Chapter 16 Overview of Action Stage

Examples of Open Questions and Probes For Actions

"What kinds of things have you tried?" "How did it work when you tried that?" "What ideas do you have about what to do in this situation?" "What would be the benefits of changing?"

Examples of Giving Feedback

"You expressed yourself very clearly and concisely in the role play." "You are smiling a lot and seem more open to making changes" "You maintained good eye contact but your voice sounded hesitant when..."

Giving Feedback

Can be defined as the helper giving information to the client about his/her behaviors or impact on others

Assumptions of Behavioral Theories

--->Focus on overt behaviors rather than unconscious behaviors --->Focus on what maintains symptoms rather than on what caused them --->An assumption that behaviors are learned --->An emphasis on the present as opposed to the past --->A valuing of an active, directive, and prescriptive role for helpers --->A belief that the helper-client relationship is important to establish rapport and gain client collaboration but is not enough to help client change --->A focus on determining adaptive behaviors for specific situations rather than on seeking personality change --->A reliance on empirical data and scientific methods The defining characteristics of the behavioral approaches is that behaviors, emotions, and cognition are all learned

Cautions When Giving Direct Guidance

->Helpers need to be aware that they can offer help but cannot force clients to take it ->Helpers are providing options for clients, not taking over ->Heleprs have to know the client's limits of how much they can offer ->Direct guidance has the capability to foster dependency by shifting the responsibility for solutions from clients to helpers ->Dont use too much direct guidance or it will create tension

Skills of Action Stage

1.Open questions and probes for action (are the most used skill in the stage) >>> its purpose is to stimulate client in their thinking about action. 2.Giving information 3.Giving feedback about the client >>>allows helpers to let clients know how they come across to the helpers. 4.Process advisement >>>used to direct the process of sessions, particularly in doing therapeutic exercises (ex. facilitating behavioral rehearsal) 5.Direct guidance >>>occasionally useful to give advice to clients about the best strategies 6.Disclosure of strategies >>>is another, more tentative, way to suggest action ideas

Philosophical Underpinnings

>> The major philosophical underpinning of the action stage is that clients are the active agents of their own lives. (they make the decisions about how they want to be) >>The stage is client-centered, with helpers facilitating clients in thinking about change rather than imposing change on them. >>When clients decide for themselves what to do differently, they are more likely to take responsibility and ownership for their actions than if helpers dictate what they should do >>Helpers should be supportive, and not be invested in whether and how they change. (whetehr the client chooses to change is his or her choice)

How Behavioral and Cognitive Theories Relate to the Action Stage

>>Behavioral and cognitive theories fit well into the action stage of the helping model because they provide specific strategies for helping clients change. >>When clients have explored thoughts and feelings thoroughly and obtained insight about themselves, action allows them to determine how they would like to change their lives. >>The major difference between behavioral and cognitive theorists on the one hand and the three-stage model, on the other hand, is that the former do not emphasize the importance of engaging in the exploration and the insight stages.

Giving Information

>>Can be defined as providing specific data, facts, resources, answers to questions, or opinions to clients ...educating the client ( the rationale for asking you to develop your own ideas is for you to take responsibility for coming up with choices) ...providing information about assessment or psychological tests ...educating the client about the world or psychological principles (ex. such as postpartum depression)

Goals of Action Stage

>Encourage clients to explore possible new behaviors >Assist client in deciding on actions >Facilitate the development of skills for action >Provide feedback about attempted changes >Assist clients in evaluating and modifying action plans >Encourage clients in processing feelings about action

Process Advisement

>Process Advisement is when helpers direct clients to do things within helping session (ex. "show me how you acted when your roommate asked to borrow your new dress) (ex. "play the part of the man in your fantasies")

Theoretical Background (Behavioral and Cognitive Theories)

Behavioral theories lay the foundation for the action stage. Modeling: --->Learning and performance --->Bobo doll study Cognitive Theory: --->Stimulus-organism-response

Direct Guidance

Can be defined as making suggestions, giving directives, or providing advice for what helpers think clients should to outside of helping sessions -One form of direct guidance= homework assignments (ex. monitor exercise and eating behaviors) -The way homework is given can influence the client's receptivity and willingness to implement the homework (clients are more likely to implement homework that fits the problem) -Some helpers (Rehabilitation counseling, job placement) need to do more direct guidance than others (college counselors) -Direct guidance indicates what helpers think clients should do instead of just giving information and providing facts and data

What is the Cognitive Theory

Early behaviorists such as Skinner believed in a stimulus-response model (meaning that people respond directly to environmental cues,.. Ex. how noise leads to a startle response) -->Much of the helping process takes place at covert levels. Which is why a cognitive model makes sense because a helpers intentions for their interventions and perceptions of clients reactions influence their subsequent interventions

Disclosure of Strategies

Helpers make suggestions through disclosing strategies that they personally have tried in the past. Helpers then turn the focus back on the client and ask for their reaction (Ex. When I feel angry, I take a deep breath and count to ten. I wonder if that would work for you?)

What is Operant Conditioning?

In operant conditioning, behaviors are controlled by their consequences --->Reinforcement ( anything that follows a behavior and increases the probability that the behavior will occur again) >positive reinforcer= An event, privilege, or material object that increases the likelihood of a behavior occurring again >primary reinforcer= biological necessities (food, water, and sex) >secondary reinforcer= praise and money ---->Things are not always reinforcing (food is typically reinforcing only when an individual is hungry) ---->To be effective reinforcement must be contingent on, or directly linked to the behavior ---->SHAPING (in order for a behavior to be reinforced it must first be performed.) ---->PUNISHMENT (occurs after a behavior and reduces the probability that the behavior will occur again) 3 punishment procedures --a) presenting an aversive event (such as a frown when a client says something you don't like) --b) removing a person from a situation in which she or he would otherwise be able to earn reinforcers (timeout) --c)reducing a person's collection of reinforcers (taking away candy) --->GENERALIZATION which involves the transfer of learning from one's situation to the other, similar situations. (ex. if kicking and hitting are punished with a timeout, and good behavior is positively reinforced at school, one would expect a decrease in kicking and hitting) ---> EXTINCTION reduces the probability of a behavior occurring by withholding reinforcers after the behavior is established. (ex. IF parents attention reinforces children fighting, then a helper will suggest that the parent ignore the fights as a way to decrease the behavior of the children)

Markers for Knowing When to Move to Action

It's generally best to wait to move into action until the client is ready for action. 1. when the client has gained insights and starts spontaneously talking about action 2.(sometimes at the beginning of the first session) When the client presents with a specific problem and simply want relief from that problem (ex. a simple phobia) Which makes sense if the helper approaches the problem straightforwardly 3. Repeatedly some clients are in a crisis and need to move quickly to make some changes immediately. (with these clients helpers need to move to action quickly) 4.Finally, when the client is stuck in insight and not making changes it is appropriate to move into action. (ex. the client who wallows in insight for years even though they know the reason for why they are dysfunctional). Such clients can be gently encouraged to move to action.

Direct Guidance

Making suggestions, giving directions, or proving advice for what helpers think clients should do outside of helping sessions "When you have a nightmare the next time, wake yourself up and imagine a new ending where you..." Collaborate with client Choose a task that fits the problem Be clear about what you want the client to do

Open Questions and Probes For Action

Open question and probes in the action stage are aimed specifically at helping client explore action

What is Modeling

People often learn things even though they have never been reinforced for performing them. Modeling is also known as observational learning. which occurs when a person observes another person (the model) perform a behavior and receive consequences --> whether or not a person performs a behavior that is learned depends on the consequence -->Kazdin noted that imitation of models by observers is greater when models are similar to observers, rather than when they are more prestigious, higher in status and expertise than observers. Also, imitation is greater when several models perform the same behavior. -->Modeling is an important component of helper training. Watching experts conduct therapy is incredibly useful.

Rationale and Guidelines for Using Open Questions and Probes For Action

Rationale: --->They are useful to gently guide clients through the action stage --->They are the primary tool that helps helpers find out whether clients are ready to change, what they have tried before, what ideas they have for action, what barriers they see to change, and how they respond to action ideas --->Using them the helper implicitly communicates that he or she is guiding or coaching the client to figure out about action rather than providing answers --->Helpers encourage clients to solve problems with their support Guidelines: --->should be done gently with an air of curiosity --->The helper is collaboratively inquiring and helping the client figure out about the action --->helpers shouldn't ask too many questions at one time --->make sure to give the client time to respond --->vary questions with other skills so you don't sound repetative --->Make sure questions are open and not closed

Rationale and Guidelines for Giving Feedback

Rationale: -->Brammer and MacDonald suggested that effective feedback can increase clients self-awareness, which in turn can lead to behavior change. -->Clients prefer positive feedback and think it is more accurate than negative feedback -->Feed back about the client ("you did good explaining your feelings") is similar to immediacy (I feel good about our relationship) in that both involve something about the client -->Feedback can be difficult for beginning helpers because it is a different behavior than one usually uses in social interactions and can be met with resistance. Guidelines: -Give feedback cautiously -Make statements descriptive (ex. you spoke very softly) -Emphasize strengths (you effectively articulated your feelings) -Give feedback about things clients can change (nonverbal behaviors and actions, rather than about physical characteristics or circumstances that cannot be changed (height and personality) -Give feedback in close proximity in terms of time to the occurrence of the behavior (ex. You spoke with more assurance that time) -Give feedback with a lot of empathy

Rationale and Guidelines for Giving Information

Rationale: -->In the action stage sometimes helpers transition into a teachers role to provide information (ex. a helper might educate a client on their mental condition) -->Sometimes helpers do not have information to give, which is why helpers should at least know all of the basic information -->Information is not always the most appropriate intervention in situation Guidelines: -->Before giving information helpers may find it useful to ask what information or what misinformation clients possess. -->Explanations of intentions is critical to ensure that information is delivered appropriately helpers can ask themselves the following.. "do i want to educate the client?" "do i want to normalize the experiences? "do i want to explain what is happening in the session?" "Does the client need this information?" -->Helpers should not provide too much information at one time and put crucial info (referral numbers, assignments, and homework) in writing. -->Helpers must turn the focus back on the clients -->rather than give info right away, the helper might ask client what is motivating them to ask for information -->Once the helpers knows the motives behind the request of information the helper can answer directly -->There are times when it is good to avoid giving information (whenever the answer is "yes" to either of these questions) 1. Do i want to inappropriately minimize client anxiety? 2. Do I want to show the client how much I know?

Rationale and Guidelines for using Process Advisement

Rationale: -->helpers are experts on how to facilitate the helping process and, hence, often have suggestions about what clients can do in sessions to facilitate the change process -->Clients aren't experts, so they rely on the helper for judgments -->The primary use of process advisement is through behavioral exercises such as behavioral rehearsal or role-playing. Guideline: -Clients are generally agreeable to trying things in sessions that helpers deem appropriate if they trust the helper and are presented with a credible rationale for why the exercise might be helpful -->Helpers try to be attentive to signs that clients do not want to follow process advisements (hesitating, "yes, but......" or arguing) -->Some clients do not want to follow process advisements no matter how skillfully it is presented by the helper

Rationale and Guidelines for using Direct Guidance

Rationale: ->Direct guidance given through entertainment formats is not preceded by through exploration which can cause people to rely on others making their decisions rather than coming to trust their own instincts ->Direct guidance can occasionally be useful in helping situations, especially when given by a trusted helper ->An individual in a crisis situation may need more explicit guidance (such as suicidal clients or victims of child abuse) Guidelines for Giving Direct Guidance: ->before giving direct guidance, helpers should first consider what their intentions are ->It is helpful to remember that it is easier for clients to make small, specific changes than to change many big things all at once ->It is suggested that helpers write down assignments to help clients remember them. ->When clients ask or beg for direct guidance, helpers have to be careful to distinguish between the honest and direct request for direct guidance and the expression of dependent feelings ->Clients often have negative reactions if helpers ignore their requests for advice

Rationale and Guidelines for Using Disclosure of Strategies

Rationale: ->It is important to disclose only those strategies that seem like they might work for the client. ->Hearing what another person has done can provide specific ideas for new behaviors ->Disclosing what has worked for the helper is also somewhat disarming Guidelines: ->Disclose about concerns that have been resolved and that do not make you vulnerable ->Helpers should be aware that a client might be unduly influenced to do exactly what the helper does ->Helper should be aware that Client might be unduly influenced to do exactly what the helper does. ->Helpers must provide disclosure tentatively, indicate that it might or might not work. ->Then turn the focus back on the client

Deterrents to Action

Sometimes newly gained insights spontaneously lead to action and sometimes they do not... why? >>Becasue clients feel stuck, understand the situation incompletely, or only at an intellectual, or they do not take personal responsibility for their role in the maintenance of the problem >>insight might also not lead directly into action due to the fact that the clients might not have the necessary skills to take the next steps >>Sometimes even if they understand themselves thoroughly and have the skills to change, clients may lack the motivation to change >>So, be aware that sometimes clients cannot make all the changes they may want or need to make because of limited talents and resources

Rational for Action Stage

Two Reasons for Moving Beyond Insight into Action: 1.becasue most clients seek help to feel better or to change specific behaviors, thoughts, or feelings. It is important to help attain these goals 2. taking action is crucial for consolidating the new thinking patterns learned in the insight stage. Action makes insight more understandable and practical