: Implement change at'ld
sustain momentum.
Maintenance Stage • Assist client to deal with periodic ObStades or (elapses.
Sustain cha~
• Counselling goal: Sustain change.
COGNITIVE BEHAVIOURAL COUNSELLING

"l know rhar you believe )'OU understand what )'OU think 1 said, bw
l 1m nor sure ,·ou realit;e that whar you heard is nm what l meant."
- Robert McClosk~
Thouahts nre the birthplnce of emotions, sclf-cstttm, nnd behaviour. Positive (helpful)
thinlcina creates an "I can do it" attitude, which IC3ds to a arenter willinancss to embrace
new chaJlengcs and to rake appropriate rislc.s. Neg3tive o r unhelpful thinlcina panern~
on the other hand, Cre3te distress and interfere with one's ove.rnJI sense of weJL-being.
Cognitive behavioural tedmiqucs focus on increasina helpful thinking and on changina
problemntic behavioural patterns.
Cognitive behavioural coun....elling (therapy), or CBT, hns been empirically tested c:ogniti¥t beha-tioura.l c:ounselli,_
in hundreds of studies. T he results have demonstrated its usefulness for a wide range of (therap7'): Acoonsellint appiod
t!l31 assists dients to ii.ntify-.:J
sociaJ, emotionaJ, and mental health p roblems such ns mood disorders (depression and mdfy unhelpW t!linling and pdlt!m.a~it
bipolar disorder), anxiety disorders (obsessivc<ompulsive disorder and post.-traumatic bebtiour.
stress disorder), substance use problem~ enting disorders. g:imbling problem~ anger,
personality disorders, srres~ unresolved afief, 3S weJI as medical problems such ns hyper-
tension and low b3Clc pain (Buder, Chapman, Fauman, & Bcc:lc, 2006; Chambless &
Ollcndkk, 2001; ond Beck & Beck, 2011).

Figure 7.3 ABC Model
Amc.ric:.m psychiatrist Aaron T. Beck (192 1- ) is considered the founder o f CBT.

\Vills (2008) identifies the ccm:raJ assumptions behind Beck's npproach: ''At rhc heart
o f the CBT paradigm the.re is a very simp le yet effective working modcJ: the way people
think a bout their situations influences the W'll)' they foci and behave" (p. 5). CBT docs
not focu s on finding the root causes of problems; rather, it emphasizes problem solving
to hcJp clients find new W'll)'S o f thinking a nd responding.
Counsellors can q uickly teach clients the basic ideas behind CBT and, in the pro--
ccs.s, hcJp chem lenm a bout how unhelpful thinking impacts behaviour and emotions,
and how behaviour and thinking that is lenmcd can be unlearned.
The k~• to changing problematic behaviour o r emotions is to explore and modify
d istorted thinking:, and then to learn and p ractis e new responses. CBT focuses on under-
standing current thinking(thc prescnt)and problem solving todcvdop new behavio urs.
Marie and Aiesh:3 3re pa$$(":i1~-t-rS on the same airline fh.i1t. t-.-b ne ii consumed by her
le::tr th3t the pfane will eras.I,. thin.kin¥. "This is 3 d3n~rous situ3tion. \\1h3t if the
en&ines fam A nd 2ir turbulenee will surely te3r the pl:me :lp3rt." Aiesh3 boards the
pfa.ne 2nd qukkl)' immerses herself in a book with no intrusiv~ thou$:hts o( <lrin~
Ellis (2004) developed the famous ABC model (Fiaurc 7.3) as a tool for u nderstand-
ing why Marie and A icsha experience the flight so differently. ln the model:
■ A represents an activatina cvem (in this case, the airplane flight).
■ B refers to the beliefs that are triggered by the activating event, A .
■ C is the consequent emotion or behavioural reaction.
C lear!)•, Marie's beliefs about fl)•ing arc markedly different from Aicsha's. Cogni.-
tive behavioural counselling would concentrate on how Marie can modify her thinking
about flying, which is based on erroneous and distorted beliefs about its d angers. More-
over, the skills Marie learns will help her adapt to future problems she may encounter
in other areas o f her life.
SUCCESS TIP
If ooe's thinking changes, behaviour and emotions a~ d'lange. If one's behaviou( changes,
thinking and emotions also change. If one's emol:ioos change, thiMing and behavi::lut also
d'lange. See f igu(e 7.4.
Cognitive behavioural counselling uses a combination of methods to help clients

learn more effective copina strateaics. indud ina
■ hclpina diems recogni:e thinking patterns, in particular those chat are unhelpful;
■ hclpina d iems modify thinking patterns; and
■ assistina clients to develop action plans and strategics (modifyina behavio ur).
208 Chap1er 7
Figure 7.4 Interd ependence of Feelings, Behaviour, and Thinking
Helping Clients Recognize Thinking Patterns

"\Whether )'OU rhink you can or think )'OU can 1c- Jou 1re right."
- Henr)' Ford (pubi,c dom3in)
Frttauend)•, behaviour persists because clients are locked into unhelpful wnys of thinking
about their problems or solutions. Thinking pnne.rns that drive fee.lings and beh.nviours
are frequently outside a client's awareness. and theyemerJ;e from schema or core bdiefs.
Schema are the "basic beliefs individuals use toorgnni:e the.ir view of the self, the world,
and the future" (Sperry, 2006, p. 22). Significantly, a person's thinking ma)' be driven
by schema, assumptions and errors in thinking that are not fact based. (ndividuals who
are potentially very capable may act as if they were incapable because of faulty beliefs.
Automatic thous;:ht.'i occur spontaneously and are often outside of one's awareness. automatic thoughts: T~ s t!l31
Usually, they repeat weJL-establishcd themes such as. "J ,von't succeed," and this repeti• CICtW spoo1a118lUst, and areob outSd'
tion strengthens J)O\\'er of the belief. Such unheJpful or maladaptive thoughts can lead
«• 's Nareness
to distress., innction, low self-esteem, depression, and reluctance to engage in healthy
risk-taking, such as initiating social relationships. Cognitive beh.nviouraJ counselling
helps clients recogni!e automatic thoughts, identify "errors in thinking," and explore
how thouRJus hinder them from re3ching gon.Js. Table 7.4 outlines some common heJp-
ful and unhelpful core beliefs clients might have. Once clients become aware that an
automatic thought is about to h.nppen, they can practise replacing that thought with an
alternative. This interrupts the repetitive cycle of problematic behaviour. On a broader
level, clients IC3rn to understand and modify schemas that drive dysfunctional bchav•
iour and painful emotions.
TABLE 7.4 Helpful and Unhelpful Core Beliefs

Unbtlpful Helpf\11
• I am unlovable. • I am a pe-rson wOr'thy of IOve and r ~cl.
• To seek helJ) is a sign of weakt'less. • I can ask for and offe-r assista~.
• Without a (elationShiJ) partnier, I am OOlhiog, • I am resJX)nsible f0t my own haJ)piness .
• I wi• fail. I am helptess. • I will do my best, savour my success, and le-aro from my
mistakes.
• I have to be IOved by everyooe. • I accepr that not everyone wi\J IOYe me.
• I must be J)erlect in ever-ythiog that I dO. I musa be soon by • I accepr my limitations: they dO not diminish me.
otners as the best
• I am special; I can lake advantage of J)OOJ)le. • My rights as well as the rights ot Others need to be (espected.

Example: A new social setting t,iggers Troy' s automatic thoug,,ts: "'I don't belong.
I won't fit in ... These thoughts originate from hisc0re belief, " I am unlovable." Hi$
automatic thougtits and his core beliefs aeate anx.iety and fear. His strategy is to
use drugs to curb his anxiety, which in tum lead to the new belief that he won' t
be able to cope unless he uses drugs.
Unhelpful Thinking Patterns

It is the mark of an educated mind robe able ro enrerrain a thought
wirhour accepting it.
- Aristotle (publie domain)
Most of the rime, our thoughts are outside of our awareness. Cognitive behavioural
counselling is designed to help clients develop conscious awareness of the.ir thinking
p3ttern~ then criticall,.•examine the.ir validity 3nd usefulness. Subsequently, clients Je3rn
strategies for interrupting unhelpful thinking, while increasing helpful thinking and
behaviour.
Thinking errors can easily lead to faulty ime.rpretations and maladaptive behaviour.
Other thinking patterns. while they ma)' be 3ccurate, 3re simply not helpful. In 3 cfossic
early work, Beck (1976) proposed the notion of "Cognitive Triad" (alc3 Beck's Triad)
consisting of views about seJf, the wo rld, and the future to explain depression:
Self: "I am worthless. .. (or ui,worth)·, useLess,. and de:f"tdent)
\Vor)d; "The world ii unsa(e.•· (failure is imminent)
Futun:-: "TI,e future is arim.·• (problems will per-Sise inde:l"mitel)•)
The assumption is th3t the negative tri3d sustains the client's depression; therefore,
CBT focuses on helping clients to ch3ni;e their maladaptive and unhelpful inter-prcta..
tions of self, the world , and the future.
.-thelpful tt,,intd,_ patterns: Fatty It is important to understand the major unhelpful chinking patterns, such as e.mo.-
m:so11i11g caused bydist«tic., ifltOfflplete tional decision m3king. distortion, selective 3ftention, worry, m3gnif,c3tion/minimiz3,.
• at,sis. ~ ity. ripfty, and
self-defeating tllougllt.
tion, mind reading, ~rfcctionism, and self-defeating thought.
Emotional Decision Making In a Mr. Spock (Swr Trek) world , nil decisions would
be b3sed on totaJI)• objective, ration31 nn3lysis of the facts, 3nd emotions would pin)' no
p3rt. In eve.ryday life, it's not so simple. Emotions can 3nd often should pin)• a p3rt in
most decisions. Emotional decision m3king is problematic when it results in negative
o utcomes. Or, emotions might strongly support one conclusion despite evidence to the
contrary. For ex3.mple, peo ple might feel inadequate and unlovable while igno ring the
fact that they have nc:hieved succes~ and they h3ve many friends.
Distortion Disto rtion results from misinterpretations, faulty assumptions, o r c u),.
tural biases. An extreme form of this is delusio03l thinking, which involves holding
beliefs th3t have no b3sis in reality. Here are some common examples:
■ Misre3ding 3nother person's silence as lack of interest (mind reading).
■ Assuming th3t othe.rs should know wh3t we want, neo:J, or feel without be.ing told.
))}) BRAIN BYTE I Tl' ':: I ,[1, I ~1 ",1: I
Recent brain research (Naqvi. Shiv. & Bechara, 2006) is rationality and people make (and sometimes repeat)
mapping hO'N different parts of the brain (some rational decisions and actions that are not in lheir best interest.
and some emolional) are ac1ivat&e1 during decision mak- Moreover, this can continue despite full awareness of lhe
ing. In some circumstances. the Memoriooal btain" hijacks continuing er-r0c.
210 Chap1er 7
■ lnter-preting lade of eye contact as a sign of disrespect or lying when, in fact, the
other ~rson is from 3 culture where dir«t e)•e contact is discouraged.
■ Arriving 3t false conclusions such as bclie-.•ing (after hurting a friend's feelings) th:.n
"( 3m a horrible ~rson', and she'll never spe3k to me 3gnin."
Selective Attention Selective 3ttention errors arise from a failure to look 3t all
3Spects of 3 problem or siruation. For e.x3mple, people with low self-esteem m3y owr-
look evidence of their successes and strengths by looking only at their failures or limi-
tations. Or, people ma)' be egocentric and not consider other people's fecJings or ideas.
As a result, they may be seen by others as insensitive. Selective 3ttention ma)' involve
3ny of the following:
■ Listening onl)• to information and facts that support )'OUr point of view.
■ Having 3 selective memory th3t overlooks or distorts important information.
■ Losing focus on wh3t a person is S3)'ing (beatuse of factors such as boredom, pr«>e-
cupntion with personal issues, or setting distractions).
■ Focusing only on the present without considering the long-term impliai.tions.
■ Oispl3ying egocentric thinking that does not consider other points of view or the
impact of one's behaviour on others.
Worry or Rumination Excessive worry interferes with problem solving, 3nd it m3y
lead to feelings of an.xiet)•, depression, helplessness, and pessimism. Unhelpful wor-
rying might involve dwelling on P3St events or failures, or it m3y focus on events th:.n
clients fc3r might h3ppcn in the future.
Magnification/Minimization These types of thinking p3nerns distort faces b)•

extreme and exaggerated thinking. Here are some examples:
■ Splitting (all or nothina}-the tendency co interpret people, thing5i, 3nd experiences
as either totn11y good or totally b3d, with no sh3des of grey.
■ Overi;:eneralirntion-drawing conclusions from a single fact or event. For example,
after be.ing rurncd down for a job, 3 man concludes th3t he is wonhless and no one
will e-.'e.r hire him.
■ Discounting-rejecting compliments by refusing to believe that the other person
is telling the truth.
■ "Catastrophizing"- mngnifying small mistakes into disaste.rs or tot3l failures.
Mind Reading This common error 3rises when people assume they know how others
3re thinking or feeling. Mind reading frequently arises from personal insecurities. For
example, low self-esteem m3y result in interpreting the actions of others as rejection.
Perfectionism
HC3lthy individuals set re3Jistic, challenging, and achievable goals. They 3re motivated
to do their best, 3nd they maintain high standards for themselves. Conve.rseJy, people
who 3re perfectionists set unrealistic standards of 3chie-.•ement with 3n expectation of
constant success. Perfectionist individuals are under constant srress ai.used by the 3n-Xiet)'
to perform, or the renli:z:3tion that they have failed to reach or sustain the.ir unrealistic
expectations of seJf. lrration.nJ beliefs that arise. from perfectionism include the following:
■ I can't make a mistake.
■ I nm 3 failure if ( 3m less than perfect.
■ I have no value unless ( 3chieve the very best.

■ If I can't be perfect, then J might as wcJI give up.
■ I have to be the best. To win is the only option.
■ I'm probably going to fail anyway, so wh't' try?
The personal cost of perfectionism can include chronic pessimism, lo"' self-esteem,
lack of confidence, depression, anxiety, and obsessive concern with order and rou-
tine. Pc.rfectionists frequently use the words must, only, always, nevc.r, and should (the
MOANS acronym introduced in Chapter .S).
setf-ctekating thoughts: lnne, Self-defeating thoug.hts are irrational (unhelpful) idC3s about one's own weaknesses.
liilog• al critic-M MSs.JteS. Albe.rt Ellis (1962, t984,t993a,1993b, and 2004) has wrinen a grc3t deal about "'hat he
defined as irrational thinking and its impact on emotions and behaviour. Ellis argues that
people's belief S)'Stcms influence how they respond to and understand problems and
events. \\:fhm the.ir beliefs are irrational and characterized by an unrealistic shor.dd, they are
lilcet,., to experience emotional anxiety or disturbance. This thinking is often accomi:mnied
by sdf-dcprccating internal dialogue: "I'm no good," "Everyone must think I'm an idi()(,"
and "No one likes me." Ellis believed that irrational beliefs come from sdf-imposed rigid
dc.mands or shotdds, such as") have to be perfect" and "Everyone has to love me."
MOANS: Matf'C¥1orthe'Mlfdi Golden and Lesh (1997) use the acronym MOANS for five ,vords that often signal
must. ought. alwa,s. neve,, and ncgntive self-talk: muu, ot1gJu, alwa:,s, netff, and should.
should, Mflich . I irrati>nal or
self-defeating ~gilt. ■ I musr succeed or 1 am worthless.
■ I oughr to be able to do it.
■ I afuu,s sere"' up.
■ I "'ill net'l:'r be able to get a job.
■ I sho1dd feel different!,.,.
■ Everything mua be perfect.
SUCCESS TIP
Chen.ts will profit from considering what triggel'S self~efeating thoughts. Fof U'IOse with
addiction problems, triggerS afe a pfelude to subStance abuse. By suceesshJly eounte-ring
cogndive triggerS such as Mlt'le only way I can telax is to use drugs,· subSlaoce abuse and
relapse can be preve-ntoo.
Helping Clients Increase Helpful Thinking

\Vhcn people learn to P3't' attention to their thoughts, they can begin to identify those
thoughts and pancrns that are unhelpful and then take nction to change their thinking.
Thinking patterns arc often well established and firmly anchored by core beliefs, so
considerable practice mn't' be necessary to ~ffect change.
An important first step is to hdp clients become a,.,,.-nrc of their automatic thoughts.
Counsellors can ask questions such as:
■ What were (arc) you thinking!
■ How strong was this thought!
■ How much (1- J0)do )'OU bdievc it to be true?
■ How does this thought/imngc link to fcdings and behaviour?
■ HcJpfuH Not HclpfuH
If clients have trouble identifying thought5i, counseJlorscan ask them to visualize and
"replay" the problem situation. Or clients can do homework to monitor their thoughts
2 12 Chap1er 7
and rc3ctions. (The.re arc numerous online sites that offer thought monitoring form~
example: https:.//www.psychologytools.com 3nd search for the heading "CBT tools.")
SUCCESS TIP
Yv'hen clients de-scribe ptoblem situations or em::,t.ions, lhe quest.ion "What we-re you lhink•
ing?" may help lhem to discover- unhelpful thinking pattei-ns that have contributed to the
problem Of 1he outcome.
Thought-Stopping/Diversion Negative self-mlk can easily b«ome 3n 3utomatic

response. Thought-stoppini is 3 technique for interrupting repetitive unhelpful think- thought-stopping: A tedriaique I•
ing that impedes action and confide nce with positive, empowering substirutions. After brea._, tile pattern of «¢itne
self-defeating llioug)I patter-ts.
identifying negative self-talk, clients nttd to develop positive st3tc.ments to replace khniquesilclude tkluglll replacement.
intrusive negative thoughts. Herc 3re some examples: yea.g •stop• il)'Cllr mind un~il die
undesiied t._.t disappears. wpping
Unhelpful Thou~ht: "I'm so stressed about aoing for the job intc.rview, I'm aoing an ebstic b.t on the wrist toshil
to p3nic 3nd make a complete fool of myself." t!lilling. and acthily diwrsion.
Thought Substitution: "I'm qualified for the job. I can control my 3nxiety through
deep breathing."
Unhelpful Thouiht: "(f I don't do everything well, then I am a failure."
Thought Substitution: "I don't have to be perfect. I'm hum3n and sometimes I'll
miss the mark."
(see Ba:k & Beck, 201 I, p. 213 for more examples)
Clients might find it useful to think the word STOP to intc.rrupt unhelpful thinking,
then immediatcl)• use thought substitution to introduce helpful thinking. A lternatively,
other cues can be used as a thought.-stopper. One d iem carried a p icrurc of hc.r son
as a baby. This helped hc.r interrupt negative thinking 3bout him that w3s trigi;er~ b)•
his current drug abuse. Anothc.r im3gincd 3n 3.XC as 3 cue to substitute a new helpful
thought. Figure 7.5 illustrates the sequence.
Thoughr.-stopping works, but it requires practice. Negative self-talk P3ttc.r ns may
represent years of learning th3t must be "unlearned," and the best wa't' to do this is
to IC3rn new ways o f thinking. Intrusive thoughts c3n 3Jso be countered by diverting
attention with activity, music, physicaJ activ ity, or mcdit3tion.
Mindfulness ln recent years, many cognitive bdi.avioural counsellors h3ve intc•

grat~ mindfulness techniques in their ,vo rk. Mindfulness is simpl)• defined 3S "3warc- mindfulness: FOQlsing on momeaM~
mcaent ~noes wilhlul judgment
ness of present expc.rience with accept3nce" (Siegel, 2010, p. 27). W ith mindfulncs~
Unbelpful Thoui,-t
Thought-Stopper
New helpful Thought
Figure 7.5 Thought-Slopping Sequence
Supporting Empowerment and Change 2 13

"the intention is for parricip3ms not only to bring their 3w3reness to prcscnt•momcm
expe.ricnce but aJso to become 3w3re of the tendency of the mind to w3nde.r 3W3\' from
the moment and to IC3rn to gcndy guide it b3c.k without judgment" (Bowen, Chawla, &
M3rlatt, 2011, p. 34). 1t helps people to disengage from worry about past, current, and
future problems that m3y not occur.
Mindfulness is not difficult, but practice is essential. Mindfulness has shown to
be an effective adjunct to cognitive beh3viouraJ therapy in the treatment of a range of
disorders, including depression, obsessive-compulsive disorder, posvtraum3tic stress
disorder, and others (Firouzabadi & Sh3reh, 2009; Godfrin & van Heeringen, 2010;
and Vujanovic, Niles, Pietrefesa, Sc.hmenz, & Potter, 201 I).
SUCCESS TIP
"MiOO lhe Gap·- TM time gap between lhinking and action provides an opportunity to
make new chc::ices. In the abSence of effort and attention, lhe same unhelpful patterns of
thinking aoo behaviour 'liill be (epeated aoo strengthened. Mindfulness slows dOwn experi-
ences and giving people an opportun.ty to identify thinking patterns. SubSeq~ntJy, they
can practise helpful ways of thinking and responding, Practice then c,eates and sarengthens
new netXal pathways.
Evidence Finding Beliefs ma'>' arise from foulty assumptions 3ncJ ocher errors in
thinking, or they m3y be based on emotions, not foct. UnchnJlenged beliefs can limit
new learning, 3nd they may lcccp clients locked in old, ineffective W'a)'S of acting or
thinking. Evidence finding is 3 CBT technique th3t teu.hcs clients to be their own "de,.•.
il's 3d\'OC3tc" through the use of disputing questions to test the validity of their bclicfs.
As well, counsdlors c3n also encourage clients to seek out information 3nd data by
suggesting they talk to others to expand their perspective. Counscllors can 3Jso directly
challenge beliefs with facts., examples, or they can use brainstorming t«hniques to gen-
erate alternate idC3s. Guided discovery (Neenan & Dryden, 2006) involves asking qucs..-
tions to help clients consider perspectives that are currcnth• outside their 3w3reness.
Herc are some counsellor responses that will stimulnte evidence finding:
■ How much of what you believe is based on how you foci 3nd how much is based
on fact?
■ How do )'OU know chis to be true? Do you have facts or 3re )'OU assuming?
■ Let's try to explore evidence that this may not be true. Play devil's advocate.
■ What 3rc some other w3ys of thinking about '>'our situation?
■ If 3 friend thought this w3y about his situation, whnt would you SU)' to him?
Oo,,1 be-
SUCCESS TIP
e,,~hing you lhink (Thomas l<ida, 2006).
Reframing
retr-am.ing: Atechnique ror lllelping
dients look at things dittetealty by Reframin,: is 3 counselling skill thnt hclps clients shift or modify their thinIcing by sug-
suggev.ing altematite inteqntatic.s, gesting altt~rnative interpretations or new mC3ning.s. It empowers clients by focusing on
perspe«iws.• new ~ s . Re.tr.es
should Pl!S:ftl loffeal Hd p)Siti...e solutions and redefining negatives 3S opportunities or challenges. Client stubbornness
alle.m,a.;iw..-ays ot llin-,_ might be r~framed as independence or greediness as ambition.
2 14 Chap1er 7
> : •.
Neuroplasticity refers to the brain's ability to wow and teat- taste, visual hnages, and bOClily sensation uslng techniques
ra* neut'al pathways based on MN ex.perien::::es 0c leacning. such as the foUOwing;
Cor'Wersely, ne1Xal pattrways that are not used will be pruned.
• Mindfully attending to a sensary ex.perience. such as eat-
NetXal groMh can be JX)Sitive Or' negative, bul in the at>sence
i~ a banana.
of awareness, effort. 0r new ext,erience the br'ain tenets to ad
on autopilot, repeating and reinforcing established patterns. • focusing on breathing; paying attention to the Row of
MiOClfulness creates awareooss of lhOughts and feelings as Ulougl\t<.
well as the ability to change mental focus with the goal of • Simply paying attention to any daily activity such as wash-
influencing bt'3in wowth in a positive way. i~ the dishes..
Although niOOfutness can stimulate re-la.xation, that is • Perl0tmi~ 100 "bOdy scan,· which helps people beCOme
n01 its goal. MindhAness involves a 'Mlde range of strategies aware of physical sensations that often precede 0r accom-
lhat might invOlve al five senses. It helps people develop pany habitual msponses. The ptocess invclveS systamati-
self-awareness and acceptance of their moment-tCHnOment cally locus1ngattention on ead'I part of 100 bOdy, including
lhOughts and leeli~ b-f paying attention to one ex.pe-rience breathmg. (See Bowen, Chawla, & Matlall, 201 I, p. 42, 0<
at a time. Mindfulness can focus on sounds, thou~ts. smets, Siegel, 2010, p. 72 f0< detailed k\stJuction<).
Ex3mp1e: Out 3~ 11, is pfarina b::a:Seball b)• himsel(. He throws the bdill inm the 2ir 3nd
exclaims. "I'm the are3test b3uer in the Yi'Orld.'' He swin{tS 2nd misses. Once ~in. he
tosses the ball into the 3ir and 53.ys. "I'm the are3test OOuer in the world." He SYi•in,a:<i
2nd misses. A third tune he thrOYi'S the ball into the air prodaimin,a ernphatblly. "l'tn
the are::atest pitd,er m the world."
(See Table 7.5 for 3dditional ex3mplcs.)
Before presenting rcframcd ide3s, counsellors should use active listening skills to
fully understand the client's current pe.rspectivc. As well, emP3thy is crucial~he.rwise,
clients may conclude that their feelings are being discounted or trivi31i!cd.
SUCCESS TIP
flve ways to refr'ame:
• Tum p(Oblem statements into gOalS.
• Help c~nts accepa thei( emotions and reactions as ·n0tmal.•
• LOok at pe(ceived weaktlesses as strengths.
• See ;,trtggers· as an opportunity to ac1 differently.
• Exi:,or-e the posdive outcomes of advet'Sity.
Rcframing should not be confused with p latitudes, such 3S "It's 3hvays darkest
just before dawn," which arc typically not very supportive or helpful. An ex3mple of a
welL-meaning but misguided re.frame thnt people give in times of grief over the loss of
3 child is "You're )'OUnJr-)'OU C3n hnve more children." A response such 3S this ignores
Exi:,oring the past may help clients develOp some insight as lhOu.ght-stopping, behaviour-al rehearsal, and the Mmira-
into theif behaviour and emotions. However. it may feinbce cle question,· beeause these actions ""ill create new neural
neural pathways tr.at have sustained unhelpful think.I~ and connections that will support goats and changes that clients
actions. Consequently, it is rn'lportant to use technklues such largel

TABLE 7.5 Reframi ng
°'
Client's Petspeethre Statement Reframlna l ead
This counseling is a waste of lime. Sounds as if you've done some tt'lrtking abOut how out work coukS be m0te
relevant to you.
I 000·1 fit in. I come from a differ'en1 cult...-e Of eour'se. Some people have not had ex.pel'ience with your culture, and they
and my ideas and values must seem strange. may be frighte-ned. Per'haps you couk1 IOOk at tt'lis in a different w.ry. Your
experiences migt\t alSO be fascinats"lg lot people wt'lo have not lived outsi:1e
lhe country. They nigl\l wetcome your fresh <leas.
I'm very Shy. When I first join a group, I You llk.e to be patient until you have a sense of wf'lat's happens"lg. People
usually don1 say anythi~. who are implJSive are WOr"Jd~ to develOp this skill. You also soom to want to
devt'ICII') altemative-s, such as being tnOr'e expressive in 100 beginning,
F'Ot tne firSt time in 20 years, I'm 'liitnout a job. Obviously, thi:S is devastating, At the same time, I wonder if this migt\t also be
an op(X)rlunity fOr' you to try something different
Wheneve-r I am late fot curlew, my mother I'm curious aOOUt why she might do this. Per'haps She haS ttouble telling you
waits up fot me and immediately starts hOw scared She is that something may have happened to you. It might seem
scre.ami~ at me. strange, but hef anger could be het w.ry of saying hOw much She IOves you.
My life is a mess. rve lived on the street lot Sounds like you've had kl sut'Vive under conditions that might have defeated
the last six m::>nths. m:>St people. How did you do that?
the person's grief by offering well-meaning but simplistic and ineffective advice. Rcfram,.
ing should not trivialize complex proble ms with pat answers; rathe r, it should offer a
reasonable and usab le altcrnntivc frame of reference that challcng,es clients to brc~llc out
o f unhelpful Wa)'S of thinking about their problems.
Tim ing is important. Even though it may be obvious that a client's thin king is
d istorted, it may be wise to hold back on rcframing until the client's problem is fully
explored. Moreover, as p reviously SUficsted, it is important chat the client's feelings be
acknowlcdg,ed through empathy. Exploration and empathy ensure chat the cou nscJlo r
unde rstands the client's feelings and situ ation, a nd they pro\tidc a basis for the client to
consider reframcd ideas ns rc3sonable o r wo rthy of consideration. If counsellors push
clie nts too q u ickly, clients ma y feel d cvnJucd and misu nde.rstood, and in response they
ma y resist new idcns. Empathy helps counsellors to establish and maintain credibility
with their clients.
In addition, counsellors ca n use rcframing to invite clients to cake control over
feelings and bcha\tiour:
■ C lient might S3Y, " I can't get ori;:anizcd ." Herc, a counsellor can chaJlenge the d iem
by proposing that the diem rcframe this state me nt with " I won't let m)•self get
organi:ed."
■ C liem m ight sa y, "She makes me feel hopeless.." In response, the co u nsello r can
propose that the client rephrase the stateme nt by SU)•ing, "l have decided to feel
hopeless." The latter response underscores the client's control over personal fccJ.-
ings. As part of this wo rk , counsellors can empower their clients by explaining
that clients have ownership over their feel ings and that no one can make the m feel
a cenain wa)•.
Refrnming can ene.rgi:e clients. \\:fhen clients arc locked into one wa)' o f thinking
about their problems, their solutions a re lim ited. But when they consider new perspcc~
tivcs., problems that seemed insurmountable can yield new solu tions. Moreover, rcfram,.
ing can serve to red irect client anxiety away from self-blam e and onto ocher rational
explanations that a re less self-punishing, ln these W'U)'S. effective refrnming e mpowers
clie nts to action, problem resolution, and management of debilitating feelings.
2 16 Chap1er 7
))I) BRAIN BYTE
canae1ian neuropsychotogi.st Donald Hebb (public domain; of CST. In particular. the positive symptoms of psychosis,
1949) made the now famous saatetnent, ..neUl'"ons lhat fife espedatty delusions reduced in severity. As well, afte-r tr'eat-
together' wire togethef: The meani~ i:s tr.at repetitive actions ment, clients had decreased fear and anger responses. A
0r tnoughts strangthen neural pathways and links. F0r exam- ,eport ~ Mayat (2004) noted 1r,a1while anUoop,essanl moo;.
ple, if one experiences anxiety in a social situation. repeated cation attacks depression by alteri~ the neurotransmitters,
expe(~nces may cause the per'SOO to beCOme stuck in a pat- cogrilive behatJioural therapy atso cha~ tne brain, but in
tern of social anxiety fueled by unhelpful self-talk. With CBT a diffetent way by d'langing activity io tne ptefront.al cortex.,
clients learn to bmak lhis pattern and, in the process, new ~ppocampal and dorsal cingulate areas of Iha brain. Another-
neural pathways are created and sare~ened. study by de La~ et al. (2008) using patients with Chfonic
Thete i:S ex~iinental evi::leoce tr.at CBT alte-rs the btain. fatigue syndrome (CF'S) demonstrated that brain shrink.age
f0r example, a study by Kumari et al. (20 11) found that (eefebral atrophy) associated with CF'S might be partially
lhere are meas.ureat:,e d'langes k'I the brain as an outcome mversed ~ CBT.
})!} INTERVIEW 7.1

The fOIIOwing interview excerpt illustrates some of the essential strategies of cognitive behaviou1al c-ounselliog. The client, a
40-~-old first-ye.ar university psyt,hology student, has sought help to deal with the fact th.at she has been " overwhelmed
and depressed" since returning to school.
Counsellor: feelings, thinking. and behaviou( afe all con- Analysis: Cognitive behavjoural counsellillg requires a co/Jab-
nected. Change one and the other rwo alSO change. In par- otative relaticnSh;p. All jm()Orlanl compofle(lt of this js edUCtJt-
ticular', it's critical to explOr'e hoN yout thinking affects yotX jng the clier'll oo hOw the process vi'Oflt"S. This wm also h(!!p
feelings and youf behaviou(. 1/'Je client to make her own intervenb'ons when she recogr,Jzes
Client: I'm at Iha pcint whete. if I don't do something fast. proble.maUc thillking.
I'm going to lose Iha whde term. I might as well drop out.
Counsellor: You're leefi~ desperate. AnaJysls: Wirh aR courrsellitlg apptOaeheS, empathyisan im{)Of-
tant response. Mote than any other skill. it tel/s clknts that they
have been heard at'ld that their feelings have been ut1derstootJ.
Counsellor: can you remember a time in the last few days AnaJysls: Ellcitiflg and exp/oriflg examples such as this ,:xovides
when tl'W'.!$8 feeli~ were particular1y strong? What was goi~ a database for helping this clknt understat'ld hOw her thoughts
lhrough yotX mind at the time just before class? contribute to her feelings. Signif,cantlY, probe.s to discover
Client: YestQ'day, I was scheduled to make my fll'Sl-ctass pre- lh;nklng ,:,atterttS may reveal "lnner dia.lOfP,Je" (se/1-defeatiflg
""'"'tion. I was llwlki~1ha1 I was gong IDma1<e a loo ci myself l/'JOught pattems) ot lmages.
in front of tt'l8 woote CbSS.. Ever,-one etse seems so confident
when lhey lalk, bul I - 1 bOOn ;n SCOOOI fat 20years.
Counsellor: And that made you feet . . .
Client: Stupid and te«ified. I finalty phoned in sick.
Counsellor: So, hem we ha\18 an e,ram~ of hOtY vd'lat you W(f'@ Analysis: [a,t;er the couttSellot atld the client discuss«/ the
lhinki~Ml'm gci~ to make a foot of myselr - influeoe:ed essential elements of cognitive behavbutal COUt'ISelliflg. N(YN
hOw you were feefi~and vd\at you did. Does 1his make sense lfle clknt's example can be used to re;nforce the princl,:,le.s..
to you? Let's use the ABCm:xlef to illustrate it. (The COUttSellor Using a flip chart ot dra";ng is very helpful for mar1y clients.,
uses a /Tip chart, A /acti,ati!lg situationHh,;,,king of mal<iflg particularly lot those who are le.ss comfortable in the verbal
the /J(ese,itatio,,, 8 /beJil!f/-·rm !!Pi!'€ to /ool( /il<8 a foci"; and moda.lity.
C /conseq""'11 emotionJ-fear. feeling °"""""/med.
Counsellor: If you agree. I'd like to ask you to make notes Analysis: Homework Is essential to effective cogr,it.lve behav-
during the next week when you fl"ld yourself feeli~ warse. loutal cout'ISelliflg. Here, the homewotk creates an opportut'llty
When this happens, I want you to pay attention to what's lot the cl'iertt to become mo,e famillar with haw her feelings and
gci~ thfough your mind. behaviour are lnb'mately COt1rJeeted to her lhit'IJdflg.
Supporting Empowerment and C hange 2 17

>» INTERVIEW 7 .1 Cognitive Behavioural Techniques <conHn"')
In the next session (ex.eefpted late(). the counsellor uses

re:framiog and lhOught-stoppi~ as tOOIS to help the client
Cha~ he< thinking,
Counsellor: YotX jo11na1 is great. You've identified rots of Analysis: The counsellor jntrOduces Ille ,:,ossfb;lfty of ,etrarmng.
great e.Kamples. Let's try somethi~ different f0t a minute.
What if it "-ere possible to look at your leafs differentty? (Cti-
ent nods approval.)
counsellor: I think it's natur"al wtle-n we ha\18 a problem to Analysis: The couflSe/lO('s ShO,t self-disclOSute commuroc.ates
C!Well on au its unpleasant aspects.. 1ktlow lhat I tend to do Ullderstaridlng at'ld a n()('Jjudgmemal attitude.
that uniess I discipline myself n01 to. For example, when you
think of how oorvaus you ant you lhink of au tne oogatives,
sud'I as you migtit make a fool of youfself. Or' your mind
might go blank vd'lile you're talking.
Client: (Laughs.) Ot that I might lhrow up in front of
ever)(lne.
counsellor: Okay, those are real fears. But b-f considering Analysis: One teoot of cognitive behavioural couflSe/Jing is
only your fear'S. you beCOme !bated on the negatives, and that people tend to pay too much attentkJn to the r,egatlve
you may be overlookl~ some im(X)rtant JX)sitives.. If you can aspects of the;r situations while Ignoring posiUw,s or other
IOOk at it diffe-rently, you might discove( a woole new way of explanations.
dealing with youf class presentation.
Counsellor: Want to try it? (The c/ief)[ nods.) Okay. lty to Analysis: As a rule, 1rs more empowering for clients togerwate
identify some positi\ie aspects ot your fear. their own suggestioos before couttSe/kJrs Introduce their Ideas
and suggestiotls. In this way, diems become self-conftootlng
and are more likely k> cane up Milfl Ideas that lfley Mill accept
as ctedible.
Client: Wefl. I guess I'm not the onty ooo W'ho is scared of Analysis: In this example. the client Is able to getterate a
public speaki~ . reftame, which lfle couttSellor embe/JisheS. Ill other situatlMs.
COunsell01: So. )'OU koow tnat ther·e wil be Other peoJ:le in 100 counsellors might 111tt0duce reframes of their O"M).
class who understand ancl will be ChOO'i~ for you to succeed.
ClleM: I never thought of that befofe-. He-re•s another- ijea:
Because I'm so nel"VOUs. I'm going to make sure th.at I'm
mally ptepa(e-d.
Counsellor: Great! Do you think it mi.gr.I be possible to Analysis: The cout1seltot offers the ct'ient a teframed way of
look at yo1S fears diffe-rentJy? Consider that it's normal to IOOJdng at ttef\,'()U'Sf'leSS.
be ner\'ous. Or go a step further and look at it JX)Sitive-ly.
Maybe- there's a part of it that's exciting-kind of like going
to a SIC.3ry movie.
ClleM: I did come baek to school bec.ause I hated my bOring Analysis: The client's response suggests that this notion is
jOb. One thing is for SU(e, I'm 001 OOfed. possible.
counsellor: So, the more you scare yourSelf, the mom you Analysis: SponttJneous humcur helps tfle client see her protr
ge-t your money's worth. (Tfle counseJkJt and the clie.nt lemS ltt a lighter way (yet aflOlflet reframe).
laugh.)
counsellor: Her-e's an ide-a th.at WOrkS. If you agree, I'd like Analy,is, Anolhe( ,xamp/e ofcounse/6ng l>OrOOwOrk. The CO<Jr>-
you to try it o,,,r tne next -k. Eve,y lime you notice yourself sellor ifltroduces tflOught-stopping-a 1echmQue to help clients
starting to get overwhelmed or feeling distressed, in'lagi.ne a COtltrol self-defeating thiflidng (DattlNo &Freeman. 2010). The
stop sign i"I )'OU' mind and immecfiatelysubstitute a healthier basic assumption is that ;f self-defe:Jtlng lflOugflts are inter-
though!. rupted, tfley will eventually be replaced by more em()OK-ering,
Jmitoo perspect1,es.
218 Chap1er 7
~JO INTERVIEW 7 .1 Cognitive Behavioural Techniques (con,;nue)
Reflections:
■ How mig,,t you intrOdue:e cognitive behavioural c-aunselling to a 10-year-Old child?
■ Suppose the client returns f0c the next session and reports that "thought-stopping did not wo,k." Suggest
counsell0c choices f0c dealing with this outcome.
■ Identify this client's neural pathways.
At this point. the cout1se/10t could also help the client develop diffeI11t1t chok:e strategies for dealirtg with dysfut1ctional
thinking. such as an activity dlverslot1 to shift attention. use of a prepared cue C/Jfd with a positive thought ,ec0rded,
imagining success. 0r su~tituting a different Image.
CONVERSATION 7.2
STUDE:NT: can we use CST to deal wtth OU( C)N(I (eac;tions? CIT COunsellor, The CBT approach ;m<)I,.,. payu,g attenuon
to the connectbn amoog hOw we Irtink, feel, and behave.~-
CIT Counsellor: AbSOlutely! Clients can Mpush out buttons:
3'Na(eness (egat'ding dienl behaviour~ wrich trigger unhelpful
test our patience, and leave us OOUbti.ng OUf ability to wOr'k
thir'iung ghies us an opp:)rtunity to criticaly exarna"le thei' valkl-
effectively. Sometimes. negative feet.i~ such as a•(· frus..
tratioo, 0t lea( can e:toud OU( objectivity and impalt OU( ability. ily, then Challenge umelpful lhOughlS I>, usir,g · ~ · ~ SUCfl
as 1hougN-stopping. Iat-Nays IY'ld it telpful toconsi:Jet that my
°'
Feelings ot atttaction p(otectiveness can be just as p(ob-
dent's behavioU" may be theit usual way, so if, fOt' ex:ami::,e,
lematic. When we begin to take client behaviout personall'j,
they a(e rude to me. I can understand that this is part of their
\\tlen we become disconnected from essential skills and alti-
pe~ty. and I am much leSS •kely to take it pe,sonall'f.
tudes such as being nonjudgmental and empathic, it's time
to do some wOt'k on self. That's wtlere CBT strategies can be Student: People in (ecovery from substance misuse leam to
very hel plul. recogni:ze triggers that could lead to relapse. Counsenors can
STUDE:NT: How?
do the same thing by identifyi~ client situations behav- °'
burs, which trigger problematic feelings.
HELPING CLIENTS MAKE

BEHAVIOURAL CHANGES
Goal Setting
Obstacles are those frightful rhings you see when )'OIi take your eyes
off your goals.
- Henr)• Fon:!, public: dom::ain
Goal scttini is a counselling process th::at helps clients define in p recise, measurable terms goal setting: Acomefling prooen
what they hope to ach ieve from the work of counselling. Goals c3n be classified as p ro- t!l.i'! hefps tlieals de.fine ii precise.
musurablf' lefms what they h04)e to
cess or outcome goals (Shebib, 1997; N)•srul, 2011). An outcome ioal relates to what adliew fiomtile r.ort ot CCJUns6g.
the client hopes to achieve from counselling. These goals have to do with changes in the
outcome goal: Atoal rtla;edto
client's life, such as getting a job, improving communication with a spouse, de:.lling with
what the dient llopes to achieve from
painful feeling~ o r managing self-defeating thoughts. A process ioal conce.rns the proce- uunselling,
dures of counsclling. including such variables as the frtttuency of mttrings and the nnture
process goat: The •~sand
of the counselling relationship. Process ,;oals are strategies for reaching outcome gooJs. pnndures tut -.ill be used iacaselling
There is wide suppon in the counselling literarure fo r the importance of setting to assist cli!•ts in ieaclil:g tileir to3ls.
goals (Nystul, 20 11 ; Marrin & Pear, 20 11) Goal setting serves many important purposes,
including giv ing direction, d efining roles, motivating, and measuring progress.

Giving Direction GooJs help to give direction, purpose, and structure to the work
of counselling, thus, helping counsellors and clients decide whic.h topics and activities
arc rcJcvant. When clients and counseJlors arc dear about their goaJs, they can begin to
structure their thinking and action toward their artainmcnt. Setting g,c,als hcJps clients
make reasoned choices about what they want to do with their lives. Goal setting helps
clients prioriti:e these choices.
Defining Roles Goals provide a basis for defining roles. When g,c,als are dear, coun.-
seJlors know which skills and techniques are appropriate, and clients know whnt is
expected of them. Moreover, when counsellors lcnow the g,c,al of the work they can
make intelligent decisions regarding whether they have the skills., capacity, and rime to
work with the client. Jf not, they may make a referral.
Motivating Cools motivate clients. Setting and reaching g,c,als is also therapeutic. 1t
energi:es clients and helps them dcvcJop optimism and self-confidence about change.
Cool achievement confirms personal capacity and further promotes action. \Vriting
dO'l.\rn goals ma'>' add an extra measure of motivation.
Measuring Progress Goals help pro\tidc benchmarks of progress., including de.fin.-

ing when the counselling relationship should cnd--that is, when the gools have been
reached or their pursuit is no longe.r \•iable.
Developing Effective Goal Statements

Sometimes clients arc able to dear!'>' articulate whnt they hope to achieve as a result of
counseJling. At other rimes, they have difficulty identif)ting their pi.ls; however, through
systematic interviewing counsellors can help these clients define and target their goals.
ThewidcJy used acronymS.M.A.R.T. (Bovcnd'Ee.rdt, Botcll, & \Vadc, 2009; Harms &
Pierce, 2011) defines the c.haracte.ristics of effective g,c,als: Specific, Mcasureable, Ac.hicv..
able, Realistic, and Timely.
Effective Goals Are Specific One defining feature of a counselling relationship is

its goal-dir«ted nature. But some clients begin counselling with vague and undefined
gools:
■ "I want to feel better."

■ "My husband and I nttd to get along better."
■ "I need to make something of my life."
These g,c,als arc starting points, but they are useless until they arc described as dear
and concrete targets. Beginning phase work that explores problems and feelings should
lead to the dcvclopment of goals that define and structure subsequent worlc. Then in
the action phase, clients can devcJop these goals as specific and measurable targets. This
step is a prerequisite for action planning-the development of strategics and programs
to achieve gools. Vague g,c,als result in vague and ill-defined action plans, wlu~rcas explicit
gools lead to precise action plans.
In Chapter 5, concreteness was introduced as the remedy for vagueness. Concrete-
ness can add pr«ision to unclear and ambiguous g,c,als. For example, when clients are
describing the.ir goaJs, counsellors can use simple encourage.rs., such as "TeJI me more"
and "Yes, g<> on" to g,tt a general overview of what clients hope to achieve. This is the
first step in shaping workable goals.
The next step is to use questions to define terms, probe for detail, and develop
examples. This step hcJps to cast the emerging g,c,als in precise language and move from
220 Chap1er 7
good intentions and broad aims to sp«ifac goals (Egan & Schroeder, 2009). He.re arc
some sample probes:
■ \Vhat is )'OUr goaH
■ \Vhcn you say you'd like to feel better, what exactly do )'OU mean!
■ Describe how )'OUr life ,vould be different if you were able to reach your goaL Try
to be as detailed as possible.
■ If )'OUr problem were to be solved, what would need to be different in your life?
■ \Vhat do you think would be the best resolution to your problem?
■ \Vhat arc some examples of what you would like to achieve?
■ As a result of counselling, whnt feelings do you want to increase or decrc3sc?
■ \Vhat do )'OU want to be able to do thnt )'OU can't do now?
■ If I could watch you being successful, what would I sec!
Some clients are reluctant or unable to identify gools, and they may respond with
a dead-end statement like "I don't know" when they are asked for their goals. To break
this impasse, counsellors can use some of these responses:
■ "Guess."
■ "\Vhat might 't'OUr best friend (mother, father, teacher, etc.) SUfiCst as your gool!"
■ "\Vhat W'Ould you like to achieve but don't think is possible?"
A good gencroJ technique is to encourage clients to visunli.!c themselves reaching
their gools.
\Vhcn clients say, "I don't know," their responses may indicate friction in the coun.-
selling relationship. and this answer is a way of sabotaging the work. In such cases,
goo! setting might be pre.mature, and the focus of the interview ma)• nttd to shift to
relationship problem solving (immediacy). Moreover, when clients say, "I don't know"
they might also be saying, "I can't do it" or "I'm afraid." Here, counsellors can suggest
setting a very small goal as a starting point (e.g., "If you could make just one tiny change
in )'OUr life, what W'Ould it be?").
SUCCESS TIP
Yv'hen clients say, ·1don't know: oon•t rush in too quickly with anolhe( quest.ion 0t com-
ment Often, aftet a short s,lencQ, clit:?nts wil generatQ ne-w ideas, fQelings, or thoughts.
Effedive Goals Can Be Me.asured \\:fhcn goals arc measurable, clients arc able to
evaluate progress, and they know precisely when they have reached their goals. More•
over, dear goals sustain client enthusiasm and motivation. Vague and unmeasurable
gools, on the other hand, can result in aP3th)• and vague action plans.
Baseline A baseline is a measure of what is hnppcning now. 1t becomes the reference
point for measuring future change. For example, a baseline miaht be how often during
any I .S-minutc interval a child is off task in a classroom. Baselines might be taken over
one or many selected rime frames to obtain an average. Mcasurc3blc pl]s identify how
much change in the basclinc is targeted. ln this example, suppose the baseline shows that
the child is off task an average of 8 minutes during any I .S...minutc interval. The goo! might
be to increase the frequency of on-task behnviour to 12 minutes during any I.S...minutc
interval in the next three weeks (i.e., reduce off-task behaviour to maximum 3 minutes).
Thus, goals need to be defined in terms of changes (increases or decreases) in base-
line behaviours, thoughts, or feelings. Gools should also hnvc a realistic schedule (a target
Supporting Empowerment and Change 22 1

date to start working on them and a rorget date to reach chem). Counsellors can help
clients frame goals in quantifiable language with questions such as. "how often?" "how
many times?" and "how much!" The question "When will 't'OU start!" is a simple but
pO\\•erful way to ensure client commitment co the change.
Example (sk ill): "My goaJ is to upress my opinion or aslc a question once per
class."
Example (thoughts): "My goal is to manaae self-depr«acing chouaht patterns by
substitutina positive affirmations each time 1 say to myself that I can't do it."
Example (fee.lings): "My goa.1 is to reduce anxiety when I speak in public from a
subjective level of 8/10 to 3/10 within the next six months."
Other measurable goals would include, "Tari;:et \\-eiaht reduction of 9 lcilograms in

10 weeks" or "Make five calls per day to potential employers."
Effective Goals Are Achievable and Re.alistic A goaJ has to be somethina thac
clients can reasonably expect to achieve, even though it may rttauirc effort and commit.-
mem. So counsellors need to consider variables such as interest in achieving the goals,
skills and abilicic~ and resources (induding the counsellor) available to help in rcuhing
the goals. In addition, the goals need to be significant enough to contribute to managing
or changing the core problem situation.
Bue some clients may be reluctant co set chaJlengina goals or even to set goals at aJI.
This situation can occur for a number of reasons:
■ Poor sclf-estcem
■ Fear of failure
■ Lad: of awareness of capacity for change
■ Fear of change and rclucronce to give up established patterns
■ Lad: of resources to support pursuit of the goal (Shcbib, 1997, p. 210)
Addrcssina these reluctance issues is a prc.rttauisitc for goal setting. \\:1hen problems
arc complex and the client's capacity or self-esteem is low, settina short.-term goals or
subgoa.Js is particularly useful. Short-term goals represent small, anainable steps to,.,,.-ard
long-term goa]s, and they help clients build confidence that long-term goal achievement
is possible.
Clients need to sec goals as relevant to their needs and consistent with their values.
Thus, when clients arc involved in the process of deciding what their goa.Js arc, they are
more likcJy to be motivated to worlc coward achieving them. Counsellors can suagcst
goals, as in the follO\\•ing:
Ex3mple: Evelrn w:lS referred to the oounsellor for help in copin& with Trevor. her
IS.,.~r-<>1d stepson. who wu in\'Olved in petty crime. E"elyn·s itnmedi:ue ~-041I w3s t'O
enrou~e Trevor to move out of the house. and she hoped that the counsellor tni~t
help her do thi$.. Durina the interview. it btt21n~ apparent to the counsellor that Evel,.,n
needed help ck...elopina parentina ski.Us for dealu~ with Trevor 3nd her tv.'O other teen,
3~ step$ons.. Without di:smissinK E,-ely-n 's objec1h-e. the counsellor su~.sted th3t this
be p3rt o( their 3~•end3.
When clients are forced co come to counsdlina by a third party, they may not feel
committed to any of the aoa.Js of counselling. Thus. the chances of success arc dimin.-
ished greatly unless some mutually acceptable working agreement can be reached.
Understanding a client's values is an important part of goaJ settina. Some clients
arc motivated by spirituaJ va.Jucs, some b\• mate.rial gain, and others by family values.
Other diems focus on immediate gratification, while still others have objectives th3t
arc long term.
222 Chap1er 7
?l.·1 ina Le(t his &nuly in Ch.in:1 to ron\e to North A n ~. He has see.1 his wi(e ooly once in
the last lh'i' )'i'arS. wben he rc-1.u med to C hin.2 (or a sho rt visit. He main12ins ~ ularcont:k't
with her 2nd their s~'i'3.r,okl son. He sends mueh o( hli monthly tor home to support hli
wi(e and extended futruly. Ah.hoUW, he hopes th:3t one d ay hii &nuly will be 2bte t'O joi.n him,
he has at«pt.ed th:. his purpMe is to position futun- ~ner.ttionsol his furruly (or a belt.er lie
Sometimes clients set go3fs that require others to change, such as " I want my hus-
band to stop rreating me so badly." Counsello rs nttd to encourage clients to form gooJs
based on what is unde.r the.ir control, name.I)• their own fccling:si, behaviour, and thoughts.
C lient complaints and problem statemems c3n usually be rd ramcd as positively
worded goa.1 statements. Herc arc some examples:
Ex.:unple I
Client : E\'e-r)One 2lwa)'S takes ad" a.1112~-t of me.
Cou nseU.o r: Sounds as tho~ you 'd like to Je3n, to sttnd up for yoursel(.
Exmnple?
Client : I'm tired o( not worldn,a,
Cou nsello r: Put simply. your ~-Ml is to ~t a job.
Ex.:unple 3
Client : M)• li(e is a mess.
Cou nsellor: You would like to Ond a way to ~t your li(e in order.
The above responses change the focus of the interview from problems to gooJs. Of
course, the co unseJlor and client will have to worlc togcthe.r to shape these vague goaJs
into more explicit te.rms.
Effective Goals Are Timely Setting go3Js in a rime frame, that is, identifying a tar-
get for gool achievement, is important for planning the work. The rime frame should
also be realistic-not too quick and not too slow. \Vhcncvcr possib le, goal statements
should include "b)• when" the goaJ will be achieved. For example-:
■ To improve my grade-point average from C to B b)• the end of the semester.
■ To make prayer a daily part of my life.
■ To develop skills at organi!ing my rime and setting priorities. I need to set up a
schedule so 1 can plan at least a month in advance.
))!} INTERVIEW 7.2

The fOllowing interview e:xc:e-pt illustrates goal-settii,g techniques. Prior to this d ialogue, ex.plo,ation and active li$lening
enabled the counsell0r to develop a solid base of understanding. With this work apparently finished, it seems timely to
move on to goal settii,g.
Counsellor: I'd like your optnion. Am you (eady to move on Analysis: The counsellor uses a phaSe trat1sib'ot1 to suggest mov-
to makl~ a change? If so, the nex.t steps would be set a ing f,om problem exploration to making a change. This wf/1 also
goal. then exi:,ore hO'N you can ad'lieve ii. Change the eot1tract. The c/J'enrs response signals that he is
Client: Yeah, I'm not getting any younger. It's now or nevef. ready to move from the C011templa.tlw! stage to the prepatatlotl
for change phase.
CounselIOI: Help me understand what )(llld like to change.
c,i.,.., 1need IOrelocus my IKeoo the ir.-es 1na1a,esrc,o,1an1. Analysis: At this point. the counsel/Or will have the criteria for
Counsellor: What do you mean? effectMJ goals (i.e.. specific. measureable. ach;evable, te:Jllstic,
aM b'mely) as a teferer,ce point. Subsequent questioos Mill be
Client: I've been so busy with \\()rk that I (eally haven't had
too much time f0t family. That has to d'lange.
deslf!l1e<J to help ffame the goal atowld these ctiteria.

>» INTERVIEW 7.2 Goal Setting<conHn,e>
counsellor: JUSI so we can be dear, can you try to be more Analysis: The counseJIOr' e.Slablishes the baseline at'ld encour-
specific? Suppose you're successful. What Will be diffetent ages goal setting k, behavjoural terms that are clear and mea-
from the way thi~ are noN? suteable. Goals should specjfy what clie.nts v.i/1 be oo;,1g, oot ;,,
Client: Less work, more famity time. NON, work takes so temrs of what they want to stO() dOing. A Clear measurable target
much of my rime and energy I don't ha\18 anything 18ft for for change emetgeS.
family.
counsellor: Okay, you'd like to be able to give tnOr'e time
and commitment to family. To do that you'd have to cut
baek on work. What's the situation now?
Client: I'm locky if I can have dinner- with my family onice
a week, and I can't remembe-r the last time my wife and I
had a night out.
counsellor: So, in a typical week, wtlat do you see as the
balance between WOrk and famtly?
Client: If possible, weekends-strictty famil'j. One night a
week rese-rved as ·<Sate ni~t· with my wile.
counsellor: You smile and seem excited as you talk abOut Analysis: Empathy is still an lm()Oftant compooont of the worl<
this. even though the eortvetSat!M has become more focused on the
Client: I lhink it's what I 008d to do to be happ,j. behavloural domain. The c/J'e,,l's res()()(lse conlitms tl'lat the
empathic statemoot is accurate. II gives this c/J'ent an opportUJlity
to be mere deftnmve abOut his em<Jljooal needs
counsellor: You said ..if possiblEt when you talked abOut Analysis: CounseJIOrS have a tesportSibility to help clients CM-
cutti~ baek on wOt'k. What problems do you anticipate? skier the implicatiCt'ls (positive and negative) of tflt!ir goalS and
Client: 1-'d like tot,y for a manageme-nt position at the com- action p/ar>s.
pany. but evetyone's so competitive. I've got to pu1 i"I the
hours if I'm going to keep my sates abOve the others. And
~ S3leS is the flrst thing lhey IOOk f0t when It's time f0t
promotion.
counsellor: vou·,e torn. To compete-. you\ie got to put in Analysis: The courtSe/lOr acJu'lowiedges the ctient's ambiva-
the hour'S. Bui if you dO that, it 1akeS away from you, time lettee-a factor that often ;mpeoes decis.kx'I mak;11g and acb'oo.
and energy 'Mth the famlly. That's a lot of st,ess. Jdenb'freati<Jn of ambivaleoce helps the client gel Clarity Oil the
Client: Now that you JX)int it out, it seems obvious. I've chokes.
been under stress fo, so IOog. I don't even think abOut it
anymore. It's ctea, to me now that the p(ace ot success is
just too much.
counsellor: Meaning that if you have 10 sactifice time with
youf famtly to get aMad. you're not interested.
(Client nod~)
counsellor: Sounds as if you've made a decision, but let Analysis: By exploring the imp/icatkx'Js of the client's goal, the
me play devil's advoc.ate. Suppose you cut back on your courtSellor helps w ,:,tevent the client f(()((J acting ;mpuisive.ty.
job and IOst a promotion. How would you feel abOut that? Goals atld actiotl plat1s are much more likely to be pursued jf
Client: It would be hard on me, but I think not near1y l/'Je costs and bet1efits a,e clearly uMerstOOd atld antld,:,ated.
so hard as what's happening n<YN. At heart, I'm really a
family man. I'm certain of it. Famity has to be number
one. My career is impoftant to me, but it's my second
p(aotity.
224 Chap1er 7
~JO INTERVIEW 7.2 Goal Setting<conHn,e>
CounsellOf: Lei's go back to you( goat What Olher problemS Analysis: The counsellor cot1b'nues the ptOCeSS ofexf)IO(ing risks
do you anticipate? at'ld problems. By dOing so. ptOblemS may be anUcipated at'ld
(20 seconds of s;1ence.J srrateg;es to overcome them devekJped. Often goalS and actiotl
plans fail or are abatl<JOiled because of u,ianb'c/pated obStacles.
Cllent He-re's one. My family is so used to geniog along
The cout1sell0r is free to be an acJive participant in kJentify;ng
without me, they've developed lives of theit ONn. I guess I
riSks. but, as a tule. dNMts shOuld have the fitst Of)()Orlut1Uy.
can't ex,:,ec1 them to dro,:, everythlflg f0t me.
Counsellor: So hO'N can you daal with that reality?
Cllent: That's easy. 1guess 1·11 just have to negotiate with
100 family on how much time we'll spend together-.
Counsellor: One thought oe:curS to me. How Yrul youf bOSS
teact if you suddenly start spendi~ less time on 100 job?
Oo you think 1tiat's somethi~ to considet?
ReHectJons
■ What indicators suggest it is appropriate to move on from problem exploration to goal setting and action planning?
THE PROBLEM-SOLVING PROCESS

Counselling is a dcvclopmcmal process. Jn the beginning phase, the process go3J is
the development of a strong dicm...counsdlor working relationship and contract th:.n
describes the worlc to be done and the respective roles of both the counsellor and the
client. 1f clients arc motivated to make chan,;c~ then problems c:m be identified and
explored, which provides the foundation for goaJ ~tting and action planning. Clear
goa.Js and a systematic action plan hcJp to prevent failure that often comes from impul-
sive or premature action.
Problem Exploration Problem Solving
Problem solving has four steps: (1) identify a1tcrnatives for action, (2) choose an
3Ction strategy, (3) develop and implement plan~ and (4) evaluate outcomes.
Step 1: Identify Alternatives

The first task in selecting a plan is to list alternative ideas for nchieving the goals. This
step holds clients bade from impulsive action based on the first alternative awil3ble,
which may simply be a repe3t of previous unsuccessful anempts nt change. When there
is choice, clients can make more rational decisions. Brainstorming is one way to quickly
generate a list of possibilities. To encourage clients to generate ideas, counsellors can
use leads such as these: "Let 't'our imagination run wild and see how many different
ideas you can come up with that will help you achieve 't'OUr goa]s," "Don't worry for
now about whether it's a good idea or n bad one." Sometimes counseJlors can prompt
clients to be creative by aenerating a few "wild" ideas of their own.
Step 2: Choose an Action Strategy

Once a creative list of alternative action strategies is identified, the next task is to assist
clients in evaluating aJte.rnntives nnd making choices. This involves helping clients intd·
ligently consider each aJte.rnntive by exploring questions such as:

■ Is it sufficient to make n difference to the problem!
■ Is it within the capncity (resources and ability) of the client!
■ Is it consistent with the client's values!
■ What are the costs?
Cost miWlt be me3sured by time, money, and energy expended in finding resources
to execute the alternative. As well, n1te.rnntives might result in other losses for the client.
For example, suppose a client wishes to end a P3ttern of alcohol abuse, but the pe.rson's
friends are drinking buddies. If quitting drinking involves developing new activitie~
the potenti31 loss of friends and social structure must be considered as a negative con.-
sequence that will have an impact on the client. Unde.rstanding and exploring this loss
is important, for unless clients are awnre of nnd prepnred for these contingencies, they
may be unable to sust3in an)' efforts at changing.
SUCCESS TIP
HelJ) dients conduct autopsies (atso known as post-mortems) on past experiences as a tool
to helJ) them identify er(ors tn thinking,. triggerS, J)roblemat.ic (espooses, and successes.
HelJ) them answe( the ciuestions -What wen1 wrong?" "What couk1 I have done differen.Uy'r
and "What worked weir?·
Step 3 : Develop and Implement Plans

Developing and implementing plans involves four substeps: (I) sequencing plans,
conti,_enc,- plans: Prewntiw plans (2) devcJoping contingency plans, (3) putting plans into action, and (4) CV3luating plans.
that anti:ipate possillle barriers tu Effective plans are maps that detail the sequence of events leading to the finaJ gonJ.
dients miglll NOO'.llter as lley carry cm
actioo,e.s. Counsellors should avoid t3ilor-made plans in favour of customized strategies that are
desianed in collnbomtion with individuaJ clients. Some of the import3nt questions that
need to be answered include the following:
■ What specific strategies will be used?
■ In what orde.r will the strategies be used!
■ What resources or support will be needed at each step?
■ What are the risks and potential obstacles?
Contingency Planning Effective plnns nnticip:ne the potential obsrades thnt clients
might encounter along the wa)t Once clients know and accept the possible barriers that
could inte.rforc with their plnns, they cnn develop contingency plans to deal with these bnrri,-
ers. This preventive work hdps lcttp clients from giving up when things don't go smoothly.
A variety of different strategy choices can be used to suppon- contingency planning::
■ AnticiP3tory questions such as "What will )'OU do if .. . (detail possible obstacles)?"
■ Role pln)•ing (including counsellor modelling) to explore and practise strategies.
■ Use of contracting-before problems occur, counsdlors can ask clients for advice
on how they can respond when the time comes. For example (to a client who has
just begun a job se3.rc.h): "\\:'hat would you want me to do if a few weeks from now
I notice thnt you're becoming frustrated with your job senrchf'
With flight simulators, airline pilots learn to tly aircraft in eme.rgencies. Should n
re3l-Jife emergency happen, they are able to respond with confidence knowing that their
training has preP3rcd them. Simila.rly, contingency plnnning helps clients prepare for
pe.rsonal challenges and sustain the.ir goals. It hdps to prevent rclapse to previous but
ineffective ways of thinking and reacting.
226 Chap1er 7
Other Selected CBT Techniques A wide range of behavioural change techniques
can be used and customi.!ed to address the needs of clients (Maclaren & Frttman,
2007; Neenan & Dl)tden, 2006; Vonk & Early, 2009). These include the following:
■ "Auropsie.s'' hcJp clients evaluate and learn from past experiences. As we have dis-
cussed, clients often rcpc11.t and reinforce the same thoughts and actions., sometimes
with full knowledge that they arc not w-orking. A counselling autopsy involves sys-
tematic review of past actions to identify "triggers," unhelpful thinking and thc.ir
link to behaviour and feelings. Of course, there is also considerable wJuc in review-
ing what worked. This enables clients to identify and build on proven strategics.
■ Relaxation rraini'ng helps clients manage anxiety and tension.
■ Assertion rmining, where clients learn to express feelings or thoughts and achieve
their rights while respecting the rights of others.
■ Relationship problem solving, where clients can learn communic3tion skills and con-
flict management strategics.
■ Homeu.ffl enables clients to implement and practise change strategics discussed dur-
ing CST, such as activities that provide pleasure. Home,.vork may also include chart-
ing and monitoring: emotions or bdi.aviour through the use of diaries and checklists
to measure baselines and progress to goals. Homework enables clients to see tangible
and positive results from counseJling, which builds confidence for further change.
(f clients encounter implemcnrotion barriers., these can be addressed quickly.
■ Expo.n,re provides gradual desensitization to anxiety-prO\-olcing events. Real or imag-

ined exposure ma)' be combined with relaxation training to inhibit anxiety.
SUCCESS TIP
HALT (hungry, angry, IOnely, and tired) is an acronym fof common feelings that can triggef HALT: An acronymfer hungry. angry.
ic.ly, and tired. HALI is a quick w.y to
(elapses. Help d ients explore what they tend to dO, and what they migt\t dO differently, when
~ clients as.sess trigvrs and plan
they are hungry, anwv. lonely, or tired. alteruti...e ,esponses.
Counsellors need to support and encourage clients as they deal with the stress
of change. One way they can help is to remind clients that anxiety, awkwardness, and
periodic slumps are normal when change is occurring. Meanwhile, counsellors can loolc
for ways to re.frame failure or setbacks as learning opportunities. Empathy should be
used to support clients dea.Jing with feelings that accompany chanacor setbacks. During
implementation, counsellors should also encourage clients to use fnmih•, friends, and
support groups to assist them.
Step 4: Evaluate Outcomes

Effective plans include continua] evaluation during the implementation phase. Evalua-
tion recognizes and confirms success and is a powerful motivator; however, cva.Juation
may also uncover problems that need to be addressed. For example, it may become
apparent that the goals arc too unrealistic. (f they arc too challenging and unreachable,
counsellors can hcJp clients define smaller goals. Similarly, if goaJs prove to be too
easy, they can be modified to provide more chaJlengc. Thus, regular review of progress
ensures that goals and action strategics remain relevant and realistic.
\Vhcn evaluation rcvcaJs that the plan is unlikely to be successful, efforts can
be redirected toward redesigning the plan or scJecting a different strategy for action.
In some cases, the client may need help that is beyond the capacity of the counscllor; in
this case, referral to another counsellor or service is appropriate.

CONVERSATION 7.3
STUDENT: I get stuck when a client sa~ Mf've tried 4M),ything doesn't WOrk, but She may have abandOned this tactic after a
and nothing seems to wor'k.• few minutes wtle-n 1t appeared that the intensity of her chikS's
tantrum was incteasing. In thi:S situation., you could help her
TtACHER: You feel stuck, \\tlich is ,:recisefy how the client feels.
Clionis cllen t,mg out in coun,..,., the same ,....,gs !hat they
anticipate thi:S obSlacle so lhat she would n01 be demota!ized
if it recurred. Or maybe she has been giving her cr.ik1 lots of
are experien::::ing. This reality can be a useful tool f0t empathy. OOl'Wet'bal attention, not realizing hO'N this has been reinfOr'c-
Wl>!n clienlS say lhey'"' trkld ev~-,g. ;r, important not IO iog the tantrum.
ge1 into a )'es, but. game, vd'lereby counsellors generate ideaS
and clients diStl'iss them with a "yes, blA. response. STUDENT: I can think of anothe-r example. One of the mem-
bers of my work group was havi~ uouble with her supervisor'.
ST\JOENT: So what are my cooices? She tOld us that lhere was no point k'I &al.Id~ to him because
he didn'1 listen af'r'f'N<¥Y. But from lhe w.ry She desctibed hOw
TUCH£R: I'd be interested in ex.plOfing wtlat the client did.
she 1a1ked to him, I wouldn't listen either. She was vicious
Oid he or She try loog enough? At the rigf\t time? In 100 right
and cruel.
way? Satnetimas problems gel worse before they get better,
and clients may gj\18: up too soon. A mother migt\t lty igoor~ TEACHER: So, if She we-re )'()IS c~nt, she WOIAd need SOtne
her' child wtlen he has a &antrum and then tell you ignoring help devetopi~ awareness about hO'N she affects Olhers.
BRIEF COUNSELLING
Since the I980~ the 3ssumption th3t counselling nttded to be lengthy to be effective h3s
been successfully challenged. In many settings. counsclling relationships are brief, some-
t..ief counselling: A.uippioadlito times limited to a few sessions, a sing.le session, or e\-en a brief encounter. Brief coun.wllin~
counselling characteriled bJ a foClls approaches., with the.ir emphasis on strenarhs, resources, problem solving. solutions, and
OR r~ s and solutic.s rather than
pobl.-s. coll3bora.tion with clients, are now accepted as effecti\-e for m3n't' clients (&ttino, 2007;
Cameron, 2006; Carpctto, 2008; Hoyt, 2009~ and Presbury, Echterling:, & McKtt, 2008).
Steve de Sha:er (1985), one of the early pioneers of brief counscJling, argues that
it is n()( necessary to spend time searching for the root causes of a problem, nor is it
necessary to have elaborate knowledge about the problem. In brief counselling, the gonJ
is to help clients do something different to improve their situ3tion rather than repent
the same ineffectual solutions. Small changes (e.g., insight, reduction of painful feelings,
and new skills) can h3ve a dramatic long-term impact by moving clients from a point
of despair to one of optimism and motivation to work on changes in other areas of
their lives. Bec3use of its emphasis on action and change, brief counselling hdps clients
become "unstuck" from ineffectual ways of thinking, foding, and acting. Clients can be
encouraged to rdrame by focusing their 3ttention on wh3t's working. thu~ interrupting
their preoccupation with problems 3nd foilure. This focus may gene.rate or renew the
clients' optimism that change is possible. In addition, brief counselling., even a single
session, can be therapeutic for clients if they are able to unload pent-up feelings. A car~
ing and empathic counsellor can encourage such ventilation and reassure clients that
their reactions and fodings are normal. This can significantly reduce feelings of isol3tion
by disputing the belief that many clients hold: "I'm the only one who feels this way."
Selected Brief Counselling Techniques

P'recounselling Change Momentum for change is often established at the momem
clients seek counselling. Carpetto (2008) notes that studies have shown that chanaes
frequenth• occur in the interval between the rime clients make an 3ppointment to see a
counsellor and the first meeting. Thus, counsellors can make use of the foct that some
clients realize progress while w3iting for their first scheduled appointment.
228 Chap1er 7
SUCCESS TIP
capitalize on the possibttty of p(ec:ounselling change by asking questions suctl as MSince
making )'Ou( appcintment, have )'Ou noticed lhat lhings have i.mproved in arry way, hOw·
M!I' sma1r?· If lhe response is pos,tive, suss.a~ thi:S change (l'l()vement by helping the client
identify lhe feelmgs, thougNs, and behaviout associated with ii.
The Miracle Question A cypicaJ miracle question might be formulated as follows: m.irade question: Used ia twiel or
"Suppose that tonight while you're s1ttping a miracle happens and )'OUr problem is si• •s.ssi:in coun~ asa Wk/ to
~ dients who It.ave difficulty coaing up
solved. \\:fhen you w-nke up. what will be different 3bout your life?" Variations of this •ill definei:I goals. ne miract!' questica
question ma'>' need co be dcvdopcd to accommodate different dic:nts. For example, dlJlenges clieaa to imagine how their
some clients may object to the religious overtones in the question and a more neutral lives 'M)Uld be different ii a mftde sct,e:J
their pobl.-s.
term, such as something remarkable, could be used. The following example illustrates
the process:
CourueUor: Suppose when you v.'OkC' up tomorrow son~hin& rem::u-kab1e has h3p,
pened and your problem i.s ~one. How would )'Ou know t~t )'Our proble1n is soh~!
Client: Well. for one thin¥, I'd be worryin¥ leu.
Coun.se.ltor: What mi~,i )'Our fanuly ~ as d1((erent!
Client: I'd be n\Ol'i' w1llu)¥ l'O ~l involved in fanuly activities.
Coun.se.ltor: Actwities!
Client: Thinv like SportS. family outin~rnovies 2nd so forth.
Coun.se.U.or: \Vh::u else would ther Ond di((erent? !Note: 1t is imporbnt (or the cow,~
sellor l'O use probes sueh as this to elicit detail. I( a chan~e can be inu¥ined, the more
possible it "'111 ~m 2nd the 11\0re the behaviou~I e~n~-e.s 10 1nake it possible will
berome 2ppore:nt.l
Client: I think that we'd be h3ppier. Koc just because we' re <loin¥ fun thi~ tOiether,
but we'd be 2f¥uh1¥ less about money 3nd our other problems..
Coun.se.ltor: How much o( this is already happenina!
The above excerpt shows how quickly the counsellor c:m move the interview to
focus on change and solution possibilities, which heJps clients become more hopeful
about their situation. As Carpeno (2008) concludes, "they nre aJready on their way to
findina solutions to their problems" (p. 181). Since the client has imagined nnd described
some o( what nttds to h3ppen to solve the problem, the counsellor's next task is to
get the client mO\tina in the direction o( the "miracle" with questions such as "\\:'hat
would you need to do now to beain co move tO\\>ard the miracle?" or "\\:'hat would it
t3ke to make the first step?"
SUCCESS TIP
It is important lhat lhe client, 001 the counsellor, articulates the answet 10 the miracle
ciuestion, and it is the client whO must describe what changes or SOiutions need to happen
fot the miracle to occut. The counseUOt's role is to manage lhe explOration and solution-
finding ptocess.
Helping Clients Get on Track Counsellors don't need to stay with clients until all
the.ir problems are solved and the.ir lives are in order. With brief counsdlina, the relation•
ship may end when the client has a plan in mind, nnd they are headed in the right direc•
tion. Once clients st3rt the process, counsellors should consider ,;errina out o( their way.
Suppo rting Empowerment and Change 229

Looking for Exceptions Clients often st3\' fix3ted on their problems 3nd on
whnt doesn't work, and they continue to repeat or cxnggerntc "solutions" that have
alread't' proved unwork3blc. By doing so, they fail to notice times when they are
successfully managing their problems. Looking for exceptions ch3Jlcngcs clients
to focus on those momc.nts, hO\\•cver r3rc, when they arc coping successfully. The
assumption is that there 3rc times when clients arc successfully m3naging their prob-
lem, 3nd they do many positive things th3t they 3rc not aware of (\Vchr, 2010). There
are moments when anxious persons foe] calm, 3Cting-out children listen to their par.-
ents, and 3ngry people arc peacdul. By dr3wing clients' attention to these moments,
they c3n remember and discover potentially successful answers to chronic problems.
Challenging clients in this way stimulntcs them to think about more exceptions in
their live~ thu~ increasing sclf.-confidcncc and their 3Wareness of proven success
experiences.
When clients are 3skcd, "\Xlhnt is different 3bout those occasions when )'Our
child obeys you or 3t least responds more receptively to your requests?" or "What is
different about those rimes th3l you're not 3ngry or only minim31Jy up~d" the coun.-
scllor is requesting that clients report on experiences to which they h3\'e paid 3lmost
no nncntion.
Working with exceptions provides a quick 3nd powerful wa't' to motivate and
encrgi!e clients to think about solutions rather than problems. The process is as
follows:
I . Identify exceptions to those times when the client is hnving difficulty.
2. Help the client explore what was different about those times; including what
(specifically) the client w3s doing differemi)•.
3. Identify elements (e.g., behaviour, setting, and timing) thnt contributed to n
successful solution.
4 . Hclp the client plan to do more of what was successful.
In the follO\\•ing brief excerpt, the counsellor uses the technique to 3Ssist a diem
who is having trouble dC3ling with her tttn3ge son:
CounS(>IJOr. From "-hat )'Ou\,e been sarifl$:. it's a r.are moment when )'Ou 2nd your son
ean sit t0$;ed~r and 1:ilk e:dmlr.
C lient: M3)'be on« or 1wi«' in the bsc year.
CounS(>IJOr. Let' s look 21 those two times. I'm rdil)' curious :.bout wh::u w:lS d1ffe-rent
about them th::u en:!lbled )'Ou to talk without A~tin¥, Pd one lime that worked best.
C lient: Th::u's e:.sy. ?l.·1)• $011 was excited be<-3use he w:lS ~h,¥ 10 a n'.K':l. concert, and he
was in a re31l)• K()od mood. I (e.lt more refaxed too. He just seemed more approach:3ble
th:u day.
CounS(>IJOr. H::n,e )'Ou cons.dertd that port of your success m,d\t h3,,e t'O do with )'Our
mood! Perh:3ps your $011 was more appro:lt.h:3ble because )'Ou Yi'eri' more refaxed.
C lient: Interest in¥ point.
CounS(>IJOr. Let' s explore- tJ13t 2 bit furtheT. Btt2use )'Ou w~re inore relaxed. what else
w:lS dif(ert:nt 2bout tJ,e wa)' you handled this encounter!
C lient: I d,dn't (eel stressed, $0 I think I w:lS more open to listenif1¥ t'O him.
CounS(>IJOr. \V~t v.>ere )'Ou doin&di((ere:ntl)·!
C lient: I let him talk witJ,out jutnpina into aJ'iue.
Finding Strengths in Adversity Hardships 3nd difficulties often have positive

spin-offs in th3t people develop skills to deal with their misfortunes or discover cap3ci.-
tics that they did not know they had. Following arc some S3mplc probes:
230 Chap1er 7
■ How hnve you mnnag~ to keep going in conditions that would h.nve defC3tcd n IQ(
of people!
■ You h.nve dealt with this problem for a long time. Man)' people would not have sur-
\•ivcd. How did you man.a.gem keep going? \Vh.ntstrcngthswe.reyou3bletodrnwon!
■ \Vhat h3\-e you le3rncd from life's trin.Js and tests?
■ Have hardships heJped to shnpe your values 3nd ch3racter in positive wnys!
■ People often develop t3lents or discover strengths from facing challenges. How has
this been true for you!
Using Solution Talk To gee clients to notice their skills and C3P3cities, counseJlors
c3n use smcemems nnd questions such as, "\Vhen )'OU've successfully coped, how did
you do it!"
(n 3ddition, counsellors need to be 3lert for opportunities to reinforce clients'
strenw:hs. Personal qualitie~ actions th.nt underscore their determination, nnitudes,
positive decisions, nccomplishments, effort t0\\"11.rd ch3nJ;c. and courage in the face of
3dversity can 3JI be used to bolster clients' sense of c3pncity and self-esteem.
Clients mny nlread't' h3ve 3 rich undersmnding of their problems 3nd the W"n)'S in
which they might be solved. Counsellors need to tnp their clients' expertise about pos-
sible nnswers to their problems:
■ \Vhat solutions h3\-e you already rried?
■ \Vhat would your best friend 3dvisc you to do!
■ To soh-e )'Our problem, wh.nt will you have to do?
■ Lee's cry to identify something different for 't'OU to do to solve 't'our problem.
■ Lee's brainstorm solution ideas. The wilder the idea, the better.
SUCCESS TIP
Use a ciuestion such as ·What do you want to d'lange abOut yourself today?· as a quick way
to set a goal-ditected sessional contract.
The Change Continuum Often clients 3re overwhelmed with the number and depth
of their problems. Their despair C3n C3sily infect counsellors. The continuum is a tool
to assist clients to become motiwted in the direction of positive chnnge (sec Figure 7.5).
When clients c3n gain some control over their situation through smn.11 successes, this
promotes further optimism nnd chnn,;c. Counsellors do not have to be involved for the
whole change process.. Sometimes helping clients hC3d in the right direction is the extent
of their involvement. Here's3nexampleof the use of the continuum with Figure 7.6a toe
illustrating how it might be present~ to the diem: Kim, n young woman of 19 who is
heavily involved in drugs, seeks counselling for help "to get her life in order."
Couruellor. (U~:s a mp <:har t to draw the continuum depkted fate:r.) Khn. think
about :m are::t of ,.·our life where )'Ou v.--oukl hk.e t'O nuke a chan~-e. The eontinuum rep-
resents thi~ ai bad :lS ther eould be if thi~ K()t v.-'Orse 21 one end, and )'Our ultimate
iOaJ at the other end.
Kim: I ,~d to c~,~ my whole h(e.
As Bad a:s I Coold 8e My Ultim.ate Go.al

{Nea;ative> (P-ositiTe)
Figure 7.6a

Counse.Uor: Okay. let 's work on the bi& picture. Let's ::.cld desi!ripl'OrS that represent
each end o( the continuum.
Kim: (Rei/x>nse depfcaed later.)
As Bad a:s tt Cookl Be My Ultiaate Goat

(Neptive} (PositiTe)
- Using hard narcotics - Job

- Prosaitution - Drug-free
- HIV-positive - Money in the bank
- Criminal activi ty - Friends who are "clean•
Figure 7.6b
CounseUor. \Vhere 3re )'Ou on the continuum!

Kim: (Dr.I.wit 3 cl.rcle.) I'm 3bout here. prett)• lle3r the bottom.
Figure 7.6c
Coun!l(>IJOr. \V~t direction 2re you headina!

Kim: (Dr.l.wit3n urow.) "?l.·ty li(e is a n ~ 2nd it's~ttin& worse."
Figure 7.6d
CounseUor. M2)•be you'd :1.¥re<e that the direct ion )'Ou' re he::.clin¥ in is ultimately more
llnport3nt that where you 2re on the continuum.
Kim: Absolutely, I can see th3t.
Coumellor: So wh3t 's one thll,i th::n v.'Oukl need l'O happen for )'Ou to cl12flie directions!
Kim: Th3t'se::asy. I need a pl~ o( m)•Own. a.nd I need to~~ out o( this3re3.
CounseUor. let's st~ut there 2nd mW th::n the locus o( our work.
Figure 7.6e
Comments: T he continuum hns a number o( usdul fe3ntres. lt is visual, whic.h

makes it easier for some clients to understand. It is a quick way to prioritize complex
problems and aools. This helps clients aenerate a sense o( control and d irection. Once
completed, it provides shortha nd communication for counsellors and clients. The two
basic questions o( the continuum can be used at the beginnina o( subsequent interviews
to nssess proaress and to identify emeraem issues: "\Xfhe.re are you on the continuum!"
and " \Vhat dir«tion are you headed!"
232 Chap1er 7
SUMMARY
■ Empowerment counselling rests on the foundariona.1 belief that clients are capable
and that they have the right to manage their own lives.
■ Canada's senior population, now almost 6 million, represents a growing diverse
group with 3 wide range of differing needs and cxp«tarions.
■ C risis intervention aims to empower clients by helping them regain physical and
psychologicaJ safety, control, and b aJancc.
■ Morivurional imcrviC\\•ing is a practice 3pproac.h that uses rhc scages of change model
to hcJp clients overcome ambivalence to changes. Its central fenturcs include active
listening, especial I)• empathy, developing discrepancies, and rolling with resistance.
■ The stages of change modcJ {prccontcmplarivc, contemplative, preparation, action,
and maintenance) provide a useful framework for understanding where clients are in
the process of chanae and for making intdli~ent decisions regarding the usefulness
of particular counselling skills.
■ C ognitive behavioural counsclling hdps clients understand how unhelpful thinIcing
can lead to prob lematic behavioural and emotional responses. Cognitive behav-
ioural counselling hdps clients brc:.llc out of established (but ineffective) patterns
of thinking and behaviour.
■ Brief counselling recogni.!es that short encounters have the potential to be helpful
for clients. Brief counselling techniques include the use of skills such as the miracle
question, looking for exceptions, finding strengths in adversity, using solution talk,
and the chan~e continuum.
EXERCISES
Sett-Awareness fruit. Next, slowly chew it while foousing on the taste and
I. RetlectMareasW'l you life~echat'@e:isp:)SSitje, is MC~ feel ot the fn:it in your mouth.
sa,y, cx has already occurred. Classiy your Sla!l<! ol Chare, ~ilh c. Bteath meditation. Find a quiet place 'lff'lere you can be
ead'I issue baSed on the stages ot d'la(€e model: pmcontem- comfor&able. Obser\18 your breathtng by attendtng to the
plative, conlM'li:tative. i:reparal.bn, action, and maintenance. flow of air through your nose and into your lungs. Watch
What could potential~ ·mo,,e• yQtJ from ooe stage to aoo,het? yQIJ' lhaugl\ts, and when a judgment arises, silently label
2. Start a log that chronic&es your automatic lhtnking, for ;1 "iudli)ng." (Adapted from Siegel. 2010, p. 83)
example, wtlen you meet someone new, before ask.i~ a 6. Interview seniot'S. Discuss their current oeedSand expecta-
question in class., when you want to ask fOr' help, etc. tions. Meet with coueagues to Share your fandtngs and to
3. Think of a crisis thal you have faced. Try to recal your reac- exi:,ore implications fOr' counselli~ this group.
tbns in each of the three majOr' domains:. feetil~. thtnki'lg.
an:S behaviou'. What h ~ you cope with and rec:ovet bal- Skill Practice
ance lollOwi~ the crisis? What factors acted 33:linst recovery? 1. Working with a COiieague. take turns exptoring a time in
4. Use the concepts fromi this chapter to practise goal setti~ your life when you were unmotivated. What feelings were
and action planntng fOr' yourself. Pick ooo or more 1arge1 associated with lhis periOd? What helped you get unstuck?
areas (behaviour, feeli~. thoughts, skirts., Or' relationship). 2. Worktng ~th a part~r. use setected brief counsetltng tech-
DevelOp a baseline. niques from lhis chapter to help him or her deal with a
5. Practise mindfulness: prOblem area.
a. Go lot a watk. focus on COOtdinating your breath with 3. Conduct a practice interview with a coueague lhat focuses
your steps. oo goal setting,
b. Eat a banana or other fruit. Pay careful attention 4. Conduct an interview with a colleague (as client) usmg the
(sequentially) to lhe sttuclure, cotour, and feel of the principles of cognitive behavioural counselling.. Expl0te a

problem area that the client ideotiOes as real and cu«ent 4. Suggest refr'amed responses f0t ead'I of the folto.vi~ client
where they wish to make a cha• . Tty 10 help you( dient: ssatements:
a. identify automatic thoughts. a. 1can, dO it
b. evaluate automatic thougt\ts. b. (A studetlt counsellor.) I feel so unnahxal and phony
c. develop strategies for controlling and modifyi~ auto- expressi~ empathy au the lime.
matic thoughts that are not heli)flA. c. I really want my kidS to avoid maki~ lhe same mistakes
d. set a goal fo, action (home.-ork). I did. I dOO'I know wtly they don't listen to me.
d. If he realy IOved me, he'd send me flowers.
5. Rec0td an interwew with a coneague (as dienl) wt'lere you
explOre a ptoblem 0t situation where they are ambivalent. e. M'ylife isa mess.
Review the recording ar\d i::lentify statements lhat "suslai.n f. I'm tired of being depressed al the time.
1alk· and "change &alk. •
5. Name at least 10 different ways to motivate clients.
Concepts 6. £valuate haw the folloliing ssate~nts meet the ciileria f0t
1. Suggest quesltons you mi~t ask dients to assess their effective goals:
slage of cha~. a. To be a better perSOn.
2. Identify wtlid'I saage of d'lange beSI describes each of the b. To get my bOSS to stop haSSling me.
fOUOwing clients: c. To drink tess.
a. "I hardty knON anyone who smokes anymore. I'll get d. To be able to disagree with someooe without dis.missi~
the<e too one day." lhem or their' ideas.
b. MWhat's the i:ont of IOOking f0t WOrk? Since the big stock e. To improve my fitness by next year to the potnt whel'e I
market Cr'ash there a(en't any jobs: out u-iere ariyway: can run 1 ldlo.ineue in eight minutes..
c. "It's been almOSI six. m::,nths since my lasl drink. I don't
7. Practise brainstO<ming techniques. Identify 5- 7 diffe(ent
even crave it like I used to:
action Sltategjes for a client wt'lo wishes 10 qllt drinking,
d. Ml wish I could fr'ld a way 10 get off drugs:
3. ~lore how each of the dient sa.atemeots might impact their

bahaviwr at'd em::>tioos. What errors .-. th~g am api;:ar'ent?
a. " 111oev« get a job:
b. "She didn't even sayhettowhen She saw me at the st0re.
I guess She doesn't like me."
c. Ml have to be number one.·
WEBLINKS
Links and resources on the toplc of motivation.al interviewing Sh0rt a1ticle on anti-oppressive p,actke from a child and
youth care perspective
www.motiv.ationalinterviewing.org
http://Cyt•net.org/cyc-on Ii netcycol- 1203-moore.htm I
Links to .articles and resources on goal setting
Mindfulness Exercises
www.selfgrowth.com/goal .html
www.sh1lm1nd.eom.au/m1ndfulnessandrelax.ation.htm
Beck Institute fOt Cognitive Behavior Therapy
A practical guide to elder .abuse and the law
www.becki nstitute.org
http://www.bcl1.o,gk.1tes/def.ault/f1les/Practic.a1_Guide_
Online tools for CBT EogHsh. Rev_JULY. 20 11_0.pdf
https://www.psychologytools.tom .and search far the heading
··cer tools"
Substance Abuse Mental Health Service Administration (SAM-
HSA> publication: '"Brief Interventions and 8,ief Therapies for
Substance Abuse··
www.ncbi.nlm.nih.gov/books/N8K64947
234 Chap1er 7
■ Understand the nature of client resistance.
■ Describe techniques for dealing with resistance.
■ Explain the use of confrontation.
■ Identify key wriablcs for violence risk assessment.
■ Identify and describe strategics for preventing violence.
■ Describe strategics for intervening at c3ch phase of violence.
■ Understand the importance of debriefing critical incidents.
■ Describe counselling interventions for deaJing with angry and potentinJly violent
situations.
RESISTANCE
Resistance, a term first introduced by Freud, refers to a normal defensive re:.lction chat resistance: Adefensiw reaction br
comes from the natural d rive to preserve the scarus quo. Changing one's patterns of dients that iMerf«ts ■idl, « debys the
pnnss of a.selling.
thinking and behaving. even when desired, creates anxiety. le requires people to alter
existing and familiar P3ttc.rns of communic:.lting o r coping which, however painful o r
235
unhelpful, are at least familiar, and so the prospect of ch:.mJ;c represents some risk 3S
well 3S potentiaJ gain. Thus, resistance protects clients from the stress and threat of
ch3ngc.
Thus, resistance may be the dient's re3ction to being pushed (by the counsellor) to
do or accept something the client does not ,.,,.,mt. ln fact, the psychological need to stay
connected to the fumili3r may c3usc dients to resist the very ch3nges they 3re sedcing. For
example, 3 client may verbalize a strona desire to curb drinking, but foil to engaJ;c with
aarced.-upon goaJs or 3ction plans to work t0\\'3rd th3t pl]. Clients may be ambivalent
about ch3nge and the risks 3nd fears of chanJ;c may cancel any momentum tO\\>ard 3ction.
Active listcnina. particularly empathy, reduces or prevents resistance. Other
counse.llor responses may increase it. These include the follo"'ina:
■ Arauing for change
■ Assuming the expert role
■ Critic.i!ina. shaming, or blaming
■ L3belling
■ Being in a hurry
■ Claiming pre-eminence ("I know what is best for you") (Miller & Rollnic.k, 2002,
p. 50)
By pa)ting attention to diem resist3nce, counsellors can e.x3mine how the.ir o"'n
responses miaht contaminate the intervic"', and what they might do differently to
prevent, ncutrali!e, or reduce resistance.
SUCCESS TIP
Newton's third law of motion states that for eiJety action lhem is an ec:::iua1 and opposite reac-
tion. Resistance is lhe equal and opposite madion thal happens when clients feel pressumd
or coerced. CounsellOrS need to monitor and reduce the.' tespon~ thal are aceeler-ating
resistance while incmasing responses that reduce 11.
Signs of Resistance
Resistance may reveal itse1f in a variety of ways, rangina from oven hostility to passiv-
ity that impedes the work. Herc are some client beha\tiours and signs that m3y suagest
rcsist3ncc(Cormicr & H3ckney, 2008; Gl3ddina& Alderson, 2012; Miller & Rollnick,
2002, 2013; and Shulman, 2009).
I . Failure to comply with the basic procedures of counselling, including keeping

3ppointment~ being on time, 3nd pa)•ing fees.
2. Hostile or argumentative st3tcments (c.a., "This is a \\'3Ste of time," "You can't make
me cooperate," "That's none of 't'OUr business.," and "I don't "'3nt to be here").
3. Passivity (e.g., silence, withholding information, persistent short responses such as
"I don't know," extreme self-censorship of ideas and feelinas)--such passivity may
indicate th3t the client does not want to be there, or it m3y mean that the feelings,
content, and ch3Jlenges of the interview are more than the client is willina or 3ble
to face.
4. Diversion as a \\"ll't' of avoidina difficult, rhreatcnina, or incrimiMring content
(e.g., chanaina the subject, using excessive humour, making sm3lJ t3lk, inrroduc-
ina irrelevant m3teri3I, being overly talk3tivc, intellcctua1i!ina. and restrictina the
conversation to parricul3r topics).
236 Chap1er 8
5. Uncoopc.rativc behaviour (e.g., failure to follow through with plans or homei.vork,
foJsc promises).
6. Subtle unde.rminina (e.g., acting seductivcJy, nnemptina to redefine the counsdlina
relationship as a friendship. uccssive praisina. being sarcastic).
7. Creating the illusion of ,vork, described by Shulman (2009) as cngnging in convcrsa,
tions that appear important but that in reality are empty and hnvc no real meanina
bcc:.mse they do not cmpO\\•er cliems to change.
8. Nonve.rbal cues suagcsting a passive-aggressive response, such as not making e\'C
contact, foldina arms. sitting on the edge of the SC11.t, using an nngry tone of \'oice,
clenching fists, raising eyebrows, fl"O\\•ning, and sighing.
9. Blaming, malcina excuses, and expressing unwillingness to chnnae.
Understanding and Responding to Resistance

Some Resistance ls Normal and Desirable Counsellors do not have to view all
resistance as problematic. Skilled counsellors rccoanizc resistance, but they are fl()(
threatened b\• it. They see resistance as a sianaJ that clients' defences are cngngcd, and
this insiaht opens a pathway to greater unde.rstandina of their clients. For example,
in the beginning phase of counscllina, before trust and a working contract are ncgoti•
atcd, mnny clients tend to hold bade. At this stage, their counsellors arc srrangers, and
it would be unwise for clients to open up too quickly without lcnowina how precious
personaJ information might be treated.
Shenfor nnd Horejsi (2008) note that it is common for clients to be somewhat defen-
sive, particularly in the bcginnina phase when a person's naruraJ resistance to change
can be trigi;crcd by fear of what lies ahead: "Even a smnJI amount of change can create
a discomfort or fca.r for clients, cspccinJI)• if they hold riaid beliefs. are inflexible in their
thouaht processes and behaviors, or arc fearful about risking change in the.ir relationships
with others" (p. 205). Some clients resist because they do not understand the expectations
or the process of counselling, so they wisely remain cautious and guarded. Until relation•
ship contracting estab lishes the gonJs and purpose of the work, clients may hold back
from fully pan-icipating. CounseJlors also need to be explicit regarding their expectations.
They should not assume that what is obvious to them will nJso be obvious to the.ir clients.
SUCCESS TIP
Help clients unclefSland how anxiety and ambivalence abOut change may c,eate more
anxiety wtlid'I sabOtag,es action plans, then use anticipatory conttaeting to sttategjle hO'N
this can be addtessed.
Resistance and the Stages of Change The '""ll< of change modcl (ProdUlska &
Norcros~ 2001) was introduced in Chapter 7 as a modcl foe unde.rstanding the develop-
mental nature of change. Different skills and strategies nre used to cn~c clients durina
diffe.rcnt srog:cs. For example, clients who arc at the precomemplativc stage of change do
not accept that they ha\'e a problem and arc noc thinking about making c.han~ e\'en
though their behaviour is problematic for them and others. At this srog:e, stratejpes such as
confrontation ro push a client tml"-ard change arc likely to be met with resistance, bur other
stratejpes (ca., open questions and empathy) will help to ncutrali.!c the resistance. Some
clients who arc precontemplarivc hold ro their current mode of thinking, feeling. and actina
because thq• lack the cne.rg)• necessary for change, or because they nre pessimistic about the
possibility of change. Whate\'er the reason, these clients resist counselling because it is
casie.r and safc.r than cmbracina change. Counsellors might deal with this resistance b\•
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clients 237

communicating optimism and by helping clients set small but achi,ei,-nblc: g,ools. By support-
ing and rc:.inforcing smaJI successes, counsellors contribute to the emp<:M·c:m'litm of the.ir
dim.ts. Hcmrevcr, during this proc~ counsc:llors should express empathy rcgnrding the
cha.Jleng:es and fears associated with any chani;c:. Oients nttd to unde.rscand that they will
00( be humiliated or ovc:rwhdmed b\• the demands of counsclling. Counselling can be
presented as a way for them to find d"K" resources, suppon-, and motivation for change
At the contemplative srog:e, dim.ts arc ambivalent about the change process and may
simultaneously desire and resist efforts and opportunities for change, "even when such
action is counterproductive and dysfunctional" (Gladding & Alderson, 2012, p. 141). The
messai;c:s from clients seem to say, "I want to change, but I don't want to change." This
ambivalence: can frce!c: clients in a state of indecision; and the resolution of ambiwlc:ncc: is
the key to change (Mille.r & RoUnidc, 2013). Even for those clients who arc highly m()(ivatcd
to change, the prospect of changing involves risk; risk creates anxiety, and the simplest
way to reduce anxiety is avoidance. From this perspective, resistance: is viewed as self-
proto:ti,e. To rc:solvc ambivalc:nct in favour of change. the benefits of change must ourn't'iJC'l
the risks and anxiety associated with change, or anxiety regarding chani;c: must bt reduco:J.
SUCCESS TIP
Openly extifessed resisiance from a client can be a weat opportunity fof felationship build-
ing and goal setting If it leads to frank discussion of (~ expectations, barriers, and fears.
Relationship Issues Somc:timesdic:nts become increasingly resistant as counselling

progresses. This mn't' signa] that the process is moving too quickly or that there is unrc~
solved conflict in the counsellor- client relationship. Clients ma,., be resistant because
of transference renc:tions or simply because they do 00( feel a good connection with
their counsellors.
Resistance may emerge when counseJlors chaJlenge long•c:stablished behaviours or
attempt to encourage: discussion or goal setting in areas that clients would like to avoid.
psychological reac:tance: TIie Miller and Rollnick (2002)dc:vc1opc:d the theory of psyc.holos:ical rcac.tance to describe
teadeaq for peopleto iflttiSe problea
how painful consequences (e.g., personal suffering from drug addiction, nagging from
behavicu if t!ley bEIM thei fie«tim
is threatened. Dis lkory can help us concerned family members) may actually increase the undesired behaviour. This thtory
•d.f~and -.fly uiging by COIICfflled predicts "an increase in the rate and attractiveness of a 'problem' behaviour if a person
triffids and family mayh.Ma pe.rcc:ivc:s that his or her personal freedom is being infringed or changed'' (p. 18).
pa.radcaical effec.1.
Some clients have dealt with the social service system for many years and sometimes
their whole lives. They ha\'t' had many o:peric:nces with socinJ worke.r~ ps)•chiatrists,
foster homes, counsellors, and the criminal justice system, which have shaped their
expectations. Frequently, they have had bad c:xpe.ric:ncc:s with helping professionals or
other persons in authority, and they fear the same outcome again. For example, if they
expe.ric:nced othe.r counsellors as rude or unrrustworthy, they may be guarded with new
workers. This defense protects them from furthe.r rudc:nes~ inconsistency, or breach of
trust. Armed against the counsellor before they even meet, these clients may view car-
ing as manipulative and empnthy as intrusive. Asking nbout prior o:peric:nces hclps to
bring feelings and issues into the open, including any preconceptions or fears about the
current relationship. \\:lhen counsellors do this, they shoukl provide: a brief explanation
to let the.ir clients know they arc not prying for gossip:
CounS(>IJOr. H::1:"e )'Ou had 311)' other e-xpedences with eounsie1!1~ in the p.,n!
C lient: Yes, 11\)' h uslxlnd and I went for marital rounsellin¥ about 1wo yearS :lK().
CounS(>IJOr. \V~t dkl )'Ou like and dislike ::ibout that e,:pedenee} 1'1n 2ski~ beeau.u I
think it will help me to un.derStand 2 bit about your eicpeetatiorn1. I'd like to learn what
v;·orked for )'OU 2nd wh::1:t d,dn't.
238 Chap1er 8
Resistance may also dcvdop because of conflict in the current rcJntionship. Coun-
selling rcfation.ships, like all rcfotionships, a.re subject to periodic stress and conflict.
Counsellors cnn make mistakes and say the wrong thing, and they can offend their
clients. Vulnerable clients may be ovcrh• sensitive, or they might misinterpret mes.sages
and fed ang,crcd. This is an inevitable reality of the chemistry of human encounters.
h's a.I.so rruc that resistance may have origins that beg3n long before the current
relationship. Man)' clients have had negative cxpc.riences that leave them suspicious and
doubtful about the wluc of yet another encounter with someone representing the system.
\Vhac sets effective counsellors a.part is chc.ir ability to be sensitive to clues such as
verbal and nonvc.rbal shifts in the tone of the interview that signal that there is friction
in the relationship. Effective counsellors arc further distinguished by their willingness
and capnc:it)• to address these issues with nondefen.sive caring, By doing so, they not only
prevent furthc.r resistance but they also build trust and understanding with their clients.
Immediacy was introduced in Chapter 3 of this book as a process for exploring.
dttpcning, and evaluating counselling rcfotion.ships. \Vhen resistance blocks the work
of counselling, immediacy provides a way to deal directly with diem concerns rcgnrding
the counselling process or the rcJntionship itscJf. As a rule, if resistance is increasing.
it is wise to deal dirccth• with it; ochc.rwise, the client ma)' never return. The following
questions and statements illustrate the potential variety of responses that can be used
to move the interview to,\--a.rd a discussion of resistance:
■ How do you fed about be.ing here!
■ I'm wondering what's happening between us. Arc you feeling angry toward me!
■ Let's Stt if we cnn agree on what we want to accomplish.
■ lf J'm not mistaken, every time I mention your father you change the subject.
\Vould 't'OU rather avoid that topid
■ How committed arc you to making changes?
■ Do you believe it is possible for 't'OU to chan,;c?
■ \Vhat does it mean to you to be scc.ing a counsellor!
■ Arc you worried chat 1 will cry to force )'OU todo something you don't want todo!
\Vhcn nonverbal cues sug,;cst resistance (e.g., lack of eye contact, single word
an.swc.r~ crossed arms, and abrupt tone), counsellors miaht try "breaking the ice" with
statements such a~ "ff I fdt forced to come to counselling, I think I'd fed quite resentful."
Shulman (2009) comments on the fact that communication is frequently indirect
in that feelings and concerns are expressed in ways that might not be immediately clear.
Such indirect communication challenges counsellors to understand what clients might
be trying to SU)' behind the words expressed. For example, a client who asks whether a
worker has children may be communicating her fcnr that a childless worker might not
understand her struggles. By picking up on the question behind the question, workers
create an opportunity to explore these fears. Similar indirect communication might be
embedded in clients' questions such as these:
■ Have you e-.-cr been in jail!
■ Do you know what it is like to be on welfare?
■ Have you used street drugsl
Table 8.1 presents alternative ways of responding to personal questions such as
those mentioned earlier.
Resistance and Fear of Change For most people, it is difficult to change from
established routines and ''"-a.ys of coping. They communicate fears regarding the imagined
consequences of change through resistance. Some clients have trouble with intifl'IOC)•, and
OiHlcull Situations: Engaging wltll Hard-10- Reacll Clients 239

TABLE 8.1 Five Choices for Respondi ng to Personal Questions
Client! 00 )'OU "3ivt Child11n?
1. Answer 100 ciuestion: Mt dO not have any ch'iklren.•
2. Uptore 100 meaning of 100 ciuestion: Ml'm cu(k)US abOut your reasons for ask.-ig.•
3. Uptore 100 implication ot different answe-rs: ·what would it mean 10 you if you heard that
I don't have any d'ltldreo?" or M •if you heard that I have d'lldreo?"
• •
4. Empathy: "Are you pemaps wonted lhat I might not underStand what it's like f0t you. a
single mom with rwo kids?·
5. Silence: Provides an opportunity foe the client to elaborate and perhaps share concerns
and feelings associated Viith the ciuestion.
counselling may be seen as an unwanted intrusion that thre3tens their need to maintain
persona] distance and privac.,, A variety of counsellor responses might be considered:
■ Candid discussion with clients about the.ir fears and the reaJ risks of change.
■ Target small but achievable goals.
■ Empathi:e with the clients' fears.
■ Reassure clients that they will n()( be pushed beyond their capacity and that they
are in control of the pace of change.
■ Limited counsellor self-disclosure to nonnali:e fcars about change.
Resistance and Personal Beliefs Some clients are resistant because they believe
that taking help is a sign of weakness. They may belie,rc that counselling will undermine
their persona] autonomy. For others, culturnJ or familinJ values promote privacy about
one's pe.rson:.d struggles and the belief that they should 00( be shared with stranJ;ers.
One Wtt)' for counsellors to address this resistance is to look for appropriate opportuni..
ties to reframe counseJling as a sign of strength rather than feebleness. CounseJlors can
also deal with fcars about loss of independence by making sure that clients are active
and informed partners in the wo rk of counselling.
Involuntary Clients and Resistance Sometimes resistance stems from clients'
resentment at being forced to come for counselling and an inab ility to see a need for
change. These clients may see themselves as fighting "the system," and the counsellor
who represents it. Jnvoluntary clients typically receive services from large bure:mcraric
organi.!ations, but the structure and procedures of these agencies can make it d iff,cult
for counsellors to suppon the.ir clients. Systems designed to help clients may over-
whelm them with rules and regulations. and counsellors often have to make troubling
decisions on how to use their SOl.«:e resources and time. It is important that counsellors
understand how clients ma,., percei,rc them.
Johnson and Yanka (2004) remind us that clients may overestimate the extent of a
worker's power. \\:'hen clients assume counscUors have more power than they acrually ha,rc,
they might withhold information, avoid mcetin~ or otherwise resist counselling: therefore,
frank discussion of roles. responsibilities. and dlC' limits of p,0\\tC.r may assist in clients' fears.
With imoluntary clients, it is important to restore their sense of control and right
to self-determination. These clients need to be able to answer the question "What
can counselling do for me!" They need to see go3Js and outcomes that they desire as
opposed to those imposed on them. Counsellors need to be patient with unwilling di,.
ents by rem3ining nonjudgmental and ca.ring. Moreover, they can decrease resistance by
demonstrating their ability to talk calmly with their clients about their re3sons for not
wanting to be there. Counsellors should be especially diligent about informing unwilling
clients about their rights, includ ing the limits of confidentiality. Cfe3r, succinct state-
ments about these issues will help to reduce the.ir suspicions.
240 Chap1er 8
The brain is wired to keep us safe. Ne-ut'31 patl'wtays over time- creati~ pressure to reverl to famtliat patterns, thus, sabOtag-
tesult rn Mhacd wited" ways of thinki~ 0r dci~. Em::>tiooal ing the change. Significantty, some of this anxiely may be
teactions to risk tald~, changi~ behaviout, Or feeling pres- dis~ ced as resistance or ange-r towatd counset.lOl'S, eve-n
SlXed by others may be ex.perienced as threats to tne comfOrt when clients are wilting parttlers in the Objective to change.
of the siatus quo. This c,eates anxiety aoout change. even CounsellOr'S can help by assisting clie-nts to anticipate and
when lhe d'langes are soon by clients as gOOd and oosirable. plan for the natural an.x.ie-ty associated with modifying
The brain reduces this anxiety by avoiding the change or established patterns.
Sometimes cou nsello rs C3n modify expectations throuWl re.framing. The follo"'ing
interview excerpt provides a b rief illustration:
Cou nselto r: What do )-Ou hope to :te.hie-.,e!
Client: Kothin i,
Cou nsello r: What' s behind th:u answer!
Client: I Ju st think th at eounsellin K is 2 waste o( t ime. W h::u iood does it do to talk
2bout problems 2n)•way!
Cou nsello r: You :Uso seern to be s:ayina th::u i( eounsellina could in some W'3)' help )'OU
with your p roblems,. rou would be tn<Ke s::ttisf",ed.
Client: I iueti so.
(n Cha pte r 7, " rolling "'ith resistance" "'as introduced as a way to avoid an)' direct
ch nJlengcs that might p r«ipitate a power struggle. This strategy ide ntifies bu t accepts
the resistance. This approach is illu strated as fo llows:
Client: I Ju st think th at eounsellh,i is 2 waste o( t ime. W h::u iood does it do to talk
2bout problems 2n)•way!
Counse!Jor. Gn'en your pessimism . it seems t'O 1ne t~t you 're wi.se to be eau oous 3bout
w~t we mi$:ht aeromphsh here.
The following story pro\•idcs anoth er example:

A hol)• man and an athe.ist met o ne dar. The 2theisc ehal!ena«( the ho!y rnan to deb.1te,
exd:1ilnll1i, "I don't beUe-,,e in God!" TI,e holr nun replied. " Tell me about the God you
don't belie\~ in... TI,e atheist talked :lt l ~ h about the2bsu n:I W'3rSth ::u h::.d been (ou~h t
in the name o( God. H e m :M':ked the "hypoerites" who espoused their reliaious values
2nd belie(s but beha..,ed in q uite the opposite fashion. TI,e holy man hstened p.,tiendy
until th e atheist h::.d sakl his pieee. Onl)• then d,d he respon d: "You and I h ave 2 lot in
eomrnon. I don't beUe-,,e in that God either...
Figure 8 .1 o udincs some counsello r responses that both incrc3se resistance and
d«rc3se resistance.
Resistance and Counsellor Self-Awareness

Cou nseJlors should monitor a nd manage their own emotional rcoctions to resistance.
C lient resistance can be u nsettling and demoralizing, and it can test almost any counsel-
lor's ability to be- nonjudgmental. Common co u nseJlo r rc3ctions include fo3.r, anxiety,
avoidance, defensiveness, anger, pessimism, and a sense of r~jection. Counsellors ma y
tu rn against their client~ b lame them fo r their problems. and look for "'ays to rder
them to another counsellor.
(n response, clients ma y v iew their counsellors' defensive reactions as proof thnt the
situation is hopeless. Thu~ it is important that cou nsello rs find wa)'S to d eper sonalize
OiHlcull Situations: Engaging wltll Hard-lo- Reac h Clients 24 1

Rnponses Tllat lncttase Resistance
-Unsolicited advice
- Pushing for change
- Pre.aching. moralizi~ and b lamWt.g
- Argui ~ and warning
- Powe, struggles and defensive res,ponses
- Judging
11.!sponses Tllat Decrease 11.!sistance
- Empathy
- Nondefensive responses/open mind
- Genuineness and respect
- Rolling with resistance (see glossary}
- Reflective res,ponses
- Strengths approach
-Radical acceptance (see glossaty}
Figure 8.1 Resistance
CONVERSATION 8.1
COUNSEllOR: You Ya(lr'k, With stroot-ir'WOtved youth. What have ~ standards. He came in to see me-. but ii was evident that
you leamed about working with invduntary clients.? his main motivation was to preser\'e- his job. With him I found
that 1t worked best to encourage him to express his anger-
YOUTH COUNSULOR: I learned the ha(d way dOeSn'I work.
about being told vd\at to dO. This diffused his resi:slance to
r oom's no point in lecluring, mol'aliziog. Or' p(eachi~ abOut
the point whe(e- he- no longer- saw me as the eoomy.
lhe dange-rs of dfugs. What seems to work bes.I is to focus on
lhe mtationship. YOUTH COUNSEUOR: It's like that With OIS clients as weU.
With youth on probation, I like to look fOr' w.rys to gNe- them
COUNSELLOR, How dO you dO that?
powe-r and i.nvOlve lhem i.n decision maktng. Here- again,
YOUTlt COUNS£LLOR: Somelmes it's just little thk,gs. lil<e bring- empathic listening can he-Ip lhem arrive at a plan that suits
a
ing a cup coffee to a sex.-trade "M.er, Or' cheeklr'lg to see If them, one that doesn't fool imposed.
they are all '1@1\t 0t 0000 anyth;~ I t,y., be ready b- the "teacfl-
COUNSlliOR: So invduntary clients are n01 necessarily pre-
able moment· That can hai:.:,en anytime, such as after' a #bad
contemptative. Many ar-e well awa(e- of their prOblems and the
date" 0t "1len they'm Wng oo.n. Ti>!n, empathy and list,n;~
need to change. They just don't like bei~ t(:j(I what to dO,
stulls are best, espedaly empath-,. Spend;~ lime voth Clients
vothout r,aw,gan "agooda" goes a bng waylOward eslabHsli ~ and that's the key to "«ki'lg succe-ssft.Jly with them. When I
"«keel in corrections, I found that many of my clients wem ini-
trust When the time is ~t. you'll be the "Ill> to" person.
tiall'f resistant and overtly hostie to authority. Oients wilh such
COUNSELLOR, That's ,lghl As you know, involuntary clients anti..authOritarian values are not goi~ to respond to directhie,
can be (ebeUious, and bei~ fotced into counseni~ arouses rtgi:j attempts toconuot them. St.d'I strategies will onlySeM to
lhei( defences. F'Ot example, I fecentty me1 with one- W'ho ircrease resislar.:e. Asalways, payi~ attention to the relatioo-
was refe(red by his emplOye( beeause- he could not get along Ship is. crucial. F'OI' example, 'lfith dients comi~ out of prison,
with his CO-\\()rkets. He ctaiined that others i.n his wOl'k team retationShip eted1biity can be devet)pe-d btf OOlpi~ them 'lfith
simpty had diff!CIAty ooaH.ng with his assertive- man~ and his baSic needs_ SUCf'I as hOuSiog. d:)thes, lood, and a job.
the situation. Otherwise, they run the risk of further worsening the situation by rcject.-
ing the client or reta1iating in subtle W'tl)'S..
CounseJlors need to be ab le to objectively evaluate their own conduct and take the.ir
foir share of responsibility for resistance. \Vhen counsellors have high scJf-awarencss
o f their action~ they are able to monitor themselves and change their behaviour to be
242 Chap1er 8
})!} INTERVIEW 8.1
The followi og inte,view excerpt shows some ways avoid and reduce resistance when dealing with an angry client. The client
is a young male, age 19, who has been referred to an addiction c-ounsellor as a condition of his probation. It is clear from
the client's nonverbal Mhaviour th.at he dOesn't want to be there (e.g.• he has not removed his coat, he gives single-wo,d
or shOrt answerS to questions. and his voice tone is hOstile).
Client (with angry tooe): Me we going to be hete IOOg.. I Analysis: The client's oPening comment clearly communlcbtes
got things to do. his ,es/stance in a way that should not be Ignored.
Counsellor: I know that you wefe fofced to come here by Analysis: At th;s Point, the counselk:Jt needs to conuot her own
you( probation office(. I'm wondering hON you feel abOut emotional response to ensure that she does not become defen-
1h31. sive, a response that would almost certainty Increase resistance.
Client: I' m teally not in the mood to be cros.s~mioed. lnsJe.ad, the counse/10t encourages the client to say more about
Counsellor: Of coul'Se-. you a(e free to leave at any ,:dnt. his feellngs. The counsel/Or reminds the client that he does
But be:fofe you do, why 000·1 we take a moment to talk have a coo;ce about whether to stay or go, which ls designed to
Slr'aighl. give him back some of the power he feels he has lost.
Client (sal'C'Astk:'al,),'): I think lhis is al crap. It makes no Analysis: Use of "rad;ca1 acceptance" (see Chapter 7). The
sense. What's lhe JX)inl? counsellor II/es to find a point of agreement, but her respanse
Counsellor: I appreciate youf honesty. ls greeted by m0te anger. At this point, it ls Important that
Client: I'm here, so let's get lhis done. the counsel/Or not give up. Even though the client's respanse
Is less than Ideal. he has heard what the counsellor said. The
counsellor needs to remain calm, patient. and empathic. This
will give the client an Of)p()ttunity to sp/11 out some of his anger,
which often helps to soften it.
Counsellor: It sounds like you've been through lhis befO(e, Analysis: The client's earlier statement that he ..doesn't want to
and it didn't wOl'k out. be cross-e.umlned" Is a good ind/c.ation that it might be w;se,
Client: Yep! More Ihan once. at least at this paint. to avoid directly questioning the client.
Counsellor: If you want, I'd be hapP'f 10 listen 10 what went Questions would be inapp,o,:,,iate In this interview.
wro~. The counsellor proc.eeds, while trying to honour the client's
Client: I'm lited of people tryi~ to control my life. need for autonomy and control.
Counsellor: Fait enough. We agree. You don't want to be Analysis: The counsellor contlnue.s to honour the client's right
cross-examined. and I cSon't intend to try. You don't have to to self-determination and autonomy.
tel me abOut anything you d0n'I want to Ialk aoout.
Client: Let's get one thing clear. I do 001 nOOCI you(
permission to do anything.
Counsellor: Ag(eed. But since you have decided to stay, Analysis: The counsellor continues to ..roll with ,es/stance. "
let's talk. If you'te feeling angry because yotX prObation The counsellor tries to ally herself with the client by using setf-
officet ltlinkS you ooed counselling, I can undel'Sland. I d;sc1osure to encourage him to talk about h;s res;stance. She
s...-e do not like it when I'm forced to do something against emphbSizes that the client has made choices.
my v.ill.
Cllent: It's noI you. I just don't see the point. There's Analysis: The counsellor's persistence wo,-ks, as the client
n01hing wro~ with me. I don't undel'Slancl why I have 10 begins to open up. At this paint, it Is Important for the coun-
come here. sellor to avoid becoming defensive. If she starts to "sell" her
client on the merits of counselling, she may lose him.
Counsellor: Souncts as if you reatly want to star\CI up and Analysis: An inferred empathic response .acknowledges the
say, "Thisi:smy life. 8uttou1.· client's feelings.
Client: Yeah. What gives tnem the right to say I'm ctazy? Analysis: Cautiously. the client begins to share his feelings,
Including his reservations about what will happen In the
relationship.
Counsellor: Aocl now that you're hem, you might be wot- Analysis: The counsel/or uses immediacy to verbalize the
tied that l'lldo the same thing, That I will try to get into you( client's central concern, which the client has expressed
Mad. tell you what to do. lmf)l/c.itly.

>» INTERVIEW 8.1 Dealing with Resistance <cont;nue)
ClleM: Of coufse. Isn't that how it wor'ks? 1have been to Analysis: Despite his initial resolve to 1<1tep his distance from
counseling before. (Laughs.) You guys a,en'I hap~ unleSs the counsellor, the client Is beginning to connect. He Is seeing
you're mucidng someone up. the counsellor as less of a thieat.
counsellor: (Laugt'ISJ Well. we have to Shrink our ciuota Analysis: A little humour from the counsellor helps build rap-
of heads. ,:,o,t whileshOwlng empathy with the clfent 's feelings. The
ClieM: (Laughs.) My Mad is staying just where it is.. counsellor's humour affirms he,- ability to talk about the issues
without becoming defensi've. However. when using humour tim-
ing is cdtlcat. What WOrlts very v'le/1 in one situation might
result in disaster in another.
counsellor: I am impressed that you're able to say what Analysis: The counsellor does not attempt to break down her
you want client's defences, which are helping this client cope with a
ClleM: I do not believe in playing games. threatening situation. Instead, she reframtfS his stance as a
strength.
counsellor: Me neitnet. So. let's talk abOut Vtt\at you'd like Analysis: There is much wo,k to be done to establlsh a solid
to see happen here. I wdl need some help from you. And working relationship with this client. The counsellor's responstfS
if it's okay with you, 111share some of my ideas. allow the process to move forward, but her manner gives the
ClleM: I guess so. It is not like I have a chOice. I've seen client some much-needed cont.rot and power. Asking far the
dozens of social wor'kerS in my lite. They alt talked a good client's help about process and direction is very empowering.
game, but it didn't hell:) me one bit! How tS this going to An imp0rtant beginning has been established.
be any difte(en1?
Reflections:
■ How ml&Jlt tllls lnttrvlew have evolved diffttentfy It tbe counsellor bad used questlonin1 as her main tool for
Inquiry?
■ What are SOftle ot tbe personal feelings you ml&Jlt need to control if you were tbe counsellor In Uds scenario?
■ How can you approach clients wt,o have bad muldpte " bad,. experiences with counstllOrs or others In the soclal se-rvice
system?
■ How would you respond to tile cllent's last question...How b tllls goin1 to be any different?
more effective. Hill (2004) echoes sentiments from mtmy sources with the simple yet
profound 3dvice to counsellors to "respond to client 3n,;cr as they would to 3ny other
emotion" (p. 417).
Counsellors can use colleagues and supervisors for support when dc3Jing with
highly resistant clients, who can tax the patience of even the most do:lic3ted counsel..
lor. CollcginJ support c3n help counsellors unwind from tough sessions. They c3n help
counsellors to be more objective, or they can be 3 source of fresh ideas for rc3ching
difftc:ult clients.
CONFRONTATION: PROCEED WITH CAUTION

M3ny people associate confrontation with conflict and hostility, an association arising
from the fact th3t confront3tion often comes from frustration or anger. For counsellor~
dfective confrontation is not 3 hostile 3ct. Confrontation is simply a way of directing
clients' attention to 3spects of their personality or behaviour that they might othcnvise
overlook. 1t is a tool to move clients to a higher level of understanding of themselves
and others. Moreover, caring confrontation can d«pcn the level of trust in the counsel-
ling relationship. It is nJso a m3jor skill for helping clients dcvclop fresh pe.rspcctives on
244 Chap1er 8
CONVERSATION 8.2
STUDE:NT: What are someways tos:¥y Mno• toc~nts? I feally lddS, I've found that, even wtlen they test lhe limits, they
hate 1t wtlen I have 10 deny them what they want o r ~. may need limits and even welcOl"OO them when imposed. It
increases lheit se~ of safety and control when they learn
TEACHER: That is my reacti::)n too. None of us in lhe hefpi~
the bOundaries of acceptable behaviout.
professions wants to be seen as harsh or uncaring. Saying
Mno• may evoke feelr'lgs of gull in us. as well as stro~ nega- TUCHER: I agree. I think it is important that you dOn't make a
tive re.actions from our clients.. We realy ooed to be able to hasty tetreat. Expect that anger, defensiveness, and countet-
address our own emotions as well as those ot the clW!nt. attaek ate the ways that some clients tespond to frustratbn.
In extr'etne situations., you need to protecl youtself. Anticipate
STUDE:NT: I suppose it's a realtly of the business. Sometimes
potentially violent situations and take defensive action. Also,
we have to make tough decisions, suctl as who gets the train-
be s....-e to debfaef with a colleague or superviSOr' after dif-
ing money and who qualifles for assistanice. In the tesiclential
flellt encount-el"S. And if ~ssary, take a tl'eak 10 e~ute
part of the protJam wtlete I wOl'k, we often have to say no
that yout teacrions do not contaminate yout abdity to deal
when the klds want exceptbns to then.des. No pto~m when
with your next client objectively. Flnall'j, remind yourself that
you're able to give them what they want. But vd\at about wtlen
no mattet how yout client teac1s, you must stay in a profes-
you have to turn oown reciuests?
sional role.
TEACHER: Even when you're sayi~ Mno: it's important lhat
ST\JOENT: woon someone says ·no· to me, I find it a IOt eas-
clients kOON you cam. You ooed to istan and be available to
ier 10 accepr it if I koow why. So, I try to explain my tationale
respond with empathy and compassion. fk'ld a way to ShOw
or the policy. Then I invite questio~ while remaining clear
you understand. even if you are no1 able to give yout clients
'llf'len the policy is nonnegotiable.
what they want. Or see If there rS a way to compromise to help
yout dient save face. What do you think? TEACH£R: If you can, help your clients identify othet ways to
meet theit needs.
STUDE:NT: I have teamed a couple of thi~. Be ditecl, deat,
and brief. Don't waffle, hrll, Or' a\'Oid 1he ·oottom line.· With
themselves and the.ir behaviour. Neverthcless., it is a skill that should be used sparingly
and with caution. As a ,;eneral rule, confrontation has the greatest chance of success
when clients accept it as part of the counseJling contract.
Types of Confrontation
The rw-o main types of confrontation arc feedback confrontation and confrontation of
incongruities. Feedback c.onfronrarion provides new information to clients about who feedback confrMtalion: Used to
they are, including how thq• are pe.rcci\'ed b)• others and the effects of their behaviour prom!~ informatiln to tli!alsabol!II
who they are. iflduding ha# they al!
on others. Feedback confrontation can be used to hcJp clients become aware of the peaiwd by octiiers ud the effects d tileir
consequences of their decisions and actions. It is not reserved for ncg:itivc or c.ritical bebl'iour 011 others.
feedback; it can also be used to identify strengths.
ln some case~ clients do not rccogni!e the hnrmful effects of their behaviour on
themselves and others. They continue to behave in ways that are hurtful, yet they lack
insight into how they arc affecting others. Because they are unaware and fail to sec the.ir
behaviour as problematic, they have no motivation to chan,;c. Feedback confrontation
can hcJp these clients examine the consequences of their actions. The following arc
examples of client blind spots:
■ Jerry thinks of himself as humorou~ but he is unaware that his jokes are offensive
and sexist.
■ Nathan has b3d breath and body odour.
■ Parvindcr is unaware of how his aagrcs.sive behaviour pushes others away.
■ Estelle has bttn in a series of rclntionship.s in which she has been batter~. She does
not understand how this has affected her children.
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clien ts 245

Despite its potential power 3S 3 helping tool, focdb3clc confrontation is often mis.-
used. Some counsellors 3Void it, perh3ps because they foar that they might alien3te
their clients or arouse their ange.r. Other counsellors feel the need to keep the hcJping
rd3tionship pleasant, so they distort or lie to clients to sustain their 3pproval; howeve.r,
effective counsellors need to be willing 3nd able to confront clients when ncces.s3ry.
Thus, counsellors must re.main aw-arc of their beliefs, fears, and expectations regarding
confrontation to use this skill 3ppropriatdy.
Sometimes beginning counsellors (and some experienced ones too) arc reluctant
to confront. They ma)' hold beliefs such as the following, which potenti3lly limit their
effectiveness:
■ "I was brought up to believe th3t if you don't have something good to SU)', then
don't s3y anything 3t all."
■ "If I confront, 1 might damai;e the relationship. I don't want to upset mydient.s."
■ "I don't want to hurt my clients."
■ "My clients might retaliate."
Yet most of the preceding beliefs 3rise from an erroneous unde.rstanding of con-
frontation as 3 "no holds ba.rrcd" assault on clients. As.saufo-typc confrontation strate~
gies should, of course, be avoided. At the othe.r extreme, refraining from confronting
clients under any circumstance is 3n evasion of responsibility that cuts clients off from
the potential benefits of new information and focdbaclc. Competent counsellors should
not withhold potentially useful feedback.
confrontation of ir1COf'CRJities: The second type of confront3tion, confrontation of inconiruities 0vey, Jvey, &
US!d to point «11 incoosiM•iesiu z3foquctt, 2010), is directed at inconsistencies 3nd mixed mes.sages:
client's wfbal and nofl\'elbal aessaies.
wlues « beliefs. and behlriour. ■ Discrepancy between a client's verbal 3nd nonverbal messai;es.
Client: (Crying.) It'll really nothifl$:.. I'm not bothered.
■ Discrepancy between a client's values or beliefs 3nd bch3viour.
Client: There' s nothi~ more important IO me than my 1:...-.ls. I know I h:wen't spent
much tin-.e with them. It' s just $0 h3rd to !lay no to my buddus when tlltyuk me 10 help.
■ Discrepancy between wh3t a diem s3ys 3nd what he or she docs.
C lient: I'm ronunitted to l0<>kh)¥ (or v.-'Ork. Yesterd3)' sornethil)¥ eaine up before I could
~-et to the emplorrnent omee.
In confronting discr~pancies, counsellors need to re.main calm 3nd nonjudgmental

while presenting clients with facts. Ivey, Ivey, 3nd 231:.lquett (2010) look at confront3•
tion as 3 way to support clients in a gentle and respectful manner rather th3n 3 h3rsh
c.h3lleni;e. Its purpose is to 3id clients to h3\-e a more complete understanding by offer-
ing additional inform3tion or perspective. 1t opens up new possibilities for changes in
thinking and behaving.
The Misuse of Confrontation

Although confrontation has potential for motivating clients to change and can assist
clients in dcvcJoping insight, misuse of confrontation can be destructive. As a rule,
counsellors should use it sparingly 3nd should be prepared to offer support and c3ring
to ensure that confront3tion does not overwhelm or dcvast3te their clients.
There are risks to confrontation, 3nd some diems do react poorly. They ma,.,
respond with hostility 3nd 3ttempt to question the integrity or credibility of the coun-
sellor. Such a hostile renction m3y be 3 type of denial, indicating that the diem is
simply not read)• to 3clcnowlcdi;e the va.lidit)' of the confront3tion. Hostile renctions
arc more lilcdy to occur when foedb3clc or confront3tion is unsolicited, but they may
246 Chap1er 8
occur even whc:n dic:nts nppc:3r to be seeking informntion or feedb3clc. Counsellors aJso
nttd to consider that harsh dic:nt rc:3ctions may arise for legitimate re3sons. Somc:times
fc:edb3ck is confusina or the manner and cone: of the: counsellor are abrupt. Secure:
counsellors have: to be opc:n to the possibility that they may have erred.
Confrontation is not an oudct for n counsellor's anger or frustration. \\:fhen coun-
sellors are not in control of their own fceJings, dic:nts are more lilcc:ly to view them as
agg:rc:ssivc: and to fc:el che.ir confrontation is unsupportive. The: counselling reJntionship
is formed to mttt the: needs of clients., and responsible counsellors forgo thc:ir own
needs to this c:nd. In addition, counsellors should be: se.lf-aware enough to know che.ir
reasons for wanting to confront.
Ovc:rly confrontational stylc:s have bc:c:n found to rc:sult in a hiah diem dropout
rate and poor outcomes. "Counsel in a directive, confrontational mannc:r and client
resistance aoes up. Counsc:l in a reflective:, supportive manner, and rc:sistancc: goc:s down
while: change tallc incre3sc:s" (Miller & Rollnic.k, 2002, p. 9). Ultimatc:ly, "the: manner in
which we prc:sent confrontations affects the way thc:y are hC3rd and accepted or rejected
by the client" (Spc:rry, Carlson, & Kjos, 2003, p. 120).
SUCCESS TIP
"Oo n01 confront another- perSOrl if you do not wish to inc:rease your tnvolvemi:mt wdh that
indh,iduar (Hamaellek, 1982, p. 230).
Principles for Effective Confrontation

Principle Number 1 Unsolicitc:d confrontation cc:nds to result in resistance:, hostiL-
ity, and dc:fc:nsivcnc:ss, but solicited (invited) feedback is more: likeJ,., to be: accept~.
The skill of anticipatory contractina can be used to engaae clic:nts in acceptina
fttdback,
CounselJor. One of the wa)'!I I rni~t be abte to help is br s.h3rin& sorne of tn)' impres-
sions :.bout wh::u )'Ou 3re <loin¥, or e"en about our rt.l3tionship. \\1 h3t do )'Ou think!
Client: Sure. I would 2pprtti.:ue that.
CounselJor. \Veil, let's look ahead. Suppose I wanted t'O t hee )'Ou sorne feedback about
son~hifl¥ I thou~,t you v.--ere <loin¥ wron¥ th::u )'OU were noc aware of. \Vh:n would be
the best way {or me t'O 2pprooch rou!
Client: I do 1101 like to be O\"erwheln~. And I like th e ~ mixed with the bad.
This example shows how contracting can be: used to hclp the counsellor "custom,-
i:e" feedb3ck to mttt the needs and expectations of the client. Some: clients like blunt
fttdback; othc:rs prefc:r it "sandwiched" bc:twcen positive statc:ments. AnticiP3tory con-
tracting empowc:rs dic:nts and communicatc:s respect for their rights to malcc: choices.
\\:fhen confrontation is invit~, it is much less lilcc:ly to mttt with resistance.
Principle Number 2 Confrontation should be: used sP3ringly and in combination

with ocher skills, particularly sensitivity and empathic listc:ning.
Confrontation may involve: fc:c:db3c.k thal is unsenling for clic:nts, and emp3thy
reminds counsellors to remain sensitive to the impact of confrontation. In addition,
counsc:llors should not confront dic:nts without assisting them to dc:vc:lop new altc:rnn,.
tivcs. Confrontation should also be: measured to avoid ovc:nvhdming clients with more:
informntion than they can handle:. Jde31Jy, confrontation should not unde.rminc: the: sc:lf-
c:steem of clients. At first, dic:nts may rc:spond defc:nsivc:ly to feedb3ck, but after re.flc:c.-
tion, thc:y ma,., be more accepting. Altc:rnativc:ly, they may nppC3r to be: accepting but
latc:r become resc:ntful. Thus, it is important to chc:clc with dic:nts how chc:y fttl about
0iHlcull Situations: Engaging wltll Hard-10- Reacll Clients 247

the fttdba.ck or confrontation. Counsellors should monitor immediate rc3ctions. As
well, checking back with the client during the next session is a u~ful tool for identifying
delayed reactions and for noticing any feelings that might impair the relationship. The
foUO\\,ing example illustrntes the process:
CounseUor. rm wondedni how )Ou (elt 2bout our last rneetinK. Remember, I sh3rtd
with you some o( my opinions about the thin,iS )Ou 2re doll,i th:u seem to d1stan«
you from )Our family.
Client:! 2lmost did not eome tod2y. (S1leoce.)
CounseUor. Beeause!
Client: I W2S emb3rr.lSS('d by what )'Ou thol¢ht o( me.
Coun!l(>IJOr. You thou~t th3t I 1nleht think less o( )OU!
C lient: Yes..
Coun!l(>IJOr. \VouJd )'Ou like to Ond out for sure w~t I think!
C lient: Oh1y.
This counsellor's strategy ~ts the staJ;c to help the client correct any distortions,
and it is cruci3l for dealing with the aftcrm:.nh of confrontation. It :.dso reinforces the
understanding thu any feeJings about what happens in the counselling relationship can
be dealt with openly.
Principle Number 3 Confront3tion should serve the goals of counselling by leading

the diem to improved ways of behaving, thinking, and feeling.
Relevant confront3tion alw'n)'S meets the needs of the client. Thus, it is in3ppropri.-
atc for a counsellor to use confrontation as a means to vent frustration, anger, or to
punish clients.
Counsellors can best deal with feelings related to the relationship or the work b\• using
1-st3tcments ruhe.r than trying to mask their feelings as helpful feo:lback. I-statements
are assertions about personal feelings or rc3ctions that do not b lame or judge othe.rs.
Instead of saying "You don't care," an ].-message would be "J feel confused when )'OU
don't answer my questions." I-statements arc much less likely to cause resistance.
Principle Number 4 Confrontation must be timed appropriately at a point when

clients 3re ready and willing totalcc ad\.-antageof fecdb3clc and when there is a reasonab le
possib ility thu feo:lbock can motivate them to change.
Counsellors need to pay attention to timing and ensure thu there is a well-developed
counselling relationship to support confrontation. As a rule, it is preferable to avoid
strong confrontation in the beginning phase of coun~lling. Cliems are more receptive
and likely to 3ccept fttdbaclc as credible when there is a relationship and di.mate of
trust, when they do 00( feel insulted and misunderstood. Otherwise, they may neve.r
return.
Confrontation should be done as dose as possible to the relevant behaviour, events,
or circumstances chat ::are being addres~. In some case~ such as when strong emo-
tions arc clouding communication, it may be best to wait. A client's ab ility to handle
confrontation is a cruci3l va.ri3b le. ff clients arc aJrcady ovcrwhclmed with feelings., con,-
frontation may add to their stress b ut contribute little to their ability to cope Moreover,
clients who are hiahly defensive and guarded may respond poor!)• to confrontation. In
such siruation~ counsellors may find it wi~ to deJay or avoid confrontation entirely.
Effective confrontation is an investment in the relationship. After confronting,
counsellors neo:I to be able and willing to invest ti.me to hclp their clients understand
any feedb3clc. As well, counsellors must be 3Wilable to heJp clients deal with any feeJ.-
ings chal ma)' result from the confront3tion. Conscqucnth•, the end of a counselling
inte.rvicw is J;Cnerally a poor time to confront.
248 Chap1er 8
Principle Number 5 Effective confrontation needs to be specific without 3ttadcing
the personality of the client.
Coun.seltor (Choice 1--inefTecth"(' confront:ulOn): You don't ~m 3t 211 interested in
w~t's h3ppeninSt he-re. I( you're too la:y t'O eare 3bout our v.-,ork. why don't )'Ou just
quie (Coirnsdlor U a1tackmg and ji.dging the dknt w&hmd of/nm.a any concrde ffflloock.)
Coun.se.U.or (Choice 2-more e:tTe:ct.h-e confront3t.ion): When )Ou don't show up lor
2ppointments. I wonder whether you're 2s committed to your ~"()c.11$ 3S )'Ou say )'OU are.
(CoirnselJor'J ro:mmenu me linked to ipttlflc dlfflt bmadou,.)
CoumeUor (Choke 3-most e:tTe<:.th·e confront:uion): I think )Our best work h::1s
h::1ppened on those d3)'S when )Ou C3tne on time and when you mok the e(lort to (ocus.
?l.·ty sense is that i( )'Ou eould nuke e\'err 3ppointrnent, )'Ou·d ~'t't a lot rnore out o( our
time tottether. (Counsdlor {oruseJ on u,engtM and u.fam the clfrnt can Jo tl,m u,·ill bt mtm
elftttlt,e-flf!O/,/_eare motfrau-J more fry posklt" f....dbad.: 1han n~th~ /«dbad.:.)
AGGRESSION AND VIOLENCE

CounseJlors, social worke.rs, child care counsellors, and othe.r social service profession-
3fs, especi3lly those who work in residential c3re, arc increasingly vulnerable to \'lolence
(Macdonnld & Sirotich, 2005, 2001; Newhill, 1995, 2003). For ex3mplc, 3 counseJlor's
denial of a client's request for fin3nciaJ assistance may e-.•oke rcta1iation. Hospitals,
especially emergency rooms, can be a particularly d3nj;erous pl3cc. A survey of over
9000 rcgiste.red nurses in Canad3 revenled rhat 3Jmost 40 percent had experienced some
form of workplace \•iolcnce and 3bout 20 percent had been ph)•sic3lly ass3ulted (spit
on, bitten, hit. or pushcd)(Canadian lnstitute for Health (nformation, 2012). A study at
one private psyc.hi3tric hospit31 found that the frequency of violence by m3Jc patients
was SO percent higher than a dec3de before, and that violence by fom3Je patients was
ISO percent higher than a decade before (fardiff, Marzuk, Leon, Portera, & \\:leiner,
1997). One srudy (Alink, Lenneke, Euser, &ke.rmans.-Kmnenbury, & Van (J:endoorn.
2014) of worke.rs in residential care rcvca1ed th3t 81 percent experienced some type of
victimization (verbal, physical, and sexual harassment) and 37 percent were subject to
physical \•iolence.
Situations th3t may increase counsellors' risk for violence include:
■ Dealing with people who arc using street drugs.

■ Dealing with menta11y ill people who 3re not tnlcing their mcdic3tion or mixing
prescribed medication with street drugs.
■ lnvestig3ting situations of child abuse 3nd neglect.
■ (nstitutional w-ork in prisons, group homes, and hospita1s.
■ \Vork th3t includes some clements of social control (e.g., prob3tion, involuntary
clients, 3nd establishing eligibility for income assistance).
■ Assisting police intervention in domestic abuse.
■ Hospital emergency work.
Canadian studies by MacDon3ld & Sirotich (2001, 2005), de LCSClcuc (2004), and
Rytm (2016) found the following:
■ Almost 90 percent of soci3J workers have experienced verbaJ harassment.

■ 90 percent of C3nadian front.-line residential care ,vorkers experienced physic31
\•iolence from residents (or the.ir rcfatives).
■ About 65 percent have been threatened with physic3l harm.
■ About 30 percent have been sexually h3ras.scd.
OiHlcull Situations: Engaging wltll Hard-10- Reacll Clients 249

■ Close to 8 percent have been physically ass3ultcd 3nd injured.
■ One-third of 31) workplace \•iolence incidems took place in soci3I service or health
cnre setting~ with about 71 percent involving physicn.1 assault.
■ About SO percem of incidents were linked to substance 3busc.
■ Males were nccused in 93 percent of the 3ssnults, and 54 percent of them were
under 35 years of 3gc.
Sometimes clients c3usc fc3r bcc3usc their behaviour is thrc3tening, or they h3\'e a
history of violem behaviour. At other times, counsellors' fears arc b3scd on intuition or
hunches, the inte.rnnJ response to subtle signals thnt not all is well. Jn fact, some clients
provide 3bundant reasons for fear, because of either intimidating behaviour or overtly
violent acts.
intimidating behaviour: Beha'AOUrs Intimidating behaviour includes name c3Jling, obscene or sexually hnras.sing
such u aa.e calling: using obsce. • language 3nd gestures, shouting, threatening displays of power such 3S fist sh3king,
st1uall1 harassing lang_u.aie and g_~ures:
sho~ •d tlrm1ening tkough invasion of person3J sp3ce, stalking. and verbal threats. Clients also beh3ve in an
lisplays al po-• soch as fist shaking. intimidating m3nner when they will not take no for 30 answer or when they refuse
iMdilc personal ~ . stalking, and to leave the office. As weJI, clients ma'>' attadc workers with personal insults, or they
issuing wfbal 1-Ws. Ttles.e behlriours
should be testrMled to l)fMllt escalatioo ma'>' intimid3te them with threats to call the newspaper or ch•il rights groups. Jn gen.-
to~o!Nce. era], intimidnting bchnviour should be controlled or manngcd to prevent escal3tion
to violence. The following case ex3mplcs of threatening behaviour arc aJI b3scd on
re3J incidents:
■ New client in a welfare office s3y~ "If I don't get some help. )'OU'll be sorry."
■ Man, in his lnte twenties st3.res obstinately at an inmke ,vorker.
■ Angry parent tells child protection w-orkers that if his child is not returned, the
worker will know what it's like to lose someone you love.
■ Tccnai;er in a group home refuses to com pl)• with house rules. He tells his child c3re
counscJlor. "I've had enough. Things arc going to change nround here."
■ Parole officer meets 3 new parolee for the first time. He is pleaS3nt 3nd cooperative,
but the parole officer knows the man h3s a short fuse and a long history of ass3ult
chnrges.
■ Mental health counsellor dC3Js with her client, a young m3fe with a history of self.
destructive behaviour. 1t is obvious that he is not caking his medication, and he
seems unusunJly agitated.
■ Ten.-year-old child who witnessed 3busc at home grabs a pair of scissors 3nd lunges
tO\\>ard the counsellor.
violent behaviour: ~ . pu-,:. V io lent behaviour means hitting, pushing, biting, slapping. kicking, throwing
biiing. slawing. lid.ing. th10t1ing obje::ts. object~ and using weapons such 3S guns, knives, or syringes. 1t 3fso refers to kidn3p-
•d usilc weapons such as ,.ns. lniws.
or s,ringes. ping and st3lking..
■ SociaJ worker in a hospital emergency ward is threatened with a syringe by 30 3ngry
HIV-positive patient.
■ Angry client picks up 3 chair nnd hurls it 3t the counscllor.
■ Client, disgruntled with the counsellor's rcfus3l to provide him with money, spits
in the counseJlor's face.
Nonetheless., it is important thnt counsellors do not become hypc.rvigil3m 3nd con.-
duct their w-ork in constant fear. Such 3 Sta.nee m31ces it difficult for them to seP3rnte
nctu3l h3!ards from siruations thnt present no rcnJ risk. Moreover, unw3rramed fear of
clients leads to uninformed responses. Though very real dangers exist in the workplace,
250 Chap1er 8
by and large it is a pince of safety. The challenge is to be able to answer some basic
questions:
■ \Vhich clients are likdy to become violent! \Vhat arc the indicators of potential
\•iolence!
■ Under what conditions should a client's anger be cause for concern?
■ \Vhat are the skills and behaviours that can be used to de-escalate dangerous
situations!
SUCCESS TIP
Anget, when ex,:itessed assertively, rS a n0tmal and potentlalt, useful part of retationShip
communication. Assertive anger' respects the tigt\ts, obligations, and feeh.ngs of setf and
others. /1€gressive anget k\volves intimidation, misuse of po-Her, and disr'especl fOr' Olhel'$.
Risk Assessment for Violence

Violence arises from a complex array of psychological, sociaJ, biologicaJ, and physi-
ological foctors. Although certain wri3blcs are more lilcely risk factors. risk assessment
is difficult and violence ca.nnot be predicted with precision (Miller, 2000). There is
simply no foolproof way co predict with certainty who is likcly to become violent.
Violence may be pe.rccived as a desperate act by an angry client to regain control and
power. Multiple srressor~ such as poverty, the loss or absence of supportive relation-
ships, and substance abuse, may magnify a client's vulne.rability and stress to the break-
ing point. Moreover, counsellors ma'>' be in positions of authority with the right to deny
clients access to goods or services. Clients ma'>' perceive such denials as further threats
to their fragile power and sclf-estce.m, and the risk of violence may escalate. Attacking
others works as a psychological defense against feelings of shame and humiliation.
Based on his review of the academic literature, Ross ( 1995) identifies five pri-
mary causes of violent crime in Canada: "interpersonal conflict situation (over smru~
resources, power, control, and reputation), presence of WC11.pon~ influence of drugs
and/or akohol, media facilitation, and cultural or subcultural reinforcement" (p. 348).
The key variables that have been found to have some validity for predicting \'lolencc
include: (I) past and current behaviour, (2) substance abuse, (3) ai;c and gender, and
(4) personality (sec Fiaure 8.2). The more risk factors present, the greater the risk, but
the presence of a risk factor docs not mean that a given person will become violent in
a given situation.
Past and Current Behaviour The best predictor of future violence is a history
of violence (Miller, 2000), and the more r«ent and severe the violent behaviour, the
greater the risk. Kclleher's (1997) conclusion that a history of violent behaviour should
always be given serious consideration is «hoo:I consistently in the research on vio-
lence: ''Although the argument can be made that historical c-.•idencc of violence is not
a guarantor future violent behavior, an understanding of any form of violent criminal
activity clearly supports the contention that a history of violence is often a pr~ictor
of future violence" (p. 13).
Counsellors should be particular!'>' interest~ in noting how a client has handled
difficulties and frusrrations in the past. Some clients who were victims of abuse as chil-
dren have grown up without a capacity for warmth and empathy for others, which can
make them oblivious to the suffering of othe.rs (Miller, 2000). ln extreme cases, violence
ma'>' even bring these clients pleasure or sexual gratif,cation. Counsellors should also be
interested in the level of remorse that clients show for past acts of violence, P3rticularly
OiHlcull Situations: Engaging wltll Hard-10- Reae ll Clients 251

Histay
.-o1c-"',
c::=:::
Puor Conflict Resolution Skil s
Command Halucinalions
Figure 82 Risk Factors for Violence
for those who show no regret. On the other hand, clients who have IC3rncd other ways
of man3ging thc.ir anger now have more choices and 3re less likely to 3ct out physically.
(n this respect, it might be rcve3Jing for counsellors to explore how their clients arc man-
aging stress outside the counscllina relationship. For cx3mple, do they show evidence
of a lack of concern for the s3fcty of others! Are the.re indic3tors of inappropriate or
uncontrolled anger? Arc they typicnJly c.xtremet,., defensive, irritable, or self-centred!
To what extent arc they prone to impulsive behaviour! Impulsive clients might assure
counsellors that they have no intent to harm 3nyone and then artack another client in
the w3iting room 10 minutes later.
Furche.rmore, clients who have 3 specifK pfon of \tiolent action and the means to
carry it out rcpresem 3n immediate risk of violent behaviour. Counsellors need to con.-
sider their professional obliaations 3nd lcgnJ requirements to w3rn 3ny intended victim
by examining their codes of ethics 3S wcll 3s relevant legislation or lea31 precedent.
Substance Abuse Viole.nee from substance abuse is associated with
■ the effect of drugs.

■ violence to act drugs, and
■ violence in the drug culture.
Common sense 3nd cmpiric3J rcsc3.rch sugaest that intoxic3ted 3nd agitated clients
should be appro3ched C3utiousi)•. Substance abuse, particularly in combination with
other risk factor~ compounds the risk of violence (Miller, 2000). Rcvicwina the role
of druas in violence, Roth (1987, pp. 13-14) concludes the followina:
■ H3Jlucinogens such as LSD 3nd PCP, glue sniffing,, amphetamine~ 3nd barbiturates
have been 3SSOCi3tcd with agaressivc and homicidal beha\tiour.
■ N3rcotics tend co suppress violence, but individu3ls miaht become violent in order
to g,et these druas.
■ Alcohol reduces inhibitions. and it is implicated 3S the most frequent drua linked
to violence.
Furche.rmore, many studies link substance misuse to violent behaviour (Sw-anson
et al., 1997; Tardiff ct 3J., 1997). Newhill (1992) reviewed the available research
and recorded that certain druas subdue aggression, whereas others escalate it:
252 Chap1er 8
''Anticholincrgics. antipsychotics., antidepressants. sedative hypnotics. and analacsics
tend to suppress aagrcssion. Amphetamines and withdrawal from drugs such as mor-
phine or nkohol induce aggression" (p. 70). Moreover, people who abuse drugs are at
an increa~ risk of victimization. The link between drua abuse and violent behaviour
may arise, at least in pan, from the fact that alcohol nnd other drugs are more likely to
be abused in a dan,;crous pince.
Age and Gender The vast majority of people who arc \•iolent and who have bttn
arrested for violent behaviour are male. The highest risk for violence is found in people
from 15 to 39 't'cars of age. The rate of violent nets for this age group is three times chat
of the general population (Newhill, 2003). Violence declines with age, but dementia
and other cognitive problems cnn result in an increase in violence by those over 65.
Personality Some clients deal with their sense of persona] fragility by lashing out at
others, and they arc hypcrvigilant about protectina themselves from perce.ived threats
from others. Miller (2000) notes:
Tendendes IOW3rd low frustration 1oler.u1ee, impulsive beh:wior, ,-ulne~bi.lit't' m criti~
dsm. {eelini hmnil1:ued and powe-rless. superlkial rel.:uionships, l.:iek o( emp3thy. a
p.1ttern o( exte-rnali:inK problems. and failinK 10 aceep.t responsibilit't' for one's own
:1etions 2re 311 assoeiated with more-violent beh:wior. (p. JOO)
De Becker (1997) nutions that some people assume the worst possible motives
and character and thnt they write che.ir own scripts: "The Scriptwriter is the t)'J)C of
person who asks you a question, answers it himself, then walks aW'll't' angry at what you
said . .. The things that go wrona arc the work of others who will try to blame him.
People are out to get him, period" (pp. 148- 149). These clients beJicve that you arc
uncaring and bent on harming them. \Vhatevcr counsellors do and however caring che.ir
actions. these clients will react based on their expectations. They may try to control the
rcJationship through manipulation and imimiduion; however, this behaviour should be
interpreted as a warning signal only. These clients may not escalate co violence.
Violence and Mental 11 lness

The question whcche.r people with mental illnesses nrc more dangerous than the aeneral
public continues to be the subject of research, debue, and controve.rsy. Not surprisinaly.
many people believe that there is a strong link between mental illness and violence. But
advocacy aroups argue that the media, through selective and exnagerated reporting,
have stimulated the deveJopment of false assumptions 3bout the dan,;crs posed b\•
people with mental illnesses. Sens:ation3Jizcd headlines such as "Schizophrenic Man
Kills \Vife, Then Turns Gun on HimseJf" and "Voices Told Mc to Kill My Child" cre-
ate the impression thnt mcntaJ illness is associated with violence; however, objective
research evidence supports different conclusions.
SUCCESS TIP
Viole-nee that Ot'igj.nate-s from psychOSeS and olhef ne-ufdOgjc:al pfoblems can fOr' the most
par1 be prevented lh(OUgh r'nedication and suppor1 sel'Vic:es. This unde-rscore-s lhe imJ)Or'-
tance of wortung with dients to enhance- medication compliance, as well as providing teady
access counse-lling fot ettSis management, pee(support, and basic ne-eds soch as hOuSing.
One comprehensive Canadian stud,., of the literature on the link between mental
illness and violence concluded that there is no scientific evidence that mental illness
causes violence (Arboleda~Florez, Holley, & Crisanti, 1996). Echoing many other
research finding~ they aJso implicated substance abuse as the most significant risk
OiHlcull Situations: Engaging wltll Hard-lo- Reac h Clients 253

))I) BRAIN BYTE 11 : j T : I I' I : ,1 I j , ' I '
Otganic brain disease and head ttauma may reduce clients' A Sludy of prisoners linkS a hist.Or)' of brain trauma with an
rn'lpulse contrOI and le-ad to an iocrease in aggre-ssion and increased likellhOOO lot viOlence (McCOOk, 2011).
viotenice, as wet.I as changes in memory and ability to teason.
factor, noting that studies suggest that "individuals are 3t grc3tc.r risk of being assaulted
by someone who abuses substances rather than someone who is suffering from major
mental illness such as affective disorder, anxiety disorder, or schi:ophrcni3." Another
study (Sw-nnson ct aL, 1997) confirms the link between violent behaviour and substance
abuse, particular!)• when there has bttn absence of recent contact with mc:ntaJ hC31th
service providers. A different stud,., concluded that predictions of violence based on
a history of violence were more accurate than clinical predictions based on diagnosis
(Gardner, Lich, Mulvey, & Shaw, 1996). Overall, persons with mental illness arc over
2.5 times more likcJy to be \•ictims rather than perpetrators of violence, particularly
when other factors such as poverty and substance abuse arc present (Canadian Mental
Health Association, 2005). The vast majority of violence comes from people who are
not mentally ill, yet the widespread belief that persons with mental illness pose a threat
contributes to the stigmatization of this group (University of 'W ashington, School of
Social Worlc, 2015).
Although "major mental disorder and psychiatric disturbance arc poor prcdic~
tors of violence" (Harris & Rice, 1997), Miller (2000) found that certain mental
disorders, such as schizophrenia with paranoia and command haJlucination~ mania,
substance use disorders, antisocial personality disorders, and borderline personaJity
disorders, arc more lilccly to be associated with violence. Moreover, in recent dcadcs,
deinstitutionalization of psychiatric patients has resulted in unprecedented numbers
of people with mental illnesses in the community. Clients with a history of severe
mental illness and violence who stop taking their medications can be very dangcr-
ou~ particular!)• if they have command hallucinations (voices and images directing
them to be violent).
A comprehensive follow-up study of patients discharged from psychiatric hospitals
concluded that former patients who do not abuse drugs arc no more violent than a
random population sample (Bower, 1998). Pastor (1995) concluded that unrealistic and
dcJusionnJ thinking tends to increase the likelihood that violence will result. He aJso
noted, "Manic symptom~such as irritability, increased energy or activity, ps,.·chomotor
agitation and grandiosity, also increase the rislc of violent behavior. A belief that 'oth-
ers' arc responsible for the person's misfonune increases the lilcclihood of srriking out
against those persons" (p. 117 3).
Violence Risk Assessment: Key Questions

Although long-term prediction of violence is difficult, counsellors should be able to
make reasonable short-term forecasts based on consideration and assessment of the
follO\\•ing questions and issues:
I . Docs the client have a history of violent behaviour or an arrest record for \•iolcm
crime? The counseJlor should review agency file records and other anecdotal
evidence for information.
2. To what extent does the client appear dangerous, as evidenced by marked or escn,-
lnting agitation or threatening behaviour! The counsellor shoukl consider verbal
threats as weJI as nonverbal expressions of aggression.
254 Chap1er 8
3. (f the diem is threatening violence, are the thrents concrete nnd specific? Docs the
client have a plan? Docs the diem have the means to carry out the stated plan! Docs
the diem have a weapon or access to one, especially a gun?
4. Is the client under stress (e.g., recent death, poverty, unemployment, or loss of
social support)? Has there been a r«ent event that represents the last straw for the
cliend Noticeable changes in baseline behaviour (the client's usual pe.rsonalicy and
manner) should be noted, such as the folJO\\,ing examples:
■ Haydon, usually quite demanding and argumentative, becomes quiet.
■ Jeff, a 16-yenr-old group home resident, who is typicaJly ve.ry social, withdraws
to his room.
5. \Vhat systemic factors might be exacerbating the situation (e.g., missed or delayed
appointments and denial of benefits)?
6. \Vhat counsellor variables might be heightening the client's anger! Is the counsellor
acting in ways that the diem might see as provocative! For example, is the counsel-
lor defensive or judgmental coward the client!
7. \Vhat high-risk symptoms arc present! For example, is the client experiencing com.-
mand hallucinations! Is the client impulsive? ls the client near panid Js the client
narcissistic or sdf<entred and prone to blaming others for his or her misfortune!
Is the client hypersensitive to any criticism or hint of rejection?
8. Is the.re e-.•idence of substance abuse!
9. Has the client failed to talce ps)•chintric mediations! Has the client cut off or failed
to lceep scheduled contact with a psychiatric caregive.r!
10. Docs the diem believe that he or she is able to control his or her behaviour! Is the
client socially isolated?
I I. Is the.re a history of brain injury or organic brain disease?
These questions are references for the purpose of assessment only. The presence of
any of the factors docs not menn that the client will necessarily become violent. How-
ever, when there are numerous strong dues that suggest violence, counsellors should
procttd cautiousl)• and look for ways to reduce risk factors to establish safety.
Managing Angry and Potentially Violent Behaviour

Preventing Violence Effective intervention begins with prevention. Org3ni:::ations
nttd to be open to the fact that there may be clements of their se.rvice system that act
as trigi;ers for clients who are stressed or have short fuses. Additionally, W'Orkers need
high self-awareness to r«ogni:e their own triggers, as well as how their responses and
behaviour miaht escalate frustrated and angry clients to \'lolent responses.
Systemic Factors Many clients come to counselling inn state of crisis, with low tol•
e.rnnce for added stress. Consequently, it is important that ai;ency policies and routines
Soctely f0r Neutoscience (2007) tepotted findings on Hyperactive tesponses in the amygdata (r'esJX)nsible foe man-
IM neutobiology of aggression. II found evidence of brain aging thteats and fear) and decreased activity in lhe frontal
damage in neutal cifcuits telated to motal decision mak- IObe are also imi:,icated. As well. bw fe\iel:S of the neurotrans-
i~ in viOlent individuals. Damage to the pte:frontal cortex, mitter serOlonin may help predict violence.
and the angular' gyrus can al:SO increase violent behaviout.
OiHlcull Situations: Engaging wltll Hard-10- Reaell Clients 255

do not compound the risk by exacerbating: client frustration. Parada, Sarnoff, Morron,
and Homan (2011) comment on this Canadian rea1ity:
Conununity member!? who use ~bl services o(ten h::1:"e to wait too Ion¥ for an 2ppoint,
n~u, wait too loi,i to be seen on the day o( the If 2ppointment, and ha"e t·o o little tune
with )Ou or othe-r pro(ession.3ls when ther are f'ln.31ly seen. The (ornu they must rom,
plete are o(ten le:i,Kthy and con(usinK. Some a~-t:i1C)' sta(( can be insensiti"e, unhelp(u1.
or dow·n rlj~ht rude. Then t·o~-tther. these prae,e«s reinfor« the idea that community
member!? who have to use these service!l 2re unworth)' and fad:. di1;nit)' (p. 6)
Organizations need to understand that for many diem~ systemic change is what
is needed. Part of this ought to include review of the structure and service delivery
systems of the agencies whose mandate is to help.
Agency Safety Precautions In settings where there is significam risk for violence,
procedures should be developed for dcnJing with potentially \tiolent clients. In foct,
employers usuaJI)• have a leg3J responsibility to provide a safe working environment.
Minimum S3(cty precautions might indude the following:
Policy Agencies should develop and regularly review policies and procedures for
dealing with potentially violent situations. Policies should address issues such as the
procedures for visiting homes, giving clients home phone number~ using last names,
and interviewing after hours. Gene.rally. counsellors should not make home visits alone
if there is a possibility for violence. Many counsellors who work with potentin11)• dan.-
gerous clients use unlisted phone numbers as a way to ensure privacy and safety. In
e>..'"treme situations, such as dange.rous child abuse investigation~ counsellors may need
to be protected by police. GenernJI)•, counsellors should avoid making unescorted visits
to high-crime areas. And onl)• those counscJlors with leg3l authority should investigate
allegations of child abuse or neglect.
Staff Training Training: should address tactics for dealing: with difficult clients,
including those who arc involuntary, angry, or acting out. Front office and reception
staff should also be rrnincd so that they can relate to clients in W'n)'S that do not escalnte
the clients' frustration or anger. Periodic team simulations will ensure that everyone
is familiar with their roles and responsibilities. This prevents members of the team
from becoming confused during: a critical incident. Simulations also help staff build
confidence in themselves and trust in the.ir colle3gues as backups.
Interviewing Procedures and Office Design Counsellors who arc interviewing:
diffteult or dangc.rous clients should work in offices where access to immediate help can
be provided. A silent system for alerting othe.rs that a dangerous situation is developing:
should be implemented (e.g., panic button and encrypted phone message). Leaving the
When counsellOr'S 0r clW!nts feel fear 0r threat from the other-, (OOr'adfenalioo) are released which cause an incfe-ase in
the classic "flight or fighr response may result f0r eithe-r 0t heaft rate and blOOCI pmssure. MuscleS tense-, breathing rate
bOth. Stofed me-m0tie-s of sinilar threatening events have an iner-eases, digestion SIOw Of stops and blOOCI glucose levets
eOOr'mous influence on hO'N individuals fe-spood. five majOt iner-ease-. Because attention is fuly directed at the lhreaten-
afeas of the brain, amygdala, hippocampus. hypothalamus, i~ situation, individuals may be- unawafe of 01he-r things
thalamus. and se-nSO<y c0tte-x all play a part in the deci. such as hO'N lheir responses are affecting Olhe-rs (Layton,
sion to fun (fligt\t) Of fight, (although some may respond btf 2015; Shetr'3r'd. 2015). Thus, some angry and aggfessive
freezing). When the lhreat is pefCeived as real, h0<mones clients may be quite unaware how Mghte-nlflg the-.' behatJiouf
such as epioophrioo (adrenaline) and norepinephrine i:s to Other' peo,:,e.
256 Chap1er 8
door open durina the inte.rview can aJlow other staff to monitor any incrc3sing danger,
but this practice may violate the client's conf.denti3lity.
SUCCESS TIP
AA ideal office seating artangemen1 gives bOth the eounsello t and lhe client a clear,
unobStructed path to the dOOr'Way.
Files on clients with a history of violence should clearly document details of any
pa.st violent behaviour or thrc3ts. For clients with a high propensity t0\\"11.rd violence,
a te3m approach may be desirable, with nvo or more persons being present during the
interview. In such cases, it is usually preferable if onh• one person does the interview-
ing. This can lessen any feelings the client might have of be.ing ganged up on. Too many
people may heighten the client's anxiety. Backup help can be stationed out of sight, but
on quick standby for dangerous situations.
Off1Ce furnishings should be carefully c.hrucn to minimize risk. For example, shat-
terproof glass can be u~, and items that a.re potential weapons, such as scissors, should
be removed. Also, soft lighting and calming colours ma)' have some modest effect on
mood. In addition, the agency itself should have good external lighting. Finally, during
high-risk hours. such as late at night or earl,., in the morning, access doors should be
locked, and worke.rs should not have to w11.lk alone into dark parking lots.
Table 8. 2 on the next page provides some tips on how to prevent and manage anger
and \'lolent behaviour. The table is ori;pnized according to the phases of violence, which
are discus~ in the next section.
SUCCESS TIP
A writtM script for staff call$ to police 0t emergency baekup intervention ensures lhat rel-
evant tnfotmation is presented quickly and Cle.arty. In a panic situation, people may forget
bas.ic information, such as emetge:ncy phone numbel's.
The Phases of Violence

The Na.tionaJ Crisis Prevention Institute (2012) has developed a modcl for nonviolent
c.risis inte.rvemion that is widdy used in Canada. It is based on four phases of violence: phases of violence: The lour-phase
(I) anxiety, (2) defensiveness., (3) acting out, and (4) tension reduction (see Figure 8.3). med.I (a:IW!.1J', de-fenSM!leSs.. aclillg Gil
and tensioo fedo::tiol) duit desc!Us tic,,.
Each phase is characterized by particular indicators and demands specific responses. u is.es escabte to ~olelce:.
Phase 1: Anxiety In the anxiety phase, there are often enrly warnings that a.re
marked changes in the client's behaviour. The client's agitation and anxiety may include
verbal cha.Henges, such as the refusal to follow directions or questioning of authority.
Statements such as "You can't tdl me what to do" accompanied by finger pointing
may suggest escalating anger. Signs of escalation, such as pacing, intense staring, and
refusing to sit down, should be noted (Shea, 1998). Other indicators may include exces-
sive euphoria., angry facial expressions, increased voice volume, and prolonged scar-
ing. Counsellors should watch for changes in diem baseline behaviour or personality
panerns.
During the anxiety phase, the diem may respond to gentle directives and invita.,-
tion~ such as "Let's mlk and see if we can work things out" and "I'm willina co listen."
This phase offers counsellors the best opportunity to intervene earl)• to prevent anger
from intensifying into acting-out behaviour.
OiHlcull Situatio ns: Engaging wltll Hard-lo- Reac h Clients 2 57

TABLE 8.2 Preventing and Managing Anger and Violent Behaviour
Preventive Phase
• Recogrilze (tSk factors.
• Identify and minimize systemic factors lhat might be triggers fOr' clients.
• Structu,e the agency to reduce client s1ress and danger to personnel.
• Set up emergency (esponse protocols.
• Ptaetise crisis f&SJX)nses \\1th simlAatioos.
• Take steps to ptotecl identified intended victims..
• Self-awareness.
Earty Wamill& P11ase (Anxiety)
• Pay attentbn to changes in clienl behaviour such as increased anxiety.
• Attempa to identify and mctify client ~trtggerS. •
• P,omote client inVOlvement in dedsi:)n making to g'Ne 100m a sense of emJ)Owerment and
contrOI.
• Take Mgut instincts· and 1hmats se-riouSly.
• Use empathy and feassuraoce to acktlowledge and atteoo to client needs.
Lall Wamlnc Phase (Defensive)
• Pay attentbn to changes in clienl behaviour such as increased defensiveness, challenges,
aoo vefbal threats..
• Set dear, reasooat,e. aoo enforceable limits.
• Respect client need for increased space.
• Remain calm and avoid sudden movements.
• Avoid using an authoritarian tone; fesJ)Ond assertively.
• Use basic: counselling Skills.
• SeafCh lot compfomises and -win-win· solutions.
Uncontrolled Anger and Violence (Acting 0111)
ca1 the police (do not try to disarm clients who have weapons and do n01 risk personal
safety untess una\lOidable).
Try to ensure the safety of eve-ryone, including bySlanclers, Other Slaff, and the client.
Use a team apptoach, induding. if necessary and appropriate, physical festr'aint, but
ex.treme caution is reciuired as untrained persons can inflict inj...y or death.
• Refef or artang,e to transpor'l dients to hOspital fof assessment or medication.
• Try to re-eslablish verbal eotrwnunication.
Tension Reduction
• Support lhe client's feturn to a state of calm.
• Re-e:ssablish communication.
• £licit availat,e family support.
Post-Event follow Up
lr'WOtve clients in loog-term counselling.
Help clients le.am nonviolent ~lutions to prot,ems.
Implement consequences, if any.
Conduct i'ldividual and team debriefing.
• When clients have plans to harm a specific victim. wam the victim and notify the police.
• Review ptOCedures fof handling distupaive clients.
Usually. clie nts enter the anxiety phase bcc:3usc of stress., which can come from muL-
tip le sources, including jobs, rcfotionships, health, 3nd fin3nces. Clicms define stressful
events; thu s, counsellors cann ot measure stress just by k nowing the facts about a situ3.-
tio n . What one d iem might sec as an o pportu nity, ano ther m ight ex perience as a threat.
Kcllchc.r ( 1997) d escribes the triggering event as 3n incident that pushes the poten tially
258 Chap1er 8
Figure 8.3 The Phases of VIOience
violent person toward violence-: "ft is the provc.rbi3l 'stmw that broke the camel's bade,'
and , like the straw, may often be perceived by others with far less significance than it's
perceived by the perpetrator" (p. I I). ~fore clients sec counscllors, they may nJrc:ady
be feeling helpless and abandoned. Any counsellor o r agency behaviour th:.n the client
views as provocative or rcjcctina ma'>' further propel the client tou•ard violence. Cou n-
sellors may have to d eny assistance, and clients ma'>' believe that they are denying them
3ccess to goods or services. These clients may perceive- themselves as "losers" and look
for ''""n't'S to save focc, indudina resistance, with statements such as "I don't have to put
up with this rreatment."
(ndividuals who arc predisposed to violence respond to stress with incrc3sing anger
and anxiety. A person's cmotionnJ reaction can also in6ucnce whether he or she might
become violent. La.big (1995) suggests that people who are p rone to anger, hatred, and
those who tend to blnme others arc at h igher risk or becoming violent, while those who
are more cmP3thic are less likdy.
Oe.aling with Threats CounseJlors need to take action when clients exhibit changes
in their norm:.d behaviour. T his action co uld include referral for psychia tric assess-
ment and re-cvnJuation or medication. Jmmcdiatc crisis intervention might result in
moving the diem o ut or the environment where others might be injured, for examp le,
a crowded waitin g room. As wcll, long-te.rm co u nseJling might focus on anger manage-
ment or relaxation train ing. The immediate goaJ is c risis management, but the long-term
goaJ is crisis prevention. T h is interesting conclusion reached by Quinscy, Harri~ Rick,
and Cormie.r ( 1998) cha.Jlcnges one common misbdief: "encouraging angry individunJs
to relieve anger through catharsis (e.g., boxing, using a punching bag) is concraindicatro
because it ma'>' lead to increased hostility and aggression" (p. 204).
SUCCESS TIP
"When arry type of th(eat (fr0tn a client) includes indirecl or veiled ,efe(ences to lhings lhey
might do, such as 'You'I be SOfr/ Or' 'Don't mess wilh me; ii is best to ask directly, What
do you mean by that?' ASk e.xaclty what lhe person is threatening to dO. HtS elabOt'ation w,II
almost always be weaket than hi:S implied threat If, on lhe Olhet hand, his ex~nation of
the comment is actualy an explicit lh(eat, bettet to ieam ii now than to be uncertain latet·
(de Becker, 1997, p. 117).
Cou nsellors need to be attuned to their own fears and anxieties. Appropriate
anxiety is a due that the situation is escalating and that remroiaJ action is necessary.
De Becker (1997) argues that people have a basic intuition that teJls them when aJI is
not well, bur that they often disregard the red flags or danger. It is only in rhc aftermath

that they re.fleet and renli!e that they had suff,ciem informntion to make bener choices
but that they ignored it.
Phase 2: Defensive This is a late warning phase with dear indicators that the per-
son is about to lose control. The client may become more challenging and beJligercm
by making direct threats and pro\'Ocations. The client has become irrational and dear
warning indicators may be present, including clenching or raising of fists, rapid breath.-
ing, grasping objects to use as weapons, and showing signs of movement to,.,,.-nrd nttack
(e.g., grasping the arms of the chair and denoting that the client is about to rise and
advance) (Shea, 1998; Shea for & Horejsi, 2008).
At this point, it is crucial that counseJlors refrain from reciprocating with the same
ngg,-essive behaviour that the client is using. This requires some self-discipline, as the
counsellor's narural reaction might be to respond in kind, which onh• serves to escalate
or precipitnte \•iolence. Decreased eye contact might be nppropriate with some clients.
As well, counsellors arc wise to increase the physical distance between themseJves and
their clients since potentially violent persons ma't' have an increased need for space. Note
that physicaJ contact, hO\\rever wdl intentioned, should be nvoided. Sometimcscounsel.-
lors try to calm clients by touching the.ir shoulder~ but this is ill-advised as clients may
interpret it as aggression.
During this phase, counseJlors need to be .self-disciplined and to modeJ calmness.
\Vhen counsellors stay calm, clients arc more likely to emulate their composure. This
calmness should be rcftecto:I in their voice and manner with slow, non.-jargonistic lan-
guage Counsellors who speak caJmly and avoid any loud or authoritarian tone have a
greater chance of caJming their anxious clients. On the other hand, counsellors who
match their clients' defensiveness and anger exacerbate the situation and increase the
possibility of \tiolent retaliation. Rigid and authoritarian counsellor reactions may leave
clients feeling pressured or trappo:I.
It is essential that counsellors mnintain their own equilibrium and remain in con.-
trol. They need to develop the.ir capacity to monitor their own feelings and behaviour,
including the.ir ability to ask for hclp or to withdraw when they arc not in control. Coun.-
seJlors also need to resist any tendency to be baited by clients inro angry confrontation
or retaliation, which only escalates the crisis. Jf clients ~rce.ive that their counsellors
arc anxious and not in control, they may become more irrational.
Labig (1995) re.minds us of the importance of emotional tone. He notes that a loud
or aggressive \'Oice can quickh• precipitate retaliation, while a voice tone that is calm
and supportive inhibits violence. Simply put, a threatening environment increases the
risk of violence.
&sic communication and counselling sJcjlJs are excellent tools both for preventing vio-
lence and for dealing with clients who nre on the verge of losing control. In particular, active
listening skills communicate that counsellors nre willing to listen to and learn about clients'
wants and nttds. Counsellors should try to speak calmly and avoid any mannerisms that
clients might inte.rprct as threatening (e.g., touching a client, making a sudden movement, or
invading a client's persona.1 spoce). Encourage the client to sit and to be comfortable. Listen,
e.mpathi.!c, paraphrase, and sum.mari:e. while avoiding defensiveness. As a rule, respond
to clients in the anxiety and defensive phases with supportive and empathic. smte.n'litm:s.
However, some clients mn't' misinterpret empathy as an um\--nnted intrusion on per-
sonal privacy and react defensiveJ,.,. Counsellors should be alert to clients' reactions to
certain topics or questions. This will help counseJlors make intelligent decisions about
when it is appropriate to chaJlenge or confront, and when they should back off because
the subject is agitating the client to a dangerous level.
The Power of Compromise Violent clients often fee] disempo\\'ered and disadvan.-
ta.g:ed. \Vhe.n counsellors promote compromise, they restore some balance of power
260 Chap1er 8
in the rclntionship and show their willingness to reach n solution. Conve.rscJy, when
counsellors argue with, threaten, or ignore the needs of their client~ the clients may
become incrcasingl,., belligerent.
Compromise helps clients find a way to save face and retain the.ir dignity. While
counsellors have the responsibility to set appropriate limit~ they must not argue with,
ridicule, challenge. threaten, or unfairt,., critici:e clients. The lanauage used b\• the coun-
sellor can help establish an atmosphere of compromise and mutual problem solving-.
for example, "Let's work together to find a solution we can both live with" and "I really
do want to find a solution."
Client: (Ydling loudJ:y.) I 3m sk.k a.nd tired of ~ttin& the run3round.
Counse.Uor. (Calmf:,.) Your ::u-~er nukes it dear to me how stronaly rou feel 2bout thil. l
can see that this is a.n import:mt issue fm- )'Ou. but I wi.11 be able to work better with ,..ou
i( you St2)' calm a.nd don't threaten me. let's~ i( there·s 2nothe-r w-3y to appro-Y.h it.
Client: (Padng and ,dling.) Are rou '--oi~ l'O help me or not!
CounseU.o r: (Calmf:,.) I'm willina to work with )'Ou on the problem.
Client: (Siu and stmes lnttndJ.)
Counsello r: I understand th::u )'Ou think that thii is the best solut ion. I al.so appredate
)'Our reasonilli, but there ::are two of us here. We !"K'ed to Ond 2 solution that both of
us ea.n ln't' with.
Client: (l.At.1dl,-. but not 1dlms.) I a.in tq•i~ l'O be reason::tble!
Counsello r: Oka)', I'm liste:nina. I'd like to hea.r your ide:as.
Hocker and Wilmot (1995) identify five principles for establishing effective collabo-
ration: (I) join with the other, (2) control the proccs~ 00( the people, (3) use produc-
tive communication, (4) be firm in your goal~ flexible in your means, nnd (S) remain
optimistic about finding solutions to your conflict (p. 212). They suggest a variety of
means for ope.rntionn1i! ina the principle~ such as usina "we" language to affirm com-
mon interests, activcJy listening even when you disaarec, and persuadina rather than
coercina. As well, they emphn.si!e the importnnce of separatina the issues from the
rcJarionship and dealing: with the important items one at a time. Such a collaborative
approach requires that counseJlors remain positive, creative, and constructive. The gen-
e.ml goal must be "\Ve, working together, can solve this problem that is confronting:
us" (Hocke.r & Wilmot, 1995, p. 205). Dubovsky and \\:lcissbera (1986) underscore the
importance of promotingcollnborntion. They contend thnt the diem "protects himself
from feeling powerless, inadequate and frightened by attempting to demonstrate how
powerful and frightening he can be. His threatening: behavior increases if he feels he is
not be.ina taken seriously" (p. 262).
SUCCESS TIP
If aggressive behaviout is escalating. the safety of otherS must be a p(aorily. This might
include evacuating the waiting room, removing ot;ec1s lhat ~ t be used as weapons, and
seeking baekup from othet avatlable staff.
Setting Limits Setting and enforcina reasonable limits makes it possible for
counsellors and clients to continue ,vorking: together. Failure to set limits reinforces
actin,;-out behaviour, which if unchecked could lead to more violent and destructive
consequences. In the defensive phase, clients may still respond to appropriate limits.
Limits let clients know what will and will not be tole.rnu,.d, but counsellors need to
apply ce.rcain principles in setting limits. Counsellors should be specific and tell di•
ents which behaviour is inappropriate since they ma)' not be aw3re what is acceptable.
OiHlcull Situations: Engaging wltll Hard-10- Reae ll Clients 261

Moreover, they may 00( know how their behaviour is affecting others. Limits should
include enforceable consequences, and counsellors should state the consequences of
noncompliance.
SUCCESS TIP
um,t setting is m:::,(e effective when it is s1atoo rn a poSrtive tone Viith a payoff f0t compli-
ance, as tn lhis ex.ample: •If you stop yet.ling at me, then I wiU sat wdh you to see if we can
find a Sdution.•
Phase 3: Acting Out At this stage, the diem has lost control and has become assaul.-
tive. Protection of seJf and others is the primary goal. Jde~dly, a,;ency procOOures are
operative, 3nd counseJlors who are dealina with such situ3tions will receive immediate
assistance from the st3ff team. Police intervention 3nd restraint of the acting-out diem
may aJso be rttauircd. \\:lhen deaJing with acting-out client~ a team approach with a weJl.-
ori:ani!ed and trainOO staff is the preforr~ way to address the crisis. A team approach
provides increased safety for everyone, including the client. A wcll.-train~ team may
subdue violent clients before they injure themsclvcs or othe.rs, but staff should be
train~ in techniques for physical restraint and control. The team members provide
support and can act as witnesses if litigation should arise because of the incident.
Police Intervention Counsellors should not hesimce to call the police if a client
becomes too threatening or 3garessive. No counsellor is expected to risk his or her lifo
or endure physical assault as part of the job. Moreover, sometimes clients are unwilling
or unable to constrain che.ir hostility, 3nd police or psyc.hi3tric restraint is esscntial for
managina the crisis. Police intervention is particularly crucinJ when deaJing with clients
who have weapons. In addition, counsellors should not cry to prevent 3 client who
is determined to leave by blocking the exit. In genera], counseJlors who are assaulted
by clients should consider laying criminal charges. This establishes the importance of
clients' takina responsibility for their 3ctions.
SUCCESS TIP
Neve( t:,ock angry chents from leaving yout offa; allow a deat path f0t them 10 exit. Never
run aftet clients wtlo storm out
Never interview when )'OU arc alone in the office. Never enter a client's home when
you know the client is talking about hurting someone.
Phase 4: Tension Reduction The tension r~uction phase is characterized by a
gradual reduction in aggressive behaviour and 3 return to more rational behaviour.
The client may still be driven by adrenalin, so it is important that counsellors proceed
cautiousl't' to avoid reoctivatina aagres.sive acting out.
Follow•up Counselling Interventions Clients can be counselled to b«ome nJert to
their own warning sign~ such as "tenseness, sweating pa]ms, a ciahtening of the stom,.
adi, pressure in the chest and a surge to the head" (Morrissey, 1998, p. 6). Once clients
3re aware of che.ir own trigge.rs, they can be counselled on appropri3te diversion3ry tac.-
tics, such as employing rclax3tion techniques, talcina time out, and using assertiveness
3nd other bchaviouraJ response. alcern3tives. Morrissey ( 1998) describes a technique
that a counsellor used with a client who was on the verge of violence. The counsel,.
!or reassured the client "that he was there to help him and commended the client for
262 Chap1er 8
coming to sec him rather than acting on his feelings of rage. He also asked the client
what was keeping him in control thus far and used that as proof to reinforce the fact
that he could indeo:I control himself" (p. 6).
At the end of the tension reduction phase and after the diem has returned to nor-
mal, the client ma,., be mcntaJly and ph)•sicaJly exhausted and show signs of remorse
and shame. Con5tt1uently, counseJling can be direct~ toward helping the client use the
experience as a learningopportunit)•- forexamplc, todcvclop alternative responses for
future similar stresses. Interview 8.2 provides an example.
Counsellors arc wdl prepared to tcnc.h theirdients techniques for resolving conflict
and crises nonviolcmi)•. The skills of counselling arc also, to some extent, the skills of
effective everyday communication. Communication skill training equips clients with
more choices for asserting the.ir rights and respecting others. Assertiveness training cnn
hclp clients express feelings in a nonaggressive manner. When clients arc able to respond
assertively, they establish an atmosphere of cooperation and conflict cnn be peacefully
resolved. Often conflict is difficult for clients to settle because they arc unable to sec
the perspectives or foclings of others in the conflict. Clients who learn empathy and
other active listening skills are better able to compromise because they arc less likely to
judge their own behaviour as absolute!)• right and that of others as absolutely wrong.
Sometimes, long before \•iolence erupts, counsellors intuitively focl chat the situ-
ation is worsening. This foding ma,., be based on unconscious reactions to subde cues
and indicators. Counsellors and clients might find it useful to rry to concretely identify
these dues. Doing so will assist clients in becoming sensitive to those initial psychologi-
cal responses that signaJ the imminent onset of the anxiety phase. Clients who become
adept at rccogni!ing early warning indicators arc in a much better position to cake
early warning action, such as withdrawing from an explosive situation or switching to
healthie.r problem-solving strategies.
Critical Incident Debriefing

An organi!ation needs to have a mechanism in place for debriefing after a \'lolent or
hostile act. This enables the counseJlor to restore a sense of equilibrium. It is important
to remember that a critical or violent incident may also affect and traumatize staff who
were not direcdy involved, including clerical, janitorial, and kitchen personnel; there-
fore, they should be involved in the debriefing.
Counsellors who have been assaulted or threaten~ with assault ma)' be trauma-
ti!cd. They ma,., experience symptoms such as recurrent images or thoughts of the
event, distressing dream~ flashbacks, and intense srrcss when returning to the scene
of the incident. There may be a marked decline in their ability to handle routine work
tasks. and they may fee] detached and isolated from colleagues. They may dcvdop sJeep
difficulties and have difficulty concentrating. Frttauently, they return to work in a state
of hypervigilancc, constandyexpecting funhcr trauma. Often, they describe themselves
as "numb" and unable to enjoy activities that usually give them pleasure. Macdonald
and Sirotich (2005) review~ studies and reported that victims of client violence might
experience the following:
■ Troubled relationships (with colleagues and famil't•)
■ Reduced ability to function in the ,vorkplace
■ More absenteeism
■ Higher levels of burnout, depression, anxiety, and general irritability stemming
from threats or abuse
\Vhen symptoms such as these arc present, counsellors should consider obtaining
mcdicnl assessment or professional counselling.

)}) INTERVIEW 8.2
In the following e:x.ample, the counsellor, a g,oup hOme worker, is revi~ing an incident with her client. The incident
o«uned two hours ago and was predpi~ted when the C-Ounsellor denied the client, a 16-ye:ar-old male, permission to
meet with some of his friends later that nigtit The client threw his chair ac,os.s the room and stormed out of the office
while saeaming obscenities.
Counsellor: I'm wondering if ltlis is a good lime to talk Analysis: Whenever ,:,oss/ble. it's im,:,ortant that clfents be
abOut vd\at happened eartiet tOOay. Invited to review prior incidents.
Client: It won't happen again. can we just forget it evet
happe-ned?
counsellor: You're ~t. We need to move on. HoNevet, I
think it's im(X)rtant we bOth rake a IOOk at it to make some
~ns so it doesn't oc:cuf again. Okay?
ClleM: I guess I gol a bit carried away. Analysis : Often. violent or acting-out clients are so preoccu•
counsellor: 1was scared. pied with their own needS and fears that they don't realize
the impact they have on others. By telling the client how she
ClleM: I'm sony. I won't let ft happen again. fell, the counsello, hopes to inc,ease his capacity for empa.
counsellor: 1accept youf apol:)gy. thy. Acceptance of her client's aPology does not condone his
behaviour. as would a statement such as "lt'sok.ay. Don't worry
about it. No real harm was done."
counsellor: It mighl be helpful fof bOth of us to go ove-r Analysis: One goa.l of counsel/Ing is to help clients recognize
what happe-ned to see hON it migt\t ha\18 been prevented. their own early warning indlcatOrS that they are in danger of
losing control.
Client: I was stil upset from see-ing my mOlhef. When you
said no, it was just too much.
Counsellor: H' s never bee-n easy to, you to Ialk to your Analysis: Empathy confirms that feelings have been heard and
mom. You always seem to come back realty wound up. understood.
Clitnt: Yeah, lhOSe are- the days lhal people Should Slay Analysis: The client rationalizes his behaviour, putting the
out of my face. respons/bj//ty on others. Without directly challenging the
raUonalizatlon. the counsellor shifts the focus baek to a client
Counsellor: Good point. Sounds like you know lhal you
strength.
need some time alone when you're stfe-ssed.
Client: You got it
Counsellor: As we talk. I'm wondeting what p(evented Analysis: Feedback confrontation challenges the client
you from &aking that time. If you' d taken lhe time- to coal to consider so~ new alternatives. The counsellor takes
off befOfe approachi"lg me-. tt'li"lgs would have been a IOt advantage of an opportunity to reframe the client's problem
diffefe-nt statement Into a goal.
Client: Sure, I koow I have to le.am to control my tempe-t,

bul once- I gel gotng I just can't seem to stOI) myself.
counsellor: Put anott'le-t w.ry. yotX hope is to find a way
to deal with your feelings so that you don't get angry and
huft someone.
Client: I don't know if tnal's possible-.
counsellor: You've already shown me that you have some Analysis: Acknowledgment of the client's restraint. hov,-eve,
Sklll at doing this. You threw the chair and you said some late. ,:,rovl~s a base for further development. This recognizes
awflA lhiogs, bul afte.-ward you left lhe (OOm withOut doing the client's strengths by /JCknowledging and reinforcing nonag.
any mOl'e damage. This tell$ me lhat you have the- ability gressive behavioural altematfves.
to bring thi~ under contrOI.
Reflections:
■ How would you assess that the time is right to initiate a follow-up interview?
■ Suggest hOw anticipatory cont,acting migJ,t be used as a next step.
264 Chap1er 8
CONVERSATION 8.3
Youtti Worker: What Should a eounsetlOr' dO if assallted btf deb(t0f is an opportunity to Share lee6~ and concerns. By
a client? doing so, indjyijua~ typicaly diSCover that Olhers are affected
in similar ways and 100 powef ot group support is mobilized.
counsellor: The(e are many lypes of assaults fa~iog from
verbal lhfeats to ph)'Sical anackS causing i.njuiy. All of them Counsellor: In addition, fMJCamining the clfcumsaances of
afe frigt\teni~ and potentialty traumatic. the assaul is important. A numbef of key questions shoud be
addfesSed, including: Wefe there indicators ot an esw:.alati.ng
Youtb Worker: We Should not f0<get that any assault on a
risk of violence that were misSed? Were thefe aspects of the
counsel!Or also impacts other wor'k.ers in the agency, even
seuing's sttuctu(e Of policy that contributed to the assault?
those who wefe not pfesent during the altercation. Their psy-
Was thefe ade(luate sharing of inf0tmation within 100 agency
chOIOgjcal needs sholJd not be ignored Or' minimized. AA
(e.g,, history of viOlence, substance misuse, and non~pli-
assault on one v.()rker is a fetninclef to othets that they are
ance With psychiatri:: medications)? What ctia~am neces-
also vl.dnerable. In some cases, the assaulted worker- (or tnell
sary to pfevent further k'lck:lents? Uptoring these questions
colleagues) ate 1taumatized. Thi:S can have serious tepe-rcus-
can help the team to develop bette-r procedufes and confi-
sions fOr' lheit pe-rsonal and profe-ssional wol'k.
dence f0t handling futu(e incidents..
COuMellor: lndividualS may ex.perienice a myriad of ern::,t.ions.
Youth Worker: Since an assault increases peoples' feeli~ of
including fear, anger-, Shame, denial, contempt f0t dients, Or' vulnerability, 1t is important to monitot how it migtit affed
even guilt. All of lhem are normal; au of lhem ~d to be
relationships with othef dients. For example, individuals, Or'
processed. Poople whO wol'k in the eounselli~ field already
even the entife setting. may ovefestimate the risks posed by
know 100 be-neflt of the counselling ptocess. and they ShOuld
the entire client population. This might resl.dt in excessive
not hesitate to use counselling to deal with their own em~
procechxal rutes or struch.-al changes that impair the agen-
t.ions. To do so is a sign ot strength, 001 weakness. Oetr'ief-
cy's overau effectiveness. Counsellors must aaso be wary of
iog with a trusted cOlleague 0t supervisof 0t using emptoyee
tta!WerrW'lg uncesolved feelings to other clients.
assistance services afe possible options.
Counsellor: GOOCI point. I know o~ worker who, after an
Youtti Wor\et: A team detr'ief whefe indi\lk:lua~ are enicour-
assallt at the agency, deck:led to leave his office dOOr half-
aged to Shafe their feelings about the incident is an important
opened during intel"Views which compromised confidentiality.
way to regroup. The team deb(aef ShOuld include all person-
He alSO became very reluc&ant to addfess pote-ntiallysensilive
nel in the setting, no1 just the prolessional counsem.ng staff.
issues fearing lhat it m.igt\t arouse client anger 0t defensive-
It may be helpful to have an outside facilitator conduct the
ness. As a fesUt. many of his counsetling interviews femained
team deb(tef.
superficial With opportunities for meaningful WOr'k passed
STUDE:NT: What Should happen dufing the deb(t0f? over. foftunately, an alert supervisof intervened with sup-
portive supervision and feferfed the WOl'kef to an emptoyee
Youtb Worker: The basic goal of any counselling or team
assistance counsem~ service.
debtief is to f&-eStablish a sense of contrOI and saiety. The
Even whc:n counsc:llors are not injured, the thre3t of \•iolence can be just 3s trau-
matic. Typic3J rc:sponses may include hclplessnc:s.s 3nd thoughts of lc:aving the: profes-
sion. Thc:se fc:c:lings may devc:lop immo:li3tdy or emerge: after 3 dd3y of monrhsor c:ven
years. Consc:quc:nth•, it is important to debric:f critical incidents to lc:s.sen shock, reduce:
isolation, and restore personal control. Tc:3m debriefing should take place: as soon 3S
possible: after the: incident. Debriefing should be conducted by 3n objective third part)'
in a s3fc: setting. lt should be: hcld as soon 3S possible 3ftc:r the: critical incident, usually
within 24 to 72 hours, to minimize: the effects of any traum3 that victims or witnesses
may be e.xpc:riencing. This is important in promoting a rc:curn to the norm3J routine of
the agency. A t)tpic3l debriefing sc:s.sion is like 3 counsc:lling inte.rvic:w. The debriefing
should reinforce team inte.rdepc:ndence. Sometimc:s counsc:llors 3.rc: re1uct3nt to ask
collC3guc:s for 3ssist3ncc:, bc:lieving th3t 3slcing for heJp is a sign of incompetence. One:
goa.1 of a debriefing is to develop a staff culture in whidi. asking for heJp is understood

critical incident debriefing: A as a sign of strength rather than a weakness. A critical incident debriefini generally
tummeeling held to deius.e the ~ I has the following elements:
ol a rio!NI or tra.atic Mal sudlas
• assault on a staff meiaber. Oelwiefing I . All team members are invit~ to share feelings and reactions about the curre.nt or
assists 'Mlfkers to nonn• and deal 11ith
t h e ~ that my be amsed because
prior incidents. Active listening can be used to promote this process. This hcJps
ol the Mal. As wel. <1£,,lmfing is used indh•iduals who were threatened or assaulted to "normaJizc" their own rcac~
to ieriM and rt'nse prewa(iw, ud crisis tions. Counsellors should rttiuirc little persuasion about the benefits of talking
illefYNlica, pnndures.
about their feelings. They might be reminded that sharing foeJings is something
they routinely ask of their clients. Helping team members manage feelings is the
major objective of the debriefing. At this time, it is important to identify the
potential ph)•sical and emotionaJ reactions that staff may experience. As well,
information regarding service~ such as employee assistance programs (EAPs)
that arc available to staff who need additionaJ help to manage their emotions.
should be detailed.
2. The team conducts a post~moncm on the violent event. A thorough analysis of
what transpir~ is used to re,.•iew and reinforce procedures for dealing with \•iolem
clients. An important question for the team to consider is "\Vhat, if anything,
could we have done to prevent this incident!" For example, the team can explore
whether an)' early warning indicators of pending violence were overlooked. They
can investigate whether there were things that individuals or the agency did or did
not do that contributed to the client's behaviour.
3. The tcam debriefing is an important "tcnc.hablc moment" when staff are highly
motivated to develop their skills. Jt is a chance to explore alternative responses that
might have bttn used at all stages of the critical incident. Role-play and simulations
can be used to practise alternative responses. This step helps empo\\'er individuals,
and the tcam by moving them away from any tendency to foci hcJplcss.
COUNSELLING ANGRY AND VIOLENT CLIENTS

The obvious counselling goal is to assist these clients to develop skills and responses that
do not harm others. Safety is the top priority. \Vhile there is no single best strategy, the
follO\\•ing intervention choices c3n be tailor~ to meet the needs of individuaJ clients.
Prevention
Sometimes, long before violence erupt~ counsellors intuitively foci th:.n the situation
is worsening. This feeling may be based on unconscious reactions to subtle cues and
indicators. Counsellors and clients might find it useful to try to concretely identify these
dues. Doing so will assist clients in becoming sensitive to those initial psychologicnJ
responses that signaJ the imminent onset of the anxiery phase. Clients who become
adept at recognizing early warning indicators arc in a much better position to take
early warnina action, such as withdrawing from an explosive situation or switching to
hcaJthicr problem-solving strategics.
Assertiveness Training
Assertiwmess: AssertiYEflm inYC!hes Assertiveness involves exercising persona] rights, induding the ability to express focJ~
eiertisilc personal rights, including ings and ideas without guilt or undue anxiety, without dcnyina the riahts of others
the ability to EqftSS ~ and ii!as
Mthout "'1 or~ aaiiety. witb>ut (Shcbib, 1997). 1t rttiuircs respect and empathy for oth~r people. Assertiveness train-
den,ing the ripls ol cthen ing helps clients express feelings in a nonaggrcssivc manner. \Vhcn clients are 3blc to
respond assertively, th~y establish an atmosphere of cooperation where con6ict can be
pcac~fully resolved. lt is dcnrly distinguished from aggression, which involves the use
of po\\'er, domination, and intimidation to achieve one's goa.Js, and p3ssivity, which
266 Chap1er 8
foregoes personal rights and needs. CounseJlors can he.Ip clients develop assertive com-
munication skills such as active listening, especially empathy. Some clients know how to
respond asscnivcJy, but low seJf-estccm or fe3r inhibits them from making appropriate
assc.rtive choices. Cognitive bchaviouraJ counselling can be used to address these issues.
StTategics such as rcJa.xation training, deep breathing. and mindfulness can be used to
assist clients to deal with anxiety.
The skills of counseJling arc also, to some extent, the skills of effective cvery-
da'>' communication. This puts counsellors in a good position to tC3ch their clients
techniques for resolving conflict and crises nonviolently. Communication skill tTaining
equips clients with more choices for asserting their rights and respecting others. Often
conflict is difficult for clients to settle be.cause they arc unable to sec the perspectives
or feelings of othc.rs in the conflict. Clients who learn empathy and othc.r active listen-
ing skills arc bettc.r able to compromise because they arc less likely to judge thc.ir O\\•n
behaviour as absolutcl)• riaht and that of others as absolutely wrong.
Cognitive Behavioural Counselling (Therapy)

As discussed in Chaptc.r 7, Cognitive BchaviouraJ Therapy (CBT) hcJps clients to iden-
tify and manage unhelpful thinking patterns such as catastrophizing or blaming others.
CST can also focus on hcJping clients learn alternate behavioural choices which, when
practised, will lessen any tendency to default to the anger mode.
Anger Management
Anger is a normal emotion and the appropriate expression of ange.r can dttpen relation-
ships. Out of control anger can destroy relationships. Anger management skills include
recognizing and managing: trijlR:e.rs (e.g., avoiding problematic situations). CounseJlors
can use role playing and modeling as a Wtt)' to help clients develop alternate responses.
They can aJso teach breathing and relaxation techniques.
Substance Misuse Interventions

The use of illicit substances is strongly linked to increased \•iolencc, so intc.rvention
tari;:cting this important area is crucial. A wide range of choices include 12-step pro-
grams, residential treatment, CBT, harm reduction, rreatmem of co-occurring mental
disorders, traditional hC3ling practices, exercise, nutrition, spiritua1ity, and many other
strategics have proven effective.
Psychiatric Intervention
Psychiatric assessment can determine whether medication is wnr-rantcd. Antidepressant
or antiaru:iety medication may be useful as an adjunct to counselling. Medication alone
is not recommended.
Reduction of Stressors
Resolution of issues rcJatcd to unemployment, poveny, relationship d,•sfunction, and
housing arc important targets for intervention.
Counselling Victims
CounseJlors may be caJled upon to deal with domestic \'lolcncc where the majority of
victims arc women. A 2015 survey by the Canadian \\:1omen's Foundation provides
startling statistics that unde.rscorc the c:xtem of the problem for women in Canada~

■ Fifty percent of women over 16 report h.nving expc.ricnccd :.n IC3st one incident of
physical or sexual violence since the a,;c of 16.
■ Every six da)'S a woman in Canada is killed by hc.r intim3tc partnu
■ On 3ny given day in Canad3, more dun 3.300 W'Omcn (along with thc.ir 3,000 children)
3re fore~ to sleep in 3n emc:ri:ency shelter to esc3pc domestic violence.
■ Each year, over 40,()()() arrests result from domestic violence-that's about
12 pc.rccnt of 3JI violent c.rime in C3nada. Since onl'>' 22 percent of 31) incidents
3rc report~ to the police, the rcaJ numbc.r is much higher.
■ As of 2010, there were 582 known cases of missing or murdered Aboriginal women
in C3nada.
■ In a 2009 Can3di3n national survey, women reported 460,000 incidents of sexual
3ssault in just one )'C3.r, but only about JO percent of all scxua.1 assaults arc reported
to police.
■ More than one in ten Can3dian ,vomen SO)' they h.nvc been stalked.
When counsellors are ,vorking with ,•ictims of violence, the number one concc.rn
is to help them take steps to ensure their s3foty. Clients should be made aware of their
rights 3nd options, including use of police (phone 911), restraining orders, and tr.msi.-
tion homes. When dC31ing with pc.rprtrators of victims of spouS31 violence, counseJ,.
lors may face the ch3llcn,;c of dealing with cultural or religious ideologies that favour
p3triarch3l domin3nce 3nd control. Further, cultural norms may preclude disclosure and
the victim, fearful of judgment and shame, may suffc.r the 3buse in private. Counsellors
might explore whether there 3re culture-specific resources such as support groups or
community lea.de.rs th.nt might be of assist3ncc.
For m3ny and varied reason~ women ma'>' choose to stay in abusive relationships.
Counsellors nttd to rem3in c.mp3thic 3nd suspend any tendency to impose judgment
or to push women to leave. While counseJlors can help women understand the inherent
risks of remaining in the home, they need to support the decision to Sta)' or leave as
belonging to the W'Oman, even where this choice sec.ms to defy logic.
SUCCESS TIP
A comtn00, repeat~g pattem (cycle), often emerges in abusive (elationships. This cycle of
abuSe ot violence develOps lhrough lou(slages: (1) build-up of tension, (2) abusive incident
(Wf'bal. emotiOtlal, physical, and sexual), (3) abuse( rem0fSe, and (4) hOOeymoon pe-riOd
(when al is calm).
))}) BRAIN BYTE I Cl '.I' I : 1,: ;,,,1,

The br"ains of children who are abused (Or witness abuse) can cortisol), rearni~ deficits such as difficulty concenttating/
be profoundly affected and lead 10 a wide range of p(oblems, focusing, language acquisition, orga'-ling. loss of interest
including emotional (egulatbn (damage 10 tne amygdala, and (damage to the cortex and hippoc.ampus), sleep distu(-
cha~ in brain chenistty affecting neurottansmitterS such bances, retationShip issues, and low self-esteem (American
as epinephrine, dOpami"le, serotonin, and tne stress hOtrnooe Psychological AssoclaUon. 2015; Kendall. 2002).
268 Chap1er 8
SUMMARY
■ Resistance is a common defensive reaction thnt interferes with or delays the process
of counselling. It may be evident in a variety of ways, such as failure to cooperate
with the basic routine of counselling, subtle or direct nnacks., passivity, and non-
vc rbaJ cu cs.
■ lt is important for counsellors to evaluate their own feelings and behaviour as well
as aspects of the a~cncy that might be triggering resistance.
■ Effective confrontation heJps clients come to a different level of understanding,
behaving, or feeling.
■ Clients ma,., become violent or rhrc:.nening for 3 number of reasons. Although it
is difficult to predict with certainty which clients will become violent, some risk
factors can be isolated. The best pnxlictor of violent behaviour is a history of vio-
lence; substance abuse is also a common variable. Other factors that counsellors
should consider when assessing risk are age, gender, and pcrsonaJity characteristics.
■ Effective management of potentially violent situations includes prevention and
appropriate responses to the four phases of violence: anxiety, defensiveness, acting
our, and tension reduction. It is important to debrief critical incidents to lessen
shock, reduce isolation, and restore personaJ control. Team debriefing should take
place as soon after the incident as possible. lt should provide an opporrunity for
people ro ta1k about their feelings and to review what went wrong.
■ Counselling interventions include a focus on safety, assertiveness training. anger
mana~ement, cognitive behavioural counseJling, harm reduction, psychiatric assess-
ment and treatment, and support for victims of spousaJ abuse.
EXERCISES
Sett-Awareness a. Youth whO has ~ne problems
I. Self-evaluate your pe-rsonal comfo,1 wtlen confronting b. COiieague who has, in youf opinion, behaved in an
others. unprofessional maMer
a. What people woukl you have difficulty confronti~? c. Client whO coosiste-ntly arrives late for appointments
b. Do you avoid confronti~ 2. Evaluate the effectiveness of each of the confrontations that
c. Think of times wtle-n it was feasonable 10 confront but foltow; suggest impfovements:
you dkl.n't What prevented you from confronting? a. Try to dO bettef oex.t lime.
d. Flnish the fOUOwing sentenice: Whe-n I confront, I foot • . b. You'fe an idiot.
2. Review )'OU' extie-riences deali~ 'Mth inclMdualS wtlo are c. You'fe saying that you'fe Okay, yet you're ctyk'lg.
a~. fe-sistant, or pote-ntialy vident. What i:S youf natural d. Grow up and ac1 yout age.
reaction whe-n someone's ange-r starts to e-scarate? Oo you
e. As IOOg as you continue to act llk.e a doofmat, you'te
te-nd to fight baek? Of do you withdr'aw? What aspects of
gotng to get abused. If you'te setious at>out protecting
yout experience wiU help you deal effectively 'Mth difficllt
y0Ul'Self, le.ave hint
situations? What aspects will impede your ability?
3. Reflect on your thoughts, feelings, and behaviour wtle-n you 3. Interview counse-llOfS from diffetent settings tegafding
wer-e fOfced ot pfessured to do somethi~ against your will. their experiences with tJiolent Of JX)tentiall'j vident clients.
How might your feactioos help you to undel'Sland and wOr'k Discuss suategies that they have found effective.
with clients whO are "involuntary·? 4. Work in a small group.Assume thatyouaremembel'sof an
innet-city needle exchange centte. Devetop detailed JX>li-
Skill Practice ciies and pfocedures fOr' deaW~ with violent and JX)tenlialty
1. Wot'k with a colleague to role-play an appropriate counsellOt violent clients.
confrontation in each of the fOUOwing situations:
OiHlcull Situations: Engaging wltl'I Hard-to- Reael'I Clients 269

5. Suppose you review lhe fde on your oox.t dienl, a l&yeaf. b. He doNtlplays the serious nature of the incident.
Old male, and discovef thal he was IOUCI and abusive with c. He's stil a~ry.
his previous counsetlOr'. What are some JX)SSible ex~na-
lions tot this client's behaviour? Suggest some strategies fof 8. Wot'k with one Or' two COiieagues to practise asse-rtiver'W!lSs:
wOr'king with this clienl a. &pressing anger-
6. Work in a smatl group to exi:,ore the potential beneflls and b. Saying Moo• to a requesa
riskS ot each of the fOllowing: c. Sharing positive feelings such as IOve Of affeclion
a. Having an unlisted phone num bet d. Accepti~ a compliment
b. Making home visits alOOe e. &pressing disagreement
c. Making home visits onty when accompanied by a (Suggestion: Role play aggressive and passive responses fOr'
coueague each of the pfeceding scenarios, then discuss hON asser-
d. Conducti~ joa"lt interviews for potentiall'y hostile clients tiveness dlfet'S).
e. Using only youf fll'St name with clients 9. Conduct an ex.tended role play baSed on the fOUOwing situ-
t Knowing that a dient has a history of viole~ ation: You have just begun a new job as a youth wOr'ket in
a residential woup hOme. Yout client i:S a 14-yeat-dd bOy
r.. Interviewing a client with a police office( present
wM has been in care since he was six years old. Ouri~ that
h. Refusing to see a client with a history of tJiolence time, he has lived in ovef 17 foster ho.ines. After mooting
I. Striking a dient to defend yourself you, he says, '"Why ShOtAd I tfust you? You guys are all allk.e.
J. ca1;og the police You make all sorts ot promises, but nothi~ ever happens.
This is just a jOb fof you, but it's my life. Next month, there
k. Warn.i~ an intended victim
wil probabl'f be anOthet new wOr'kef.•
I. Seeing a client whO has been dra"lking
Concepts
7. The setting is a residential centm foe youth. Youf laSI lntet-
I. Research legal and ethtcal codes to ex.plore your
..;ew with Petet was partkl.Jarl'j distressi~. It ended wilh his
responsibility to notify intended victims of vidence. Talk to
throwing lhe Chait against the wall, swearing loudly at you,
counseltors and agencies fOr' their opinions.
and then stormi~ out of yout office, Slamming the dOOf in
the pfocess and breaki~ one of the hinges. This in.ddent 2. Write a ShOrt concept paper lhat deSO'ibes what you believe
seems to have been pfecipitated by his frusttation at not are lhe elements ot effective confrontation.
being anowed to smoke in the centre. OevelOp a ~n for 3. Hamachek (1982) says, "Oo not confront anothef person
dealing with Petet during the next lnteMew and in the com- if you do not wish to rnc,ease yolM' invdvement with that
ing months. Suggest specific leads you can use in the oox.t individuar (p. 230). DIM!lop a tationale that supports lhis
lnteMew. Considef Itvee possible scenarios: statement.
a. He di.splays remorse over- wtlat happened. 4. How can assertively ex.pressed anget deepen relations.hips?
WEBLINKS
The Crisis Prevention Institute provides information abOut train- A comp,ehensive Canadian study on mental illness and
ing programs and resou1ces fo, nonviolent crisis inf0tmation violence
https://www.er1sisprevenbon.com/Spec1a1ties1Nonvio1ent- www.phac-aspc.gc.calmh-sm/pubslmenta1_111ness/index-
Cnsis-l ntervention eng.php
Canadian Centre f01 Occupational Health and Safety provides Canadian Centre fo, Threat Assessment and Trauma Re:spoose
information about violence and violence p,evention offers information and training for responding to th,eats and
potentially violent situations
www.ccohS.caloshanswers/pS)'t'hosociaVviolence.html
http://www.cctatt.c-am
Th is ttbsite provides acc-ess and links to a wide rang_e of
health and emotional issues (use the sea1ch feature to find
material on violence).
www.mayocl1nic.com
270 Chap1er 8
sleep sports
hygiene nutrition
physical
healthca activity
C.anbedone/Shutterstock
■ Understand the nature and bf'COOth of mental illness in Canada.

■ Ex-plain the structure, use, and limitations of the Diagnosiic and Suuisrical Manual
of Menral Disarders (DSM).
■ Describe rhc characteristics of and rrearmcm for major mental disorders.,
including sc.hi:ophrenia, mood disorders. :mxicry disorders, eating disorders,
and personality disorders.
■ Explore the mcntaJ health issues of children and youth.
■ Describe rhc nnrure and impact of substance abuse.
■ Identify best-practice approaches for w-orking with clients with substance use
problems, including those with co-occurring disorders.
■ Identify suicide warning signs and strategics for dc3ling with clients who arc
suicidal.
MENTAL HEALTH IN CANADA
Attempts to treat mental illness date back thousands of years, but they were typically
inhumane and crud when judg,ed by tocfay's standnrds. Historically, trc3tmcm of poople
with mcntaJ disorders was barbaric and ineffective with practices such as exorcising,
burning "witches/' bloodletting, whipping, starving, imprisoning, or housing in over-
crowded "snake pits'' or insane asylums. During the twentieth and twenty-first centuries,
especially in the last 50 years, mental disorders have gradually been recogni:ed as health
problems. and more humanitarian practices have been dcvdopcd co rcplncc procedures
based on superstition, fear, and ignorance.
Over the past 70 years in Canada, there has bttn a major and continuous shift in
the delivery of mental health services from lonj;•tcrm treatment in hospitals to tT'C1lt.-
mcm of patients in the community, a process known as dcinstitutionalization. Today,
the population of mcntaJ hospitals in Canada is only a smaJI fraction of what it was
40 years ago (Scaly & 'W hitehead, 2004) and some, such as Riverview HospitaJ in
Coquidam, British Columbia, which once hou~ thousands of patients, are virrually
dosed. However, there arc some proposals to reopen abandoned facilities based on
modeJs of treatmem different from the traditional "wnrchousing" methods of the past.
The development nnd refinement of a ran,;c of psychotropic drugs has been the driving
force behind deinstirutionali!ation because these drugs enable patients to control hnJ,.
lucinations and behaviour that might otherwise preclude their living in the community.
However, this move toward community treatment has often been poorly funded, nnd
new problems for those with mental disorders have resulted, particularly homelessness
(Davis, 2006). Dcinstitutionalization in Canada left many people with mental illness in
communities with in:.ldcquate tre3tmcnt. suppon, and outreach. \\:rhile no one would
argue for a return to the ''\\--nrchouscs" of the nineteenth and earl)• twentieth centuries,
it is clear that many people dischar,;cd from rhc mental hospitals are now living in dire
conditions, often in poverty-stricken inner cities such ns the Downtown Eastside in
Vancouver. Table 9. 1 outlines some facts about mental health in Canadn. The Mental
Health Commission of Canada (2012) proposed an overhaul of the mental health system
that called for broad changes, including the promotion of mental health throughout life,
suicide prevention, support of recovery through use of optimum integrated services,
removal of S)'Stemic barriers to worlc and education, and the strengthening of services
to Northerners. First Nations, and Jnuit peoples.
Mental Health Assessment

The purpose of psychiatric diagnosis is 00( to label clients but to match dingnosis to
treatment decisions based on the best scientific evidence regarding which rreanncnts are
likely to be most effective with each disorder (Corcoran & \\:lnlsh, 2009). Psychiatric
assessment and dingnosis involves (idea.Hy) an in-depth interview, including a thorough
history of the person's situation. Physical examinntions, including brain scans, electro-
encephalograms (EEGs), and lab tests, mny be u~ to rule our O'l'J:anic illness, which can
cause psychiatric symptoms. Psychological tests mny be u~ to nsscss thinking, person.-
aliry, and other variables. ln nddition, families and friends are an important source of
information, particularly when clients arc denying the presence of psychiarric symptoms.
Psrchintric diagnosis is influenced by cultural and societal values. For example, at
various times in history, homosexuality has been considered both an aberration and a
gift. Jt is no longe.r considered a mental disorder.
There may be vast differences among individunls with the same mental disorder.
Psychological, social, and b iological variables in8uencc how illness manifests in each
272 Chap1er 9
TABLE 9.1 Mental Health, Canadi an Fac ts
• One in frve C3nadians ot au educatbnal backgroundS, income tievets. and cultures will
experience a menial illness or subsiance mis.use problem duri~ their lifetime-.
• Most mental itlnesses begin in adOlescence and young adulthood.
• Mental itlness arises from a complex k\tetaetioo of biologk.31. genetic, persooaffly, and
e-nvitonmental factors.
• Social ar\CI wOl'kptace pressures, poverty, subsiance abuse, and learned behaviow'al and
lhinking patterns can inftuence 100 onset and outcome of mental illness.
• Studies have Shawn that at least 23 percent and as many as 67 percent ot homeless
people have a mental l lness..
• During any ooo-yeat period:
• Over 8 pefcent ot the canae1ian population expedence a mooo diwdet
• 0.3 percent ex.pe-rience sct.zophrenia
• 12 percent experience an anxiety diSOr'det
• AltOOSt 2.5 percent expe(aeoce an eating disotder
• One in ten people ex.petience some disability from a diagnosable mental disorder.
• In canae1a duri~ 2001- 2002, tnere were almost 200, 000 psychiatric hOspital admissions
with an average stay of 43 days--over 8 mtlion patient days.
• MOr'e hospital beds in canada (8 percen0 are tl\Jed with persoos with schiZoph(enia than
with any Olher condition.
• Mental itlness costs the healthcare system as much as $7 biltbn, while the annual total
impacl of mental heafth (healttk::a(e, lost prOductMty) exceeds $51 billion.
• As many as one--thir'd of the homeless have a mental disorder.
• App(oxlI1'13tety 1 percent of canae1ians wi\J ex.pel'ience bipolar disotde(.
• At least 2 percent of au deattrs are from suidde.
• Personality di:sol"ders affect between 6 percent and 9 percent (estimated) of the C3nadian
population.
• Suicide accounts for 24 pe(cent of au deaths among tnose 1S to 24 years of age and
16 percent among 1oose aged 25 to 44 years.
• Psychiatric ptoblems are the second leading cause of hospital admissions among 1oose
20 to 44 years (j(I.
• Most mental itlness can be 1reated.
• Best-practice intervention favours t(eatment in the community using a variety of
counselling inter-ve-ntions, occupational therapy, and medication.
Sources.- British CotufT't>ia Schizophrenia Society. 2008: Centre Jot Addiction and Mental Health. 2017:
Corcoran & Walsh. 2009: [>a,.,is. 2006: Go.<emment oi Canada. 2017a: Heatth Canada. 2002a: NIMH.
2012: Public Heatth Pf,,ett:y oi Canada. 2002: Regen( & Glancy. 2010: and Siatistics Canada. 2005.
person . In addition, people with mentaJ d isorders ma)' have con cur rent p roble ms, such
as poverty, su bstance ab u se, a nd social or reJationship d iffic ulties. A co-occ urring
diso rder is p resent when a person has both a substance abuse problem o r addictio n and
a psyc.hiarric d iso rder.
Psychiatric d iagnosis is made by a physician, prcfcrab l)• a psych iatrist, o r a psrchol-
o gist who is train~ in clinical assessm ent. Some jurisdictions aJlow social ,vo rke rs who
have co mp le ted considerab le training and supervised experience to make a diagnosis.
Everyone who wo rks in the field should be aJert to sians and S)'mpto ms that warrant
a referral fo r medical and psychiatric assessment. Significant warning signs include:
hallucinations, delusions., identity confu sion , m em ory loss, parano ia, inapp ropr iate
anxiety, eupho ria or sadness, mood swings, eating a nd bod,., image problems. o bses.-
sions and co mpulsion s., self~harm (e.g., c utting), and substance misu se.
Menial Disorders and Substance Misuse 2·73

SUCCESS TIP
Unless you have specific training, avcid lhe temptation to diagnose me-nt.al iUness. Le.am
to (ecognize the ge-ne<al symptoms and signs of me-ntal disorde-rs such as psychOstS
(hatluclflations and delusions), uncootrOllable- emotions (anxiety aoo depression), and
disturbances in thinking. Then make appropraate ,eterrals, support treatment, aoo promote
tnedication cotnplian::::e.
The Diagnostic and Statistical Manual

of Mental Disorders (DSM)
The DiagnoSLic and Statistical Manual of Mental Di$0Tders (DSM), published by the
American Psychiatric As.soci3tion, is used by ps,.·chologists, psychiatrists, 3nd other
psychotherapists throughout the United States, Cannda, and many other countries to
Diagnostic and Statistical Manual classify and diagnose mcnta.1 disorders. DSM docs not include guidance or information
of Mental Oisorders: Publisiled by on treatment. In Europe and some other countries, the International Classification of
the American Pi)(.hiatric As.sociat._i
Oiscascs-10 (IC0- 10) is used. The first edition, known as DSM-1, was published in
"°
is uv.d ps,t.hct>gists. Pi)(.hiatrists,
•d Oiher psyddllerapiUi todassify and 1952, and it was lar,;ely based on psycho3na.l'tttic principles. DSM-I listed 106 diagnoses
lia:gnose aEGtal disorden. and with cnch subsequent revision, the number increased to the current number of
almost 300.
With the publication of the third edition in 1980, psychoannhttic theory was aban.-
doncd in favour of a system b3scd on diagnostic criteria. The criteria were rcsc3rched
and developed to help increase rdiabilit)•- the prob3bility that different clinicians
would assess a client with the same diagnostic result or conclusion regarding a person's
mental disorder.
DSM-Ill and DSM-IV used a multiaxinJ S\'Stcm (five axes) to facilitate a more
comprehensive assessment.
■ Axis I and II: to classify clinicaJ disorders, with Axis JI reserved for pcrsonn1ity
disorders and mental retardation
■ Axis lll: to rcpon relc..,ant medic:.ll conditions such as hypothyroidism (which can
cause depression) that affect a mental disorder
■ Axis IV: to report significant strcs.sors such as job and housing problems that miRht
be concributina to the mcntaJ disorder
■ Axis V: Cjlobal Assessment of Functioning Srnle (GAF): used to score on a scale
of 0-100 an individunJ's highest level of functionina in three major are3s: socinJ
functionina, occup3tional functioning:, and psychological functionina. Predictably,
people who have a higher level of functioning before their illness ,;cnemllydo better
than those with a lower level (Saddoclc & Saddock, 2004).
DSM-5 DSM-5, the latest edition, was published in late sprina, 2014. lt contains a
number of sianificant changes including: the followina:
I. The traditionnJ Roman numeral has been dropped and subsequent revisions will be
identified as DSM-5. 1, DSM-5.2, and so on.
2. The multiaxial S)'Stcm introduced in DSM-HI has been eliminated, and all disorders
arc now classified in a single section with 22 chapters.
3. Chapters are ori:ani!cd with a lifosp3n approach, beginning with disorders that are
most likdy diagnosed in childhood.
4. Aspcrae.r's S)rndromc has been eliminated.
274 Chap1er 9
5. Revised model for classifying substance use disorders. which also includes the
addition o f g3mbling disorder
6. New disorders: hoarding and disruptive mood dysregulation
7. The archaic term "mental retardation" has been rep laced by inteJlecrual disability
and intcllecrual developmental d isorder
Appropriate Uses of the DSM The over view in this chapter is a b rief introduction
to the basic structure of the manual. Counsellors should use the DSM classification
S)'Stcm as a diagnostic tool onh• if they have appropriate specialized clinical train-
ing. Typically, ind ividmds who use the DSM in the.ir cou nselling p ractice are licensed
psychiatrists or those with grnduate degrees in counselling or psychology. Unrrained
practitioners should not attcmJX to make ps,.·chiatric diagnoses.
Ho\\'ever, all counsellors should have a thorough knO\\•ledge of mental disorders
and the.ir effect on individuals and fam ilies. At the ver y least, they should be able to
recogni!c behavioural, cmotionaJ, and cognitive difficulties that suggest the need for
further assessment (sec Figure 9. 1). The DSM contains valuable information rcg3rd ing
variations in culture, age, and ,;ender with respect to particular mental disorders. The
manual also provides counsellors with refcre.nce materiaJ on the prevalence of mental
disorder~ including lifetime ris k, the typical patterns o f disorders, and data on the
frequency of specified d isorders among biological famil y members.
- -
Warning
Signs
-
Figure 9.1 Signs of a Potential Mental Disorder
CAUTION: The presence of one 0t f1'IOfe oi these warni "1 signs does not mean lhe i ndividual has a
men1a1 disorder: however. 1hey may signal the need for a professional assessment to assess medical or
psychiatric illness.

Definition of a Mental Disorder DSM-5 de.fines a mental disorder 3s follows:
A mental dison:le-r is a S)'ndrome eh3r:v!ted:ed by dmic::alJy si¥ni0eant disturb.In« in
::an individu::al's COitJ1it.On. emotion r~ufatk>n. or behavior th::n refleets. 2 dys.(unetion
in the psyeho1otie3I, bio1otie3I, or de"eloprnent2I process.es underl)' int ment21
(unetionh-)¥. MentaJ disorders. ::are us.uaJI)' assoc:i::ated with si~nil"tet.nt dist ress in sociaJ.
occupational. o r other import::ant 2ctivities. An expec12ble or euhur:1111)' ::approved
response 10 a oommon strdSOror loss. such 3S the de:ith o( 2 IO\wl one. ii not 2 mentaJ
disorder. Soefallr ckvi2nt behavior (e.~. politkal. reli&iOu!l. o r seicwil) and conflicts. that
::are prim::ml)' beh'i~n the individuaJ 2nd soeti'l)' 2rt not ment::al dison:lers unless the
deviance or conflict results (ron, 2 dys-fo~1on in the individuaJ. 2s. described 2bcn-e
(Amerk::an Ps.yehi::atrie Assod::at ion, 2013. p.20).
Unlike medic:)) disorders. sueh 2s.di::abete!l. there2re oode:ar fab1ests th3t helpdinki:ms
10 di2~nose 111ent11I disorders. Consequentlr, 111en121 health dinK"fans. must rely on
DSM~5 criteria 2nd their jud~rnent 1odeterrnine i( the DSM threshold for 2 mental dis-
order has been re::.ched-"siil)if'leant distress. in soei.31, oee-upahon31. or other important
::.etwities.. (Amerlean PsrehiatrK" Assodat.On. 2013, p.20).
T he.re can be significnnt diffe.rcnces among individu:.ds with the s:.un,e diagnosis. One
person with schizophrenia may suffer debilitating effects 3nd his o r her bch3viour may
present as bizarre. but 3nother m3y respond to medic3tion to the point where he o r she
functions "norma.11)•, " with no one suspectina that this per son h3s a mentaJ disorder. In
addition to the severity o( the disorder, other foctors. such 3S age of onset. presence o(
social support~ 3Vail3bility of treatment, 3nd willingness to follow rreatmem regimes,
affect how weJI people cope.
SUCCESS TIP
Everyone can have intense emot.ions and lhOughts when dealing with stress. These reactions
sholld not be confused with a mental disor'der. A diagt'losis of a mental diSOr'det can only
be justified when lheSe reacti:)ns happe-n over an extended pe(tOCI, and there is significant
impairment ot a perSOO's ability to function in daily life.
Critique of the DSM~S Even before it w3s published, OSM-5 3ttractcd a high level
o ( criticism. Among the most voC3l was Dr. Allen France~ author o ( Sm.,ing Normal:
An Insider's Relolr Agai1m Our..-of-Comrol Psychiatric Diagnosis, DSM-5. Big Pharma. and
rhe Medicalizarion of Ordinary Life. Frances, ch3ir of the task force that compiled DSM
IV argued th3t the new DSM-5 will "IC3d to massive overdiaanosis and harmful ovcr-
mcdic3tion" with n ew or sharply revised mental d isorders such 3S disruptive mood
dysregulation disorder, medicali!ing normal arid, minor neurocognitive disord er. and
m3ny others.
T he DSM, however, usdul as 3 tool for intcllcctu311)• understanding mental disor-
de.rs, is based on the medical model of diaanosis with an emph3sis on symptoms and
p3thology. Cou nscllina is p rimarily concerned with individua.Js in a soci3l conre.xt, with
an emphasis on hcJping them to deal with re lationship problems, crisis events, difficul.-
ties rcJatcd to in3dequate resource~ and problems dealing with ori:ani!ations such 3S
schools or government wclforeoffaces. Effective co u nsellors 3dopt a strenarhs 3pprooch
to problem solving that 3ssumcs the powero( individua.Js to overcome adve.rsit)'. With a
strengths perspective, they emphasi:e "human resilience-the skills. abilities, knowledge,
and insight that people accumul3teover time as they srruggle to sur mount 3dversity and
mttt lifo ch3Jlenges" (Corco r3n & Walsh, 2009, p. 10). They endeavour to find and
respect the successes, 3ssets, and resources o ( people, indudina those resources avail.-
able within their culture such 3s swe3t lodges and other hcaJina ritua.Js. \\:fhiJe Compton
276 Chap1er 9
and Galaway (2004) rccogni!e the advantages of the DSM in terms of its wide use and
common language for professionals, they also uri;e caution, re.minding us that:
■ Many phenomena included as mentaJ disorders are more usefully explained in

social, economic, or environmental terms.
■ Psychiatric labels often IC1ld co lifetime stigmnti.!ation.
■ Diagnostic reliability re.mains suspect (p. 196).
Lloyd SOOe.rer, medical dir«cor of the New York State Office of MentaJ Hea1th
offers this succinct comment on the value of the controversia.J DSM:
A di.:1KJ10stie m.:m~I of men1:il disordeTS eannot be eluded. Clink':ians need spec1(k· ways
of dedarin¥ what the)' obse-n'i' co be one oondit1on or~mother so che)'C2n spe::ak t'O eaeh
other 2nd t'O p3tients and fanulies. Rese::trehers need reliable db¥ooses co stud)' whether
t re::ttments work, and the course- and proauosi.s of diseases (Sederer. 2012.)
SUCCESS TIP
Most practitioners as well as people wrth mental diSOfderS and theif families wfl find mud'I
more useful and use-r-friendly infotmation on psychiatrk:: illness thtough organizations sud'I
as the C3nadi:an Mental Health Association (d'lma.ca) 0t lhe canae1aan Cen1re f0t Addiction
and Mental Health (carm.ca) than lhey Viill from the DSM. Both sites pfovide compfehen.
SNe information and ad\lice on specific iUness, medications, tfeatment and supPQC'I fof
fecovery, not jusa tfeatment of symptoms.
Structure of the DSM DSM-5 organi:es mental disorders under 20 major chapters
with each diagnostic class funher subdivided into specific disorders (APA, 2013). The
chnpters arc organized based on a developmental lifespan, starting with disorders first
diagnosed in childhood, then progressing to adult disorders. Table 9 .2 provides an
overview of the structure.
Major Mental Disorders

This section provides only a very brief synopsis of some of the most common mental
disorders that counsellors are like1)• to e.ncounte.r, including sc.hizophrcnin, mood
disorders. anxiety disorders, eating disorders, and personality disorders.
Schizophrenia According to the Schizophrenia Society of Canada (2009), schizophrenia: Athronic Mft1al
schitophrenia is a chronic (continuing) mental disorder affecting about I pe.rcent of the disorder i11rot-..., s,'llft.aas std as
hallucilations.. delusioa, discwdefed
population. ln rare case~ children can develop schi:ophrenia, but it usuaJly sta.rts in the t!lillling. and social isciblion.
late teens or early Ntenties for men, and in d"K" twenties and Cl.rl)• thirties for women.
Although the exact cause remains unknown, it is bdievcd that the disease is a biochemical
brain disorder involving suspect neurotransmine.rs sud,, as dopamine and serotonin. The
children of a pGrent who has schi:ophrenia are IO times more likcly to dcvdop the disor-
de.r compared to children of a parent who does not have it (NationaJ Institute of Mental
Health [NIMH), 2012). Schi.!ophrenia is a chronic, lifdong illness with no cure: 00\,·evcr, it
can be treated, and most people are able to rccovc.r and continue with their lives. Nevenhc-
less, an estimated one of every ten people with the illness dies by suicide (NIMH, 2012).
Contrary to popular opinion, people with sc.hi:ophrenia do not have split personaJj,.
tics, like Dr. Jekyll and Mr. Hyde. Furthermore, although some once accepted it as truth,
parents do not cause sc.hi:ophrcnia➔ The current perspective on the disorder is that it
is caused by an imbalance of the complex, inte.rrcJat~ chemical systems of the brain
(NIMH, 2012), but the.re may be no single cause. The symptoms of schizophrenia wry
among individual~ sometimes dramaticaJI)•. The s~mptoms arc commonly classified as

TABLE 9.2 DSM-5 Structure
M•JO< c.te&OIJ Specific DJsorde.-s Under Thb Cateaory
Neu(Odevelopmental disotderS • lntetlectual; communication; autism spec1rum; attantion deflcil/hyperacrivily; learning;
motor
SchizOl')htenia spectrum and other • SchiZotypal per'SOOatity, delusional; bl'ief psychotk; subStanc&-incluOOCI psychotic;
psychork:: disorders catatonic; schizophreniform; schizoaffeclive
Bipola( and related disorde-rs • Bipolar I; bipolar II; cyctothymic; subslance induced bipolar
Depressive disorders: • Disruptive mood CfySregulation disol"dEr; major' depressive disorder; persistent
depressive diSOr'det (dysthymic) pramenstrual dySphoric diSOr'det; subslance/
meclkation◄nduced depressive diSOr'der
Anxiety disorders: • Separation anxiety; selective mutis.m; specific phobia; social anxiety; panic;
ago,aphobia; generali?ed anxiety; subStance induced
Obsessive-compulsive and (elated • ObsessmKompulsi\18; txxly dySmorphic; hoarding; hair putling (trichotillomania);
disorders excoriatiOl'Vs.Jdn picking. subslaoce induced
Ttauma and stresw-related • Reactive atiachment: disinhibitecl social e~etnent; post-traumatic stress.; acute
disorders stress disorder; adjustment
Dissociative diwde<s • Dissociative identity; dissociative amnesia deper'SOOali:zation/dereali?.ation
Somatic symptom diwders • Somatic symptom; illness anxiety; corwersion: psychOlogical factors affecti~ medical
conditions; factitious
F'eeding and eating disorderS • Pie.a; rumination; avoidant restrictive fOOO intake; anorexia oorvosa; bulimia oervosa;
binge eating
Elimtnation di!.orde-rs • Enuresis. eOCOl')resis
Sleep.-wake disorders: • Insomnia; hyper'SOtnnolence; narcOlepsy; sleep apnea; central steep apnea; Sleep.
related hyi::x,ventilation; circadian rhythm sleep wake; diSOr'det of arousal; nightmare;
rapid eye movement sleep behaviour; restiess leg; subStance induced
Sexual dySfunctions • Delayed ejaculation; erectile; female orgasmic: female sexual intetest/arousal disorder;
genil~petvic pain penetration disotder; male hypoactive sex.ual desire; premature
ejaculation; substance induced
Gender dysphoria • Gencl« dySph0tia in children; gendet dysphOr"aa in acldescents or adults
Disruptive, impulse controt, and • Oppositional defiant; inte<mittent ex.ptosive: conduct; antisocial perSOnality disorder:
conduc1 disorders: P}'l'omania; kleptomania
Subs1aoce use and addktive • Akxlhol: caffeine; cannabis; hallucinogen; k'lhalant: opioid; Sedative hypnotic;
disorders stimulant: tobacco; unk.no-,m subStance; gambling
Neurocognilive di:sol"ders • Oefirium; mild & ma;or neurocogoitive (e.g., Alzheimer"s, vascular oeurocognilive,
traumatic brain injury, due to HIV infection)
PerSOOality disorders: • Paranoid; schi:zoid: Sd'li:zotypal; antisodaf; bOr'dertine; histtionic: narcissistic; avoidant;
dependent; o~ompursi\18
Paraphilk disorders: • Voye-uristic; exhibitioni:stic; frotte-uristi::::; sexual masochism; sexual sadism; pedaphillk;
fetishistic
Condit.ions kit furthet Sludy • Attenuated psychosis syndrome; depmssive episodes with short~uration hy(X)mania;
(further research encouraged with perSistent complex bereavement; caffeine use disotder; Internet gambti~ disorde1;
poss.ibil~y of i~lusion in future OOIXObehavioural disorder associated with prenatal ale:OhOI ex(X)sure; non-suicidal self-
editions ol DSM) injury; suicidal behaviour
Soorce: Based on Diagnostic and Statisaic-al Manual of Mental Oiscrdets (OSM-S-), American Psychiatric AssociatKIO
positiw, symptoms: S>,9rptoms ol positive o r negative. Positive symptoms may include hallucinntions, delusions., bizarre
ps,t.hosis that incWe hal!l:inatioa,
behaviour, agitation, thought disorder, disorpni:ed speech and behaviour, and catatonic
delusioa, biiarre bdt,lriout, agitati>n,
thought disorder, dis«ganind sp«th behaviour. Ncaative symptoms include blunted or flattened affect, poverty of speech,
•d bebtiour, and cata;oai:: behariour. emotional and social withdrawal, lack of plC3sure (anhedonia), passivity, difficulty in
(See also nega!Ne sy,tt¢Mt1J abstract thinking, and lad, of ,;oaJ.-dirccted behaviour (Ralph, 2003). Antipsyc.hotic
medications (neuroleptics) are the most effoctive way of tre3ting the positive symptoms
of sc.hi:ophrenia➔
278 Chap1er 9
There arc a wide variety of early warning sians of schizophrenia, indudina negative symptoms: s.,np,oas
noticeable sociaJ withdraw-a.I, deteriorating persona] hygiene, irrational behaviour, s1ttp d ps,chosis tu include blunted c:r
Hattened afP.Ct. pc,.,e,tyof speech,
disturbancc5i. extreme rcaction5i. inappropriate laughter, cuttina or strange use of words., emotilnal ud social 'lliihdn111al, lack of
and many others (for a more complete list, sec British Columbia Schi:ophrcnia Society, plei.suf! (anhedonia). passivity. drlficu.,
2008, p. 6). in abstract Hilling. -.:I Del ol g_oal•
direaEd bebl'iour. l'See also positive
S]1Q,Ot(IIIS.)
SUCCESS TIP
Psychotropi::: medication, wtlete warranted, is only the firSt step in treatment Aftet medi-
cation, counsetlOt'S play a key role tn assist~g clients to manage the negative symptoms
of Sd'li:zophrenia and othet mental disotderS. This is crucial since negative syrnptOO'ls can
be far more dt$1'uptive for people with mental diSOtderS and lheir families than positive
symproms.. Counsenors can also educate families abOut oogative symptoms, which Viill help
them 10 reali:ze lhat these ate symptoms of the disotder, not the resun of lack ot wYlpower.
(Velllgan & Pips, 2008).
Hallucinations There arc wide variations in the symptoms of persons with schi:o -
phrcnia➔ Most sufferers, however, experience hallucinations, usually auditory but hallucination: Afals.e • distor;ed
sometimes visuaJ or olfactory (related to smcJI). These hallucinations ma'>' be \'oices senso,y pattplion std as Ilea,.,_
~ tasi.i, to~ or s.lling_
that tell clients what to do (command hallucinations), or they may be \'lsions of things what otks do not
that do not exist. Persons with command hallucinations telling them to harm them-
selves or others are dangerous risks for suicide, homicide, or other violent behaviour c:onvnand hallucination: Adistor;ed
peaptioo of voi::es-.:J iaa,es dir..ct-,
(Soddock & Soddock. 2004). aae to perfcm some a«ion (e.g., attack or
Hallucinations can affect any of a person's senses, causing them to hear, see, taste, ijtsa.eone).
touch, or smell what others do not. Auditory hallucinations arc the most frequent type
of haJlucination and arc most common for people with schi!ophrenia (60-90%) (Clark,
2015; Fauman, 2002). VisuaJ hallucinations arc much less common, and they are more
likely to occur as a result of acute infectious disease. Olfactory haJlucinations may
occur because of schi:ophrcnia and oraanic lesions in the brain. Tactile hallucinations
(touch) ma'>' occur as a reaction to drugs. Kinesthetic hallucinations may occur after the
loss of a limb ("phantom limb") and O\\•ing to schi zophrenia➔ 'Withdrawal from drugs
may cause vivid hallucination5i. such as the sensation that insects are crawling under the
skin (delirium tremens, common with alcohol withdrawnJ; Saddodc & Saddodc, 2004).
In fact, the symptoms of alcohol withdrawaJ may be clinically indistinguishable from
schi:ophrcnia (NIMH, 2012). \\:lith disordc.rs such as schi.!ophrenia, people may have
auditory hallucinations with voices that arc complimentary, but more often the \'oices
are hostile (Shea, 1998). These \'oices may be so re3f that clients bcJievc that they have
had broadcasting devices planted in their bodies. For example, one client was convinced
that her demist had secretly implanted "radio receivers" in hc.r dcntaJ fillings. Jc w·as so
rca1 to her that she could not dismiss it as imagination.
lt is important to know that many things can cause hallucinations, including
psrchosi~ high fever, mind-a1tering drugs (marijuana, psilocybin, LSD, and opium),
medication5i. withdrawal from depressant drugs such as akohol, brain disease and injury,
epilepsy, sensory deprivation or sensory ovc.rlo3d, oxrgcn deprivation, hyperventila,
tion, hypoglrcc.mia. extreme pain, e>..'tended fasting, dehydration, and social isolation
(Bcrerstein, 1998: Regehr & Glancy, 201 O; S3ddock & Saddodc. 2004). Hallucinations
can also occur in persons who have impaired vision but no mental disorder.
Delusions Delusions are false beliefs that "cannot be influenced or corrected by rea, delusion: Oist«tEdbeiefsort~
son or contradictory evidence (Fauman, 2002, p. 149). Persons with sc.hi:ophrcnia may pat.'lerns t!l.it c..nct be thallengEd by
«hen • sint ruson • "'idelltf.
experience delusions or distorted beliefs involving birnrre thought patterns. OcJusions
of persecution, t)tpical in paranoid sc.hi:ophrenia, may lead people to believe they are

be.ina chC3ted, controlled, o r poisoned. Other common deJusions indude reliaious
delusions (bclief th3t one is a m3nifost3tion of God), deJusions of grandeur (bizarre
thought broadcasting: The
beliefs about one's 3b ilities), deJusions of being controlled (e.a., belief that one is being:
delusiod baie-f that aae's thinking caa d irected b\• radio mcs.s3gcs), thought broadcasting (belief that one's thinking: can be
be heard t,, cthen. hC3rd b\• others), 3nd thouJ:ht in....ertion (beJief th3t thoughts are being inserted into
one's brain by others). Not all deJusions arc bizarre. Ex3mplcs of non-bizarre delusions
thought insertion: ne delusi:inal
belief that thoughts are being inS!fted are the client's belief that he or she is being watched or that 3 famou s person loves the
il:o• 's brain t,,othffs. client (erotom3ni3) (F3um3n, 2002; Saddock & Saddodc, 2004).
Disordered Thinking Another common feature of sc.hi:ophrenia is disordered think.-
ing. Jndividuals may be unable to think logically, o r they may jump from one idea to
another without any apparent logic3l connection. Thinking ma'>' be so disorganized and
fraamented that it is tota.11'>' confusina to others.
Social Isolation Persons with schi:ophrenia arc often socially isolated and withdrawn.
They may be emotionally numb, have poor communication skills, 3nd show decreased
motivation 3nd 3b ility for self-care.
Treatment of Schizophrenia Hospitali!3tion may be 3 ncccss3ry first step in the effcc..
tive treatment of 3Cute psychotic symptoms, p3rticularh• if there is a risk of violence
(R3lph, 2003). Antipsyc.hotic medications such 3S clozapine and risperidone are used
to decrease the positive symptoms of the disorder- h3llucinations, aaitation, confu-
sion, distortions, and delusions. There is no cure for schizophrenia, but long-term d rug
m3intcnance now en3bles most people with the disC3sc: to live outside 3 psychiatric
institution.
Counselling is an import3nt adjunct to antipsychotic medication. Counsdlors rypi.-
cally target their 3ctivitics at helping clients d eal with the socinJ aspects of the disease.
As well, counsdlo rs c3n be instrumental in encouraging clients to sedc psychiatric atten-
tion when necessary, and they c.nn suppon psychiatric initiatives by cncouragina clients
to continue with any prescribed medic3tion. This is crucinJ since about 50 percent of
people with schizophrcnfa are noncompliant in mkina their mediation 3nd for those wirh
co-occurrina disorders., medic3tion noncompliance is more common than not (Substance
Abuse 3nd Mental Health Services Administration, 2008). l ong-actina (one to six weeks)
antipsychotic medication is an option for those who have difficult)' (R31ph, 2003).
One client, a young university stu dent, jpvcs us a sense o f what the world of a
person with schizophrenia is like:
I want t'O sue 11\)' dent ist. O\'er the pr3st year. he has been installu)¥ r:1d10 t ransrniuers in
ll1Ji1l{tS. Now he uses them to rontrol me. A t Ar-St, he was nke. and then her.aped me
11\)'
wlule he ..vork.ed on 11\)' tee-th. Sometimes he makes me sl~p with eomplete str.1.ns;er!l.
I( I don' t ~-et them remo"~ soon. I misht be forced t'O do son~hin~ awful. There are
others. I talked to a woman on the phone the otllt-rday. Her dentist d,d the s::une thin&-
\Ve ne«I to~-<> undef¥round where Yi't, ea.n be sa(e from the e:nemr.
depr-ession: P«v1.Siw de-fbtica in
aood dufatteriz!d by S)mptoms std as
sadness. hope-lmness. dec1uS!d enera, Mood Disorders The two most severe mood disorders (3Jso known as 3ffcctive
• d diffiOlty CC1Ceatr~ nmeatering, d isorder s) arc major depression 3nd bipolar disorder, o r manic-depressive illness.
• d ma-,: Meisi>ns.
Depression About 8 percent o f Canadians will deaJ with depression 3t some point in
bipolar disorder: A aooi disorder their lives; however, it is diagnosed twice as often 3mong women, who m3y be more
characteriied by alternatilc pericds al
vulnerable to it or they m3y be more likeJ,., to seek treatment (Davis, 2006). Although
depressi>n and a.tmally hEigltt.enEd
aood. sometimes to tbe pciill of ever yone has bad day~ the depressed foding:s usually pass q uickly. A clinic.nl d i3gnosis
i,andi>siy. , , . Mith bipctar diticwder o f depression is made when a person's depressed mood becomes pcn'3sive over time
auy t>euve irrati)nallyte.g..!(ini on and interferes with the person's ability to cope with or enjoy life. In this way, depres-
.aintdled bu,-i sprees. committing
seiual indisueioa, and talilg part in sion is differcntinted from the normal mood swings th3t ever yone experiences. Dep res-
foolish businen iMstmeats). sion is almost certainly more widespread th3n statistics suggest since it often goes
280 Chap1er 9
_ CONVERSATION 9.1
STUDE:NT: What is pafanoia? genetics. stress. laek ot sleep, hi~ fevef, side effedS of medi-
cation, street drugs. and medical conditions such as st(Okes
MENTAL HEALTH WORKER: Paranoia is a very common type
can all conttibute to paranoia. Paranoia rS also a common
of delusion that involves faase Of lflc!ltional beliefs 1riat others
symptom in many mental diSO<ders includi~ dementia,
afe intant on caus~g one harm. A certain level of suspicion
schiZOl)hfenia, par'anoid personality drSO<der, and moOCI
is normal and desirable as it ptotects us fratn venturi~ into
disorders such as depression and tipolar disorder.
dangetous situations and from othets taking advantage ot us.
Ho-NENet, i.ndividualS with pamnoia jl«Sist in lhell mistrust of ST\JOENT: How do you treat it?
olhefS, even when evidence to the conttary is ptesented.
M£NTAL HEALnt WORKER: Medications and counselling can
They are hypervigilant, and they ate obsessed abOut the
be effective, but often people afe unwd\i~ to seek treatment
hidden motives of others. Typically, lheit interactions With
beeause they do not believe they have a problem. M0teovef,
people, inch.Jdiog counsellOrS and othet ptofessionals, ate
they are highly suspicious of lheir doctors and counsellors.
filtered thr'OUgh theit paranoid lens..
Antidepressant, antianxiety, and antipsychOtic medications
STUDE:NT: How can you tel if it's a delusion or n01? are often used. Counse!IOl's can help btf working with thei(
dients to ens.xe medication complt.ance. When symptoms
MENTAL HUlTH WORKER: Sometimes. delusions are bizarre
get noliceabty wOl'se, it rS often a sign lhat they am off theif
aoo easdy identified such as the patient who believes that
medication.
someone has put trans.rnittets in Mr teeth in Otder to send
her messages and control her behaviou". Other times. 1t may ST\JOENT: What are some counselling stmtegjes?
be difficult to detet'mioo if it is a delusion or if 100 client's
Mt NTAL HEALTH WORK.ER: Counsellors and others Should
fears are justified. It's important to keep an open mind. One
avoid being drawn into ar'guments regardi~ the delusion.
woman, who had schizophfenia and a number of bi:zarfe
Most often, such an approad'I wdl be met with fesistance and
delusions, had trouble convincing people she had been sexu-
the client wiU only furthef question lhe moti\ies of lhe hefpef.
ally abused by her doctor. They assumed that because ot he-r
As atways. relationship is the key to workil'lg effectively
illness. her accusation was yet another delusion. In fact, 1t
with someone who rS paranoid, but this will fe(fuire patience,
later- proved to be true.
as 1t is common that the client with paranoid delusions w'III be
STUDE:NT: My gfandmothef, who had detnentia, thOUgt\t lhat highty diStrusrhA of counsetlors, particularty if they challenge
her ldds were steali~ ftom her. She aaso believed that they the validtly of strongfy held beliefs. Generalfy, you·• want to
~Med to kill het in ordef to get he-r money. In fad, it was empathize with the client's feeli~ without supporting the
hef faili~ memory. She was misplaci~ hef possessions, delusion. Ho-.vevet, with SOtne clients. empathy may be expe-
then she would conclude she was a vi::::tim of lheft. rienced oogativel'j as an "attempt to get inside lhei( heads_·
so the counsellor may need to Shift to a less. threatening topic.
MENTAL HEALTH WORKER: YOU( gmndmothef'S situation is
Sometimes, the beSI course of action is to distract the
not uncommon wilh detnentia. HowtM!I', we need to be open
diient by changing the subjed Of actMty. Clients who are
to the possibility ot elder- abuSe. Seniors with dementia afe
motivated to overcome paranoia can use anxiely manage.
a vlJoorable g(oup, and there are certainly Sduations v.t'lere
ment techl'liques and cogriitive behaviour'3I strategies 10
famly membets take ad\<antage of them btf controlli~ and
addfess unhelpful thinking. Innovative approad'les am atso
using their money for personal gain.
avatlable. One uses custom.ized avatafS to represent a pe(.
STUDE:NT: So, what's the t'OOt cause ot paranoij delusions? son's paranoia, lhen the person lea(ns to confront and control
the pamnoia (avata() through role plays and simulations.
MENTAL HEALTH WORKER: The cause rS stdl unknown, but
the consensus is lhat there is no s~ gJ,e cause. Envir0nment,
untrc3tcd. Jn fact, it is sometimes rderred to as the "common cold o f menta1 illness."

The signs of depression, sometimes described as clinical depression o r major depres-
sion to separate it from ordinary sadnes~ can be organi!cd into four major categories
with specific S)rmptoms:
t. Mood disturbances
■ constant sad, anxious, or empty mood
■ feelings of hopelessness or pessimism
■ feelings of guilt, worthlessness, o r helplessness
Menial Disorders and Substance Misuse 281

CM:r SO bilioo neu-ons i"I the bfain al"d b:)jy communicate with Dopamine: Parkinson's disease, schizophrenia. altention
each other- by sendi'lg li1y chemical$ called neurotransmitters deficit hype-ractMly diSOtder, motivation. and depression,
from one neuron to another-. A neufon may have actNe neural moveme-n1
pathway connections to 10,<XX> or more neu-ons. Dysfunction Gllltamale: obSeSSiw<0mpul:Sive disorder (OCD), Sd'li:zophre-
in 100 neurotransmitter- may be one conlributing factor in a nia, depression, and autis.m
number of mental and physical diSOrdets. A com pl& a«ay
Aeelylchollne: deptes.sion (excess) and deficit (dementia)
of factorS iocludi~ he-redity, social factors, environment life
sttess, and othe-r unknown fact0ts make it unlike-ly that a Horeplnephrfne: depression (deficil) and schizophrenia
single cause fer mental inness is pre-sent (excess)
GABA: anxiety and fear (def.cit) Sources: NIMH, 2015; Hefner, 2015: Mohler, 2013: and Beish.am,
2001.
Se101onln: depression, mOOCI, sleep. appe-tite, impulSe con-
trot, and aggression
2. Ch3ng:es in behaviour
■ diminished inte.rest or pleasure in d3ily activitie~ including sex
■ decre3scd energy and fotiguc
■ withdraw·nl from others
3. Alterations in thinlcina
■ difficulty thinking, concentrating, and remembering
■ inability to malce decisions
■ recurrent thoughts of dC3th or suicide
4 . Physical complaints
■ restlessness or irritability
■ fatiaue or loss of enc.ray
■ sleep disturbances, indudina insomnia
■ loss or gain of appetite and weight
■ chronic P3in or other pe.rsistent bodil't' symptoms that are not caused by ph,.•sical
disC3.sc
■ suicide 3ttempts (American MedicnJ Association, 1998; American Psychiatric
Association, 2013; NIMH, 2012).
Scott Simmie, a Canadian journ3Jist, describes how his depression included

obsession with thoughts of suicide:
I spent wttks in bed, un:tble to f'lnd a rea.son t'O ~t up. S1eep wu 11\)' drut- dlt only.
albeit te1nporary. Ml)' to esc:,pe what had befallen 1ne. \\1hen ::rwake I brooded. almost
obsessiv~I)·, on death. Pietured 11\)'stl( dttinK pulleys $0 I oouJd h::ma 11\)'Sel( in the
eondo. .. . Mose mominKS, tilt llrSt thol¢ht that entered my he:3d was to put 2 i[un t'O
it. lbna. Problem solved. (Simrnie & Nunes,. 200 I. p. 27)
In a repon on diaanosis trends by Intercontinental Medical Statistics Inc. (IMS,

2001), which compiles statistical information for the Can3dian hC3lthcare community,
researchers noted th3t visits to 3 doctor for depression have shown the largest increase
among C3n3d3's leadina diagnoses. Ourina the period of 1995 to 2000, JMS statistics
rcve3lcd that visits to doctors in C3n3da for depression inctc11.Scd 36 percent, with
7.8 million consult3tions with doctors for depressive disorders. Put another way, almost
3 percent of nJI physici3n visits we.re for depression. \Vomcn represented 66 percent of
those diagnosed with depression. About 47 percent of individuals (m3lc and fom3Jc)
di3gnoscd with depression were in the 3ge group 40 to 59, 3nd 31 percent were from
the next largest group. m3de up of individu3ls aged 20 to 39. Significantly, depression
282 Chap1er 9
CONVERSATION 9.2
STUDENT: What ShOI..ICI I do when clients begin halllJC~tiog? calm, and anowiog dients more lime 10 process and fespond
are important when dealing with dients ~ are haltuc~ti~.
TEACHER: The first cotUm ShOulcl be the safely of lhe cli-
Counsellors sOOUld avoid patronizi'lg 0t huinouri~ clients
ent and others. including yourself. Pay particular attention
abOut lheif hallucinations, as lhis behaviour may pfomote
to die-nts whO desctibe voices Otdering them to hurt lhem-
further halluc~ atrlg. One way that counsellors can fespond
setves or others (command hattucinations). This might be a
'Mthout arguing is to simply state lhat they do not sense what
psychiatric emer-gency, particularl'j if lhete is evidence that
theif clients afe ser\S.ing. They can ex.press empathy that
the clW!nt haS little at.:lity to resist the commandS.. Police inter-
ack~dges the lee6~ that clents may be ex.periencing
vention may be necessary to bri~ the person to the hOspital.
beeause of theif hallucinations. CounsellOrs atso can help
Let's talk abOut vd'lat not to oo. Counsenors need to tesist
dients deal wsth any stressors that may be inc,easi~ the
the tamptation to argue with clients abOut the reatdy of their
frequeocy of hallucinations. F'Ot example, if being in large
halh.,cinations. Altnough some clients are aware of wtle-n they
crowds or rl"is.u'lg Sleep br"i~ on halludnations., clients can
are hallucinating and have leamed to li\ie 'Mth 1t, others are
take steps to minimi:ze these pfecursors. It may be helpful to
convinced of their hallucination's authenticity and dis.miss
work With clients to help toom learn ski!IS for contfCIU..ng theif
argi.unents to 100 contrary. Their' ex.pe-rience is very real and
hallucinations.. F'Ot ex.ample, they can discipline 1oomselves to
has to be accepted as such. Thi.s is alSO ltue when dients
dir'ect lheir thoughts and activtties el:Sewhere. One researthet
are delusional; however-, imptobable 0t bizarre the delusion,
found that silence, isolation, and attention to oneself tend to
it is real to lhem.
promote hatlucinalions, but distr-action, explOt'atary activity,
Re~mbe-r that many thi~ can cause haUucinations.
movement, and extemal stimulation tend to impede hallu-
When someooo is hallucinating beeause lhey have 1aken
cinations <S.lva & Lopez de Sitva, 1976). So simpty diverting
a s1ree1 drug such as LSD, the beSt appfoach is to @Mure
dient attention can be a useful strategy.
safely and wait until the effects of the drug dear. I..n some
circumsta~ such as 'llf'len the dient has schizophrenia, ST\JOENT: I learned something from one of my dients that I
hallucinations afe g,ener-ally tteated wtth anti psychotic medi- found helpflJ and profound. I remembef him saying to me,
cations. Consec:iuently, feferr-al to a ph)'Sician Or' psyd'liatrist Ml have a mental di:sor'd,e,, but don't forget I ha\18 the same
is essential to make sufe that cliants have been assessed needs and fears as ENe,Yone else.· I was reminded that he
fof an appropriate medication to control their hallucinations. and I were m::,fe a•ke than unlike each other.
Subse(luently, it is important to ensure that clents are taJd~
TEACHER: MOfOOVef, hallucinatior\S and delusions, which
theif medkation and that their dosage is appropriate.
often define illnesses such as Sd'li:zophfenia, are common k'I
Haih.,cinations can be frigt\teni~, so it is important that
nOf'mal "e. Clar'k (2015) reported that -nanu::::inations, despite
counselbrs remain cam a..nd offet reass...-ance to clients that
common mi:sconceprions, are a part ot normal healthy life:
they are safe. The canae1ian Mental Health Association (2015
onU..ne) emphasizes 100 impor1ance ot fespecting a client's F'o, ex.ample, we might hear a noise and lt'link someone
personal space and not touching them without invitation. has called our name. Or, in the periOd between waking and
They suggest minimiMg distr-actions and noise, femaini~ sleeping, we nigt\t temporarily rose contacl with reaHy.
now ranks second behind essential hypertension as the leading reason for visiting a
physician. Moreover, the report su~est~ that almost 3 million Canadians have serious
depression, but less than a third of them seek help.
SUCCESS TIP
Premorbid functioning is a n'l8asufe of how wel an individual coped bef0te the onset of
mental disofdet or the nisuse of subStances. Ma tlJe, lhOSe who have a histo,y of success
in broad areas of life such as car'eer, relationships, and management of emorions Ml have a
more positive prognosis lot success. Asking clients to describe rimes in lheir IN8s when they
dkl not ha\18 a prOblem (e.g., when they wete not misusing drugs) is an effective way of iden-
tifying strengths as well as reasonable success goalS (i.e., retum to premorbid functioning).
Depression is beJieved to be caused by a complex combination of three primary

variables-biologicnJ, genetic (inherited), and emotional or environmental (American
MedicnJ Association, 1998). BiologicaJ o rigins are associated with brain chemistry and

hormon3l activity. RcsC3rch has demonstrated that some families are more likely to
have members who suffc.r from depression. Although no specific gene has been linked
to depression, the.re appears to be ample evidence that heredity lends to an increased
vulnerability to depression. EmotionaJ and environmental causes might include stress.-
ors such as the death of a loved one, a job loss, or the brc3kup of a relationship. As
well, depression might be the result of sleep disturbances. illness, or drug reaction.
Depression that originates from physicaJ illness usually abates once the physical illness
is trcnt~. Depression is symptomatic of a medical condition in about 10 pc.rccnt to
IS percent of all cases. Known physical causes of depression include thyroid disease,
adrenal gland disorders., hyperparathyroidism, diabetes, stroke, infectious diseases such
as \•iral hepatitis, autoimmune disorders, vitamin and minc.raJ deficiencies, and cancer
(American Medical Association, 1998). Thu~ clients who are den.ling with depression
should be referred for a medicaJ chcclc,up as an adjunct to counselling.
Counsellors can assist people who are depressed in a numbc.r of ways:
■ HcJp them recognize and identify the symptoms of depression.
■ Rdcr them for appropriate medical examination and treatment, whic.h might
include medication or hospitalization.
■ HcJp them to develop coping strategics for dcaJing with stress.
■ Counsel them for loss or grief.
■ Assess and manaac suicide risk.
■ HcJp them develop cognitive/behavioural strategies for overcoming low seJf-estccm
and other self-defeating thought patterns t.hat often accompany depression.
■ Support and understand emotions.
■ Provide family counselling to intc.rrupt communication patterns that contribute to
or escalate depression.
Bipolar Disorder With bipolar disorder, depression a1tcrnates with manic episodes.
During manic periods, people typically experience heightened energy, a euphoric mood,
and a grearJ,., incrca~ sense of confidence, sometimes to the point of grandiosity.
They may have sharpened and unusuaJl,.•creative thinking, aJong with a much-decreased
need for sJeep. Or they ma,., experience a flight of idC3s (thoughts without logicaJ con.-
ncction). Alt.hough they may engage in increased aoaJ-directed activities at work or
school, they often engage in them without rcg:ird to the consequences, thus, IC3ding
to irrational behaviour such as uncontrolled bu)•ing sprees, scxuaJ indiscretion, and
foolish business investments (Amc.rican Psychiatric Association, 2013; NIMH, 2012).
Scon Simmie's recollection of his mindset when he was in the midst of the manic
phase illustrates the irrationality of this state:
Despite e"\>erythinK rd been throu~,. I w:lS still oonvineed that I w:lS in pe-rfe<"t health.
t~t the real probLe1n wu the (~1lure o( other!? to ~ i : e that somethinK extraordi,
nar't' and wonderful h::.d h::,ppentd to 1ne. That I had been spintuall)• re.born. TI,::u 11\)'
limitless potential had Onall't' been (reed. (Slnunie &. Kunes. 2001. p. 25)
))}) BRAIN BYTE I C,_:,r ,, ,r

Current thinking suggests that it tS a combination of fac:tOrS tnem more vulnerable to further episodes, when even small
that results in deptession. For example, if people with a pre,. stressful events can tr1gger depression (American Medical
disposition to depression ex.pe-rieoce stressful life crises. tney Association. 1998). Thyroid prOblems (overactive 0r unclerac-
may devetop depression. SubSe<!uently, lheif first deptessive tNe) and hOfmooal imbalances (e.g.• after' chikibirth) can also
epiSOde may stimulate d'langes in brain chemistry 1h31 leave pray a rde in depcession CTartakovsky, 2015).
284 Chap1er 9
Thus, it is very difficult, though not impossible, to persuade people to accept
treannent. including hospitalization, during the manic phase of the illness. Supportive
counsellors, famil't', and friends may convince them to seek trentmcnt. but in some cases.,
particularly where behaviour has become self-destructive or dangerou~ involuntary
hospitalization may be necesS3ry.
Bipolar disorder usually begins in adolescence or early adulthood and continues
throughout life. It is often not recognized as an illnes~ and people who have it may suffer
neo:llcssl)• for yenrs or even decades. There is evidence that b ipolar disorder is inherited
(NIMH, 2012). Persons with untreated bipolar disorder ma)' experience devastating
complications, including marital breakup. job loss, financiaJ ruin, substance abuse, and
suicide. However, almost everyone with bipolar disorder can be helped through the use
of medications such as lithium, whic.h has demonstrated effectiveness in controlling
both depression and mania. Bipolar disorder ca.nnot be cured, but for most people,
treatment can keep the disease under control.
Anxiety Disorders A nxiet)' disorders arc characterized b\• higher than normal levels anxiety disorders: "'>ce than nonnll
of fear, worry, tension, or anxiet)' about daily events. High anxiety may be present with- 1Mb al fear. 'Mlff)', v.sion.« afllie1y
abOCII daily ewnts.
out apparent reason. Four serious anxiety disorders arc obsessive-compulsive disorder
(OCD), phobia~ panic disorder, and post-traumatic srress disorder (PTSD).
Obsessive-Compulsive Disorder (OCD} An obsessive-compulsive disorder (OCD) obsesSM-Compu.lshe disorder
involves recurrent, unwanted thoughts and conscious, ritualized, seemingly purpose- (OCO}: RecurNI, unw•ed thoughts
and conscious.. ritualilell s ~
less acts, such as counting the number of tiles on the ceiling or needing to wash one's purp)seles.s acts, such as u untii-, the
hands repetitively. Behavioural techniques and medication have proved effective in numbs of tiles on tile ttiling oc aeeding to
treating this disorder. •asllone'i'-'is repetiiwfy.
Phobia A phobia is an irrational fear about particular events or objects. Phobias phobia: An irr.atic.al fear atoll
result in overwhelming anxiety in response to situations of little or no danger. Most particdar events or obje::ts that mula
in t'l!hflelming anriety ii iesp)llse
people have phob ias of one sort or a.nother, such as fear of flying, height~ public speak- to siiuatioos ■heie tilef! is little or no
ing, or snakes. For the most part, people dcaJ with their phobias through avoidance, danga.
which decreases the anxiety associated with the fear. Unfortunately, avoidance increases
the fcar of the particular object or situation. Treatment of phobias is necessary when
they interfere with a person's capacity to lead a normaJ life. For example, agoraphobia
(fear of open or public spaces) prevents people from leaving the S3fety of their homes.
Trcatmcnt in such cases is essential to help clients escape what ,vould otherwise be
seve.ret,., restricted lives.
\Vith systematic desensitization, individuals with a phobia arc first taught how to
manage anxiety through relaxation. \\:'ith the help of the counsellor, they construct a
hierarchy of anxiety-provoking events associated with the phobia. Finally, they lcarn
how to control their anxiety with progressive.I,., more difficult exposures to the anxiety-
producing object or event. ln addition, other specialized bdi.aviouraJ techniques, such panic disorder: Sudden atlaclsClf
as flooding (immersing a person in the situation causing fcar or anxiety), relaxation tero and irr.atic111I fear~ i . d
training. and pharmacologic (drug) trcatment, may be necessary to relieve anxiety by an c,,endllelming SMSe Clf impeading
disorders. doom. 0uri-, a panie attack. a persoo
mlJ eq>Hiellce S)'lllp,-s std as an
Panic Disorder A panic disorder involves sudden attacks of terror and irratio- aroeli!rated he.aft ra~ SM:--,_ shaking,
shortness o! bieath. dlieSI pail. . .sea.
naJ fear accompanied by an overwhelming sense of impending doom. During a panic and fear Clf dying or 1os;.g aintd.
attack. a person may cxpe.ricncc symptoms such as an acccle.rated heart rate, sweating.,
shaking, shortness of breath, chest pain, and nausea. as well as a fcar of dying or losing posHraumatic stress disorder
control (American Psychiatric Association, 2000). Medication and psychotherapy have (PTSO): Disabling symptOms such as
emotilnal n..t.ess.. sleep dm.bance
proven effective in trcating this disorder.
(11. -mares. difficulty sleeping).•
Post.Traumatic Stress Disorder ( PTSD} Post~trau matic str ess d isorder (PTSD) ieli--, tbe Mal fdbaing a tt-atic
e.811 sedl as r•. ass.tttt. n.a.111ra1
S)•mptoms devcJop following traumatic events such as rape, assault, natural diS3stcrs disaster (earthquakes, foods.. et£:.). •ar.
(ennhquakcs, floods, etc.), war, torture, or an automob ile accident. Symptoms may tortuf!, or aa w.omobie accident
Menial Disorders and Substance Mi suse 285

occur immo:linccly after the event or ma,., be dcla,.·ed by months or 't'C3rs. R«ollec~
tions of the event result in disabling symptoms, such as emotional numbness; sleep
disturbance (nightmares, difficulty sleeping): reliving the event; intense anxiety at expo-
sure to cues that remind the person of the trauma: avoidance of activities. people. or
conversations that arouse r«all of the trauma; hypervigilance; and outbursts of ange.r
(American Psychiatric Association, 2013). PTSD symptoms often dissipate within six
month~ but for some people the symptoms may last 't'ears. Relaxation training and
counselling are effective tools for treating this disorder.
Eating Disorders The two most common eating disorders. anorexia ne.r~a and
bulimia, are most likel)• to affect adolescent and 't'oung adult ,vomen, with about 90
percent of all those afflicted coming from this group (NIMH, 2012). Approximately I
percent of adolescent girls dcveJop anorexia ner~a and as many as 10 percent develop
bulimic disorder (NIMH, 2012). Eventually, half of those with anorexia will develop
bulimia (NIMH, 2012). Eating disorders are difficult to rreat because many people
refuse to admit that they have a problem and resist treatment. Counsellors and family
need to persuade those affected to see.k rreatment, but this can be hard because people
with these disorders may argue that their only problem is the "nagging" people in their
lives. Because of the life~threatening nature of eating disorder~ involuntary rreatment
or forced hospitalization ma,., be necessary, particularly when there has been excessive
and rapid we.ight los~ serious metabolic disturbances. and serious depression with a
rislc of suicide.
The National Eating Disorder (nformation Centre (NEDJC), a Toronto-based non.-
profit orpni!ation, offers this explanation of the cause of eating disorders:
E2tinK d1sordeTS 21re C3used b't' 3 combiMtion o( soc:iet2!. indMdu2I, and l211nily l2ctors.
They 2re 21 maiufest3tion o( rompLex underf)•ina str~!es with ;dentity 21nd self~oncept.
and of problems t~t often stem from tr.-um2tic experiences and patterns o( soc:ialb,,
t.On. E3tina d1sorderS are oopifl¥ behaviourS that provide the indMduaJ with ai, outlet
for d1spbcement o( (ee.linv <>r with 21 (false) sense o( be.in¥ in oontrol. Common t'O a.JI
ea.till¥ disorders is a per\'asive underi)'ifl¥ sense of pcM•erlessness.. (2005)
Social and Cultural Variables For most of recorded history, plumpness in women was
deemed desirable and fashionable. But during the last 60 years, particularly in Western
cultures, women have been bombarded with media messai;es that promote slimness as
the route to a successful and happy life. Societal emphasis on body image, combined
with the unrealistically thin ideal of the supe.rmodcl, has contributed to an obsessive
preoccuP3tion with weight control and dieting (Davis, 2006). One stud)• found that
the top wish of a group of girls aged 11 to 17 was "to be thinne.r," while another sur-
vey discovered that girls were more afraid of becoming fot than they were of cance.r,
nuclear war, or losing their parents (Berg, 1997, p. 13). Mothers and fathers who are
overly concerned or critical about their daughters' weight and physical attractiveness
may put the daughters at increased risk of developing an eating disorder. People pur-
suing professions or activities that emphasi:e thinnes~ such as modelling, dancing, or
gymnastic~ are more susceptible to the problem (NIMH, 2012).
anorexia nervosa: An w ing Anorexia Nervosa Anorexia nervosa occurs when people reject maintaining mini~
lisortler that «w"S wheli people ,ejed maJJ,., healthy body weight. Driven by low self-esteem and an intense fear of gaining
aaint.aillil-, a minimally llealthy bojy
•igllt. DriYffl bJ'llwsdl~teemand an
weight, people with anorexia use techniques such as purging (e.g., fasting, vomiting, and
illens.e fear d gaining weight. peoplewittl taking laxatives) and excessive exercise to reduce body we.ight. Even though they may
,_.e;oa 11Se ~ v.ch as pur,;.g diet to the point of starvation and they look emaciated, they will still insist that they
(e.g.• fiSlitg. \'Offlitil:g. and ta.ijni are too faL Anorexia nervosa can be life threatening, and as many as 10 to 15 percent
laxatives) and messiw mn:ise to nduce
"'Y""il'l. of suffere.rs die of the effects of proloni;ed starvation (NIMH, 2012).
286 Chap1er 9
The symptoms of anorexin include excessive weight loss. belief chat the bod'>' is
fat, continuation of dieting despite a lower than normal bod'>' weight, cessation of
menstruation, obsession with food, eating in secret, obsessive exercise, and deprcs..-
sion. People with anorexia are often perfectionists with superior athletic ability. There
is some evidence to suggest that people with anorexia starve themscJves to gain a sense
of control in some area of their lives (NIMH, 2012).
Treating eating disorders requires a team approoch consisting of physicians, coun-
sellor~ nutritionist~ and family chcmpists. Group therapy may be a helpful adjunct to
individual counseJling to reduce isolation. Re.framing and other methods for helping
clients change their distorted and rigid chinking patterns ma'>' be extremely hcJpful
(sec Chapter 7). As well, antidepressant medications such as fluoxetinc (Prozac) and
imipraminc may be used.
Bulimia Bulimia occurs when people adopt a patte.rn of excessive ovc.rencing followed Bulimia: An e:~ disorder t!la1 «cars
by vomiting or other purging behaviours to control their weight. lndividuals with buli- •hell people a&pt a pattern of eu:essi,,e,
Mti'ting ~ d by\'Offliting • ot!ler
mia usuall'>' binge and purge in secret. Typically, people with bulimia feel isolated, and pur,-g bEfl..wioors to contiol tlleir wa_..
they deal with their problems through overeating: then, feeling guilty and disgusted,
they puri;:c. Because they may have normal or even above normal body weight, they
often hide their problem from others for yea.rs. By the time, they finally seek treatment
(sometimes not until they are in che.ir thirties or forties), their eating disorder is firmly
entrenched and difficult to treat.
The symptoms of bulimia may include cessation of menstruation; obsession with
food; eating in secret; obsessive exercise; serious depression; binging, vomiting, and
other purging ac:civicics (often with the use of drugs); and disappearances in the bath-
room for long periods of time. (n addition, as a result of excessive vomiting, the outer
layer of the teeth can be worn dO\\•n, scarring may be present on the backs of hands
(from teeth when pushing fingers down the throat to induce \'omiting), the esophagus
may become inflamed, and glands near the cheeks can become swollen (NIMH, 2012).
Individuals with bulimia are at increased rislc for substance abuse and suicidal behaviour.
Personality Disorders: " Stable Instabi lity" A pc.rsonalit)• disorder is charac:cer-

i:ed by significant impairments in such areas as empathy, capacity for intimacy, nbilit)•
to regulate emotion~ self-esteem, disregard for the rights of other~ and impulse con-
trol. The diagnosis requires chat the impairments have an onset in adolescence or enrly
adulthood and chat they are enduring over time.
Personality disorders involve extensions (excesses or dcfteits) of pc.rsonalit)• traits
that we nil possess, but to warrant the diagnosis the criteria for the particular disorder
must be met and must result in significant distress or disability for the individual or oth-
e.rs. Diagnosis requires considerable time and expertise, and counsellors should avoid a
common tendency to quickly conclude that someone has a personality disorder because
of his or her behaviour. Personality disorders arc diagnosed based on history, observa-
tion, and collateral information, not solely on current behaviour. Psychometric tests
might also be used. Proposed changes to DSM-5 classification of personality disorders
met with considerable resistance from the mental health community, and they were not
approved. lnstcad, an alternate model has been introduced for further study and at the
same time, the DSM-JV classification has been retained. The new model anempts to
address the limitations of chc DSM-IV dassifteation, for example, chc fact that most
people do not fit into one of the subtypes. Often, they meet the criteria for rwo or more
personality disorders (comorbidity).
(n DSM-5, the JO personality disorders (retained from DSM-IV) are:
■ Paranoid: disrrust and suspicion
■ Schizoid: detachment and restricted emotional ran,;c

■ Schi: otyp3l: acute discomfort in rcJntionships., cognitive distorti o ~ dd beliefs
3nd superstitions
■ Amisoci31: disreg3rd for the r ights of others
■ Borderline: unstable rcfotionships nnd self-image; impulsivity; emotional swings
■ Histrionic: excessive emotion3lit)• and attention seeking
■ N3rcissistic: grandiosit)'; lack of empathy
■ AvoKl3nt: socially inhibited 3nd fodings of inadequ3cy
■ Dependent: submissive and needy; lack of confidence
■ Obsessive-compulsive disorder: p reoccupation with orderliness, perfection and
control
■ Personality disorder trait specified
Table 9.3 outlines c.h3Jlengcs to the counseJling relation.ship th3t clients with
pc.rsonalit)' disorders might present, along with 3ppropriate counselling responses.
TABLE 9.3 Personality Disorders: Common Challenges and Responses

What to Expect In the Client-Counsellor
Nature of Cballence Relationship COunulllng Choices
Oislfust and suspicion Accusations; suspicion; misinterpretation of Be cautious wilh humour, war'mth, and
counsellor's intentions and behaviour empathy; be concrete and straightforward;
probe with caution; client may be
uncomtortable with eye contacl; sit beside
client if convenient
Detactunent and social inhibitbn Discomfo,1 with k'ltlmacy; avddance; Assist client to devt'IOI') sodal and
client may be a'Ml.ward and uneasy duri~ interactive skills (if v.ilti~; accepa that 100
interview, especially when dealing with the relations.hip may be em::>tiooally superficial;
emotional dOmain anxiety management
[J;srega rd lot tne (,gl\ts of others Deception; manipulation; attackl~; Avoid cha\Je~iog; esaablish a clear contract
(anUsocial pe,sonafity) buflyi~; breakmg rules; braggi~; may be and limits. ex.plain rules; accept that ii is
charmS'lg with great ability to convince even unlikely that 100 client wil cha~ ways of
experienced workerS of their sincerity thlflkl~. so help clients find goo:J reasons
fol Changing
Unslable relationships and self- Emotional VOiatiiity; an.get and threats; Set relationship bOundaries.; remain calm;
imag,e; impulsivity; emotional self-destructive acting out; self-injury; manage your o-,m negative reactions.; help
swings (tx>rder1ine perSOnalily comptaS\ts to management; expectation to clients manage emorions, self-injury, and
disorder) be taken care of: flirting; acting helpless; suicide attampts
constant crisis
Sense of entitlement: grandiosity; Mar-.putation; breaking rutes: competi~ Focus on hefpi~ client dev80p seif~steem
lack ot empathy; self-centred for attention: ex.pedal.ion of sel'\lice and and more realistic expectations of others
(narcissistic personality disorder) admiration: wanting special rules
Excessive emotionality and Tempe-r tanttums; suicic:le gestures; d'larm; Help client mOdulate emotions, impulsive
attention seeklflg (hislrionic) dramatic affect: approval seeklflg actions, and sensitivity
Preoccupation with orderliness, C(iticism; problems with ambiguity or tack Help client learn to recognize and modify
perfection, and contrOI of sttucture; vulnerability unhelpful thinkl~; anxiety management;
help dient-sel realistic goalS: help client
devebp flexibility and comfort with
ambiguity
Excessive dependency; Dependency; advice see-kl~ and compl~ Tram client rn assertiveoos.s; fostet
submissiveness and neediness; ance; acr.-ig helpless independence: mcogr.?e strengths; se1
and lack of confidence Short-term goats to reinforce capacity and
success
288 Chap1er 9
ADHD i:s characte-rized by pfOblems wilh saayi~ on taSk, but an.xiely disofde-rs, reactions to chemotherc1py, dfugs (e.g,,
a numbe-r of medic.al conditions can atso ptesent with IM marijuana. cocaine, and caffeioo), hypothyroidism. PTSO,
same symptOO'ls including seizure drSOl"ders, HIV infection. abuse ot ttauma, Sleep distufbance-. and learnlflg diSOr'dets..
Child and Youth Mental Health

Many mental disorders. such as schizophrenia 3nd b ipolar disordc:.r, typically c:.mc:ri;:c: in
13te adolescence or early 3duhhood (O3vi~ 2006), but indic3to rs (premorbid symptoms)
may show up in children. Other disorder~ including mood and anxiety disordc:.r~ m3y
start in childhood or 13tc:r in life. Common childhood disorde.rs include: the following:
■ Anxiety disorder, the most common disorder seen in children
■ Anc:mion-deficit/hyperactivity disorder
■ Anachment disorder
■ Opposition3J defiance
■ Conduct disorde.r
■ Obsessive-compulsive disorder
The following arc some case examples illustrating some of the complex beh3vioural
problems th3t youth workers 3od other professionals might encounter in their w-ork
with children:
■ Nc:e.m3. age 7. goes from being complc:cc:ly c3Jm to blindly running, screaming.
and hitting anyone in his path. He's triggered by changes in his environment, even
seemingly small and insignific3nt strc:ssors.
■ Rc:becc3, 3ge 10, throws herself on the ground as soon 3S she c:nte.rs the scho0Jy3rd.
She dings to her mother, beaging to be taken home.
■ Emilio, age 12, loves wrapping plastic bags around his penis 3nd masturbating
during class. His behaviour was so disruptive that he needed to be placed in a
spec.i31 d3ss 3way from other students.
■ Nasim, 3j;C: 9, poured gasoline on the fa.mil)• C3t, and then tried to burn the house down.
■ Pierre, ai;c: I.S, w3s introduced by the teac.he.r to the rest of the d3ss. She jumped
on the desk, pretending that she had 3 gun, screaming obscenities, 3nd threatening
to lcill everyone.
)}t) BRAIN BYTE

Eady marijuana use among Canadians aged 15 to 24 dependency and impaifment of the brc1in's tewafd system
years has harmful impact on their brc1ins in lhe- afeas of can occur f0r as many as ooo out of six adole-scent use-rs.
mem0<y, attention. inf0<mation pfoce-ssing, learnlflg, COO!· ccanadian Centfe on SubStance Abuse, 2015). cannatis
dination, appetite, mOOCI, motivation, response- to pain and use at an earlier age alte(s the btain's dopamine- system
pleasufe, as well as risks 10 mental health (association and is associated with a highet risk of psychosis and
with psychosis and schiZophfenia). Sttuclutal damage- to increaseci negative emotionality-depre-ssion, anxiely, and
IM btain and teduced frontal lobe btain mass damage-s poor ability to deal with stfess. (Manza, Tomasi. & Vol:kow,
executive funclioning tel.ated to planning, decision mak• 2017) This reality has imJ)O<lant implications fot counsel.
ing, motivation, seJf.awateness, and goal selti~. cannabis lors who WO(k with youth.

■ Pie.rrc, age 9, is preoccupied with nrranging the books nnd m:ne.ri3ls nt his work
desk to the point that he cannot eng3ge with cfass activities.
■ Pari, aJ;e 18, is prone to intense emotion:.d renctions. \Vhen stressed, she threntens
suicide or cuts herself. She is sexually promiscuous and uses nny srreet drug avail.-
able. \Vhen asked about her cutting, she sa)'S. "I don't lcnow why I do it. It just feels
good. 1t makes the pain J;O away."
Each of the preceding examples must be understood in the context of the
environmental foctors that hnve contributed to the child's extreme behnviour. For
example, Niclc was nbandoncd by his mother at birth, and even though he is only
7, he has been in over 30 foste.r homes. Although any child of any background can
devcJop a mental disorder, a number of factors can increase vulnerability, including
poverty, violence, abuse, illness, school difficulties, family breakdown, death of a
fomily member or friend, nnd others (Gladding & Newsome, 2010). Mcneal disor-
ders in children compound developmental challenges. The complications of mental
illness, particularly when left untreated, can lead to an increase in suicidaJ behnviour
and addictions.
Simon Davis (2006) from the University of British Columbin School of Socinl
\Vork, reviewed n number of Canadinn studies and reported the following:
■ As mnny as 14 percent of children have a mental disorder at any given time.

■ Eight to 14 percent of children in Ontario have visited a menml health professional
in the Inst yenr.
■ Children arc a high-risk suicide group with the rate of suicide idention ranging from
12 to 20 percent (one-year prcwJence), and suicide representing 24 percent of aJI
deaths among those aJ;cd 15 to 24.
■ For children, an anxiety disorder is the most common mental disorde.r, with a one.-
rear prevalence rate of nbout 10 percent.
In 2002, the British Columbin Ministry of Children and Family Development
(MCFD) commissioned a study that summarized existing research on child and youth
mental health. Their nnalysis concluded that the prevalence of menta1 disorders in chi),.
dren and youth thnt cause significant S)rmptoms and problems was about IS percent,
with nnxicty, conduct, nttention, and depressive disorders the most common.
General Considerations He.re are some issues counsellors should consider when
working with children nnd ndolcscents who have mental disorders:
■ Assessment and intervention need to conside.r the context of family, culture, nnd
social milieu. Attempt to modify environmental factors that arc contributing to
the child's behaviour.
■ Modify inte.rvicw strategies to meet developmental and individua1 needs. For exam.-
pie, with younge.r children games, nrt, nnd play can be used to facilitate expression
as well as to develop rapport.
■ Support or ndvocatc for a thorough assessment that will determine the child's needs
for medication and academic supports.
■ Use best-practice approaches that arc adapted for children. For example, Dr. Jane
Garland nt BC Children's Hospita1 developed a program caJled "Tnming the \Vorry
DrnJ;ons" that uses cognitive bchaviouraJ thcrnP\' to help children who have been
diagnosed with nnxicty disorder. This program is now used in mnny parts of Canadn
with ndaptations for various age groups. The ''Friends for life'' program (2012) was
290 Chap1er 9
AdOleSCent btains are particulatly vuloor-able to drug misuse. teenager's assertive decisi::>n making to enable them to say
£arty use increases tne risk of developing a subStance disor'- ·no· to drug use. p-ovk:li'lg education to help tr.em understand
oor, i'\terieres with brain maturation, which is normally accet- how their devetoprng brains ate inpacted by drug use, and
er-ated du!W'lg adolescence, and damages the br-ain in areas safe risk laking lhal Supj)O<IS personal llJ'OMh "IUlout Ille need
associated wilh leaming. language, and memo,y such as the to use drugs.. One strategy suggested b-f Winters and Ania is
hippocampus, which ShOwS a decrease in volume (Winters & to teach teens hoN to use a Mred light (stop), yellO-N ligt\t (cau-
Atria, 2011). The authors stress tne importance of teaching UOO), and green ligl\l (proceed)" model f0t deeiskln malung.
developed in Australia and is now used throughout the world, including Canada,
as a structured approach to helping children cope with anxiety and depression. It
focuses on building resilience and self-esteem.
■ Family intervention is essential. Families need education to understand the
narure of an't' mentaJ disorder that their child is dealing with as well as informa•
tion regarding medications that are being used. As well, family counselling can
assist the family to make changes to environmental factors that arc contributing
to the illness.
Counselling and Working with People Who

Have Mental Disorders
Ideally, people with mcntaJ disorders should be dealt with through a team approach
that includes psychiatrist~ psychiatric social ,vorkers. social se.rvicc workers, counsel-
lors, occupational counscJlors, nurse~ and volunteers. As a team, they sh.arc common
objectives:
t. Motivating clients to scclc and remain in treatment and, in severe case~ arranging
for involuntary treatment.
2. Supporting clients to rerurn to or re.main in the community (hcJping with hous-
ing, life skills training, employment and career counscJling, and assistance with the
negative symptoms of the illness).
3. Assisting clients in dealing with the cha.Henges of medication (e.g., compliance and
side effects).
4. Educating clients and their families about the nature of the disorder.
5. Assisting clients in dcaJing with the consequences of mental disorder~ including
stigma.
6. Helping clients and their families dcvcJop and use suppon system~ including self.
help groups and professionals.
Clubhouses Social support is offered to clients with chronic mental illness through
clubhouses. These organizations emerged in 1940s with the first clubhouse, Fountain
House, opening in New York, which became the visionary model for aJI subsequent
clubhouses. They operate in the community as a means to promote recovery for their
client~ who arc referred to as "members." A typical clubhouse will provide food, social
interaction, employment assistance, recreation, and suppon to find housing in a safe
environment. Members, who work along with staff, fully particiP3te in all aspects of

programming and management of the cemres. Staff \'lew themselves as collC3gues of
the members, and they often dcvcJop reaJ and lasting friendships with membc.rs in
much the same Wtt)' as they would in a typicnJ work environment (International Centre
for Clubhouse Development, 2012).
Mental Health and Employment Davis (2006) reported that unemployment and
underemployment rates in North Ame.rica for persons with serious mentn1 disorders
range from 70 to 90 pe.rcent. The devastating impact of unemployment and job loss is
well documented in the literature (Solle~ 2011; Borgen, Amundson, & McV,ca.r, 2002;
and Soper & Von Bergen, 2001). Aside from the obvious loss of income from not hav.-
ing a job, there ma)' be significant consequences to job los~ such as increased stress,
loss of self-esteem and identity, and negative effects on health and well-being (Bolles,
201 I; Davi~ 2006). Davis obse.rves that "unemployment may sianificandy impact the
memal health of someone who is aJready strugaling with the stigma associated with a
psychiatric illness" (2006, p. 260).
For most people, a job or career is a pivotaJ part of their identity. A protracted
pe.riod of unemployment can result in a loss of self-esteem and persona1ity. Morcove.r,
pe.rsons who are unemplo)•ed lose the routine of their daily lives., the structure of the
workda't', their sense of purpose, and the social contact with friends and colleagues at
the workplace.
In addition, the financial impact of job loss can be devastating. Dn)••to-day survival
can be tenuous at best as individuaJs and families strugale to survive on savings or mea.-
gre socinJ assistance benefits. Financial problems become a crisis when unanticipated
expenses such as car repairs., sc.hool foes. or medicaJ bills appear. Job loss can easily
result in the loss of one's savings. one's home, and the ability to sustain a social and
recreational life.
Assisting people who have mental disorders often requires medication, but this is
insuff,ciem to achieve foll recovery. A British Columbia Ministry of Health report on
best practices concluded:
Tilt hter21ure and ~ r u provkled stronK evklenee that v.-,ork has 1na.11r benef'ks for
people " '1th serious mental ilJ1ltS~ indudin~ impro,·ements in their pS\"<:hbtrk srmp,
h'.>mS,. reduced hospit3li:ation, Kri":::lter soeb1 inter..c-tion. dttreasa-.1 levels o( anxiety.
enh::u,eed sel(.-esteem and sielf'~onf'ldentt and O\'e~ll itnpro\'en,ent in their q~lity o(
li(e. (2002, pp. 5-6)
AlthouRh a full discussion o( employment counscJling with individuals who have

memal disorders is beyond the scope of this text, the following broad initiatives can
form the basis of support:
■ Marketing to employers. dispelling myths about diems and promoting the positive
contributions that they can make to an organization.
■ Offering pre-employment service~ including career counselling. skills training,
work experience, job sC3.rch skills (e.g., networking. rCsume preparation, and inter.-
view rehcnrsnJ).
■ Assisting clients to identify and access cducarionnJ resources.
■ Lifo skills counselling for clients who lack b3sic abilities in such are3s as managing
finances, maintaining prope.r hygiene, getting to work on time. and getting a.Jong
with supervisors and co-workers.
■ Using voluntcc.r work as a way to improve self-esteem and develop job skills.
■ Using a variety of employment paths such as supported employment, where
sustained assistance for skill development and adaptive strategies for dealing with
the c.hallen,;es of the workplace are pro\•ided.
292 Chap1er 9
■ PcrsonnJ counscllina that assists clients to develop positive sdf-cstccm and optimism
by rccogni!ina strcnaths that they have acquired through hobbic~ persona] life
expc.ricnce, voluntC"C.r work, and other employment.
■ Using group and peer suppon to hdp reduce isolation.
■ Using the job dub method (Airin & Be-said, 1980), a srructurcd aroup approach job club method: An iMetsi...e -.:J
that provides support, job scarch skills training, and matcriaJs and supplies for stru:tsed approach to j® fin-,: based
<d ~ supp)l't and structured learning
completing a successful job hunt. a«iwties. The sol! p.rposech job dub is
■ Assistina clients in dcalina with ,vork-rda.tcd stress issues (Azrin & Bcsald, 1980; to ~ partqiaats fm wcrk.
British Columbia Ministry of Health, 2002; Cartan & Tilford, 2006: Davis, 2006:
Niles, Amundson, & Neault, 2011; and Sears & Gordon, 201 I).
Psychiatric Medications The 1950s witnessed the introduction of powerful

chemicals that have resulted in dramatic advances in the rreatmem of mental disor-
ders. Medications have enabled the vast majority of people with mental disorders to
be trcatcd and managed in the community and not locked up in psychiatric facilities.
Mediai.tions may be able to control the S)rmptoms of mental disorders, such as halluci-
nations, but they do not cure the illness. They can increase the effectiveness of counsd-
lina by increasing the cnpncity of the clients to hear and respond. Many people neo:I
to take medication to control the.ir illness for the rest of their lives. Counsdlors do not
prescribe medications, but they provide support to clients in a number of important
wars: ma.king rdermls to physicians, hdping clients assess the pros and cons of takina
mediai.tion, discussing adverse side effects, helping clients and families access informa-
tion a.bout medication (purpose, side effects, and risks), and advocating on bcha.Jf of
clients to health providers.
There may be wide variations in people's reactions to medication (c.a.• some
respond bener to one than another; some need larger doses; some e.xpe.rience side
effects; and others do not). Medications may result in unwamed side effects, such as
tardive dyskinesia. (charactcri!ed by uncontrollable movement), drowsiness, weakness,
tremors, slurred speech, sleep disturbances, sexual dysfunction, increased hean nm;
dry mouth, and hcadachcs (Walsh & Bentley, 2002). Some clients may stop takina
mediattion to avoid these side effccts.
PS)·chotropic medications aJte.r the neurotransmission processes, the chemical and
dcctrical system of the bra.in. There are five main categories of psychotropic medication
(Walsh & Bender, 2002), as outlined as follows:
■ Antipsychotic (or neurolcptic) medications such as loxa.pinc, ha.loperidol, antipsychotic {or ne.uroleptic)
clo!apinc, and rispc.ridone arc used to treat psychotic illnesses such as schizophre- medication: Mexaticm SClCft as
dlbpomazine.1t.aq:E1i:td, cloupne,
nia. AntipS)•chotic medications may be taken daily, but some medications arc avail- and risperidone that are uv.d 10 treat
able through injcction (once or twice a month). Jnjcrtions are particularly useful for illnesses such as sc.hitq:111,ienia.
ensuring that clients take the medication. Newer a.ntipsychotic medications (e.a.,
clo!apinc, risperidonc, olam.apine, and quctiapine), aJso known as novcl or Ut)tpical
a.ntipsychotics, do not have the same level of adverse side effects as some of the
older (conventional) drugs such as chlorproma!ine (Thora.!ine) and haloperidol
)}t) BRAIN BYTE

A psychOtmpic drug is any medication used to treat a mental neumtransmitte-rs, but lhey are not designed to CIXe the
health condition sud'I as depression ot Sd'lizophmni:a. These illness. They can alSO have harmful side effects, and they
medications Mtp to manage symptoms by changing brain may sttuctutally altet the brain foe ootte-r Or' worse.
Menial Disorders and Subslance Misuse 293

antide1)ressant (Haldol). Antipsrchoric medications have enabled most people with schizophrenia
medication: Medicali>ns s«h as
to be treated in the community rather than in institutions, the primary method used
Pmac. PZOI. and Z"'1ft that aie used to
llelp ~ deal •idl serilus IH1)ESsilll. for the first half of the twentieth century.
■ Antidepressant medications such ns Prozac, Paxil, \\:fellbutrin, and Zoloft arc used
mood-stabilizi,_ medications: to help people deal with ~rious depression and anxiety disorders (NIMH, 2012;
Medica:icm sd as lithiumcarttonate
that are used to Cllllrd the aanic Walsh & Bcnrley, 2002).
s)111ptoas and aooi 5111-,s of~ar ■ Mood-stabilit.ing medications such as lithium carbonate, vnlproic acid, and carba.-
disorder.
ma:epine are used to control the manic symptoms of bipolar disorder.
anti-anxiety medication:
■ Anti-anxiety medications such as VaJium, Librium, beta-blockers, and bcnmdi.-
Medica~i• sudl as Valium and Librium
that are used to ccatrd serious ud a!epine~ are used to control ~rious and persistent anxiety, phobias, and panic
......
persistent arwf1J, phobia, and pati::
■
attnc:ks.
Psychostimulants such as Adderall, Ritalin, and Cylen are used to trent anemion
psyc:hostirr.,.lants: Medicati>ns so::h dcfacir/hypcractiviry disorder (ADHD).
as Ritalil that are uS!d to tieat aneaiion
deficitl\tjpera«riiydiscwder (AOtlO). ■ Addie.lion medications such as naltrexone, Antabuse, and methadone arc used
to support addiction recovery and treatment. There are also a \.'nriet)• of medical
addiction medications: Medicatioos
aids such as the drug Bupropion, patches, sprays, gums, and lo!cnges for dealing
such as aaltra:one.. bupreno,pl!ine. and
•thatt. that a,nsed to Sllppcwt with nicotine addiction. Medication may also be used to assist p«>ple through the
addi«• recovery •d uwmern. withdrawal process from drugs such as akohol and heroin.
CONVERSATION 9.3
ST\J0ENT: My pracricum isat an k'lne(-city drop-in centre for' STUDENT: I think a big problem is hornelessne-ss and
people With mental diSOr'dets.. One ot lhe bigg&sl challenges isolation.
we face rS wofkiog with dients wtlo dOn't take lheir drugs.
TEACHER: Ye-s, Clients. wiU tend to dO better if they live in a
They end up telapsi~ Or' gc::i~ to the etnetgency toom on a
supportive e-nviror\ment. And tor SOtne this me-ans a sttuc-
tegulat basis.
ttXe-d and supe-rvised se-tting. such as a mental health bOard-
TUCH ER: I kt'IOw vd'len you say drugs you'te mfe-ning to theit iog home. wtlete professional help and e-n:01.Xage-ment ate
ptescribed medications.. Since many clients use str'e-et drugs.,. available. When clients resist medication beeause of adverse
it's bette1 to use the term ..medication· to maintain the dis• side effects, it is crucial that this. be discussed with the-ir doc-
r.-iction. As you suggest, faiture to &ake ptesctibed medicatbn tors since side effects can often be addre-ssed with altemative
rS an enormous ptOblem. I te.ad recently that apptoximately medications, partkulatly if the client is taking some of the
50 percent of inclM1ualS with Sd'li:zophmnia are noocompG- oldet medications. tong-.acring inj,e,ctions are another useflJ
ant. and there is a high co«etatbn between medication non- alte-rnative.
compliance. violence, and suicide, partiel.Aar1y when the-re
STUDENT: What can counse-tlelr'S do?
rS a ~lXl'i~ subStance abuse ptoblem (Leo, Jassal, &
Saw~ 2005). Noncomplianice can mt.an not taki~ mediC.3· TEACHER: They can make sure that clients have access to
tion at all. not using it correctly, 0t mixi~ it with stre-e-t drugs. adequate information abOut thell illness and its treatme-nt.
They can also assist clients. in deve-bpi~ and using routine-s
ST\J0ENT: So what can we dO abOut it?
to manage their medication. Momovet, counse-lliog can help
TEACHER: first, I think it's. important to undetstand factots. clients re-solve ambi\latence abOut using medication (e.g., by
that contribute to clie-nts not taking the-it medications. such providing inf0tmation abOut the potential consequence-s of
as adverse side effec1s, medication costs, or the complex. protonged nonc:ompliance and the be-ne:fits of compliance).
nature of the-ii' medication regimen. Their iltne-ss may atso As wea, counselt)rs may be able to help farl'lly members Vfith
cause a lack of w,U o, motivation to take their medication. infOr'mation and ideas on hO'N they can support medication
Some may simply be ur\able to unde-rstand o, fOllow the compliance. And, as you said, it's impor&ant to assist clients
toutines. MOr'eovet, clients. who are paranoid mi~t fear they in findi~ supportive housing,
are be-ing poiso~ or controlled by medication and thus
be unwilling to comply. Clients. whO are manic may prefer
to stay lhat way.
294 Chap1er 9
Medications are approved aftc.r research studies demonstrate their effectiveness in
treating a particular disorder. However, once they arc approved, physicians ma'>' legally
prescribe chem "off. label" for other disordc.rs. For example, an anti-psychotic medica-
tion could be prescribed to treat depression or to manage excessive anger. Although
off-label prescription is common and accepted medicaJ practice, there are risks. There
may be adverse reactions that have not been documented, or the usdulness of the drug
for the targeted disorder ma'>' not have been proven.
SUBSTANCE USE DISORDERS

Substance abuse is estimated to cost Canadians about $40 billion per year for healthcare, substance abuse: Caatin~ ust of
13w enforcement, and lost productivity (Hc.ric & Skinner, 2010). The Canadian Centre on subst.-es des-iite s.,.ficant cilfiwls:ies
in areas such as health ~ I,
Substance Abuse (2012) estimates that akohol and tobacco represent about $31 billion emoti>nal, . t co_gnitwe), family and
of this cost. Beyond the financiaJ costs are the devastating impacts chat substance abuse ether relatio.ships. iep pioblem, and
can have on individuals and families: use ifl haiardoos situ31i111;s. ld'iduals
mlJ also t1perieace incm:sed tolerance.
■ Disruption or breakdown of famil'>', job, and social life whft leads to increasesii tile amount
used, and iriihdr,11111S)9ri)i0ms•d
■ Loss of control and the ability to c.xc.rcise good judgment ua...,s, tdli:h ofte11 pttipitate relapse.
■ (ncreased rates of violence and abuse
■ McntaJ and physical health deterioration, including premature dench from the
continued use drugs or accidental death from overdose
■ Fecal alcohol spectrum disorder caused by alcohol use during pregnancy
■ Leg-al problems arising from the pursuit of illicit drugs or the consequences of
behaviour such as impaired driving or disordc.rly conduct
■ Death from overdose. In 2016, the.re were almost 3000 opioid deaths in Canada
with the majority (about 75%) occurring in maJes (Government of Canada, 2017b).
Hcrie and Skinner (2010) highlight akohol and tobacco as the substances causing
the most harm in Canada~ "tobacco is by far the most harmful drug:: tobacco accounted
for 16.6 pe.rccnt of aJI deaths and $17 billion in lost productivity and healthcare costs
in 2001" (p. 37). "Alcohol accounted for 1.9 percent of all denchs., with $14.6 billion
in costs" (p. 37). A Canadian Centre on Substance Abuse (CCSA) survey (2004) on
addiction reported the following:
■ Nearly 80 percent of Canadians aged 15 years and older drink.
■ Seventeen pe.rccnt of pasvyenr drinkers are considered high-risk drinkers.
■ Hiah-risk drinkers are predominantly maJes and are under the age of 25.
■ Fourteen percent of Canadians reported using cannabis in the past year, but
30 percent of I.S- 17-ycaM>ld youth and just over 47 percent of 18-19-ycar~ld
'>'outh reported having used cannabis in the past '>'ea.r.
A Health Canada (1007) study on substance abuse by youth produced the following
statistics:
■ About 61 percent of '>'ouch have used cnnnabis in their lifetime.
■ About 16 percent have used hallucinogens.
■ About 12 percent have used cocaine or ecstasy.
■ Almost 10 percent have u~ speed, and almost 2 percent have used inhalants.
The medications prescribed by a physician arc manufacrurcd under strict condi-
tions to ensure purity. Thq• arc approved for distribution based on scientific evidence of
their cfftttivcncss. Physicians consider factors such as a pc.rson 'sage, weight, and other

medications that 3n individu3l m3y be t3king. Notwithstanding these controls, there 3rc
risks. Medic3tions c3n have significant and dangerous side dfccts for some individu3IS.,
so physicfans monitor the effectiveness of the medic3tion, and they inte.rvene when
neccss3ry to mediate 3ny adverse reactions.
Street drugs, on the other h3nd, have no such controls 3nd the risks 3rc com,.
pounded. The drug m3y be different th3n users expect, or it ma'>' be mixed with other
unknown or toxic subst3nces. ?\•forcover, the str«t drug ma'>' interact poorh• with
3ny prescribed medication, causing a risk of significant health problems or death. As
well, there arc other well-known problems 3ssociated with illicit drug use, including
HIV 3nd hepatitis infections from cont3minatcd nco:lle~ violence and crime in the
pursuit of drug~ 3nd family breakdown. Table 9.4 outlines some commonly abused
substances.
The Opioid Crisis The misuse of opioids is now a nationaJ crisis in Canacfo. ln
2016, there were almost 3000 opioid deaths in Can3d3 3nd in 2017, the number
exceeded 4000 (Government of Canad3, 2017c). About 75 percent of the deaths
were male. In Canad3's m3jor cities, emergenq• intervention with n3Jrrcxonc (Narc3n)
has S3Vcd thousands of lives, but esc3Jating opioid use still results in over 10 deaths 3
day prompting governments in Can3da 3nd the United States to decforc it a nation3l
emergency. Rccenth•, N3rcan emergency kits have been m3dc available to users and
others who 3rc likcJy to encounter overdose situ3tions. Prescription drugs suc.h 3S
suboxone, methadone, and buprenorphinc HCI c3n 3ssist with shore.- 3nd long-term
withdrawal from opioids.
Many people became addicted to opioids when they used medications or illicit
drugs such 3S ox,•codone, Vicodin, fcnt3nyl, heroin, and morphine. Fent:myl is 3 dC3dly
opioid SO times more potent than heroin th3t continues to take m3ny lives every day
in Canad3. Sometimes, people migrate to street drugs when they 3rc un3blc to get
prescription oxycodonc.
Opioids cause a burst of the neurotransmitter dopamine, which precipitates 3 surge
of plC3surc known 3S a "high." Drug dependence, 3ddiction, and tolerance c3n happen
very quickly. Opioid drugs C3n be snorted, injected intravenousi)•, or smoked.
Withdrawal from Drugs: Detoxification

The.re is no ~t rimelinc on how long it takes to detox from addictive drugs. It depends
on factors such as type of drug, how long it was used, how much, method of injection,
genera] health, history, and generics.
\\:lithdrawal (detox) from drug~ including opioids, can range from mild to severe.
Prolonged use of opioids c3n alter the functioning of the brain, including the limbic
system, the brain stem, 3S well as the spinal cord. Dependency occurs when the person
requires the drug to dC3l with P3in or to 3Void withdraw3I.
Detox is often undertaken in 3 hospital or speciali!cd ce.ntrc that is equipped
to dc3l with the medic3J symptoms and risks of withdraw3J. For those who are 00(
3t high risk of severe ph)•sic3J withdr3wal symptoms, there 3re outpatient detox
progr3ms.
\\:lith opioids, acute withdraw31 symptoms (first 72 hours) usu3lly start after about
12 hours and may include muscle aches, anxiety, sl«p disturbance, diarrhea, cramp-
ing, nausc3, rapid hC3rtbc3t, 3nd high blood pressure (Hc3lthlinc, 2018). Symptoms
3rc at their worst during the first few d3ys 3nd weeks and they will gradually dccrc3se,
but protracted effects from withdraw3J c3n l3st up to six months or longer. Since opi•
oids offer immediate release from the pain of withdrawal, rcl3pse during this period
296 Chapter 9
TABLE 9.4 Commonly Abused Substances
Substance Reasons fOf Usina Potential Risks
TObaeco • Habit. prevent discomfort of • Heart disease, strOke, cancer and many othei-
(cigarettes. cigars, withdr'3'N31, relieve bOtecSom, and signiflcan1 health risks, and addktioo
snuff, and chewing tobacco) peer group pressure
Alcohol • Elevated m::>Od and (elaxatioo (ION • Nausea, em::>l.iooal volatility, ioss of COOr'dination.
(!kiu°', beef, and wioo) dose) violence, fetal alCOhOI spectrum diwdei-, live( and
• Lower'ed S'lhibitions heart disease as wet.I as hundreds of otl1e(
sigoiflcan1 health risks, addictbn, and death from
ove(dose
tannablnolds • Euphoria, inc,eased heart rate • May 1tiggei- psyd'losis, anxiety, O( depression;
(marijuana and haSh;sh) • Medicinal uses (pain Or' nausea (espiratory infection; worsens outcomes lot people
relief, appetite stimulanO with psyd'loti::: diSOtderS
• Stowed (83Ction time
Opioid, • Sedation. euphoria, and pain Dizziness, confusion, nausea, addict.ion, HIV and
(heroin, opium, eodeine, management hepatitis infection fro«l Sharl.ng needles. and death
fentanyl. and co-lentanyO from ove(dOse
Stimulants • lnc,easeci energy and exhtlaration • Anxiety, panic. violence, heart and cardiovasculat
(cocaine, amphetamioos, prOblems, w~ht loss, severe denlal p(oblems
and meth) (meth), stroke. seizures, and addiction
Club Dru&s • l.ower'ed anxiety, hallucinations. • Anxiety, slOOS') distu(bances. deptession. seizures,
(MOMA-ecstasy and GHB) and muscle tela.xation coma, death
Dlnoelatlve • F'eetiogs of detachmtmt from bOdy l(etn()rs. memo,y IOSs, nausea, delirium. da•rous
(ketamine-. PCP, saMa, and perceptual distortions physiological changes (tespitatioo, heart rate, and
dexlromethOl'phan (cough blood pressure), inc(ease in viOlence, bss of coordi~
suppressanl)) nation, and death
Hallucinogens • Hallucinations and euphOria AaShbackS. increases in txxly temperature, heart
(LCD, mescaline, peyo!Jl, rate and blood pressu(e, rapid emotional Shifts,
and psiloc:ybin) nervousness., anxiety, and paranoia
Inhalants • StimlJation and IOSS of inhititioo Headache, nausea, IOSS of motor c00tdination,
(paint, g)ue, and g;,sotine) depression, memory impairment serious damage to
cardiovascular and oel"Vous systems., unconscious-
ness, and sudden death
Prescription meds • Pain (eief, stimulation. (eduction • Addktion (iOCJ"eased tdarance and need fo(
(opioid pain relievers su::::h as of anxiety, and assisiance with hog)\ef dOses), hOSliUly, psychosis, -aled body
oxycodone. central oeNOus sleep diSOr'det'S temperatures, irregl.Jat heartbeat, cardiovascula(
system depressants used to failure, and seizures
treat anxiety and slees) di!.or'-
ders.. and stimulants)
Synthedc dru&s • Simtla( 10 methamphetamine, but lntanse halluci.nations and psychOlic breaks,
(a.k.a . bath salts Sdd uncle( much mOl'e intense paranoia, self-mutilation, rapid heatl rates, suicidal
a variety of names such as thoughts, and death
Bliss and lvo,y Wave)
Sowc;es.- Harvard Medic-al School, 2012: Herie & Skinner, 2010: National tnsaitute oi Drug Abuse, 2012: and National Institute of Health, 2012.
is a high risk, hc:ncc: the: nc:c:d for significant medical and counseJlina support durina
this pc:riod. Physicians can prO\•ide medications to deal with many of the withdrawal
symptoms.
\Vithdrawal from alcohol ma,., result in significant symptoms and he31th ris ks
including anxiety, insomnia, vomiting, fatigue, tremor~ heart arrhythmia, mental con-
fu sion, problems with mood and tc:mpcr. The: most severe: symptom is deJirium trc-
mc:ns (but not c:vc.ryone will c:xpc:rience them) characte.ri!ed by hallucinations, h igh fevc:r,
confusion, agitation, and seizures (American Addictions Centc:rs, 2018)

Counsellors can support clients during withdrawaJ (detox) in a numbe.r of Wtt)'S:
■ Preparatory discussion that helps them anticipate and strategi:e ,.,,.,._..,s to manage
symptoms of withdrawal
■ Provide encouragement, empath)•, and optimism while dir«ting clients' attention
to long-term goals and payoffs of successful detox.
■ Use of coanitive behavioural strategics to hclp clients address "unhelpful thinking"
that might otherwise sabotai;e detox and recovery. Re.frame S)•mptoms as evidence
of the body henling itself.
■ Relapse prevention counselling during and after detox.
■ Reforral and advocaq• for lon,;-term treatment and support follO\\•ing the detox
process.. Ideally, this should begin immediatel,.•.
■ Using detox as a "tettchable moment" to support clients to undertake loni;-te.rm
treatment.
■ Encouraging peer and family unde.rstanding and support.
■ Making sure clients understand that afte.r detox, tole.rnncedecreascs. ff they relapse,
the same amount of the drug that they once used may now result in an overdose
or even death.
SUCCESS TIP
Si.nee many clients have co-oceuning diSOr'de-rs 1hat invotve- addictions and one Of more-
!'l'lental disofdel'S, detox. from subStance misuse-, while important is insufftcienl on its own.
Olhet disotde-rs need to be assessed and 1reatee1 at the same- ii.me-.
Substance Use Disorders and the DSM

DSM-5 classifies substance use disorders under the category "Substance Use and
Addictive Disorders." Jt offe.rs diagnostic crite.ria for disorders related to the follow-
ing substances: alcohol, caffeine, cannabis, haJlucinogens, inhalants, opioid~ sedative/
hypnotics, stimulant~ tobacco, and unknown substances. The Substance Use and
Addictive Disorders section also features the non-substance addiction of gambling dis.-
order, which ,.,,.,._s previously classified as an impulse control disorder. This section of
DSM lists a broad range of mental disorde.rs that can be caused by substances (e.g.,
substance-induced psychotic disorder, substance-induced bipolar disorder, substance-
induced depressive disorder, and many others). In fact, physicians and other profession-
als who assess ps,.·chiatric S)'Tllptoms will first assess whethe.r substance use is causing
the symptoms.
Brain Plasticity and Addiction

twain plasticity: The tnin's ability Brain plasticity refo.rs to the brain's ability to modify itself through experience and
to mdfyitselfttuougll aperiencf and
learning. Tolerance is a need for more of the substance to obtain the desired effect, or
learning.
experiencing less of an effect with the same amount of the substance. \Vithdrawal is the
toler"anee: A.eedfor .-eoladrugto presence of physical symptoms when the drug is no longer taken; withdrawal S)•mptoms
obtain die desired effea « less tffed 111ith stop when more of the drug is taken.
the sa• amount ol the s.tlbstancf.
Many drugs affect the natural reward pathways of the brain and cause addiction
withdrawal: The presence of ~cal by aJtering the brain's ability to produce dopamine (Gibb, 2007). Euphoria from using
S)111ptoas 111flen a drug is to longe, taten.
addictive drugs comes from the massive increase in dopamine that results. In response,
"the brain attempts to re-establish some form of equilibrium b\•decreasing the brain's
298 Chap1er 9
responsiveness to the dop3mine.. .. It docs so by r~ucing the number of dop3minc
receptors. ... As a consequence, the person becomes tolerant to the drug. requiring
more to achieve the same effect" (Gibb, 2007, p. 178). Sim pl)• put, the brain is using
its ability to be plastic to "prot«t" itscJf from the excess dopamine made available
by using the drug. Significandy, if individuals stop using the drug, the brain's plas-
ticity in adjusting (reducing) the dopamine receptors leave the user more depressed
than they were before they beg3n taking the drug. ln cum, chis leads to withdrawal
symptoms such as anxiety, anger, and irritability. Given time, the brain may be able
to reset the dop3mine system b3ck to a normal level; howeve.r, changes to the b rain
"may even be lifelong. depending on the duration nnd inccnsit)• of drug use" (Mate,
2008, p. 142). Moreover, "the worse the addiction is, the greater the brain abnormnl-
it)' and the grC3ter the biologicnJ obstacles to opting for hc3lth" (Mate, 2008, p. 146).
Such changes to the brain are one rc3son for the high races of reJnpse among addicted
opioid users.
Supporting Recovery from Addiction

Addiction is associated with a wide range of associated problems which may affect
individuals to a greater or lesser extent including: criminal behaviour, birch defects,
hepatitis, HIV, heartnung diseases, sexually transmitted disc3ses, financiaJ ruin,
psrchiatric comorb iditics, incrc3scd incidence of suicide, homicide, \•iolcncc, child
ab use, job loss, and famil)•/reJncionship stress. The impact of these problems often
remains even afte.r individuals recover from addition. A comprehensive counselling
intervention should include assessment and action plans to address these complex
chaJlengcs..
SUCCESS TIP
A Study by Fr'aS&( Health in Bfltish COiumbia found that most Ovt:?(dose deaths do no OCCU(
on the stteets as commonly believed. Theit study revealed that 90 pe,-cent happen indOOl'S
with 70 pe:(cent oce1Xring in hOmes (Chan, 2018). This undel'SC:oms the importance of
counselling discussions with clients that locus on safe drug use habits..
There is no single best p3th to recovery. The uniqueness of each client's needs,
preferences, and fC3diness for change means that smi.cegics that work weJI for one client
may not be appropriate for another. Consequently, it makes sense that counsellors avail
themselves of aJI possib le avenues for c.hanJ;c, including the following:
■ Detoxification (Detox) programs provide medical supervision and support for people who
arc withdrawing from drugs. \\:lithdrawul from drugs often results in uncomfortable
The neufotrans.mitte-r dOpamine acts as a natural teinfoteef functioni~ ot the i:,eas...-e pathway. They prOduce a ftOOCI of
ptOCluci~ pleasufe, wtlich motivates us to continue behav- dopamine, wtlid'I causes euphoria. In the ptocess lhey may
iours that support our needs. Arly of the frve senses-smell, damage 100 pleasute patl'wtay limiting its ability to ex.pe-ri-
Iouch, heating. seeing. 0c tasting-can trigger a pleasing ence i:,easure from the toutlnes of daily living, As a fesult.
dopamine butst. The pleasute pathway iocludes a part of withdtawal from many drugs tesl.Ats in deptession as the
Ir.e brain caned the wnual tegtne:ntal afea, which releases brain is unable to pt'Oduce 01 utii?e suff~ient dopamine to
dopamine to other parts of the bfain. including the nucleus sustain a sense of wen-being.. (Erickson. & Wilcox, 2001 ;
aecumbens, the septum. IM amygdala, and the pcefton- Ashwell, 2012; LOOS & Ungjo,d-Huglles, 2012; C.pu?Zi &
IaI cortex. Orugs such as cocaine interfefe with the nofmal Stauffer. 2016).

and sometimes dangerous physical reactions (cg., anxiety. agitation, tremors, pain, and
sometimes oousea, vomiting, and diarrhea), which need to be monitored and treated.
Akohol withdnn\-,i.J can be cxrrcmdy dan~rous, with symptoms such as haJlucinarions,
heart att:adc, and stroke. Dcroxifteation programs arc from thrtt days to two weeks
in duration, and they can be offc.rcd on an in-patient or out-patient (Daytox) format.
■ Psychoeducacion provides education to individuals who have a substance abuse or
mental health problem and their families. The goal is to hcJp them better understand
the physical, psydiologicaJ, economic, and social implications of their substance
use, including the reality that rcJapses arc often pan of the recovery process.
■ Cognici,~ beha,,ioural counselling was introduced in Chapter 7 as an approach to
assist clients to develop new ,.,,.,._..,s of thinking: and responding, An important part
of this approach is relapse prevention, which involves helping people to recogni:e
social, psychological, or physical triggers that precede substance abuse, and then
plan alternate response strategics.
■ Moriliarional inrert.1iewing was introduced in Chapter 7 as a way of engaging and
working with clients who are at different stages of change.
harm reduction: .-dlods wch as ■ Hann reduc.rion involves methods of reducing the damaging: effects of drugs with-
.edle e..dt;ange, ,-o,rams and metudcne
• IBt!flance, thal teduct die d3m--,: out requiring users to stop using: substances. The Centre for Addiction and Mental
etlects Of d:rug_s willlelut rtQuiting users to Health (CAMH) has strongly endorsed the value of harm reduction programs:
Sb:$ using subd&fl(tS. "There is evidence that programs that reduce the short.- and long-term harm to
substance users benefit the entire community through reduced crime and public
disorder, in addition to the benefits thnt ace.rue from the inclusion into mainstream
life of previously marginali:ed members of society. The improved health and func.-
tioning of individuals and the net imP3ct on hnrm in the community arc notable
indicators of the early success of harm reduction" (CAMH, Position on Harm
Reduction: Jts Meaning and Applications for Substance Use Issues). Examples of
harm reduction programs that have proved effective include needle exchange
programs and safe injection sites as well as others as per Figure 9 .2
■ Addiction medications arc now available and give physicians a wide range of
pharmaceutical supports for addictions treatment. Herc arc some of the most
common addiction medications:
■ Methadone maintenance replaces illicit opioids (e.g., heroin) with mcdic31Jy
prescribed and regulated methadone, a synthetic opioid. It has proven to be effec-
tive in substantially decreasing illicit drug use and reducing crime and violence
(Health Canada 20026; Ranaghi, 2005). Methadone maintenance is viewed as a
viable alternative for those who are unable to obtain the more desirable drug-free
condition. Buprcnorphinc (Suboxonc) is an aJtc.rnativc to methndonc.
► Safe lnjec1Klfl Sit es

--~-----------<
Ha1111 RN• ction Strmt:ies (e:u• pln)
,, Need le uchange
► Reduc:IKll'I of dtug use ,.. lxug substitutKln

(e.g. methadone)
► Safe,sex ,... Heroin maintenance
► Nal()l(Me ,... Vapor attemari...e to

cigarettes
s-- Decrimi na.liz.atKlfl ► Buddy System
Figure 92 Harm Reduction Strategies

SOURCE: lesztk e:zer,.,.ookal'Stlutterstock
300 Chap1er 9
■ Nn1tro:onc used to block the effects of opioids and alcohol.
■ Disulfiram (Antabuse) has been used for over SO 't'C3rs to treat alcohol addiction.
It works by making use.rs sick if they have a drink.
■ CampraJ is used to reduce akohol cravings, and it is now available in Canada.
■ Narcan is an emergency medicine used to treat heroin overdoses.
■ Smokers now have man't' different medications and nicotine replacements
available to help them quit, including patches. gum, wrcnidinc (Champix), and
bupropion (Zyban).
■ Anti-3nxiety and amidepressants can be used to treat co-occurring mood and
anxiety disorders. As well, many of these medications have demonstrated
effectiveness in rWucing cravings for some users.
■ Self-help progmm.s include well-established groups such as Alcoholics Anonymous
(AA) and Narcotics Anonymous (NA). These groups provide support and feJ,.
lowship for those who are working to become drug free (abstinence). Although
these group~ whic.h arc b3.sed on a twe1vc.-step program, are not appropriate for
everyone. they have proven effective for many people who are struggling with
addiction.
■ Re.sidemial treatment progmm.s provide intensive counseJling, including housing to
individuals and the.ir families. Residential programs can be short term (thrtt to six
weeks) or long term (up to two 't'C3rs or more).
■ A.uerrit.-·e Communiry Tremmenr (ACT) is a method of working with people who
have significant mental health or addictions problems. The model involves a
multidisciplinary te3m with 24/7 availability that is able to deliver services in the
community. The te3m provides service where the client lives rather than waiting
for or expecting the client to come to the agency office. The NationaJ Alliance
on Mental Health (2012) concludes that "ACT clients spend significantly less
time in hospitaJs and more time in independent living siruations. have less time
unemployed, earn more income from competitive employment, experience more
positive social relationships, express gre3ter satisfaction with life, and are less
symptomatic."
SUCCESS TIP
Supportlflg clients to stop Of reduce smoking has been Shawn to reslAt tn highef rates of
fecove-ry from othet addictions. Smoking during rec:ove-,y may incfease cr.1vings b olt'lef
subStance-s that were used together. (McClufe et al., 2015). Thi:S finding contr.1dic:t a Viklely
held belief that ciulttklg smOking threatens fecovery. Clients who stop smok~g have O\lerall
better geoor.1I health and imJ)fO\led financial status, which contribute to stress (eduction
thus iocfeasing strength f0t the chall,e-nge-s of recovery. Therefore, thefe is no r'e-a!.00 to delay
cessation unbl Olhef addictions afe addfessed.
Co-occurring Disorders
A co-occurrini disorder exists when an individun1 has one or more substance use c:o«eurri~ disorder: A1Efm us!d
to desuibe a situatia. ii whQ a person
problems and one or more mental disorders. For example, a person with schi:ophrenia
hu bodl a s.tlbstalltf use discwds and a
miaht n1so be addicted to akohol, or an individuaJ with bipolnr disorder might abuse Pi,Chiatric disordff.
sedatives. In fact, the individual might have more than two disorders; for example, he
miaht be addict~ to amphetamines but also have major depression and a pe.rsonalit)•
disorder. Cc>«t.'.'uTring di.sorders is the emerging term of choice. but the terms concurrenr

disorders and dual diagnosis arc also commonly used. The most challenging situation is
whe.re there is both 3 seve.re substance misuse disorder and a severe mental disorde.r.
(n these case~ high-level coordination of service pro\tidcrs (physicians, social workers,
menta.l he3lth profcssionaJs, and residential coordinators) is essential in order to provide
integrated intervention.
The Centre for Addiction and Menta.l Health (CAMH) reports that "studies show
that about half of the people with e.ither a mcntaJ he31th or substance use disorder have
had problems in the othe.r domain at some point in their life" (2009). Meuser, Noordsy,
Drake, and Fox (2003) reviewed the literature and found the lifetime probability of
someone in the general population having a substance abuse or dependence disorder is
about 17 percent, but for people with sc.hi:ophrcnia the rate jumps to 47 percent, for
those with depression the prob3bility is 32 pc.rccnt, and for those with bipolar disorde.r
the probability is 56 percent.
Despite the very high incidence of co-occurring disorders, historically it has been
very difficult for individuals with co-occurring disorders to get proper trentmcnt.
CAMH (2009) offers this ovc.rvicw:
When people with co-occurri~ subst21l« use and ment~I health problems seek help.
the tre:ument tht:)· rtte1\'t, is too o(ten directed 3t onlr one of these problems. Helpi~
clients to address one ke)' problem C3n sometimes start 2 process of thans..~ that ~-oes
on to h:t,'t, far,reachll,i positive e((~ts; other tunes this 3ppro3t.h does little to improve
clients' over.tll situ3tion. and 1113)' e\'en m::ake both problems worSe. To underStand how
we can best help 3 client, we need to look 3t th::u person 2s 3 whote. 2nd se,e how th::n
persoi, 's problem!l O\'ffl3p, di~uise, or ex3~er:ite one 300ther. Onl)' then Yi't, c:m bf-ain
10 offer help that is effect1\'t, (Treatirli Conrurrent Oisorden: Pre(2ce).
SUCCESS TIP
Best-practice sel'Vice fot people with ~cutring disordets te<iuites that tteatment for
their mental illooss and theit subStance abuse be olfeted at the same time by the same
counsellor. Asse-rtive community tteatment (ACT) rS a ptoven way to engage people in
tteatment 0t harm teduction.
SUICIDE COUNSELLING
The American Association of Suicidology (2009) describes suicide as a permanent
solution to a temporary, trc3tablc problem. Suicide intervention is crisis counselling
that requires counseJlors to assess the immediate risk (sec Figure 9.3) and inte.rvcne
to prevent their clients from completing the suicide. This challenges counsellors to
rapidly establish a supportive relationship. Active listening slcills arc cruciaJ, for unless
suicidaJ clients can be convinced that the counsellor is gcnuincJy interested in their
wcJforc, they ma)' cut off communication. In Canad3, it is not illegal to attempt sui.-
cidc, but aiding or abetting suicide is an illcg3J 3ct. Table 9.5 provides some facts about
suicide in Canada.
Warning Signs and Risk Assessment

\Vhilc there is no assured wa)' of predicting that a person will attempt suicide, there
arc some important warning signs: threats of suicide, history of attempt~ mcthodol.-
ogy, stressors, p,ersonaJity factors, alcoholism, social supports, and gender and demo--
graphic variables (American Association of Suicidology, 2009; Centre for Suicide
302 Chap1er 9
Mental
Disorder/
Illness
Figure 9.3 Suicide Risk Factors

-
Sao:illllJ
TABLE 9.5 Suicide: Canadian Facts

• In canae1a, the ktlown annual suicidal death rate (all ages) is abOut 17 per 100, 000 for
males ar\CI 5.5 per 100, 000 for females. Ovetall. almOst 4,000 people a year die by sui-
ci:1e, but the real figure may be much higher due to underreporli~.
• In 1999, suicide was the leadi~ cause ot death for l.ndigenous people up to age 44.
• Suicide accounts for 38 percent of deaths amoog l.ndigenous youth.
• Men complete suicide at a rate of four times that of women, vd'lere.as women attempt
suicide at a rate of four times that ot men.
• Men are more likety than women to use lethal metho:Js (e.g.• guns aOCI hangJ.ng).
• Physk.al mooss is estimated to be a contributl~ factor in up to 50 percent of suicides.
• Approximatety 40 percent of people whO have completed a suicide have made a preWOus
attempt.
• Some drugs can produce depression that leads to suicide.
• The death rate from suicide is higtier than the death rate from motor vehicle accidents.
• The suicide rate for persons maJ"fied with children is aOOut hatf that of never-married.
single people.
• The suicide rate for persons uOCler psychiatric care is 3 to 12 times that of no~palients
(over 90 percent of people whO die by suicide have a mental disorder, usually a mood
disorder). Key risk factors are subslance abuSe, depression, personality disorders, aOCI
sct-.zophrenia.
• The suicide rate is higher a ~ people wtlo are unemplO)'ed, and it increases with
economic recessions aOCI depressions.
• Higrl-risk groups are mate physicians (whose rate is two to three times that ot the general
male poplJatioo), dentists, musicians, law enforcement offters, lawyers, and insura~
age,,IS.
SolN'ces: American Association of Suicidology, 2009: Centre for Suicide Pre\lffltion, 2009: He.atth
Canada. 2002.a: Saddoc:k .and Saddock. 2004: and Statisaic:s Canada. 2012a.

Prevention, 2009; Harvard MedicaJ School, 1996; Saddod: & Snddodc, 2004; and San
Francisco Suicide Prevention Jnstitute, 2009).
Threats of Suicide C lients who mile about suicide, or who appear preoccupied with
dC3th and dying, should be considered at risk. Research has shown that eight out of
ten suicidal persons give some sign of the.ir intentions. Sometimes the clues are de3r,
such as when clients direct])• thre3ten to take their lives. At other times, there are only
hints of suicidal objectives, such as giving awa't' possessions, making finaJ arr.m,;ements
(e.g., expressing wishes for the.ir funeral, writing a will), or involving themselves in
increased risk-taking behaviour. Threats of suicide and other warning signs are a cry
for help. and counsellors should talcc them seriously.
History of Suicide Attempts About 30 to 40 percent of people who commit sui.-
cide have made a previous attempt, and about 10 percent of those who attempt suicide
succeed within 10 years. But eight to ten times as many people make a suicide attempt
as those who complete it (CfcW\orn & Lee, 1991: Harvard MedicaJ School, 1996);
however, it is lilcdy that the number of completed suicides is underreported, since in
some cases what appear to be accidenmJ deaths are, in fact, suicides.
SUCCESS TIP
LOok at suicide warning signs as an invitation to communicate.
Methodology As a rule, clients who have a specific plan and a lethaJ method for talc.-
ing their lives are at greater rislc than those who do not have such a plan and method.
Moreover, the more developed the plan and the greater the potential lcthalit)' of the
proposed method, the greater the rislc.
Certain drug~ such as antips)•chotic medications, sleeping pills, antidepressants,
and analgesics (such as ASA), are aJI potential overdose drug~ cspcciaJly when taken in
combination with other drugs.
Stress Clients who are current1,., coping with significant stress, such as a de-3th,
divorce, spiritual crisis, or loss of job, money, status, sdf--confadencc, or self-esteem, are
at greater rislc. As weJI, a recent medicnJ illness may be a factor. About two-thirds of the
clients who commit suicide have seen a doctor shortly before their death (Hirschfc]d
& Russell, I997).
Personality Changes Counsellors should explore whether there have been
recent and drastic changes in their clients' usual manner. Changes such as social
withdrawal, sudden changes in mood, loss of interest in activities that previously
gave them pleasure (sex, work, friends, family, job, and hobbies), increased sub.-
Sta.nee abuse, changes in sleep p3tterns, and loss of interest in persona] appcarance
ought to be closely assessed. As well, counseJlors should look for signs of depres..-
sion, apathy, anxiety, and general pessimism about the future. Not all suicidal people
are depressed, nor are all depressed people suicidal. Some people contemplating
suicide ma)' seem at peace, even euphoric; however, depression is a signal to counscl.-
lors to assess suicide risk.
Alcohol Addiction Rese3rch has shown that people who are addicted to akohol
have an increased risk of suicide compared with the gencraJ population. As many as
IS percent of people addicted to alcohol commit suicide, and the suicide rate for
people who are heroin dependent is 20 times that of the ,;cneral population (Saddock
& Saddock, 2004, pp. 391 - 392).
304 Chap1er 9
Gender and Demographic Differences \Vomen attempt suicide three or four rimes
as often as men, but men tend to use more leth:.d mcthodsand account for 7.S percent of all
complcco:f suicides (Statistics Camlda. 2012a). High-risk groups include those with a men-
tn1 disorder, young people, seniors, lndigt-nous people, homosexual~ and those in prison
(Health C3nnda, 2002a). The hiW)est suicide rates for men are in the ~54-'t•ear-old group,
with about 25 completed suicides per JOO, 000 of population, but the rate rises after aJ;e
65 and peaks for thoseove.r 90atabout 33 per 100,000. For women, those at most risk arc
in the 40-54-,.•car-old age group. with an ave.rage of 9 completed suicides per 100, 000 of
population (Statistics C3nada, 2012a). Suicide is also a sc.rious problem among youth. In a
survey of 15, 000, Grade 7 to 12 srudents in British Columbia, 34 percent knew of some.-
one who had attempted or died by suicide:; 16 percent had seriousJy conside.ro:J suicide;
14 pc.rcent had made a suicide plan; 7 percent had made an attempt; and 2 percent had
required medical attention due to an attempt (Canadian Children's Rights Council, 2012).
Suicide Intervention The counselling principles discussed in this text form the
basis for working with clients who are suicidal. Suicide intervention can start with
the assumption chat the person is ambivaJent. The fact that the person is still alive and
rcuhing out for help is a positive indicator chat part of him or he.r wams to live. The
strategics described subsequently provide a basis for intervention that may help to tip
the scale in favour of living. Table 9.6 dispels some common myths about suicide.
Active Listening This skill cluste.r, particularly empathy, crc11.tcs safety for the client
to express and explore feelings. Counsellors must resist any impulse to moralize,
give advice. or judge. which might create a danae.rous power struggle. Active listening
communicates to clients that they are not alone.
Risk Assessment Although no counsellor can determine with certainty whether a
client will cry to commit suicide. knowing about and exploring risk factors is essential
for intclliJ;ent intervention. As described ea.rlier in this section, some of the key risk fac-
tors that counsellors should consider include past attempts, current menmJ and physi-
cal status, the presence of a \tiable plan, the means to kill oneself, mlk about suicide,
personal losses, efforts to put one's affairs in order. and substance abuse. Counsellors
need to explore these variables in a calm, nonjudgmental manner, without moralizing.
and offe.r support and empathy throughout the process. To assess the potential lethal-
ity of a plan, counsellors should investigate factors such as the lethal potentiaJ of the
suicide method (e.g., time between attempt and likely death), the extent to which the
person has access to the means (e.g., presence of a gun or sleeping pills), and the pos-
sibility of discovery and access to rescue. Protective factors should also be considered.
Strong spirirual beliefs and a social suppon S't'Stem, including a positive relationship
with the counsellor, are strengchs that should be mob ilized.
TABLE 9.6 Suicide Myths

M,.,. Fact
Sut ide occurs without wafni~. Thefe are warnrng signs abOut ~ percent
of the time.
People wtlo lalk abOut suicide afe 001 This is a cry for help tr.at. if ignored, may
s«ious aoout killing 1oomsetves; they afe result rn a suicide attempr. The attention
just ttylrlg to get attention. they need is to be listened to.
Asking abOut suicide may put the idea k'I Tar.king aoout suicide .-. a calm. sup(X)rtive
someone's mil\CI. way (educes isolation and gives people
a d'lance to 1ar.k aOOUt their despaif. Not
talking abOut it may iocfease the risk.
SolN'ces: Canadian Assoc:iatKll'I for Suicide Pm,entioo, 2009: Oakville Disatess Centre, 20 12.

SUCCESS TIP
A question such as "What has prevented you fr'otn killing yourself so faf?" can be a powerful
lead to uncovef pfotective factors and cop.-ig strengths.
As k the Inte nt Question Counsellors nttd to overcome :.my reluctance to ask clients
if they have consider~ suicide 3S a solution to thc.ir prob lems. Asking about suicide
will not plant the idea in the client's mind. In fact. bringing the issue into rhc open can
relieve clients of the stress of trying to hide their intent, whereas avoiding the topic
increases feelings of isolation and hopelessness in the suicidal person. A counscllor
should always take sc.riousl't' :.my vc.iled or vague comment about suicide. \\:fhen clients
make statements such as "Sometimes life doesn't s«m worth it," a follow-up question
such as "Have you thought about killing )'OUrsdfl" should be used to put the issue on
the discussion cable.
SUCCESS TIP
Consiclet routinely asking the intent question "Are you thinking abOut killmg you(seltr
whenever- you are dealing wrth d ients woo are depressed 0t dealing wlh a etisis in lheir lives.
Crisis Intervention Counsellors have a rcsponsibilit)• to prevent suicide once the diem
makes this intent known. Crisis inte.rvcmion strategics may include the following:
■ Removing the means of suicide from the client (e.g., flushing pills down the toilet
and confiscating guns). This prevents clients from acting impulsivc1)•.
■ Negotiating plans for the next step: This plan should be very concrete and detailed,
outlining e.xact]y what the client will be doing. hour by hour. until the next contact
with the counscJlor. Some counsellors use a "no suicide" contmet, which involves
an agrttment that the client will not hurt himself or herself until the next contact
with the counscJlor. when a new contract may be negotiated.
■ Decreasing isolntion and withdrawal: For many clients, ta.Jking about their problems
with a counscJlor is sufficient to reverse the drive to suicide. In addition, counscJlors
should make every effort to recruit capable family members or friends to be with
the client through the crisis phase. For the.ir support to be helpful, the client must
perceive these people as credible and supportive. They ma)' need to be available on
a 24n basis during the crisis period.
■ Emergency hospitalization: All jurisdictions have mental health legislation that
defines when clients can be hospit3li!cd. Typically, imminent risk for suicide is a
compelling reason for involuntary hospitaliz3tion.
■ Address cnvironment31 strcs.sors such as harassment and bullying: In late 2012,
Amanda Todd, a IS.year-old British Columbia girl killed hcrseJf and left a strong
video mes.s3gc on the Internet detailing her continued harassment and cyber•
bullying by her peers. Subsequently, her case received unprecedented intern3,.
tional attention. The b ullying was not the only factor le3ding to her death, but
it dearly contribut~ to her fin31 decision to take her own life. Amanda's death
underscores the responsibility of counsellors, particularly those who worlc with
youth, to uplore and attempt to remedy problems such as bullying. Clearly,
youth counsellors need to be willing to t3lk to youth about depression, suicide,
3nd bullying.
306 Chap1er 9
Suicide Relapse Prevention The lon,;-term goal is to address the circumsmnccs th:.n
led to the need to make a suicide attempt. This might involve counselling or medication
to trc3t serious problems such as depression and other mental disorders, addictions. or
uncontrollable pain. Advoc3cy and support can help alleviate the stress of unemploy-
ment, homeJcssnes~ and bullying. Cognitive behavioural counselling C3n be useful as
a way to hclp clients deal with issues such as low scJf-esteem, as well as controlling and
managing emotions and seJf-Oefcating thinking patterns.
SUMMARY
■ The Diagnostic and Siarisriail Manual of Me-ntal Disorders (DSM) is published by the
American Psychiatric Association to guide psychologists, psychiatrists, and other
psychotherapists who use it to classify and diagnose mental disorders. It uses a
multiaxial system-a comprehensive cva.Juation S)'Stem that includes not only mental
disorde.rs bur also medical condition~ psychosocial and environmentaJ problems, and
an assessment of a client's overaJI lcvcJ of functioning..
■ Major menmJ disorders include schi:ophrenia, a serious mental illness that results in
a range of symptoms, including haJlucinations. delusions. disordered thinking. and
social isolation; mood disorde.rs such as depression and bipolar disorder; anxiety di~
orde.rs such as obsessive-compulsive disorder {OC0), phobias, panic disorder, and
post-traumatic stress disorder (PTSD), which are characteri.!ed by greate.r than normaJ
levels of fca.r, ''"-orry, tension, or anxiety about daily C\'Cnts, or aru:iet)• without appar-
ent reason: eating disorders such as anorexia and bulimia; and personality disorders.
■ At any given time, as many as 14 percent of children may be dealing with a significant
mental heaJth problem, which can compound devclopmemal challenges. Unrreated
memal illness in children cnn le3d to an increase in suicidaJ behaviour and addictions.
■ Substance use disorders may result in dependence, withdraw3J, and serious disrup-
tions to work, social, and family life as well as leg3J problems.
■ A co-occurring disorder is present when the individual has one or more substance use
problems and one or more mental disorders.
■ There is no certain way to prtXlicr that a pe.rson ma)• attempt or complete suicide, but
certain warning signs and risk factors cnn be considered. The principal risk factors
include past attempts, current menta1 and physicnl status, the presence of a viable plan
and the means to kill oneself, taJk about suicide, pcrsonaJ losses, efforts to put one's
aff3irs in order, and substance abuse.
EXERCISES
Sett-Awareness c. Someone has IOSt a job.
I. If you were responsible for defining mental illness, how d. You or someone in your family has an eating disorder.
would you define it? e. Someone you kOON carries out suicide.
2. E.xptore hOw you and your family 0t friends might react to
3. Examine your own attitudes and beliefs. abOut mental
the fOUOwing events and situations:
illness.. How have you( values been Shaped by personal
a. You or someone etse haS a mental ilnes.s. experience? By the media?
b. You or a member of you( family is HIV.positive O( has 4. Should counsellors. be tequired to p,-event clients in
AIDS. advanced stages of fatal illnesses from ktlling themsel\ies?

5. How can you manage you( own oogative feelings that might is sexually ~ucusaoo uses al'l'j str'OOt drug available.
be triggered when you afe working ~th clients wtlO have When aSked abOul het cutting. She says, · 1 don't know
pel'SOOaffly disor'del"S? why I dO IL It just feelS good. It makes Ille pa;n g,, 21N3y."
6. Under- what conditions do you think a pel'SOO with a mental What might be an appropriate role for a community-based
diSOr'det SOOUlcl be forced to treatment? chik:I and youth ca,e counseuor on the multidisciplinary
team in each case? What additional information would
Skill Practice you r\OOd to devetop a case plan ftom a child and youth
1. A client asks you to ex.plain his o, hef diagnosed mental counsem~ perspective?
diSOr'det. What migt\t you say? Assume that the dOCtOr' has 5. Imagine that a client is Showing some of the signs of a seri-
totd the client very little aoout the nature of the disorder. ous mental Utness. Brainst0<m different W¥ to addfess
ROie-piay youf response with a coueague. Pl'actise your this. Assume your goal is to motivate your client to Seek
tesJX)nse using different mental disorderS (e.g., sd'lizo- assessment and treatment. What are some of the different
phreoia, depfession, and 00fder1ioo pe,-sonality disor'der). responses you might expect to hear from the dient?
2. Clients with perSOOality disorder"S might d'lalleoge you with 6. A person reveats that he is thinking of suicide. He asks that
pr·ovocative behaviouf sud'I as: you promise not to tel anyone. How ~ t you fespond?
a. Missing sessions 7. Pr'ilctke askrlg the intent question with student cOleagues.
b. Jumpi~ from etisis to cii:sis 8. You are a youth cafe counseuor WOr"ld~ in a high Sd'IOO.
c. Open disptays of anger or par'anoia Recently, one of the grade 11 students kitJed herself. In an
d. AAti--authOritart.an attltudeS Internet JX)Sti~, She detailed hef depression and a long
history of being s.ubfeel to cybefbulying. You have been
e. Dependency
asked to participate as part of a team to develop a bulyi~
Suggest suategy choices for dealing with each of these and s...Cide prevention program for the schOOI. Desctibe
behaviours: the JX)lentt.al role tor youth cafe WOrkerS in such a protJam.
3. Practise a suicide intervention interview with a colleague 9. Suggest counselling options lor WOrki~ with dients who
whO playS the tole of someone whO is contemplating sui- have Mnegalive symptoms• associ".ated with psychosis.
cide. Tty to complete an assessment of risk and protective
10. Discuss the counselling imi:,ications of the use of cannabis
factorS. Al an appfoprlate JX)int in the interview, aSk the
among young teens.
intent question.
4. Imagine that you are a youth worker (community baSOO) Concepts
whO is working as par1 of a multidi!.ciplina,ry team with the 1. Why do people stop taking theif psychotropic medication?
fOUOWing clients: Describe what a counseltor migt\t s:¥f to a client who refuses
• Neema. age 7, goes from being comptetefy carm to to take Of appearS to be off his medication.
blindfy running, screaming, and hitting anyone in his 2. Scan magazines to identify feature stories highlighti~ diet-
path. He's triggered by changes in his enviforunent, i~ . Discuss how these might have an lfflpact on feadets.'
even seemingly sman and insignificant sttes.sOr"S. self-image and behaviouf.
• Rebec:c:a, age 10, throhS herself on the ground as soon 3. Imagine that you are a counseltor wol'ld~~th a 21-year-del
as She entel"S the schoolyard. She clings to hef mothef, woman wt'loas.kS you to ex.plain what tx>rderltne personality
begging to be taken hOme. disor'det means. What migt\t you say? Assume She has been
• Emtfio. age 12, loves wl"3pping ptastic bags around his diagnosed 'Mth it, bul her dOCIOr' has told her little abOut the
penis and mast...bating during class. Hi.s beha!Jiour was nature of the disordef.
so disruptive that he needed to be placed in a special 4. Rudy has a history of serious depfession. During a recent
ctass .rNay from Olhef students. visit. he seemed unusually ·upbeat.· He took the opportu-
• Naslffl. age 9, poured gasoline on the family cat, and nity to thank you tor all yout help. What might be happeni~
then lriecl to burn the hOuse dONn. for Rudy?
• Pierre, age 1S, was intrOduced by the teacher to the resa 5. This chapter descr'ibeS persoMlity di:sO<ders as "stable
of the ctass. She jumped on the deSk, pretandrlg that ins&ability.• What does this mean?
She had a gun, screaming obseenities and threatening 6. In what specific ways might street dfugs Msetf-medicate·
to ki\J everyone. mental diSOr'det'S?
• Pi«re, age 9 , is preoccupied with arta~~ the bOOks 7. S<,gge<t how answe,s to the Question "What has kept you
and mater'iats at his work desk to the point that he from killing yourself so fa,r migr\t be used to assisl clients.
cannot e•ge with dass activities.. 8. Discuss why there is societal (and often self-imposed)
• Pari. age 18, is ptOOO to intense emotional feactioos. stigma attached to havi1"€; a mental disorder, while no stigma
When stressed, sOO threatens suicide Or' cuts herself. She is attached to having a physical disease sud'I as diabetes.
308 Chap1er 9
WEBLINKS
The Centre for Addiction and Mental Health (formerly, the Canadian Association for Suicide Pre"Yention
Clafke Institute of Psychiatry and Addictions Research f oun- http:/Jsuicideptevention.ca
dation) has resources on addiction and mental health issues
Mental Health first Aid Canada
www.camh.ca
http://www.mentalM.althfirSUiid.c.alen
The Centre for Suicide Prevention is a Canadian-based organi-
zation providing info,mation, training, and r~c:h on suicide Mental Ht.alth Commission of tanad~ strategy for ave-hauling
canada's mental health system
http://$uicide1nfo.ca
htlp:/Jst,ategy.mentalhealthc-0mm1sst0n.ca (then $earth for
The Public Health Agency of canada has c-amprehensive Changing D1recbons, Changing Lil,ies)
re-pods and information on ment.al illness in canada
The National Institute of Mental Health piovides information
www.phac-aspc.ge:.calpublicathniic-mmac/index.-eng.php
on mental health medications, including known side effects
The Canadian Mental H~lth Association has fact and info,ma- www.n1mh.nih.gov/health1publications/mental-health-
tion sheets on a wide range of mental health issues medicationskomplete-1nd&.Shtml
www.c:mha.ca
The pros and cons of marijuana
The American Association of Suiddology is a leading source httpsd/med ic.aIma1ij uana➔ procon.orgA, aew.1esou1ce.
of information on suicide php?resourcetD:000 141
www.suicidology.org

Osmanpek33JShutterstock
■ Define culrural imellig:encc.

■ Understand the Canadian multicultural mosaic including the diversity of its'
citi:ens and the challenges faced by immigrants, including the impact
of oppression and racism.
■ Describe the key cJemems of cultural understanding.
■ Explain the basics of multicultural counselling.
■ Demonstrate knowledge of skills and attitudes necessary for w-orking with lndig•
enous people.
■ Describe the importance of spiritua1it)• in counselling.
CULTURAL INTELLIGENCE AND DIVERSITY:

WORKING WITH COMPETENCE
Competent counsellors don't just tolerate or accept diversity; they welcome and value
differences. By w-orking to achieve empathic connections with their culturally different
clients, counsellors arc best able to position themselves to respond dfcctively to clients
310
with a d iffercm w-orldview. According to Arthur and Stewart (2001), to achieve k nowl-
edge about the factors that sh3pe their client's worldvie ws,
(c jounselJors need t'O possess knowl~e about the historr, v:ilue!l. and socidili.::1tion pr:,e.
tkes o ( ruh ural aroups within Can::.cli:m society, and how t heir herita~-es,. includlfl¥ the
socio-political issues (::.dna these aroups. nuy h:t,'t, influenced their person.31 and sodal
de"eloprnent .. . . Cultural imowlediti' includes infornution about the d ient's ruh ural
roots, values, per«.ived problems and pre(erred inter\'e:nt1ons.. as v.--etl as an)' Siifllf'.e2nt
within aroup dl\'n'Sit)', ind udina d1((erina le"e.ls o( socioeconomic s tatus. :)C'('ultura11on
and raei.:11L-identity commitment. (p. 7)
Table JO. I o utlines cultural im e.lligcnce competencies for Can adi3n co unseJlors. Cultural Intelligence: Theatilityto
These co mpetencies en compass the co re beliefs. knowledae, 3nd skills that 3re essenti31 adapt • d integrate sli11, kflCMtedge. and
attitds tonsislEGI witil; the Qlure of
for working with C3nada's multicultural community. Un der ideal conditions, clie nts dients.
C3n receive service fro m 3gencies and ,vo rkers from their own co mmunities in their
°"'n (3nauai;e. In lari;:e urban areas, this m3y be possib le for some groups, but mo re
o ften mino rity group clie nts must engai;e with mainstream agen cies, but o ften these set.-
tings arc structured to meet the needs of the domin3m culture. The reality o f C3nacfa 's
diversity 3nd increased se nsitivity to the needs o f diverse gro ups h as resulted in m ove-
ment, albeit slow, to reorg3ni:e agency structure, po licy, and staffing to become mo re
inclusive. As pan of th is transform3tion , all co u nseJlors n eed to pursu e d eveloping
their c ultural intelligence.
TABLE 10.1 Profile of a Culturally Intelligent Canadian Counsellor

Skills ✓ Adapts counselling skins and procedums to be consistent Vitth the
needs. values, and healing pmctices of different groups
✓ Utilizes resou,ces, people, and counselling sup(X)rts from 100 client's
own community
✓ 1ntt!3'ates cllhx ally approp(.ate spitituality into counselling practice
✓ W0tks from an anti-oppressive, strengths-based phitosophy
✓ Prevents stereotyps"lg by tieaming abOut the lf'ldividuality of each d ient
knowled&e ✓ Explores tne cultur'al values, beliefs, customs. and wOr'lcfviews ot clients
✓ Undefstands the dynamics ot powe, and privilege enjoyed by dominant
culture
✓ Recogni:zes that minority groups are often the 1argets of opp,&SSion
✓ Awa,e of 100 oppression lhat Indigenous people, minOr'ity groups
and immigrants have faced while valulf'lg lheir inherent strength and
res~nce (e.g., Residential SchoolS, Japanese inte-mment. and job
diso'imination)
✓ Appreciates 100 sacrifbls inmigrants and refugees have made i'l lheir
jou,ney to canada in Ofder to escape per!.Onal, retigtous. Or' JX)litk:al
oppression
Values/Sett• ✓ Alerl to monitoc hoN one's own culture. values., and beliefs might lead
awarenes.-S to bias and difficulty making empathic connections with olherS \\tlo are
diffemnt
✓ Honours diverSity as a JX)we:rful force for unity
✓ Values 100 im(X)rlance of French language and culture to canacfian
identity
Behaviour ✓ Makes multicul ur'al compete-nee a prior'ity fOr' personal and prolessional
devt'IOpment
✓ Open to hearing the lf'ldividual stoties of cllturalty diffefent clients
✓ Oev8ops friendShips and inVOlve-ment with individuals and groups from
drverse communities
✓ Advo:.ates on behalf of minority g(oup clients
Cultural Intellig ence 311

The Importance of Multicultural Involvement
Books, films. courses, and seminars can be invaluable sources of inform3tion for coun.-
scJlors in their quest for cultural sensitivity and understanding. These tools can greatly
d~pcn intcJlecrunJ knowledge and awareness about cultural customs and variations.
They arc nlso important for stimulnting thought and broodcning knowledge about diver..
sit)•; however, counsellors also need to embrace c:x~riential learning. MulticulturaJ
events, travcl, and visits to wrious churche~ S)rnagogucs, and other places of worship
will expose counsellors to the subtleties of culture, including the wide variations in
style and practice that exist within various groups. Multifaith calendars c:m be u~ as
a starting point to learn about the religious holidays and festivals that different people
celebrate. Cultivating multiculrural friendships 3nd involvemc:m in multiculrural org-a,.
ni!ations help counsellors broodc:n thc:.ir worldvic:w, increase: their tolerance:, and IC':3.rn
about the: many different ways to make: sense of the: world.
Cross-<ultural o:pc:ric:ntinJ IC':3.rning exposes counsellors to the: reality that the.re 3re
m3ny diffc:.rent wars to view and solve: the S3mc: problem. But achieving cross<ultuml
compete.nee: is diff,cult, perhnps impossible, if counsc:Jlors remain pc:.rson3Jly isofoted
within their O\\'n culturaJ community of friends and family.
In addition, contact with different cultures provides opportunities to rehearse
ad3ptivc: functioning skills th3t help us survive: in the: diversified global village: of the
future. By lc:3rning to work with those: different from oursc:lve~ we learn that we C3n
develop the: facility for working with future cultures thnt we: do not rec know (Pc:dc:rsc:n,
2001, p. 20).
THE CANADIAN CONTEXT: CULTURE

AND DIVERSITY
Despite: being the second f3rgc:st country in the: ,vorld geographic31ly, with an arc:3 of
almost 10,000,000 squ3rc: kilometre:~ C3nnd3 is one of the: most sparsely populated,
with the: bulk of the: population of 3bout 37 million (2018 estim3tc:) residing within
300 kilometres of the: United States border, 3nd more than 50 percent living in four
m3jor metropolitan cc:mrc:s. C3nada is lari;:c:r than Chin3, rec has less than 3 pc:.rcc:nt of
Chin3's population. Can3da h3s six different time !ones and shares 30 8891 kilometre
east- west border with the: United St3tc:s. C3nnd3 has nvo official languages (French and
English), and all off,ci3J govc:.rnmc:nt documents must be: published in both 13nguages.
Can3da's multicultural mos3ic is defined by the prc:sc:ncc: of do:ens of different
cultural and l3nguagc: groups, each of which brins:,s their own traditions and bc:Jic:fs
to the: Canada's collc:c:tivc: identity. Below is a quick snapshot of Can3da's ethnic and
religious divc:.rsity:
■ Can3da h3s a higher proportion of immigrants th3n any other G7 country.

■ In 1971, C3nada adopted 3n offici31 policy of multiculturahsm. This was followed
by the 1982 Charter of Righu and Freedoms that protected multiculturalism.
■ Over 20 percent of Canada's population arc: immigrants (80% of whom live: in
Can3da's six largest cities) with over 200 languages spoken as chc:.ir mother tongue:.
■ Among Canadians, approximately 66% identify as Christian; 3.2 % as Muslim;
12.5% 3S Hindus; 1.4% as Sikhs; 1.1% as Buddhists; 3nd 1.0% as Jewish
(Statistics Canada, 2018; Can3dian Popul3tion, 2018).
The: diversity of Can3da 's population goes beyond culture, langu3gc:, and religion
to include: a wide: range of variables that define our diffc:.rencc:s, including age:, gc:ndc:.r,
economic smtu~ sexual orientation, and marit3l smrus. Figure 10.1 presents some of the:
3 12 Chap1er 10
TOO etl'le(gent faet:t of cultural neuf~ienice has found dWferent activity (Han, 2015). Put simpfy, 1wo people from dM!fgent
brain activity amMg cultural grwps. F'Ot example, tnere are sig- cultures may behave, think, and lool in very di:ssimHar ways,
nificant diffe(ec-ces in neural activity i"I areas su:::tl as pain pet• with ul'!Klue neural i;:athways fn'lg f0t each. The simi;:ie tn.ih is
cepUOn, visual pe-rce,::tion, face recognifion, and rest.lg state that culture shapes how one views and interacts with tne WOrkS.
--
CUIGllll.ad
Communication
-
Slyle. •
relalionship
preferences. and
o f coooseUing
Figure 10.1 Selected Elements of Diversity
many cJements of d iversity. Table 10.2 defines some of the k~• te.rms th3t counseJlors
should understand when workina within Can3da's multicultural environment.
Diversity defines and unifies the country. T h roughout its history, the people of
Canada have m3intained 3 commitment co d iversity. Amona nations, Canada h3s
3cquircd a leadership role 3S 3 model for diversity. The country's receptivity to diver•
sity is reflected in a b road range of federal and provinciaJ lejpslation. Concurrently, the
Canadian workplace itself has come to realize 3nd r«ogni:e the value of d ive.rsity 3S a
desirable g,c,al for o raani.z3tions. This perspective was underscor~ by Prime M inister
Trudeau ccJebratingCanad3's Multiculruralism day:
To<:fay, C3n::.di.:ms from coast to COc:lst join t'O$:etllt-r to celebrate the multintltu~lism
~md openness that 1nak.e us who we- are as a count q•. C a.n::ltlbns rome from e>.'e?")' rorner
of the world, speak two o(f"iei.:111 la~u::t:~s 21nd hundreds more. praetice nun)' faiths.
21nd represent nun)' rultures. Mu1t iculturahsm is at the- he::lrt o( Ca1Uda's herit~'C' and
identity- and as C a.n::.di21ns. we ~1i:c- th:n our diffc-renus m3ke us st ron& (2017).
SUCCESS TIP
The importance of avcid,ng ster-eorypes needs to be emphasi:zed. 1.ndividuals of any group
Or' cl.Alure may or may not hdd 10 lhe ~1ues and customs of tneir' group. Some adhere com-
i:,etely, whtle others may be assimilated into lhe mainstream society. Never assume from
physk.al appearance lhat the perSOO was bOrn outside canaoo, speakS a foreign language,
Or' adheres to the cutture that he or she appears to tepresent.
Cultural Intelligence 313

TABLE 10.2 Selected Definitions
• Aborftfnal: first Nations. Met.is. or Inuit peoi:,&. (Note: Indigenous is rcw the preferred
term.)
• Acculturation: The process b-f wtlid'I people adapt and blend in with a different culture.
Cultwal app,oprlatlon: 80frowing, adOptiog. or distorting elements of an01oor culture
inapprOl)riately or in a way lhal is disr'espectflA.
Cultwe: How people defW'le themsetwies; may include Shared behaviou'al pattems \\1th
mspecl to fOOCI, lhe arts, CUStol"RS. ritual, identity, and tr'aditions.
Cultwe shock: DiSOrienting and stresshA physical and psyd'IOIOgjcal re3C't.ions to a new
culhxe lhat may include depression. homesickness, and teermgs of helplessness..
Diversity: The vast range ot differences among us, including such variables as age, gender.
race, economi: s1atus, sex.ual orientation. religtous/spi.ritual beliefs. ethntity, marital sta
4
tus, atilities, and language.

Ethnicity: Shared components of race, language, customs. and religion.
Ethnocentrism: The belief that one's values. beliefs, and traditions are inhefently supetioc to
those ot Olher'S.
first Nation,: Status and nonsaatus Indian people.
Immigrant! A pefSOO from another country whO has been accepted by the C3nadian gov-
ernment as a pennaoont tesidenl
lndlaenoYS pe0ple: Ol'iginal residents of NOl'th America lncludl"lg their decendants..
Indian Status: The siatus enjoyed by peoon ,ecogni:zed and registered undet the Conadian
Ind/an Act lot a mnge of g(M?rnment pl'QWams and ser-vic:es as well as certain land, hunting.
ftShiog. and monetary rights.. Precise treaty ~ts differ amoog the various Fir'S'l Nations.
lndlaeno• or Ab«lalnal u lf-aovem111ent: Gove-rnance designed. estabished. and adminis-
te,ed by lncUgenous people.
LGBTQ: Lesbran. gay, bisexual, transgender. and queer community.
Ma,glRalizatJon: Fonnal Or' informal exclusion of groups o, indivi:fuals from fuU participa-
tion in society.
Non-Status IOOlans: Persons who have Indian ancestry and tetain theit Indian identity but
have IOSI their le-gal status under the Indian Act.
Norms: Shared expectations regarding wtlat is accep&able sud'I as clothing, greeting rou-
tioos, maMers, and eye contact.
Ptefudice: Oisem~ment and denial of rights of others based on memberShip rn a
group.
• Race: Group of people Vitth similat skin tone and fadal chafaCte(ISlic:s (Note: the concept
of mce is a social consarucL not a biolog'k:al reality based on disc,eet genetic diferences
among people).
Racism: Oppr&SSion and discrimination based on taCe.
Retuaee: A pefSOO offered prOlection by the Go...ernment ot canada bec:ause of a justified
fear of persecution in his o, her counby.
Wofldvlew: Beliefs that are 100 foundation for 100 meaning people attribute to the wortd,
themselves, and life.
Xenophobia: F'ear. suspicion. Or' distrust ot people who are different o, foreign.
AlthouRh we share co mmo n hum3n values and need~ we arc uniquely different.
Some differences such as skin co lour, gender, age, race, height, weight, 3nd o ther body
c haracteristics 3re dear ly visible. Other differen ces such 3S scxu3J orientatio n , religio us
affiliation, a nd eco no mic status are less obviou s.
SUCCESS TIP
Counsellors have a responsibildy to acfvoc:ate for systemic change to reduce opptession and
the misuse of po.ver, and improve clients' access to services and resources.
314 Chap1er 10
Canadian Immigration
Canadian art and community celebrations mirror the rich diversity of its citizens.
Throughout the year, fcstivnls, religious ceremonies., and various cukuraJ events pro\tidc
people with opportunities to honour thc.ir own hc.rimi;c and mkc pan in the ceremonies
of others. But this has not always been the case. Until 1968, immigrants to Canada
were largely of European ancestry. The lmmigmrion Acr of 1968 replac~ criteria for
entry that were perceived as racist. As a result. the ratio of visible minorities among
immigroms ch:.mJ;cd from less than I percent (pre-1960) to more than 7.S percent todtt)'·
These changing demographics have ch.allc:ngo:I aJI institutions, including soci3l service
provider~ to re-examine their structures, philosophies, and service delivc.ry methodolo-
gies. Even the theoretical basis of counselling practice is under pres.sure to become more
culturo11)• sensitive to the diverse worldviews of the client population.
Immigration policies in the latter part of the twentieth century increased the need
for counsellors to develop skills to relate to incrc3singly heterogeneous ca.scloods. ln
fact, typical counselling caseloads in Canada are characterized by diversity in terms of
culture, age, race, gender, and se>.."Ual orientation. lt is a certainty that counsellors will
worlc with clients who have different culturoJ b3c.kgrounds from their own. Canndian
census data reveals that over 20 percent of Canada's people we.re born in another coon.-
try and immigrated to Canada. In Vancouver and Toronto, over 40 percent of the
population has a mother tongue other than English or French. Statistics Canada (2012b)
estimates chat by 2031, between 25 and 28 percent of the populncion will be foreign
born, and almost 50 percent of those ai;e 15 and over will be foreign born.
\Vhen working with immigrants, it is important to understand the circumstances
under which they came to Canada. Some come as investors and are independent, while
others arrive destitute from refugee camp~ where they may have w-aited ye3rs under
harsh conditions for permission to immigrate. Some refugtts and their families have
experienced unimaginable violence and trauma, and they may have undiagnosed mental
health problems such as post-traumatic stress disorder.
The Canadian Immigration and Refugee Proreaion Acr establishes many different cat-
egories of immigrants, including the following:
■ Skilled workers who qualify based on education, skills, and ,vork experience
■ Entrepreneurs and investors who can crc-3te jobs or stimulate the economy
■ Provinciall't••nominated immigrants who fill regional labour shortages
■ Live-in otregivers who can apply for permanent resident status after completing two
't'cars of employment in Canada
■ Family class immigrants-chose sponsor~ by dose rcfotives
■ Foreign children adopted by Canadians
■ Refugtt clnimants-people who arc s«king protection as defined by the Unit~
Nations' Geneva Convention relating to the Status of Refugees
ComP3risons of Canadian ime.rnal approaches to ethnic relations with chose of the

United States often suggest chat the American "meJting pot" contrasts with the Canadian
"cultural moS3ic." The assumption is that the United States promotes integration of cul-
tures wlu~reasCanadians encourage preservation of ethnic culture; howe,.'Cr, studies have
sho,,vn that the differences between the two countries arc not as distinct as the two models
suggest (lsajiw, 1999). In fact, the United States more closely resembles the Canadian
mosaic metaphor than the melting pot. In both countries, the tendency is for ethnic
groups to retain their distinct individual identity. Of course, cad,, culture contributes to
the national identity and is in turn subject to its influence. One dear example is the extent
to whidi. the non.-Asian population in North America celebrates the Chinese New Year.

Nevcrthdc.s5i. (snjiw (1999) highlights one importnnt diffcrmcc in race relations between
Canada and the United States: "In the Unito:J SmteSi, the lar~t groups setting priorities for
ethnic relations nre Blocks, now called Afro-Ame.ricnn5i. and the Hispanic5i. main!)• immi,.
grants from Latin Ame.rica, particularly Mexico. ln Canada, the rw-o main groups that set
priorities arc, above all, the French of Quebec, and the Native Peoples" (p. 58).
In Canada, lndigenous peoples claims for self-government and te.rritorial rights have
reached a mud,. higher profile than in the United States. In addition, French Canadian
struggles for cultural equnlit)•and prese.rvation of their language P3ro11cl those of Hispan,.
ics in the United States. For French Canadian5i. language has become the principal battle-
ground for prese.rving their culrural heritage; howeve.r, the is.sue of Quebec separation
from Canada continues to remain important. Increases in Asian immigration to Canada
have also grendy affected the culturnJ mix of many nrea5i. particularly large urban centres
such as Vancouver, Toronto, and Montreal. lsajiw (1999) suggests that substantial increases
in immigration have resulted in tension and "an uneasy balance bcrwttn an understanding
and acceptance of the immigrants and feelings of suspicion and even mode.rate hostility
tow-ards them and towards minority ethnic groups in gene.rnJ. A factor in this mood is a
degree of racist feeling agninst the prcdominatcl't' non-white immigrants" (p. 93).
SUCCESS TIP
CounsellOrS actively work to understand lhe d.rverse el.Atul'al baekgr'ound of the cliQt'ltS nh
woom lhey wOr'k, and do oot condone Or' engage .-i discrimination based on age, cOIOur,
culture, ethnicity, diS3bilily, gendet, religion, sexual oriQt'ltation, marital, 0t scxio-ecooomic
status (C.nadian C<luosemng and Psichotherapy Association, 2007, p. 89).
Problems Faced by Immigrants and Refugees

Immigrants to Canada face a wide range of practical problems that may result in their
coming for or being referred for counsclling. He.re are some examples of the issues that
counsellors might expect to emerge when w-orking with immigrants:
I . Lan~u-a~e: Clearly, one of the most chaJlenging problems for an)' immigrant is to
acquire sufficient knowledge of the country's lnnauag:e so that he or she can fully
participate in the community. For children, language acquisition comes quid:J,.,, but
for many adults, it may be many years before they arc prof,ciem. For others, the
challenges arc formidable, and they ma)' withdraw to the snfery of their own ethnic
group, neve.r full)• assimilating to their new country.
2. Employment: For many immigrants, coming to Canada results in loss of status,
as credentials acquired in their home country may n()( be accepted in Canadn. In
conjunction with other problems including language barriers., prejudice, and lack of
familiarity job finding techniques, some never return to their former occupations.
3. Po~<ert)•: Immigrants who have escaped oppressive conditions may have been forced
to leave their possessions and wealth behind. Others may be required to take entl)•~
level or minimum ,.,,.,i.ge jobs in C anada and, as a result, subsist on mnrginal income.
4 . Discrim ination: Discrimination can frustrate an immigrant's ability to find employ-
ment and housina. and it can evoke feelings of b inemess or hostility and affect
their psychological well-being. Economic stressor~ including company downsizing
and consequent unemployment, can result in rhe scapegoating of immigrants and
minorities for societal problems.
5. Culture shock: This phenomenon, which mn't' be experienced in varying degrees,
can include bewilderment, increa~ self--consciousness, embarrassment, shame,
longing for their home country, and loss of self-esteem.
316 Chap1er 10
6. Parent-child relationship friction: As a rule, children learn the ho st language: mo re
q uickly than their pa rems d o, and they adnpt more q uickly to Canadian life. Thu~
parents mny ndapt by o ver-reliance o n their ch ild ren for tnmslntion or interacting
with their new co untry. Fears for thc:.ir children may lend them to beco me over-pro-
tective, which can lead to parem-<hild conflicts or acting-o ut behavio ur.
7. Male-female role adj ustment issues: C lien ts mny come from culrurc:s where male
dominance is accepted and em bedded in the routines and beliefs o f thc:.ir society.
8. Seniors: Some senior~ panicularh• those who immigrated to C anad a in their Inter
't'C':1lrs may have limited ab ility to co mmunicate in French o r English. During the
time, they lived with extended family this ,vo uld have been manageable, as o thers in
the famil't' co uld nssist them with daily tasks and translntion. However, if rhc:y no w
fi nd them.s elves in institutionnJ care, they could find themsclvcs in a fncility where
no o ne speaks their langungc: or und erstands their cultural customs.
lmm ia rnnt S toriell

• NoUShein, a ptastic su(g,eoo from Pakistan, not able to practice in canae1a, was fOr'ced
to lake a minimum wage ;ob at a piua restautant where she \WrM \\1th 1wo oU>ier
foreign-ttained physicians, a teachet, and an accountant, atl of toom destined 10 (emain
underemptoyed.
• fareema, a spe,cialiZed oral s...-geon. (ettained as a dental assistant. Her new emplc)yer
neve( knew that she had more lt'aining than him.
• 1ssam came to canae1a in 2016 as a Syrian (efugee. Determined to adopt his felt coun-
lty, he immersed himself in le.aming the language. He works seven days a week at U'l(ee
ION-paying jobs 10 provide fOr' his family of 9. To avoid prejudice, he changes his fW'SI
name to Tom.
• Toflg, age 55, a refugee from Iran. has n01 been successful in learning English. He relies
on his teenage child(en to help him navigate the challenges of living in canada. He strug-
gles to understand his teenage d'ltldren who have little memory of the values and customs
of his native country.
• Monifa, age 23, immigrated with he( family twelve years ago. She wens as a settlement
worker at a I0:.3I itnmig(aru services society. fully integrated 10 Canadian fife, she's in
continual confict with her parents who are committed to traditional values including
arranged marriages.
• Thirty years afte-r being ex.pelled from Uganda, Kiaan is a prOSP'!f'OUS bus1nessman and
active as a phtlanthropist prom01ing healthcare in his country of origin.
• Jessa, determined to pionee( a new life in canada tor het family, is employed on a tem~
tary work visa as a live--in nanny. She sends a la(g,e portion of her meagre earning to her
motile( in the Philippines v.t'lo is cal'ing foe her two child(en. age 4 and S.
• Mike, after 15 years in canae1a, still IOngS to return to his ba'thi::,ace k'I Engtancl where most
of his ex.tend family still ive.
• Maryam. age 86, ftom Afghanistan. is a (esiclenl in a IOOg-term ca(e horne. She receives only
occasional visits from het famiy. She speakS onl'j a few words of E ~. and tnere is no one
who Speak$ her first language, Pash.to. She is dep,essed and exp,essed a deSite to die.
Recent Canadian Immigrants and Refugees There are unique chaJlengcs for
co unsellors who wo rk with recent immigrant~ pnrticula.rly those who do no t speak
English o r French. These challen ges arc mngnified when dic:nts are refugee:~ who may
be poorly prepared for life in C anad a:
Kot onl't' is the.ir arriv21I u su:Ul't' ~ e d ~ ' 21n ::arduous. o (ten d an~erous joumer. the.ir
Risht w as usl.dll't' prttipit21ted by soei.:ll. eth no-r.M.':i.:d . re.lis.Ous,. o r po.Jitic31 stri(e---even
war. Manr re(u{ti'es h ::n'i' been the viet ims o( o r witnessed. to rture and other atrocities.
(Turner &. Turner. 2001, p. 17 1)
Counsello rs who cannot d raw o n their own experiences for understand ing need
to be willing to learn fro m their clients about the eno rmous trauma and suffering

they hnve experienced. A traumn-informed approach with emP3thic inte.rest will help
them avoid duplicating the experience of man)' survivors of concentration camps,
who were prevented from getting treatment and assistance "because the exnmining
psyc.hintrists were unable to comprehend the enormity of their suffering" (Ruskin &
Bc;scr, I998, p. 428).
Ex:lmple:: P3ri-..ash fled from her home in the ?l.·1..1dLe Ease a(ter a lo~ period of re1¢iou!l
perserotion. Hei-father 2nd her brother \\"en" both executed tor relusi.na to den)' their lhha'1
Faith., : d t ~ she claims the o(r.c1:d expbn::ttion cited ,>:'l.rious Aet1t,OU!l crimes ~a.inst the
sc:ue. All a tet>n:1~-tr, s.he w3:S imprisoned and W:l.$ subjected l'O l'Orlure. but then without
expl:1.n::uion she was reteased from j:111. Herek.lest brother Mnalni imprisoned with his fate
unknown. Kewly 2rrh'OO. in Canada. P3riv:)Sh h:ls only m~i.n31 EUWish but strona deter,
mi.natM'Jn to nuke 2 new Me Hei- spiritl.dl oornmitrnent remains «"ntral to her worldview.
Westwood and lshirama (1991) offer this caution counsellors working with
immigrants:
Chent resistanee and distru!lt in the counsellm~ process nuy be Set in motion b), cross,
C'ultur.d insensitivities., such 3:S the counsellor' s disrel.'.ardina the d1ent's a~ and so,daJ
status and ~lli.n¥ him or herb)• the OrSC name. usinK ex«"ssive in(onnality and (nendU,
ness. probifl¥ into pri\+ate (eeli.n!.'.S. demand in& h¢ le.,.els o( sel(,disdosure and ex:pres,
siveness., and ::.dviee l.'.i\'ini, (p. 137)
Sociopolitical Realities
\Vich ethnic minority clients and lndigenous people, the.re are typicnJly historical and
sociopolitical realities of oppressive racism that cannot be ignor~. ln Canada, this is
panicularh• relevant when working with (ndigenous clients, whose cultures, including
their languaJ;es, spiriruality, customs, leadership, and sociaJ structure, have bttn eroded
through colonizntion nnd systematic undermining by Canadian gove.rnment policies
and legislation (Poonwasie & Chane.r, 200 I; Backhouse, 1999). Residential schools were
established to force children to assimilnte and accept Christian values. These schools,
which shockingly operated until 1996, left behind a wclL-documented legacy of physical
and sexual abuse (Truth and Reconciliation Commission of Canada, 2015).
Counsellors should not be surprised to find that their culrurally different clients
present with suspicion and caution, expecting that counselling will be yet another expe-
rience where overt or subtle evidence of bins will come to the foreground. Sue and
Sue (2008) a.rgue chat counseJlors need to consider the problems that minority clients
(ace chat are not under clients' control, such as bias. discrimination, prejudice, and so
on, and clients should not be blamed for these obstacles. To do so is victim blaming.
They suggest that in counselling sessions with cukuraJJ,., different clients. "suspicion,
npprehension, ve.rbal constriction, unnatural reactions, open resentment and hostility,
and passive or cool behavior may all be expressed" (p. 93). They conclude that culturally
effective counsclling requires profossionnJs to unde.rstand these behaviours nonjudg-
memally, to avoid persona1i! ing chem, and to resolve questions about their credibility.
Counsellors should consider acknowledging diversity differences ea.rly in the reJa,.
tionship. Davis and Proctor (1989) argue that "acknowledgment by the worker o( a
worker-chem dissimilarity will convey to the client the worker's sensitivity and aware.-
ness of the potential significance of race to the helping relationship. It will also convey
to the client that the worker probably has the ability to handle the client's feelings
regarding race" (p. 120).
When counsellors and clients are from different cultures, frank discussion of their
differences is nn opportunity to "put on the table" variables related to dissimilar vnJ,.
ues and perspectives chat might otherwise adverseJy affect the work. Although this is
an important process with aJI cliems, it should be a priority whenever there nre sharp
3 18 Chap1er 10
difforenccs between counsellors and clients. This will assist counseJlors in understand~
ing their clients' worldviews, including the.ir priorities for decision making.
Cou n.selto r: Cle:ul)·, you and I 21re \'e-r)' different. I wonder i( it m~t help me to spend
21 bit o( time t21lkina to you about your C'ulture and )'Our take on thin~.
Client : t,.-b n)' people here in Can::.cl:1 think it's r:tther odd that 11\)' wife's mother and
father li\'e with us. But they Just don't underst:tnd.
Cou n.se.U.o r: What don't ther unde-rs:t:1nd?
Client : In Can::.cla. kids i.:row up 21nd, onc-e the)' re::.ch 19 or 20. they C'an't w3it to ~ t
2wa)' lro-in home to establish their independen«. In ourruhure. we want to be with our
fanulies as much as posslble. Uvina with our p3rent'S is n3tur.l! :tnd expe<-ted. \Ve don't
Stt it 21s a burden. It's 21 areat blessin,a th3t "~ C'an be IO~ther.
Counsellors also need to consider the notion that not 31) groups in Can3da have the
same smrusor J)O\\ter, despite the fact that all groups have the same legal rights. Power dif•
forentials th3t lead to oppression and discrimination can exist by vinue of race ("white
privilege"), sexism, hcte.rosexism, and dassism (Miley, O'Mcli3. & Dubois, 2004).
Power and Privilege Despite the foct that the majority of Can3dians value dive.rsity,
some individuals or groups rem3in vulnerable to oppression, margin3Jization, preju-
dice, and violence based on their membership in a group. and this foct h3s significant
implications for the counselling relationship. Discrimination and oppression continue
to be realities for visible minorities and lndii;enous peoples and "racism is widely per-
ce.ived to be 3 major problem in Can3da" (Fleras. 2012, XX).
Rothm3n (2008) reminds us of the p<:M'cr differential that surrounds our relationships
with clients including the reality th3t counseJlors 3re rypic31Jy educated and middle cf3ss
3nd the fact th3t they ma)' have considerable power in m30)' settings (e.g.., the ability to
deny service 3nd remove children from homes). \\:'hen counscllors are al.so members of
the domin3nt culture, the imbalance of power and privilei;e is e-.ren more pronounc~.
Consequcnd)•, counsellors need to be espcciall)• sensitive to the fuct th3t their acrion5i, C\ten
when wcll meaning:, may be experienced 3nd interpreted very different!)• by their clients.
SUCCESS TIP
TM onus is on counsetlOl's to adjust lheif style to moot the needs and ex.pectations of the
clients they serve.
KEY ELEMENTS OF CULTURAL

UNDERSTANDING
Worldview
Worldview is the looking gl3ss through which clients see the world. Dodd (1995) worldview: A person's "belief~-
describes worldvicw 3S: abOCII 1M 1131111! of the lliwrse. iis
peaiwd e-fiect on h__, beblicm. and
.. . a bel1d S)•SCem :.bout the n3tu re o( the unh-e-rse, its pereeh-ed e((eet on hmnan aae's place in lie unMIW. Wcrldvi!w is
beha\'iOr, 21nd one's pfaee in the unh-e-rse. \Vorldview is 21 (und3mental eore- set o( a ~ t al coce- sa al as~ ions
eqibilill& neural forteS, the utureof
:issmnptions expl:tinin~ eultu~I forees,. the Mtu re o( hmnanldnd, the n21 u re o( ~ood humankind. die nature al g_ood-1 tvil.
:ind evil. luC'k. fate. spirits, the power o( sianif"ie,nt 01her!l. the role o( time. and the ltd. ta1e. spms, the ~ r of sigpific-•
n21 u re o( our phrskal and natu~I resou rc-es. (p. 105) ethers.. the role- of time. and the utureof
OJf ph~ical-6 •at.al f!SCIJltts" (Dodd,
Because the worldviews of counsellors and the.ir clients m3y involve different beJief 1995, p. !OS).
S)'Stems based on different assumptions and explanations, communic3tion misunder-
standings can easily occur and, 3S Sue and Sue (2008) note, cultural oppression may

result. Counsellors m3y, for example, encounter clients whose essential worldvicw is
fatalistic (i.e., they believe th3t they have little control ovc.r what happens to them and
that luck is the prim3.ry factor govc.rning their fate). This fatalism has profound implic3~
tions for counselling and ma)' sc.rvc to explain (at least partially) why some clients pc.rsist
with passivity and pessimism. ff we look onh• at the individual (3nd possibh• )•ield to
the temptation to b'3mc the victim), then we arc ignoring the systemic problems and
discrimination that must be redressed for minority groups to have ttiual return for
their efforts.
Culture is not an 3djunct to counselling. It is not "something to be gotten over or
gonen around in order to get on with the rcn1 business" (Ruskin & Beiser, 1998, p. 438).
lnstcad, it provides the cssenti31 context for understanding and responding to clients.
CounscJlors need to understand how cultural origin influences client behaviour 3nd
worldview. Similarly, they nttd to be aware of how thc.ir own culrural past influences
their assumptions 3nd responses. Moreover, counsellors need to remember th3t they
arc members of a professional community th3t 3dhc.res to a specific social or political
ideology 3nd that they hold to a belief system that m3y be at odds with those of their
clients. This 3Wttrcncss is a prcrttiui.sitc for developing the consciousness to ensure that
counsellors don't impose their worldvicw on their clients. Subsequently, they will be
less likel)• to m3kc erroneous assessments or judgments based on their own pc.rspectivcs
regarding behaviours such 3S lack of eye contact-considered inappropriate by some
cultural group~ but valued by others as important to reJation.ship intimacy.
SUCCESS TIP
'Whenevet we find oursetves begj.nning to dtaw negative conclusions from what the other
has said o, done, we must take the time to step baek and ask whether lhOSe wotds and acts
mighl be open to diffetent intetpreta~ whethet lhat othet pel'SOO's ac1ions may have a
diffetent meaning from within his cultural conventions.· (Ross, 1995, p. 5)
Table 10.3 suggests sample questions for exploring worldvicw. They will help
counsellors to understand diffc.renccs and control the tendency to be ethnocentric- to
believe that one's belief~ values, culture, and behaviour 3re "normal" while those that
arc different 3rc abnorm3I. Culturally intelligcm counsellors know th3t people can see
or do things in m3rkedly different 3nd 3ccepcablc ways.
TABLE 10.3 Sample Questions for Exploring Worldview

Whal are yout views and feeli~ abOut counselling?
Whal dO you value in life?
Whal telative importance do you ~ ce on family? (Work, leisute, making money, being
successful, etc.)
Whal makes you laugh? (Cry, become sad, etc.)
How, vd'len, and wilh whom do you express emotions?
To wtlat extent are gift giving and other gestures ot hOSpitality knportanl to you and you(
family?
Who has po-.ve-r in yout famity?
Whal is the knportance of spi(d.uaity or teligjon .-. your life?
Whal are yout views on bri~ing up chik:lten?
Whal dO you think is the purpose in life?
Whal dO you think Should be the roles of men and women?
Whal happens when you die?
320 Chap1er 10
Personal Priorities, Values, and Beliefs
Everyone is differently motivated. Some people arecarcc.r oriented and others arc driven
by spirirual beliefs. Counsellors may find thcmsdves working with clients whose views
and attitudes on such major issues as J;Cndcr equality, spirituality, and scxmllity differ
sharply from their mvn. But when counscJlors understand thc.ir clients' priorities., thq•
are in a much better position to support decision making and problem solving that is
consistent with their clients' beliefs. Counsellors need to be sclf-aware and to have self-
discipline in keeping thc.ir persona] views and values from becoming a burden to their
clients. ff counsellors cannot worlc with reasonable objectivity, reforral may be necessary.
For some client~ idens and vnJucs that define personal and familinJ responsibilities
and priorities are deeply rooted and defined in the traditions of their culture. There
may be little room for individuaJ initintive and independent decision making that is
~parate from considerations of family and one's position in the hie.rarchy of the famil)•.
For these clients, family and community are their sources of hdp. and this reality has
enormous implications for coun~llors. To proceed without unde.rstanding, involving,
or considering centraJ family figures predestines counseJling initiatives to failure.
European and Nonh American notions of healthy adaptation include a focus
on "self-reliance, autonomy, self-acruaJization, self-assertion, insight, and resistance
to stress" (Diller, 1999, p. 61). In contrast, Asians have different value priorities that
include "interdependence, inner enligluenment, negation of sc-Jf, transcendence of
conflict, and passive acceptance of rea1ity" (Diller, 1999, p. 61). Thu~ individuaJism
and personal assertion may not be as important for Asians as they rend to be for the
dominant cultures of Canada. To process information correctly and make accurate
assessments, "counsellors need to determine what is relevant behaviour within the cli-
ent's current cultural context that may be quite different from that of the dominant
group" (Arthur & Ste\\"8.rt, 2001, p. 8). For example, they need to lcnow when the
value of family or tribal responsibility supersedes personal need. Moreover, with some
Asian groups, humility and modesty are prderred over confrontation, and conflict or
disagreement may be expressed through silence or withdraw-al Thus, all behaviour must
be interpreted based on its learned and culturaJ origins.
Pedersen (2001) offers an amusing but profound comment on the natural tendency
to assume that others see the world the same as ourseJves: "\Ve have been taught to
'do unto others as 't'OU would have them do unto you' whether thq• want it done unto
them or not" (p. 21).
A client's personal values can be identified through interviewing or simple tests
and questionnaires. Lock (1996), for example, uses an inventory that assists people to
ranlc,order 21 different values (e.g., need for achievement, creativity, power, and wealth)
based on their relative priority.
Identity: Individualism versus Collectivism

When w-orlcing with clients of different cultures, it is important to determine where the
die-m's identity emphasis lies within the individual or within the family or community
Stain imaging has r'e\lealed hO'N tne brain's response varied (being in control) and independence, lheir btains limbic sys.
amoog people from cultures viewed as individualistic (West- tem responded ShOwing i:,eas...-e. while the btain pleasure
e-rn) and 1oose tnal valued cOllect.Msm (East Asian). When centres ot East Asians fired in response to more submissive
Weste-rnerS we-re exposed to stimuli that leatured dominance ;mage,y <Azar. 2010).

CII •. _
Figure 10.2 Individualism versus Collectivism
(Hackney & Cormie.r, 2005). North Americans place hiah value on individuals becoming
independent from the.ir families, but in many cultures, separation from family is ncithe.r
sought nor desired. ln North Ame.rica, rUfied individualism tends to be pri:ed, but
among many Asian and Hispanic aroups, greater priority is given to famil't' and commu.-
nity (Sue & Sue, 1999). In general, counsellors should remember chat for many African,
Asian, Middle Eastern, and Indigenous client~ "individual identity is alW'a)'S subsumed
under the mantle of family" (Ruskin & Beiser, 1998, p. 427). Consequent!)•, counseJlors
can expect that extended family or even members of their community shouJd be included
in counselling.
The bipola.r axis of individualism~ ollectivism (see Figure 10.2) is frequently used
to compare culrures. Jndividualism pertains co societies in which ties between indi-
viduals are loose; eve.ryone is expected to look after himseJf or herself and his or her
immediate family. Collectivism refers to societies in which people from birch onward
are integrnced into strong, cohesive in-group~ which throughout the people's lifetimes
continue to protect them in exchange for unquestioning loyalty (Hofscede, cited in
Pedersen, Dragun~ Lonner, & Trimble, 2008, p. 28).
Generally, Cannda and the United States have hiah ratings in individualism, whereas
East Asian and Middle Easte.rn countries are more collectivistic. Failure to understand
cultural differences in chis area can easily lead to erroneous conclusions. For example, in
\Vestern society, it is exp«ted that emotionally healthy individuals will, as they become
adult~ achieve independence and ph\•sical separation from their families. Conversely,
in a collectivist culrure emotionally health)• individuals continue to be emotionally and
socially enmeshed with che.ir families. From a Western pe.rspcctive, a 30-year-old adult
living with his parents might be judged as overh• dependent. This bias is e-.•ident in aJI
\Vescern theories of devcJopment, which "agree that normal devclopment starts in full
dependency and ends in full independency" (Pedersen et al., 2008, p. I .SO).
Culturally sensitive counsellors need to be aware of the influence of extended fam,.
ily in decision making. Conside.r, for example, the potential dilemmas regarding con.-
fidentialit)• with the diem who comes from a family whe.re the famih• leader, not the
client, is responsible for decisions reg3rding counselling. There may be sharpl)• different
role and rcJnrionship expectations among culrures. In addition, culrure-bound counseJ,.
lors who define a healthy malc-femn1e rcJntionship as one based on equal division of
household responsibilities will find themseJves in difficulty if they rry to impose their
assumptions on a famih• who holds a more craditionaJ gender division of roles and
power. See Figure 10 .3 for some othe.r common eJements counsellors need to be aware
of to achieve cross--culrural understanding.
Although all cultures tend to have at least some respect for their clders, some cuJ,.
rures place wry high value on the elders of the community. Many African~ especiaJly
)'Ounge.r ones, defer decision making until they consult with older family members
(Dodd, 1995). The North American tendency to stress individuality and personal deci.-
sion making might be regarded as disrespectful to parents in many African, Middle
322 Chap1er 10
- Identity:
Individualism vetSIIS
Collectivism
- Qaa nicrti-
Relationship Etpecu1tions
Beliefs about How

_ S.....dAcl
Time Orientalian
Figure 10.3 Key Elements of Cross--Cultural Understanding
Eastern, and Asian c ultures. ln these cultures "to honour one's parents throughout life
is considered one of the highest virtues" (Dodd, 1995, p. 11 7). Obligation to one's fam-
il)• or even to the community may take pr«edc.ncc over self, nnd failure to fulfill one's
obligations ma'>' bring shame and embarrassme nt to the fam il)•.
Counsellors should consider fam ily a nd community as hdping networks that exist
within their clients' cult-uraJ communities. Such natural helping opportunities should be
used as adjuncts or a1tc.r nntivcs to profcssionnJ counselling. However, invohting others
should be with the permission of the dic:nt, except under unusual circumst:.mccs such
as when the client is incapacitated o r incapable of makina nn informed choice. Some
cukurnJ groups indude d ecC3scd persons ns part of the.ir nnrural helpina network. For
example, many Jranians believe that dec.C3sed relatives can appear in their dreams to
offe.r guidance nnd support. Morrissenu (1998), from the Ontario Cou chiching First
Nation, eJoqucntly describes his be.lid :
Sinee all li(e i.s b3se<I on a circle. and 2 d rde has no bf-ainni~ and no end, li(e eannot
end in de::uh but rather 12kes on a different form 2nd rneanin~. When Yi'e unde-rstand
"all our relations.'' v.--e will know our ancest'OrS 3re just as mueh 2 part o ( us mday 2s
when the)' Yi'ere ph)•Sieall)' walkll,i Mother Earth. In this sense, v.--e 3re nc,<cr alone. Our
relations are still present to help us. (p. 90)
The 1978 Jranian revolution resulted in larae numbers of Iranians, mosrh• Muslims
and &ha'i~comina to Canada. Shahmirmd i (1983)noted that lnmians are highl)• fam ily
o riented, a nd counseJlors can expect that elder relatives mn)' accompanydients to coun-
selling. As well, Iranians will tend to be formtd, particularly when dC3lina with people
in authority, so last names should be used until fam iliar ity is established.
))t) BRAIN BYTE

Cultural neuroscience investigates how culture shapes 100 beeame active. With the £astern group, the same area acti•
bmin. Ooo recen1 finding using bmin imaging techniques vated wtlen they thought abOut a mother. but no such activity
discovered differences in brain activation wtlen Westernets wasevi::lent 'liith the Westerners. This research suggests how
and Easterners wete aSked to think abOul Mseir (one's iden- individualism and cOflectivism are hardwired in the brain.
lity and ltaits). With bOth groups, the medial prefrontal cortex. (A2a1, 2010)

Verbal and Emotional Expressiveness
An important consideration is dlC' client's beliefs regarding emotional expression and di~
closure of persona] information. The \\:1cste.rn approach to counselling "involves henvy
dependence on vc.rbal expressiveness, emotional disclosure, 3nd examination of bl"haviour
patterns" (Hadcncy & Cormier, 2005, p. 125). This m3y be in smrk conrrast coorhe.r cultures,
notably Asian and Hispanic, where emotional control is favoured. Al.so, what is acceptable in
one culture may be-offensive in another. For example, what is considered assertive behaviour
in North America might be seen as arrc,aancc in other pnns of the world, and what North
Americans interpret as shyness might be defined as respectful bclinviour elsewhere.
Many counscllors place hC3vy emphasis on the exploration of problems nnd feeJ,.
ing.s as a means to assist clients to develop insight and understanding. But this course of
action may conflict with the approach favour~ by somecukurcs, namdy to ignore fed-
ing.s by concentrating on activity with an expectation that counsellors will be directive.
Many \Vestern counseJlors favour a RoJ;erian approach, which encourages clients to
express feelings and counsellors to respond with empathy. Sue and Sue (2008) highlight
the danger of this approoch with some cultural groups:
Emotional expreSSl\'i',nesi in oounsellini and pS)·ehotherup)' is frequently :. hiihl)'
desired K(JQ.L Yet many cuhur.11 KrOUps V3lue restraint o( scronK (eelin,iS. For ex3mple.
m:ll1)' Hispo.nie :ind Asbn cult-ures emphasi:e th3t nuturit)' :ind wisdom are :.ssocbted
with o!"K'·s ability to control emotions 3nd (eelin~ This applies noc onl)' t'O public
expressions o( an~r 3nd (rustration, but 3lso to public expressions o( lo,'i', and affe-c,
tion. Un(o11un.2tei)', therapisu un(3ml.li3r with these cultural r2mit"tC3tions tlU)' perceive
their clients in:. very l"K'l.'.ati,'i', pS\"<:hi.:urie lil.'.!1t. lndn'.-d, these clients are o ften deseribed
as inhibited, lack.in~ in spontai,eity. or repressed. (p. 143)
Similnrly, Sue and Sue( I999)observe that since many Asians have difficult)•express-
ing their fodings openl)• to strangers, counsellor attempts to empathi.!e and interpret
feelings may result in shaming the client. Consequently, they propose more indirect
or subtle responses: "In man)' traditionaJ Asian group~ subdcty is a highl)• prized art,
and the traditional Asian client ma)' fee] much more comfortable when dealing with
feelings in an indirect manner" (p. 45). \\:lhereas \Vestern counselling methods tend to
emphasi:e open expression and exploration of fee.lings as a method to develop insight
and manage pain, many cultural groups do not favour this approach. Indigenous people,
for example, ma)' fed threatened by demands for personal disclosure from counsellors
(Diller, 1999). Sue and Sue (1999) observe that many Asians believe that "the reason why
one experiences anger or depression is precisely that one is thinking about it too much!
'Think about the family and not about yourself' is advice given to many Asians as a W'n)'
of de3ling with neg3tive affective cJements" (p. 65). Consequently, counsellors should
consider that lceepingone's emotions private is for some cultures an indicator o( matu.-
rity. This will assist counsellors to avoid neg3tively labelling such clients as resistant,
uncooperative, or depressed; however, this docs not rule out open discussion between
counsellors and clients about the merits o( dealing with repressed or painful feelings.
Versatile counsellors are able to shift away from introspective approaches that
emphasi:e insight and exploration of feelings when this shift meets the nttds o( cultur-
ally different clients. For example, action-based strategies that focus on de-.'C'loping skills
or accessing resources are sometimes more cukuralh• appropriate. This shift has equal
validity when working with clients with limited economic means whose primary need
may relate to getting a job, finding housing, or feeding their families.
Alexander and Sussman (1995) suggest cre3tive approaches to multicultural coun.-
seJling that draw on the minority client's everyday li(e experiences. Culturally relevant
music, for example, miaht be used in waiting rooms as a way of welcoming clients.
Similarly, aJ;enC)• and office architecture and art should be culturally inviting.
324 Chap1er 10
Communication Style
Some clients 3rc uprcssivc 3nd keen to talk about their experiences 3nd feeling~
whereas others are more reserved and carefully guard their privacy. Some clients like
to get to the point and task quickly, but others prefer to informally build up to it.
Clients may also differ sharply in their nonverbal communication style, including how
comfortable they arc with eye contact, their need for physical space and distance, thc.ir
comfort with touch, their concept of time, and the way they use silence. Some clients
find that a convcrsationaJ distance of I to 1.5 metres (arm's length) is comformblc,
whereas others find the same distance intrusive. For example, many people from the
Middle East stand dose enough to breathe on others. "In fact, the brc3th is like one's
spirit and life itscJf, so sharing your breath in dose convcrs3tion is like sharing your
spirit" (Dodd, 1995, p. 166).
GcneraJl't', Jndigenous people tend to speak more softly, use less eye contact (indi.-
rect gaze), and dcJn,., their responses (using silence) (Sue & Sue, 2008). A simil3r style
is e-.•idcnt among Asians, who also m3intain a low.-kcy 3ppro3c.h and arc more likely
to defer to persons in 3uthority. McDonald (1993) offers this simple but impressive
suggestion: "Interviewers must 3Jso be careful to remember th3t a response is not
necess3rily over when the speaker pauses. There m3't' be more. Give time for full
expression" (p. 19).
Eye cont3Ct is another 3rea of difference. In the dominant white Canadi3n com-
munity, ere contact is experienced as a sign of listening 3nd showing respect, 3nd lnck
of eye contact is perceived 3S evasive and inattentive. But in other cultures, casting
one's eyes dou.•nw3rd is a sian of respect. For the Navajo 3nd many other lndiacnous
people, direct eye contact communic3tcs harsh disnpprovaJ (Dodd, 1995). Ross (1995)
refatcs some important principles he learned from an lndigenous mentor and elder from
Nonhc.rn Ontario, Charlie Fisher, who commented on communication errors Ross
made in speaking to 3n elder in the locaJ community:
Verbal expressions o( pniiu 2nd Kr:l.ti1ude 3re emOO.rrassina and impolite, esped:llly
in the presenee o( others. The proper «Jui-Se is to quiet1't' ask the perSOn to continue
makinK hi.s contribution l"K'>:t time 3round. Lookifl¥ someone in the eye. 2t leu1 a.mon&
older people in the conununity, w:lS 2 rude thin¥ l'O do. h sends a SiKJUI that )'Ou consider
that person in some &shion inferior. TI,e proper W3Y l'O send 2 si,aual of respect w:l.S to
look do•,vn or to the s;de, with onl't' oce2slon:ll s:_fa.nees up to indte:1te 211ention. (p. J)
Ross aJso notes that Fisher reassured him that his errors prob3bl,.• did not offend
the cJder who "knew, after 311, that a grc3t many white men simply hadn't lc,uned how
to be.have in 3 civili!cd manner" (p. 4).
Sue and Sue (2003), c.mphasi!ing how communication styles arc strongly linked to
culture, make this observation:
Whether ourconversatM>n proee«ls with flu or st:l.fU. whether v.--e interrupt one a.nothe-r
continu:lll't' or p ~ d smooth1't·, the topics we prefer l'O discuss or avoid, the depth o(
our in\'Olvement, the forms o( inteniction (ritual. reportee. 3r{tumentatn-e. perSua.sive.
etc.)2nd the thannel we use to conununkru:e (vefbal,001werb.-ll ,'i"rSuS nom'i"rOOl,verbal)
2re 311 aspttts o( ronununication style. (p. 126)
Language
Counsellors need to listen carefully to the voc3bulary and idioms that their clients use to
express ideas and feelings. while keeping in mind that those minority clients who are 00(
fluent in the counsellor's lnngunge will have trouble expressing their thoughts. The more
th3t counsellors can match their clients' style, the greater their rapport with them will
be \\:'hen counscJlors use jargon or unfamiliar words, clients may feign understanding,

or the experience mn'>' leave them focJing vulnerable and discmpo\\'cred. Of course,
counsellors also nttd to avoid tnJking down to diems. Sometimes interpreters will be
necessary, but family and friends of the client should not be used because of the risk
of breaking confidemiality nnd the fact that their inclusion may introduce bias.
In nddition, \\'Ords mn'>' have differcm meanings or connotations for different cul.-
rurcs. For example, the word school may evoke terror from some people who associate
the term with the abuses of residential schools. CounseJlors should also conside.r the
degree of formality thnt may be expected by clients. Addressing clients as Mr. or Mrs.
may be much more appropriate than using first names. Some clients ma'>' see indiscrimi-
nate use of first names as overly fomilia.r nnd insulting.
Culturally different clients arc often pnrticulnrly attuned to nonverbal communi.-
cation (Sue & Sue, 2008), nnd they will respond very quickl)• to subde indicators of
counsellor bias. ln counselling, they may test counsellors with questions about their
racinJ views and nttitudes to measure how much they can be rrusted. CounscJlors' non.-
verbnJ responses to such inquiries will often reveal more nbout their real views than
their words.
Relationsh ip Expectations
Clients from some cultural groups may have expectations thnt test the North Ame.rican
guidelines for counscJlors. Ruskin and Beiser ( 1998) provide examples related to the ficJd
of psrchinrry that parallel the challenges faced by counsellors:
In nun'>' cultures,. people expect to express positive feeli1l{tS by aivina a aift. Should 2
thcr.-pist :1«-ept patients' aifu! ls this 2n ::aspect o( transference th3t rnust 2IW3)'S be
interpreted! Is a s:.ift a bribe! Gl\'ins: a aift to a tl~r3pist ,nay be a ruhur.-11)' approprl,
::ate expression o( ar.uitude :1nd respeet. Depri"i~ the p.,tient o( this ruhurally sane,.
t.Oned pro,cess may invoke f~ltn$;$ o( hurt pride. s.h:111~, or a~er th::u interfere with
the ther:tpy. ln\'itina the !)S)"<:hi::urist to f:un1I'>' ceremonies :u,d speei::d o«-asions ,nay at
f'lrs:t seem huppropdate. but is not at all unusual. In sueh inst:u,ces,. 1he ther::apist tlU)'
be well ::.dvised to consult with other ther::apists or culturally literate colle:a~-ues before
maldn& a decision. (p. 437)
Ex:unple: JO)'tt. a '>·ouna social v.'Orker, r«2lled !'loo.\• s.he became amdous when herchent.
aJam::ak::m sinale p.,rent, told her th3t she wished to ah-e her a aift to th:u,k her for her
help. Joyce did not want to insult the v.-otiun br re(usina the aift. but she was ::.eutel'>'
::rware th::u her d1ent was poor and could OOrel'>' 2(ford to feed her &mil'>'· Moreover, she
wu roniCerncd with not viol:1tina professional ethiei. FortuMtely. her dient resoh-ed the
d1le.nuna when she presented Jo,.-« with a ar2pdruit tied with a red nbbon. For Joyce's
dient. the arapefruit had areat S)'mbolic vilue.
Anothe.r domain that counsellors need to navigate carefully is the area of ph)•si.-
cal contact nnd culture. Cultural groups differ on the extent that touch is expected
or tolerated, and funher issues related to gender arc a complicating factor. The codes
of ethics of both the Canndinn Counselling nnd Psychotherapy Associntion nnd the
Canadian Association of Socia] Workers are silent on the is.sue except to prohibit
contact of a sexunl nature. The code of the NntionaJ Association of Social \Vorkers
(1996) outlines the responsibility of social workers to set "culrurnlly sensitive bound-
nries" (Standard I. 10) regarding physical contact, but no sp«ific guidance beyond this
directive is offered.
Moreover, there arc cross-culturnJ varintions on how people greet each other nnd
the spatinJ distance tha1 is m3intained during conversation or greeting. \\:lhe.reas n hand.-
shake is common in Nonh America, people from other cultures bow, hug, nod, or kiss
on introduction, and this m3y wry depending on setting, degree of intimacy, or nature
of the relationship. Some Vietnamese men do not shake hnnds with women or their
326 Chap1er 10
elders; nor do some Vietnamese women shake hands (Dodd, 1995). Another variation
conce.rns how people greet each other. Some clients are comfortable with first names
only, but others are more formal and prefc.r to use tides. Some cultures expect one to
greet the head of a family or elders first (Dodd, 1995). Jranians, who favour formn1ity,
may stand up when counseJlors cnte.r or IC11.vc the room (Shahmirzndi, 1983). Iranian
same-sex members stand dose.r than in North America, but opposite-sex members arc
likeJ,., to be fa.rther apnn (Shahmirzadi, 1983). Middle Easterners may expect that offers
of refreshments be given several times with encouragement to ncc:cpt.
Relationships among various cultures may have historic roots of friction and oppres-
sion. CounseJlors may expect that the feelings minority group clients have t0\\"8.rd the
dominant culture will influence the counselling relationship, particularly when counsel-
lors arc pe.rccived to be representatives of the controlling culture. (n some case~ feelings
such as anger and suspicion will be overdy expressed, but they ma,., also be unexpressed
and revealed only through subde or indirect ways. Clients who arc overly compliant or
ingratiating may, in fact, be masking their anger or hiding the fact that they feel inad-
equate in a relationship of unequnJ power. In any case, clients will carefully observe how
counsellors process and den] with their feeling~ with the future of the reJarionship or
decisions about returning for a second session hinging on their counseJlors' capacit)' to
address such feelings nondefensively.
Many cultural groups may have limited experience with counselling (Shahmirzadi,
1983). Consequently, it is important that roles and procedures be defined dearly, a step
that i~ of course, important for all counselling relationships regardless of experience
with the process.
Beliefs about How People Should Act

This includes clients' beliefs about receiving hdp from counseJlors. Do they believe
that taking hdp is a sign of wcalcncs.s? Do they think that families should be able to
solve their O\\'ll problems without outside intervention! \Vho do they believe should
initiate conve.rsarions? What are their expectations of the role of the counseJlor? \\:'hat
exp«tations do they have of people in authority? How do they feel men and women
should relate to each other?
Clients from some cultures will tend to defer to authority and wait for their coun-
sellors to take the lead in the interview, rarely volum~ring information or taking the
initiative. They may be rcluct:mt to challenge the authority of their counsellors or even
to admit that they do not unde.rstand.
lime Orientation
There are interesting and important differences among cultures regarding how they
view time. The dominant Canadian society tends coward preoccupation with time,
with people's lives dh•ided and regulated by appointments and time constraints. The
common saying "Time is money" describes the drive t0\\"8.rd getting ahead and mak-
ing progress. But other societies may be less future oriented and more focused on the
present or past. Consider, for example, the importance that Asians and lndigenous
people place on one's ancestors and ddcrs in defining one's life. Indigenous people
may be more grounded in the present and "artificial division of time (schedules) is
disruptive to the natural pattern" (Sue & Sue, 2008, p. 199). Some clients will malcc
conside.rable sacrifices by coming to Canada and working for years separated from
their children and families in order to provide future opportunities for their families
(including those who are not yet born), to improve their lives. Their rime orientation
may extend weJI beyond their O\\'ll lifetime.

COUNSELLING IMMIGRANTS
AND MULTICULTURAL CLIENTS
MulticukuraJism h3s bttn identified as a lccy force that has influenced the philosophy
and practice of counselling (P~c.rscn & Locke, 1996). lt takes its place :.dong with five
other in6ucntia1 forces: ps\•choanaJysi~ behaviourism, humanism, social justice, and,
most rcccndy, neuroscience (s« Chapter 11 for a complete discussion of the six forces).
Diversification of society has made it imperative that counscJlors dcvdop new anirudcs
and skills to de-liver effective service to their multicultural dientdc, particularly since
research has shown that "many tradirion:.d counselling approaches are not effective (and
in some cases arc even harmful) when used among culturally and raciaJly diverse diem
populnrions" (D'Andrca, 1996, p. 56).
Counsellors need to be familiar with the culrural milieu that has defined thc.ir di.-
ents' identities. This will hclp guard counsellors from judging client beh.nviour 3S 3bnor-
m31 or symptomatic of ment31 illness when, in fact, it is perfectly acceptable within the.ir
clients' cultural frame of reference. Trust is.sues in the client-counsellor relationship
need to be understood and addressed with due consideration of any history of opprcs.-
sion and abuse b)• the dominant culture. This will decrease the likelihood of asses.sing
the diem as unmotivated, resistant, and hostile.
Barriers to Culturally Intelligent Practice

A re..,iewof the literarure(Turncr & Turne.r, 2001; Sue & Sue, 2008)sujlRCSts a numbe.r
of b3rricrs and recurrent themes that prevent culruraJly sensitive practice from being
the norm:
I . Ignorance reg3rding the underlying philosophical, structural, and tcc.hnologicaJ
3Jte.rations th3t 3re necessary.
2. Inability or reluctance rodcvclop ai;cncy services from 3 "one-si:e-fits-all" 3pprooch
to one founded on respect for multicultural diversity.
3. Failure of professionals to recognize, ncccJX, 3nd honour culrural diversity.
4 . L3c.k of counsellor self-3w3reness regarding how their cultural values and socializ3,.
tion 3ffcc.t their prncticc.
5. Evidence th3t counscllors do not invest equnJ time and energy in their work with
minority group clients.
6. Failure of training programs to address ethnic issues adequately.
Capuz! i 3nd Gross (2009) report that rcsC3rch h3.s demonstrated th.nt ethnic minor-
ity clients tend to avoid seeking help from m3instrcam counselling agencies except in
emergency siruations. In 3ddition, they arc typicaJly not satisfied with the outcomes
of counselling and "may distrust the counseJling experience which may be viewed as
intrusive, objectifying, and dehumanizing" (p. 417). Shcafor and Horejsi (2008) suggest
that "ove.rlooking client strengths, misreading nonverb3J communication, and misun-
derstanding family dynamics are among the most common errors m3de in cross--cultural
hcJping. Bch.nviours motivated by religion and spiriruality, family oblig3tion, and sex
roles 3re often misunderstood" (p. 177).
Ruskin 3nd Beiser (1998) conclude that Asians are more likely to avoid sec.king
mental health se.rvices because of the fc3.r of stigma. They may also be less likely to
accept referrals for 3ssistance and ma,., termin3te service more prem3turcly th3n white
clients. This is not .surprising, given (vey's ( 1995) observation th3t "traditionnJ counsel.-
ling and therapy theory are White, mn1e, Eurocentric, and middlc-cfoss in origin and
practice" (p. 55).
328 Chap1er 10
One Canadian srudy documento:I the barriers that inhibit ethnic groups from acces.s-
ing the mem:al health S)'stem. The study reported that many find the barrie.rs insurmount-
able and avoid it, while others who utili:e it find the se.rvices innppropriatc and ineffcctive
(Canndian Taslc Force on Mental Health Issues Affecting fmmigmnts and Refui;cc~ 1988).
fn addition, ethnic groups ma.,., differ in their expectations of counselling. While
Weste.m.-trained counsellors may favour more passive approaches that empower clients
to develop solutions to problems, other cultures may cxpcct that the helper will be
more active and give them direct answers. Hays and Erford (2010) highlight that the
importance that counseJling places on promoting values such as seJf-nwareness and
emotion:.d disclosure arc not congruent with many cultural groups who favour limito:I
self.-disdosurc of emotions.
Controlling the Tendency to Stereotype

CounseJlors are cxpecto:I by their codes of ethics to appreciate and respect the unique-
ness and individuality of each client and to avoid being blinded by ste.reotyping groups
and cultures. Stereotyping ma.,., be defined as holding firm judgments a.bout people
based on preconceptions. This is illustrated by ideas like believing one ethnic or racial
group is miserly or another "can't hold their liquor." Abundant evidence of stereotypes
can be found in ethnic jolccs that typecast and smear various groups.
ft is criricaJ that counseJlors realize and accept that people from different cultures
have different standards of bdutviour and that they often respond to or interpret actions
in wideJ,., divcri;:ent ways. Counsellors can srudy particular cultures and may reach con-
clusions that support certain broad gencralirntions about that culture, but this is no
gua.ramec that any one member of that culture will adhere to the de.fining norms of
their subgroup. Consequenth•, counsellors should make no as.sumptions. Jn fact, clients
are often simultancousl)• under the influence of man)' culruraJ groups that may exert
powerful but comrndictory !eve.rage.
Ex3mple: lb!Jit. a 20.ye:u---old A!lian. is a Ar!lt-tener.uion C,nadi.:m. Her p3rents emi,
$tl"'3ted from Jndi.:1 s.hordy bdore he-r birth. They ret3in 1na.11r o( the value!? o( their
tr.ldi1.0nal t'Uhure. indudina the expectation th3t 831jit will h::we an arran~ed nurri3~.
Baljit re-spttU her pore:nts. but this oonflku with her Kr0Wll1St desire l'O choose her own
m3rri:.~ partner. She 31so wanu l'O honour her spiritu31 traditions. BalJlt is active in her
community. buts.he 2lso has m3n)' friends frorn d1(f'kuh t'Uhures and reliStions.
Thus, a diem lilcc Baljit belongs "to multiple group~ all of which influence the cli-
ent's perceptions, beliefs, foding.s, thoughts, and behavior. The counseJor must be a.wnrc
of these in8ucnces and of their unique blending or fusion in the client if counseling is to
bt. successful" (Pa.nerson, 1996, p. BO). Jn general, one's personal culture is influenco:I
by many factors, including family of origin, social circle, community, and education. As
weJI, it may change over time and be in8ucnccd by catastrophic events such as illness
and war or by economic rea1itics such as poverty.
Although individuals within cultural or other groups tend to share certain values
and customs, individua.J differences may pre..,ail, and any one person within the group
mn't' or may not conform to the cultural norms. There may a.Jso be wide diversity within
the same group. fn Cannda, for example, the.re a.re many lndii;cnous peoples, including
(to name onl't' a fow) Algonquin, Blnd:fo()(, Cree, Haida, and Ojib\\"8.y. Two key ques-
tions need to be considered:
t. To what extent docs the client hold cultural values and traditions consistent with
his or her own culture of origin?
2. \Vh3t cultural \lalues and traditions are unique to this individua.J (i.e., differing from
those of their culture of origin)l

Exploring and u nderstanding the culture, language, and history of the populations
counsellors work with is an important step in preventing stereotyping. To some extent,
books and films can provide this knowledge base, but dir«t contact a nd experience
with different cultures is a bcner way to learn. Counsellors can gain this experience in
a number of W'tl)'S. such ns by visiting ethnic districts., ancnding c ultural festivals, and
c ultivating friendships with a diversity o f people. HO\\'C\'Cr, it is important to re.member
that a member of a particular culture docs not necessarily hold the culrural values that
characterize that culture. Within any culture, there can be a wide range of individunJ
d ifferences. Even members o f an individunJ family may exhibit wide variations in their
c ultural identity.
SUCCESS TIP
Expect lhat you wYI n01 be able to fully unOOfStaOCI the cullur.11 values and eustOO'ls of every
individual or divel'Sity group. An attitude of CIXiosily and a wiUingoess to leam wil help )'Ou
to avoid cultural mi.slake$. If you do make a mistake, admit ,t, apolOgjle, learn frOO'l ,t, and
modify )'Our responses.
Respecting Diversity and Individual Differences

As noted earlier in this chapter, there have been dramatic shifts in the d emographics
o f Canada, with a significant increase in non~white populations. ln some cities and
provindnJ areas, non-white populations have become o r soon will become the majority.
The implications of these changes have meant that counsellors arc increasingly called
on to serve clients from diverse cultures. But Spe.ight, M 't'ers, Cox, and Highlcn ( 1991)
caution counsellors against seeing multicultural counselling as something d ifferent
from " regular" counselling. They warn against u sing a "multicultural 'cookbook' with
each gro up reccjving a 'recipe' that includes a checklist of the group's characteristics
and some instructions rcgnrding how the co unseJing should proceed" (p. 30). Such an
approach may result in stereotypes and in a failure to recognize individual differences.
S ince within-group c ultural differences ma,., actunJly exceed between-group differences,
"nJI counselling, and, in fact, aJI communications are inherently a nd unavoidably mu!~
ticultural" (Pede rsen, 2001, p. I8).
Respect for diversity chaJlenges counsellors to modify their approaches to fit the
needs and expcctntions of their clients. Counsellors need to become alert to any con~
flicts between hO\\• they sec and do things and the d ifferent worldviews that d rive their
clients' perceptions and actions. To achieve this, counsellors nttd to dC\•dop self-aware~
ness of their own cultural worldvicw, induding their values, assumption~ biase~ and
assumptions about others. They nttd to remember that everyone is somewhat culture~
bound and that counsellors' heritage and socialization limits their capacity to be fully
objective about the worldviews of others.
Learning from Clients

Given the diverse range of clients that cou nseJlors work with, it is not realistic to expect
that they can know about the cultural values and c ustoms of aJI groups. Fortunatdy,
counsellors can use clients as sources of information by asking d icnts to teach them
about thc.ir beliefs. Smith and Smith & Morrisette (200 1) stress that counsdlors should
avoid the "expert role" by becoming students of their client's culture. Simple q u es-
tions such ns "\Xfhat do )'OU think I need to know about your culture and vaJues to
understand your situation?" can start the p rocess. Additionally, the process of inquiry
ser ves to deepen the devcJopment of the basic foundation of co unsd ling-na.mdy, the
330 Chap1er 10
counscllor-clicnt relncionship. In face, this appro3ch empowers clients., and it should be
followed with all clients, not just chose who 3re culruraJl't' diffe.rent from the counsellor.
Every client represents diversity with his o r her own culrural mix. (n this respect,
K3dushin's (1990) comments on cultural attitudes are particularly reJevant:
What may ultimatelr be more important th::m l:.no,,\-l~ie is an 2tt1tude. TI,e intervte'Yi~r
needs to (eel with convietion th::u herrulture, wa,., o( li(e, \'alues, etc.. are onl't' one W3Y
o( doll,i thbl{tS: th at there 2re equal!)' v.ll.id W'3)'S. noc better o r worse, b ut different. Cul,
turaJ di((erences are easily transmuted into ruh u r2I deGde:nctd TI,ere needs to be an
openness and r~ep-twity toward such di((erenees and a wi.llin~ness 10 be t3u{tht b,., the
client :.bout s ueh d1((eren«s . . . . Because the inten•;ev.--er is less lil:el)' to h ave h::1d the
experie:nee, which permits empathic unde-rStandina o( the l"::IC:i:illr d1((erent inter\+ie-vi•tt,
she needs to be more re::.ci)' 10 listen. less re::1d,., to eome to eondusions. more open
to iuidance 2nd corrttt1ons o( her presuppositions by the intervievi•ee . . .. (p. 304)
Table 10.4 summ3rizes major guidelines for working with multiculruraJ clients.
TABLE 10.4 Guidelines for Multicultural Work

1. Openly acknowledge and discuss diffefences in r-ace, gender, sexual Ol'ientation, and so
forth.
2. Avoid stei-eoryping by expecting S'ldi'Jiclual differences. Encourage clients to teach you
abOut theif values, be68fs, and customs. Ph)'sical appear-ance ooes not necessarily
°'
mean that a person speaks 100 language adhetes to 100 values°'
customs ot the
culture he 0t She appears to fes,resent.
3. Increase ml.Alkulhx al self-awareness tlvough personal study, pfofessional devetopment,
and personal il'WOtvement (e.g.., cultivate multicuttu-al fOOnclShips and attend multicuttufal
events). Und«stand and appreciate how youf cul ufe. attitude, beliefs, eustorns,
experience. and fetigjon inftuence what you s:¥y and dO in counsetfi~ .
4. Seek to understand how historlc:al events., such as residential scho:lls and the internment
of Japanese tanadians duri~ Work1 War IL inftuance current beliefs and behaviouf.
5. Expl:)fe hOw prOblems like poverty, uoomptoyment, ageoc:y policies and pfocedures.,
and systamk:: prejudice affec1 youf client. Whenevef possible, advocate appropriate '°'
systemic change. For example, e.xamioo hoN ageocy structure, policy, statnng. and even
architeclufe sel'Ve dOminant groups while excludi~ minorities.
6. Remain oondefensive when dealing 'Mth clients who have expetie-nced discrimination.
Expect that they may be distrUSlflA, so,netimes hostile, towatd pfofessiooats who
represent wf'lat they pefceive as 100 oppressive powef of the dominant group.
7. Slay alert to hOw language-. S'lcluding ooovei-bal variables. has different meanings fOI'
diffei-ent people.
8. Adapa counselling strategies and goats to meet 100 needs ot individual clients instead of
expecting clients to frt into your styt,e and expectations. Considet eultutal contex.t when
w0tking with all clients. especially ethnic minority clients.
9. Pay particl.Jar attention to family, community, Or' lribal ex.pedal.ions and rotes. (Who
makeS im(X)f&ant dedsi::>ns? Who should be invited to counselli~ meetings?)
1O. Seek and use oatLXal helping networks and traditional healing practices. including
famity and community (esoufces.. Re~mbet that spirilual and feligjous values are
knportant components of multicultufal underslandi~. Spiritual leaders from the client's
community may S'I some cases be used in the counselling pfocess:.
11. Basic needs (fOOd, Sheltet, and emi:,oymenl) may need to be discussed tlrsl.
12. When dealing with d ients fOI' wtlorn Etlgtis.h i:S a second 0t subsequent language, speak
more stohfy <not mor'e budty). Sometimes single wOl'ds ot phr-ases afe easier fof them to
underStand than complete sente~.
13. If you are using a ltansla!Of', look at youf client, 001 the ttanslator. When usi~
ttanslators, avoid using famity and Mends ot the clie-nt. The client's permission to use
a ttanslator Shouts be secured. Ideally, the counsellOr' should be fully fluant in both
la~ages and familiar with 100 client's cultur-al baekground.

Counselling Seniors
Counsellors m3y find themselves working with seniors in residential care facilities
where their client is isolated because they are unable to speak the language. Jn such
setting~ counsellors will nttd to look for creative ways to 3ddress this problem. For
example, they can worlc with staff to find ways to acknowledge and honour their client's
religious holidays. Or, they c:m encourage the inclusion of culture specific food on the
menu. They can facilitate links to individuals or organizations from their client's cul.-
tllre. They could encourage and assist the client to displ3y artifactSi, picture5i, or mcmcn.-
tos. The use of mmslacors or volunt~rs who speak the client's language can be used
to hcJp establish rapport and increase the client's ability to express themselves in their
own lang:u3ge. In larger urban settings, there may be opportunities for the client to be
housed in a facility thnt has a higher proportion of residents who speak their lnnguage.
It is especially important that counsellor~ particularly those who are culrurally
different from their clients, talcc some time to lenrn nbout the customs and vnlucs of
their senior clients. This knO\\rledge will inform them as they try to adapt their work to
respectfully include their client's worldview. As always, cultural ste.re(){ypes neo:I to be
nvoided nnd individual differences ncknowledged.
The Importance of Counsellor Self-Awareness

Coi1nsellors who pres1nne that rhey are free of racism seriousl)'
underestimate the impact of rheir own socialiiation.
- P.B. Pede-rsen (1994, µ. 58)
Culturally competent counsellors arecommined to understanding the.ir own ethnic and

value base. They consider how factors sud,, as the.ir O\\'ll rnc:c, culture, sexual orientation,
and religion shape their worldview nnd affect their work with clients who are different
from them. They strive to devcJop nnd demonstrate understanding and comfort with
diversity.
Counsellors must const:.mdy question the rele..,ancc of their behaviour, vnlucs, nnd
ethnocentrism: TIie inclinati>n to assumptions for particular clients and cultures. Ethnocentrism is the inclination to
jldge ottiier <tJIMes 11Eti1iwlyin Rbtion judge other cultures negatively in relation to one's O\\'n cultural \llllues and norms. Coun.-
tome·s Otlll cuit.al values and norm.
seJlors who worlc from an ethnocentric perspective may be predisposed to discount the
importance of cultural traditions nnd beliefs. \Vorse still, they may sec cultural traits
ns something to be treated or chnnged because they use. their traditions, standards,
and mnjority norms ns a measure of normal behaviour. But resp«t for individunl and
culrurnl diversity implies more than just tolerance. lt requires counsellors to accept
that other cultures nnd lifcsrylcs arc equally valid, albeit different. This is an ethical
responsibility for professional counseJlors. For example, St:.mdard A.9 of the Canadian
Counselling nnd Psychotherapy Associntion's Code of Erhic.s directs counseJlors to pur~
sue knowledge nnd experiences thnt help them undersmnd diversity:
CounsellorS strl\'t, to under:n:md and rttpeet the dl\'t,rSit)' o( theirclienu. includll1id1(,
(erenceii rehued to 2~. ethnicity, ruh u re. ~ndeT. diS3.bility, rel1&ion. sexual orien12tion.
and !IOC.':io,,ttonomic: status. (CCPA. 2007)
Typically, counsellors are well-meaning individunls who see themscJves ns moral
nnd accepting. Thu~ ns Sue nnd Sue (1999) suggest, it may be very difficult for them
to understand how their actions may be hurtful to the.ir minority clients through the
following:
■ Stercot)rping. It mn)' be tempting to accept n commonly held but erroneous belief

about a particular ethnic group.
332 Chap1er 10
■ Adhering to counselling strategies th:n are culrure-bound. For example, many peo-
ple of colour prefer that "the helper lbcl more 3ctivc, self..disclosing and not 3Vcrsc
to giving advice and suggestions where 3ppropriate" (Sue & Sue, 1999, p. 29).
■ Bclie-.•ing th3t one's own cultural heritage and wa't' of doing things is superior.
Uncheclccd, this can lead to oppression.
INDIGENOUS CLIENTS
It is important to 3cknowled,;c the diversity of the more th3n 600 Indigenous groups
in C3n3da. Although there are great simil3rities 3mong them, 3nd they share many
common vaJucs and ch3racteristks., C3C.h of them h3s a unique identity. Moreover, the
individu3ls within enc.h community m3y share all, some, or only a few of the.ir Nation's
values and traditions.
The term Aboriginal refers to the descendants of the origin3l inh3bitant:s of North
America. In C3nad3, the Constitution defines three groups of Aboriginal people-lndi,-
3ns, Meris, and lnuit~ ach of which has a unique culrure, fongu3ge, custom, religious
practices, and so forth. Mctis have mixed First Nation and European ancestry. They
mn't' have cultures influenced by their ancestral roots. such 3S French, Sc(){tish, OjibY..it)',
3nd Cree.
Currently, the term Indigenous P«>plcs is preferred over the terms FirSL Nations or
Aboriginal, but some Jndigenous people prefer to acknowlOO,;c their nation, for example,
the Owcdccno or the Klahoosc. Each Jndi,;cnous community is diverse and has its O\\•n
governing system, but the members of different groups 3re bonded by common vaJucs.,
traditions., and practices from their ancestral heritage.
Statistics Can3da (201 S) presented the following d3t3 based on a 2011 survey:
■ About 1.4 million people or 4.3 percent of the totaJ Canadian population had an
Indigenous identity and increase of over 20 percent since 2006.
■ There 3re more than 600 reserves (]and reserved for the exclusive use of the lndig:-
enous peoples) in Canncfo, most with populations of less th3n l000.
SUCCESS TIP
One~ tot counseHOl's to deepen theit ktlowtedge abOut Indigenous issues is lh(ough
film. Since 1996 lhe National f im Board of canacia (NF'B) has supported the Aboriginal
(Indigenous) f im-maklflg P(ogram. The NF'B has a (ieh variety of cl.Ahxally informative and
sensitive films that ex.ptom Indigenous issues sud'I as (to name a few) cultural heritage,
heali.ng ptaetices, arts, family, and sweat l()jges. Online tesoutce catalOgues a(e avaiable
at www.t1fb.ca.
Indigenous Va lues and Worldviews

France, McCormick, and Rodriguez ((2013) identified lndij;cnous vaJucs and worldvie,.vs
that shape how they view thcmsdvcs and their relationship with the majority culture,
including the centraJ role of spirituality, harmony with nature, kindness., honest, integ-
rity, brave.ry, balance, 3nd humility. In order to work effectively with lndigenous peoples,
counsellors need to undcrst3nd and incorporate these values. &lance, for e.x3mple,
modeled in the medicine wheel, looks at the interconnectedness of one's emotional,
spirirual, mental, and emotion3l being. France et a1 (2013) underscore the spiritu31 aspect
of healing n(){ing th3l, "it is to the Great Spirit or Cre3tor, perceived everywhere, th3l
Indigenous people rurn to in times of need" (p. 296).

Indigenous people view ment:.d nnd ph)•Sic:.d he~dth in a unique way. "Illnesses., both
memal and physical, are thought to result from disharmony of the individual, family,
or tribe from the ways of nature and the naruraJ orde.r. HenJina can only occur when
harmony is restored" (Oilier, 1999, p. 61). Traditional healing practices are directed at
restoring this harmony. Jack Lawson, an Indigenous addictions counseJlor, describes
how balance can be restored:
\Ve sit in a ~lkini drde. but it is the issues we talk 2bout that ~ue important. The issueii
h::n,e t'O do with 1':uh,e t'Uhure, identit)·, how th!?)· See themseh,es :u 1'2th'e PeopLe. the
ef(ecu of stere<>t)•pintt. justi0ed 2~r. posith'e identity ck,.,eiopment. 2nd eeremony.
And we use dtuaJ objttt.S 2nd eere1nonies as part of the proees:s: e~e feather!! 2nd
pipes, smudi i1l{t. SVi'elt lodi ei. and so on, introdudn& our cukure imo the treatment
process and aeknowled¥h1i what the)' are ~-oin¥ throu~ ritual!)' and with eerernonies.
Such a pr<>ee$$ Ou natural!)' with our t'Uhu~I underStandin¥ of health and siclmess.
\Ve ::iso discuss the effecu of oppression. while at the iiame time ~dreiisitli- the issueii
around deniaJ. refapiie pre"e:ntion pb1nnina;. and rtt<n't:T)' nuinte:n::mce. (Qumed in
Diller, 1999. p. 171)
Poonw-a.ssie and Chaner (2001)describc the cl.ash of worldviews that occurred when
European Christians first encountered Indigenous people:
European Christi::m Can:ad1ans beJte'\,ed th:u the)' Yi'c"re meant to dominate the Earth
and its creatures. TI,e Abof1¥in:!1I peoples believed th:n the)' were the le:ast important
creatures of the unh't:rSie :tnd that they were dependent upon the four elements (Ore..
water. earth and air) and all of creation for sur\'i\'aJ. (p. 65)
Oppression of Indigenous people in Canada has created much pain as they we.re
robbed of their land and their children were removed to abusive residentinl schools,
whe.re they were forbidden to practise the.ir own cultures or speak their languages. In the
boarding schools, the goal was to make the children forget their traditional culture and
adopt white and Christian values. Government policies were based on the assumption
that Indigenous people were primitive and thnt they needed to adopt the culture of the
European settle.rs. Canadian gove.rnments systematically anadccd the tribal systems, and
this resulted in marginalization and a loss of Indigenous identity.
In recem )'ears, the Canadian government has drafted and ratified legislation to
redress some of the historical wrongs agninst Indigenous populations. Land rights we.re
first r«ogni:~ in 1973; the Canadian Chcmerof Righuand Freedoms in 1982 identified
the riahts of Jndiaenous people to protection of their cultures and lanauaaes; and a
federaJ government report, G,arhering Srrength: Canada's Aboriginal Acrion Plan, tried to
establish collaboration with Jndigenous people in health, social, politicaJ, and «onomic
arenas (Arthur & Collins, 2005). The Truth and Reconciliation Commission was estab-
lished in 2008 with a mandate to explore and acknowledge the abuses of the Residen.-
tial School System. Acknowledaement of the severe harm that the residential schools
caused for Indigenous people was seen as a first step in a long-term healing process to
deaJ with the aftermath of policies and programs that promoted cultural genocide of
the Jndiaenous communities.
The final report of the Commission in 2015 identified 94 "Calls to Action." Many
of these have significant impliations for social workers and other counsellors who W'Ork
with Indigenous communities including:
■ Emphasis on keeping Indigenous children in care in culturally appropriate settings.

■ Social service professionaJs, child weJfore agencies, and courts to receive train,.
ina that sensitizes them to the history and impact of the residential schools and
that all decisions reaarding lndigenous children take this into account. (Truth and
R«onciliation Commission, 2015).
334 Chap1er 10
Working with Indigenous People
Given the wide diversity among Indigenous peoples, it is impossible to offer precise
counselling guiddincs that appl)• to everyone in the group. McDonald ( 1993) offers a
number of J;C:nc.raJ pointers for working with Indigenous people, but these must be used
with grcn.t respect for individuaJ differences:
t. In contrast to mainstream Canadian~ whose responses are quick, lndigenous people

may pause before offering a response.
2. Indigenous people tend not to engage in "small talk." As a result, they may be
misjudged as "shy, reticent, or uncooperative by an interviewer when, in fact, the
behaviour may actually indicate they foci that there is nothing worthwhile to Sil)',
so there is no reason to comment" (p. 19).
3. Indigenous people may appear stoic or unconcerned because of a bcJief that it is
improper to share personal feelings or information with a stranger.
4. Expect short and direct answers to questions. As wcJI, there may be a culturaJ ten-
dency 00( to "\'oluntccr" information.
5. Lack of e)'C contact from Indigenous people may mean respect for the person.
SUCCESS TIP
Min ordef to facilitate eommuorty empo-He-rment. all those wtlo collabOrate wrth Abo(.gjnal
commuorties in healing initiatives must undetSland and accepa that AbOt'igk'lal people$ have
practiced viable healing methOdS based on their wOrtdview throughout theif history, and
these methods must be recognized and accepted as eciual to Eu(oametican therapeutic
apptoaches.· (Poonwas.sie & Charte.., 2001, p. 70)
Smith and Morrissette, 2001 conducted a stud)• of the experiences of white coun-
sellors who ,vork with Indigenous clients. Some of the.ir key observations and conclu-
sions are summari!ed as follows:
■ Honouring difference, maintaining flexib ility, and using creative approaches is criti•
cal to effective counselling. A central part of this is the willingness of counseJlors
to understand Indigenous experiences and culture in terms of their traumatic his-
torical context.
■ Counselling relationships may need to include e>..'tended families, ciders, and tra,
ditional healers. Counsellors need to believe in the community's capacity to solve
its own problems.
■ \Villingness to learn from clients, elder~ and Indigenous co-,vorkcrs is important
to relationship development and success in counselling. Counsellors must be
willing to relinquish the expert role and adopt "a willingness to have one's knowl-
edge challenged, to worlc with uncertainty, and seek guidance from the Native
community" (p. 80).
■ Counsellors need to respect and be open to the power of lndig:cnous spiritunJity.
They need to be willing to become involved in community e\'ents, which may test
and redefine contemporary professionaJ boundaries.
These condusions are echoed by Choney, Berryhill,Paapke, and Robbins ( 1995),
who also re.mind counsellors to consider such variables as "differences in communica,
tion styles, gender role definition~ medicine, and socinJ support networks. including
family relationships" (p. 87).

Traditional Healing Practices
For lndigenous people, various practices and ceremonies are u~ in which the "under-
lying goal . .. is 3Jmost always to offer thanks for, create, and maintain a strong sense
of connection through harmon't' and balance of mind, body, and spirit with the natural
environment" (Garrett, Garrett, & Brorhcnon, 2001, p. 18). Some examples of the vari.-
ous ceremonies include the sweat lodge, vision quest, and powwow. They are used in a
number of ways such as "honouring or healing a connection with oneself, between one-
self and others (relationships; i.e., family, friends., and community), between oneself and
the natural environment, or between oneself and the spirit w-orld" (p. 19). In Indigenous
traditions, life is embraced through the senses., which includes the awareness of medicine,
which might include physicaJ remedies (herbs and spices) but aJso extends beyond:
Medk:ine is in e\'i'r)' tret', pl.:mt, rock. animal. and person. It is in the l~t. the soil, the
w:uer. 3nd the wind. Med kine i.!l somethi~ that h3ppencd 10 year!l 3K() that still 1nakes
you s1ni.le when you think about it. Medicine ii th3t old friend who calls rou up out
o( the blue because he or she w:lS think!~ about you. TI,ere is medteine in w3td,inK 3
small child pfa)'. ?l.·1edicine is the reassurin&snuleo( an elder. There is n~icine in e\'e-r)'
e"ent, memOr)', pbce, perSOn 3nd movement. TI,ere is even medidne in empty s ~
i( )'Ou know how to use it. And there can be E)O\','i'dul medicine in p3in(ul or hurtful
experiences :lS v.--etl. (G3rrett et al. 2001. p. 22)
Elders arc being reaffirmed as cc:ntm1 figures, and many Indigenous people are once
again adopting rraditionaJ holistic healing approaches. Poonwassie and Charter (2001)
include rhe following examples:
■ medicine wheels (used to represent the balance: of menml, physical, emotional, and
spiritunJ dimensions of the person)
■ storytelling
■ teaching and sharing circles
■ ceremonies (e.g., sun dances, medicine lodges, fasts, sweats, pipe ceremonies, moon
ceremonies, giveaways, and podntchc:s)
■ traditionaJ role modeJs, sud,. as cider~ healer~ medicine people:, traditional teacher~
or healthy community members
SPIRITUALITY AND COUNSELLING

"In rhe marrer of religion, people eagerly fasten their eyes
on the difference benveen their own creed and yours; whilst the charm
of the study is in finding the agreements and idenritie-s in all the
religions of humanity."
- Ralph Waldo Emerson
The Statistics Canada National Household Survey (201 I) highlighted the continued
shift in the religious affiliation of Canadians. The majority of Canadians (67%) arc still
Christian, but this is a signifteant drop from a rate of over 80 pe.rcc:nt in 1991 (Statistics
Canada. 2005). The changing nature of the nation's rc]igious makeup is a result of the
shifts in immigration described earlier in this chapte.r.
Cunningham (2012) defines spirituality and religion as follows:
Rt.llgN>n: the institution::di.:ed, fonn31 belie(s,. do~nu!l,. 3n,d practkes l'O whkh followers
o( 3 p,utkufar spiritual path 3dhere.
Sprlriri.a.liry. the innei-. more persoool experiences o( clients.. especi3lly the 11ea.rd, for meani°"
and purpose .. . whkh mar be expressed within or withou1 the strocture o( n>l~ion. (p. 23)
336 Chap1er 10
Some counsellors nre uncomfortable nddressing spiritun1it)• in counseJling. fe3r of
imposing one's values and belief~ general discomfort with discus.sing religious issue~
and lade of knowledge or skill in addressing rdigious issues may lead counseJlors to
unnecesS3rily avoid making spiritual beliefs a tari;et for counsclling discussion. Cunnini;-
ham (2012) questions wheche.r "we can truly understand our diem~ their difficultie~
or their strengths if we do not understand their spiritual worldview, including the fact
that they do not embrace spirituality in any form" (p. xv).
Historically, many counsclling texts failed to address or even mention spiritunliry.
One major counselling textbook with more than 600 pnges is completely silent on the
issue. 'W hen spirituality was nddresscd, typicnlly the discussion was confined to ethi-
cal issues and discussion of the professional requirement that practitioners respect and
accept diversity. Ho\\'ever, spiritual or religious dimension~ often intimatdy entwined
with culture, are beginning to receive incre3Sf!d attention in the literature and professional
organimtions. For example, the Association for Spiritual, Ethical, and Rdigious Vnlues in
Counseling has been formed under the auspices of the American Counseling Associntion.
Most people nre lilcdy to report some religious affiliation or conviction. Moreover,
for some individuals and many cultural subgroups, religious practice plays n central role
in the.ir social lives and may be seen as n major source of support. Jndeed, all cultures
have important religious perspectives that must be understood as pnrt of the process
of understanding clients and their worldviews. Consequently, counsellors should not
refrain from working in this important aren, pnrticularly when it mttts the needs and
expectations of their clients.
Counsellors mn'>' work in a religious setting where their \\'Ork is de3rly framed
and guided by the values of the.ir pnrticular faith. Others may work in secular settings
without any religious connection. Jn such setting~ spiritual counselling is i;e3red co the
client's spiritunJ values and belief~ not the counseJlor's. This requires chat counseJlors
become comfortable with religious diversity. They do not impose their religious or
personnJ \•iews on their clients. Examples of spiritual issues that might be discussed in
counsdling include the following:
■ Emotional struggles to r«oncile emerxing personal beliefs chat are in conflict with
one's religious background (e.g., n client "losing fnith ").
■ Feelings such as guilt that emerge from lifest)•le choices that nre in conflict with
one's religious values (e.g., a diem contemplating an abortion).
■ Client fttling.s such as anger coward God (e.g., a diem whose child has died).
■ FamilinJ conflict (e.g., common~law unions in violntion of religious laws).
■ Family discord relnted to one's level of involvement (e.g., children who lose interest
in attending religious services).
■ The meaning of life (e.g., exploring experiences chat clients describe ns spiritual or
religious to discern the meaning of these expe.riences for them).
■ De-3th and dying (e.g., position regarding an afterlife and the meaning of life's
diffteulries).
■ Establishing a life plan or problem solving thnt is consistent with spiritual values
(e.g., de31ing with a divorce).
Frequemly, culrural identity is meshed with religious identity. To understand cul-

ture, counsdlors must understand religion and spiritunliry. Religion influences the way
people think; it shnpes che.ir values and sways their behaviour. Ethnic custom~ ca1endnr
observances, music, and art may all be rooted in religious beliefs and practices. For
people in many culruraJ minorities (and some from the dominant culture), the.ir lives
are centred on their religious institution.

Moreover, ethnic minority clients m3y be more inclined to scdc heJp from elders
and religious lc3ders from within the.ir own community. Clients with a strong religious
connection respond best to counselling initiatives that mkc into account their spiritual
community, values, and practices. This miWlt include helping them to access and con.-
sider relevant sacrro writings as wcll ns heJping rhem to use the resources and practices
of their faith, including prayer and mroitation. But counsellors who arc not informed
or do nor consider spiritu31 is.sues when they arc important for their clients have dif•
ficulty establishing credib ility in this lcind of counselling relationship. Not surprisingly,
research has demonstrated that highly religious clients do better in counscJling and are
less likely to drop out prcmarurcJy when rhcy arc m3tched with counscllors who have
similar rcJigious values (Kelly, 1995). For example, members of the &ha'i faith, who
tend to come from a variety of ethnic origins, generally strive to obtain counselling scr•
vices from professionals who are versed in their faith. Cultural understanding rttiuircs
appreci3tion of spiritual vn1ucs.
SUCCESS TIP
F'aillxe to inttOCluce spil'itualily as a topic f0t discussion and a target foe inlial assessment
may discourage dients fr'otn talking abOut theit spirltual connections. The implicit message
to clients may be that their counsellO<S are not cotnfortable with the topic 01' that they do
n01 see it as important
Counsellors who arc vcr5ro in the spiritu3J teachings of their clients' belief system
should discuss with them the extent that they wish counselling to be framed within
tenets of their faith. CounseJlors who are not versed in the spiritual teachings of their
clients can estab lish crcdibilit)• by demonstrating that they are open to spiritu3l clements
as their clients cxpe.ricnce them. Subsequently, they can best assist clients by helping
rhcm to articulate or sort out spiritual and religious issues. As well, counseJlors can
refer clients to religious IC3dcrs from their faith or enlist their assistance. KeJI,., ( 1995)
offers this perspective:
A eounsellor who underStands 2nd ~pt('.tS the client's relijtious dimension is pre-pored
10 enter th::rt part of the client ·s world. At this point. the eounsellor does not ne«I 2n
expert knowled~e o( the client's p.1rttc."uhu spiritual or reliiious be.lief but 1"'3ther an
alert se:nsitivit)' to this dimension of the client' s li(e. Br respondinSt with respeC'1ful
underStandin& to the spiritual/n>liKM'>us 2spect o( the d1e:nt's problem, the oounsellor in
ef(ec:t is jourrU~)'ifl¥ with the dient, re:.cl)' to Je3n, (rom the client 2nd 10 help the client
d:u-i(r how his or her spirituality <>r reli~ ousness may be understood and folded inl'O
(resh perSpttth-es and new decisions (or positl\'t, KrOWth 2nd chan~-e. (p. 11 i)
Empathic responses arc powe.rful ways to respect clients and communicate under•
standing of clients' fccJings. An illustrative counsellor response to a client struggling
with spiritu3l is.sues might be "Seems like )'Ou're feeling a bit lost or disconnected. This
frightens you, and you're looking for a wa't' to find spiritual peace."
But in the S3mc way th3t there arc wide variations within cultures, it is important to
remember that there may be wri3tions within religions. For some, religion and spiritua.1.-
ity arc central to their lives, and nJI of their decisions and choices in life are considered
in the context of the.ir spiritual commitment. Others may identify with a particular
religious belief, but their involvement and the extent that religion influences their actions
ma)' be m3rginal. Moreover, complexity is incrc3sed because individuals may give a
diffe.rent interpretation to rcJigious teachings. Clients ma,., self-identify as spiritunJly
oriented without being affiliatro with any ori;pnizro religion, or they may be members
of a pnrticul3r faith but rcpon that spiritun1it)' is not central to their lives.
338 Chap1er 10
CONVERSATION 10. l
STUDENT: What Should you do if a clie-nt asks you to pray you agreed to accompany het 10 church on a regl.Aat basis
with him Or' het? or invited het to attend one of yout religious ceremonies. In
fact, you may have enhanced your capacaty 10 work with her
COUNSEllOR: H's unfikely that you'd ever get such a reciu&St
in that you gained further insighl into her spiritual values and
in a secular or nonreligious setting. Ho-...-evet, in retigbus set-
beliefs. Kelly (1995) atgues that wtlen a counselloc and a
tings, o, wtlen clients seek help from counsellOrs affiliated
dient have the same teligjous values, IM counsetloc may
wtlh an organiZed re~o. prayer might be ~d at the begil\-
accept an invitation to participate in a prayer, but he advises
ni~ and the end ot a session. fOr' clients, this helps to esta~
extreme caution.
Ii.sh the spir"1tual nature of thi:S particl.Aar counselling wor'k.
Certainly, clients W'ho CCll'ne for religious counselling expect ST\JOENT: Suppose clients aSk me about my religion. What
that prayer- may be part of lhe work. But in a secl.Aar setting. sholAd l dO?
most counsellors and agencies would agree that 1t is usually
C0UNSEll0R: Out role is to help clients make informed
inappropriate to pl'ay wtth clients. They might wittless a dient
choices based on independent irwestigations. You might
\\tlo 'M'SheS to Pl'ay but 001 participate actively.
answer the question about your teligjon directly and then
STUDE:NT: In fad, 1t did happen to me. I have a field ~&- ask vd\at prompted the question. You could assist the c~nt
ment at a hOsprtal \\tlere I assisted a CathOlk woman. Her to ex.ptore spitdual questions. but this must be done fratn a
husband was te<minaUy m. and She asked if I would join position of neutrality without any attempt to corwert the client
the family as they celebrated last rites wtlh their pfaest. I to your religion, which \\()Lid cleatly interfere with his or her
accepted, but I woooer if per'haps I've tl'oken arry ethic.al 0t right to setf~ete..-mination. As for teaching the client yout
prolessional rules. religion, I wouldn't go there. Instead, refer clients to teligjous
specialists to help them meet 1ootr spiritual ~s.
COUNSEllOR: from the circumstances you descobe, I don't
belie\18: that anyone could teasonabty accuse you ot unpro- ST\JOENT: When ptayer and spirltua•ty are important for Cli•
fessional conduct. In a sduation such as this, I think you ents, 1think it's okay 10 assist in settk'lg goals and action plans
need to ask two important questions. F'lrst did you interfere that will help U'lem fulfttl this need.
with yout client's right to setf determination? The reciuest was
4
C0UNSEll0R: Sute, and this migt\t Include encouraging

initiated by yotX client. and gr.ten the context, yout tesponse
them to use prayer~ they believe that this is an important
seems supportive and appropriate. What's important is that
part of lheil' life.
you did n01 lf11pose yout retigjous views on her. Second, did
you vidate 100 legitimate bOUndaries of yout rde? II doesn't ST\JOENT: I also It.ink that it's Okay to pray for yotX dients.
appear that you compromised your tole with her by enteri~ A signifk.ant part ot the 1)01)1.dation believes that others Viill
into a dual relationship. This would occut if you srarted to benefll from our ptayers.. So why Should we deny our clients
meet her outside yout prolessional mandate, b instance, if this oonefrt?
CounscJlors need to 3cquire a bro3d knowledge of the world's major religions.

This is a formidable cask considering the wide array of beliefs and traditions that exist.
In C3nada, counseJlors will certainly e.ncounter clients from the following groups:
Oi.ristianity, Jud3ism, lsfam, Hinduism, Sikhism, Buddhism, 3nd 83h3'i. Although b3sic
knowledge can be obtained from books, this should be supplememcd with 3ppropri•
3te ficJd exploration. Many faiths permit visitors at religious ce.remonies 3nd sponsor
pub lic information events.
SUMMARY
■ Counsellor culrural intelligence is the ability to acfapt and integrate skill, knowledge,
and artitudcs consistent with the culture of clients.
■ Canncfa's multicultural mos3ic is defined h)• the presence of dozens of diffe.rent cul•
rural and (3ngu3ge groups. C3ch of which brings their own traditions and beliefs to

the Canada's collective identity. It is further defined by individual differences such
as scxuaJ orientation, education, economic staru~ and many others. Jmmigrants to
Canada may face many chaJlengcs, including language barriers, unemployment or
underemployment, poverty, discrimination, and culture shock.
■ The key clements of cultural understanding include: worldvicw, personal priori.-
tics, identity orientation (individualism versus collectivism), verbnJ and emotional
c.xprcssivcnes~ communication style, language, reJationship expectations, beliefs
about how people should act, and time orientation.
■ ResC3rch has shown that many ethnic minority clients avoid scdcing counselling,
and when they do, they arc typically not satisfied with the outcome. Successful
counscJling includes controlling any tendency to stereotype by acknowledging incli.-
vidual differences, learning from client~ and making self-awareness a priority.
■ Successful work with Indigenous people is more likel't' to occur when counsellors
honour differences, include extended families and elders in the proces~ and dem.-
onstratc thc.ir openness to learn from Jndi~enous peoples' spiritua1ity.
■ For many people and most culrural groups, spirituality and religion are an impor-
tant part of their worldviews. Consequently, counsellors should develop comfort
working in this important area➔
■ Culrura.Jly competent counsellors tr)' to understand their own ethnic and value
base, including how factors such as their own race, culture, sexual orientation, and
religion shape their worldvicw. They need to dttpcn their understanding of differ-
ent cultures. Although books, films. course~ and seminars can be rich sources of
information about other culture~ counsellors also need to embrace ex~riential
learning.
EXERCISES
Self-Awareness f. When is ii approp(aate to discuss religi:)n 'lfith clients?
1. Oevetop a pel'SOnal plan fOr' incfeasi~ )'Ouf mllticultufal g. What are the implications of your re(€ious views when
sensitivity. Include strategies fOr' ext,erientiat learning (e.g., woddng with someone with a similar pel'Sl)ective aOCI
lncreasi~ )'Ouf cir'cle of multicultutal friends and k'lvolve- when wodUng with someone with radically different
ment k'I mllticultural events). views?
2. What is your emotional reaction when you moot Or' counsel 8. Pede,sen (1994) says, ·C<>unseltors who presume lhallhey
someone from a diffetent culture? afe free of tacism seriously uOderestimate the impact of
3. To what ex.tent does yotX cultural membership give you theit ONn sociali:zation• (p. 58). Explore the validity of this
pnvilege? quote with respect to )'Ouf own life.
4. In what ways is your WOtlcfview the sarne as or dlterent from 9. Spend an hotX wilh someone who speak.S an01her la~uag,e
that of youf parents? Youf COiieagues? Youf teacher'? that you do not understand. Communicate~ in theit lan-
5. Take a cultul'al inventOty of )'Ouf friends. To what extent do guage. What dkl you learn this ex.petience that will add to
they come from difterent cultums? youf undetstandtng of wol'ld~ with new immigrants?
6. What does being C3nadian mean to you? What values afe
Skill Practice
tin.keel to betng a C3nadian?
7. ~ IOr'e your spiritual valueS through the KIIIO-~ Questions.: t. lntel\liew sev~I people who are cultur'ally different to learn
abOUI theit worlcMews..
a. Ate religions good Of bad?
2. SpeOCI an hour Of so with a person from a different culture.
b. Is my rel~ the onl'j correct one? Use the sample questions from this chapter to begin an
c. Should cults be illegal? expl0<atioo of his°' het WOrldview.
d. What ooes spirituality mean to you? 3. Practise different chOices fof tesJX)ndi~ to a client who
e. Should spiritual issues be int(Oduced by counsetlOl'S? askS, ..Oo you believe in Goctr
340 Chap1er 10
4. Suggest hoN you might \\()l'k 'Mth a dient, Ruth, wtlo is deal- 8. Use libtary dataooses o, 100 online database of Statistics
i~ 'Mth the folk)\\;~ pro~m: Ruth is a devout Chtistian Canada (www.statcan.gc.ca) to research the dem()iJaphic
wt10 is very close to he( family. She has oocome foman- cha,acteristics ot youf community. Identify the plac&S of
tically invdved with Jacob, a Jewish man, bul he( fathe-r tirth and molher tooguesof the IOC:al immigrant community.
insists thal s.he tnafry within hef own faith. ExtilOte statistics related to Indigenous groups rn your area.
5. Invite an lndige-nous pe:rSOn to share with you some of his What are 100 implications of you( data for counsetlOr'S wM
Of het ex.pe-rienc&S in a residential schOOI. Re-member lhat hope to work in yout afea?
this is a very sensitive topic, so be pfe-pated to be empathi::: 9. Invite an Indigenous pel'SOO to Share with you some of his
in resJX)r'lse to i».verful feelings that might be re-vealed. o, hef experien:es as a student in a residential schOOI. Cau-
tion: This is a very sensitive topic, so be pfepared to be
Concepts empathic in tesponse- to power'ful feelings that might
I. In what ways dO diver'Sity issues such as ethnicity, gendet, be Shared.
and sex.ual orientation affecl counsetlor effectiven&Ss? 10. What uni(lue problems might a(.se when counseltorS and
2. Research hOw mental illness may be intetpreted by differ- clients are from the same culture?
ent cultures. 11. Think abOut specific customs and beliefs lhat you might
3. Describe how coun.se-tbrS can be sensitive- to clltural norms encounter' when you work with clients from diffetent cul-
wtltle hon.outing indrvklual diffete~. tures. In what areas do you have difficulty working with
4 . What are some of the barriers lhat clients from ethnic objectivity? (Possible examples: ananged marriages, male
min0tities face- when seeki~ counsem~ se-tvices? dominance in lhe family, and female genital mutilation)
Ate there dfcumstances wt'lere counseltors shouk1 express
5. ExplOre the religions ot the WOrld (e-.g., attend setvices and
theit opinion and d'lalleoge the views Or' be-haviouf of their
festivities and acciutfe a multlfaith calendar).
clients?
6. How can counse-tot'S assist clients to ex.plOfe spil'itual and
re-tigjous issues without imposing their own religious values?
12. Identify different choices to, how a coun.seuor might
respond to this client question, ·what a,e your religious/
7. Do you think it's appropriate for counseflOr'S to privately pray spirilual beliefsr
for theif clients?
WEBLINKS
canadian Heritage p,omotes Canadian content and cultural Statistics canada
understanding www.statcan.gc.ca
www.canad1anhentage.gc.ca/index_e.dm An online magazine abOut Canadian immigrants
Indigenous Services canada and Crown-lndigneous Relations www.can.ad ian1mm1grant.ca
and NOrthern Affairs Canada (formerly Indigenous and North-
Unks to the Truth and Reconciliation Commission's websites
ern Affairs canada) piovide extensive information oo federal
prog,tams and services as wetl as readings on the culture and http://www.trc .ca/websitesllrcmsti tut ionli ndex.php?p:.890
history of I ndigenous peoples.
httpsJlwww.canada.ca/enlindigenous-services-canada.html
httpsJlwww.canada.ca/enlcrown-ind,genous-relatio~
north,e,n-affairs.html

■ Acq uire a basic understanding of the b rain and mind.
■ Describe how neuroscience is emerging as a new force in co u nseJling,
■ Identify merhods fo r stu dying the brain, in cluding neuroimaging,
■ Explo re hO\\• th e concept o f ncuroplasticity can b e used in co unselling.
■ Explain th e basic structure of the b rain .
■ Understand the fu nction o f n eurons and neurotransmitters.
■ Describe the range o f acquired brain injuries.
THE REMARKABLE AND MYSTERIOUS BRAIN

On a cold and U,'et u.inter morning, Bob o,ncomes his "txctf.St".s'' and begins his daily run.
As expccred, the {rNL few kilomerres are gruelling and painful bur, midutty rhrough che
nm, somerhing magical is abour ro happen.
Asionishing decrrical and chemirnl et't'nu are unfolding. Aroused l7y elec'lricic-,, small
molecules a u"tiken and move across Lin1 gaps in his brain, exciting billions of others chat
send signals down familiar pachwa:is creating a euphoric feeling chm Bob experiences as
a "runner's high," his reu-ard f« persetffing.
342
A tricious dog imerrupu rhe sereniry of Bob's nm and begins ,he chase. lnsrandy, Bob's
brain assembles iu stress and danger response ream under rhe command of che hypo-
thalamus. Ir signals ocher pans of ,he brain and body ro release neuro1ransmirters and
hormones .nteh a.s adrenaline, gluramace, and conisol ro deal urirh rhe threatening dog.
Responding ro energiting signals frc,m the brain, &b's heanbear increases ro pump mOTe
blood ro rhe limbs, his lungs dilate co allow excra ox,gen intake, he runs faster, and he
escapes co run another da,.
Rerurning ro the solitude of rhe run, in a Utt)' rhat remains a m:,s~ rhe greacesr mirade
of all oca,rs. Bob's mind energizes tvith self•aU'areness: freeing him to contemplace his
existence, his place in che uni,~e, his fmure. and his connttrion with God.
Throughota the nm. omside of his conscious auttreness, Bob's brain funaions as an actil't'
coach and 1rainer. Ir organites and commands a l'ast ream of neurons ro make his run pos-
sible. Ir m01.-es his legs, regulates his breathing. moniro,s his heartbeat, and processes t:i.ntal
signals ro produce ulrm-high definition 3D pictures u..ith stereophonic sound in c,rder ro
coordinate his m01.\"mnu, amid h.aiards, IMimain equilibrium, and retuTn him safet,home.
Ir's dear rhar Bob's brain, nor his legs, deserws rhe credic for the run.
The brain is a complex, perpetual morion machine that controls everything we see,
do, he3r, and think twenty-four hours a day, non-stop for our entire lives. Usually, we
associate the brain with thinking and making decisions. In reality, its role is for more
rcu.hing. lt powers ama!ing e1ect:rical and chemical interactions involving hundrOOs of
different org3ns and structures within the body and the brain itself. The human brain,
with its vast network of alive constantJ,., changing neural connections is the ultimate
multitasker, simultaneously managing everything from our henrtbcat to our drc-3ms,
from our immune system to our imagination. AlthouWl we associ3te the he3rt with our
foding~ it is in fact the brain that controls our emotions.
The brain is a ceaseJess director, observer, parricip3nt, chor«>grapher, and script•
writer of our existence. lt also rclendcs.sly re.invents itself, literally altering its structure
and chemistry in response to our experiences.
Most of the ,vork of our brain is done without requiring our conscious attention.
It works silendy to make our he-ans beat, fori;c memories, and orchestrate complex
chemical and behavioural rc-3ctions to protect us from danger, even before we arc
consciousl)• aware of any thrent. \Vithout our brain, survival is impossible.
A New Era We've only just begun. With breathtaking speed, over the last 20 yc3r~
neuroscientists have uncovered vast knowledge about the brain and its mechanic~
but they are still at the early stages of unravelling the m)•ste.ries of the most complex
and cap3blc object in the universe. Until recent year~ the brain remained mysteri-
ous, and linlc was known or understood about how the brain actually works. Now,
in a new era, with amaiing brain imaging techniques and extraordinary emphasis on
resenrc.h, the brain is slO\\rly divulging its secrets.
\Vorldwide, brain resenrch has become a priority, with work proceeding at an
unprecedented rate. For example, the government and The Brain Canada Foundation,
a nonprofit public-private p3rtnership formed to support brain research, by the end of
MaKh 2018 invested almost 210 million dollars to over 900 researchers. Such research
is generating a constant stream of discoveries that inform innovative and effective intcr-
w .ntions for brain disorders.
Serious interest in the brain is no longer confined to professionals. Book~ television
specials, and popular mag3!ines like Narional Cjeographic, Scinttifr,c American, Time, and
Discmier are publishing content on the brain for all to rend. Libraries and bookstores
now regularly fo3ture displays on the brain, including a gl'O\\ring body of material on the
topic of brain health and vitality. Terms like "frontal lobe." "serotonin," "dop3mine,"
"neurotransmitter," and "brain plasticity," once the j3ri;on of resc3rc.he.r~ academics
Neuroscience and Counselling 343

))}) BRAIN BYTE Tl,_ r), I-<,,, G·,, I
Al billh, a single brain cell has beCOme 80 billion netXal
ceus eager 10 define out existence. The brain i:s an ins1ant
adapting. and, if necessary, repail'ingdamage. New OielX0OS
are created <neurogenesis), and the massive ne1Xal highways
I
supe(centre of learning, Two decades later, lhe bt'ain i:s still
maturing (hOpefuUy) to create a mind with gOOO judgment
and impulse contr'CI. l.n every insiant, the bt'ain is changing.
tr.at contrOI everything are fOl'med, srre~ened. or pruned.
o.-e, • meume, expedence and reflection give ,;se 10 voSdam,
a fair' trade f0t the memory, and cognitrw! declines of aging.
I
The bt'ain is 75 percent water a n d ~ onty 1400 grams, pet hOur. Contrary to popular myth, we use au ot our brain,
but it uses 20 percent of the bOdy's energy and bl()()j to fuel allot the tiine. Unlike the piclures in the tx>okS, the parts
SO billion net.ifons. each of which i:s connected elec1tochami- of the bt'ain are not cCj()ur cOded. The brain is mostly g,ey
cally to as many as 40, 000 otherS at a speed ot over 400 km Viith the same consistency as tofu.
and doctors, are now part of everyday languaae. Empowerment comes with this knO\\rJ.-
edgc. People have access to the knowledge that can make them informed consume.rs of
memal health and counsdlina se.rvices. They can take charge of their brain health by
learning strategies for dealina with disorde.rs such as Alzheimer's.
This chapter can only provide brief information about a selected range of topics
that are important for counsellors. Given the a.rowing importance of neuroscience for
counse.llor~ readers should take advanta,;e of opportunities for further stud,., a\--a.il3ble
on the web, in research report~ journals, and books.
NEUROSCIENCE: AN EMERGING FORCE

IN COUNSELLING
Over the past 100 't'C3r~ five key forces(Figure 11. l)or approaches have influenced the
direction and philosophy of counselling. Neuroscience is on track to become the sixth
force. Each force offers counsellors important perspective, knowledge and guidance.
•• :_, CONVERSATION 11.1
Counsellor: What's 100 difference between the mind and the life. In the laSt 35 years, neuroscientis!s ha\18 made remark-
btain? able progress in unde:r'Slanding the brain. New research
findi ~ are coming at such a rapid rate that even neurosci-
Teacher: tt depends on whO you ask. Prti!OSOphers. theot:,-
entists have 1touble keep.-ig up. In the future, we Yrul ptOb-
gians. biot:,gjsts. and neuroscientists \WI each have their OM'I
ably actllh'e an almost com~te description of the structure,
definiion and. even within lheir discipline, lhey wdl not find
chemistry, and electrical circuitry of lhe brain. What abOut the
consensus.
mind? It's stil a mystery. We know \18,Y littte.
111give you my opinion. The brain is the physical Or'gan at
Counsellor: I wondet if traditional scientifac research and
top of our heads. The mind rS wtlat v.-e are able to do wtth
out brain, our capacity fOr' problem solving and ci-eatrvity, our analysis are .-iaoociuate toc::iS for studying the mind. The mind
is concemed wilh the nature ot realily, consciousness, curios-
consciousness, and our capacity to experience I0\18: and joy
ity, and spirituatdy. These matters are:n't part of the ph)'Sical
as well as deep sadness. It al!.O disti~ishes us from Othe,-s
warId that can be Sludied in the same way. They don't adhe,-e
by defming OU( indivi:fuality and persooaldy.
to the taws of physics. Maybe, because of this. we'I neve-r
The gre.atesl maNel of the mind is 1tattohSus to reflect on our be able to fully understand the nature of the mind. I.n fact
existence and find spir•itual significance and putpose to
OWf'I I hOpe lhis is 1rue.
344 Chap1er 11
Neuroscience
Social
Psychoanalytic
Jusaice
Behaviourism Mutticulnwalism
Humanism
Figure 11.1 Key Forces in Counselling
While some counsellors may strongly align themsclves with 3 particular approach, most
rccogni:e the value of drawing on the insights offered by different theories and models.
This has been the essenti3l theme of this book based on the premise th3t wise counsel-
lors m3ke informed choices based on individual situations 3nd client needs.
Six Key Forces in Counsel ling

t. Psychoanalysis focuses on helping clients develop understanding 3nd insight
regarding the origins of their thought~ feelings, and behaviour. Heavy emphasis is
pfoced on exploring the unconscious.
2. Beha,fourism looks 3t hum3n bch3viour as 3 product of learning and the environ•
ment. ln this approach, behaviour is shaped by reinforcement.
3. Humanism with Carl Rogers at the forefront, is b3sed on the philosophy th3t pco•
pie a.re innately driven toward growth 3nd fulfillment. Core conditions (empathy,
genuinenes~ and unconditiona.1 positive regard) are seen as "necessary and suf.
ficient" qu3Jities needed by counsellors co hcJp clients manage problems and
emotions.
4. Multiculturalism involves framing counselling interventions in the come>..'t of our
clients' cultural ,vorldviews. ln a multiculrural society such 3S Ulna,13, it 3 necessary
perspective, regardless of the counselling 3pprooch adopted.
5. Social justice recognizes the importance of counselling professionals working to
hcJp establish more equity reg3rding the distribution of wealth, resources, and
opportunity. Social justice accepts th3t client problems m3y be the unfortunate
outcome of oppression, poverty, and m3rginalirntion.
6. Neuroscience is the scud)• of the nervous system (see Figure 11 . 2), which includes
the central nervous system (bra.in 3nd spinal cord) and the peripheral nervous sys•
tem (nerves outside of the brain and spinal cord). Neuroscience explores the cl«·
tric3J and chemic3J activity of the brain using a variety of experimental 3nd brain
imaging techniques.
Neuroscience explores how the bra.in controls thinking, behaviour, and emotion~ 3nd
how the bra.in rc3cts to such things as physical or ment3l illness, trauma, and subst3nce
misuse. NeurocounseUing, a term 00( yet in widesprc3d use, is the integration of neu- newocounselling: ne integrati>n
roscience into the practice of counselling, A neuropsychia.trist is a medical doctor who «ne..osci!llce into die practicf al
uunselling,
spccia.1i!es in the trc3nnent of neurological injury or disease. A ncuropsychologist is
3 psychologist (usua.Jt,., with a Ph.D.) who deals with the psychologicaJ problems 3SSO·
cia.ted with brain injury or disease. In Can3da., only those with a medical degree can
prescribe medic3tion, b ut in the United St3tcs (in some jurisdictions), specially trained
psychologists can prescribe a limited number of mcdic3tions.

ThoraclcH
SaphMou~ Nt!rve
Figure 11.2 The Nervous System

SOURCE: 5'181)£81lerlalShutters.!oek
Competent counsellors try to understand their clients by considerina many

vari3bles, indudina genetics, developmental levcJ, prior learning, reJa.tionship 3nd
family dynamics, impact of subst3nce misuse, presence of mental disorders, over311
health, the influence of cultural and spiriru3J beJicfs, as well as S\'Stemic issues such
as poverty, unemployment, and oppression. Neuroscience, as an emergent force,
will add 't'et another dimension for counseJlors to consider. It represents no thrc3t.
It won't nea3te the long-est3blished 3nd important cornerstones of effective coun.-
selling such 3S rcJationship and the core conditions. espcci31Jy emp3thy. Jn fact, as
will be explored later in this c.h3ptcr, neuroscience h3s endorsed the validity of these
cornerstones.
WHY NEUROSCIENCE IS IMPORTANT FOR

COUNSELLORS
Neuroscience Endorses Counselling
A growina body of neuroscience rcsc3rch is providing counsellors with scientific
proof of the vaJue of their work as well 3S guid3nce on which counseJling strate.-
gies arc effective in given situ3tions. McHenry, Sikorski, & McHenry (2014) call on
counsellors to embrace neuroscience 3S an important additional tool reg3rdless of
the.ir theoretic3J 3ppro3ch, notina th3t "31) of the m3in theories of counselling can be
supported through the use of brain imaaina that provides evidence of brain changes
in diems" (p. 12)
Neuroscience will 3dd credib ility to the ficJd , empowe.rina counseJlors with the
confidence th3t comes knowing that their intc.rvemions arc based on solid science. As
Hill 3nd 03hlin (2014) note:
Confirnution by neurosden« of wh::u were lar~elr intuitive pr::1eti«s opens 21n

unprecedented way forw:1rd for us :u therapi.sts to rel'me o ur teehnique. and ourselves.
(m- e..-en areater suc«ss., while !e::rvll,i behind those p~kes n'•,,e:Ued to be inelfeetu:U
or f'\'t:n detrime:11121I (p. 11)
346 Chap1er 11
(n the future, neuroscience will no doubt continue to offer significant insight and
precise guid:mcc on wh3t works and what doesn't. Herc 3re some e.x3mplcs of notable
and reJevant neuroscience research findings for counsellors:
■ Neuroscience has confirmed the effectiveness of the mainstays of counselling, lis-
tening, empathy, and a focus on wellness (Ivey, Jvey, & Zalaquctt, 2010).
■
■
Counselling aids in the generation of new neurons, a process knmvn as neurogcncsis
(Ivey et al., 2010). This is importam because ncurogencsis aids damag,ed brains to
recover, 3nd it can slow brain degeneration caused by dcme.nti3➔
Neuroscience is providing specific guidance on how to promote neurogenesis. It
-·
newogenesk: TIie proktioo of •w
supports the efficacy (effectiveness) of counseJling strategics that include exercise

and diet (Arden, 2015), an argument in favour of counscJlors encouraging clients
to add these lifestyle changes co their action and recovery plans. Similarly, stress
managcmcm, having positive relationships (including the diem/counsellor relation-
ship), spirituality, 3nd mcntaJ stimulation increase neurogencsis.
■ Social interaction stimulates the brain's rc\\'tlrd circuitry and the release of dopa-
mine and oxytocin, neurotransmitters that increase motivation, feelings of well-
be.ing (doP3mine) and levels of attachment and trust (o)..·ytocin) (Stanford, 2017).
This finding reinforces the importance of the counsellor/client reJationship, whic.h
is strongly linked to counscJlor empathy.
■ The counselling relationship, long recognized 3S the most important c3ta1)'St for
client change, creates the fertile conditions for heaJing the damages created by stress
and supporting the growth of new neural path\\'1lys fundamental to wellness and
mental he~llth.
■ Mindfulness helps the brain to refocus, decrease worry, increase worlcing memory,
and decrease stress.
■ Exercise hclps to slow cognitive dee.line.
■ Specific interventions such as exposure therapy can help to repair the damage
caused by trauma damages to two important pans of the brain, the am,.•gdala and
the hippocampus (Trouchc, Sasaki, Tu, & Reijmcrs, 2013).
■ Problem-solving worlc and sclected computer games enhance cognitive functioning.
■ Most counsellors are 3\\'tlre that confrontation is general I,., a poor strategy for effecting
change (Miller & Rollniclc, 2013). Neuroscience tells us why. Confrontation 3rouses
the brain's fight or ffiaht response as it mobili.!cs for what is experienced as an attack.
As a result, wfu3bJe energy that might otherwise be h3rnessed for ch3nge is dive.reed
to defence of the status quo. EmP3thy, on the other hand, offe.rs no such threat and,
in fact, acts to calm the brain and 3dd to the development of the counsellor/client
relationship. a major variable associated with favourable outcomes in counselling,
■ Counsellors who use a strengths approoch stimulate their clients' prefrontaJ cortex
to shift to positive thinking and emotions, which in turn heJps to overcome unhelp-
ful and negative thinking patterns (Jvey, Jvey, Z31aquett & Quirk, 2009).
■ Dahliu (2017) cited research showing th3t when clients are involved in decision
making and have choices, there is increased activity in the caudate nucleus and
other areas of the brain that 3rc involved in motivation. The research su~ests th3t
clients with choices have a greater sense of control, incrc3scd motivation, and nn
overall more positive mood.
Neuroscience Adds a Biological Perspedive Emergent research that reveals the

biologicnJ b3sis of many mental disorders is helping to guide the development of prc-
ve.ntivc 3nd intcrventive strategics. The research is also informing counsellors 3bout

SUCCESS TIP
Evidence-Based Practice and Neuroscience
Ewe!ence-based best practice (EVP) means that we counsel clients using the best available
evidence that what we a(e ooing has a reasonable d'lance ot successfuly meeting d ient
needs and goals. Typicaly, EVP was baSed on research (outcotne and contrOlled Sludies),
eulural considemtions, cooosof et~ and .-ic!M:1ual d ient variables, as v.'1:!11as practitioner-
and colleague ext,erience. Now, neu(oscience is providing eounselbrS wtth EVP in growing
a scientific bOdy of knoldedge abOut how specific strategies can positivety impact lhe br'ain
and facH,tate change Or' repair ot damaged bfains. This EVP research makeS a strong case
in support of an ectectic and customized approach to counselling that allO-hS f0t change
and adaptation based on the i'ldividual needs of clients and situations. A "one-si:ze-fits-a11·
model ot counsetlmg may wOr'k well rn one sduatioo., but fad miserably in anothet.
how the brain is impacted by crisi~ trauma, substance misuse, nnd socinJ determinants
such as poverty.
Since many counsellors have had linlc or no training in neuroscience, they will need
to include this topic in their rc3ding and profcssion:.d development agcnd3➔ Counsellors
do not need to become experts in neuroscience, but it is imperative th3t they have at
lc3st a b3sic understanding of the brain and the terminology. This will enable them to
be 3ctivc consumer of neuroscience inform3tion.
Neuroscience Provides Counsellors with Another Rationale for Systemic
Change Research endorsing the vnJuc of counselling interventions is providing com,.
pclling arguments for increased funding for counselling preventive and trc3tment pro.-
grams. The Centre for Addiction 3nd Mental Health (2017) estimated that the totaJ cost
of untrc3tcd mental illness in Can3da is more than 51 billion dollars. 03ta such 3S this
provide an cmpiric31 b3sc for counsellors who 3re 3ctivc in lobbying for politic31 and
systemic change to grossly undc.rfundcd mcntaJ health 3nd 3ddictions system.
Neuroscience Offers Guidance on the Use of Technology for Treatment
Counsellors who are wcll vc.rscd in neuroscience C3n inform and refer clients to take
advanmi;c of rapidly emerging technology. For example, Li, Montano, Chen, & Gold
(2011) describ~ how virru3f rc3lity can be used to rewire the brain to deal with pain
m3nagc.mcnt. T«hniques such as biofeedback c3n be utilized to supplement more tradi.-
tional counselling 3pproachcs. Another promising tcchnologic3J advance is Transcranial
M3gnctic Stimulation (TMS), which involves the use of magnetic pulses to stimulate
the brain. An effective alternative to medication, this technique has proved very useful
in treating depression, including for those who have not responded to medication.
Neuroscience Reduces Stigma Moral and cultural judgments c3n inflict shame
on those dealing with mcntaJ disordc.r~ a reality that often leads people to fori;o treat,.
mcnt 3nd suffc.r in silence. Neuroscience research has made grc3t strides proving that
there arc i;cnetic and biological causes of mcnt3l disorders. These findings suppon the
argument that mcnml disorders ought to be understood and treated in the s3mc way
that biological disease or injury is 3ddressed. Stigm3 will be reduced when people lc3rn
and occcpt that mental illness is not a choice caused by moral wc3Jcncss. Neuroscience
knowledge will hcJp to change thinking so th3t brain based disorders 3re viewed no
differently than any biological disease or injury. Counsellors can pl3y 3 major role in
communicating this notion to client~ their families, 3nd the community.
Neuroscience Provides Explanations Useful for Psychoeducation Psrcha<du-
cation, long 3 mainst3y of counscJling, involves helping clients 3nd their families learn
348 Chap1er 11
about the nature of their problems, including practical information on how they might
address social, psychologicaJ, «anomic, and other concerns. Neuroscience expla,
nntions can be used by counsellors to help clients understand how their b rains arc
impacted by the.ir life experiences, trauma, illnes~ and substance misuse. Most coun-
sellors are not experts in neuroscience, so they must be careful that they do not exceed
the limits of their competence in this arc3➔ They need to refrain from giving medic31
advice or offer ing opinions on ncurologicaJ issues in which they are not qu31ified.
Neuroscience is Available on the Int ernet As a result of widespreld access to
information onlinc, clients have opportunities to become better informed rcg3rding
their conditions. There is, however, a real risk that clients., or even professionals, will be
misled b\• false o r misleading information. Sometimes, people will post to the lnternct
based on their beliefs or personal experience, but their statements may be mnJiciou~
fabricated, o r simply wrong. An informed client is empowered, but a misinformed
client may de.La.,., or suspend tT'C1ltment based on an unverified opinion expressed on
the Jnte.rnet. Counsellors can best support clients by encouraging them to consult with
reputable sources such as ,;overnment or national user sites. \\:fhcn counsellors have a
basic working knowledge of neuroscience and the brain, they are in a much better posi-
tion to help clients access and utilize factual and rcJiablc information.
\Vhat counscllors can do is hcJp clients acquire a basic understanding of how their
problems might be influenced b\• the brain. To do so. counsellors need at lc3st a rudi-
mentary appreciation of how the b rain works. For example, research has demonsrrated
that excessive anxict)• might be due (in pan) to an ove.rac:tive amygdala. (Arden, 2015).
This knowledge can form the b3sis of a simple explanation that can hcJp a diem under-
stand and deal with their anxiety. Herc's nn example:
Coun.settor: One of the interestin~ thin~s the)'°ve diseov~red is that wben people (eel
overly 2mdous. there ·s a pore o( the br2in th:lc's overactn'i'. Howe>.'i'r. the ~'()()Cf news is.
it ean be man::1~-('d.
Client: How?
CounseUor: Some peopLe 2re helped with 1nedie:iition. but th:lt's S011~hinK for )'Ou and
)'Our doctor todi.9russ. You\'i' l'Old ine th:lt ii helps l'O ::tvo,d sltuaoons where )'Ou S.e t over~
whelmed. and th:lt'sone ~-oocl eopina strateay. It's the e\'i'-r)<l3't' si1u ::11ions and rnomenu
that )'Ou e:iin't ::rw>id where )'Ou nee<! 2 solution. Ri$.ht!(Client nods) Generally. ::rvoidanee
decreases amdety, but incre.1ses (e::ar. so the next tune )'Ou face the situ:ttion. )'Ou will be
e"e:n mott2nxious. I( )Ou want. Yi't, tan work l'O develop a stratea:r that wi.11help )'Ou take
Sm.:!111 steps to O\'i'reome both lt:1.r and anxiety. You'll be in eh::a~. 2nd I won't t r)' to
(oree )'Ou to do anythirl{t.
ln the example above, the next step might involve the use of a best-practice counsel-
ling strategy such as systematic dcsensitimtion, a technique that combines relaxation with
incremental exposure to an anxicty-provolcing situation. (Caution: the use of systematic
desensitization should be within the counsellor's area of competence.) Clients such as the
one in the example often report feeling rclie\'ed when they finnJI,., understand the reasons
for their problems and empowered as they learn that their problems can be managed.
SUCCESS TIP
Neuroeducation
Counseilol'S can use neu(oscie-nce info"nalbn to help othe-rS to uncle-rStand behaviou". FOr'
example, ctuld(an in a class(oom whO might olhe-rwise be labelled as Mood; "difficl.At;
Or' "spoi100• a(e, in facl, (esponcl1ng to faulty brain che-mistry ot behavioutal pattetns long
Shaped by (e-petition.

Neuroscience Provides Guidance on Medication KnO\\rledgeof ho"' medications
enluncc, inhibit, or augment brain and bodily functioning is cssc:ntial for asscs.smcm and
goal setting with dients. For example, many psychotropic medications lead to weight
gain, so counsellors can support clients with wcllness initiatives (e.g., diet and exercise).
As a result, medication compliance may be improved since clients will be less likely to
abandon their medication because of the discouragement associated "'ith wc.ight gain.
Neuroscience Offers Hope Because our brains arc "'ired based on past cxperi.-
ences, there is strong pres.sure to act and think in a manner consistent with this "'iring.
Put simpl)•, we are creatures of habit, even when our habits of thinking and behav.-
ing arc problematic, the usunJ position that brings clients to counselling. However, the
good news is that we can chan,;c our brains and change our futures.
Neuroplasticity One of the most exciting and relevant discoveries in neuroscience,
neuroptastkity: The braia's ability n europl-asticiry refers to the brain's ability to change itself by forming new neurnJ con,.
todla-ie itself ~ lonnilc •w neural ncctions in response to learning, changes in the environment, or as compensation for
connecti>ns in responst 10 li!'arning.
injury or disease. Neuroscientists have found that not only can the brain change, it iscon.-
standy changing. (Ncuroplasticity "'ill be explored in more detail latc.r in this chapter.)
Ncuroplnsticit)• concepts can be used by counsellors to convey hope to our clients.
They can help clients understand that thq• are 00( permancndy doomed to thc.ir current
thinking, behaviour, or c.m()(ions. They can provide guidance reg3rding how dients can
change or "rewire their brains" in ways that reduce or eliminate thc.ir current problems.
Neuroplasticity can sho"' clients ho"' tools such as cognitive behavioural counselling,
mindfuln~ risk taking, meditation, exercise, and diet can be the roots of positive change
in their lives. For both counsellors and clients, neuroscience provides the factunl basis
for the use of techniques., such as cognitive behavioural thc.rapy, that harness the brain's
amazing neuroplasticity to form new neural pnthw-nys to rcplnce and extinguish unhcJpful
and harmful thinking and behavioural pane.ms. Peckham (2017) offc.rs this perspective:
The very definition o( neuroplastidty sh,o,,vs us th::u aeceptance o( c:ircutnstanu does
not ha"e to be the end of the Storr. If ~penences have shaped us in wa)'Sth::u current!)'
ea.use distress (both t'O ourSeives and to others in our lives). w~t expe-riences could
e~1~ us 10 have better li"es! \\'hat expedences 1ni~t v.--e need! (p. 15)
Ncuroplasticity research confirms that nc"' learning is not only possible throughout
the lifcsp3n, it is also inevitable. Old dogs can, in fact, learn new tricks.
Here's ho"' a counsellor might explain it to a client:
CounS(>IJOr. In the last 30 rear!l. br.1.in reSe3rehers have di:sco"ered th3t our br3ins are
constant!)' cha.ni.:i~
Client: So, w~l's thebiadeal. h's not son~hini.: I can control.
Counsellor: T~t' s wb3t evt:r)'One believed until rttendy. 1'0Yi', the)'°"e learned th3t
there ii ac1ually a lot we can do to help our br3ins aroo• and heal. Since your br2in is
aoini.: m char)$:e 21n)'way. rou 1nleht as well be helpina it cha.nae (or the better. And the
aood ncws is th3t "re now know how to do it.
Neuroimaging Modern advances in neuroimagina have provided facts and inform3tion

with enormous implications for counsellors. Research is increasing!)• guiding and inform,.
ina counscJlors ho,,v their clients' brain structure and c.ht.mistry might respond to different
intervention strategics. \Ve are wcll on our w-ny to understanding how spcciflC counselling
strategies change the brain to promote positive arowth, including neuro~nesis, the grmvrh
of new neurons, somrthina that a short time ago was considered impossible. Clients can
c.hnn,;e their brains. Counselling can support, enhance, and accelerate this outcome.
A Look Ahe.ad (n the coming decades, n~uroscience will continue to have a major
impact on our understanding of ment3l and physical disorders. Counsellors, social
350 Chap1er 11
workers, psychologists, child cnrc worlccr.s, and other social service provide.rs will neo:I
to have at least a basic understanding of the brain and the implications of neuroscience
research for their fields of practice.
Academics and researchers in the counselling ficJd will no doubt begin to J;Cneratc
their own research and commentary from a neuroscience perspective. Educators will
be chaJlengcd to integrate neuroscience into professionaJ training programs. Research
reports in any discipline arc often difficult for the average person to understand and
absorb. Frequently, this result in a disconnect between the empirical results of science
and thc.ir application to field practice. Counselling spccifte litc.rarurc utilizing neurosci•
cncc has the potcntiaJ to bridge this gnp.
(n the same way that multiculturalism has become a continuing theme in virtually
all counscJlor education program~ neuroscience will confirm its' place as a new force.
There is still much to learn, but there is abundant room for optimism that neuroscience
discoveries will continue to pro\•idc hope for client~ and guidance to counsellors on
how to help people rcP3ir damaged brains and slow ag:c-rclatcd decline. NcuroscientifK
research will dcvclopgrcatc.r precision regarding how chemical, elcctricaJ, and strucrural
abnormalities in the brain lend to brain disorders like Ahhcjmcr's and mental disorders
such as depression and schizophrenia. Along with this will come new psychotropic
medications, custom designed to restore equilibrium and function to wounded brains.
The future holds fantastic possibilities!
STUDYING THE BRAIN

Neuroscientists and psychologists can learn about the brain in many ways, including
through dissection, neuroimaging, the study of electrical activity in the brain, animal
srudic~ and behavioural research. They can aJso learn a great deal by exploring how
injury or disease affects normaJ functioning and behaviour, or by monitoring the brain
as it struggles to heal and recover. For example, if doctors needed to remove a tumour
from your brain and this affected your \•ision, they could assume that this part of your
brain was involved in vision. Double-blind experiments are used to study the effects of
medication on the brain. ln a double-blind experiment, one group is given a placebo,
another the medication, and the results arc compared. Neither the subjects nor the
researchc.r lcnow which group is receiving placebo or medication.
Frontal lobotomies, which involved destroying a piece of the brain, were often used
in the mid-twentieth century before the advent of antipsychotic medication. The results
were unpredictable and often hor-rcndousJy debilitating, The damage from lobotomies
showed the important role that the frontal lobe of the brain plays with respect to per-
sona1it)• and other higher-order operations.
Brain Imaging
Neuroimagina or brain imaging involves the use of various tools to explore the struc- newoimaging: TlleuseolvariOl!stooli
ture and function of the brain. It has e-.'Olvcd considcrabh• since the discovery of X-rays to e,:ilore the struct:. •d ru1eti>n of
tile brain.
by Wilhelm Rontgen at the end of the nineteenth century. Since the 1970~ technological
innovation has produced machines that now provide unprecedented maps and images
of the structure and activity of the brain.
Although brain imaging t«hniques cannot be used for psychiatric diag:nosi~ they arc
useful for ruling out physical causes that ma'>' lead to psychiatric symptoms. ln addition,
they can show how the brains of people with ps)•chiatric conditions function diffe.remi)•.
For example, "ls)tudies showed that during tasks involving emotions, people with depres-
sion, comP3rcd to those without depression, had activity in a region in the middle of the
front of the brain. Another study helped us understand why people with anention deficit

hyperactivity disordc.r have trouble paying nttcntion because n pan of the fronrol lobc that
helps us focus is less nctive (Sitck, 2016). Findings such as this supponcd the development
of counselling str:uegics that help people with (Attention Deficit Hyperactivity Disordc.r)
ADHD scay on caslc, such as establishing routines and selecting quiet spaces to w-ork where
there is not too much stimulation.
MRI (Magnetic Resonance Imagi ng) A procedure that urili:es mngnctic fields
nnd radio wnves to cake three-dimensional structural pictures of the brain and body
Magietic Resonance lrnagi,_ or-i:ans. Mainctic Resonance lmagini (MRI ) aids in the dct«tion of brain abnor-
(MRI): Aprooedu,e that utims malities such as tumours. multiple sclerosis (MS), dama,;e from stroke~ infection~ nnd
aa:gneit fields-.:J radii ■aws to Lale
three~ima sional struNur,1 pictures of
accidents. A Functional MRI (fMR]) aJso utilizes magnetic fields, but it measures
the brail•d bcdyorgans. nctivity in the brain while the individual is involved in diffc.rent activities or thoughts.
Although fMRJ can identify areas of abnormal activity in the brain, this technology
Functional MRI (fMRI): Use of
aa:gneit fields to -.asure activity ii the has not rcu.hed the point where it can be confidently used to dingnosc mental illness.
twain .,... an D idual is invd\'ed ii Furure innovations may make this more feasible and reliable.
liff«NI activities or thoughl
CAT (Computerized Axial Tomography) A CAT (Com puterfaed Axial T o mogra-
CAT (Computerized Axial phy) scan uses X.-rays to dct«t abnormnlities in oraans. CAT scans of the brain can be
Tomography): US! ofX~ys to de!ed
used to diagnose a wide range of problems, including strokes., rumour~ damn,;e from
abncrma1ities in «pns.
head trauma, bleeding, slcuU mnlformation~ and oth~r conditions.
PET (Positron Emission PET (Positron Emission Tomography) A PET (Positron Emission Tomoiraphy)
Tomography): tladilauiw d)1! injected sc3n uses a radioactive dye that is injected into the body to measure blood flow and to
ilto the boty to measure ltloi flo-- . and
detect probkms ■idl, the heart, br• and detect problems with the heart, brain, and central nervous system (brain and spinal cord).
central nEl'YCIUs system(brail and spiul
cord).
EEG (Electroencephalography) EEG (Electroencephalo~raphy) painlessly and
without risk measures electrical activity in the brain. This is used to assess or rule out
conditions such as rumour5i, stroke, head injury, nnd ~pilcpsy. Neuroscientists have iden,.
EEG {Elect,oen-aphy), A
tool used to musul! electrical a«i\W)' in tificd five distinct types of electrical brain wave~ ddca, theta, alpha, beta, and i;pmmn
the brail. (Figure 11.3), which incrcase or decrease depcndina on whal we nre doing or feeling.
HUMAN BRAIN WAVES
GA'IM,\
__
.....w
""""'-
,
J1 100 Ht
~- --..,...
....
RJU
nur., ,.,
........,
DELTA
C · )H1 ..........
......,
Figure 11.3 Brain Waves

..
'
SOURCE: Melba/Shutterstoek
352 Chap1er 11
Techniques such as ncurofccdback or biofeedback, which use EEG to show clients their
brain's clectric3l activity, teach them through trial 3nd error to control brain wave activ-
ity as a W'tl)' to reduce anxiety and stress (Myers & Young, 2012). Research also suggests
this strategy may be u~ful for conditions such 3S migraines, post-tnmmaric stress disor-
der (PTSD), and ADHD (Nordqvist, 2017).
Emergent Technologies Diagnostic methods for srudying the brain are advancing
rapidly. EmerJ;:ent technolos:ies, include new techniques such as: Magnetoencepha, Emergent Technologies: New
logram (MEG), used to record magnetic fields; function:.d near-infrared spectroscopy, diagnostic tools for si.t,ilg tile brain,
inc:Wilg .libpetoencephalo_gr• tMEC).
(FN(RS) which uses light to r«ord changes in brain oxygen lcvds; diffusion MRJ fuldi>nal near-inltand spearosaipy
(DMRl), u~ to measure water diffusion in the brain, event-re1ated optical signal (flatS). diffusi>n MRI tl:lilRO.
(EROS), used to assess changes in opricaJ properties in the brain; voxcl.-based mor- ewa!•ielated optical signal (EROS).
and wael-bas.ed molJb)metry (WM}.
phomctry (VBM), used to me3sure 3natomical difference in the brain; 3nd many others
(Mental Health Daily, 2017).
,)}t) BRAIN BYTE

Weill Corneil Medicioo (2017) reported resea,ch utmz. helped doctors to determine which patients were more likely
fMRI anal)'sis of over l000 people with depression. It to tespond to different therapies such as deep brain stimula-
vealed fouf disrincl sublypes of deptession, each with tion. a procedure wtlere etecttOdes ~nted in 100 brain are
iCIU8 patterns of abnormal bcain activity. The results used to stimlJate it.
NEUROPLASTICITY: AN EMPOWERING
DISCOVERY
An exciting and relevant neuroscience finding with enormous implications for counsel-
lors 3nd clients was the discovery in the 1990s of brain neuropl3sticity. As noted earlier
in this chapter, ncuroplasticit)' refers to the brain'sconsrmu changing of neural pathwa\'S
3S 3 result of new IC3rning, experience~ disease, and injury. Prior to this discovery, it
was believed that the brain remained relatively unchanged after C3rly childhood. lt was
3ssumed that we are born with all the neural capacity th3t we will ever have, 3nd th3t
brain d3mage, stress., depression, and other life events will result in permanent loss of
this neuraJ capacity.
Peckham (2017) makes this interesting observation, "n3ture assumes th3t the cxpe.ri•
encesof our future will be similar to the experiences of our past (p. 14)." So, our brain's
neural pathways form and strengthen based on our experiences 3nd are programmed
to expect more of the same. UnfortunateJy, neural pathways may form that strengthen
unhelpful thoughts or behaviour such as seJf<riticism, violence, or the belief th3t one
cannot cope without using alcohol or street drugs. This reality has profound implica,
tions for a person's overall ability to deal with life challenges as the following examples
illustrate:
Ex3mp1e I: Andre:. StrN' up in an environment wheres.he learned th::u "cluklren should
be seen a.nd not heard." On the r2re occasions when she expressed (eelin¥S or ide:.s. she
w::tS berated <>r punished. As an adult, she has diff'kult speak in¥ in Stroups or lormin&
intim3te relations.hips be(-3use o( her oons12nt le3r of rejection. She ropes br keepin&
to hersel(. essentially lead in& a so.Jitary l1f'e.
ExampLe 2: ?l.·1ikln"d wasenooul"3it«I from an e:.dy ~e l'O purSue herdre:ims. Her parenu
pnwided her with a rkh thi.ldhood fulJ of thalLer)ih-)¥ ex perien~s that $t:tl.'e her a ehan~ to
de-.-elop a wide ran~'\'.' of interesu ::md hobbies. As an ad ult. she is an independent risk taker.

Clear!)•, MildrOO's brain is "wired" for success while Andrea has many neural path.-
ways that, if unchallc:ng:c:d, program her for failure. Although Andrea's past has left her
ill-«auipped for life as an adult, with time. patience, c:ffon, and practice:, her nc:uroplas..-
tic brain can be chang,ed. She docs not have to be destined to a future defined by the
realities of her past. CounscJling can help her to reprogram her brain. Using cognitive
behavioural techniques such as those introduced in Chapter 7, she can be hcJpcd to
recognize: problematic thinking, and how this negative!)• impacts her behaviour and
emotions. Then, with the hcJp of a counsellor, she can talcc: steps to reprogram unhelp-
ful thinking and automatic responses.
How to Stimulate Neuroplasticity

Neuroscience has demonstrated that brain change is continuous. Every da,.•of our lives,
our brains change in response: to every interaction, thought, fccJing. and experience. For
better or worse, the structure and chemistry of the brain is in a constant state of flux.
The counselling challenge: is to help clients increase the probability that neuroplastic
change will be productive: and positive. Herc arc some things counscJlors can do and/or
be familiar with that promote: ncuroplasticiry:
■ Encourage creativity and new c:xpe.ricncc:~ such as learning to play a musical instru-
ment or a new language:. PathWtt)'S in the brain that arc not used arc pruned, so the
old adage "use it or lose it" applies to the brain.
■ Promote dic:nt panicipation in c.xc.rcise. Exercise has been shO\\•n to stimulate the
growth of neural connections. slow brain decline: in people with dementia, and even
stimulate the growth of new neurons (Budde, Wegner, Soya, Voekker-Rchagc: &
Mc.Morris, 2016).
■ HcJp clients visu3Ji:e solutions and success. Neuroscience research has found that
visualizing solutions and success "prewirc:s" the brain with neural pathways to those
desired ends. One counselling strategy is the "miracle: question" (sec text Chapter 7),
which helps clients fantasize how their lives might change if their problems disai;
pen.red. Conversely, dwelling on past fuilures or imagining future failure reinforces neu-
ral pathways supporting fuilurc:. Consequently, counsellors should teach thc.ir dicnts
how to build and srrmgrhen (through practice:) neural pathways b\•visualizing success.
■ Encourage goal setting, which stimulates the brain with challenges. This is particu.-
larly important for Canada's aging seniors as a way to slow age-related cognitive
dee.line. As they retire from the challenges of their jobs. it is important th3t seniors
reroin a sense of purpose, so working with them to set goals that meet the SMART
criteria discussed in Ch3ptcr 7 (specific, measurable:, achievable, realistic., and in a
time frame) (sec Chal){c:r 7) helps to nurture positive brain plasticity.
■ HcJp clients deal with the anxiety and stress that h3ppcns with ch3ngc: or rislc taking.
Excessive stress divc.rts energy that could otherwise be used for learning and action
plans. Counsellors can assist b\• helping: clients rccogni:e th3t change stress is normal
and prc:dicmblc:. They can help clients predict and m3nagc potc:ntiaJ stress points.
■ Remember that the counselling relationship itscJf is a powerful ally to change. It
can provide clients support, empathy, and a milieu for cmc.rgc:nt problem solving.
As such, its imporronce as a motivator and sustainer of the ch3ngc: process should
never be underestimated.
■ Encourage clients to access physical rehabilitation services for brain injuries. For
example:, using repetitive movements helps the brain form new neural connections
for a movement such as waJking th3t m3y have been damaged by injury or illness
(Liou, 2015).
354 Chap1er 11
■ Use cognitive bch.nvioural counselling to extinguish unhdpful thinking (ncg3tivc
thought patterns) by replacing them with helpful thinking (sec Chapter 7). Learned
unhelpful thinking is also a product of neuroplasticity.
■ Hdp clients r«ogni:e the importance of sleep and the nttd to deal with problems
such as sleep apnca. Research has shown that sleep boosts neural plasticity and lack
of sleep is damaging (Gorgoni et aL, 2013).
■ Be a,.,,.-are that that early life experiences can play an important part in the recovery
of individuaJs who arc later impacted by sud,. things as trauma or substance misuse.
A key consideration is whether a client's ncuroplastic brain is wired for problem
solving, resilience, and healthy living, or not. An example will illustrate:
))(,,,in and his friend ?l.•fa.rco bec=ime heavil)' involved with dru.a,i in the.ir bu, teens..
Both had :. fh,e,yt:ar,lon& history o( 2r-reiits and inearcerations wben they Onally
entered a Montreal dru& rehab 1rea1men1 ren1re in their e::.rl)' tv.--enties.. Devin was
r.1!$00 in a lovin¥ environment where he h::.d access to e:nriehh,¥ ei.:pedenttii and
sports. t-.-b rco waii ph)•Sieall)' and se:xu:allr abused 2s 2 ehild. then spe:111 o,.•er ten
yearS in 2 loi,i series o( foster homes.
ln reh.nb, Devin has some advantages. Although long dormant, his brain already
has neural pathways supporting good values and sound judgment, whereas Marco
learned that the world is an unsafe place where his physical and emotional needs
will be unmet. \Vith Devin, a counsellor might strategize ways to re-energize
dormant neural path\\>n)'S th.nt support mcnta1 and social coping such as by encour-
aging him to recaJI early memories where he felt safe and loved. \\:'ith Marco,
a counsellor needs to prioriti:e the development of a trusting relationship with
him. The strengths approach philosophy suggests th.nt Marco, as a result of his
experiences., may have dcvcJopcd resilience and capacity, the counscJlor should
look for ways to recognize and b uild on these strengths. This approach will help
counterbalance neural networks programmed with expectations that he will be
abused and rejected.
STRUCTURE OF THE BRAIN

The brain is composed of thrtt pans: the cerebrum, cerebellum, and the brain stem.
■ Cerebrum: The largest part, the cerebrum controls hi~c.r-order functions, including cerebrum: Part al the twain that
emotions, learning, and sensory processing. The cerebrum h.ns two hemispheres aintnts hig)er-order functi>ns.. ind~
emoti>ns. learning. ud sensory
(right and left) and four lobes: fronmJ, parietal, temporal, and occipital. \\:'ithin the pnnssing..
lobe~ there arc a larJ;c number of pan~ each of which has at least one and more
often, multiple functions. One of the major parts of the cerebrum is the limbic
system, which, b«ausc of its criticaJ role with respect to emotion~ is of major
interest to counscJlors. The limbic system includes the th.nlamu~ hypotha1amu~
amn;dala, and the hippocampus. For any function controlled b\• the cerebrum,
such as emotion, memory, or decision making, there may be a major centre which
regulates it, but often as not, many other brain parts play a role.
■ Cerebellum: The cerebellum, sometimes rderred to as the "little brain" comprises cerebellum: The part GI lie brain
about 10 percent of brain \'olumc. Jt can be found behind the top part of the brain auociata:I 'lliih mowmeat S8$(I')'
peaptioo, -.:J • •cosdina:ica
stem (Figure 11.4). The cerebellum is associated with movement, sensory percep-
tion, and motor coordination, so it is not surprising that damage to the cerebellum
could result in paralysi~ tremor~ and prob lems with motor coordination (body
movements) and ataxia (loss of control of bodily movements). As well, this part of
the brain is one of the areas th.nt is advcrscJy affected by schizophrenia (Mobcrgct
et al., 2017). lt is aJso bcJievcd th.nt the cerebellum is involved in a wide range of

) )!} INTERVIEW 11.1
This brief interview excerpt illusllates a number of important counselling strategies. It intioduces the idea that the client's
unhelpful thinking is an outcome of learning. not personal failu1e or inadequacy. The client has been talking abOut his foar
of taking risks, which has held him bac,k in his career and personal life.
Counsellor: The bt'ain is like a muscle. &efcise it and it Analysis: A brief introduction Is gi ven, which helps to nor-
gets srro•(. Sometimes, and it can happen to anyone, mallze the client's situation with the notion that the client is
we uain our minds to do lhiogs that aran't helpful. not the only one with th;s problem.
Clk>nt That makes sense. I thiok I'm pr()!Jammed f0t fail- Analysis: The client engage.s with the concept and relbtes it
ure. Wheoovef I face a d'lauenge Or' new situation. I keep to his thinking patterns.
Iii~ "Whars1he JX>inl? I can'ldolt."So, ldon'1even 1ry,
Counsellor: I'm guessing you've been dOiog this for a long Analysis: ..Not yet." lightens the mOOd- app,opriate and
time timely humour is an important part of counselling. However.
Cllent: Al my lite. "not yet" also conye_ys the Implicit message that what's been
Counsellor: Well, no1 yet. (Client laughSJ true in the past does not have to be true in the future. This
communicates hape for change.
Counsellor: How srro~ is this belief? Sc.ale of 1- 10? Analysis: The counsellor wants to get a sense of the degree
Clftnt: Atx>ut an 11! (Client chuckles, then tears up.) that the client is committed to his be.lief. It's no surprise that
(Pause of 10 S<!COOds.) he also shares (nonvetbally) his pain.
Counsellor: It hlXls to think aoout it Analysis: Counsellor empathy Is Important when feelings are
Cllent: A lol e.rpressed.
Counsellor: It's not easy but what your br'3in has learned Analysis: The counseJ/o, conye_ys hope. The intef'lllew contin-
can be unlearned. The br"ain can be rewired. ues with an ex.ample of the strengths approach In ,:,,ac.tlce.
Cllent: My tll'SI reaction is, "II won't \\()rk f0t me.· (Pause The counsel/Ors patience during the JO.second pause gave
of 10 secondsJ See, I've done it again. the client a chance to challe.nge his own reaction. This pro-
Counsellor: Good for you. vou•ve already started by recog- vided the counsellor with an c,pening to recognize this as an
ni:zing the pattern. That's an important fil'SI step. empowering sJrength. The counsellor might have picked up
on his PM,Slmism with empathy. but there was some value in
Ignoring the pessimism and suggesting a ref,ame insJead. The
client has already dee.lated his "normal" thinking pattern, so
the,e is merit In not getting drawn Into this too heavily.
Counsellor: In the last 20 years, a rot of work has been Analysis: The relationship is now well-Positioned to further
done explOring hO'N the brain WOrk.S. This has given us discuss the process, then contract to e.rplore change strate-
IOts of gui:Sance on how to change thinking patterns. TM gies and action plans.
prindptes are ciuite simple and theyWOrk, but they require
a IOt of persistence and patience to rewire your brain.
Cllent: can you gjve me an example?
Counsellor: There are manyw.rys.. but here's one. Researd'I Analysis: The counsello, ,:,,ovldes a simple, non-jargon/zed
has sho-Nn that visualizi~ sucooss can be just as effective e.KAmple ofan action ,:,Jan that can be used to help the client
in changing the brain as actuaUy dOing it. Here's hO'N it change unhelpful thinking patterns.
works. You'U choose a situation you want to change, one Letting the client Jcnow there wlll be challenges ahead allows
vd'lere you've been saying to yourself, MI can't dO it.· Then, the client to anticipate and strategize how to handle them.
111help you magk'le or play out the situation where you are This makes ft less lfl<~y that he wlll lose motivation when he
successful With ~ . you'I aciuall'y change your brain faces obstacles.
b-j cha~i~ the way you thiok. Repetition i:s the: key to this Implicit in the action ,:,Ian is the neu,oscience conc.ept that
v.iting. It won't be easy-like you said. it's an .. 11/10: So, new learning Is enhanced with ,:,,actlce and repetition.
we'll fight the old pattern 'Mth a .. 12 ...
Reflections:
■ Suggest what the counsello,'s next steps might be.
■ What CtlgJ'litive behavioural counselling p,inciples are illustrated in the interview.
■ What are some of the obstacles that the client might enc-aunter. Suggest strategies to handle them.
356 Chap1er 11
Figure 11.4 The Cerebellum
SOORCC: Decade&! • al\atoMy onllne1Shutter1toek
disordc.r~ including ADHD and 3Utism spectrum disorder~ as well as mood and
anxiety disorders (Phillip~ Hcwedi, Eissa, & Moustafa, 2015). Counsellors can
support clients in s«king treatment from psychotherapists for exercises that will
help them to deal with movement and balance problems in order to reduce the risk
of injury from falling.
■ Brain S,em: The brain stem connects the brain to the spinal cord and provides brain stem: P~rto!tillebrain abowtille
nerve pathwars for passing sensory information from wrious sources (e.g., spinal spiulcord that contds breathing. heart.
and blood l)ESSllle.
cord and inner car). The brain stem is essential for essential body functions
such as breathing, heart control, and sl~p cycles. lt is responsible for control-
ling central nervous system functioning. including breathing, consciousness, and
blood pres.sure. Bec:3use of the vital role regul3ting bodily functions, damaae to
it can be life thrcatenina. Jc has three main parts: midbrain, pon~ and medulla
(Figure 11 . .S).
• The midbrain (mescnccph alon) pla)'S a role in sleep, hearing, \•ision, 3nd the regu-
lation of body temperature. It is 3lso associated with vision, hearina, motor control,
Midtwain (mesencephaton): Brain
stru:tse as.so:iated 'llill sleep. helrini,
-.is• bed)' ~atwe. vis- . lllearing.
slttp/wake, and arous:nl (alertness). -« cootrnl. steeplw.ale. and a10Usal
(alertness.>.
HUMAN BRAIN
Cerebell!M'n
Figure 11.5 The Brain Stem

SOORCC: OUWS9USIShutter1.todc

Pons: Part of the br• t!lat aids in tile ■ The pons aids in the transmission of mcssa,;es between the cortex and the cerebeJ,.
transmissi>n of • ssag_es between lie lum. As well, it is also involved in b reathing and sleep. Nerves from the pons play
corta-1 the cerebellum. as_. as
pbying a role in breathing, steep, bit-,:. a role in b iting, chewing, and swallowing.
Chl!lling, and s-•aHCMing. ■ The medulla, respo nsib le for bre3thing and regulating blood pressure, is essential
for survival.
Medulla: B,ain suuuure ,espm;sible for
tnatti., •d regulating blood press.. The thalamus, at the top of the brain stem, acts as the brain's switchboard and rein)•·
ing sensory information to the appropriate part of the brain. It also has a part in how
we ~rceive pain and in some aspects of motivation, learning, memory, and emo tions.
The hypothalamus, located between the thalamus and the brain stem, is involved with
body functions such as thirst, hunger, temperature, sleep, and blood pressure.
Hemispheres
The cerebrum, protected by the eight fused bones o f the skull, is divided into two
hemispheres, right and left, enc.h o f which has different functions. Generally, the right
hemisphere co ntrols the left side of the bod'>' and the left hemisphere controls the
right side. The right side o f the brain is more involved in artistic and creative tasks
while the left side of the brain is better at tasks chat involve critical thinking, lo gic, and
langua,;e (see Figure 11 .6). A stroke on the left side of the brain will affect the right side
of the body, while a stroke o n the right side o f the brain will affect the left side of the
corpus callosum: twvefibres tu'I body. The two hemispheres are co nnected by the nerve fib res o f the corpus callosum,
connect the two heaisplieresd tile brain. which facilitates communication between the two hemispheres.
white matter: Brain tissue t!lat White and Grey Matter The terms "white matter" and "s:rcy matter" are often
supports conflEdi>ns in tile brain by used to describe brain tissue. Grq• matter is compo.sed o f ceJls that help us think.
lllelpint the transaissioo -1 speed of
illonn.l'tica sharing betwefll parts of the
twain.
grey matter: B,ain tissuecomposEdd Left Brai n Functions

cells that lllelp ss dllilk.
Dlqital
Linear Vorb;,I
Logic Ana!l(tic thought
Verbal ::::>ystem
DigitalDigital . . ••
Obi-... Logical ObJect1ve 111,u~
Analytic thought BigNc'~~r ANla•
Sclenceandmath Qrder-,-- ~•.Intuition

Verbal Digital Art a nd mu~ic Art
Analytic System Objoctlvc Art ~,. E1J1....c:?t1on
Logica1 Language Dream""•111Cn,too Art Novel
Color Free -.....
Science and math Intuition M . . ., ~ . . . ., , " '
Syste_m Order ....; ~.~R,ftdom Emotio~F re~J!YJ!Y

Log1cal ,_. - Hohshc thoughte;g ree
o ,. ... Analytic Art Random Art Color
~Imagination Color Creativity""
Holistic thought "Art 0
Creat1v1ty""•lntuition 8 . ...,_
C rea t .IVe ColorMusic19
Free•··"'•
Rig ht Bra in Functions
Figure 11.6 Right and left•Brain Functions
SOURCE: ti:itsana 8ai!oey/l23RF
358 Chap1er 11
> : •.
A coml"OOO belief tS that people can be classified as "(~t- (Univetsity of Utah. 2013) has found no support fot this
bfained· Of ..left-brained; suggesting 1001 one part of 1r.e belief. The reality seems to be that bOth sides ot the bt'ain
bt'3in is used tnOr'e tr.an the other-. Howevef, tecent reseafd'I are irwotved in most functions.
White manc.r supports connections in the brain and help the transmission and spttd
of infor-m:nion sharing between parts of the brain. Most white m:mcr functions somc-
whnt like the insulation on an clectric wire. (n the central nervous system (brain and
spinal cord), the white matter insulation, known as myelin or myclin sheath, protttts
nerve ccJls (Fiaurc I 1.5). Many things can damage the mycJin shC3th, including MS,
stroke, infection, and excessive use of nkohol. Damage to the myelin sheath is called
demyelinntion, which can cause wide-ranging damn,;c, including problems with emo-
tion~ movement, sight, hearing. 3nd thinking. 03magcd m't•clin (Figure 11 .7) is a central
feature of MS. Medication and counscJling should be utili:ed to hdp clients dC3l with
the cmotionaJ and psychological effects of dcmycJin3tion.
Brain Lobes
Each of the two hemispheres has four lobes (Figure 11 .8). Although it is common to
identify certain responsibilities for C11C.h lobe, the reality is that all parts of the brain
are involved and activated during any function through intricate connections that arc
not fully undc.rstood. Neuroscientists 3rc only 3t the beginning stages of unravelling
this complexity.
A Universily of Cailifornia. Irvine study (2005) found that man between 100 sexes was found to be equal, the res.ullS helJ)
had 6.5 times m:)(8 e,ey maI.tel' than women whie women had ex.plain v.tty men tend to be bette.- with precise scienices like
10 times the amount ot while matter. While genetal intetligenice matnemati:::s whie \\()men more often excel Viith la~ag,e.
Figure 11.7 Healthy Myelin {bottom neuron) and Damaged Myelin {top neuron)
SOORCC: BlueRJ~edaal'StlutterStock

-LOI&
-
wa a
-
TEMPORAL LOSE
Heating
Le•mtng CEREBEU.UM
Ft,elin(P
Figure 11.8 Lobes of the Brain

SOURCE: NolevstiunerStock
frontal klbes: P.Jft GI die brain The frontal lobes arc often referred to as the executive portion of the brain beatuse
mponsillef«bigher-cwderfun«ic.i of their involvement in higlu~r-lcvcl thinking. These lobes arc enormously important
such u decision making, prottlemsol',tng,
jldgm.-, and---econtrol. for managing complex behaviour, including decision making, prediction, appropriate
behaviour, problem solving, working memory, impulse control, judgment, sc:xuaJ and
social behaviour, and various aspects of personality. Misuse of substance~ stroke, or
injury to this part of the brain c:m cause significant problems or impairment in all of
these areas. Alcohol, for example, may lend to permanent frontal lobe damage that limits
an individuaJ's abilit)• to m31cc rationaJ decisions, including the decision to limit or ce3sc
drinking. In addition, akohol 3nd other substance may lower inhibitions and cause 3n
individual to act irration3Jly in w3ys that ,vould be otherwise controlled by the frontal
lobes (e.g., impulsive behaviour, violence, and suicide).
Adolescents, p3rticularly males, arc more likely to cngaae in risky or impulsive
behaviour such 3S subst3ncc misuse, reckless driving, casual sex, and violent behaviour.
This is p3rtly expl3incd by the fact th3t the prcfront3l cortex, the front of the frontal
lobe, does not folly develop until late adolescence. In addition, peer rcfationships and
strong needs for approval m3y lead adolescents to increased risk behaviour. Steinberg
(2008) uses neuroscience rcsC3rch to 3rguc th3l this risk taking is ine,.•imble. He also
cites n•se3rch suggesting that preventive educ3tion31 programs h3VC been largdy inef~
fective. He argues that attention should shift to t3ctics such 3S raising the driving a,;c,
grc3ter policing of alcohol s3fcs, 3nd increasing access to mental health and contracep-
tive services.
Although schizophrenia and other ps,.•chotic disorders 3re most often associated
with the positive symptoms of hallucinations and delusions, cognitive impairment (e.g.,
memory, thinking, and judgment), involving significant problems with front31 lobc exec-
utive functioning, is often far more dcbilit3ting. E3rly recognition 3nd treatment of
psychosis is essential in order to prevent and minimi:e brain deterioration that results
from untreated ps,.•chosis.
occ:ipital lobes: Thepat1sdtillebrain The occipital Jobes at the back of the head are responsible for visu3f proccs.sina.
mponsille fcnisual processing. \Vhcn the occipit31 lobe is damaged, a person will h3VC trouble corrccdy processing
360 Chap1er 11
Stoca's afea is located in the left hemi:sphe:re of IM frontal atea in the parietal and tempo,al tObe is essenti.al f0r
tObe. It plays a vital rOle with tespect to language and undetsaanding speech and finding the (.gilt WOr'ds to ex.press
speech. Damage to this part of IM btain can result in a thoughts. People with Wet'nicke's AphaSia can speak, but not
speech dis0<der known as 8foca's Aphasia. Wernicke's understand Olhets.
whnt they see. For example, prosopas:nosia, or foce blindness, is a disorder in which prosop,agnosia: Adisorder whete
people cannot recogni!e faces, even with people with whom they are famili3r. Counsel- peoplecannot m::o_gnilf' laces. e-tea d
peoplewittl 'llklmthey an fa__,
lors can assist by helpina people with prosopagnosia to develop recognition strategies (ab as face blildness).
such as using voice, manne.risms, or clothing for identity dues.
Vision problems sud,. as macula.r degeneration can cause disorders such as Charles Charles Bonnet Syndrome
Bonnet Syndrome (CBS), a condition chal often causes visual hallucinations amona (CBS): a condili>n that ofteacnrses
-.isual hallucinatioos am<11g peoplewho
people who have lost their sight or have severely impaired vision. Given Canada's agina haw lost t!leirsiglll • haw SMfely
population, this rt':llity has important implications for counsellors who work with seniors. impai!!d visiln.
Consequmd't', counsellors who worlc with this population will want to acquire specfali:cd
skills to assist them in dealina with age-related visu:.d problems. Psychoeducation is vimJ in
order to help the client and famil't' to understand the condition, and to offer reassurance
that the person with CBS is not losing his or her mind (Bier, 2017). ReforraJ for speciali.!ed
assessment and trentment will introduce clients to strategies for managina the condition.
These might include eye exercises (Bier, 2017), alte.rations in lighting that might precipitate
or exacerbate the problem (Murphy, 2012, cited in Bier, 2017), and counselling to de~d
with any sociaJ or psychological condition resulting from CBS.
The temporal lobes process auditory information, as wcll as some responsibilit)• for temporal lobes: prion of the brai•
visual memory and speech. Damage to the temporal lobes (e.g., trauma and epilepsy)can t!l3! contiolivisual meao,yand ~
impact functioning in any or aJI of these areas and aJso result in problems with emotional
response and personality changes. Both Ahheimer's and Parkinson's can cause temporal
lobe damage involving memory, especiaJI,., in the hippocampus (Goodtherapy, 2017).
The parietal lobes process body sensations such as touch, pain, and temperarure, parietal lobes: part al the twain
as well as playing a role in vision, re3ding, and in solving mathematica.1 problems. left iesponsible kif prooes5ilc bojry SMsatioa
such as told. pain, and temper;ttureas
parietaJ lobe damage can result in 3 number of problems, including "Gerstmann 's Syn- _. as pla,-g a sole ii visioo. ~ ing,
drome," characteri!ed by difficulty with writina (agraphia), mathematics (acalculia), and solving malkm..r.ical pioblem.
lanauaae, and lefo-riaht confusion. Riaht parietal lobe damage may lead to problems
with sdf-carc. A stroke in the p3rietal lobe can cause a number of spatial, visuaJ, and
sensory problems.
Brain Lobes and Counselling

Effective counsellors utilize a range of different counseJling approaches that honour
individual and situationaJ needs. Different stratc,aies stimulatediffe.rent pGrts of the brain.
For example, a client may have g:Tent diffteulty tmckina and understanding l.anauagc, but
remain quite adept at processing \tisual cues that draw on the.occipital lobe. Activities such
as mindfulness and relaxation training activate the parietal lobe. All OOucamrs know that
people learn bene.r by doing, which enhances skill as well as memory. Hence the impor-
tance of helping clients set and implement action plans for change. As a rule, the more that
counsellors use a variety of strategies, the greater the extent that they \\till be able to enaage
different parts of the brain for understanding and problem,solvina process.
McHenry and colleaaues (2014) propose that counsellors tailor their approach
depending on which lobe is dominant for a given client. For example, suppose a client
overh• inteJlecruali:es her problem with little emotionality. Here, the frontal lobe may

be dominant so she may respond bette.r to approaches such as CBT that focus on logic
and thinking. At the same time, invitarionaJ empathy (see Chapter 6) might be used to
stimulate and encourage new thinking in the emotionaJ areas of the brain. However,
ddving into the emotional area ma'>' evoke more resistance from this diem since it is
not her usual mode of processing. Nevertheless, it may ultimately be more useful for
the diem because it opens up new (emorionaJ) perspectives that pre-.•iously have not
been part of her thinking. The c.hallenJ;e for counsellors is to baJance respect for this
diem's natural disposition and strength (i.e., logic) with appropriate and wdJ.-timcd
encournj;ement to conside.r emotions (invitational empathy). Contracting and counscJ.-
lor trnnsparency regarding the process and rationale for doing this will be hcJpful, as
illustrated in the example below.
Ce111n.ullin-: One of your areat stre~ths is your abilit)' to lo~;cally :tnaly:e your issues.
and this is itnporta.nt. Noc e\'e-r,.one is ~-ood at th1s 2nd )'Ou are. I'm also :tw::are th::at v.--e
h::n't'n' t 12lked mudl 2bout )'Our feehn,as. In 11\)' ~perience. l\'i' found emotions pfa)' 2
very important rote in problem resolution. Research also eonAnns this. So. I'm wonder,
i1l{t i( it m~,t be use(u1 lorusto spend 2 bit of time ~lki1l{t2bout rour (eelu,~ \Vh:lt do
you think? (Noce:: In this ex2mple. the counsellor ::attempts to oontr:tet with the d1ent t'O
11\0'.'t' the interview to the a.ffeetn't' (feelinli)doma.in b)• ::appeal,~ to the client's stren~th.
lo~te, ::and re2soni~ abilit)•I.
The Limbic System

limbic system: ThelMain'saintnt Although other parts of the brain arc involved, the limbic system (Figure 11.9) is often
centre b emo:ic.s. referred to as the control centre for our emotions. lt's also involved in motivation and
memory (Dahlit.z & Hall, 2016). Because of its central role regarding emotions, it is
important for counscllors to have at least a basic understanding of this pan of the brain,
panicularh• the amygdaJa and hippocampus.
The limbic System
Cingulate
gyrus
Fornix
<:e<ebrum
Cerebellum
Mommllory body
Amygdala Hfpp0<ompus
Midbrain
Pons
Theb,ainstem {
Medu1Ja Spinal cord
oblongata
Figure 11.9 The limbic System

SOURCE: JOShua Abbas/123RF
362 Chap1er 11
CONVERSATION 11.2
Counsellor: Ale lhefe inherent diffefences between the Neuroscfendst: F'emaies have a latgef, more dev80ped lim-
tl'ains of men and women? bic system. wtlid'I gives them more abiity to recogni:ze and
ptocess emotions, but this may make them more susceptible
Neuroselendst: The short answer is yes. In an article, psy-
to depfession. We Shouk1 alSO considef that they are mofe
chologisl Gregory Jantz, PtiD (2014) summari?ed a number
•kel'j to Seek treatment foe depressive disor'ders. While we afe
of variances. He noted lhat diffetences .-i the fetative propor-
on the 10pic. researd'I has Shown that women am more likely
t.ion of gray and white matter in male ve-rsus female bt'ains
to experience generalized anxiety diSOtdef, panic di-sor'def,
lea\18 women (in gene-ran tnOr'e adept at multitasking. vd'lie
and social and othef phobras (Eaton et at.. 2012).
men do better with highty task-fooused wol'k. AlthOugh males
and females have 100 same bt'ain parts and neurotr'ansmit- Counsellor: Ale thefe afeas vd\ere men afe more ltkely to
ters, the evidence is that lhey utilize I00m diffe-renlly teacfi~ expe(aence problems?
to a tendency lot men to be tnOr'e imputsive. Women utilize
more oxytocin, the bonding chemic:al. Research supports the Neurosclendst: Yes, men afe more ltkety to have substance
conclusion that men am tnOr'e interested in technical details abuse pfoblems, antisocial pefsonallty disorders, ADHO,
aoo are better- at the exact sciences sucri as mathematics. syndrome, and they have a higher' incidence of dyslexia.
Women are beuer with social sciences. But let's never- fol. It is often said that women are more likety to internalize
get that these are genera!izati::)ns. There are plenty of female prot,ems wtlereas men externalize I00m and ha\18: more of a
sdentis!s who outshi~ their male counte-rparts. canadtan tendency to act out (Eaton et at, 2012). In this sense, a~f
~IXOIOgisl. Or. Robetta Bondar, 100 first Canadian female aoo aggfession in men may actually be symptoms of
astronaut, rS one great example. depfession.
COunsellor: Cullufe and socialiZation are alSO at ~Y hete. Neurosdentlst: I want to stress lhat we cannot igrofe environ-
mental lor'ces (ourtufe) when we consider- difference between
Neuroscientist: Yes indeed. And the number of \\()men in sci- the btains of men and w0tnen. Ouf btains am shaped by
ence is growing. One Sludy (Ontafio Network ot Women in expe(aence, so 100 socialiZation of men and women must be
Etlglneeri~. 2017) found that the number' ot \\()Men in engl- considered when we compare.
~iog pt(){Jams in C:anada, once a male bast.ion., has grown
68 percent since 2007. Counwllor: I'm wondeti~ about the counselti~ implkations
of what you've been saying. It seems mor'e llkel'j that women
Counsellor: We often hear that women afe more feeling wolJd more readity respond to counsellors wtlo featufed
Ofiented than men. Is triis suppofted by neufoscience empathic responses and a gfe.atet oppoftun,ty to discuss
fesearch? and undetsaand theif emotions. Action plans couk1 featufe
Neuroscllfttlst: With resped to leefi~. Jantz (2014) offered cognili\ie behavbtXal strateg;es to avoid internalizing and self.
that \\()men have a 13lget hippocampus and are incli~ to blame. which wouk1 help combat deptession. Men nigt\t be
be more sensitive to stimulation from OUf five major se~. more responsi\le to action approaches strategiziog specific
Addtlionalty, before boys Of girts am barn, their tl'ains have activities and actions to ovefcome depfession in Ofdef
developed with different hemisphe(ac divisions of tabOuf. to feduce any behaviour that is harmful to lhemselves of
Female bfains are able to draw on vetbal cenlfes in bolti OUlets.
sk:les ot the brain and women are often better' communic:atars
Neuroscientist! I agtee. As always, explori'lg individual needS
and more extiressive, particulatly wrth fespec:t to feeli~. In
and diffefences It1rou~ 100 contracti~ process is essential
this sense, \\()men are likely to process feelings IOnger Irian
for defming which counsem~ approactl is be'St. In any case,
men, wtlereas men are mofe likely to move quickly on to
empathy is stiU an effecIN8 aoo necessary skill for worki~
the next task. As Baron-COhen (2005) put it, "women are
'Mth men.
hafd-wired to, empathy.• Hem again, remember' this is a
generalization. No one wouk1 afgue that the famous o,. car1 Counsellor: You've alerted me to one very impor&ant point.
Rogers. 100 foundef of persoo-centfed counselling. was not Nex.t time, I'm dealing witri an angry male client, I'm going
adept at empathy. to explore \\tlethet I'm actually dealing wrth someone who is
depfessed.
tounsellor: Why are females m::,re likefy to be diagnosed with
deptession?

amygdata: M importaat pan ol the The Amygdala and Hippocampus The amn:dala, an often-srudied nJmond-
twain associated widl em(D)lls s.a::h as
fear ud _,a. shnped brain part (limbic system and tempornJ lobe), is involved in emotions such as
fear and anger. As with most brain structures, there is duplication with two am)'gdalae,
one in C3ch hemisphere of the brain.
hippoc:arnpus: The pa.rt o! tile brain in The hippocampus is another critical pan of the limbic system. lt is responsible for
contrd ol stcring memories. storing memories. The hippocampus and thcamygdaJa are connected, and this partner-
ship is responsible for the strong emotions that are connected to memories.
Trauma and depression can damage the amygdnJa and the hippocampu~ but coun.-
seJling can repair or lessen the dnmnge. After trauma, the amygdala often becomes
hypersensitive, and it may quidcl)• react to even minor stress by activating high intcn.-
sit)• stress responses, P3nic, or even PTSD. From both trauma and depression, the
hippocampus shows a reduction in volume, which results in greater difficulty distin.-
guishing between current and past experiences (Bremner, 2006, \\:rlassoff, 2017). As n
result, flashbacks may occur where nn individual re-experiences a P3St event. Neurosci.-
ence research confirms that both medication and counselling contribute to repairing
the hippocampus and calming the am)•s:.:fala to make it less reactive (Sapolsky, 2001).
There arc a number of strategies trained counscJlors can teach clients who nrc dealing
with traumatic flashbacks. including:
■ Breathing and relaxation training to calm emotions
■ Diversion
■ Stopping techniques to remind oneself that what is occurring is not current
Eye Mowement Desensitization and ■ PTSD treatment such as Eye Movement Oesensititation and Reprocessing
Reprocessing (EMDR): A18:m• (EMOR), nn cvidencc-ba~ approoch to dealing with trauma based on the theory
~ h for dealing 111ttt.u.-, tmEd
on ltle 1iHJ._ eaoti>nal pn,llleas al! thnt emotional problems are caused by memories thnt have not been stored prop-
caused bJ me.cries that Ute IOI be81 erly (Shapiro & Solomon, 2010).
stoted property.
Consider a client who is afraid of public speaking to the point where even the
thought of it sparks his nnxiety. (n response, he may use nvoidanec to cope with his
fear. Avoidance mtt)' temporarily reduce his anxiety, but ultimately it increases both
his fear and his anxiety nbout speaking in public. Exposure counscJling, a best•practice
technique, pro\tidcs a systematic way to reduce both fear and nnxiety (Trouc.hc, ct aJ.,
2013). Counsellor mnnagemcnt and support during the process increases the lilcdihood
of success. CounscJlors can also help clients become empm,-ercd by utili!ing progressive
relaxation, mindfulness, meditation, exercise, and breathing as tools to reduce anxiety,
thereby rctrnining the amygdnJa. Damng:c to the hippocampus can be addressed b)• mcdi.-
cation and cognitive behnvioural counselling (Gradin & Pomi, 2008).
cingulate: Pa.rt o! tile limbic systan The ciniulate in the limbic system plays an importnnt part in the regula-
that plays an impcwtant Plf1 ii the tion of emotions. Problems such as PTSD, schizophrenia, and anxiety disorders
re,gulati>n of emot~s.
have been found to be (in part) rclntcd to over or underactivation of the cingulate
(Stevens, Hurley, & Taber, 2011). Counselling strategics such as the use of cognitive
behavioural therapy are recommended for clients who have difficulty with emotional
regulation. The goal here is to hcJp clients learn how to manage anxiety (reJnx) and to
devcJop more choices for dcaJing with cmotionaJ c.haJlcngcs in their lives.
))}) BRAIN BYTE I P,, I ,. ,ti ",r: 1,

The-re is evi::lence that the amygdalae of peo,::,e diagnosed as may atso have damage to the frontal IObe, which impairS lheit
psychopaths am smallet lhan those of othet people, which abtlity to exefcise setf~ontml and good judgment (Scientific
f&Sults in 100 often-noted lack of fear arnoog this group. They Ame-rican. 2017).
364 Chap1er 11
Cranial Nerves
The brain has twc1ve pairs of nerves known as cranial nerves. They perform vari•
ous functions, including connecting sense organs such as the nose or eyes to the
brain. Other cranial nerves form connections from glands and organs. Herc is a list
of the crani3J nerves (by convention assigned a Roman numeral) with their primary
function:
I. Olfactory - smell
I I . Optic - vision
11I . Oculomotor - eye muscle and pupil
I V. Trochlcar - eye movement
V. Trigc.minal - faciaJ touch pain and chewing
VI . Abduccns - eye movement
VII . FaciaJ - taste and faciaJ expression
VIII . Vcstibulocochlear - hearing and baJancc
I X. Glossophnryngcal - taste and swallowing
X. Vag:us - hean rate and glands
XI . Spinal accessory - head movement
XI I . Hypoglos.sal - tongue
Damngc to cranial nerves can be caused b)• disc3se or injury. Some craninJ nerve
dam3ges can be very serious c3using loss of senses such as \tision 3nd hearing. Neuro-
pathic nerve dam3ge adverscl)• affects a person's ability to feel or move. Sometimes., over
3n extended pe.riod of time, people can r«over from cranial ne.rve d3mage. Counsellors
can support this recovery by helping clients to make lifestyle changes to reduce high
blood pres.sure, increase physic3l 3cti\tit)•, ce3sc smoking. 3nd manage excessive use of
3lcohol. 0ohn Hopkins Medicine, 2017).
The Endocri ne System

The body's endocrine system consists of 3 network of glands in the body and brain, endocrine system: Hebnvt al glad
which secrete hormones into the blood stre3m. These glands produce hormones such in tile body and brain. which secrete
heme.es into 1M blood stieam.
as insulin, OX)ttocin, estrogen, cortisol, somatostatin, and dozens of others that control
3 wide range of body functions. The pc3-si:ed pituitary gl3nd is often referred to 3S the
body's "m3ster gland" because of its control over many other glands such as the thy-
roid, ovaries, and adren3l gl3nds. Figure 11.10 presents some of the other m3jor glands
that counseJlors need to understand.
Problems such as di3betes occur when the gl3nds over or underproduce hor-
mones. For example, adrennJin is a hormone produced by the renal glands that mobi-
lize the body to deal with fe3r 3nd threat. \\:'hen the 3drenalin lcveJ ,;oes ouc.-of-bal3nce
))I) BRAIN BYTE

The bOdy's encloetioo and nerv0us systems control the opera- CNS. The nervOUS system uses rapid flri~ eleclrical impulses
tion of the bOCly and mind. The central nervOUS system (CNS) to release neutotransmitterS aoo activate neul'al patl'wtays.
is eotnposed of the btain and spinal cord, while the peripheral The endocrine system involves glancts that secrete hormones
nervous system consists ot oorves and ganglia outside the into the blOOd stream. us· acti:)ns are SION, bul loog lasting.

Endocrine Glands of Human Body
_____
_..........._._..
•~etend
...
-. _...
___ _,_.....,.
T!wrN)ldaa.lld
~---,.,_.......
----...-
_,
-~-------
,■rMl!yrokl
.... Cl•ndls
---
--
T.,,,_
._
_,.
__
Gl,ftd•
_
.,...,.......,.,..
lufffflll Ollfldl
---
-·
,,nc_
-·
..---.--
.._,...,_
...~-"'"......,,
.- _.
..·---
-~---...
T•11■
_ ....,._,.,................,-.
---..-
-·
..-,.,
---
Figure 11.1 O Major Glands
SOUICf: uclab/StlutterStock
problems ensue (Figure 11 . 11 ). When the delicate balance of other hormones is

disrupted, depression, sleep. sexual, anxiety, and weight problems may result. Coun.-
seJlors who arc alert to this possibility will want to conside.r referring their clients fo r
medical assessment.
In addition to medioi.1 intervention, clients with endocrine p roblems may benefit
from lifestyle counselling that focuses on nutrition, exe.rcise, and anxiety management.
Counsellors can help clients set goal~ develop action plans, and strategi:e to deal with
obstacles that might othenvise sabotage goal attainment. Family and sociaJ support
system involvement is also an important component of success. Counsellors can play
an important ro le b\• helping clients find support groups to assist them with chronic
(long-te.rm) management of endocrine conditions. Support groups arc especiaJI,., useful
for clients who aredcnJing with conditions such as diabece~ which, as it rcquirecontinu.-
ous daily attention and motivation, can be emotionally taxing.
NEURON S: THE BRAIN 'S INFORMATION

SYSTEM
The nervous system is dominated by two t)'J)C'S of cell~ neurons and glia. Generally,
neurons rransmit information and glia cells support neuron~ although recent research
has revealed that glin cells are also capable of transmitting information (Dahlin, 2017).
T he.re are over 80+ billion nerve cells or neurons in the b rain that produce chemicals
called neurotransmitters which are the key to brain functioning. Neurons are responsible
366 Chap1er 11
Adrenalin
HORMONE FEAR
OH
HO~HN....._CH,
HO~
>
Reduced
.....
ho rmone
Normal
-
WEIGHT GAIN, FATIGUE,
POOR CONCENTRATION, ANO
lC/W SEXUAl AROUSAL
ANXIETY. lftRITABILITY.
HYPERACTIVITY, ANXIETY,
ACUTE STRESS, INSOMNIA.ANO
tltGH BLOOO PRESSURE
Figure 11.11 Adrenalin

SOORCC: Timooinal'Stlutterstock
for transmission of information in the brain and spinal cord. There are three main pares
of the neuron (Figure 11.12):
t. The soma (cell body) controls the neuron.
2. The dendrites r«cive information from other neurons that are then sent to the cell
body.
3. The axon is covered by mydin (mydin sheath), which protects it and aids in the
transmission of electrical signaJs that are criticaJ for activating neurotransmitter~
chcmicaJs which enable one neuron to communicate with another. Dendrites on
neurons receive and transmit electric signals.
Neural Transmission Neural transmission is the process by which neurons arc newal transmission: C-Uions
activated or fired thus enabling neurons to communicate with cnch other. Neurons bE1•een neurons in die br.!in for
transaitting informati>n.
could not communicate and the brain could not do its job without neurotransmit•
te.rs. The neurotransmitters are released by one neuron, and they then travd across a
small gap called a synapse or synaptic cleft (Figure 11 . 13) to another neuron (recep-
tor neuron or postsynaptic cell). The.i r release is triggered by chemicals in the body
(e.g., sodium and potassium) whic.h create an dec:tricaJ charge that causes the neuron
to fire (i.e., release the ncurotnmsmitters). Ncura.1 pathway~ once activated, allow
us to complete all of the functions of daily living- for example, thinking. moving.
and breathing.
(f the neurotransmitter causes the receptor neuron to fire, it is now activnt~ to
signa.1 other neurons to fire. This creates a neural pathway that may involve hundreds
of thousands of neurons in the brain. NeuraJ transmission ends when the neurotrans-
mitter returns to the neuron that relea~ it, a process called reuptakc. Reuptalcc is an

/Dendrite
Myelin sheath Node of Ranvier
Figure 11.12 The Pans of the Neuron

SOURCE: joshyaistlutterstock
Signal transmission
at a chemical synapse
Presyna ptic cell
Nerve impulse
Synaptic deft
Figure 11.13 Synapse

SOURCE: OeslQnua'Shutterstoek
dficic:nt process that aJlows for "r«yding" of the: neurommsmittc.r. Some: medications
temporarily prevent rcuptakc allowina the neurotransmitter to remain active longer.
For example, Promc0 prevents the rc:uptake of serotonin which relieves the: symptoms
of depression.
Different neurons have different shapes and functions. Sensory neurons transmit
information from the sensory ori:ans (skin, eye~ and cars). Motor neurons carry infor-
mation from the: brain to the: limbs. \\:fhc:n a neuron rccc.ivc:s a neurotransmitter, it is
called a receptor neuron or postsynaptic ccJI. Receptor neurons arc programmed to
accept one specific neurotransmitter for which it is proarammc:d. Jts' shape: is like: a lock
that can only be opened b)• a lcc:y, its assiancd neurotransmitter. Figure 11 . 14 illustrates
l)tpc:s of neuron receptors.
368 Chap1er 11
RECEPTORS
•
Vision Touch Smell Taste
Figure 11.14 Types of Neuron Receptors

SOORCC: Des.igrlua/Shutterstoek
" Neurons that fire together wire together" This famous phrase was coined by the
Canadian ncuropsychologist Donald Hebb who obsc.rved that IC3ming and repetition
crenccs strong and enduring neural pathways. NcuroJ pathwa\'S strengthen with repeti•
tive behaviour, thought~ or emotions. Subsequently these "wired" ncuraJ pathwa\'S
become cnrrenchcd and automatic.
Ideally, children grow in a consistent 3nd nurturing environment where neural path-
ways dcvdop that support hcaJrhy sclf-estccm, empathy for others, and a capacit)' for
3ppropriate risk caking. Unfortunately, problematic neural path\\"ll)'S such as those that
sustain unhelpful thinking(c.g., unrealistic anxiety and self-Ocfearing thought), can form.
'With every repl3y of an unhelpful thought, the neural p3thway becomes stronae.r and
more resistant to change. Practice makes the thouaht automatic.
Newton's famous first law of morion states that objects at rest tend to Sta)' at rest,
and objects in motion tend to stay in motion unless acted on by some force. This law
also seems like an apt description of how the will brain continues to repeat established
panerns unless something is done to interrupt it.
There Is Hope! Problem3tic neural P3thways can be replaced and neuroscience teaches
us how to do it. Counscllor~ using to:hniques such as cognitive behavioural thetaP',',
heJp clients to curb unhdpful thinkina by replacing unhealthy neural pathwnrs with new
pathways that support mental wellness. Since the problem3tic neural pathwn)'S are "wired
together," considerable repetition with the replacement thouahts or behaviour will be
necessary in order to effect change. Counsclling can be the force that c.hani;es the fixed
momentum of the brain. Counscllors can support clients b\• helping them to understand,
anticipate, and manai;e the challenges that clunges to wired neural pathways entails.
reuptake: Proctss llflerebJ
Coun.se.U.o r: I( we rontmue todo. thmk. or (eel son~hu)i. 1t be«.unes ::autonutic:. Even IINOtransahrs ate mbsortied i,, the
when we knoo• it's not helpful, we tlU)' keep doin¥ 1t bt<-::ause our brams are proar2rnmed ~that released twm.

to keep us on the s:1me path. When Yi't, tr)' to eh::ul{ti', our brains. out o( h3bit. m::ty
~bot~-t the cha.11~-t, 2nd v.--e end up K()lna b::.ck to the same old pouern.
Clien t: So, 21n I stud.!
CounS(>IJOr. No! The '--ood newii is th::tt cha0$:e is possible. but it 12l:.eii 2 pbn. potience.
and. pr.v!tice. As part o( thi.!l. it will be ilnportant to expect to (eel some anxiet)', 1nnrbe
(ear. But, a.iudety c:u, be a positive ii~ th::tt you a.re m<wina (orward and maid~ eh::10$:e!l.
I( rou aaree, we ean ..vork tQ$:ether to make this h:tppen.
SUCCESS TIP
Neuroplasticity and Chan&e
This simple truth, IOog a mainstay of cognitive behavioural eounsen1ng, and now confirmed
b-f neu(oscience research on brain ~sticity, rS that the key to change and managing prob-
~matk behaviour is p,actice and repetdjon of MN behaviour to build new or replacement
neur.11 pathways.
Major Neurotransmitters
Neuroscientists have identified over 100 diffc:.rcm nc:urotransmittc:.rs. Some: neurotmns..-
mittc:rs such 3S dopamine, serotonin, and norc:pinc:phrine 3lso act 3S hormone:~ released
by the: endocrine system into the b lood stream, whereas neurotransmitters are released
from one neuron of the brain to 3nothc:r (firing). Amona the more significant neurotrans-
mitters arc: serotonin, dopamine, glutam3tc:, acerykholine, 3nd GABA. Neurotransmitters
arc: further cfossific:d 3ccording co function as excitatory or inhibitory.
Abnormally low or high leveJs of a particular nc:urotnmsmittc:r or b reakdowns in
the: electrical siana.Jling th3t fires neurons arc: often major causes o( physicaJ 3nd PS\''"
c.hi3tric disorders. For example, faulty electrical signals can le3d to epilepsy or ca.use: the
tremors associated with Parkinson's disC3sc:.
excitatory neurons: "'--ens that Excitatory Neurons Excitatory neurons send neurotransmitters such as epineph.-
send neuu1ransaiiters that stimulate the rinc: and norcpinephrine that stimulate: the: brain and increase the likelihood th3t a
twain .tilctease the likelihOOO that a
receptive neuron will fire.
m::ep!M •urc.• fire.
glutamate: uritato,y aeu• Glutamate-an excitatory neuron associated with lc:3rning 3nd memory. Glutamate
associated Mith le¥ning a. aanoty. abnormalities have been linked to 3 number of menmJ disorders, including Ahheim,-
er's, 3Utism, obsessive: compulsive disorder (OCD), schizophrenia, and depression.
(National lnstitute of Mental Health, 2015) Glutamate: is the main excitatory and most
plentiful nc:urotransminc:r in the brain.
Nore-pinephrine (also called noradrenaline)-excitatory neurotrnnsmitte.r 3cti.-
norepinephrine: An Pcitll!Oly vates 3nd mobilizes the body's stress response:. Abnormal levels of norepinephrine
•uro".r.-mitter that a«rt~es ud the can lend to physical and psychologicaJ problems (see Fiaurc: 11 . 15).
body's stress respcme.
Dopamine-involved in many function~ including movement, 3ttention, and prob-
dopamine: Neul'O'.r.-mitt.er itwlred
ii mcr~nt. aneaiion. and prciblem lem solving. Dopamine is most often 3ssoci3ted with mood, and it is released when
sohing. we: are involved in activities th3t we: find pleasurable. Subsequently, this motivates us
EndOfphins (endogenous m::,rphine) pituitary gland and the br"ain 10 prOduce pleasure and reduce pain. &erci:se. choco-
hypothalamus interact with opioid receptOr'S (001Xons) in the late, and sex. are known to release endorphins.
370 Chap1er 11
Norepinephrine
RAGE HOflMONE
Reduced
,.....
hormone
Nom•I
--
-
DEPRESSION, POOR MEMORY,
LACK OF ENERGY, CONCENlRATION,
ANO MOTIVATION
INCREASES BLOOD PRESSURE,
HEART RATE. CAUSES
HYPERACTMTY. ANXl£TY ANO
STRESS, ANXIETY, IRRJTASIUTY.
ANO INSOMNIA
Figure 11.15 Norepinephrine

SOORCC: Timooinal'Stlutterstock
to repent actions which release dopamine. A deficit in dopamine can result in Parkin-
son•s disease. As well, there is e-.•idencc that dopamine ab normtdirics ma'>' be a factor in
sc.hi:ophrenia or attention deficit hyperactivity disorder (Nation3l Institute of Mental
Health, 2015). However, it is likel'>' that other ncurotransmittc.rs and causative factors
are also involved when a person hns sc.hi:ophrenia (Brisc.h ct al., 2014). Figure 11 .16
illustr:ucs the impact of excess and dcflcicm dopamine.
Inhibit ory Neurons Inhibitory neuron.'> send neurotransmitters (such 3s serotonin inhibitory neurMs: Neurcm di.at
3nd gamm3.aminobutyric acid (GABA)) to calm the b rain and decrease or inhibit other produce neurotransmitters t!I.M c-a
tile brain and d«rease or inhibit oCk
neurons from firina. "'--' fiom wing.
Serotonin-a major inhib itory neurommsmitte.r found mostJ,., in rhe g3strointestin:.d
tract and the b rain stem. Serotonin hdps reaulate mood, body tempe.rarure, pain, 3ppc- serotonin: An inhibituy
titc, and sleep. Lower levds of serotonin are believed to be 3ssoci3rccf with depression, ne.etransaiter round in the
gastrointes!Utrat1 and the twain
impulsiveness, and agaression. (It should be noted that there is some controversy 3bout
stea that ~ reg_ub.1e aood, boty
whether depression is in fact a result of low serotonin levels 3nd some neuroscien• tempnture, pain, appetiie, and sleep.
tists such as Arden (201 S) argue that the actu3l causation is much more complic3ted.)
Excessive serotonin C3n lead to a potcnriaH,., fatal 3nd very d3ng:erous condition knO\\•n
3S serotonin syndrome (Mayo Clinic, 2017a) with symptoms of high fever, irregular
))I) BRAIN BYTE Doparlll rie

Addictive drugs create an e-normous surge of dopamine in rush). In 1....-0, thi:s increaseslhe drhie (morivation) to continue
100 brain C(eati~ an elevated level ot pteas...-e (d(ug higt\ O( to use drugs in Otde( to (ecapture the rush frOO'l the drug.

Dopamine
HORMONE PlEASURE
HO~
HO~ N~,
Red uc.d
,.....
ho rmone
No rmal
--
-FATIGUE,
DEPRESSION, ANO
LOSS OF INTtR£ST IN LIFE
Figure 11.16 Dopamine

SCHIZOPHR£NIA
SOURCE: titnonlna1Shu11er1todc
hC3rtbent, and seizures. This may occur if clients talcc too much medication or if they
tn.kc their mcdic:nion with other medicines or illcgn) drugs. Figure 11.17 depicts the
impact of excess or deficient serotonin.
Antidepressant medications such as Pro!ac can rapidly increase serotonin Jev..
els; however, counsellors should be aware that it may take weeks for m~ications to
impact depression (Andrew~ Bhnrwani, Ltt. Fox, & Thomson Jr, (2015). Counsellors
can re.mind clients of this fact and encourage them not to abandon trcanncnt prema.-
turc]y before the medication has had a chance to talcc effect. In rhc following example,
the counsellor, while careful not to give medical advice, supports the client's rcJarion.-
ship with the doctor, provides general auidance regarding medication compliance, and
acknowledges the strengths of the client.
Client: The doctor put me on 2n 2ntidepreSS3.nt a few v.--eeks ait(). but 1t'!i not worknl{t.
I h::n,en' t ah,en up. but I'm ..vonderina i ( it' s worth the effort.
CounselJor. \Vh:11 dkl the doctm- tell you about the meds.
C lient: Lou! But, I don' t remember 211)' o( 1t.
Coun!l(>IJOr. Ord !ihc 5:1)' anrthm& 2bout hoo• Iona 11 1ni,aht take (or the medication t'O
work!
C lient: Now that )Ou mention it, she did say 1t tni~t take a while.
Counsellor: Sure. Sometimes these med!i can take 2 month or lo~er to kiek in. And
sornetin~ )'Ou mi~t need a h.iat,erdose, ore\'enadifferentdrua.So. )'Ou ni'ed tobe .
Client: Patient!
CounselJor. Also. street dru~ may mteden\ so it' s unporta.nt to let )'Our doctor know
i( you 2re USmi, By the way. I'm impressed that )'Ou\ee been able t'O ha.11¥ m there. TI,at's
a real stre~th.
372 Chap1er 11
Serotonin
HORMONE HAPPINESS
NH2
HO
Reduced Normal
,.....
hormone
-
SADNESS. APATHY,
IMPAIRED l HINJ(ING,
MEMORY ANO ATTENTION,
LETHARGY, ANO DAYTIME SLEEPINESS
Al.COHOl.lSM
SEROTONIN SYNOflOME
HAltUCINATIOHS, EUPHORIA,
ANXIETY. F£V'Elt SEIZURES. ANO
TflEMORS IN THEHANDS
Figure 11.17 Serotonin

SOORCC: Timooitlal'Stlutterstock
Acetylcholine-linlccd to central nc.rvous system functions. including wakefulness.,

:mcntivcness., anger, aggression, sc>.."U3lity, and thirst. Acetylcholine also pln)'S a role in acetytcholine: •uro".r.-minerilled
Alzheimer's. (Francis., 2005) (McGill University, 201 S (Note-: Sometimes acct)•kholinc to u ntral nervoos syva functi>ns.
incldlg ■a.-.e.-iness.. attMtiwness.
acts as an excitatory ncurommsminer while :.n other times., it functions as an inhibitory afl8E(. aggrmie11, sauality. and dlirst
neurotransmitter. This depends on the type of receptor neuron that absorbs it.)
GABA (gamma~aminobutyric acid)-pla,.,s a role in conrrolling fear and anxiety,
moto r control, and vision. Adequate levels of GABA arc critical for relaxation. GAB.A: • ibit«y •uro".r.-mitt.er that
~ to ccatrol fear and allliety. Mt«
AbnormaJitics can cause anxiety, disrurbanccs in mood, sleep, epilepsy, and pain
aintnt and rision.
(\VcbMD, 2015). It is the main inhibitory neurotransmitter in the bra.in.
Mirror Neurons
Mirror neurons arc neurons that fire when we observe another person doing or say- mirror neurons: ~ ns that fire
ing something. Significantly, our brains mirror those of the other person by firing •hell 'Ill! observe aflO'!her pe,,_ doing
« s.l)ilg in tile same WNJ as ii •e w«e
in the same way as if we we.re doing or sa)•ing it. Mirror neurons arc active when we dclilc or sa,-g ii.
watch a hockey game, attend a mO\•ic, and especially when we witness or hca.r the emo-
tions of others. When a diem expresses emotions, mirror neurons in the counseJlor
may react with the same emotions. This phenomenon has powerful implications. For
one thing. it may leave counsellors vulnerable to \•icarious trauma from the cumu-
lative impact of working with clients who have been traumatized. 1t also presents
counsellors with opporrunitics for empathy if they pay dose attention to their own
emotional responses. For example, if a counsellor is feeling lost and confused as he
listens to his client, he could use this observation to inquire whether his client is
fceJing the same.

CounseUor. I'd like to know how you mi,aht be (eelinK r~t nov.•. I'm (eelu)¥ a bit lost.
and I wonde-r i( th:u's also h::tppenll,i for )'Ou.
CUent: Oh~! It's oot just 1ne. I'm total!)• muddled.

Coun!l(>IJOr. Okay. w~t do we need to do t'O iet bc:iek on tr:1ek!
Although our own mirror neurons might be one cue that aids in the experience and
expression of empathy, they arc only one part of a very complex system of empathic
pe.rccption. Counsellors need to remember that their own prior learning, experience,
culrure, and their present mood impact the receptivity and accuracy of their mirror
neuron reactions. Siegel (2012) presents an example that underscores the importance
of tentntiveness when inte.rprcting client behaviour or inferring emotions:
If )'Ou are from Kew York City and I raise 11\)' hand in front of )'Ou. )'Ou mar im:1.¥•
ine that I am hailh,i a eab. I( you are eurrently a student, )'Ou 111:ay im:1.¥ine that I am
intendinK to ask a question. If )'Ou have been abused. you mar feeJ that I am ~in¥ t'O
hit )'OU . (p. 166)
Glial Cells
gtial cells: CellswhQpn,,ides.ppcrt (n the brain, ,:Hal cells or glia, which are for more plentiful than neurons, provide
to neuas. essential support to neurons. Without them, neurons would be unable todo their ,vork.
There are five main types of glial cells with the exotic names. Astrocytc, Microglin,
Oligodendroglia, Epend)rmal, Satellite, and Schwann. Enc.h of them have specialized
functions such as carrying nutrients, disposing of dead neurons. or protecting the ncu.-
ron (m)•clination).
Reward Pathway
reward pathway: 11;-ur,tcircuii The reward pathway (or pleasure pathway) is a pathway in the brain that reinforces or
that rMants pll!'aStnble auivities Mih rewards activities with dopamine that it finds pleasurable. The reward pathway involves
dopamille.
ventral tegmenml area, the nucleus accumbens, the pre.frontal cortex, the hippocampu~
and the amn;dala.
Pleasurable sensory experiences (e.g., food, sex, nnd positive relationships) cause the
reward pathway in the brain to rclease dopamine, which creates feeling of well-being.
Dopamine also acts as a rcinforce.r, which increases the probability (motivation) that the
individual will repeat the experience thnt generated the reward. Many prescribed medi.-
cations, such as opiate-based pain killers, and most street drugs, such as heroin, cocaine,
nnd mcthamphctamine, also nctiwte the pleasure pathway. They do so in dramatic W'tl)'S
that flood the brain with massive amounts of dopamine, which causes disruption nnd
damage to the normal!)• balanced re\\'tlrd pathway. This dnmage reduces the person's
capacity to experience pleasure for normal activities and thus the drug becomes the only
way to fed olcay. As a result, the drive to use the drugs increases, and it mtt)' become
the dominant force in the person's life. Continued use of the drug lends to tolerance
and ever increasing levels of it nrc required to achieve the desired effect, or even to feel
"normnl."
Epigenetics Gene~ which we inherit from our parents, contain the code or instruc-
tions that define us, including the colour of our eyes. how we look, and our susceptibiJ,.
«
epigeneties: The st.ty hGw certain ity to certain di.se3scs. Epis:enetics is the study of how certain genes can be activated
genes can be IINn'ated • deacti-t~ei:J or deactivated b\• life experiences such ns nutrition, environment, poverty, nnd espc.-
~ life experialces, sudl as nutrit•
environmat powrty, and especially cially trnumn. Srudies have shown that epigenetic gene changes from life experience
trauma. mar trigger depression, schi: ophrenia. akohol abuse, anxiety, nnd many other condi.-
tions in those already predisposed genetically to them (Albe.rt, 2010, Ptak, & Petronis,
2010). For exnmplc, a review by Radhalcrishnnn, \Villcinson, & o•souzn (2014) revealed
374 Chap1er 11
how marijuana can trigger psychosis in some individunls who are predisposed to it. Of
significance to counsellors is the fact that epigenetic gene changes caused by ex~riencc
can be pnsscd down to future generations.
SUCCESS TIP
lntercenerational Trauma and Epicenetics
The-re is support fof lhe conclusion that lhe e()igeoetic i.mpact of historical ttauma such as
that expe(aenced by Indigenous people- tn lhe Residential Schoots may we-ti have accumu-
lated O\let geoeta~ negatM!ly impacting the cOleclive health of lhe whole- commun.ty
(Bombay, Matheson, & Anis.man, 2014). This ftndi.ng can help clients and counseUOts
undel'Slancl the- tong-term impact of ua1.una experie-nce-d within the-if family and Nation.
Further research will no doubt reveal more specific information rcgnrding how and
when interi;:enerationnl generic change occurs, and this will offer guidance regarding
customized counscJling interventions to prevcm (idea.Jly) or address problems. \\:fhat
we nlready know is that a ranac of counsellina interventions, including the counsdlina
rcJarionship itself, diet, exercise, s1ttp, and the provision of safe environments for those
affected by trauma, can lessen the effects of adverse epigenetic experiences (O3hliu,
2016). Epii;cnetics offers the empowering idc3 that our clients' genetic codes do not
fully define the outcome of their lives. Chani;c is possible. Using techniques, they learn
in counselling, clients have the ability to influence whether acnes activate.
BRAIN PROBLEMS
The brain has undeniable remarkable ability and cap3city, yet it is very fragile. Although
pr()(cctcd somcwhnt by the skull, it is vulnerable to injury as wcJI as di.sc3sc. Sometimes,
recovery is possible, and the brain has the caP3cit)• to reprogram itself to compensate
for damage. Sometimes damage is irreversible and degenerative, as with A b heimer's a
condition for which there is not 't'Ct a cure. There arc over 400 different neurological
diseases and disorders (Brainfoct.s.org, 2017). The following subsections will explore
common and significant disorders of the brain.
Mental Disorders
The Diagnostic and Statistical Manual of Menta1 Disorders (DSM-5) describes and clas-
sifies hundrWs of diffc.rcnt disorders arrani;cd in developmental sequence. Sec Chapter 9
for a full discussion of this important topic.
Meningitis
Meninaitis is a viral inflammation of the lining of the spinal cord or brain. Sprc3d b)•
dose contact with ()(hers, and it is an extremcJy .serious condition that requires immedi-
ate medical attention.
Encephalitis
EncephaJitis is an inflammation of the brain. It is usunlt,., C3uscd by a viraJ infection.
Symptoms might include fever or hC3dac.he and sometimes the inflammation can cause
confusion or sei! urcs. Some people experience personality chani;cs, memory loss, and
haJlucinations 0-fcalthlinkBC, 2017). Jt is treated with antiviral medication and r«ovc.ry
c3n take months.

Brain Tumours
Brain tumours can be benign (non-cancerous) or malignant (cancerous). They arc rreat~
in a variety of war~ including surgery, chcmothcmpy, and radiation.
Amyotrophic lateral sclerosis (ALS or Lou Gehrig's

disease)
Amyotrophic lateral sclerosis (ALS) is a progressive, fatal d isorder in which the brain's
motor neuron~ which carry signals from the brain to the body. b reak down and lose thc.ir
ability to communia nc with muscles. There arc about 3()(X) Canadians living with ALS
(ALS Society of Canada, 2017).
Cerebral palsy
Cerebra] palsy (CP) is a disorder resulting from brain damage before o r during binh
that affects bod,., and muscle movemcm. CP affects I of every 500 people in Canada
(Cerebra] Palsy Association of British Columbia, 2017). Symptoms vary widdy from
person to person with some only mildly affected while others require constant care.
Epilepsy
Epilepsy is a non-contagious brain d isorder in which nerve cells in the brain cause a
person to have seirnrcs, although not all seizures involve convulsions. (n Canada, about
0 .6 percent of people h.nve epilepsy (Epilepsy Canada, 2017). 1t may be caused by such
things as rumours, infection, or injury to the brain. It is usually rreated with anticon.-
vulsant medication. One additional ch.nJlenge for people with epilepsy is denting with
the stigma and discrimination that often accompanies the disease.
Huntington's disease
Hu ntington's disease (HD) is an inher ited brain disorder which causes the brain cells to
d ie, leading to a graduaJ, eventually fa tal inability to control movement, as well cognitive
and emotional decline. Approximatel,.• I in every 1000 Canadians has HO, and children
who h.nve a parent with the d isorder have a 50 percent ch.nncc of devcJoping the disease
(Huntington Societ)• o f Canada, 2017). There is now a test to determine if an individual
will develop HD disease. Cou nsellors may have a role supporting people who arc trying
to decide whcthe.r to rake the test.
Multiple sclerosis (MS)

MS is an autoimmune disease, in which myclin, a cover p rotecting nerves, is damai;cd,
resulting in the d isruption of nerve impulses. Symptoms arc unpredictable, wry widely,
and ma,., include fatigue, muscle weakness, \•ision, or mood problems. Sign ifica ntly,
for reasons not yet known, Canada has one the world 's highest rate of MS with I in
340 Canadians living with the disease (Multiple Sclerosis Society of Canada, 2017).
SUCCESS TIP
What to do if Someone is Havin& a Seizure
Stay catm. Don't try to resttain the pe-rson o, pul anything in theit mout~hey 'MIi 001
swallow his toogue. Make sure the ama around them is safe by moving hazards such sharp
objects ot items that could inj...-e. CUShion the pet"SOl"l's head. Aftet lhe seizure stops, posi-
tion 100 pe-rSOn on lheit side.
376 Chap1er 11
Counsellors can assist clients with MS deal with the social, emotional, and financial
effects of the disease. Family counsellina can provide a safe venue for people to d eal
with the often d iff1eult emotional and relationship issues associated with the disease.
Parkinson's disease
Parkinson's is a p rogressive brain disorder caused by the brain's deteriorating inab il-
ity to produce doP3mine, a n eurotransmitter critical to movement and rhe regulation
of emotions. Most people are familiar with the tremors caused by Parkinson's, but
S)rmptoms can also include fatiaue, movement problems, sleep disturbance, cognitive
dee.line, and mood p roblems, especially depression. Wopn, which the brain converts to
dopamine, is the most common medication. Parkinson's, affecting over 100,000 Cana,
dians (mostly seniors), is the second most common neurodegenerative d isorder after
A lzheimer's (Parkinson Canada, 2017).
Tourette syndrome
Tourette S)rndrome (TS) is a neurological disorder ch.nracte.ri:ed by repetitive vocaliza,
tions and involuntary tics. lt was named for Dr. G«>ri;:es G illes de la Tourene, a French
neuroloaist who diaanosed the condition in 1885. Tics can include ere b linking, lip-
licking, shoulder shruaging., and head je.rldna. 1t might involve invo luntar y hoppina,
jumping, or spinnina. ns well ns meaningless voc:.dizations (Tourette Canada, 2017). The
Canadian Psychological Association (20 17) suggests that the prevalence o f TS is about
0.005 percent of rhe population and is more likcly to affect males.
Medication and specially designed bchavio urnJ and cognitivecounscllina techniques
are used to treat TS. Deep stimulation a nd transcranial maanctic stimulation are also
being explored as potential tre3tmcnt options (To urene Canada, 20 I7).
Dementia
Most people have heard of the terms dementia and Alzheimer's and often they are used
interc.hani;eab ly, but the.re are differences. Dementia, now known as neurocognitive dementia (netn!COgnitive
disorder in DSM-5 is a genernJ term that includes a large number of disorders such ns disorder): Ag_en.nl te,m di.at it cludes
a number of liscwders ■here tilere are
A lzheimer 's, HD, Parkinson's disease, and Creun fcldc.-Jakobdisease, a nd is characterized probleas rih memoq and thin-,:.
by problems associated with memory and thinking (alzheimers.net, 20 17). Of P3rticu-
lar significance is rhe fa ct that up to 50 percem of persons with dementia, indudina
Alzheimer's, are clinicaJJ,., depressed, but, adult depression does nor increase the likeli-
hood o f dementia (Singh-Manoux et al., 2017).
Ahheimer's disease, the most common form o f dementia, was first described b\•
Dr. A lois A lzheimer in 1906. It is an irrever sible, fa tal d isorder that results in behav-
iournJ and emotionnJ dee.line as well as brain shrinkage (especially in rhe hippocnmpus),
deterioration, a nd cell death. Post-mo rtem microscopic analysis o f the brain tissue of
people with Alzheimer's show abnormal protein dusters (plaques) and twisted strands
of other prore.ins called mnales. Plaques and tangles will be very p revalent in areas o f the
brain related to lear ning and memory (see Figure 11.1 S). This helps explain rhe reasons
for some of the common S)'Tl'IJXomsof d ementias such as Alzheimer's (see Figure 11.19).
Ahheimer's mostly affects people over 65 't'ears o ld with the risk incre3sing with
age, but cart,., onset can occur in people as 't'mmg as 40 (Graff-Radford, 2017). Canada's
rapidl't' aging population means that there will be a dramatic increase in the number
of Canadians who are deaJing with this d isease. The Alzheimer's Society of Canada
(20 17) estimates that there are currently about 565,000 Canadians with Alzheimer's,
but this number will grow to 937,000 in the ne>..'t 15 )'ears. ln addition to the enormous
costs (currently estimated by the A lzheimer's Society at 10. 1 billion dollars a year),

Ab:htimer's
disean
Figure 11.18 Cell Deterioration with Alzheimer's

SOURCE: Oesifl:nua'Shutterstoek
this disease will increasingly require profc:ssionaJ counsdlors who arc: wc:11 vc:.rscd in its
presc:ntntion to provide: support services to pntients and carc:givc:.rs.
The: Alzheimer's Society of Canada (201 7) identifies four stages to the disease:
■ Early: MiJd symptoms and problems with memory, communication, mood, and bch3\'•
iour. At this smge, people: are genc:rall,., 3ble to cope:, perhaps with some assistance.
■ Middle-: \Vorsening of symptoms. People may rttauirc: assistance: with daiJ,., living
tasks. Clearly, this puts steadily increasing demands on caregiver~ so they may also
need considerab le support.
■ Lau-: Severe: impairment with profound inab ility to communicate:, recogni!e fomil't'
and friend~ or care: for thc:mseJves. Continuous care: is required.
■ End of Life-: Symptoms progress further, and 24-hour-pe.r-day care: is necessary.
Prob/~• ~•Ith alnrroet 1hinkf1tg
!
,---...._ /
Symptoms
r
~
/
~
Probl~ms wfth /onpag~
Me,,,urylo.u
Disori~nlolion
1 ---► PoorJtulgem~nt
ifDementia :---....
~ LoJs of initiath~
~ Misplacing 1Mngs
Personality cJta,rgea
\ D/Jflatlry pe,fo,.,,,fngfamlllar tosb
Figure 11 . 19 Symptoms of Dementia

SOURCE: artta381Shutters!oek
)))) BRAIN BYTE I Sur1dov,r11r1g

As many as 20 to 45 pefcent of people with dementia experi- triggers such as IOw 0t fadi~ light fatigue. depfession, and
ence Msundo-Nnrng· Of late day confusion d'laracte-rized b-f sloopdistutbance (WebMO, 2017). Slicking to routines. mini-
a deterioration rn theif condition in late afternoon and eve- mi:zing stress, dietary management, and exefdse can help
ni~. Cou~ and cafegive-rs can watch lot and manage reduce frequancy and syrnptOO'ls (Roth, 2017).
378 Chap1er 11
Counselling People with Dementia and Alzheimer's
■ Empmh,: Counsellors should be aware that nn Ahhc.imc.r's diagnosis is a terrifying
expc.ricncc, not onl)• for the patient, but also for everyone in their lives. Patients
and caregivers mn't' be reluctant to share their feelings with C11C.h other, but be quite
willing to open up to a nonjudgment:.d counsellor who is willing to listen as they
share powerful emotions. Jn this regard, counsellor empathy is an important P3rt
of helping people dC3l with the emotional impact of the disease.
SUCCESS TIP
Dementia
Put emphasis on what clients can do and what lhey can be supported to dO rather lhan on
what lhey can't do or am incapable of doing. Be creative!
■ Hope: Alzheimer's is a progressive disease, meaning that the symptoms worsen

with time. The Alzheimer's Society of Canada (2017) notes that although some
dementias are reversible, Ab:heimer's is not. Counsellors neo:f to avoid conveying
foJse hope that "everything is going to be all right." On the other hand, hope and
optimism can be built on the knowledge that some of the s)rmptoms can be man-
aged with medication and counselling. People diagnosed with it can Je3d meaningful
lives for many )'ears. Enormous b rain research is now under way to find ways to
diagnose, prevent, and cure this complex disease. Although a cure has still evaded
resenrcher~ new mediations and insights about the disease give reasons to be hope-
ful that a cure and treannent will be found.
■ Srrucmre: Establishing routines and familiarity can heJp to calm people with demen-
tia who arc anxious and dealing with an increasingly forgetful mind. CounseJlors
can review the.ir client's pre-dementia routines with the.ir families, with the gooJ of
retaining as much of this as possible, even if the client is now in institutionnJ cnrc.
■ Empouierment: Based on individuaJ capacities, counsellors cnn look for W'tl)'S to help
dients reg3in or recnin control and power over their lives. Many of the counselling
strategies discussed in earlier chapters might be adapted induding: involvement
in decision making, respect for choices such as where and how dients wish to live
their lives, and the identification of activities and tasks that give clients a sense of
purpose.
■ SuppOlft for Carqit'ffS: Taking care of someone with dementia requires relentless
dedication and personal sacrifice. Counsellors can contract to offer caregivers assis-
tance such as: information and guidance about dementia and its' stage~ education
on strategies for communicating and dC3ling with the challenges presented by the
pe.rson with dementia, links to support groups, assistance to access respite care, and
personal counselling to deaJ with the.ir emotions and the difficult decisions caregiv-
ers must make such as moving the.ir loved one to a care facility.
Atx>ut 40 pe-rce-nt of people- ovet 65 will have- some mem- sewte memory loss, such as not being able- to re-call the
Oty loss-this •age associated mem:>ry IOSS. is normal and names ot famity me-mbe-rS or recent conve--rsations and events
n01 a sign of dementia. Dementia is eharacte-rized by tnOr'e (Almeimer's SocN!ly of C.nada, 2017).

CONVERSATION 11.3
Student I've just found out that my training i:ecemen1 Yrul be example, counsellOts can help those with visi::ln prot,ems to
in a centre lhat deals with clients who have detnenlia. What access audio books. Anxiety can be feduced by prOth)ting
are the important things fOr' counsenors to remember when such things as consistent routines and reminders fot those
wOl'kiog with people W'ho have dementia? with Shaft-term memo,y IOss. Putting out familiar objecls
(e.g., pictures and memOf'abtlia) can serve as comforting
Counsellor: for o~ lhiog, 1t rS important to re-member that feminoors. Counsellors can help caregtvei-s understand 100
symptoms can range from very mdd to severe-. Consequently, impor&ance of keepi~ li\ling quarte-rs organi:zed and, if use--
no single recipe forcounsettiog is possible. and interventions fl.A, putting signs on dOOrS such as the bathroom 10 reduce
must be customized to individual needs and capacities_ just confusion.
as they are lot clients witoout dementia. Even 1oose with sig-
nricant impairment may retain SCll'n8: cognitive capacity and Student: What abOut specific interviewing and counselling
streogar.s. For exami:,e, dients with advanced de-mentr.a may s.Jults?
still be at,e to express lhemsetves 'Mth music Or' art. Accor'd- Counsellor: Here again, 1riere is no ooo-si:ze--fits-all answet.
ingly, counsellors m.igt\t pfaCe a priority on fincfi~ and using But generally, counsellors shouk1 speak in a slO'N, calm,
stre~hs. includi~ are-as of the tl'ain lhat have not been feassuring manner. Because of cognitive decline, counsel-
damaged. lors ooed to allow lime fof theif clients to answe(. Counsel-
lors ooed to be comfo,1able with silence and the onus is
Student: What else?
on them to adjust pace to moor theif clients' needs. When
Counsellor: Although many dementia's, especially Atzheim- Shorl-tefm memory loss is an is.sue, freciuent simple teperi-
e-r's. have no cure, some of the commonly coexisting con- tions and summafies may help. Tar'geted shoft answef °'
ditions such as anxiety and depression can be addressed questions are preferable to IMse that require ex.tended or
medicaly and with counsem~. As much as possible, keep complex fesponses. It's also imJ)Otlant fof counsellOts to
clients involved in decision making and planning. This helps femembet the tfemendous s1tain that caregivers often face.
100m retain a sense of control and purpose. Since bOredom is Discuss with them the importance of self-care. And that
a majo, cause of depfession among seniors. including those atso applies to you too! There's lots mote inf0<mation out
with dementia, help them find meani~IJ and stimulating there. I'd suggest the IOCal Alzheirnef's Sociely as a goad
tecteatienal activily that can help combat depression. For place to start.
Stroke
str~e: A dot bkd:aie .tlich CMses A stroke occurs when blood flow to the brain is blocked. Some of the major warning
rupture ol arteriei ii the brail. signs of stroke are depicted in Figure 11.20. Although a stroke can occur at any age,
nearly three.quarters happen to p«>ple over age 65 years of age (The Internet Stroke
Center, 2017).
There are three major types of strokes:
l.schem.ic stroke: A blockage «clC!I in I . hchemic stroke occurs when plaque causes a blockage or dot in the brain.
the brail cauS!d bJ a buildup of pbqae.
2. Hemorrhagic strok e occurs when conditions such as high blood pressure cause
Hemorrhag.ic stroke: ASllOM' tut arteries in the brain to burst.
that ooc.s •tie. caaditi>ns such as lligh
ltxld pressure ca uses aneries to t.s!. 3. Tran.,;ient ischemic attack (T.I.A.) or mini stroke occurs when a dot bloc.ks an
artery. Although they may not cause damage, their occurrence is a warning sign that
Transient i.scheric attack
should be taken seriously.
(T.I.A.): A aili SllOM' duit strikes whea
a clot ttxts anartery. The effects of a stroke can vary greatly from mild to cam.strophic. The Cleveland
Clinic (2017) reports that a stroke in the right side of the brain can lead to symptoms
Btoea's Aphasia: 0iffiOlllyrih such as attention and perception difficulties, trouble processing information, poor judg-
spe,ech. undemaoil:g. and lang_u_,)J!. ment and communication problems. as well as attention and memory problems. Left..
brain strokes may result in paralysis on the right side, and communication problems
Wernieke's Aphasia: Difficulty
such as slurred speech, Broca's Aphasia (difficult)• with speech, understanding. and
..,,.
finding 'Mlf'ds ad'• using asensi:al
language), and Wemicke's Aphasia(difficulty finding ,vords and/or using nonsensical
380 Chap1er 11
WARNINGSIGNSOF A
STROKE
- FACt MM
iM<NESS
SPllCH
IJff1a.lTIS
•
IMlll>IAl1IED
lllZZINESS
8UIIIIID
VISl0N
Figure 11.20 Stroke Warning Signs

SOORCC: lr11\a SttelnlkOvarstiutterStOCk
words). People with aphasia have difficulty with language and communication, but their
difficulty is !lQ!. a measure of their intcJligcncc.
A variety of medications are used to treat and/or prevent stroke, including blood
thinners, cholestcrol lowc.ring medications, cl()( bustc.r~ blood pressure, and cholcstc.rol-
lowcring medications (Hean and Stroke Foundation of Can3da, 2017). As well, mcdica,
tions to treat anxiety and depression, whkh Hacken & Pickles(2014) found occur in 33
perccm or more of stroke patients, may be u~.
SUCCESS TIP
FAST Stroke Sie;ns
Face, is it d(ooping
Arms, can you taise bOth anns
Speech, is it SllXr'ed
Time to call 911 (Hearl and Stroke F'ounclation of C3nada, 2017)
Counsellors may be involved in a variety of W'tl)'S. including lifestyle stroke preven-

tion, cognitive behavioural and problem-solving counselling to dc3l with the aftermath
of a stroke, and fam ily counscJling. There arc a number of risk factors for stroke which
counselling can appropriately address, including smoking, weight control, sedentary
lifestyle, and heavy drinking.
Counsc-llors can refer or encourage clients to use services such as physiotherapy,
occ:upntionnl therapy, and ncurothctaJ)\'. Neurothcrnpy centre~ available in most major
cities in Cannda, can customize brain trentmcm to specific areas of the brain thal have
been damaged by stroke.

SUCCESS TIP
lnterviewin2 Skills (Stroke and Aphasia)
Oients who have had a strOke may need more time to pfocess infonnation, so they Should
n01 be ptessw--ed to res!X)(ld quickly. lntem.Jpting a sJeoce may deny dients the opportunity
toextiress their lhoughts and emotions. Speak nOfmauy and keep WOr'ds and comments sim-
ple and at a level the dient can understand. It may also be helpful 10 use ctosed questions
to get specifk:: information, as well as summaries and paraphrases to conf..-m undel'Slancl-
ing. Visual cues and gestu(es can activate other- areas of the btain that are not damaged.
Traumatic Brain Injury (TBI) and Acquired

Brain Injuries (ABI)
Traumatic Brain lniury (T8I): 8rail Traumatic Brain Injur ies (TBh) and Acquired Brain I njuries (ABls) include hc3d
iljlries Imm IJ:lo-• to lie head. sp,tts trauma (from whiplash, foiling, or blows to the head), as wdl as damage caused by sports
iljlries.. lisease. pciisoliil:g, « drat abuse. injuries, disease (e.g., heart attack, sci:-ure, tumours, and infections), poisoning, and drug
Ae·icJ.i i~ e,a, lnjt.ries (A.81s): A8ls abuse (Brain Injury Canada, 2017). The frequency of brain injury in Canada is rising
• br•injlfts ~~afterbirth with over 160,000 Canadians sustaining brain injuries every 't'ear, about .SO percent of
miler~ as a resijl d geneti:: faciln. which arc the result of motor vehicle accidents and falls (Brain Jnjury Canada, 2017).
One common type of brain injury is a concussion, which can cause symptoms such
as loss of consciousnes~ headache, di.!!ines.s and confusion, and mood changes. Usually,
with rest, a concussion will heal, but sometimes medical intervention is required to deal
with more serious symptoms such as internal bleeding.
Canada's aging seniors are one group at risk of abuse by a famil't' member or care~
giver, usually an adult child. Counsellors should consider the possibility that TBI could
be the result of abuse. Sensitive and nonjudgmental interviewing can be used to provide
an opportunity for the person to disclose abuse. Although there is no legal "duty to
repon" abuse of adults. counsellors have a professional responsibility to loolc for ways
to ensure that the.ir client has a safety plan, with options, including police intervention,
transition home~ family counselling. and ani;er management for the abuser. Where
abuse of a child is suspected, Canadian laws require that this be rcponed to the appro-
priate child welfare authorities. Further in-depth interviewing should be suspended and
deferred to the responsible child weJfare sp«ialist.
• After injury or stroke, the brain does not regenerate damaged tissue.
IDE'IOllt :::fll However, the brain's remarkable plasticity may enable it to rcorg3ni:e
Oakview Studios/ (reprogram) neuraJ pathways to aJlow partiaJ or full recovery over a
Shutterstoct< period of time. It is analoi;ous to a rood detour. \Vhen a part of the
brain is unable to continue its worlc b«ause of injury, it is capable of rewiring itself to
move the work to a different, healthy area. Recovery outcome is impacted by many fac-
tors, including age and the nature of the injury, but r«overycan be maximi.!ed through
repetition of rehabilitation exercises to enhance brain plasticity. Counsellors can heJp by
assisting clients to access locaJ rehabilitation professionals., and by providing supportive
counselling to sustain client motivation during what might be a long period of recovery
requiring patience and continued effort.
Brain and spinal cord injury arc potentially catastrophic events with the potential
to cause paraJ,.•sis as well as impact consciousness. The Mayo Clinic (2017b) describes
five different states of consciousness:
■ Coma-3 state of unconsciousness that ma,., be temporary or permanent.
■ Ves;:etative state-person is unaware of what is happening, but they ma't' retain
some responses (open eyes, sound~ and respond to reflexes).
382 Chap1er 11
■ Minimally conscious state-sever~ alter~ consciousncs~ but some awareness
of surroundings.
■ Locked-in syndrome-person is aware, un3ble to respond, but may be able to com,
muniatte with ere movement.
■ Brain death--no 3ctivity in the brain 3nd brainstem.
TBJ can precipitate a wide range of social and psychological problems. Since
affected individuals may not be able to work in the.ir chosen profession, employment
counselling professionals can work with them to secure retraining or income rcplncc-
mcnt. They can also hdp clients deal with the emotional loss (grie.f) 3ssociated with
an unplanned interruption in their work, which may result in "depression, anxiety,
relationship strain, failed attempts at returning to work, substance use, loss of self-
esteem, and PTSD rel3ted to a TBI" (Maucicri, 2012). Since family mcmbe.rs arc directly
impacted by a loved one's TBI, they may need to be considered or included in any
counselling intervention.
SUCCESS TIP
Brain Health
TM positive impact on bt'ain hearth of factors such as exetcise, diet social relationships,
(eduction of subStance use, including sm:>king, hOusing, slee,,, reduction ot stress, posi-
tive lhinking. emp10ymen1, engaging rn sriml.Aating bt'ain activity (readlrlg. education, and
games), and spirituality have been well dOCumented in the liter'ature. Al of them are vat,j
targets fOr' conttaeting in a comprehensive counselling ~n.
SUMMARY
■ The brain is a complex org3n that controls all the functions of the body, including
wh3t we do, see, hear, and think.
■ Neuroscience as 3 new force in counseJling joins psychoan3Jysis, behaviourism,
humanism, multiculturalism, and social justice.
■ There are diverse ways to srudy the brain, including dissection, anim:.d srudie~ the
impact of injury or disease, and neuroimaging.
■ Ncuroplasticit)• refers to the brain's continuous changing of neural pathways as a
result of experience and learning.
■ A range of counsdling strategics c3n be used to enhance neuroplasticity.
■ The brain is compos(Xf of three pans: the cerebrum, cerebellum, and brainstem.
■ Eighty billion nerve cells or neurons produce neuron~ which arc the lcey to brain
functioning and communic3tion.
■ Neurons communicate with neurotransminers such as dopamine and ~rotonin.
■ Learning and experience create neuraJ pathways, which may involve hundreds of
thouS3nds of neurons.
■ There arc over 400 named neurologicnJ disorde.rs and diseases, indudingdcmcnti3s,
such as Alzheimer's disease.

EXERCISES
Self-Awareness her husband. He is in gOOCI health and detennined to keep
1. How might your genetics be affected by your life hi:S 'Mfe at hOme. HoN8\ler, he admits. that the burden of her
experiences? care is becoming overwhelmi~. DevelOp a plan forsupport-
i~ htm in the coming months.
2. Think abOul hOw you might react if you or a member of
your family was diagoosed with Alzheimer's. Reflect on the 6. Talk to yotX circle of family and friends. As.k them, MWhat
ovel'afl impact for you, your friends, and your community. words.and phrases do you lhink of when you hear lhe wocd
AIZheiner"s.· Now ask them, -What \\OOld )<Ill s:¥f, leel. and
3. Make a list of thi~ you could dO to ·exercise· your mil\CI.
think if someooo dOSe to you said they had Atzheimer"s.·
4. Imagine that you are an individual whOSe parent haS HD. Share your answers. in a group discussi::>n with class.mates.
Sham your troughts M the ,:,os aoo coos ot ~ the genetic 7. YotX dient has recently experienced a strOke. He says, ·My
tesa to detemw'le if you"• develOp the disease. lite is. over.· Suggest counselling priorities for WOr"Jd~ with
5. What are your stt~t ne1Xal pathways? What events Or' this client
experiences made them strong? Whid'I are helpful to you in
8. YOU" client is a woman, age 28, Vi'M has been diagnosed
leadi~ your life? Which are ptOblematic?
with MS. In recent months, her symptoms have beeome
6. Oo you think biOIOgy and neuroscience will be able to more pronounced where She is havi~ difficulty caring for
explain the Mminci?· her twin bays., age 6. She also reports. that lhis is putti~
a severe s.ttain on her 10.yea( marriage to her high schOOI
Skill Practice sweetheart As. her counsellor, how might you assist her to
deal with her d'lalleoges.
1. Change your ooural patterns by visualizing (imagining)
change. Identify a situation in your lite where you wouk1 9. Your client is a 20-year-Old man W'ho has recently been
like to change how you think, behave, or act Set a specific di'agoosed with epilepsy. He re(X)rts that he feels ashamed
goal. NON close your eyes and visualile the ideal result. use and embarrassed by his conclil.ioo. Suggest a simple, non-
lhOught stopping to manage unhelpful thinking. jargor'Wled response to help htm deal with hi:S feelings. Use
neuroscience concepts..
2. Optbn: Work 'Mth a partner who can assisl )<Ill ~th prompts
lhat help you visuatize--for exami:,e, Whe:fe are you? WhO 10. A lhird-waoo tead'ler i:S adamant that her nl"le-yea(-olcl stu-
else is presen1? Imagine that you are to ... (situational dent diagnosed 'Mth ADHO is. just Mbeing bad.· Sugg,esa a
<Set.ails). Now, imagine yourself sayi~ .. .. You are feeling neuroscience re'SJX)nse to the teacher.
(add positive emotion consistent with success).
Concepts
3. Suggest hoN a counsellor might deal with a client recently
I . Scientists are a very ear1y stage using tech ~ to "read
diagnosed 'Mth Alzheiner"s at the earl'j stages W'ho remarks,
the mind.· Suggest ethic.al issues lhat might arise if this
·My life i:S over.·
technOIOgy is perlected.
4. What uniciue issues might a(.se for a client age 40 whO
2. Describe hON neuroplasticity can be used to explain cogni-
develops earty onset AIZ:heimer's?
tive beha..;oural counsem~ concepts.
5. You( client i:Sa 75-yea(-dd man living with his 'Mfe, age 68.
3. Dispute lhe common myth that we onty use part of OU" brain.
They have boon happily married for ovet 40 years. Three
years ago, She was diagnosed with Alzheimer's, aOCI the 4. How can we best help out dients. uti!ize infonnation on the
disease has prc,gJ&SSed rapidly. She has re.ached a point lntemet?
where she can oo longer- be left atone. Often, she has trou- 5. If the brains of psychopathS are damaged, to what extent
ble recogr'Wling family aOCI friends aOCI, on occasion, even ShOulcl they be held accountable for their behavbr1
WEBLINKS
Note: There are many national, international, and local agen- www.epilepsy.ca
cies that have been formed to provide information and supl)Oct http://braincanada.ca/
to people who are dealing with blain related problems. They
are &«!!lent resourc-es. fOt clients, families. and professionals. Link to initiatives and research from Brain Canada, a national
Here are some examples nooprofit agency that supports. innovative brain research projects.
http:Jlwww.alz.heimer.ca http://www.alz.org/research/OYerview.asi,
http:Jlwww.heartandstioke.ca A site with ui;t~d.ate cune:nt r~ch, information, data, and

links to resources on Alzheimer's..
https.:llbrain1nJu.rycanada.ca
384 Chapler 1 l
::l~lute confidenti::llity: An assura.nce th:u client disclosures are not sh::ared with anyone.
::lCetylcholine: Neurotransmitter linked to cent ral nervous system (unct.Ons,. indudina w;,il:.e(uJ,
ness. ::attentiveness, 2n~r, 2'tiression, sexuality. and thirst.
::lCtion pl3nninw:: Helpifl¥ chenu nuke th3fl¥eS in their In-es; in\'Olves sett in.a; iOals. identi6·ll,i
strateaies for c~n~-e. ::and ckvelopina plans for re::.chi~ &OQ.ls.
::lCth·e l"tenina: A 1erm de!icribina 2 d uster o( sk1lb1 th3t 2re- used to increase the 2ccuracy o(
underttandina. Auendina. usina silence. p.,r2phr:uin.a;. surnrn.:1ri:ina. questionini, ::and
sh,o,,\•ina empath)' ::are the lxt.sk skills o( act l\'t, listenill¥,
::lddict.ion medkAtiOni: ?l.·1edieations sud, 2s n::tltrexone ::and methadone that 2re used t'O sup,
port 2ddktion reco...er)' ::and treatment.
::lffect: A term that counsellors use to describe hoo• people express etnot.Ons.
■ blunted: Emotional expression is le!is than one miaht expect.
■ flAt: There is an absence or ne::ar 2bsence o( 30)' Si$:Jl.S o( einotion:11I express.On.
■ inappropri:ue: The persoi, ·s rn.:umer and mood co.11r2dtet what one mi.a;ht expect. For
ex::arnp1e. a client miaJ11 12~ while describina the death o( his mother.
■ 13bUe: TI,ere- is abnorm.::tl \'2riability in affect. with repeated, r.apid, 2nd 2brupt shifrs in
2ffeetive expression.
■ n:-s1ri<:ted or con:.1ricted: There is a nuld redu~ion in the ran~-e ::and intensity o( emo,
uonal expression.
::lffe<:.th·e diso«Jen: Distur~1l«S I.I, mood. lndudina depression ::and mania..
::lffecth·e dom:'.lin: How dienu (eel.
::lmpl:i.6ed n:-flect.ion: A technique that ex2~r.u e-s wh::at 3 chent has S2k1 with the hope th::u the
client will present the other skle o( a.mbi,..alence.
::lmyw:d:d::l: lmport3nt part o( the brain assocbted with emotions such as (ear ::and a.i,~-e-r.
::lnorexi:a. ne:r,.'0!13: An eatll,i disorder th::u O<'eurS when people reject ma.int::ainina a rnininully
hc.Uthy bod)' we.iaJ11. Drl\'en by low sel(~t eem 2nd ::an intense (e::ar o( K2inina v.--ei.a;ht, people
with ::anorexi.a use tedmiques sud, as purt:.in.a; (e.a.• l2stina. \'01nit1~ a.i,d bl:.ina la.x2tives) a.i,d
excessive exerdse to redu«> bodr v.'t'.1aJ1t.
::lnt.i,::lmdet)' medkAtiOni: Medk::at ions s ueh as V:,ibum 2nd Librium that 2re used t'O cont rol
serious 2nd persi!it ent a.i,xiety, phobia. ::and pa.i,ic 2ttacb.
::lnt.idp3to ry contnct·: An ::aareement becwe.,en counsellorS ::and clients that pJa.i,s for predicbble
events. Ant k':ip:norr oontr2cts provide auida.i,ce for counsellorS ::and ansv.--er the question.
"Wh::at should I do i( . . . t·
::lnt.idep n:-u::lnt mediCAtiOni: Medieat.Ons soch as Pro:::1e. Pax1l, ::and Zo!o(t th3t 2re used to help
people de::al with serious depre!ision.
::lnt.i..opptttih't, practice: \Vhen oounsellorS work (or structural chan£(':s in Oflt;)ni: ::at ions. po.Jiey.
2nd in prmnohnK equity in the d1stribution o( resources, opportunities, and power.
::lntips,-chotk (or neurole.ptk) mediCAtiOnll: Medteations sueh as ehlo rprom::a:ine, h::aloped,
do!. clo:apine, ::and risperidone th::u ::are used t'O t reat illnesses soch as sthi:ophreni2.
::lnxiety dill-Ordeu: More than 1lOr1naJ Je,..els o( (ear, wor q •. tension. or ::anxiety 2bout <la.ii)'
events.
::l!lse.rth·enen: Behavifl¥ a.i,d expressina thouahts and (eelinv in ::an open a.i,d honest maimer
that respects the ri..fit<,s o( other!l.
::lHumptions: Distortions or false CO.K'lusions b.,sed on simplistk re::u oni~ 1.1,romplete 1.1,(or,
m::ation. or bbs.
::lttended silen ce: Counsellor siLence char..eie-ri.:ed h)' 1naldn.a; eye oont2ct. physieaJI)' 2nd PS)'•
choloakaJly lo.cusin~ on the client, ::and beina se.l(,,hsdplmed to minimi:e int en121 a.i,d
ext ernal distf'3Ct ion.
::lttendinw:: A term used t'O des.cnbe the way that counsellors ronununieate to their clients that
they ::are read)·, will,~ 2nd able to listen. \lhb.,I, nOm't,r~I, ::and ::attitudinal cue.s ::are the
essenee o( ef(tttn-e attendina.
Link resources for social work tenns: ht tps:// www.cartha~-e.edtJsocfal.v.'Ork/$tudent-resources/

voe:tbufary/: http-J/cwrp.e:Jsi1es/defaultlrites/publiea11ons/en/Glossarr_o(_ Sod.=-l_Work_
Terrns_Febru:1rr_20 1J _EK.pd(
385
autom::uk. th.ou"h.u : 11,o~ts that oeeur spontaneously and are o(ten outside o( one's 2Yi':l..n>:nett
b:),j,ic e:m p.,thy: A counsellor's acknoo-ledi me:nt o( a el1e:nt's clearly conununic:ued (eelin~
beruhiour.111 dom:11.in: \\'hat d1e:nu :11re doini,
bip0lar dL~rder: A mood disorde-r characteri.:ed b)• alte-rnatinK periods o( de-pression and
abnor mal!)• he'ihtened mood, somet imes t'O the point o( Kr:l..nd1osity. People with bipolar
disorder ma)• behave irrationally (e.i,, tt0h1¥ on uncontrolled buyini- sprees. conunittinK
sexual indiscre11ons,. and uiki.ni- p.,rt in (oolish business hwestments).
brain pl:ut.icity: TI,e brain's ab1bty to rnodi(r itself throu~, ei.:perience 2nd learnini-,
brain s tem : P~u1 o( the brain ::11bcw~ the spln::111 chord that rontrols breathh,i, hc.l.rt. and blood
preS.Sure.
brief coun.sellina: An approach to counsetlu)¥ eharact eri:ed b)• a locus on resources and so1u-
t.Ons r.l.lher than problems.
BrOC::11'.!l Aph:),j,i:a.: Di((kult)• with Spei>eh. underst::11ndin$:, and fa.n¥u~-e.
bulimi:a.: An e::uini- disorder th ::u OC<'urs when people 2dop1 2 p.,n e-rn o( ex~ssive overeat inK
followed h)· \'01nitina or o ther pu~ina be.h::rviourS to oontroJ their wei~u .
bum out: A state o( emot ionaJ. me:ntaJ. and ph)'Skal exh ::mst ion th ::u reduces or pre,'i":11ts people
from per!onnin,a their job.
CAT (Computeri: ed A xi:111 Tomoaraphy): Use o( X..niys t'O det~t abnorr!Ulitie-s in o~ans.
cadmuis: \le-rba.li: .:u ion o( ide:3s. (earl. po.st si,aniAeant e\'entS. and assoda11ons,. which resu1t'S in
a release o( anxiet)' or tension.
cer ebelJum: Part o( the brain asSO("iat ed with movement, sensor y percept ion. 2nd motor
coordina11on.
cerebrum : Part o( the brain t~t cont rols hi$:her,order lune11ons inelud1n,a emoc.Ons. learni.n'-
and sensor)' proce-ssh,¥,
cinaul:u e:: Part o( the lunbie system that pla)'S 2n important po.rt in the re~-ul3t ion o( ernot.Ons.
corpus ~ Josum: Ken.>e ribres that conncet the two hemispheres o( the brain.
ch:'.l!Jen aina skit~: Skills used 10 enoouraiti' clients to eritieally evaluate their behaviour 2nd
ideas.
ch::tnKe t:dk: Client st2ten~,u favoud~ tha.i,s.-e.
Ch::11rlei Bonn e-t Syndrom e: (CBS): Condition that o(ten C::lluses \'i.SuaJ h::111lud nat ions amOnK
people who h::11,,e lost their si,dlt or h::t\'e se..-en:-ly impaired vision.
clo.!led que!ilioni: Questions that can e:l.$iJy be :1..11S\\'t'red with 2 simple yt:s o r no (e.a.. "Ord you
"ob)• )'OurseJ(!").
cuhur:111 intelliKen<:.e: The ability to uJ3p1 2nd int e~rate sloll, kno,vled~, attitudes oonsiste:nt
with the eult ure o( clients.
cOKnit.ive behaviour.11 COUnie:llinK (ther apy): A oounsel11n,a approoel, th : 111 assists elienu to
ide:nti(y and modi()' unhelpful thinkinK and prob1enutie behaviour.
coanith·e dom:11in: How elienu think about their situations.
comm3nd h::11lludn::.t.ion: A distorted peTttption o( \'Oi«s and im~es dim:-til,a one t'O perform
some :.et.On (e~, 2ttack or kill someone).
conc reten~: A term used to measure the clarity and spec10eity o( oonununieat1on .
confront::ttion: Counsellin,a initiat i\'e-s that thalJe~e dient'S to crltieally examine their ::.et1ons
an.d/c>r eonside-r other viewpoinu.
confront::tti.on of incona ruitie:s: Used to point out i~onsisteneies in a elie:nt's ,>erb.11 2nd non,
,>erbal mess~es. "alues or behe(s. and be~viour.
conaruence: Tilt e:,p.,d-ty to be real 2nd eonsiste:nt with clients; 1natthin,a be~viour, (eelin~
and ::.et.Ons.
content .!lumm::tf)·: A sununar)' that foeuses on eontent and is an unedited eonde:nsinK o( the
el ient ·s words.
continaency plans: Prevent ive pla.i,s that :1..111idp:ue possible b3rrier-S that clients mi~,t en.eoun,
te-r 3.:S the)• C::llrr)' Out ::.et1on plans.
contr::11<:.t : A 1~ti3ted aareement between eounsellors and clients re"ardin,a the purpose o( the
work. their fttpeeth't, ro!e!l. and the methods a.i,d routines that will be used to reach their
aareed,on objeetn-es. (~ aJso Sd:Jionaf oont,ac-1 and uml: oon,,ae,.)
co-occunina disorder : A ce-rm used t'O descnbe a situation in whiel, 2 person h:u both a sub,
sta.i,ee use disorder a.i,d a ps)'thiat rie disorder.
core condit.ioni: \\1armth. emp:tth y. a.i,d ienuinencss.
couniclJ.ina: An e:in?O"•etment pl'Oee$:$ o( helpinK ehenu to learn sk1lls. deal with (eelin,as,. 2nd
m:1..11:a,ai' problems.
couniclJ.ina refati.Oni hip: A time-limit ed period o( eonsultat ion betv.--een a eounsellc>r and 2 eh,
ent ded1C::11ted to 2el,ievifl¥ a de:f'lned s.-oal.
386 C lossary
counsellor self-disclojure: When eouf)$(".llon di$Close person:al opinions. (eelin~s. or ane<:,
doces,. it e,n be a useful tool th::u models approprfate s h3rifl$:. and it mi$:ht nonn:tli:e the
clients' (eeli1l{tll or ex:pe-rienttS. Counsellor sel(,disclosure should be used sparin&ly. sole!)'
to meet the ne«is o( clients in 2 W:l)' that does not shi(t the foeus 10 the eounselLor.
counte:rtr.ms.feren<:.e: "l1li' positive or ~ •h~ widli'S,. fantasies. and (eel in~ that 2 counse.lJor
uneonscioosly direers or tra.ns(erS to a client. stemminK from his or her own unreso-Jved
confliets" (Gbddin~ 2011, p. ~2).
<:ntical incident de.bnefin&: A team mtttm,i held tode(use the impaet o( a "iolent or l1"3unutic
event sueh as an assault on a s1,i(( member. Debriief'lnK assi.st'S ..vod:ers to norm.:1111:.e and de:tl
with the (eelin&S that mar be aroused because o( the e"ent. As well. debrief'lna is used l'O
re"iew and re"ise pm-ent ive :md erisi.s intervention procedures.
defence me<:.hAnisnu: ?l.•1ental process or re::.e11on t~t s hields a person fro,n undesirable or
un::.ecepiable thoo~,u. (eelin&S, or conclusions that, i( ~epted, would ere::ite 2mde1y or
challen,ii'S l'O one' s sense o( sel(. Common de(ence mec.hanisms include deniaJ. displaee-
ment. r2tionali:3tion. suppression. 2nd reiression.
delw.ion: Distorted belie( in\'Ol\'i.nSt bi.: :m-e tho~t patterns th3t e:mnot be el,al!en£«1 by oth,
erS uSifl¥ re:uon or evidence.
demen ti:1 (neurocoir;n.itive d.isorder): A ~neral term that includes a number o( disorders
where there are problems with memorr 2nd thinldfl$:..
dependent relationship: A counsellina relationship in whkh dients beeome 01:erlr reliant on
their oounsellorS (or dee.ision maldna, Srmptoms indude exeessh-e penni.ssion se.,ekini, (re,
quent pho1li' e,Us or o((lee vislu (or i.n(ormation, and an in:!lbi.lit)' to make simple dec.isions
o r 121:.e 2e1ion without eonsultm&with the counsellor Orst.
depreH.ion: Per\'ash-e dell.ation in rnood ch3r:w!ted : ed b)' sympmms soch as s:.dness., hopeless,
ness. decreased ener$ty. and di(t"trulty concentr3.tina, rememberin&, and tn.:!lki.na dedskms.
directi\'{S: Short statement'S that provide direet ion l'O elients on topk:s. inlornution. and ~
(e.St,. " Tell me more").
dh·erj,it)·: Vari:uions in terms o( li(estyle, C'uhure. beha\'iOUr, sexual orientation. 2~..:-. ::1bility.
relittlon. and other faetorS.
Di:aw:nosdc :1n d St·:u istical ~fan u:11 of Ment:11 OiM>fderj: Published b)• tlli' AmeriC'an Ps)'ffii.:tt•
rie Assodation. it is used br p$)'Chol~ists. ps)'thbt rlsts. 2nd other p$)'Choche-r.1pisu to cbssi(y
2nd diaa,lOSie mental disorders.
doorknob communication: A phenomenon deseribed b)' Shulman (2C(l9) v.'herein dient'S brll1St
up important issues at the end o( the interview/rel2tionship when there is little or no tirne
to 2ddress thern.
dopAm.ine: Neurocl"'3nsmitter llwoh-ed in n,o,.•einent, 2ttent.On. and probLem solvh,i ,
du.Al relat.iouship: A rel3tionship in whicl, there is both 2 eounsellinK rela11onshlp and another
type o( rebtionship. s ud, as friendship or sexu:al intimacy.
duty to warn: The pro(essionaJ responsibility th3t oounsellors ha"e 10 in(orm people whom
they be.lie-.-e a client tn.:11)' ~nn.
d)•ithymfa: A chronk condit.On with symptoms sinular to depression but that are less se.vere.
EEG ( Ele<:.troenceph21Jow:r.1.phy): A mo! used to n~Sure eltttrhl 2etivity in the bra.in.
Emeri,:ent Technoloaies: New di:1¥n-0St ie 1ools for stud)•ina the brain, indudina M::1¥netoen,
cephaloKrams (MEG). (unetion::11 near,in(l"3red spttt roscopr (rN1RS). di((usion MRI
(OM RI), e"eni,.reiated optie,I si&n:!1I (EROS). and \'Oxel-based morphometr)' (VBM).
empathy: The proeess o( aeeur.:uely understandina the emotional persptttn-e o( 2nother pe-r,
son and the oommunk a11on o( this unde-rstandina without imposlna 01li''s OYi'n (eelu~i or
re::.e11ons..
empowerlna jkUJs: Skills used to help chents ckveLopcon(klenee, sel(..esieem, and. control over
their 11\'d.
em powerment: TI,e process o( helpina clients diSCO\'e-r personaJ strena,hs and t2padties so
that they are abte l'O take eoiurol owr their li\'es; the e-xpeeted outeome o( suceess(ul eoun,
selli0$:,-
endocrine j~tem: K~work o( Stfa.nds in the body and bl"'3in t~t seere1e hormones into the
blood scream.
epi~ne tics: TI,e stud)' o( how ee-rtain Kt:11es e,n be 2et h'3ted or de::ieti\'ated b)' li(e eicperienus
soch 2s nutrition. envirorm~n. po,.-erty, 2nd espedall)' trauma.
ethical dilemma: A sltu::11ion involvin&oompe11fl¥ or rontlietin& \':tlues or prll,dpLes.
eth.ic:t1: G uide.lines t~t Wine the limits o( permiSSlbLe behaviour.
ec.hnocentrl,.m: The inelin:)(ion to Jud~..:- other euhures ~ th~lr u, rebtion to 01li''s OYi'n eu1,
turaJ \'::llues and oorn,s.
Glossary 387
excit:11.tor)' neurons: Neurons that send ncurotra.ns min erS th:::u stimufate the br2in 2nd inerease
the likelihood th::u a ~eptl\'e neuron will llre.
explorina and probin a sk.iJJs: SkUls oounsellorS use to it3ther in(onn::uion, d::ui(r definition,
seek ex:amptes. and obtain n~essar)' deuul.
Eye Mo,~ment Sensit.bu.ion and Reprocetiina (EMDR) : A treatment ::approaeh {or dealinK
with tr.aunu eQ.ud on the thtor)' that emotional problems are eaus«I b)' memories th ::u
h::t\'e not been stored property.
feedback confronrnt.ion: Used to provide new in(ormation to elienu about who the)' are,
indudm~ how the)' are per«ived hr otherS a.nd the e({eets o( their be.h:wiour on o thers.
front:111 lobe:s: Part o( the brain ~pons1bLe for hiaher-order (unctions sueh 2s ded.sion makillio
problem so1vin&, 1udament, and impulse eontrol.
F unctionfil MRI (fMRI): Use o( nuanetic: Aeld!i to measure ::.etwity in the br2in while 2n ind.,
vidu31 i.!i involved in d1(lerent 2et ivitie!i or thouaht.
GABA (aamma,-am.inobut)·rk add): lnhibimrr neurotr.ansmiuer th:u helps to eont ro1 (ear
and anxiety. motor eont rol, and vision.
alial cells: Cells that provide support l'O neurons..
alut:11mate: Exdtamry neuron 2ssoebted with le:arnina and memory.
aoal ,1;ectinw:: A rounsellinK p ~ th::at helps d1enu deAne in pred.se, n~surabLe terms wh:::lt
they hope to ::.chie-.-e (rom the work o( eounsellina.
K«')· m::me:r: Brain tis:sue oomposed o( ttlls that help us think.
hA1Jucln:11tion: A (alse or discorted sensor)' percept ion such 2s he3rillio seeina. tast in&, touchillio
or !imelhn~ what other!i do not.
H A LT: An ::.er0fly1n {or hun{tr)·, a.nary. lonely. and tired. HALT i.!i a quick wa)· to help d1enu
assess tdj¥ers 2nd plan altern.2th-e responses.
h.arm reduc tion: Methods such as needle exd,an{ti' proarams a.nd meth::.done maintenance th:::lt
reduce the d21n~ina ef(eet!i o( dr~ without requirina user!i to stop usina substanice!i..
H emorrh.aw:ic s1roke: A scroke th::at oecurS when eonditions soch as hiaJ, blood pressure e21uses
::arteries to burst.
h.ippoc3mpus: Part o( the brain in cont rol o( stori~ meinories.
hum om-: A eounsellul¥ tool that- when 3ppropri2te 2nd " ~II t imed- mar support the de,-elop,
me:nt o( the relationship. redu«> tension. encour2~-e the elient to take a hahter view o( his or
her problem!i.. or provkle a.n alternate per!ipective on their sitU2tion.
immediacy: A l'OOI (or explorinK. e\~IU2tina. and deepenina eounsellinK rel2tionshipl.
indirect q ues1ion:s: Statements that implr quest ions (e.~. " I'm curious how )'Ou responded.'').
infer-red empathy: ldent iOcation o( a client's {e,elmv based on nonverbal roes and indirttt
eommunkat ion.
JnhibitOf)· ne urons: Neurons th:::lt send neurotr.uumitteTS (!iue.h ::u serol'Onin and GABA) to
calm the br2in 2nd dttrease or inhibit other ncurons from Orill¥,
interviewina: AcquirinK and Ofi::l..ni:ina relev.lnt infornut.On usina aeth~ hsteninisk.ills. includ,
ina ::auend1~ si!entt. p:1r.1plu::uinK. sumnuri: in&, que!itioni~ 2nd empothy.
interview t raru.ition: A shi(t in the topic o( the interview.
intim.id:11tinW: beh:11viour: BehaviourS such ::u name callul¥: usina obseenc o r sexldlly h::arassina
fan¥Ua~-e and ~esture!i; s.ho utina: and threatenina throuaJ, d1!ipfa)'!i o( power sud, a!i Ost
s h:akin&, invadini personal space. s talldna. 2nd i.ssuina ,-erbo.l thre:u.s. These behaviours
s hould be ~ trained to prevent eseal::ation to violence.
in vitat.ion3J empathy: A tool a counsellor use!i to enoour4-e dient!i to eicplore emotions.
l K hem.ic s troke: A bl0<:b~-e or dot in the brain e:ause<I b)· 2 buildup o( plaque.
l ~;;:t3tement:s: C le::ar ::usertions about personal (eelmi$ or reaetions th::at do not blame or Judie
others.
job dub method: An inten!ih-t: a.nd St ructured appro:id, l'O job And in¥ based on KrOup support
and structured le:trnina activities. The sole purpose o( a ,ob club is to help partidp;1nu Ond
v.'Ork.
kinesics: The stud)' o( bod)' l311{tua~e. includma such ,"3riab1e!i 2s posture. £::.ci.:al express.Ons,.
~estures,. and ~-e moc.On.
leadinw: que;;tion : A question that sui.:~..:-sts a preferred 2nsv.--er (e.a.• "Don·t )'Ou think. our ses-
sion went real!)' " ~II toda)•?'').
learned hel plessnes.i: A state o( 1nind th:::lt 0<:eurS when individuals h::r..-e learned throu~ fail,
ure that their e«orts will not result in d,:m{ti'.
limbic ¥yscem: The br2in's eontrol «'ntre for emotions.
LIVE: An aeronrm that desedbe!i the lour essenti.:al steps in sumnuri: ina: liscen. klenti(r. ,-er,
bali:e. 2nd e ...aluate.
388 C lossary
M.aw:netk Reson::lnce l m36Pnw: (MRI): A procedure th::u u tili.:es matp,etk Oelds and 1"'3dio
w::r...es l'O take- three-<limension:111 structural pieturd o( the bl"'3in and bodr o~:u,s.
meduJfa: Br3in structure responsible for bre::1thin¥ 3nd rettul::uina blood pressure.
meu1.commun ic::ltiom TI,e n~~'C' th::u is he::ard (interpreted), which 1113)' d1Uer from the v.'Ords
spoken o r the intended 1hdS::l~'C" o( the spe::akc-r.
midbr.l.in (m eilenceph:don): Br.tin st rueture ::assoefated with s leep. he3dfl$:. vision. bodr te1n-
perature, vision. hearh1¥, motor eont rol, sJeep/~ke. and arous:al (alertness).
mindfuJness: Foeusina on 11\0men1-to,momen1 ~perienees without Judifnent.
mil-3cle question: U sed in brie( or si0$;le-session eounsellm~ as a W3)' l'O help elienu who have
di{t"tru1ty «uni"¥ up with de:Oned K(Xlls. The miracle question thallefl¥eS clients l'O itn:1¥ine
how their lives would be di((erent i( a miracle so.Jved their problems..
mil-ro r neurons: Neurons th::rt Ore when Yi'e observe ::another person doina o r 5a)'i~ in the s::ame
W3)' ::as i( "~ Yi'ere doina or sayinK it.
MQa\NS: An :teronym for the words must. oog,.t. al,n1,s. nn"'· and should. which sl{tl,::al irl"'3tio ,
n::111 or sel(,de(eatu~ tho~t.
mood dis.o«len: See a//ee.te'o,,~ diwrclen..
mood-s1;11bili..:inW: medic.atioru: ?l.·1 edieat1ons s ueh ::as lithium carbonate- th:::u are used to cont rol
the manic srmpcoms :u,d mood SYi•in.a,i o( bipol::ar dison:le-r.
motiv:uion3I interviewinW: (Mt): A noneonfront::ation::al eounsel11na approach that pn>n\Otes
beh::IV'lou~I chan~'C' br :usisth1¥ chenu to reSOl\'e and over«une ::ambiV:llentt.
nee:uh-e symptonu: Srmptoms o( psychosis that indude blunted o r Oanened aUeet. p0\'•
e rty o( speecl,. emotion::11 and sod::al withdraw::al. fack o( pleasure (::anhedonia), p,usivity.
diUieulty in abstl"'3Ct thinkini,, and la.e.k o( ~-oal.-diree1ed be.1,::1viour. (See ::also /H)seth'<'
sym1>tonu.)
neur3I tr.1nsmi.ssion: Connections between neurons in the br2in for tr2nsmitth1¥ in(onnatk>n.
neurocow:nith·e dis.o«ltt: (See also demtnda.)
neurocounsellina: The inte,ar.:uion o( neuroscience into the practice o( counsellu-)¥.
neur~niS.is: Produc1.0n o( new neurons.
neuroim:1w:ina: The use o( ,'3rious tools l'O exp1ore the structure :u,d function o( the brain.
neuropb.;;:tkit)·: The br3in 's a.bilit)' to ch3n£i> iuel( b)• lorminSt new neural com~ions in
response 10 le::arnina.
nore-pinephrlne: An exd12torr neurotr2nsmitter th3t aeth'3tes and the body's st ress response.
objecti\it y: TI,e 2bility 10 understand (eelin~s. tho u$:hu. :u,d bel,::1vk>ur witho ut ::allowina per,
son::al V:l!ues. belie(s. :u,d bi::ases to interfere.
obsessh-e•cOmpulsh-e dis.orde:r (OCO): Rtturrent. unwanted thou¥hts and eonsdous. ritual,
i.:ed. seemin~I)' purposeless aet'S. such as ooun11na the number o( 11les on the cei11na or
needh,i to W::ISh one·s h::ands repet iti\'ely.
ocdpl:n1J lobes: P3r1 o( the bl"'3in responsible lor visual proeessh,¥,
open queii:tious: Quest ions th3t promote ~pc:msh-e answers.. These types o( questions c=innot
be answered with a simple yt:s o r no (e.i,. "How do )'Ou (eel ::about her!' ').
o utcome w:o3l: A ~"04!1 rel::1ted to wh::1t the client hopes 10 achie\-e from counsellu-)¥.
p::lnic di.M>rder: Sudden att:M':ks o( terro r 2nd irration.21 (~r :)C('OmpcaniOO b)' :u, O\'erwhelmU,i
sense o( impendina doom. DurU,~ ::1 panic ::attack. a persoi, nuy ~perieniee srmpcoms such
2s ::an aeceLerated heart rate-, sweatu-)¥. sh:akh1¥, shortness o( breath, chest p.1in, n::ause:a. :u,d
(e:u o( <l)'ifl¥ o r losinaoontrot
p3nphr3sinw:: A nonj~1nei1t:l1 restatement o( the ei!IC'nt's words and ideas in the eounsellor's
own words.
p::lrie1:1J lobes: Par1 o( the brain responsible for proeessh,St bodr sens:ttions such as touch.
p.1in. and te111per2ture as well ::as pl::1yi1l{t 3 role in \'i.sion. re:adin&, :u,d sol\'lfl¥ 1n:1thematieal
problems.
PET (Positron Emission Tomoi;irnph )'·): Radioaeth-e d)·e injected into the body to measure
blood flew.•. and detect probtems with the heart, brain. :u,d centraJ nervous S)'Stem (b~in
and spin31 oord).
p h::ues of coun!l(>Jlina: Sequent i::al steps throu~, whkh counsetlu~ tends to evoh-e. The lour
ph::ases ::are prelunin::ary. beiinnin~ action. 2nd endh1¥,
p h3seil of violence: The four,phase model (::111.xi~y. de(ensh>ene.ss. aeth1St out, and t ension
reduct.On) th:n deseribes how edses ese::!ila.te to violenee.
p hobb: An irrat1on::al (e::ar :.bout portieular e\'i":nts or ob,eets th3t results 111 O\'eNiheltnin¥ anxi,
et)' in response to situ3t ions where there is little o r no d3fl¥er.
Pons: P::lrt o( the brain th::11 aids in the t ransmission o( n~~es be'lwee:n the oortex 2nd the
cerebellum, ::as well as playin¥ 3 role in breathil)¥. sleep. bitil)¥. chewU1i, ::and s~ILowinSt,
Glossary 389
pM.it.h1'" rew::ud: The 2bility o( counsellors to ~ i: e the inherent worth o( people.
p0sit.ive iymptonu: Srmptmns o( pS)·Chosis th::u include ~Uudnations,. delusions,. bi:arre
beh::1:viour, :1ait:1tion. thou~t diJOrder. di50-r¥:lni.::ed speecl, and behaviour. 2nd c:1t2tonk
beh:l\+iOUr. (See 2!JO nqadt,e syttp,om.s.)
pOSMr.l.um:u.ic s t·TISi d.iM>rder (P'TSD): OiS:tbli~ symprnm.s s uch 2s emotional numbness,.
s leep d1sturlxul« (niihtm:lres. di((kulty sleepina), or reli\+ina the e\'ent (o11o"'1na :l tr.l.u,
matk e\'ent s uch :lS r2pe, :lSSau1t, natural dis:aster (earthqu:1kes,. Roods,. etc.), war. tort ure. or
:ln :lul'Otnobile :)C('ident.
prepnr::ator)' em p3th)·: A oounseJJor·s ::attempt to consider (in ::.cl"::a:nce o( the inter\+iew)the (~I.,
i1l{tS ::and concerns that the client m::ty comm unic2te i.ndirectlr.
pro<:.!Si it()3I: TI,e methods 2nd procedures tl,::u will be used in oounsellina l'O ::assist clients in
reachina their aoo,ts.
prosop::aano11.i::a: A diJOrder where people cannot recoani:e faces. e\'i":n with people with whom
the)' are fanuilar (aka 2s (:1tt blindness).
proxem.iei: A tenn used to deseribe how people use sp::.« 2nd dist2nee in socidil beh::t\+iOur.
pseud0-<ouns cl1.ina (iJlusiion of work): A process in which the work.er and tl,e client entt3ae
in a con,..ersatio n tl,::u is empty and tl1::1:t h:u no real me2nina, Counsellina in\'oJves irreJe,
vant explor2tion o( issues,. use o( dicM:s and p.1troni.:h,i platitudes,. intel!e('tual expJora,
lion o( issues. 2nd avoida1l« o( subJe('ts or (ee.lin~ th2t in\'olve pain in fa\'our o( "~(e"
topics.
ps)·chol0jpc3J reacu1.nce: The tendenC)' lor people 10 increase problem beha"iour i( ther
belie,..e their (reedom is threatened. This tl,eor)' can help us underStand why n~h~ b)'
concerned ( riends and l21ni.l)' mar h::t\'e a par2doxic2I e((ect.
ps,-chostimub nts: Medie:u.Ons like Ritalin that a.re used to treat attent ion-deGdtnl)•pe-r3Ctivity
disorder (ADH O).
ps,-cho ther::a~·: Ad\'anced counselltni t,i~eti~ se\'ere emotional or behaviouraJ d1fGcuh ies or
disorders..
question.ina: An ::.etl\'t, listenina skill that in,..olves probi~ for inform::ttion to oonGnn under,
s tand1na and ~k d:u-i(kation.
r3dic31 ::acceptance: A str3t~ · that invoh>t:s encour2.:ina expression o( sc21.e ment'S tl1::1:t you
tend to dis::.aree with or philosophkally oppose.
refr.i.m.ina: A techn;que lor he1pi~ clients look at thin$:$ di((erentl)' b)' s u~scll,i ~hernatl\'t,
interpret::rtio!U. perSpet!tives. o r new 1ne2ni~ Reframes should present loaical 2nd post-
li\'e a1ternathee ways o( tl,inkill¥,
re.l::at.ionship-buiJdinW: ikil~ and u rntew:ies: Tools lor en.:~ina clients and de,1c"lopifl¥ t rust.
re-1::at.ionship contnct·: A nep.i2tion o( tl,e intended purpose o( the counsel11~ rebtionship.
includ1~ an ~reeinent on the expected roles o( bod, oounsellor and client.
re.l::at.ive confidenti::ality: The 2ssurnp-tion that client d1sc.-losures tiuy be sh2red " '1tl,in tl,e :liti'nCy
with supervisorS o r rolle~ues. o uu,de the ~ency with dient pennission, or with otherS
because o( lett3I requirements,. s ud, as those contained " '1tl,in chikJ/4buse leKislation.
n:scuinw:: Also called band-aidina, this in,..oh-es a oounsellor's 2ct ions th21 praeent o r prote('t
dienu (rom de::altni with issues o r (eelin{tS. Resculfl¥ 2f1ses from the oounsellor·s need to
a\'oid tension and keep the session d,ee.r(ul.
n:sl;;t·ance: A de(ensh'e react.On by clients that llnederes " '1th or debys tl,e process o( counsellif1¥.
reupt::ake: Proees:s wherebr neurotr2nsmitterS are re::ibsorbed by tl,e neuron that rele:ased tl,em.
reward p:u hway: KeuraJ circuit that re-w2nls pleasurable 2eti\+ities witl, dopomine.
s chi: ophreni::1: A chronic 1nental d1sorder involvina srmpmms such 2s halludMtions. delu-
sions. diJOrdered thinkina. and sodal isolat.On.
s ele<:.th·e attention: See. sdttdt" perception.
s electi,·e pe«:.ept.ion: A term used to describe the naturaJ 1ende:i1C)' to avoid be.in¥ O\'erwhelmed
b)' information h)' screenina out riuterial tl,at is irrelev.,.nt.
s elf,3wa reneti: The proeess o( becomina alert and kn<wi1ledieable about o ne's own -w2y o(
thinkina,. 2ct il'{t. and (~litli-
s elf-defe-atinw: thouahu: lnne-r d1aloaue o( critkal 1ness::1~-es.
s elf-detennin2don: The principle that promotes the ri~ts o( clients to ~,ee autonomr and
freedom o( choke.
s elf•t3lk: Ment~I 1ness::1~-es people p,'t, to themselves (e.a,. "l'1n no aood").
s erotonin: An inhibitor)' neurotr2nsmitter (ound in the .:astrointescin::d t ract and the brain stern
th21 helps reiulate mood. bod)' temperature, pain. 2ppetite, 2nd s leep.
s es.sional contr::act: An :1ar~ment betYi'ee:11 oounsellor and client re-tt'3rdh,i the 1opic and
expected o utcome o( an interview or session. (See also oont,actms.)
390 C lossary
sUence: A tool used in counsetlu)¥ when the client is thin.kl!)¥. the chent is con(used 2nd unsure
o( wb3t to 53.)' or do. or the client h:lS enrountered p3in(ul (~ltn$:j. Because it is cultur2il)'
det1ned, silence ean :Uso Siil):U t rust issues <>r closure.
sim ple e:ncournaers: Short phr2ses and ~tu res such 2s "Teti me tn<>re." "Go on... "Uh-h uh.''
2nd head nods th3t enrour2~e clients t'O cont inue with their nodes.
sk.iJJ 2nd _;;:t·ratea)· duste,rs: C2te&()ries o( skilb1 ~sed on their intended purpose o r helpinSt
2Ct ivity.
scaaes of chanae m odel: A theorr o( tnocivation that recottni:es fh-e th31)¥es o( sta~: p recon,
tempfat ion. contemplation. prepar.nion. 2etion, 3nd nuintenance.
st.re:n W:ths approach: A counsellin& perSpect hee th::u assumes the inherent C2padty o( people.
lndi\'idu3ls and communities 3re seen to h3\'e assets and resourus th:u ean be mobili:ed for
problem sol\'i.n~
str0ke: C lot block~e th::u eauses rupture o( arteri,es in the br2in.
structured interview: An i.nter\'iew th::u foUOYi•s a predetermined sequen« o( quesc.Ons..
sub;;:t:mce 2lxue: Continued use o( substances despite si,Knil'leant d,((lcu1ties in 2re:1s such 2s
health (physicaJ. emotional. 2nd 00$:Jihhee). fanuly 2nd o ther refationships.. !e~aJ problems.
2nd use in h:l:3rdous sit"u3tions.. lndi\'idu3ls may 3lso experience increased t'Oler:mce. "-hkb
!e::.<ls to inere:ases in the amount used. and withdrawal S)'mpt'Onu 2nd cr.rvi.ni$ "-hkb o(ten
p recJpime rel3pse.
summ:ui.:..ina: A "'3)' o( conde:nsina eonte:nt. (See :Uso content summary and themt- summary.)
swtain ni. lk: Chent st2tt"lnenu favouril)¥ the s tatus quo.
te:m p0nl to bes: Portion o( the br2in that cont rol!? visu::111 memorr 3nd ~cl,.
t heme summary: A summ3ry th::u edits um~eu3ry detail and atte1npts t'O identi()' kt')' pat,
terns 2nd 2re:as o( uf'iti'nc·y.
t houw:ht b rood castina: The delusion:al belie( th:n Ol"K' ·s thinkina ean be heard b), others..
t hou~t imer-tion: The delusional belief th3t thou~u 3n' beinK inserted into one'!? brain b)'
o thers..
thoow:ht-Moppina: A techn;que (or bre::lldna the put.tern o( repetith-e sel(Meatil)¥ thouj.f,t pdtterns..
Ted,n.iques indude thouj.f,t repl::.ceioent, yellir~ "stop'' in your mind un tU dl(>: undesired~
dis:3ppe::t.rll. snappinK an elastie bond on the wrist to shi(t think.ill$:, 2nd ::.etMty dh't'r.lM>n.
tole:rance: A need (or more o( 3 drua t'O obtain the desired e((ect or less e:((ttt with the s::ame
21nount o( the !lubstanice.
traru.fen?,n <:.e: The te:ndenc:y o( clients to communk2te with their counsellor!? in the same w=I)'
that they eonun unie:ued to sianil'leant people in the po.st.
T rnnsie:nt ischemic :ut::t<:.k (T. I .A.): A mini stroke th::u scrikes when 2 clot bloeks an 3rtery.
T ranstheoret.ical Mode.I of c h:m~: A model t~t ide:ntil'les (h,e st~e!l o( than~-e-preeontem,
pl3tion. eontemplation. prep:u-::uion, aetion. 2nd maintenanee. Counsellor response thoke!l
2re di((erent depe:ndina on the die:nt' s sc2~-e o( cli::m,ii'.
Tr.11.1. 1n:1tk Brain Injury (TBI): Br2in inJuries from blow to the head. sport.S injuries,. d1se:3se.
poisonifl$:. or d r~ abuse.
u nhelpfuJ thinkinW: p3tte:rns: F2uhy re:ISOninSt caused b)' distortion, inc:omplete 2nalysis., t'.¥0•
cent ric-ity. riStidity. 2nd sei(,defe::atinK thou~ht.
unstn.1<:.tm-ed interview: An interview tJi:1t does oot h:I,~ a prese1 pl2n th3t restriets direction.
p.1ee. or content.
v.11lues: \X'h::n i.ndividu:Us 2nd $tr0u ps eonsider import2nt or worthwtule.
vnsat.iJit-,·: The need for cou nsellor!? t'O develop 3 br«ld r2n~-e o( !?kills so the)' ean ::.dapt tJ,eir
2pprooch to f'rt tll(>: d1stinet i\'e eomplexitie!l o( e::.ch individwil 2nd eontext.
viell.dow: t r3uma: An OttupQtion31 ha::1rd for people in the helpinK pro(essions. where ther
de"elop the same srmp-toms :lS their die:nts who ha,ee been t r.aum3ti:ed.
violent be.M,·iour-: H1ttins:., pushinK, bitins:., d3ppina,. kicldntt, thro•,1.'inK objeets. and usinK v.--e3p,
ons such 2s auns.. knh-es. or syrir\{ti'S..
warm th: An expression o( nonpossessive C3rin& th3t re.quires ~-e:nuineness 3nd invoh-eme:nt,
the aecept2nce o( the equal wortJ, o( otherS. 3 non1udwnen12I 3ttitude, and 2void2,~ o(
bfaminK,
\ Ve,rnicke ',i; Aph::ufa: 01((kuhy Andi.Iii words 3nd/or usU,i nonsensie31 words.
white matter : Brain tis!lue th:lt su pport.S eonntttions in the bf3U, by helpinK the tr.ln!lmission
2nd speed o( infornution !l~rinK betv.--een parts o( tJ,e brain.
withdr.1w:1I: TI,e presence o( ph)•Sieal srmpcoms whe:n a druK is oo lol)¥er taken.
work contnct·: An 2areement th3t speciOes the intended ~"()c.11S <>r o utoome o( counselltn~
worldview: The W2)' one peoce.h-es. explains., 3nd 1nak.es !lense o( the world ineludinSt belie:(!?
2bout topies such 2s God. politks,. &mil)', justice, respect (or others, 2nd the e:iwironment.
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Tables, Figures, Conversations, Interviews, and
Brain Bytes Index
Brain Bytes TI,e Ri~u Ea.r Aeh'3nt:a~. JOO

Trans(eren«. 86
Ado-Jes«nt Of\.li Use. 29 1
Trauma, 39
Ado-Jes«nt M::u-1Ju:ln3. Use. 289 Types o( Depress.On. 353
Ajl¥ression. 255
W hite a.nd Grey Matter. 359
Attent ion,def'ldtni),per3et ivity Disorder (ADHD), 289
Broca' s and Wernk.kc- Areas,. 361
Childhood Abuse ::md lntinute Refat ionships,. 87 Index of Conversations
Children ::md Abuse. 26S A1t enmh>t:S to Q uestu~ns,. 137
COKnitn'e Beh::1:viou1"3I CounsellinK, 2 17 Counsellin& and Ps)'thOther2py. 35
Counsellu,i and the Br.ain. 34 Counsellin& People with Deme:nti:a. 380
Cre::uin¥ Kew Keur.u PathW'3ys. 215 Counsellor Sel(, Disdosure. 87
Culture and the Pleasure Centre, 32 1 E«ective P3raphrasin K, I 19
Cuhur-aJ Neuroseie,~. J I J Gallows Humour. 11
DeprdS.On. 284 Genuineness. 73
Dopornine Help(ul Friiends :and Counsellors,. 50
Emotional Memoriies,. 162 How Can I Be Empathic: i( I H::n't' Not Had the Sarne
End in~s. 89 Experience! 185
End.~rine S)·Stem verSus Nervous S)'inem, 365 How l'O Handle an AS$3uh. 265
Ethie:111 21nd Mor31 O«:ision Maldn&, 11 How l'O Respond to H:alludn:uions. 283
Ethics and Neuroscience. 13 I'm Just a BeKinner, 20
Fi~ht m- Fl~ t. 256 J\'t, Tried E,'t,r)•th i1'&, 228
H~ Tr3unu and Violenee, 25~ lnereasifl¥ E1npathic: Voc::ibulary, 173
Individualism 21nd Colleet ivism, 323 Learnin i to Deal with S1ie:nee, 116
ls it Kort~! or Dementia! 379 Mind :and Br2in, 34~
Ustenini, 97 Note Ta.kin.a,. 156
Loe3t ion o( Emp,uh y. 17 1 Pa.raooia, 281
?l.•1emory. 127 Person:ll Feeli1l{tS Get in the W3y, 16
?l.·Hnd(ulness. 215 Personal ln\'Olvement with Clients. 18
?l.·Hr ror Keurons. 163 Pr2yi1'{t with Clientl. 339
?l.·1ultit21ski~ 105 Problems with Liste:ninK 2nd Respond in¥, 107
?l.fosk, 36 Re:SnlinK and. Su pport1~ 62
Ka.iraJ Development 2nd ?l.•t aJ¥in:l11:a11on. 147 SayinK No. 243
1'airot ransm itt,,'~n1:and Men12I Illness. 282 Should I Re:.d the Flit , 53
Kon verbcal Proeessin~ 109 U ncondit.Onal Positwe Reia.rd, 71
Ch:yt•oc:in. 6S W hen Butl'Ons:are Pushed. 219
Pleasu re P:uhw:1y, 299 W hen Client'S Don't Take their Mediea11on. 294
PS\'<':hopothie Br2in~ 364 W hen Noc 10 Use Empathy, 178
PS)'<':hotropie Medieation. 293 Workitli with lnvoluntar)' Client~ H Z
Resistance, HI
Riah t Br2in/Left Br.-in
SeLeet hee Ernpothy. 17 1 Index of Figures
SiJence. 112 ABC Model, 208
StrenKths Based Counselli~ 40 Adrenalin. 367
Stress and C risis, 196 Brain \V:a,ee~ 352
Sundownin K, Cell Oeterlorat.On with Al:heimer' s. 378
The Audito r)' Alarm S)•St em, 98 Oopc:unine. 372
The Adolescent Br.tin. 143 Empath)' ForuSeS 1he Work o( Counsellm& on the Feeli1'{t
The Ama:ifl¥ Brain Domain. 17 3
The Br2in on Relat ionship. 66 Essent ial Element'S o( Se.l(,Deten nination. 10
The Emotional Brain. 2 JO Eth icaJ Pri.ndptes Hie-r2reh y. 14
The lrn~ o( Q uest ion~ 135 Heahhy a.nd Oa.ma~d Myelin. 359
The Kon-stop Br.tin. 3-14 lndwkl l.d!ism \'ersus Colleet ivis1n, 3 2 2
408
ln1en:lependen~ o( Feelin~s. Beha"iour. and TI,inki.ni, 209 Index of Tables
Ko?)· Elemenu o( Cross-Cukural Unders12ndinK, 323
Ker Forces in Counse1Ji1l{t. 345 Common Mixed Feelin~ 167
Lobes o( the Brain, 360 Common Listenh,K Barriiers,. 98
t-.-b jor Gh11nds. 366 Commonly Abused Substances. 297
t-.-b slow ·s Hierarch)' o( Nn'.'ds. 79 Common Sympmms o( Work.pl~ Burnout, 2S
t-.-b tri.x Deds..On, M:akinKChart for Ethbl Dilernnus. 15 Conf".dent iality Guideline~ 8
Model for Resolvh,K Ethie:31 Dilemrius. 14 Contr:l.<'tinK Le::ld~ 78
Norepine·phrine, 3 71 Counsellh,K Activities and SkUls, 49
Preventina and Man:1Ki0¥ An,ii'r and VioLent Beh:3\!1our, 258 CounsellinK Skill Levels, 34
ResiSUUl«', 242 Crisis lnterve:ntion. 199
Ri$:ht and Left,Ur3in Functions, 358 DSM.. Structure. 278
Risk Factors for Viole.,~, 252 Empothy and Probintt, 42
Seltttc-d Elements o( Diversity. JI 3 Empowt:dtli and Stn'nith Bui.ldin~ 42
Se-rotonin. 373 Empowedl)¥ Senior~ 19S
~ill)¥ lnve:ntory, 165
Slanal Trans-mission 21 a Cheinie11I Synapse. 368
Slans o( a Poten1ia1 ?l.•1e:nta1 D1sorder, 275 Five Choices for Respondina to PeTsonaJ Questions. 240
G uidelines (or Counsellor Sel(, Oisd.osure. 88
Str.ueaies for AthievinK Concf"t'lencss. 148
G uidelines (or M ultieuhuf:l.1 Work, 331
St role Warnil)¥ Si$:nS, 3S1
G uidelines (or Quest.Oni1l{t. 142
Suicide Risk Factors,. 303
s),napse. J6s Helpful 2nd Unhelpful Core Beliefs,. 209
S)' lftplOtn.S o( 0ementi2. J78 How Empath)' Helps. 170
The Brain Stem. 35 7 Main12inil)¥ Objectivity. 17
The Cerebellum, 357 M:u,aaini Person::111 Needs in Counsiellini, 24
The Chal)¥e Continuum, 231,232 Me.112I Health: C an::.cli.:iin F::.eu. 273
The Elements o( Empowerment, 193 Kom>erbal Behaviour: What to Observe. 107
The Essent ial Elements o( a CounsellinK Relations.hip. 69 O\'t:f«>'lnil)¥ Listenina Barrier~ IOI
The Limbic S)'stem. 362 Person::!ilit)' Oisorde.-s: Common CbalJeOieS
:u,d Responses. 288
The Ustenina Proceu. 96
The NeT\'Ous S)·Ste1n, 346 Pre\'entini and M:an:1.i-i1l{t An~-er 3.11d Violent Beh::rv.Our. 2 5S
The P:am o( the Neuron. 368 Pro(ession::111 A$50C1:l.tions, 2
Pro(1le o( a C ultur.Ul)' lntelliient Can:1d1:u, Counsellor, 3 11
The Ph2ses o( Violen~, 259
The Skills o( Act h't, ListeninK, 102 Protnodfl¥ Cb3.11ie. 42
The TI,ree Domains. 133 Relr21ni0i. 216
Relations.hip Buik.lh,K, 41
The Sta~s o( Cb:ll1ie. 204
Respondh,K to Silence: Nom't,rlxll C lues. 117
Thou~,t Scoppina Sequence. 233
Types o( Neuron Rttepeorl. 369 Sample Questions (OT Explori1l{t \Vofldview. 320
Selected De0nition~ 314
Sel(,Awareness. 21
Index of Interviews Scr3teir Choices for Promoti1l{t C lient
CA'.)$:nith>e BehaviouraJ Ttthnique:s. 217- 219 Sel(,Decenninat.On. 10
Contl"3Ct intt, 79 Success Tips for lnterviewi1l{t and Counse1Ji1l{t Senio.-s. 146
DeaJma with Resist2n~. 24~244 Success Tips for lnterviewi1l{t Youth, 144
E((tttive Usie o( Empath)', 1~ 187 Sukide: C :u,::.cli2n F2ets. JOJ
End1~91 Sukide Myths,. 305
GoaJ Senintt, 223-225 The St.:1~-es o( Ch:m,ii'. 207
Helpina Clienu Harness Keuropfastidty. 356 The la1l{tu2tte o( P:l.T:lphraSl.l1i, 118
lnunedi:.ey. 84 The Empathk Coinmunieation Proces~ 180
ln1erviewinK Slolls. 1~157 Top 10 Counsellina Errors, 59
Listei,i1l{t. Silence. and Summa.d:ini Sldlls.. 122 Tn>es o( Empathy, 178
t-.-b te and Fem.:de Brains. 363 Trpeso( Quest.Ons. 130
PO<K Substitutes for Empothy. 183 V2lues,. Belie(s, :u,d Attitudes TI,21 Help :u,d H1n.deT
Violent Incident Follow,up. 264 axmse-lJor E((e<"tiveness,. 26
Tables, figure s, Convetsatlons, lnlervtews, and Brain Byles Index 409

A British Columbi~ Schi:ophrenfa Soc:iety, 273. 279
Budde. H .• 354
Adler. R., 110 Butler, A. C.. 207
Albert, P.R .• 374
ALexandei-. C. ?l.·1., J H
Alink. L. A.. 249 C
Al::hcimei-'!l Sodet)' o( Canad::a. (2017). 376. 3i7, 378, 379 Can~ron C. L. 228
Al::hcimers..net., 377 Canadian Assoda11on o( Social Workers.
Amerbn Addiet ion!l Ce:nterS, 297 I, 3. 4. 5. 7, 9. IJ, 18
Amerbn Assoc:i::uion o( Suieid61oQ'.)', 302. 303, 304 Canadian Assoda11on for Suidde Pn:,'i":!1t.On. 305
Amerie21n ?l.·1ediC:U Assoc:i:uion. 282. 283 Canadian Centre for Elder L::rw. 145
Atnerie21n PS)'Chi:u:rk ASSO<"btion. 39. M. 16S, li6, 282. 284. Canadian Centre o n Su bsta.nee Abuse, 289. 195
285, 286 Canadian Children's RisJ,uCoundl, 305
Amerie21n PS)'Chol~ie:'1 Assod::uion. 268 Canadian Counsellin¥ and Psye hother:l.P)· A.ssocfat ion.
Amyotrophic: Late~! Sderosi.s Sodety o( Ca1Uda. 376 I, 4. 5. 7. 9, 10, 13, 18, 34, 88. 316. 332
Andrews. P. W. 372 Canadian Institute for Health Jn(ormat ion. 249
A~u!l, L. 172 Canadian Men1~l Health Assodat.On. 254
ArbC>Jed:1,Ftore:, J.. 253 Canadian Psye ho1o¥ical Association. 377
Arden.J. B.. 347. 349, 371 Canadian Women's Found:.tion. 267
Arthur. 1'., J I I. 32 1. 334 Capu::i. 0., 20, 67, 167. 199, 299, 328
Ashwi".IJ. K.. 196, 299 Carniol, a. 194
A:ar. B.. 32 1, 323 Carpetto. G., 38, 228. 229
A: rin. N. H .• 293 Catta.n. M.• 293
Cent re (or Add.Ct.On a.nd Mental He:alth.
B 273. 300. 302, 348
Cent re (or Sukide Prevention. 302, 303
Back.house. C., J 18 Cen>braJ P3IS)' Assocfat ion o(
Baron,Coben. S., 169. 363 British Columbia, 376
Barth. A .. 97 C hambles~ 0. L., 207
Battino. R .• 228 C honey. S. K.. 335
lle<k. A.T.. 210 Cl:lrk, A . J.. 169, 170, 184. 279. 283
Beck.J. S .• 207. 213 C lesJ,on,. J.M .. 304
Beckman, C . S.. 18 Compmn, &. 47.60
Bebh::am. 8., 282 Co«oran.}..66. 272. 273. 276
Be-~ F. ?l.·1., 286 Cormier, S., 147. 166, 236
Beyerstein. B. L. 279 Co: olioo.. L. 66. 87. 1 12
Bier. 0., 361
C unni~am. M., 336. 337
Bolles. R. N. 291, 292
Bomboy. A .• 375
Bo~n, \V. A .• 291 D
Bovend' Eerdt, T. H .• 220 O 'Andrea, M.J., 3 28
Bowen. S. 214. 215 Oa.hJit':, M.• 347. 362
Bowe-r. B.. 2>4 Dale. 0 .. 3
Bo)·Le. S.. I 4 Dattilio. F. M.
Br.I.in lnJUr)' Canada, 382 D::r-.•il. L. E., 272, 273.280. 286, 289. 290. 293
BrainFacu..ora., 375 D::r-.•il. S.. 168, 318
Branm~r. L. ?l.·1., 2 5 de Becl.er. G .. 253, 259
Bremner, J.. 364 de lan£e, F.. 217
Brill. N. J.. 36. -ti. 72. 89, 90 de U~leuc, 249
Sri.sch. R .• 37 1 de S~: er, S.. 228
Brit ish Columbia Me:nt~I Health and Su bstance DrClemente, C .• 205, 206
Use Pla.nnin&Counc:il. 38 O11ler. J. \~. 32 1. 322, 323. 315. 327
British Columbia Ministry o( C hildren a.nd F:unil)' Dodd, C. H.
De\'elopment. 190 OroLet, J., 19 4
Brit ish Columbia Ministry o( Health. 292 Dubovsky. S. L. 261
410
E Hill. R .• 3~6
HirSieh(eld. R. M .• 304
E.:1ton. K R . 363
H<xker. J. L.. 261
E$;:U1, G.. 45. 48. 58. 82. 85. 169, 176. 182 Horowit:, S.
Ellis. A .• 20S. 2 12 Hoyt, M.R .• 228
Epiieps)' Can::.cl.:1. 376
Er(ord. B.T., 12, 43
Eriekson. C., 299
Intercontinental Medical Statistics lne., 282
F lnternation : 111 Centre for Clubbouse Oe-...elopment, 291
lsajiw. W.W. 315. 3 16
Franee, M .. 333
Iv~. A.E., 3~. 135. 1-10. 246, 328. 3~i
Fauman. M.A., 207. 279. 2SO
Firou:ab3di, A .• 2 J.4
Flera~ A., 319 J
Fortune, A . E .• 88 James. R .• 198
Franees,. A .• 373 Jant , G., 363
Friend!? for U (e, 290 John Hopkins ?l.·1edid nc, 365
Fuertes. J. N. Jolmson, L. C .• 203, 2-10
Jones. K.. 162
G Justitt Edoc3tion Soc:iety, 11
Gabbard. G. 86
G::ardner, W., 254 K
G::arf::u. T..5 K:ldushin. A., 108. 129. J I I
G::ar rett, M. T.. 336 Kellehe-r. M. 0., 251, 258. 259
G1bb, B.J.. 298 Kellr. E.W. 338
Gdlibnd, B.E.. 56 K<nd•II, J., 268
Gbddi1'&, S:t.86. 163. 236. 238, 290 Ktel:1. T.E.
G!kken. ?l.·1. T., 46, 196 Kwhahan. 0., 66
God(rin. K. A .. 214 Knapp. M .. 68. IOi
Golden. B. J., 212 Ko,b. 68
Golem an. U. 162. 163, 185 Kunuri. V., 21 7
Goodther lpy. 36 1
Gor~-ont ?l.·1., 355 L
Go"ernment o( O,nada, 273. 295, 296
Grad in. \ ,: B.. 364 Lahitt. C. E.. 259, 260
G,.(/, Rod(o.<l. J. 377 Layton. J.. 256
Granelto, D.• O.H., 164 Lees. R .• 299
Gm'Otta, L. 6S Leo. R. ).. 294
Greenbe-f'io ?l.·1., 89 U . A .. 3~8
Grt>hol. ).. 64 Uou. S., 35~
Lock. R. n. 32 1
Locke. S., JJ
H
H~ tt, ?l.·1. L.. 381 M
H::K':kney. H. L. 104, J H .324
Hall. E. T., 109 Macdon ::dd. G.. 249, 263.335
H::unmond, W.. 40. 1-14 Mac Lare:n. C., 22 7
Han. S..313 Man:a, P.. 289
H::mns. L., 220 Martin.G., 179.219
H::ar ris. G. T.. 254 Maslow. A . H .• 78
H3r\'ard Med.Cal School. 297, 304 Mate-, G., 299
H:l)'S D.G .• 10S. 329 Mauded. L. 383
Health C,n:u:fa. 273. 295, 300, 303, 305 Mayochnic, 39, 3il. 382
HeaJthline, 296 Mayor, S.. 2 Ii
HeaJthLin.k BC. 3i5 McClure. E. A. JOI
Heart and Stroke Foundation o( Can::.cl:1. 38 1 McCook. A., 25~
Hefner, C.. 282 Mc0on3ld. N.. 325
Heinonen. T.. 66 McGill U niversity. 373
Herie, M.. 295, 29i McHenry. B.. 346, 361
Hiek. S., IH Mcleod, S.. 64
H11l, C. E.. 1-10, 2H Medina, J.. 105, 106
Autho r I ndex 411

?l.•1e:nt:U Health Commission o( Can3'1.a, 27 2 R
Me:nt:U He:::!ilth 031ly. 353
Meuser. K., 302 R::1d~krishn::m, R., JH
R2lph. I.. 2 78. 280
Miley. K. K .. 67. 319
Milter. M. C., 251. 252. 253. 254 Ra::adii. E.. JOO
Reamer, F. G.. 6
Milter. P.. 6. 47. 236. 238, 247.347
Milter. W.R .. 106. 167, 170. 171. 199, 200. 20l. 202 Re~-ehr, C .. 273, 279
Reiter, M.. 169
Mobe~-et, T., 355
M~hler. H .. 282 Riddle, T.. 11
Ro~rS, C.R.. 43, 44, 66, 67, 69, 70,
Moore. P., 194
72.87. 169. 170. 171, 200
Morrisseau. C., 323
Morri5Se)', M.. 262 Ross.J. I.. 251, 320, 325
MultipLe Sclerosis Society o( Gm~::11. 376 Roth. L., 252
MurdO<'.k, N. L.. 162 Roth. E., 378
M)~r~J. E .. 353 Rothman.JC.. 319
RO)'«, T.. 102
Ruskin. R .. 318. 322, 326, 328
N R5•an. S.. 249
KaqvL N.. 210
Kat.Ona! Atlianee on Mental Health, JOI
Kat.Ona! Assodat.On o( Social Work.erS. 326 s
Kat.Ona! Child Traumatk Stress Ket:work. 39 Saddock, a.274.279.303, 304
Kat.Ona! Crisis Prevention lnstit"ute, 257 Sal~by. 0., 46, 162. 196
Kat.Ona! E::1tinK Disorder ln(ornution Centre, 286 San Fr.lneisi!o Sukide Pre...ention Institute, 304
Kat.Ona! Institute o( Orua Abuse, 296 Sapolsky R . M .. 364
Kat.Ona! Institute o( Health. 296 Schi:ophre:nia Sodel)' o( CaMda. 277
Kat.Ona! lnstituteo( Ment:U He,ihh(KIMH). 273, 277.279. Science 03,ly. 11
282, 285.286. 287, 293.370.371 Seientif'k Amerk::tn, 364
Keenan. M., 214. 227 SoofOe!d, H.. 11
Kesbitt, K , 7 Seal)' P.. 272
Kewlull. CE., 249. 252. 253 Sears. S.J.. 293
Kiles. S.G.. 293 Sederer. LI.. 277
Koesner, G.. 103 Sel1aman. L.. 162. 163
Kordqvist, J., 353 Sel1aman. M . E.. 205
Kystul. M.S., 66, 219 S~hmi:3.di. A .• 323. 327
Sh:tpiro.. F.. 41. 364
S~rr.-rd, M.. 256
0 Shea, S. C.. 178. 257. 260
0.lkvi lie O!St re:ss Cent re. 305 She::af'or. a W., 3. 27, 46, 49, 77, 82, 87, 9.1,
On12rio Ke1work o( \Vomen in 107. 193. 194, 237.260. 328
En¥incedfl¥ (OKWiE). 363 Shebib. a , 44, 49, 61, 68. 89. 132. 163.
169. 219. 222, 266
p Shulman. L. 48. 49. 59. 66. 74. 89. 90.
149.150.170, 177.178.236, 238
P::1ru.fa, H .. 256
P::1rklluon Canada, 377 ShuJ:. W. E., 4
Stes:eL R . 0., 213. 215. 233
P::1stor. L. H .. 254
Stes:eL D.J.. 374
P::1ne:rSOn. C.H .. 329
Ped.ham. H .. 350, 353 Slh'::11. F.. 283
PederSen. P.a. 312. 321, 322, 330. 332. J40 Slnunie:, S.. 282. 284
Plull1ps, J. R .. 357 Simon-Dack, S.. 68
Pier«. J.. 6 SU,~Manoux. A., 377
Poonwassiie, A .. 318. 334, 335 Slte.k. K.. 352
Smith. D. B.. 320, 335
Presbury, J. H .. 38, 163, 198.228
Socitty for Keuroseien«. 255
Proehash. J. 0 .. 199, 204. 237
Ptak, c .. 374 Soper, a. 291
Publ!C: He3hh ~ncyo( Canada, 273 Spe.i~n. S. L. 330
Sperry. L.. 209. 247
St::anford. 347
Q St::arr. M., JOO
Quinsey. V. L., 259 SmisticsCanada, 197. 273. 303,305, 312.315. 336
412 Author Index

Stein ber~. L. 360
Ste-.·ens. F. L.. 364
u
lJniversit)' o( Cali(orni.:1 INine. 359
Su bstance Abuse and Ment3I Health Se-r\'keS
lJniversit)' o( M::ary land. 196
Adm inistr.nion, 39, 280
lJnivertit)' o( U tah. 2 54
Su bstance Use Pfa.nnina Counc:il
lJnivertit)' o( W:uhil)¥ton. 254
Sud man S.. 136
Sue. n w. 107. 165, 3 18, 319. 322. 324,
325. 326, 3 2 7, 328.332. 333 V
Swanson. J.. 252. 25~ v~m H:weh. v:, 102
Vonk, E.. 227
T Vuj.:1novk, A .• 2 14
T.:1rdiff. K., 249. 252
T.:1rt:lk.o\+Sl)', M.. 284 w
T:uera. K. Wolsh.i. 293
T.:1ylor J., 105 ~ebMD. 373, 378
The Cent re for Addktion and ?l.•1ental He::!llth. 273. JOO. 302 ~e.ill Comell Medteine. 353
The Cle-.·efand Clink, 380 ~ehr. T., 230
The fr3nkJin Institute. 196 ~e.st wood. M . J.
The lntemet St role Center. 3SO Wk.ks. R. J.. 75, 76, 201
Thoreson. R. \V., 5 Wills. F.. 20S
Tou recte C an::.da. 377 ~ ·inter!?, K .
Trouche, S.. 347 Wl:wof(, \ ~
Trude3u.J.. 313
Truth and Rttondli:uion Comm ission o(
y
Caiuda. 3 18 , 33~
Tumer, J. C., 3 17, 328 Youn~. M .. ~S. 85. 86. 89
Autho r I ndex 413

Key: bb = brain bjte c = convetSation; f = 5gute i = inteME!w t = table
A attent ion-deAdt hn~rae.i"ity disorder (ADHD). 28%&. 352

ABC model, 208. 208/ auditor)' :al:mn S)·Stem, 98bb
Abcn·i1i:in:11l, 3 14 autom::uie thoui.:hts, 209
Ado-Jes«nu authoril)' (see power)
ri.skr beh::wiour. 360 "autopsiies", 227
21dre:nalin. 36i/ axo n. 36i
:1bsolute con0dent1:U1ty. 6
:1buse. Bibb B
duldren. 268bb barriierS to nihurallr sensiti\'e p raetiee. 328-329
senior. 145 ba.iehne. 22 1- 222
21eeuhurat ion, 3 15 ba.iie e,npc:.thr. 17 ►176. IS i
:1eetyk.holuK', 3i3 b¢innini.: phase- (o( eounsellinli:), 53-56. 69
:1equired brain injur)', 382- 383 behaviouraJ thai,s.-.:-, 219-225
:1et i1'{t o ut. 63 behavioural domain. IH. 161
ph:ase o( ".Olen«. 262 belie:( in d1,i11ity 21nd worth o( people. 8-9
:1et ion ph;)S(' (o( eounse.lJina), 5~57. 69 bipolar disorder. 280. 284-285
:1et ion p1annir'K, 46. 4 i body l:1.111.:u~-e-, 108-109
:1et ion St:¢e o( e~n~-e. 206 boundaries. 5
:1et ive listenintt, 4 ~, 102- 103, 236 br:ain
ski.Us,. 102F anu : intt, 344bb
:1ddietion ::.doleseent, l4Jbb
rned~tion. 294 eounsellini.:. J.1bb. 361- 362
supportifl¥ reeoverr, 299-301 de3th. 383
ADHll See :mention-de:f".cit h)•penet i\+ity disorder (ADHD) emoc.Onal. 2 JOl,f,
:1dvke s:_i\+i1'&, 60-61 he3hh. 383
21ffttt, 168 hem ispheres, 358
:1fftttivedisorder, 168, 162- 164 iln:¢intt, 35 1- 353
:1fftttivedomain. 132 lobes, 359-362, 360{
21~-e-, 82 m:Ue and lem:Ue. 363c
211$ri'SS.ion, 249 norwtop. 344b
Alcoholies Anon ymou!l (AA). 2 pfast kity, 298-299, 370
Al::hcirner's disease-, 377- 380, 378(. 380e problems. 375-383
Arnbi"alence. 1~168 w:a,,es. 352/
common mixed (~11~ 1671 br:ain stem. 357. 357/
motn'3tional interv~•i~ 200 briel eounsellu).$:. JS, 2 28-232
21mplif",ed re6eet ion, 202- 203 eh::ul{te cont inuum. 23 1- 232
2111\)'~al:1. 359, 364 f'lnd1fl¥ Sl n':fl¥ths in 21d\'erSity, 195, 230- 231
:11n)'Otrophk later:al sde-rosis (:als), 376 lookini.: (or exeept ion!l, 230
2111{ter rn:m~ernent miratle q uestion. 229
pote:ntk.111)' \'iolent behaviour. 255-257 solution t alk, Bl. 23 1/
:11t0rexi.:1 nervosa. 286 Broe,'!12ph21sia. 361
3nt idp:ttOr)' eont raet, 44, 76 Broe,'!1:1rt':21. 36 1
21nt i--anxie-t)' tnedkat ion. 294 bulimia. 287
:1nt i,de-pressan1 medieation, 294, 372 burno ut , 2~2i, 58
:1nt i-oppressh'e p raetiee. 194 eonunon symptom!?, 28/
21nt i,psy-ehotie rned.eat ion. 293-294 preventi1'&, 2i
21nxiety d1sorderS. 28►286
:1nxiety ph.3.u (of \'iolenee), 257- 260 C
21ssaull O,nada
how to handle. 265c culture ai,d diversity, 3 12- 313
:1ssertive community tre::ument (ACT). 301 ment:U hc.Uth, 272
:1ssertive1~ 227. 2~267 O,nadian C~rte-r o( R~hts ai,d Freedom!?, 145
21ssumptiof)$. 16. 99 O,nadian lnunl{tr3tion 21nd Re:(~ee Protect.On Aet. 315
21ttended silence. 112 e::u·eah,ers. 379
:1ttendi1'&, 103-I04 0,thar!lis, 55, 127
414
CBT (see eOK11itive behaviouruJ the-r.)py) cont rol (inter"iew) tr.t.nsit.On. 154-155
eerebellmn. 355. 357 cont rol (,~d (or), 23
eerebrum. 355 ro-oeeurri~ dtsorder, 301- 302
eha~e eont inuum. 231- 232 core beliefs ($Che.ma)
eha0$:e talk, 200-201 help(ul and unhelp(ul, 2091
C harles Borm~ srndro,ne, 361 core condit ions. 43. 69-72
cluldren corpus colLosum, 358
abuse. 268bb counsellini, 3~35
mental health, 289-291 b3rrier!l l'O soceess, 54-60
riKhts. 11 definition. 33
cl,ronk fat iKU.:- syndrome. 217 end1~ ph:ase. 37
eil,Kubte, 364 pitfalls,. 57~4
clients psrchothe-rapy. 55t
im'Oluntlr)', 242e skill ie,,,els,. 34t
person:11I in\'Olvement with. 18e !?kills and str.ue~ies. 4 1-47
physical eont~ with. 5 l'Op ten e-rrorS, 391
p r.tr il,i with. 331k "ktitnso( vioJenee. 267
~yin& no,. 243c counsellini cont raet (see eon tract)
Sexual relat ionship with, H counsellini relationship (see refationship)
tried e"l.~rythinK, 22& counselLor sel(,diselosure (se,e seJ(.Jisclosu~)
v.-·o rkina with "l.:1: y", 203c counselLor
workina with in\'Olunt2rr, 242e competent, 16-19
closed question. 127- 128 m.:m~in& (eelinas, 40
C lubhouse. 29 1- 292 perSOnal re::.etions/problerns. 58-39, 100
COinitive beh::1:vioural eounsellinawftherapy (CBTI, 41, 207- 219. \':Uues beliefs and 21tit"udes t~t help and hinde-r, 2tw
267,353 countertrans(erenee. 8~6
interde-penden« o( (eelma,i thinkll,i and beh:::tviour, 2@/ cranial ne-n-es. 365
1e<:hniques,. 217- 2191 crisis inten-ention. 197- 199. 199t
(()$:Jlith~ domain. 132- 133 critieaJ u,cklent debrieOntt, 263-266
('()$:nith~ triad. 2 JO cultural 2ppropriat ion, 3 14
rolJttti\!i.Stn, 32 1 culturuJ intelli{ti'nee
roma, 382 b3rriers. 32~329
ronunand ~lludn:u.On. 254 deAned. 3 1I
ronununieation stoppers. 62 prollJe o( 2 Canadian rounsellor. 311/
ronununieation style, 325 culturuJ neurosdenee. 313bl,
rompetenee. 18-19 culture-, 166
rompromise. 260 deAnitions. 3 14l
romputeri: 00 a.xJ:d tomOKr.tphy, 332 eat in¥ disorders,. 286
ronereteness. 147- 152 u,dividuaJ differerl«S. 166
s trat('$:.it'!l (or ::.chievinK, 148(, 1~153 kq· eLements o( under!ltandinK, 323/
roneurrent disorderS (!lee eo,.oecurrinK disorders) OOfl\'erb.11 eonununieat ion, 110
ronOdentfality, 6-8 perSOn:U \':Uue,s,. 23
ab-so!ute, 6 ple".uure cent re and. 32 l bb
Ku,deimes. St culture shod, 314. 316
rel.::1:tive. 8 cut-oUs. 18
ron(ront2tion. 47. 244-249
misuse o(, 246-24 7 D
principles. H7- H9 dttision:U b3lanee- sheet, 201
t)'pe:$, 24$-246 de(ence mechanisms. 23, 63-64
ronKruence, 43 de(ensh-e phase (o( violence). 2~262
ronnec1 (interview) transition. 156 deinstitutionali:ation, 272
rontempl:uh-e sta{ti' o( tha~e. 205-206 delusions. 279-280
rontent summ.:uy. 120 dement ia, 370-380
rontin$,_•enC)' pl.:1nnll1'- 226 ii it nornul <K. 379
rontract. 44. 73-80 dendrites,. 337
antidp:uoq•. 76 deni.:d, 63
leads,. 78t dependent refation!lhip, SJ
quest ions for establlshll,'- 131 depression. 2~284, 284N,
rel.::ttionship. 74-76 types of. 353bl,
Session:d, 77- 78 del'OxiOeation. 2~298
work. 77 de-.-elopil,i diserepa.nC)·, 201- 202
Subject I ndex 415

d iabet es. 365 eneour:a~-erS (sirnple), 45, 151
di3KJ10SiS. 273 endi1'{t (ph.:iise o( counselliflW. 57. 59. 88-91, 9 11
OG~oostk and Stat istical M::m~I o( ?l.•1enu1 O!$0rders endocrine S)'St em, 365-366
(OSM). 27~ 275. 287, 278t vs 1lt'"rvous system. 365bb
approprl::ue uSe o(/critk! ue. 275-217 endorphins, 370bb
su bstance use disorde:rS and. 298 e-pi~1et ies. 374
d i.rtttives. 45, 141 inter~-ener21ional tr.)un,a 2nd, 3 75
d iserirnin::uion. 4. 3 16 ethkal dilemmas., 11- 15
d isordered thinld1l{t. 210. 280 matrix dedsion,m akinachart , 15/
d ispbcernent, 63 model (or resolvini, 14/
d issodat.On. 63 ethkal principles hie-r:arehy. 14/
d iversity. 36 ethnicity. 3 14
selected elemenu o(, 3 13/ ethks,. 3-4
doorknob oomrnunieat.On. 90 dellnition o(, 3
dopamine:, 283. 370. 37 l bb, 372/ neuroscience, 13
DSM (see Di.:1~1ostk and StatistieaJ ethnocentrism. 3 14, 332
M:anuaJ o( MentaJ O1sorderS) e-vilu::u ion
d ual db~nosis (see cooeeurrina d1sorder) que-stions,. 134
d ual rel::uionship. 5 e-videnee, based best pr3Ct iee, 348
d uty to warn prineiple-, 7 e-videntt f'mdintt, 2 14
dysth)•tni.:ii. 16S eicttpt iOnl. 230
eicplodn~probi~ skills,. 42t. 45-46
E eicposure ther3P)', 4 1, 22 7.347
e::uina d1sorder. 2~287 eye cont~ , 325
e~-oeentric thin.kin¥, 105
electroencephal0$tr3phy (Hi), 352 F
EMOR, 41, 364 (ear o( eh:ana.:-. 239-240
emotion.::d dttis ion makin~ 2 JO (eedb::.ck con(rontation, 245
e 1notion:11I do1nain. 16 1- IM (eeli1'{t (affeet1\'t,)domain. 132
e 1notion:11I inte11¢ence. 163 (eelin{tS (see- emotions)
emotion:11I metn<>rles. l62bb (eeli1'{t in\'i'ntOr)', l6St
e 1notiotU. 164 0delity. 4
oommon m ixed (Hl1~ 1671 "f'l~ht o r fl i$:ht ·•. 256
empath)', 43, 7 1- 72. 152. 201, 3 79 Ote-s (dient). 52
basie. 175-176. 181 should I fi"::lld, 53c
client re::.c1.0ns t'O, 172 First Nations peoples. 314
oomrnunieation process. 18~ fl.:11 a({eet. 2 79
def'lnition. 169 Freud, 235
e((tttl\'t, use: o(, 1~ 18 71 frontal Jobes. 360
(OC'us on the (eelu~ domain.173/ function:11I 1n~,etk reson ::m.ee ima,ail,K
{ti'ner:ali.:.:iitions. 179-180 (FMRI). 3;2
how helps. I 70t
increuinK voe::tbul.:iiry. 17.k G
in(e:rred. 17~177. 181 GABA.373
in \'itation:11I, IH- 175, 181 GAF Scale. 274
loe::uion o(. I 71bb 1t3ILows humour. I le
poor subst itutes {or. 182- 18 4. 184i ~nuinerlt'"Sl. 72
response: leads. IS i ai(t aivin~. 90
seltttl\'t,, 171Ni &lands,. 366
sympathr. 182- 184 major. 366/
t'0~. 184-186 itfia, 366. 374
types, 17~ 178. 1781 itfu12mate-, 3 70
when not to use. 17& &OQ.I settil1K, 219-227, 225-2271
wh)' achie,•i1'{t is so d,((lcuh. 18 I are)' nu tte:r, 358, 359bb
employment, 316 aroups. 41
ment.:11 health and, 292- 293
e 1npov.--eri1'{t s.k11ls. 42t, 46 H
empov.--ennent, 3 79 hallucination. 279
def'lnition o(. 192 respond ma to. 28J.c
elements o(, 193/ halt (hun~ry a~r)' lonely t ired), 227
empty responses. 184 hann reduction. 3~ 301
416 Su bject In dex

he:::ld trauma. 382 learned helplessness. 19-4
vio-Jence 21nd, 254 le(t brain. 358, 359, 359t,I,
Hebb. 217 limbic system, 362/
help(u1 (riends. 50e limit ~ tin¥, 261- 262
he.mispheres (brain). 358 linkln~ (inter\';ew) tr21nsitiOn!l. 156
hier.arthy o( ,~ds (?l.•faslow). i9 liscenintt, 95-97, 97bb
hippot:ampus. 364 barriers. 97- 101, 9&
homework, 212 overromina barriers,. I0lu
hop,, 369 problems with and re$p0ndin$:, 107c
humanism, 345 p.,....,, 96/
humour, 45, 63 ti. V.E. (listen ident i(r verb:tli: e o?\~lu:tte). 121
¥allows. I Jc lobommy. 35 1
loeked,in srndro,ne, 362- 365, 362/
" I don' t know' ', 22 1 M

!,statement . 83 maauetie reson::1nee imaail,i (MRI). 352
illusion o( work, 149, 237 maasuf'kation. 2 11
" I'm JUSt a betinner" , 20c maintenance st~e o( chan~'C', 206
lnunedi:.ey. 45. 82-83, 8 41 marainali:ation (deAncd), 314
lnuni{tr.lnts. 3 1~3 19 Maslow's hierarch)•O( needs. 79
problems faced br. 3 1~3 19 Medieat.On (see af.so psyehiatde medication). 350
immiKr.l.tion. 3 15 medicine wl~l, 336
indi~enous peopLe 3 14, 333-336 medulla, 359
indirect question, 129 metn<K)', I 27bb
individual differenees (af.st> .w diversity), 330-331 ment:U dtson:lers (illness). 375
individualism, 321- 323. 322(. 323bb counselli~ 291- 295
in(erredempathy, 17~1 77, 181 deGned,276
in(ornution iti,•inK, 46 in C,n:«:t::11, 272- 273
informed consent, 1~1 1 s~so(. 275/
intelleetu:l11:ation, 63 vio!en«. 25.3-254
"inten t " q uestion (suicide), 306 ment:U health
intern:ll ooi.u. 99 CaMdian (::.eu, 2731
interview tra.nsit.On. 153-156 child and youth, 2&'9-291
interview. 35 employment . 292- 293
erosst'uhural. 147 mese:nceph:llon, 357
man::1Kln~ r211nblinK, 142 met~nmun.ie:111.0n. 11 1
notet3kinK duri1'&, 15& metaphors. 164
preporation for, 52 methadone, 294. ~.301
s kills. l~l57i Ml.. (see motiv:nion:U interviewinK)
Structured , 130 mklbr21in, 357
tr21nsitions. 15.3-156 mind and brain. 3Hbb
unstructu red, 130 Mindfolness. 2 1~214. 215hb, 34 7
int ilnid::1tinK beh::1viour, 250 "mind the ~p", 214
in\'it:nion:Uempcath)', 174-175. 18 1 mind readintt, 211
involuntary dients. 242c minimi:ation. 211
Jrani::m n:-,·olu tion. 323 mir.lde qucsc.On. 229
" I've t ried e\'eq1hi~". 22& mirror neuron. 16.Jbb, 373-374
mixed (eelinKS (see arnbiva.!en«)
J m.o.a.n.s. (1nust only ::iW::1ys never should). 212
ja~on, 149 mood disorder (aJ.soue bipol21r diso-n:ler; depression), 280-284
Job Club. 293 mood subi.li.:inK medications.. 294
motiv.nion:d inteNie"•inK(MI). 167. 199-207. 300
K :unplifled reflection. 202- 203
forces in eounsell in¥, 345
k.e)' r21dtC:11I ::.eceptanee, 200
kinesk!l. 108 r!ihtina ret!ex. 200
rolJina with resi.sta.n«. 202
L spirit of. 202
"la: )' " dients. 20.k muhiaxi.:U system (DSM)
fa.11Ku ~..:-. 325-326 muhkultur11I counsellinK ¥uklel1nes. 33l r
l.b.a,t.q., 314 multiple seleTOSi.!l. 359
L-Dopa. 377 muhi1uldntt, 106
Subject I ndex 417

musk. 36bb par3phraJ111¥, -14, 117- 119
myelin she::uh. 359 e((ect ive. I I~
health)' 21nd dam.:1~00. 359/ ernpothy. 119
lafl¥u~e of. 11&
N pariet31lobes,. 361
n21re:m. JOI passhee 21j$resslon, 63
Karcot ies Anonymous. 2 pei--(tttionisrn. 25. 211- 212
n::1rural transition. 153-154 personal d !stance. I 08-109
Kav:lJO, 325 persor,al (eelinKS, 16c
ne~atwe S)' mpmrn, 27~279 persor,al needs. 23-25
nenous !'!)'Stern. 345/ manaah,i, 2-t.
neu~I de...elopment. 147bb persor,al qucstio.,s. 2401
neu~l ::tbrms. 162 persor,ality disorders, 287- 288
neu~l pothways. 353, 369 common eh:allen~s and responses,. 288t
ereat in&new. 215bb p~se (interview) transition. 155
neu~I transmission. 367- 369 p~ses of counsellu).$:. 4 7- 3 7
neurocounsellmi, 345 rel3tionship. ~70
neuroeducation. 349 phobias. 285
neur0$;enesis,. 347 ph)•Sk31contact. 5
neuroim~i1l{t. 3~353 pitfulls (o( counsellinK), 37-6-1
neuron. 366 pbeatif1¥ (aJso ttt rest'uina), 62
P,rtS, 368/ "playina psyeholoai.st ••. 62
"neurons th:u Are to~ther' '. 217. 369 pLeasure p:tthway. 19%b. 32 l bb
neuropfastieity. 135. 350. 370 police intervention. 262
he1p11,i d1enu harness. 356i pons.. 358
neuroS('ience. 3H- 34 5 positi,~ re-a;)r<l, 43
tedmoK>irand. 348 positi,~ rein(orre-r. 179
""')' impor121nt (or counse.lJors. 3~35 1 positi,~ sympmm, 278
neurotransmitters,. 343. 347. 363, 36~ 368, 370-373 post-tr.-unmic stress disorder (ptsd), 4. 28~ 286
ment3I illness, 282N, positron emission tOffi0$:r.llph)' (PET), 352
no.11iulef",cience. 4, 12 povert)', 3 16
norepinephrlne, 370, 371/ P')\','t'r and privelf'$:e. 47. 319
no.werbal conununication. 1~111 pr:iyi1'{t with chents,. 339e
emotions. 165 p~onte.mpla11,~ Sl3~-e o( ehan&e, 204-205
rneaninK of. 107- 108 p~ounsellinK c~n~-e. 228
resistance, 239 prejudke. 314
what to obsen~, 107t preliminary p~se (of counsielhns:},
nonn (defined). 31-1 50-53.6S
note taldnK, 15& premorbid !'unetioninK, 283
prepar:uion sta~ of chan~-e, 206
0 prepar3tOr)' empathy. 177- 178
objecti\'ity. 15-18, 59 pri\'iLei «I communication. 6
m.:1i111ainh1¥, 171 problem sol"iOi. 225-227
obsessh~ compulsive disorder que.stions for. 133-134
(OCD~ 285 process '--oal. 130. 219
oceipit::1l lobes, 360-361 pro(essio.,aJ associations,. 2,
o(f".ee deSlKn, 2~257 pro(essio.,aJ survival. 26
"one-si:e-f'lts,all'' approach. 36 projection. 63
open ended question, 12~129 promot i1'{t eh::ul{ti' skills. 42t. ~ 7
opioid crisis. 196 prosopaoosia, 361
opioids,. 296 proxemies, 109
o utcome K()al. 219 pseudoeounsellin-'t, 59
O\~rklenti(kat ion. 17 ps)-diiatrk d1~l0sis. 273
O\'t'rinvo.Jvernent. 17 ps)-diiatrk n~ieations,. 293-295. 293bb.
OX)'t'Od.n. 6S when clients don't tak.e. 294t
PS)-diOanal)•SiS. 343
p ps)-dioedueat.On. 300. 3~349
P3Ch1¥, 55. 15► 156 ps)'tholoaieal re:)C'tance theory. 238
P21rk1luon ·s disease. 377 pS)'thOstimubnt. 294
p:1nk disorder, 285 PS)-thOther3py. 35
p.1ranoia. 281c counsellinK, 33c
418 Subject Index

ptsd (se,e Posuraumatk scress disorder) ris k takin~. 200
publie dist21l«, 109 "ro.Jlin& with resistance•·. 202
Q s
qucsc.Ons,. 44 s::1yi1'{t "no' '. HSc
alternatives,. 137..- scalin&, 201
dosed, 127- 128 schema (see "..-ore beliefs,.)
essentiaJ. 130-134 schi.:ophrenia. 280, 355
ex..-essive. 13~138 "'Scriptwriter'', 253
au;delu,es, 142,t Sttondar)' K"3in, 203
ind1rttt. 129 sele<"thee2ttention. l~IC6. 211
"intent", 306 sel(,::rwareness,. 2~22. 2k. 1~10 1, 109
six k.e)·, I 35 resist2n..-e, 241, 332- 333
leadin&, 135-136 sei(,de(e:atina thou~1ts, 212
miracle, 229 sel(-determin::rtion (client). 9, 11, IJ, 193-194
multiple, BS- 139 elements o(, 10/
open. 12~129 str.ueaies (or prornotifl¥. IOt
pit(aJls. 13 ► 1-10 sei(,d,sclosure (oounse.lJor) 45. 87..-
poorl)•.-timed. 139 ttuklelines,. 881
respond in& to personal. 2~ seU-help proarams. JOI
t )'})eS o(, I JOr sel(,e((leac)·, 203
when d1enu do not anSVi·er, sel(-c2lk. 132
140-141 seniorS.81~2
"whr' '. 140 eounsellifl¥. 332
e:in?™•ennent, 197- 198. 19&
R lnter\';ewin'- 14~147
ra..-e. 314 soc..-ess tips (or i.nter\'iev.>ini, I 46r
radsm, 3 14 sententt completion statements,. 45
radieal 2..-«ptance. 202 seromnin. 37 1- 372, 373/
ramblm~ lnter\'iev.•. 142- 143 sessionaJ cont ract, 44
ration::di.:21ion. 63 settiO¥. 51
rt::11."t ion formation. 63 settifl¥ !unit~ 261- 162
receptor~ 369-37 I sexual oont2ct. 5
exdtamry. 370 silence.35. 43. 111- 117.112bb
inhibitor)', 371 deali1'{t with. 116..-
t)'pe$, 369 encouraaina. I 16
n..framin&, 21-1-116. 21& no,wer~I cues,. 116-11 7, I 17r
re(u~314 respondina to,. I I 7r
reareuion. 63 simple encoul"'3~en,. 45, 151
relat ionship, 68-69 Si$:J).S o( cha.n~-e. 56
buildh,a skills. 4 lt, 4~55 six key qucscions. I 35
..-ontr.1.1."th1a. -14 sleep, 355. 383
l."ulture and. 326-327 S.M.A.R.T. ~ s (sped(k measurable 2e.hie\'3ble
essentiaJ elements. 69/ re:alistk timelr), 220
resi.stantt. 2 3~2 39 sodaJ dista.n..-e, 109
relat h~ ..-onf".dent iality, 8 sodaJ jus tice. 2- J. 345
relaxat ion tl"'3inifl$:. 227 sodaJ relationships (need for)
relia.On se,e spiritua11ty $0("iopo.Jitica1 realit;es,. J 18
repression. 63 solution ta1k, 231
rescuin&, 61~2 S<.>lna (cell bo<M, 367
s upportin~ 6k spot ial distance. 109
reSident ial sehooli. 318. 326. 334, 375 spinaJ thord inJUr)', 382
reSista.n..-e. 235-244. 241!,I,, 242/ spiritu:3lit)', 336-339
deaJm~ with, 243-244 splitti~ 64
in\'Oluntlr)'dienu, 240-241 S.S.T. (see sinafe sess.ion ther.1~ 1)
sians of. 236-237 st~esol cha.n~-e model. IW, 203-207. 207t, 237- 238
s tate o( eh21~ model. 237- 23S Stereot)'P<', 329
reupuike. 367- 369 strat~.ie (inte Niew) transition. 154
fiaht b rain. 358-359, 3591,1, strenath in ad\'e-rSity. 195
fiaht ear ::.dv:lnt~e. JOCU, strenaths approoeh. 40bb. 46. 19+196. 347
"d~htifl¥ reil:~•·, 200 strateaies. 19+196
Subject I ndex 419

St re$$ 2nd erisi.s. l96bb. 3>4 tr.uu(erenee, 84-86. B5bb
stiama, J48 transition, 153-156
stroke. 389-382. 3S1/ transbtorS (worldn& with). 331
intt-r\!ie-vi•il)¥ skills,. 382 transtheoretieaJ model (se,e sta~s o( th:11,i e model)
fast sla:i,s,. 381 trauma, 39hb
sublinution. M trauma in(o-rn,ed pr.l.Ctiee, 3~39, 42
substanees,. 294-296 traumatic brain inJur)' (t.b.i.), 382- 383
eomrnonJy 3bused. 2971 trust, 99, I I~
substanee use d1sorderS. 252, 295-302 tunil)¥ in sloll (see prepor.U:Or)' empathy)
violenee, 252- 253
suidde. 302- 307 u
C,n:ldian l2ets. 303t uncondition:al positive rett3rd, 7~71
m)1hs. 305t unhelp(ul think.if)¥ p:ttterns, 21~212
risk hiet·orS. 303/ U ni1ed Nations Declaration o( the Ri,.ilu o ( the
risk assessment. 305 Child. II
thrt2tl. 304
warnin& s!,il,s,. 302- 305 V
sununari.:inK, 44. I 19-122 vaJues.~11
sundownifl$:. 378N, person:al pdoritie~ behe(~ and 2ttit"udes th:at he.Ip and
supportinK, 46 hinde-r e(leetiveness. 26t
SUppre$$M'>n. fH th:at help 2nd hinde-r e(leetiveness. 2tw
sustain talk. 2~201 ,~12tive state. 382
srmp:uhy. 182- 184 ,'n'Sahlit)', ~3S
srnapse, 367. 368/ "ie:adous trauma. 27. 58
S)'Stemk th:11,i e. 3~8 "iolence, 249-268
ncurosden« 2nd, J48 follow up.141i
S)'Stematk desensiti:ation, 285 he:.d trauma, 25~
S)'Stemk (::.etors. 255-256 key questions for risk asses sment. 2 54-2 55
mental illnes~ 253-254
T phases. 257- 263, 258t
Taboos. 150 prevention and ma.i,aah,K 2,~r.
tailorina the inten•;ew 10 the el1ent 255-256. 25&
Tar2so(( v~ Re~nt'S o( the U niversity of risk assessment, 251- 255
C-li(orni2. fr7 risk (::.c1orS. H9
te:2ehinK, ~6 threats. 259
tempor.l! lobe~ 361 voice. I 08-109
tension redueers. 61
tension reduecM'>n ph:ase (o( violence), 262- 263 w
termination (see endina phase o( oounselJina) warmth. 70
theme summ.:aq•. 120 Wernieke·s 2ph2sfa, 380
thinkin&, 212- 217 Wernieke'urea. 361
heJpll,i clients inerease he.lp(uJ. 212- 217 White nutter, 358, 35,Sbb
p:ttterns. 208-212 who am I!. 22- 24
thou~t bro::.deastin&, 2&) "why'· questio!U,. l~0
thou~t insertM'>n. 2&) Wlthd.r2wal. 298
thou$:ht Sl'OppinK, 2 IJ work contract, 7~79
sequence. 213/ worldview. 3 I~. 319-320
thou~t substitution. 213 sample questions for explorinK, 3201
time oriien12tion. 327 worrr, 211
timh1K, 59, 62. 248
eonfront2tion. HS X
tolerance. 19S xenophobi2 (deOned). 314
top ten eounsellil)¥ e-rrOrl. 59t
toochiO¥ clients. 5 y
to ~ empathy. 184-186 )'OU th (af.st> .w children). 81
Tourette S)•ndrome. 377 tips for 1l1ten•iewins:., 143-IH
traditional hea.lil,K praetkes, 331. 336, 33~ suceess tip~ 144c
transient isehe.mie 2ttaek (t.i.a.). 3&'9
420 Subject Index

Bob Shebib: Interviewing and Counselling Skills For Canadians

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ISBN 13: 9?S..0..ll-484248,6

She-bib , Bob, author

1. Coun$C'linJ"'Textboob. 2. lntt'rYic-•·inJ"'T t'xtbook,.

8F636.6 .S48 2019 158.3 C201S..90364S.I

Chapter 2 The Skills, Process, and Pitfalls of Counselling 33

Dual Rebtionship!l 5 The Phases of Counselling 47

Ethical Dilemmas 11 Client ¼riab1es 58

Selective Attention 104 \\'he:!, Clients Do Kot AnS\\~r

lnvita11on::'1 Empoth)' IH Helping Cllt11S Make Bellavlolnl Changes 219

Crisi s Intervention and Confrontation: Proceed with Caution 244

■ A new Chapter 11 exploring neuroscience and counselling

THEORY AND PHILOSOPHY

Respect for Diversity and Culture

Values and Ethics

The Counselling Relationship

Neuroscience and Counselling

Social Justice and Advocacy

STRUCTURE OF THE BOOK

■ Lcarnini Objectives: key concepts that will be addressed in the chapter

SUGGESTIONS FOR STUDEN TS

■ Watching instructor demonstrations

Practice Interviewing: When You Are the Client

■ Ambivalence about sharing fceJings or details about pe.rsonaJ issues

Practice Interviewing: When You Are the Counsellor

Practice Interviewing: When You Are the Observer

Developing an Effective Learning Group

Keeping a Personal Journal

Using This Book

■ Identify the Canadian professionals thnt provide counsellina services.

■ List and describe- the core va.Jues of counsdlina.

PROFESSIONAL COUNSELLORS IN CANADA

As members, they are subject to codes of ethics governing acceptable professionaJ

Social Work and Social Justice

Purjult of Soci::ll Justice

Protesslonal Identity: Ethics, Values , and Self-Awareness 3

Protesslonal Identity: Ethics, Values, and Self-Awareness 5

Protesslortal Identity: Ethics, Values, and Self-Awareness 7

T he inte.rview it.self should be conducted in priwte, 00( whereothe.r sroff o r clients

VALUES FOR PROFESSIONAL PRACTICE

Belief in the Dignity and Worth of People

■ involving clients in decision making, g<>3l setting, and problem solving

Protesslortal lden111y: Ethics, Values, and Self-Awareness 9

Figure 1.1 Essential Elements of Self.Determination

advice or solutions. The principle of sdf~focermination oblig3tes counsellors co avoid

TABLE 1.3 Strategy Choices for Promoting Cl ient Self-Determination

)}t) BRAIN BYTE

Protesslortal lden111y: Ethics, Values, and Self-Awareness 11

Types of Ethical Dilemmas

Resolving Ethical Dilemmas

))t) BRAIN BYTE [ lI , ,, I 1 .• · JI, , · · I ,_

Protesslonal Identity: Ethics, Values, and Self-Awareness 13

Figure 12 Model for Resolving Ethical Dilemmas

provide important reference points. For example, m3tte.rs of discrimination in Canada

■ What 3re the 3dvant3ges and dis3dvant3ges of not taking action?

Figure 1..3 Ethical Princip les Hierarchy

Figure 1.4 Matrix Oecision•Making Chart for Ethical Dilemmas

Protesslonal Identity: Ethic s, Values, and Self-Awareness 15

situations •ke those? individually as ptaCbtioners. The value of supervision in suctl

Tab le 1.4 summ ari!es p rotective strategies counseJlo rs ca n u se co avoid loss of

TABLE 1.4 Mai ntaining Objectivity