Theories Ch 4

Purposes of Confrontation

Help clients explore other ways of perceiving themselves or an issue. Help clients become more aware of discrepancies or incongruities in thoughts, feelings, and actions.

Helper initiated silences

are effective when used for a particular purpose (slowing down the pace of the session, giving the client time to think).

Clarification response

asks the client to elaborate on a vague, ambiguous, or implied statement. Use when you are unsure of the client's message & need more elaboration. Use to verify a clients message. Use to determine the accuracy of messages as they are received & processed.

Interpretation

is a statement based on the helper's hunches identifies behaviors, patterns, goals, wishes, and feelings that are suggested or implied by the client's communication Can contribute to the development of a positive therapeutic relationship Identify patterns between clients' explicit and implicit messages and behaviors Help clients examine behavior from different frame of reference in order to enhance understanding of problem Promote insight

Connective listening

listening that connects us with our clients

Reflective listening

listening to ourselves and focusing our attention inward to develop sensitivity to our internal voice

Reflection

paraphrasing that adds an emotional tone Reflection of feelings is used to rephrase the affective part of the message.

Six Influencing Responses

1) Questions 2) Interpretations (= additive or advanced empathy) 3) Information giving 4) Immediacy 5) Self-disclosure 6) Confrontation

Steps in confronting

1) What discrepancy or distortions do I see, hear, or grasp in this client's communication? 2) What is my purpose in confronting the client, and is it useful for this client at this time? 3) How can I summarize the various elements of the discrepancy or distortion? 4) How will I know whether my confrontation is effective?

Steps in Information Giving

1) What information does this client lack about the issue? 2) Based on the client's ethnic, racial, and cultural affiliations, is this information relevant and appropriate? 3) How can I best sequence this information? 4) How can I deliver this information so that the client is likely to comprehend it? 5) What emotional impact is this information likely to have on this client? 6) How will I know whether my information giving has been effective?

Steps in Immediacy

1) What is going on right now (in me, with the client, in the process and interaction between us) that needs to be addressed? 2) How can I formulate an immediacy response that addresses this issue in the 'here and now'? 3) How can I describe the situation or behavior in a descriptive rather than an evaluative way? 4) How can I identify the specific effect of this situation or behavior? 5) How will I know if my immediacy response is useful to the client?

Ground rules for giving information

A helper should consider: (1) when to give information, (2) what information is needed, and (3) how the information should be delivered. Information is useful if it is something clients are not likely to find on their own. The information should be discussed in a way that makes it usable to the client. Make an effort to promote client understanding of the information (avoid jargon). Consider using digital media.

Reflection helps clients:

Address and defuse misunderstandings that arise. Discriminate among various feelings (depressed or anxious?) Manage feelings Express feelings Feel understood

Confrontation/Challenge

An influencing response where the helper describes discrepancies, conflicts, and mixed messages in the client's feelings, thoughts, and actions.

Steps in Summarizing

Attend to & recall message or messages what has the client been focusing and working on? Identify apparent patterns, themes, or multiple elements of messages Select sentence stem and description of apparent theme and weave together in summarization Construct in statement rather than question Assess effectiveness listening for and observing whether the client confirms or denies the theme

Steps of Paraphrasing

Attend to and recall message by restating covertly- what has client conveyed? Identify content part of the message by asking "What situation, person, object, or idea is discussed in this message?" Select appropriate beginning or sentence stem for paraphrase Translate key content or constructs into own words and verbalize as a paraphrase Assess effectiveness of paraphrase by listening to and observing the client's response

Ground rules for challenging

Be aware of your own motives for challenging at any particular time. Focus on the incongruity as the problem, not on the person. Before a helper confronts a client, rapport and trust should be established. Timing confrontation when the client is likely to use it (timing)

Purpose of Open-Ended Questions

Beginning an interview Encouraging the client to convey more information Elicit examples of specific behaviors, thoughts, or feelings. Develop client's commitment to communicate by inviting the client to talk and focus interaction

Four Listening Responses

Clarification begins with a question, often posed after an ambiguous client message. Paraphrase is rephrasing of the content part of a message—the part that describes a situation, event, person, or idea. Reflection is a rephrasing of the client's feelings, or the affect part of the message. Summarization is an extension of the paraphrase and reflection responses; tying together and rephrasing of two or more parts of a message or messages.

Reflection allows us to:

Demonstrate desire to comprehend Discuss what is important to the client Use verbal responses that refer to client feelings Use verbal responses that bridge or add on to implicit client messages

Client reaction to challenges

Denial, confusion, false acceptance, genuine acceptance Clients with trust issues or oppositional behaviors, confrontation can produce resistance and lead to poorer outcomes General rule after confrontation follow with basic empathy and go back to the client-oriented listening responses of paraphrase and reflection.

Guidelines for the use of questions

Develop questions that center on client's concerns and arise from what client has already said, not from helper's curiosity or need for closure Allow client sufficient time to process and respond Avoid stacking ask only one question at a time Avoid accusatory or antagonistic ?? use what instead of why ?? Don't rely on questions as primary response mode Questions are most effective when they provoke new insights and yield new information

Steps in clarifying

Identify content of the verbal and nonverbal message - what has client said? Identify vague or confusing parts of message - check for accuracy or elaboration Construct the question "Could you describe?" "Could you clarify?"

Information giving and purposes

Information giving data or facts about experiences, events, alternatives, or people. Information is necessary when clients do not know their options. Helpful when clients are unaware of possible outcomes of a particular choice or plan of action. Help clients examine issues they have been avoiding. Provide clients with structure at major transition points in the helping process such as beginnings and endings.

Three categories of nonverbal behavior

Kinesics, or body motion gestures, body movements, posture, touch, facial expressions, & eye behavior. Paralinguistics vocal cues - or the "how" of the communication; vocal qualities, vocalizations, silent pauses, &speech errors. Proxemics - one's use of personal and social space. Size of the room, seating arrangements, the distance between helper & client, & the use of touch.

Filtered listening

Labels and biases and a temptation to look for corroborative behaviors. When clients detect filtered listening they shut down

Purpose of paraphrasing

Lets clients know they have been understood Encourages elaboration of key idea or thought Helps client focus on particular situation, event, or idea Often helpful to clients who have decision to make; repetition of key ideas and phrases clarifies essence of problem Useful when emphasizing content if attention to affect is premature or counterproductive

Steps in Reflecting Feelings

Listen for feeling or affect words in client messages Watch nonverbal behavior Reflect feelings back, using different words to accurately capture feeling & intensity Start reflection statement with sentence stem Add context or situation which the feelings occur in form of brief paraphrase Assess the effectiveness of reflection

Listening vs Influencing

Listening involves responding to messages primarily from client's point of view Influencing responses are active rather than passive Reflect helper-directed more than client-centered style

Importance of stories

Listening is healing because helps clients tell their stories. Narratives construct clients' identities and infuse their lives with meaning and purpose. Ivey and colleagues (2007) recommend listening for: the facts of the story client's feelings about the story the way in which the client organizes the story. Each time story is told, another part is remembered, something new is learned, insight is gained, or wound is healed.

Purpose of Close-Ended questions

Narrowing the area of discussion by asking the client for a specific response Gathering specific information Identifying parameters of concerns Interrupting an overly talkative client who rambles or "storytells"

Ground rules for interpreting

Need to be offered in the context of a safe and empathic contact with the client. Based on the client's actual message rather than on your own biases and values. In most cases, should be phrased tentatively. Must be congruent with the client's cultural affiliations. Incongruent or slightly discrepant from the client's viewpoint are most likely to prompt change.

Unintentional disclosures

Occur when a client observes or discovers something about the clinician

Ground rules of self disclosure immediacy

Offer observations in the moment Frame feedback in present tense Take responsibility for feelings & perceptions using personal pronoun I, me, or mine Avoid extensive use of immediacy early in relationship Reserve for initiating exploration of most significant or influential feelings or issues Ensure that immediacy response not reflection of counter transference experiencing Consider cultural appropriateness

3 Obstacles to deep listening

Playing tapes prerecorded opinions Checklist listening do we agree/disagree Tension nervous in role as therapist

Three Processes of Listening

Receiving message-covert process, contemplative listening Processing message- covert process, reflective listening Sending messages- overt process, connective listening

Paraphrase

Rephrasing the clients primary words and thoughts Translating the key ideas into your own words

Ground rules of self-disclosure

Self-disclosure in most instances is not useful until rapport has been established Moderate amount of disclosure has more positive effects than no disclosure or too much Extended periods of helper disclosure will consume time that could be spent in client disclosure. The depth, or intimacy, of the information revealed. Make your statements similar in content and mood to the client's messages.

Purposes of summarizations

Tie together multiple elements of client messages. Identify a common theme or pattern that becomes apparent after several messages or sometimes after several sessions.Focusing tool that brings direction to the interview. Slow the pace of a session that is moving too quickly. Review progress that has been made during one or more interviews.

Steps in self-disclosure

What is my reason for disclosing now? Is it linked to the client's needs and statements rather than to my own needs and projections? What do I know about this client and the nature of the client's problems and diagnoses? Can this client use the self-disclosure? How do I know if the timing is right for using self-disclosure with this client? How will I know if my self-disclosure is effective?

Self disclosure immediacy & purposes

What is occurring in the present Bring up something that you feel about yourself, about the client, or about the relationship. Generate discussion or provide feedback about some aspects of the relationship or the interactions. Help clients gain awareness of their relationships and issues that may be causing problems with other people.

Steps in Interpreting

What is the implicit part of the client's message? Is my view of this issue culturally relevant for this client? How will I know whether my interpretation is useful?

Four Steps in Formulating Questions

What is the purpose of my question, and is it therapeutically useful? Can I anticipate the client's answer? Given the purpose, how can I start the wording of my question to be most effective? How will I know whether my question is effective?

Contemplative listening

When we are truly silent, we are not focused on what we are going to say next. Processing includes thinking about the message and pondering its meaning.

When are closed questions useful?

When you need a particular fact or particular bit of info Too many can discourage discussion

Leakage

communication of nonverbal messages that are valid yet are not sent intentionally

Summarization

define as two or more paraphrases or reflections that condense the client's messages or the session. Looks at themes which indicate what the client needs to focus on in therapy

Self-disclosure

the revelation of personal information about therapist

Clients use silence

to express emotions, reflect on an issue, recall an idea or feeling, avoid a topic, or to catch up on the progress of the moment.