Counseling Midterm

Front 1

Type of counseling-informing parents or clients. Use only language they can understand.

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Educational

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Type of counseling-help families cope with permanent communication disorders. Don't say "everything will be ok" or "I understand"

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Rehabilitation

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SLPs can..

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conference, train, educate, consult

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LSW

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bachelor's level licensed social worker; case manager, doesn't do therapy

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LMSW

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Licensed masters social worker; Can do a little routine counseling in addition to all the LSW can do

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LCSW

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licensed clinical social worker (masters +2 years); only level that can do therapy; similar to a clinical psychologist

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LMFT

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Licensed marriage and family therapist

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LPC

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licensed practical counselor

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congruent

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being genuine; body language, facial expressions, and tone of voice

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empathy

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clinician attempts to understand the client from their point of view; we want to be empathetic not sympathetic

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unconditional positive regard

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acceptance and respect for the client; separate the deed from the doer

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therapeutic distance

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distinguishing between client's problems and our own

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therapeutic alliance

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helping relationship and the factors involved

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good clinicians are...

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o Encouraging
o Emotionally stable
o Self – aware (self – esteem)
o Patient
o Tolerance for ambiguity
o Spiritual
• Curiosity
• Ability to listen
• Emotional insightfulness
• Set aside personal needs
• Ability to laugh

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Reasons we counsel

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1. Gather info
2. Prevent disorders from developing or becoming more severe
3. Help clients adjust to their disorders
4. Provide an environment that is optimal for change and improvement

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Boundaries/levels

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o Level 1: “I can work with you” (within boundaries)
o Level 2: “ I can continue working with you but…” (challenges to boundaries)
o Level 3: “ I can’t continue working with you” (outside of boundaries)

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discipline that is concerned with human conduct and moral decisions

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ethics

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outside sphere of law; not classified as legal or illegal

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alegal

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2 provisions about confidentiality/patient records:

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o Individuals shall maintain adequate records of professional services
o Individuals shall not reveal any information about the person served
• The professional is the legal guardian of all documents

Front 20

the therapist lets the client work their way through it, therapist just restates the problem
o Therapist NOT: offering ideas or solutions, probing, -- NONDIRECTIVE (not trying to influence) ** positive relationship*
o Attempts to promote the person’s natural positive striving and growth
o Allowing the person to vent; simply attending (making eye contact or nodding)
o "tell me a little more about this"; allows the person get it out
o Providing environment where person’s feelingsand experiences are respected and validated
o All they want is for you to listen and indicate you heard them

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Humanistic therapy/person centered therapy

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Conditions necessary for therapeutic change

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Genuineness-clincian is open and positive and warm
Empathy-being with the person but not going overboard
Unconditional positive regard-nonjudgemental; emphasis on positive relationship and not therapy techniques

Front 22

Therapy technique that says problems come from bad communication techniques and other things you learned in childhood
Emphasis is on styles of communication and self-defeating communication patterns
“I want to write a schedule for you but I think its best if you come up with it yourself”

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Interpersonal therapy

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Recurrent patterns of relating to others; a learned style of communication and interaction. Examples are friendly-dependent, hostile-suspicious, and controlling-devaluating

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Interpersonal style

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In interpersonal psychology, this is a dialogue which focuses on the immediate interpersonal process occuring b/t the clincian and the client. For example the client may talk about topics unrelated to therapy.

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Metacommunication

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Therapy that places importance on the environment in creating, modifying, and maintaining behaviors.

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Behavioral therapy

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ppl learn to behave in ways that are reinforced

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operant conditioning

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much of human behavior is caused by observational learning (modeling)

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Social learning theory

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learning process in which a neutral stimulus is repeatedly combined with another stimulus which elicits a physiologic reaction. (if a certain nurse always gives the person a shot they will be anxious when the nurse appears)

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classical conditioning

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behavioral approach for treating learned anxiety and phobias where the person learns to gradually approach a frightening situation while practicing a relaxation response

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systematic desensitization

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Clients behaviors that gradually approach the desired behavior

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successive approximations (you should reinforce these so they continue to make progress)

Front 31

therapy technique that says that the way people think about events determines how they feel about themselves
Previous experiences affect how they think and feel about things
Challenge their way of thinking -- try to show them that what they are thinking is not the case, to think about it in a different way

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Cognitive therapy

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Frequently believing the worse will happen

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catastrophizing

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reflect perfectionistic tendencies and intolerance of personal flaws

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"I should" statements

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Views events as all good or all bad

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dichotomous thinking

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believes that if something is true in one case, it is true in all cases

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overgeneralizations

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"you cant do just one thing"
Focus on family relationships/systems rather than individuals
Each person in the system affects all other members
Separate elements cannot be understood apart from the system
May bet better understood by examining in family context

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Family systems theory

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families in which boundaries aren't clearly marked and they are overly involved

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enmeshed

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family members are isolated; rigid boundaries

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Disengagement

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process in which two family members recruit a third family member to an unhealthy alliance

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triangulation

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o Each person’s unique experience of being in the world, how people perceive themselves and their surroundings and how they create meaning in their lives

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existentialism

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as much as we attempt to control events in our lives, we discover that many events are outside our control

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existential uncertainty

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anxieties about the meanings we have created for ourselves that may be obliterated by a sing event

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existential meaningless

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: isolation or our ultimate alones in the world

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existential isolation

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existential nonbeing

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death

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multicultural theory danger?

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stereotyping

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learning, incorporating, and adopting some of the values, customs, and beliefs of the dominant culture in order to fit in and get along with the society in which a person is living

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acculturation

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people who retain their original cultural identity but simultaneously become acculturated to another way of life

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bicultural adjustment

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pertains to an individual’s assumptions and perceptions about the world from a moral, social, ethical, and philosophical perspective – source of person’s values, beliefs, and assumptions.

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world view

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: few universal standards for evaluating right or wrong, healthy or unhealthy human behavior. What people believe and how they behave is significantly influenced by the culture in which they were raised

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cultural relativism

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(integration of theories) collection of techniques chosen from a variety of different approaches.

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technical eclectism

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(integration of theories) development of a conceptual or theoretical framework that synthesizes the best of two or more approaches with the assumption that they synthesis will be richer than the individual theories alone.

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Theoretical integration

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(integration of theories) attempts to distill from different theoretical systems, nonspecific elements that are common among the theories

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Common factors

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The CLIENT’S feelings, expectations, perceptions, and attitudes that shape the client’s view of the therapist

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Transference

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The CLINICIAN’S feelings, expectations, perceptions, and attitudes

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Countertransference

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being alert

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arousal

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choosing what to attend to

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selective attention

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staying focused

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sustained attention

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obstacles to attending to clients

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clinician's stress and anxiety
negative judgements of the client
rehearsals of what the clinician is planning to say

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Nonverbal communication

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• Physical appearance
• Body language
• Proxemics (Personal Space)
• Seating Arrangements – sit beside not across from
• Eye Contact
• Touch – be respectful, warn before touching

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2 types of consistency of communication:

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in the moment and over time

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counseling children

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children respond better to directive, structured style of interviewing with simple questions; use simple, clear, concrete and direct language

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counseling adults

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Most adults do not like their negative feelings exaggerated or amplified by someone else
o Older Adults: most comfortable relating information in stories
• Clinicians need to listen to the form of communication the client prefers in order to get useful information
• Interviews often begin with informal conversation about casual or familiar topics

Front 63

when individuals modify their speech style to a stereotypical pattern as a result of their perception of the person
o Baby talk – caring and controlling
o Overly personal talk – high in caring, low in controlling
o Directive talk – primarily controlling, little to no caring
o Superficial talk – neither caring nor controlling; uncaring/ disrespectful

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Overaccommodation

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use descriptions of behaviors that reflects our observations rather than global pathologizing terms
o Action Language- describe situation specific behaviors
o Note behaviors, characteristics or symptoms that are understandable reactions to a particular situation or whether they appear excessive and may be causing impairments in the client’s functioning.

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Pathologizing

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may need to use when the client or family member demonstrates noncompliance or resistance – give them a chance to solve problem with some mutual satisfaction (firm flexibility)

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Negotiating

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Specific communication skills that help clinicians interact more intentionally with clients – thoughtfully but quickly choose responses from a wide range of possibilities

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Microskills

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prompts the therapist uses to try to elicit more information from the clients (“uh huh”, “yes”)
• Adjust to gender

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Verbal encouragers

Front 68

smiling eye contact, learning forward, open body posture, nodding head
• May be used alone or with verbal encouragers

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Nonverbal encouragers

Front 69

(‘interesting’) if in doubt about what to say next, silence might sound more respectful that an overused phrase.

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Therapists' noises

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o _________ – asking too many questions may make clients feel controlled, manipulated or criticized
o __________ – clients may become confused and not know which one to answer or how
o __________ – tend to encourage specific responses which may differ from what the client truly feels

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Bombardment
Multiple questions
Leading questions

Front 71

help focus on what they can begin to do that will make the difference happen; also implies change will happen

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Miracle question

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using questions to guide the conversation from general to specific; starts broad slowly moves to more specific questions are asked to focus the discussion

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funneling questions

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making sure you understood the client correctly; occasionally summarizing the conversation to clarify or confirm what has been said

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Request for clarification

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discover the factors that exacerbate or alleviate the client’s symptoms – better, worse, more/less, hardest, easiest --- discover patterns of symptoms and behaviors an appropriate therapy strategy

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Comparison questions

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allows client to reveal his position or decision so that the clinician does not have to agree or disagree with him

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counterquestions

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assure clients that you have accurately heard the central meaning of their messages; allow clients to hear how someone else perceives them; accurately and briefly reflect or rephrase the essence of has the client has said

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paraphrasing

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rephrase, reword, and reflect what the client just said

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generic paraphrasing

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be aware of the client’s preferred sensory system to perceive the world

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sensory-based paraphrasing

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feelings that have an implied comparison to something else

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metaphorical paraphrasing

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reflecting back the last few words the client has said in order to encourage to say more

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reflection (echoing)

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repeating back to the client a part of something said that was emphasized or seemed to be emotionally charged – may be from the middle

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selective reflection

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paraphrased response of a feeling communicated by the client either verbally or nonverbally

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refection of feeling

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encourage client to have time reflect about what has just been discussed; may encourage person to voluntarily say more w/o need for a question or request for more information

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silence

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putting situation into new more positive perspective to change their attitudes or feelings

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reframing/relabeling

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attempt to help people recognize and accept that however they are feeling about whatever has happened is normal

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normalizing

Front 86

understand personon’s thoughts, feelings, experiences and relay interpretation back to them. – observationsvoiced by clinician which make a connection between things expressed by client (insight)

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interpretations

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helping people see new ways of looking at old problems; open person to possibilities may not have considered

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suggestion

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noting discprepancies, incongruities or mixed or conflicting messages and presenting them back to the person; spur change b/c behaviors are presented back for them to reasses

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confronting