Stages of the

Counseling Process
Assessment Stage

 Written, diagnostic assessment

instruments & clinical observation
 A “working diagnosis” is hypothesized
 Use: Attending skills; listening skills;
focusing skills; and observation skills
 Structure is implemented
Understanding Stage

 Empathic listening; Interpretations;

Confrontations to promote a degree of
client insight and understanding.
 Depending on one’s theoretical
orientation, issues of the past, current
family functioning, dysfunctional thinking,
behavioral inconsistencies, or self-
destructive thoughts may be addressed
Exploration Stage

 Questions; Probes; Reflection of

Feelings; Reflection of Content
 Building the “Therapeutic Relationship”
 Clients share their “stories”
 Collect background information in a
Biopsychosocial manner
Action Stage

 Goal-Setting
 Role-Playing
 Paradoxical interventions
 Homework
 Other Techniques
Evaluation Stage

 Assessing the degree to which efforts

have achieved the desired goals.
 Recycle through other stages as
needed.
 Therapeutic Alliance

 Horvath (1989, 1991, 1994) has written

extensively on the therapeutic alliance
after years of clinical research. He
identifies four main components of this
phenomenon.
These are:
 1. Emotional Bond
2. Mutuality of Goals
3. Completion of Therapeutic Tasks
4. Empathy
 Therapeutic Alliance

 Emotional Bond:
 Carl Rogers (1961) identified the three “core
conditions” necessary for change in the therapeutic
arena and these remain unchallenged to
date. There are: (1) positive regard (warmth &
caring), (2) emapthy, and (3)
genuiness/authenticity.

 These ingredients are the foundation to all good

therapy and necessary for the development of an
emotional bond.
 Therapeutic Alliance

 Mutuality of Goals
 The mutuality of goals simply means that
you and your client are working towards
the same ends.

 This seems simple enough, right?

 Therapeutic Alliance

 Mutuality of Goals
 Clients, especially those clients who have been
traumatized from an early age, will say and do
almost anything in therapy to assure that you
like them and that you are not going to ridicule,
abandon or punish them. Clients often have
competing or secondary agendas in
therapy. Clients become overwhelmed with
fear as they realize that they are going to
become exposed to the traumatic material and
begin to back-peddle away from their original
goals.
 Therapeutic Alliance

 Mutuality of Goals
 All these issues require the clinician to
remain vigilant in the on-going
development, articulation, and re-
establishment of therapeutic goals.

 While the co-construction of a

treatment plan with explicit outcome
goals and criterion with clients is
absolutely necessary, it is not sufficient
in and of itself.
 Therapeutic Alliance

 Mutuality of Goals
The clinician must continually work with the client,
helping them to continually articulate their
goals. One strategy that has proven helpful in this
area, is to ask the client at the beginning of each
session,
“What would you like to leave here with today?”

 This assures that you have the opportunity to re-

define your goals and to assure that you and your
client are working towards the same ends.
 Therapeutic Alliance

 Mutuality of Goals
 Related to this, it is important you are able to
articulate your goals for your clients with them. A
helpful way of discussing this with a client is to use
the language, “My greatest hope for you is that you
___________________.”

 This also communicates to the client that you are

active in therapeutic process. However, there is a
caveat to this discussed in the next section.
 Therapeutic Alliance

 Completion of Therapeutic Tasks

 Good therapy relies upon the client assimilating
and practicing changes and new skills between
sessions.

 There is some minor debate among Counselor

Educators about whether or not it is considered
ethical to assign “homework” to clients. Some
suggest it is best to “contract” with clients for
between-session work.
 Therapeutic Alliance

 Completion of Therapeutic Tasks

 Either way, it is important you, as the clinician

follow-up on these tasks. Whether the client
agreed to “think about” some specific issues
and discuss them next time, keep a log or some
other activity, it is imperative the clinician be
prepared to discuss their progress on each
task during the following session.
 Therapeutic Alliance
 Completion of Therapeutic Tasks
 If the client did not complete or attempt the activity,
especially after contracting with you for it
completion, this needs be addressed because it
reflects an important development in the treatment.

 What is the reason, the real reason, the client did not
complete the activity. This can be gently confronted
with something like: “What is it like for you to have
contracted to complete __ X____ (task), and to now
arrive with it uncompleted?…Is this like any other
areas of your life?…Is this feeling familiar?…What
would you like to do about it?”
 Therapeutic Alliance

 Completion of Therapeutic Tasks

 Ultimately, you are addressing goals,

right? Whether or not you and your client are
working toward the same things.

 There is a good argument for continuing to contract

with the client until the task is successfully
completed; breaking the task down into smaller
chunks of activities, if necessary.”
 Therapeutic Alliance

 Completion of Therapeutic Tasks

 It is often at this juncture where the client

must make a decision of whether or not to
commit to their healing or abandon their
hopes. This is a difficult spot for both the
client and the clinician. Careful attention to
all fears and anxieties (ie., resistance)
which the client may have toward
furthering their goal of healing will benefit
both the client and the clinician
 Therapeutic Alliance

 Completion of Therapeutic Tasks

 DO NOT ignore, gloss over, or participate in

excuse-making with the client for not
completing or accomplishing therapeutic tasks.

 This is not to suggest the clinician should

become coercive or punitive; however, you
should be prepared to gently explore the
meaning behind their non-completion of
assigned tasks.
 Therapeutic Alliance

 The 49% Principle:

 I always share with my clients that I am

happy to help them in any way that I can
with their healing, up to 49% of the work.

 I will not cross the 49% line…But, I will

stand at that line with my hands
outstretched ready to help them across.
Questions?