Counseling and Helping Relationships

Structuring

Used to set goals and agree upon plan for counseling; also used within sessions to make effective use of time and respect boundaries.

Carkhuff's scale for measurement of core conditions and effectiveness of a counselor

-Level 1: Therapist is contradictory in statements and nonverbal cues and exhibits defensiveness. -Level 2: Therapist is superficially professional but lacks genuineness. -Level 3: Therapist does not express defensiveness; there is implied but not overt professionalism -Level 4: Therapist is genuine and nondefensive. -Level 5: Therapist is open and honest and accurately and genuinely reflects the ideas and reactions to client

Phases of relationship building

-Phase one: Initiation or entry phase: This is the introduction to the counseling process, which sets the stage for the development of the client/counselor relationship -Phase two: Clarification process: This phase defines the problem and need for the therapeutic relationship. -Phase three: Structure phase: The counselor defines the specifics of the relationship, its intended outcomes, and responsibilities of both parties. -Phase four: Relationship phase: The client and counselor have developed a relationship and will work toward mutually agreed upon goals.

4 stages of counseling relationship

-Stage one: Exploration of feelings and definition of the problem: Counselors will use rapport-building skills, define the structure of the counseling process and relationship and work with their clients on goal setting. -Stage two: Consolidation: This is the process of the clients integrating the information and guidance from the counselor, allowing them to gain additional coping skills, and identify other ways to solve problems. -Stage three: Planning: During this phase, clients can begin employing techniques learned in counseling and prepare to manage on their own. -Stage four: Termination: This is the ending of the therapeutic relationship, when clients feel equipped to manage problems independently and have fully integrated techniques learned in counseling.

Crisis Intervention

A crisis situation requires swift action and specially trained mental health personnel and can occur at any time in any setting. Albert Roberts proposed a seven-stage model to deal with a crisis and provide effective intervention and support. Robert's stages are as follows: -Stage 1: Conduct thorough biopsychosocial assessments of client functioning, and identify any imminent danger to self or others. -Stage 2: Make contact, and quickly establish rapport; it is important that the counselor is accepting, nonjudgmental, flexible, and supportive. -Stage 3: Identify specific problems and the possible cause of the crisis; begin to prioritize the specific aspect of the problem most in need of a solution. -Stage 4: Provide counseling in an attempt to understand the emotional content of the situation. -Stage 5: Work on coping strategies and alternative solutions, which can be very challenging for an individual in crisis. -Stage 6: Implement an action plan for treatment, which could include therapy, the 12-step program, hospitalization, or social services support. -Stage 7: Follow up, and continue to evaluate status; ensure that the treatment plan is effective and make adjustments as needed.

Maslow's hierarchy of needs is composed of five-levels. Which needs are included in level 4? a. Cognitive and aesthetic b. Food and shelter c. Safety and order d. Love and belonging

A: Maslow's hierarchy of needs is composed of five levels. The fourth level is esteem needs and was updated to include cognitive and aesthetic needs. This includes the need for self-esteem, status, prestige, knowledge, and an appreciation for beauty and balance. Level one is the need for food, shelter, warmth, air, sex, and sleep. Level 2 is the need for safety, personal security, stability, laws, and social order. Level 3 reflects the need for love and a sense of belonging. Level 5 of the pyramid is self-actualization.

How does negative reinforcement encourage specific behaviors? a. Removing unwanted stimuli b. Adding desired stimuli c. Punishing clients for unwanted behavior d. Extinction of stimuli

A: Negative reinforcement encourages specific behaviors by removing unwanted stimuli. An example of this is putting on a seat belt to remove the sound of the car dinging (reminding you to fasten your seat belt).

Positive interactions help develop the therapeutic relationship and encourage clients to meet their goals. What are the four stages of a positive interaction in counseling? a. Exploration, consolidation, planning, and termination b. Initiation, clarification, structure, and relationship c. Initiation, consolidation, planning, and termination d. Exploration, clarification, planning, and relationship

A: The stages of a positive interaction are exploration, consolidation, planning, and termination. Stage one: Exploration of feelings and definition of problem: the counselor will use rapport-building skills, define the structure of the counseling process and relationship, and work with the client on goal-setting. Stage two: Consolidation: The client integrates the information and guidance from the counselor, allowing him or her to gain additional coping skills and identify alternate ways to solve problems. Stage three: Planning: The client begins employing techniques learned in counseling and prepares to manage on his or her own. Stage four: Termination: This is the ending of the therapeutic relationship, when the client feels equipped to manage problems independently and has fully integrated techniques learned in counseling.

How does instrumental grieving differ from intuitive grieving? a. Instrumental is thinking; intuitive is feeling b. Instrumental is action-oriented; intuitive is passive c. Instrumental is more feminine; intuitive is more masculine d. Instrumental is anger; intuitive is acceptance

A: There is thought to be two types of grieving: instrumental grieving and intuitive grieving. Instrumental is more thinking-based and about problem solving rather than feeling, and is viewed as a more masculine approach to grief. Intuitive is more emotional and about sharing and processing feelings, and is considered a more feminine approach to grief.

Reflection is a practice where counselors acknowledge the meaning behind a client's words. Why do counselors use reflection in sessions? a. To help clients understand underlying emotions b. To provide advice c. To set goals for sessions d. To allow for silence

A: To help clients understand underlying emotions. Reflection is also referred to as "reflection of a feeling" and is used for counselors to indicate that they both hear and understand the meanings and the emotions behind a client's words. Counselors do not provide advice during reflection, but let the client know that they are being heard.

Maslow's Hierarchy of Needs

Abraham Maslow believed that all humans have basic needs, that, once filled, allow movement onto higher-level functioning. The hierarchy is depicted as a pyramid with biological and physiological needs at the base. The base level includes the need for food, shelter, warmth, air, sex, and sleep. The next level, safety, is the need for personal security, stability, laws, and social order. The third level reflects the need for love and a sense of belonging, which can include both personal and professional relationships. The fourth level is esteem needs and was updated to include cognitive and aesthetic needs. These include the need for self-esteem, status, prestige, knowledge, and an appreciation for beauty and balance. The top level of the pyramid is self-actualization when wan individual has reached his or her potential, is fulfilled, and finds meaning in life. It can also include the process of helping others achieve self-actualization. It is important to realize that if clients are not having their very basic needs met (food, shelter, etc.), they will have great difficulty working on higher goals that contribute to their mental and emotional well-being.

Promoting Relaxation

As part of the counseling process, clients may need to learn basic relaxation techniques, which can be simple to learn and practice. Stress can cause increased anxiety and tension; thus, relaxation techniques help reduce both mental and physical stress. Clients may present with racing thoughts, fatigue, or headaches; techniques such as awareness, breath work, and progressive relaxation can be of great benefit. Clients who have a reduction in their stress level may be more engaged in the counseling process and better able to manage difficulties outside of sessions. Meditation is a powerful relaxation tool to help build awareness and the ability to calm oneself. Relaxation can help diminish the activity of stress hormones in the body, reduce feelings of anger and frustration, lower heart rate, and improve confidence.

Questions

As part of any counseling session, counselors will ask both open and closed questions. Open questions are more likely to provide helpful information, as they require the client to express feelings, beliefs, and ideas. Open questions often begin with "why" "how" "when" or "tell me" Closed questions may be less helpful, as they may elicit brief responses of one or few words. Counselors do not need to be aware of the limitations of asking questions. Any questions asked should have purpose and provide information that will be meaningful to the counselor and the relationship. Curiosity questions should be avoided, as well as asking too many questions, which may feel interrogating to the client. A counselor may ask follow-up questions for clarification as needed. The counselor should provide the client adequate time to answer questions and elaborate but also allow time for the client to talk freely.

Support system

As part of the intake process and initial sessions, counselors need to explore and understand clients' existing support systems. All individuals have varying degrees of social support, which can include friends, family, and community. Counselors can help clients evaluate their level of support and determine how the support system can help during counseling and after it has ended. It may be necessary to help clients find ways to develop additional support, such as through groups or organizations. A support system is necessary to provide help, encouragement, and care.

Restatement

Clarification through repeating back the client's words, as understood by the counselor

Contract

As part of the intake process counselors may wish to develop and agree upon a contract with the client. Contracts outline goals and responsibilities of both parties and may help to alleviate potential miscommunication. Important components of a contract include an outline of the service being provided, a description of the counselor's qualifications, and any explanation of the scope of practice. A clause outlining clients rights and confidentiality should be included. Lastly, the counselor ay wish to include specifics about session times, fees, and consequences of a client being late, missing, or canceling sessions. Contracts can serve to empower clients by clarifying service and allowing clients to make an active role in their therapeutic care. They may also be flexible, allowing either party to modify the contract as needed.

Initial Phase of Relationship Building

At the onset of the process, the counselor and client will progress through the relationship phase, which has four specific phases. These phases may be completed at a varying pace, depending on both parties. Some phases may be completed quickly, while others may take several sessions.

Symptoms of burnout

At times, counselors may experience a sense of disinterest or disengagement from their work, which may signal burnout. Symptoms of burnout can include physical symptoms, such as fatigue, headaches, and insomnia, and decreased resistance to illness. Emotional symptoms can include depression, anxiety, boredom, lack of empathy, cynicism, and anger. Burnout may be a result of overworking and/or providing service to clients who are not progressing in therapy, thus causing counselors to feel incompetent and ineffective. It is important to know the warning signs of burnout and engage in self care, which may involve taking a vacation; getting increased supervision or therapy; making changes to one's hours, fees or practice; or seeking continuing education options.

Attending

Attending is the act of the counselor giving clients his or her full attention. Attending to the client shows respect for their needs, can encourage openness, and can create a sense of comfort and support in the counseling process. There are several ways for counselors to attend actively to clients, including maintaining appropriate eye contact, using reassuring body language and gestures, and monitoring their tone and expressions. Counselors can communicate support and a nonjudgmental attitude through an open posture and eye gaze that shows interest but not intimidation. They should use a caring verbal tone and expressions, which indicate attention to what their clients are saying, and can be used in addition to silence to create a positive environment through counseling.

Desensitization is a behavior modification technique designed to replace an anxiety-producing stimulus with a relaxation response. Which is NOT one of the stages of desensitization? a. Exposure to the object or action of fear b. Avoidance of the object or action of fear c. Creation of a fear higherarchy d. Learning relaxation techniques

B: Avoidance of the object or action of fear is NOT one of the stages of desensitization. Exposure to the object, creating a fear hierarchy, and learning relaxation techniques while being exposed are stages of systematic desensitization.

Counselors may feel there are certain situations where it becomes necessary to make referrals for clients to seek other counselors, also known as "referring out." which of the following is NOT a reason to refer out? a. Client issues outside of the counselors scope of practice b. Dislike for client c. Client need for specialized service d. Counselor retiring or taking leave from practice

B: Counselors should refrain from referring out due to dislike for a client. This risks a client feeling abandoned and may be considered unethical. Needs for the client should be placed before those of the counselor. Counselors can refer out when retiring, taking a leave, when a client is out of the scope of their practice or expertise, or when a client needs specialized care.

What are the stages of Kubler-Ross' five-stage model for grief? a. Anger, denial, bargaining, resolution, sadness b. Denial, anger, bargaining, depression, acceptance c. Denial, panic, sadness, anger, frustration d. Sadness, anger, bargaining, denial, acceptance

B: Denial, anger, bargaining, depression, and acceptance are the five stages of grief according to Kubler-Ross.

Robert Carkhuff wrote Toward Effective Counseling and Psychotherapy, a book wherein he discovered that therapeutic interventions did not always have a long-term positive impact on clients. Carkhuff also created a five-point empathy scale, designed to measure what? a. Counselor's ability to accurately reflect b. Effectiveness of counselor c. Defensiveness of counselor d. Adequate structuring of sessions

B: Effectiveness of a counselor. Carkhuff's scale measured the degree to which a counselor was providing empathy, genuineness, concreteness, and respect. The scale measures effectiveness but refers to how defensive a counselor is toward a client.

Relationship building is the beginning process of the client-counselor relationship. What are the phases of relationship building? a. Introduction, goal setting, resistance, change b. Initiation, clarification, structure, and relationship c. Exploration, clarification, planning, and termination d. Clarification, consolidation, structure, and relationship

B: The phases for relationship building are initiation, clarification, structure, and relationship: Phase one: initiation or entry phase: this is the introduction to the counseling process which sets the stage for the development of the client/counselor relationship Phase two: Clarification process: This phase defines the problem and needs for the therapeutic relationship. Phase 3: Structure phase: The counselor defines the specifics of the relationship, its intended outcomes, and the responsibilities of both parties. Phase 4: The client and counselor have developed a relationship and will work toward mutually agreed-upon goals

Bereavement

Bereavement is grief specific to the loss of a loved one.

Symptoms of professional burnout consist of fatigue, headache, insomnia, depression, anxiety, or boredom, among others. When does burnout in counselors and helping professionals occur? a. When countertransference is not managed b. When counselors become desensitized to client issues c When counselors are overworked d. When clients regularly cancel or don't show

C: Although challenges with clients (Choices A, B, and D) can contribute to counselor burnout, the main reasons for burnout are overwork and lack of appropriate supervision

Albert Roberts designed a seven-stage model to deal with a crisis and provide effective intervention and support. What are the initial three tasks of Robert's seven-stage model of crisis intervention? a. Assessments, identifying problems, and referring out b. Establishing contact, providing counseling, and referring out c. Assessments, establishing rapport, and identifying the cause of crisis d. Intervention, assessments, and treatment

C: Assessments, establishing rapport, and identifying the cause of crisis. Briefly, Roberts's seven phases of crisis management are: -Biopsychosocial assessments -Making contact and quickly establishing rapport -Identifying problems and possible cause of crisis -Providing counseling -Working on coping strategies -Implementing an action plan for treatment -Follow-up

What are the differences between substantive advice and process advice? a. Substantive is non directive; process is directive b. Substantive is directive; process in encouraging c. Substantive is directive; process is empowering d. Substantive is fact-based; process is feeling-based

C: Substantive advice can be considered directive and may involve the counselor imposing his or her opinions on clients. Process advice is more empowering and helps clients navigate options for solving their own issues. In some situations, it may be appropriate for the counselor to offer process advice; it is less likely that substantive advice should be given.

Person-centered approach

Carl Rogers developed the person-centered, or humanistic, approach to counseling, which stressed the importance of the counseling relationship, as well as the need to evaluate therapy for effectiveness. Rogers believed that three core conditions must exist for therapy to facilitate change: empathy, positive regard, and congruence. Rogers' work was continued by Robert Carkhuff, who created a five-point scale to measure the core conditions and effectiveness of a counselor. This scale attempts to measure the degree to which the counselor is providing effective levels of empathy, genuineness, concreteness, and respect. In his 1967 book, Toward Effective Counseling and Psychotherapy, Carkhuff found that therapeutic interventions did not always have a long-term positive impact, and in some cases, clients worsened after counseling. Carkhuff's findings were summarized in a famous quote that "therapy may be for better or for worse." This led him to conduct further research on specific attributes of the counselor that contributed for successful outcomes.

Cultural Awareness

Counselors must be adept at working with diverse populations. Diversity includes race, culture, gender, ethnicity, sexual orientation, socioeconomic status, religion, and age. As part of the profession, counselors will provide services to individuals and families with whom they have no cultural similarities. Thus, it is essential for counselors to develop and maintain a level of cultural competence. The first step is for them to engage in self-awareness and gain an understanding of their own identity, including their belief systems and biases. As part of the counseling process, counselors should be able to acknowledge differences and communicate to clients with trust and credibility while demonstrating mutual respect. They should engage in ongoing professional development, both to gain skills and awareness of differing cultural needs, as well as from an ethical standpoint to ensure they are providing competent services. To maintain credibility and trust, counselors must clearly define issues and goals for counseling, taking into consideration cultural variations.

Building Counselor and Client Relationships

Creating rapport with clients requires counselors to engage in specific approaches using appropriate therapeutic techniques. In addition to the use of theory, they must convey a genuine attitude of empathy and respect for their clients. Using positive regard, as well as a nonjudgmental style, is essential to creating a sense of comfort and willingness for clients to open up to their counselor. Counselors should carefully evaluate each client and develop a plan for services that will best meet their needs. The plan should be communicated and agreed upon with the clients, ensuring that they feel the counselor is trustworthy and competent.

External stress, internal distress, and transitional stress

Crisis situations and stress have a variety of causes. External stress exists outside of a person's control and can include natural disasters, loss, illness of self or family member, crime, poverty, or job change. Internal distress is the reaction to external stress but maybe chronic and exist at all times due to an individual's coping skills and personal choices. Positive events, such as marriage, child birth, a new job, or relocation, can cause eustress, which is considered positive stress. Major life changes can cause transitional stress, which may be short term but still requires strategies for managing. Stress management techniques include maintaining one's physical health, adequate sleep, relaxation techniques, and engaging in enjoyable activities or hobbies.

What are the four phases of a crisis as defined by Gerald Caplan? a. Threat, escalation, resolution, follow-up b. Threat, intervention, climax, resolution c. Threat, rapport, strategy, treatment d. Threat, escalation, acute crisis, climax

D: Caplan's phases are threat, escalation, acute crisis, climax: Initial threat or event, which triggers a response. The individual may be able to employ coping skills or defense mechanisms to avoid a crisis. Escalation, during which initial attempts to manage the crisis are ineffective and the individual begins to experience increased distress. Acute crisis phase, during which anxiety continues and may intensify to panic or a flight-or-fight response. There are still attempts to problem-solve during this phase, and new tactics may be used. Climax of the crisis when solutions have failed; the individual may experience personality disorganization and become severely depressed, violent, and possibly become suicidal.

Carl Rogers believed three core conditions must exist for effective counseling. What are those conditions? a. Trust, empathy, and kindness b. Empathy, positive regard, and kindness c. Genuineness, trust, and congruence d. Empathy, positive regard, and congruence

D: Carl Rogers developed the person-centered approach to counseling, which stressed the importance of the counseling relationship, as well as the need to evaluate therapy for effectiveness. Carl Rogers's three core conditions for effective counseling were empathy, positive regard, and congruence (genuineness).

Critical Incident Stress Debriefing (CISD) is short-term work done in small groups and is not considered psychotherapy. Techniques used include processing, defusing, ventilating, and validating thoughts, experiences, feelings, and emotions. CISD is designed for which of the following? a. Primary trauma victims b. Human resource professionals c. First responders d. Secondary trauma victims

D: Critical Incident Stress Debriefing (CISD) is best suited to secondary trauma victims. First-degree victims need more direct assistance.

When is Critical Incident Stress Debriefing (CISD) most effective? a. When it is provided to individuals b. When it is provided by trained mental health professionals c. When it is provided within seven days of the incident d. When it is provided within 24 to 72 hours

D: Critical Incident Stress Debriefing (CISD) is most effective when offered within 24 to 72 hours of an event. It can be provided by any trained individual, including HR or mental health professionals, and is intended for groups of secondary trauma victims.

When does modeling occur in the counseling process? a. When counselors model clients' feelings back to them b. When clients provide counselors with an ideal image of themselves to achieve c. When clients are told how to behave by counselors d. When counselors demonstrate appropriate reactions and behaviors for clients to follow

D: Modeling occurs in the counseling process when counselors demonstrate appropriate reactions and behaviors for clients to follow. Modeling is nonverbal and helps clients learn appropriate behavior through observation.

When does negative transference occur? a. When counselors project feelings onto clients b. When clients project feelings toward another person in the past onto the counselor c. When multiple roles exist between a therapist and a client d. When clients become angry or hostile toward counselors

D: Negative transference can result in clients becoming angry and hostile toward the counselor. Although transference is an essential part of psychoanalytic counseling, negative transference can be difficult to manage and must be dealt with in order for therapy to progress.

What are SMART goals? a. Specific, meaningful, achievable, realistic, and time-sensitive b. Special, manageable, action-oriented, realistic, and timely c. Specific, measurable, action-oriented, relevant, and time-bound d. Specific, measurable, achievable, relevant, and time-bound

D: SMART goals are a way of planning an effective goal-setting and goal-accomplishing process. The SMART goals are specific, measurable, achievable, relevant, and time-bound. Specific is being detailed about what the goal is and how it can be accomplished. Measurable is about tracking the goal or improvements to keep up motivation. Achievable is making sure the goal is realistic. Relevant is asking yourself if it's the right time for a goal, or if you're the right person for it. Time-bound is setting a clear date to achieve the goal by so as to not lose focus.

In-Life Desensitization

Desensitization is a behavior modification technique designed to replace an anxiety-producing stimulus with a relaxation response. Also known as systematic desensitization, it is a process to help the client manage fears or phobias. The client is taught relaxation techniques, which can include breathing, mindfulness, and muscle relaxation. Next, a "fear hierarchy" is created to rank stimulus from least to most fearful. The client is gradually exposed to the object or action that causes anxiety and then moves up the fear hierarchy and practices relaxation techniques. The goal is for the client to reach the most feared object or action and be able to react with calmness and control.

Critical Incident Stress Debriefing

Designed to support individuals after a traumatic event, Critical Incident Stress Debriefing (CISD) is structured form crisis management. Specifically, it is short-term work done in small groups but is not considered psychotherapy. Techniques used include processing, defusing, ventilating, and validating thoughts, experiences, feelings, and emotions. CISD is best for secondary trauma victims, not primary trauma victims. For example, in cases of workplace violence, any employees who witnessed an event or who were indirectly impacted could benefit from CISD. Employees who were first-degree victims would need more individualized, specialized care and therapeutic intervention. It is important that CISD is offered as quickly as possible after an event; research has indicated it is most effective within a 24-to-72 hour timeframe and becomes less effective the more time lapses after the event. CISD can be managed by specially trained personnel and could include mental health workers, medical staff, human resources, or other professionals. Trained Crisis Response Teams can be ready or quickly available to provide support directly following a traumatic situation.

5 phases of grief model

Elisabeth Kubler-Ross developed the most well-known model for grief in 1969. The five-phase model suggests that individuals pass through at least two of the linear five stages: denial, anger, bargaining, depression, and finally, acceptance. Individuals can also cycle back through certain stages.

Empathy

Empathy is considered an essential counseling skill. It is used not only to initially build trust but also throughout the counseling process. The process of empathy is used to help the counselor understand the client's viewpoint. It is more complex than sympathy, which is somewhat passive and a sense of feeling bad for another person. Empathy focuses on gaining insight into the client's experience to offer effective means to deal with any issues or concerns. Although psychologist Edward Titchener was the first to use the term, it is strongly associated with the client-centered approach of Carl Rogers. Rogers believed empathy extended beyond understanding a person's situation; it involved the counselor imagining themselves in that situation. This level of empathy requires genuineness, acceptance, and a small measure of vulnerability on the part of the counselor.

Characteristics of willingness to change

Entering into counseling can provoke anxiety, fear, and resistance to change. Clients may have both internal and external reasons to want or need to change but exhibit some unwillingness to do so. Clients with internal or intrinsic understand that they need to change or move forward, grow, and achieve personal goals. External factors, such as mandated counseling, can be motivating, but may create additional resistance. Clients will be more motivated and willing to change when they have a vested interest in the process and believe they will achieve a successful outcome. Commitment to the process is essential, especially considering that counseling may not seem enjoyable or even interesting but may be necessary.

Extinguishing

Extinguishing is the process of ending, or making extinct, a specific maladaptive thought pattern or behavior. Previously occurring behaviors were reinforced, and when reinforcement (either positive or negative) ceases, the behavior will eventually be extinguished. It may be a goal in counseling to extinguish unwanted thoughts or behaviors that are harmful or a hindrance to the client.

Models of a helper

Gerard Egan developed a model for helping outlined in his book, The Skilled Helper. Egan drew from several theorists, including Rogers, Carkhuff, and Albert Bandura, to create a three-stage model for helping. The phases of the model are identifying the present situation or scenario, defining the desired scenario, and developing a strategy to achieve it. The model provides a framework and map that clients can internalize for use when faced with a problem. It was designed to empower individuals to develop skills and confidence to solve problems outside of a helping relationship.

Flaws in goal setting

Goal setting must be specific to each client and should be mutually agreed upon. Setting clear time frames, supported by the counselor, is essential to success. Goal setting may cause issues if goals are too ambitious or vague or have no identifiable benefit. It is important to explore what motivation exists for a client to work toward a goal. If adequate motivation is present, the counselor also needs to consider what will happen if the goal is not met. In some cases, failure to meet goals can cause a client to become highly discouraged and unwilling to stick with the process of reformulating goals. During the process of working toward goals a client may realize another goal is better suited. Its important to re-evaluate goals during the process to help the client grow and embrace personal change.

Grief

Grief is the emotional reaction to any type of loss. Emotions can range from sadness to despair, anger, or guilt. A loss could include a person, pet, job, or relationship. Although individuals can experience a range of emotions, there are two types of grieving. Counselors can assist clients in dealing with grief by providing support and helping them process emotions and develop skills to adjust to life after a loss. It is important for counselors to understand that individuals experience grief in unique ways and to recognize when grief becomes unmanageable and can lead to more serious concerns, such as depression.

Imagery

Guided imagery can be a powerful tool in the counseling process. Guided imagery, which draws upon the mind-body connection, can be used to help the client alleviate anxiety, relax, and control negative thoughts or feelings. A counselor, who helps the client alleviate anxiety, relax, and control or change negative thoughts or feelings. A counselor, who helps the client envision a place of relaxation and calm guides the process. The counselor encourages the client to visualize and relax into the details of the image. Clients can also envision the successful outcome of a situation or imagine themselves handling stressful situation. Once learned, clients can practice guided imagery on their own to help reduce stress and anxiety.

Finding happiness

Happiness can be defined in many ways, and individuals may have challenges in arriving at a state where they feel entirely happy. Research on happiness shows that it is small things, like activities, and not hypothetical future events or material possessions that create the most happiness. Counseling can help individuals explore times when they felt happy and work on ways to increase and maintain their happiness. By asking clients about past happy times and what about those times made them feel happy, the counselor will be able to help clients explore how to feel happier in the present. It is important to recognize that future achievements may not produce desired happiness, such as "I will be happy when..." Rather, the counselor should focus on helping clients appreciate what makes them happy in the present moment and how to use that happiness to feel fulfilled each day.

Structured and unstructured helping relationships

Individuals can get help and support from many types of relationships, both structured and unstructured. Structured relationships include those with professional helpers, such as counselors, therapists, medical professionals, and social workers. These relationships have clear goals and are time-limited both in session and overall duration. Unstructured relationships also provide support but are more ambiguous and ongoing. these can include community support, groups, friends, family, and activities such as workshops and retreats.

Phases of a crisis period

In 1964, psychiatry professor Gerald Caplan defined the recognizable phases of a crisis: -Phase 1. This first phase consists of the initial threat, or event, which triggers a response. The individual may be able to employ coping skills or defense mechanisms to avoid a crisis. -Phase 2. This second phase is the escalation, during which initial attempts to manage the crisis are ineffective and the individual begins to to experience increased distress. -Phase 3. The third phase is the acute crisis phase, during which anxiety continues and may intensify to panic or a flight-or-fight response. There are still attempts to problem-sole during this phase, and new tactics may be used. -Phase 4. The fourth phase is the climax of the crisis when solutions have failed; the individual may experience personality disorganization and become severely depressed, violent, and possibly suicidal.

Warning signs to consider before expressing personal feelings

In rare cases, it may be appropriate for counselors to self-disclose to clients. It is important to remember that the therapeutic process is to help clients, not indirectly benefit counselors. First and foremost, counselors should consider the intent and who will benefit from their self-disclosure. It is not appropriate for clients to be burdened with the counselors' emotions, as it could shift the atmosphere and power dynamic of therapy. Counselors can disclose an emotional reaction to content from clients, provided it is for the benefit of the clients. Counselors should be cognizant of their clients' level of functioning and issues prior to self-disclosure to ensure professional boundaries are maintained.

Making Referrals

In some cases, a client may require specialized service that is out of the scope of the counselor. At these times, a counselor may need to refer the client to another professional. It is important that the counselor is familiar with community resources and any specialized care a client may need. It is also essential to discuss with the client why a referral is recommended and ensure the client is comfortable with the decision and understanding next steps. The counselor must be familiar with ethical guidelines surrounding referrals and not refer out simply due to discomfort with or dislike for a client. A counselor who refers out for such personal reasons risks clients feeling abandoned, and the ACA code of ethics states that the needs of the clients must be put before those of the counselor. In these situations, the counselor should seek supervision and consultation regarding his or her personal issues. If the counselor is unable to provide appropriate care, then the client is referred out.

Group work

Individuals seeking counseling may benefit from group work in addition to, or in place of, individual counseling. Groups focus on non pathological issues, such as personal, physical/medical, social, or vocational, and act to support and encourage growth. Groups are popular for addictions, eating disorders or weight loss, grief, anxiety, and parenting. They can be homogenous and share demographic information and goals or can be heterogeneous and diverse with multifaceted goals. Group members benefit from the process through sharing and the ability to learn new ways to react and cope with difficulties. It is essential that groups have a trained leader to help create structure, boundaries, and rules and keep the group on track.

Instrumental grieving

Instrumental grieving is considered more cognitive and focuses on managing emotional reactions and problem solving. It is more thinking than feeling and is considered a masculine way of dealing with grief.

Intuitive Grieving

Intuitive grieving is more feeling than thinking. It is thought to be a more feminine way of grieving and focuses on expressing feelings, sharing, and processing emotions.

Intuitive Problem-Solving

Intuitive problem solving is based on feelings and instinct. It is an approach based on emotions and "gut feeling" about what might be the right decision. Although in some cases it may be the right way and result in the correct decision, it is important for the counselor and client to work together on understanding any problem and possible solutions. It is also important to know when to utilize rational decision making versus intuitive or when to apply both strategies.

Motives for helping others through counseling

Just as clients are motivated to seek counseling to resolve issues and/or improve their lives, counselors exhibit motivation to help others. Counseling, as a profession, allows an opportunity to positively impact the lives of individuals to help improve society. It is important as part of professional development for counselors to explore their motivation to join the profession. Some graduate programs may require individuals to receive counseling as part of their education to ensure they have adequately addressed their own issues and prevent using the clients to get their own needs met. In some specific areas of counseling such as addictions, it is more common for counselors to have experienced addiction and recovered, thus motivating them to assist others.

Modeling

Modeling is a technique used in therapy to allow clients to learn healthy and appropriate behaviors. Counselors "model" certain actions and attitudes, which can teach a client to behave in a similar fashion in his or her own life. Modeling is somewhat indirect. It is not suggested to the client to act in specific ways; rather, the counselor demonstrates desired behaviors, and the client begins imitating them.

Silence

Moments during which neither the client nor the counselor speak; can be used for reflection but may indicate resistance from the client

Positive Interaction

Once a working relationship is established the client and counselor will need to develop and maintain positive interactions to ensure the effectiveness of counseling. Positive interactions ensure the therapeutic relationship advances and supports the clients in meeting their goals. The counseling relationship has four stages.

Rational Problem-Solving Process

Rational problem solving is based on facts and clear consequences. It is an analytical approach that relies on predictability and understood outcomes. The rational decision-making process has distinct steps to define a problem and possible solutions. It is also important to know when to utilize rational decision making versus intuitive and when to apply both strategies.

Reassurance

Reassurance is an affirming therapeutic technique used to encourage and support clients. Reassurance can help alleviate doubts and increase confidence. Counselors use reassurance when a client experiences setbacks or an inability to recognize progress. Clients can be reminded of past successes to help bolster their ability to solve current problems. It is important that reassurance is genuine and not overused by counselors to pacify clients, but rather as a toll to validate and inspire continued growth.

Reflecting

Reflecting is a basic counseling skill designed to build rapport and help clients become aware of underlying emotions. Counselors "reflect back" what a client says, both to indicate they are attending and also to analyze and interpret feelings. Reflecting is more than simply paraphrasing a client's words, as it involves more in-depth understanding and an attempt to elicit further information. An example would be a client stating, "I'm not sure what to do about my current relationship. I can't decide if I should stay or leave." The counselor will reflect by stating, "it sounds like you are conflicted about what to do; this is a difficult decision to make," and follow up with a probing question or time for the client to process and react.

Errors

Reflecting is one of several active listening and rapport-building skills but should not be overused. It is essential that the counselor be able to offer back meaningful restatements and not simply repeat back what is heard. It is also important that the counselor accurately reflects any feeling and does not project or misinterpret. In some cases, misinterpretation can help the client clarify and is not detrimental to the relationship. By using reflection and clarification, any errors can be corrected. Even when errors occur, when the counselor clarifies what the client means, it communicates that the counselor is invested in understanding the client. From a cultural awareness standpoint, the counselor should be sensitive to any differences and ensure that there is a level of trust prior to engaging in more in-depth reflection.

Reinforcement when analyzing behavior

Reinforcement is a tool of behavior modification, used to either encourage or discourage specific thoughts or behaviors. Positive reinforcement rewards desired behaviors, thus encouraging the client to continue them. Counselors can provide positive verbal reinforcements, for example, to a client sharing difficult feelings, which in turn will encourage the client to continue sharing. The term positive in this case does not refer to a "good" outcome but the act of applying a reward, such as a positive reaction from the counselor. Negative reinforcement works to discourage unwanted behaviors or thoughts by removing a stimulus after a specific action. The negative does not make it "bad"- rather, it is the act of removing a negative stimulus to eliminate a specific thought or behavior.

Summarizing

Reiteration of the major points of the counseling discussion

Paraphrasing

Repeating back a client's story while providing an empathic response.

Client Resistance

Resistance to counseling, at some point, may be unavoidable. The process of change is difficult, and clients may become overtly or unconsciously oppositional when faced with the need to adjust thoughts or behaviors. In psychoanalytic terms, clients are resistant in an attempt to avoid anxiety brought to the counseling process. Resistance can be very obvious, such as canceling or delaying appointments, not following through, or not fully engaging in the process. Resistance can be very obvious, such as canceling or delaying appointments, not following through, or not fully engaging with the process. Resistance can also be subtler; clients can display resistance through inadequate therapeutic interventions, such as having an agenda that does not meet clients; needs. Although resistance can interfere with the process, it can also be very powerful to deal with effectively. Counselors need to pay close attention to resistance, understand its origins, and work to help clients recognize and work through blockages.

Reflection

Restatement of what the counselor heard from the client, emphasizing any underlying emotional content (can be termed reflection of feeling)

Goals

Setting goals is an important aspect of the therapeutic process. Talk therapy may seem unstructured or capable of lasting for long periods of time; however, both the client and the counselor are responsible for working toward measurable change. Goals of counseling can include the desire for physical change, such as getting into shape or losing weight, and career aspirations and/or social goals, such as gaining increased support or modifying relationships. Other types of goals can include emotional, spiritual, and intellectual. Goals can be immediate, short-term, or long-term, and clients may want to achieve several goals at different paces. Goals can take the form of SMART goals.

Silence

Silence can be an effective skill in therapy but must be used carefully, especially in the early stages of the process. Initially, clients may be silent due to many factors, such as fear, resistance, discomfort with opening up, or uncertainty about the process. Counselors who use silence in initial sessions must ensure clients do not perceive the counselor as bored, hostile, or indifferent. As counseling progresses, clients may gain additional comfort with silence and use it as a way to reflect content, process info, consider options, and gain self-awareness. Newer counselors may have more difficulty with silence they may believe they are not being helpful if they are not talking. Silence is also viewed differently by culture, so cultural awareness is important in understanding and using it as a therapeutic tool.

SMART goals

Specific, Measurable, Achievable, Relevant, and Time-bound -Specific: Detailing why you want to accomplish the goal, what specifically there is to accomplish, who is involved, the setting for the goal, and what kind of resources are involved. -Measurable means designating a system of tracking your goals in order to stay motivated. -Achievable is making sure that the goal is realistic, like looking at financial factors or other limitations. -Relevant means making sure it's the right time for the goal, if it matches your needs, or if the goal seems worthwhile to pursue. -Time-bound is developing a target date so that there is a deadline to focus on.

Spirituality

Spirituality is a component of overall wellness and can be incorporated into the counseling process. It must be noted that spirituality is different from religion, although individuals may define the concepts in different ways. A client's spiritual views may encompass their sense of purpose, meaning, the reason for existence, worldview, and sense of place in the universe. Counselors need to be aware of their own spirituality and be able to be appropriately support a client without imposing or rejecting their spiritual views. Spiritual practices that can be helpful in counseling include meditation, prayer, mindfulness, and reflection.

Summarizing

Summarizing is another active listening and rapport-building technique. The counselor listens to the content provided by the clients and summarizes the essential points of the conversation. This process can help isolate and clarify the essential aspects of issues and ensure that both the client and the counselor can focus on the most critical tasks. Additionally, summarization can be helpful in goal setting or at the end of a session.

Support

Support is a broad term for the way in which a counselor provides assistance and care to clients. Nonjudgmental support helps clients to open up, identify issues and the need for counseling, and set personal goals. A counselor can support a client by providing reassurance, acting as a sounding board, and simply listening without reaction. For the client, support form the counselor can allow a sense of being temporarily unburdened, which can facilitate healing. Support groups allow for peers or individuals experiencing similar issues (such as single parents and those struggling with addiction or eating disorders) to provide companionship and comfort through shared experiences.

Coping Skills

Teaching coping skills is an important role of the counselor in the therapeutic relationship. Coping skills enable individuals to manage stressful situations, solve problems, handle uncertainty, and develop resilience. Coping skills can include solution-focused problem solving, removing negative self-talk, learning mindfulness or other stress management techniques, and gaining support through friends, family, and community. Individuals may learn how to identify specific patterns to their feelings and behaviors, and thus, learn new and healthier responses. As there are many ways for individuals to develop and practice coping skills, counselors can provide options and unique plans for clients to best meet their needs.

Confrontation

Technique in which the counselor identifies discrepancies from the client in a supportive manner (counselor may also ask for clarification to determine if content was misheard prior to exposing possible inconsistencies)

Wellness

The concept of wellness is multidimensional and includes six aspects of health: occupational, physical, emotional, spiritual, intellectual, and social. Wellness is holistic and stresses the need for individuals to find balance and maximize their potential. It can be considered to be more of a luxury than an essential need. Wellness is a higher level of functioning for those who have their basic needs met and are seeking a more successful existence.

Congruence

The term congruence is associated with the person-centered work of Carl Rogers Congruence can be defined as genuineness on the part of the counselors, in that their is agreement on their words and actions. Counselors display congruence when their body language, affect, and words correspond to demonstrate genuine concern for the client. Lack of congruence is revealed when counselors express concern but at the same time seem bored, disinterested, or use language that does not indicate true understanding of the client. Counselors who are nonreactive or act as a blank screen for clients are not expressing congruence. Rogers considered congruence to be essential for effective counseling.

Guidelines for Giving Advice

There are two main types of advice: substantive and process. Substantive advice can be considered directive and may involve the counselor imposing his or her opinions onto client. Process advice is more empowering and helps clients navigate options for solving their own issues. An example would be a client who is struggling with anxiety. Substantive advice would be the counselor telling the client he or she should practice deep breathing. Process advice, in the same example, would be teaching the client how relaxation techniques can lessen anxiety and provide examples. Counselors can offer process advice to help clients better understand their problems and possible solutions. Clients may ask for advice, and in some situations, it may be appropriate for the counselor to offer process advice; it is less likely that substantive advice should be given. Providing counseling is more complex than simply giving advice; thus, counselors should explore when, why, and how to give advice, if needed. As the goal of counseling is to help individuals gain a better self-awareness and competence, giving advice may undermine the process by not allowing clients an opportunity to learn ways to solve their own issues both within and after counseling.

Touch

There is some controversy over the use of touch in counseling. Studies have found that touch, such as a pat on the shoulder or a hug, can be very beneficial to some clients. Touch can provide comfort, reassurance, grounding, and support. However, there is an argument that touch violates personal boundaries and can be considered unethical. Touch is also interpreted in widely different ways across cultures; the United States is considered a "low touch" culture. For counselors, it is important understand ethical and intercultural issues surrounding the use of touch and to use it only if and when is needed and can be therapeutically beneficial.

Five Tasks for Healthy Individuals

To assist individuals in achieving wellness, it is essential for counselors to understand all facets and influences on well-being. The World Health Organization initially defined well-being as physical, social, and mental wellness, along with the absence of disease. This idea was expanded by Myers, Witmer, and Sweeney, who created the Wheel of Wellness concept, in an attempt to understand and classify the "whole" person. The Wheel of Wellness concept in an attempt to understand and classify work and leisure, friendship, love, and self-direction. Self-direction contains twelve subtasks: sense of worth, sense of control, realistic beliefs, emotional awareness and management, problem solving and creativity, sense of humor, nutrition, exercise, self-care, stress management, gender identity, and cultural identity.

Transference

Transference is a concept from psychoanalysis that refers to the process of the clients transferring feelings toward others onto the counselor. These feelings are likely unconscious, as they arrive from childhood experiences and relationships. For example, the counselor may remind clients of their distant parent, and the clients will project feelings about the parent onto the counselor. Transference can be very powerful, although both positive and negative forms exist. Positive or good transference allows clients to work through issues with the counselor, who is safe and nonreactive. Clients can project negative feelings and emotions onto the counselor, thus being able to resolve them in the absence of a parent or individual. Negative or bad transference exists when clients project negative emotions and become angry or hostile towards the counselor. This type of transference can create a blockage and diminish the effectiveness of therapy. It is the role of the counselor to understand and manage transference as it arises in the relationship. Transference can also occur for the counselor with clients. Supervision and consultation are both helpful and necessary should this occur.