FAD Test 2

Which question is most likely to bring out underlying client meaning issues?

"Could you share what sense you make of it?"

Basic Listening Sequence (BLS)

1. establish relationship 2. open question 3. closed question 4. paraphrases used to check content 5. Reflection of feeling 6. Summarize 7. Encouragers used throughout

CBT

A base of cognitive response as key to change Time limited with specific goals If someone had anxiety wanted to come in for 6-8 sessions this is a good fit A sound relationship is needed but not central Based on aspects of stoic philosophy it is not things but what ones thinks of things that counts Structured and directive Based on an educational model (psychoeducation) Relies on induction Encourages clients to look at their thoughts and draw their own conclusions Homework is essential here Thought record

A ___________________ is an individualized application of your theoretical model that takes into consideration the antecedents of the case and your observations and inferences. A. Case conceptualization B. Treatment plan C. Theoretical formulation D. Identification of goals

A. Case conceptualization

The client may distort his or her story and blame others unfairly in which level of the Client Change Scale (CCS)? A.Level 1 B.Level 2 C.Level 3 D. Level 4

A. Level 1

"It sounds like you are really struggling to accept that part of yourself." By using this response, the interviewer is focusing on _________. A. The client B. The problem C. Significant others D. Mutuality

A. The client

When interviewer self-disclosure is done well, which of the following is an expected result? A. The client may reveal more personal detail, create trust and establish a more equal relationship. B. The client will focus on a new problem C. The client will resolve an old issue D. The client will recognize the interviewer's power

A. The client may reveal more personal detail, create trust and establish a more equal relationship.

Which key words are MOST closely associated with probing for meaning? A. Values, purpose, vision B. Emotion, affect, feelings C. Do, doing, acting D. Strengths, resilience, positive attributes

A. Values, purpose, vision

cognative behavioral therapy (CBT)

Aaron Beck Philosophy : Thoughts influence our feelings and actions Purpose is to explore thought patterns and identify if they are problematic thought patterns Behavior is maintained by its consequences Consequences that accelerate behavior are reinforces, those that decelerate behavior are punishers Help clients see that their beliefs are ineffective or irrational Effecting them in some negative way Goals is to help the client think differently CBT is self-healing Aims to increase clients competency and provide the client with coping skills they can use when facing new concerns and challenges CBT is an evidence based practice, it is currently the most used and researched method of professional helping

Level 3 of Client Change Scale (CCS)

Acceptance and recognition Substance use: they say okay im here in this program. I recognize I have issues in my life because its brought me to this point in life. Accepting it but not changing it yet. Textbook: I do see I am hurt from the divorce, I see that I am angry. Not ready to change it yet.

Dr. Scott's client is discussing a situation that relates closely to something Dr. Scott has experienced in the past. Dr. Scott begins to feel an entanglement with the client's issues. Dr. Scott is experiencing ____________. A. Transference B. Countertransference C. Distant self-disclosure D. Inappropriate self-disclosure

B. Countertransference

The basic listening sequence consists of_________? A. Attending behavior, listening skills, and self-disclosure B. Questions, encouragers, paraphrases, reflection of feeling, and summarization C. Verbal underlining, attending behavior, and influencing skills D. Open questions, closed questions, attending behavior, check out

B. Questions, encouragers, paraphrases, reflection of feeling, and summarization

Corrective Feedback

Balance between negative feedback and positive suggestions for the future Focus on behaviors that may be hurting the client or hindering growth Stick to the feedback guidelines

Individual Perspective

Being with the individual client Personal pronouns and client name place focus on the client ex. How are things Vanessa?

Negative stress

Brings clients to counseling Feeling sad angry and scared is associated with negative stress Usually what prompts people into coming into therapy Can have health issues Examples o Unemployment o Illness o Financial issues o Mental health issues

Empathic confrontation is best described as _________. A. Direct eye contact and a clear voice B. Identifying mixed messages C. A gentle, but firm, challenge D. All of the above

C. A gentle, but firm, challenge

The therapist states, "We will work on this together." What is the focus of this statement? A. The Client B. The main problem C. Mutuality D. The Interviewer

C. Mutuality

Choose the BEST method for formulating and responding to the client with an interpretation / reframe. A. Match the client's behavior with the most appropriate microskill. B. Draw conclusions from the client's nonverbal expression of feeling. C. Provide a fresh look at the issue and link ideas or information. D. Consider the ethnic and cultural background of the client.

C. Provide a fresh look at the issue and link ideas or information.

"My personal opinion is that while this relationship served you in the past, it is no longer serving you, and is getting in the way of the goals that you've outlined." When a therapist uses this response, he/she is focusing on __________. A. The client B. Significant others C. The Interviewer D. The problem

C. The Interviewer

During the ________ stage of the interview, Carlos and Lida discuss what they would like to see happen in their relationship as a result of couples therapy. A. Empathic relationship B. Story & Strengths C. Goals D. Restory E. Action

C. goals

Positive feedback

Can help in the re-story phase. Help clients discover their strengths, positive assets, and resources.

Assertiveness training

Can help with social interaction Teach clients more appropriate and useful modes of social interaction

Person-Centered Counseling

Carl Rogers Philosophy Client is competent and ultimately self-actualizing Self-actualized person is able to constantly develop and achieve full personal potential A very optimistic review - every person you meet can achieve their full potential Task is to listen and help clients discover that inner, more real self Therapist uses listening skills and reflection of meaning, with focus on clients internal strength and resilience. Focuses on the person, not the problem Focuses on meaning and feeling with less interest in the actual facts A lot of the times clients will come in telling you a lot of content, telling you a lot of facts. This model is more focused on the meaning Questions are intrusive and avoided Most appropriate for abstract, self-directed formal operational clients

Focusing to examine ones own beliefs

Check in with yourself and know if you are just curious when asking questions or what will be most useful in clients goals

Feedback guidelines

Client receiving feedback should be in change Feedback should focus on strengths and or something that the client can do something about. What can be productive.. bringing up something that the client cant do anything about is pointless Feedback should be concrete and specific Feedback should be nonjudgmental and interactive Feedback should be lean and precise Check out how your feedback was received

What is the predicted result of BLS?

Clients will discuss their stories, issues or concerns, including key facts, thoughts, feelings, and behaviors.

cultural environmental context focus

Community genogram

Dangers of self-disclosure

Countertransference, Distant self-disclosure, and innopropriate or too extensive self-disclosure

Dr. Scott has been working with a couple to focus more on the positive aspects of their relationship. During the _____ stage of the interview, Susie reports that her husband, Frank, has started to acknowledge all of the positive things that she does for the family: working two part-time jobs, picking up the kids from school, running errands, etc. A. Story & Strengths B. Goals C. Restory D. Action

D. Action

Which of the following is TRUE about thoughts, feelings, behaviors, and meanings? A. These dimensions operate independently, and the counselor must clarify each one. B. Thoughts and meanings are the most important dimensions. C. Behaviors and feelings are the most important dimensions. D. Any change in one dimension affects other dimensions.

D. Any change in one dimension affects other dimensions.

During the _____ stage of the interview, Dr. Scott helps her client confront some of the client's incongruities. A. Empathic relationship B. Story & Strengths C. Goals D. Restory E. Action

D. Restory

What philosophy is based on Benjamin Franklin's three stage decisional model?

Decisional Counseling

What are the three stages of the decisional model?

Defining the problem Generate Alternatives Decide on an action - what's the course of action going to be?

Level 1 of Client Change Scale (CCS)

Denial Client is not considering that they need to make changes In substance use treatment it might look like "hey, I don't have a problem" they might not agree that substance use is an issue. Example from textbook: client says I am not angry about the divorce.

Level 5 of Client Change Scale (CCS)

Development of new behavior and constructs Substance use: behavior changing, not just acknowledging they are doing this in their day to day life. Ex from text: you help me see that mixed feelings and thoughts are a part of everyday relationships. If I accepted my hurt and anger differently maybe I wouldn't be facing a divorce. Incorporating them day to day.

Key methods of logotherapy

Discerning what client cares for, what we are about, and their lifes meaning and purpose Questioning and reflecting meaning. As the therapist you are doing quite a bit of reflection of meaning Sometimes clients can hyper reflect on issues Do reflection is a strategy to help clients reframe and think in new and more positive ways about their issues and their life plan. Live out their meaning, act upon their meaning.

What is the 5-stage interview structure?

Empathic Relationship—Story and Strengths—Goals—Restory—Action.

Reflection of Meaning

Encourage clients to explore their own meanings and values in more depth from their own perspective. Focuses beyond what the client says. The words "meaning, values, vision and goals" appear in the discussion. A reflection of meaning looks like a paraphrase but focuses beyond what the client says

Multicultural Counseling and Therapy MCT key methods

Explore how culture, environmental and social context affect the client Don't ignore the factors, people are coming into therapy as a result of what's been going on in their life Awareness knowledge and skills on the therapists end Cultural identity development CID is important as well Having and understanding of oppression, advocacy and social justice

Eliciting Meaning

Find meanings underling life experiences. Use storytelling to discover the background of clients meaning-making. Telling you about a critical illness or maybe they've lost of love one Critical illness or loss force people to face deeper meaning issues

Homework

Generalizing goals and action beyond the session Concerned with action - generalizing thoughts, feelings and behaviors to the real world Working outside of the session can help you see more drastic changes sooner

Level 4 of Client Change Scale (CCS)

Generation of a new solution Clients have tried out solutions in the past but they are not always effective. Example from textbook:

Referrals

Help clients find community resources Sometimes appropriate referrals need to be made when problems may be too difficult for current therapeutic relationship

Thought stopping

Help clients negative self-talk Applicable to a wide range of difficulties People are hard on themselves, usually we are harder on ourselves then others

Family focus

Helps clients see themselves in relation to their present and past families Be flexible in your definition of family • Nuclear - immediate • Extended • Single-parent • Close living or friendship group ex. Sounds like your mother is the most important issue. Have I heard correctly?

Relapse prevention

Helps ensure specific action goals What specially the client will do to make change happen. Examples form intensive outpatient program

Client Change Scale (CCS)

Helps you know if your treatment is effective If clients are stuck in the client change skill, that gives you feedback if you should change your treatment

Therapeutic lifestyle changes (TLC)

Instructional strategies oriented toward physical and mental health, bringing together neuroscience, medicine, and counseling Communication skills training : Teach client communication skills to help clients develop better interpersonal relationships

Interviewer focus

Interview may provide feedback, opinions or advice from his or her perspective Use only occasionally Immediately bring focus back to the client ex. It happened to me last week, and I didn't know what to do.

Research shows that clients of counselors who self-disclose: A. Are more likely to drop out of treatment B. Have low trust in their counselors C. Like their counselors more and more report lower levels of symptom distress D. Have higher levels of symptom distress

Like their counselors more and report lower levels of symptom distress.

steps of empathic confrontation

Listen observe and note client conflict Summarize and clarify conflict Evaluate how the client responds

Main theme or problem focus

Listen to clients concerns and issues Draw out clients story Dual focus of client and their story may appear frequently ex. Which issue would you like to focus on first?

Why is meaning important to talk about?

Meaning, thoughts, feelings behaviors All four dimensions are operating simultaneously and constantly in any individual or group We are systems and any change in one part of the system affects the total

Positive imagery

Most effective in helping clients experience the sensorimotor orientation

Level 2 of Client Change Scale (CCS)

Partial examination Not full acceptance Might say ok well ill take a look at my substance use. Example from textbook: yes I hurt and perhaps I should be angry but I don't feel lit

Multicultural Counseling and Therapy MCT

Philosophy behind this is that it is eclectic and integrative approach Both make cultural environmental context central to understand client Helps us to further understand our client when we think of the contextual factors that are at play

Crisis Counseling

Philosophy: Practical and action oriented Involved 2 phases 1. Working through initial trauma 2. Appropriate follow-up and further counseling

Decisional Counseling

Practical model of therapy

Feedback

Presents clients with clear, nonjudgmental information on how the counselor believes they are thinking, feeling, or behaving and how significant others may view them or their performance. Feedback is most helpful when solicited. When client is open and receptive to that feedback.

Treatment planning

Process by which the counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long-term goals; and decide upon a treatment process and the resources to be utilized.

Interpretation/reframe

Provide the client with new meaning or perspective, frame of reference, or way of thinking about issues or life experience. Interpretations/reframes may come from the interview observations, based on theoretical orientations, or they may link critical ideas together

Stress

Psychological and physical response to change. Whether that change is actually happening now or anticipated in the future. Can be positive or negative

Reflecting meaning

Reflecting the key meaning and value words Use the key words the client uses Reflect meaning, value and how the client makes sense of the world Structure similarly to a paraphrase or reflection of feeling

Reasons to use a family genogram

Reminds client that we all exist in a web of interpersonal relationships Helps the client see the nature and impact of their family Family can be viewed from many different view points Consider family genograms as strength inventories and diagnostic instruments

How to develop a community genogram

Select the community in which you were primarily raised Use a star circle or other significant symbol to represent yourself or your client. Place the symbol in that community at the most appropriate place. Choose significant symbols to represent key items in relation o Yourself/client o Family o Influential community groups o School o Neighborhood o Peer groups o Spiritual groups Focus on one single community group or family •Start with positive stories •Maintain a solid image of positives before you begin with negative stories

How do meanings internalized from this experience serve or conflict with current life experiences?

Sometimes we have new experiences that conflict with previous experiences and sometimes the work needs to be done in generating a new story or making new meanings out of these experiences. Usually what growth and change looks like. Make meaning out of experiences.

Steps of thought stopping

Step one: learn the basic process Relax, close your eyes and imagine a situation where you make the negative self-statement. Take time and let the situation evolve. When the though comes, observe what happens and how you feel. Then tell yourself silently "STOP" Step two: transfer thought stopping to your daily life. Every time during the day that you find yourself thinking negatively, say STOP Step three: add positive images and thoughts After you say STOP substitute a more positive statement. "I can do a lot of things right" I sometimes mess up - no ones perfect Step four: make it a habit.

CBT used to treat

Substance use disorder, depression stress and anxiety, bipolar disorder, physical pain, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors

Empathic confrontation

Supportively challenge the client to address observed discrepancies

Anticipated result of Reflection of Meaning

The client discusses stories, issues, and concerns in more depth with a special emphasis on deeper meanings, values and understandings. Clients may be enabled to discern their life goals and vision for the future.

What is the predicted result of the 5 stage interview structure?

The client will establish a positive relationship with the interviewer, tell story, set realistic goals, develop a new story or way of viewing issues, and transfer new learning to daily life.

Appropriate stress

The right amount of stress Encourages Neurogenesis, new synapse connections and is required for learning and change.

other focus

The session is for the client Clients tell about friends, coworkers, roommates May be important to focus on significant others ex. How are things going with your sister?

Mutuality focus

Therapeutic alliance/relationship How the client reacts to the therapist can indicate how the client develops in relation to other people Puts client and interview on an equal level Can be quiet powerful Use infrequently ex. Right now I can almost feel your hurt. We can work through your issues together.

Focusing the session

This skill can be on the client, can be on the problem or issue, can be on the counselor, significant others, or broader contexts You may also focus on the here and now of the session

discernment

To separate to determine to sort out Determining the origin of our interior and exterior experiences Here and now body experience and imaging Sit quietly and allow an image to form What is your gut feeling? Get in touch with your body. What feelings and thoughts occur?

Your personal theory/style

Two major factors to consider: Your own personal authenticity The needs and style of the client

Logotherapy

Viktor E. Frankl Philosophy discerning meaning and purpose of your life is key

Positive stress

We all experience positive and negative stress in life. Positive stress tend to make us happy and joyful in many ways. o Buying a house o Getting married o Starting a new job o Having a baby o Moving to a new city

Questions that may orient towards meaning

What does this mean to you? What sense do you make of that? How have your values been implemented? What's important/unimportant to you? Which of your values support/oppose that action/thought/feeling?

self-disclosure

as the interviewer you share your own related past personal life experience, here and now observations, feelings toward the client, or opinions about the future. "I think if you went with that option, you might have some issues in the next few months"

Anticipated result of feedback

clients may improve or change their thoughts, feelings, and behaviors based on the therapist's ________.

Here and now focus

clients tend to focus their conversation or story on the areas that the counselor responds to This is how you can help direct the interview

interpretation

explanation of the meaning or significance of something Interpretation is from the interviewer observation and perspective. Can be the meaning of an issue or a problem, doesn't have to be meaning of life.

Distant self-disclosure

information is shared but it is too distant from the clients concern. "client says I lost my mother, therapist says I lost my dog"

Meaning

purpose or significance of something Reflection of meaning is from the clients worldview, the clients perspective

inappropriate or too extensive self-disclosure

takes focus away from client. Some things you shouldn't bring up. Focus is then taken away from client.

note taking

the book recommends you take notes & listen intentionally get permission

Anticipated result of interpretation/reframe

the client may find another perspective or meaning of an issue. Making another/new meaning out of a difficult experience. Something that was once seen as purely challenging.. looking back is your perspective different?

Anticipated result of self disclosure

the client will self-disclose in more depth and may develop a more egalitarian interviewing relationship with the interviewer. The client may feel more comfortable/trusting in the relationship and find a new solution relation to the counselors self-disclosure

Selective attention

the way you listen can and does influence a client's choice of topics and responses. Listening exclusively to "I" statements affects the way client's talk about their issues Listening to culture, gender, and context also affects the way they respond

Countertransference

unwise conscious or unconscious entanglement with the clients issues. Ex. she had a client who was bringing up and issue that she had been through also.

Key methods of crisis counseling

• Five stages and the microskills • Normalizing - how they are reacting to crisis or trauma • Calming and caring • Safety • Action • Debriefing the story • Follow up