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Ingredients of an Effective Helping Relationship 85 Your client, Lettitia, who is a client of color, is crying about being taunted about her skin color on the bus. She is very upset about what has happened to her, and this is not the first time that she has had to endure taunts due to her race. Consider the possible ways in which a helper could facilitate cultural empathy via the use of these six levels of validation in Table 3. 1. Empathy and the Holding Environment The empathic mirroring and limit-setting responses we have described are often referred to as the provision of a therapeutic holding environment (Winnicott, 1958). A holding environment means that the therapist con-veys in words and/or behavior that he or she knows and understands the deepest feelings and experience of the client and provides a safe and supportive atmosphere in which the client can experience deeply felt emotions. As Cormier and Hackney (2012) note, it means “that the helper is able to allow and stay with or 'hold' the client's feelings instead of moving away or distancing from the feelings or the client. In doing this, the counselor acts as a container; that is, the counselor's comfort in exploring and allowing the emergence of client feelings provides the support to help the client contain or hold various feelings that are often viewed by the client as unsafe” (p. 114). The therapist as a container helps the client to manage what might otherwise be experienced as overwhelming feelings by providing a structure and safe space in having to do so. Josselson (1992) points out that “of all the ways in which people need each other, holding is the most pri-mary and the least evident,” starting with the earliest sensations that infants experience—the sensation of be-ing guarded by strong arms that keep them from falling and also help them to unfold as unique and separate individuals (p. 29). A child is sufficiently nourished in such an environment and, just as important, the child also feels real. As Josselson notes in her affirmative work on adult human relationships, this need for holding or groundedness does not disappear as we grow up, although the form of holding for adults may be with institutions, ideas, and words as much as with touch. Individuals who do not experience this sense of holding as children often grow up without a sense of grounded-ness in their own bodies as well as without a sense of self as separate and unique persons. Often their energy or life force is bound up and/or groundless, and they may seek to escape their sense of nothingness by becoming attached to any number of addictions. Josselson (1992, p. 36) provides an excellent description of how the pro-cess of therapy can support clients' growth through the provision of this sort of holding environment: People often come to psychotherapy because they need to be held while they do the work of emotionally growing. They need a structure within which they can experience frightening or warded-off aspects of themselves. They need to know that this structure will not “let them down. ” They also need to trust that they will not be impinged upon by unwanted advice or by a therapist's conflicts or difficulties. Psychotherapy, because of clinicians' efforts to analyze what takes place, is one of the best understood of holding environments. Therapists “hold” patients as patients confront aspects of their memory and affective life that would be too frightening or overwhelming to face alone. (One of my patients once described her experi-ence of therapy as my sitting with her while she confronts the monsters inside) (p. 36. ) Keep in mind that in various cultures this sort of holding environment is supplied by indigenous healers as well. TAb LE 3. 1 Validation and Cultural Empathy Level 1 (V1) Listening/Observing Sample Response Helper nods head, looks at client, listens Level 2 (V2)Accurate Reflection “You feel upset about being taunted by the white kids because of your skin color. ” Level 3 (V3)Articulating the Unverbalized Reflection above PLUS “You wish they would just leave you alone and let you be who you are”. Level 4 (V4)Validation of Past Learning“I know this isn't the first time you've had to endure this. It gets too tiresome and I can see why it would be so upsetting. ” Level 5 (V5)Validation of Present Context“It makes sense that being taunted for something so basic and so important to who you are, your identity, would feel so painful. ” Level 6 (V6)Radical Genuineness“It's so remarkable that in the face of all these taunts you always hold your head up high and don't back down. ” Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
86 Chapter 3 Holding Environments and Family of Origin Teyber and Mc Clure (2011) have noted that the effec-tive holding environment provided by a helper is usu-ally dramatically different from what the young client is experiencing or what an adult client experienced while growing up. For example, if the child was sad, the par-ent may have responded by withdrawing, by denying the child's feelings, or by responding derisively (Teyber & Mc Clure, 2011). In all these parental reactions, the child's feeling was not heard, validated, or “contained”; as a result, the child learned over time to deny or avoid these feelings (thus constituting the “false self” we described previously). Children are developmentally unable to ex-perience and manage feelings on their own without the presence of another person who can be emotionally pres-ent for them and receive and even welcome their feelings. If the parent was unable to help the child hold feelings in this manner, then it will be up to the helper to do so. In this way, the helper allows clients to know that he or she can accept their painful feelings and still stay emotionally connected to them (Teyber & Mc Clure, 2011). If the helper cannot do so, either because of discomfort with the client's pain or because of feelings that have been stirred up in working with the client, then this constitutes a countertransferential reaction. Holding Environments and Self-Object Relationships Teyber's ideas reflect the work of Kohut (1971a, 1971b) on self-object relationships, in which the development of the child's sense of self depends greatly on the capacity of the child's caretakers, the “self-objects,” to fulfill certain psychological functions that the child cannot yet provide for himself or herself. Support and empathy are two of the most important of these psychological functions that the caregiver provides for the developing child. These ongoing supportive and empathic exchanges (or lack thereof) form the basis of the child's psychic infrastructure and impact how the child will be able to relate to himself or herself as well as to others. Some relationship theorists consider this idea to be Kohut's most important contribution, not only because it explains much about an individual's capac-ity for relatedness but also because his notions about the relationship between the child and caregiver have many analogues in the therapeutic relationship between the helper and client. From this perspective, when misunder-standings or empathic breaches occur in counseling, the helper may gently inquire if the current empathic break feels similar in any way to something that occurred in the client's relationship with a caregiver. In fact, in this way, one could look at the healing that occurs in the therapeu-tic relationship as the result of giving the client “a second developmental chance” (Cashdan, 1988, p. 22). Caveats and Adaptations in Empathic Responding While empathic responding forms the basis for radical acceptance of clients, like other therapeutic responses it is not universally effective and the use of it needs to be adapted across clients. As Neacsiu and Linehan (2014) observe, impasses in helping can occur when the helping process is skewed either too much toward acceptance or too much toward problem-solving and a lack of bal-ance ensues. Elliott and colleagues (2011) note that both “clinical and research experience suggest that the amount of therapist empathy varies as a function of the client” (p. 143). They assert that “certain fragile clients may find the usual expressions of empathy too intrusive, while hostile clients may find empathy too directive; still other clients may find an empathic focus on feelings too for-eign. ” (p. 146). In some instances, helpers may be more empathic by not overtly expressing empathy with cer-tain clients who do not respond favorably to empathic expressions. Because true empathy means therapeutic 3. 1 Feedback Validating Empathy Part One Here are some examples of validating responses. Discuss your emotional reactions and your response with a part-ner or in a small group. 1. I realize you are disappointed and upset about wanting me to have the same sort of feelings for you that you say you have for me. 2. It is important to you to feel very special to me. I understand this as your way of telling me something about what has been missing for you in your life. 3. I realize you feel caught between two things—your religious and cultural history and your love for this woman. You wish I could tell you what to do, and you're upset with me that I won't. Part Two 1. V2 Accurate Reflecting2. V1 Listening and Observing3. V4 Validation in Terms of Past Learning4. V5 Validation in Terms of Present Context5. V6 Radical Genuineness6. V3 Articulating the Unverbalized Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 87 attunement with clients, the best expression of empathy is the one that best fits with the person sitting in front of us at a given moment in time. “When clients do not want therapists to be explicitly empathic, truly empathic thera-pists will use their perspective-taking skills to provide an optimal therapeutic distance in order to respect their clients' boundaries” (Elliott et al., 2011, p. 146). Genuineness or Congruence Genuineness—also referred to as congruence—is the art of being oneself without being phony or playing a role. Although most practitioners are trained to be pro-fessionals, a helper can convey genuineness by being hu-man and by collaborating with the client. Genuineness contributes to an effective therapeutic relationship by reducing the emotional distance between the helper and client and by helping the client to identify with the helper, in other words, to perceive the helper as another person similar to the client. Congruence has a central place in the three facilitative conditions, in part because it sup-ports empathy and positive regard and in part because Rogers saw the process of therapy as helping clients be-come more congruent (Kolden, Klein, Wang, & Austin, 2011). Empirical support for this facilitative condition of genuineness or congruence suggests that the contribution of congruence to client outcomes is mixed but leaning toward the positive and appears to be especially important in younger, less educated, and perhaps less psychologically sophisticated clients (Kolden et al., 2011). Genuineness has several components: supporting nonverbal behaviors, role behavior, consistency, and spontaneity (see also Egan, 2014; Kolden et al., 2011). Recent conceptualizations of genuineness also have extended the definition of it to include therapeutic presence, the notion of using oneself as a healer (Geller & Greenberg, 2002). Supporting Nonverbal Behaviors Genuineness is communicated by the helper's use of ap-propriate, or supporting, nonverbal behaviors. Nonverbal behaviors that convey genuineness include eye contact, smiling, and leaning toward the client while sitting. How-ever, these three nonverbal behaviors should be used dis-creetly and gracefully. For example, direct yet intermittent eye contact is perceived as more indicative of genuineness than is persistent gazing, which clients may interpret as staring. Similarly, continual smiling or leaning forward may be viewed as phony and artificial rather than genuine and sincere. One way to convey genuineness with sup-porting nonverbal behaviors is to engage in nonverbal communication that parallels that of the client. This is called synchrony, which refers to the degree of harmony between a practitioner's and a client's nonverbal behavior. Synchrony, or mirroring of body posture and other cli-ent nonverbal behaviors, contributes to rapport and the facilitative conditions. Synchrony does not mean that the helper mimics every move or sound the client makes! It is more about matching the practitioner's overall nonverbal demeanor so that it is closely aligned with or very similar to the client's. Role Behavior Counselors who do not overemphasize their role, author-ity, or status are likely to be perceived as more genuine by clients. Too much emphasis on one's role and position can create excessive and unnecessary emotional distance in the relationship. Clients can feel intimidated or even resentful. The genuine helper also is someone who is comfortable with himself or herself and with a variety of persons and situations and does not need to put on new or different roles to feel or behave comfortably and effectively. As Egan (2007) observes, genuine helpers “do not take refuge in the role of counselor. Ideally, relating at deeper levels to others and to the counseling they do is part of their lifestyle, not roles they put on or take off at will” (p. 56). Consistency Consistency exists when the helper's words, actions, and feelings match—when they are congruent. For example, when a therapist becomes uncomfortable because of a client's constant verbal assault, she acknowledges this feeling of discomfort, at least to herself, and does not try to cover up or feign comfort when it does not exist. Practitioners who are not aware of their feelings or of discrepancies among their feelings, words, and actions may send mixed, or incongruent, messages to clients—for example, saying, “Sure, go ahead and tell me how you feel about me,” while fidgeting or tapping their feet or fingers. Clients are likely to find such messages very confusing and even irritating. Spontaneity Spontaneity is the capacity to express oneself naturally with-out contrived or artificial behaviors. Spontaneity also means being tactful without deliberating about everything you say or do. However, spontaneity does not mean that helpers need to verbalize every passing thought or feeling to clients, par-ticularly negative feelings. Rogers (1957) suggests that help-ers express negative feelings to clients only if the feelings are constant and persistent or if they interfere with the helper's ability to convey empathy and positive regard. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
88 Chapter 3 Therapeutic Presence The word presence comes from the Latin word praesentia, meaning “to be present before others. ” Think of the oppo-site of the word presence and immediately the word absence will most likely come to your mind. In the simplest form, therapeutic presence means all that the Latin root conveys, being there for the client, not just in a physical sense, but in an emotional sense as well. Presence means bringing oneself into the room with the client, coexisting with the client for moments of time and space. (It remains unclear whether the quality of presence is conveyed in distance counsel-ing or not. ) When therapeutic presence exists, an unseen, unspoken connection exists between the helper and the client. Therapeutic presence is most commonly defined as the quality of self or way of being that helpers bring to the therapeutic encounter (Geller & Greenberg, 2002). Therapeutic presence involves a giving of the self, emerg-ing out of both qualities of accessibility and centeredness. Being accessible implies being available and being open to what is happening in the moment with the client, in a sense in an unedited fashion. Being centered involves the capacity to be so aware of and grounded in your own in-ner experience that your own energy remains stable and is not shaken even in the midst of strong client emotion. As Gehart and Mc Collum (2008) observe, from this perspec-tive “the therapist must be able to fully encounter the client's experience while maintaining the ability to observe his or her own reactions and experiences and to act thoughtfully based on the confluence of these aspects of the relationship” (p. 178). T raditionally, it has been challenging to teach the concept and skills of therapeutic presence to trainees, yet emerging studies are using mindfulness training as a means for developing therapeutic presence (Geller & Greenberg, 2002; Gehart & Mc Collum, 2008). Research on mindful-ness training indicates that such practice increases one's capacity to regulate mood and increases positive affect by increasing the ability of the prefrontal cortex in the brain to shut down stress responses from the brain's limbic system, allowing oneself to readily calm and self-soothe in moments of stress and crisis. Gehart and Mc Collum (2008) note that the parallels between mindfulness and therapeutic pres-ence are remarkably similar. Some research has discovered that having clinicians who meditated prior to counseling sessions resulted in better treatment outcomes for clients (Grepmair et al., 2007). Positive Regard Positive regard, also called respect, is the ability to prize or value the client as a person with worth and dignity (Rogers, 1957). Communication of positive regard has a number of important functions in establishing an effective therapeutic relationship, including the communication of willingness to work with the client, interest in the client as a person, and acceptance of the client. Farber and Doolin (2011) conclude that “therapists' provision of positive regard is strongly indicated (by the research) in practice” (p. 183). In fact, these authors go on to say that “there is virtually no research-driven reason to withhold positive regard” from any client (p. 183). Their meta-analysis of positive regard found that this facilitative condition is especially important in situations wherein a nonminority helper is working with a minority client. Egan (2014) has identified several components of positive regard: having a sense of commitment to the client, suspending critical judgment, and showing competence and care. Positive regard also involves expressing warmth to clients (Rogers, 1957; Farber & Doolin, 2011). Commitment Commitment means you are willing to work with the client and are interested in doing so. It is translated into actions such as being on time for appointments, reserving time for the client's exclusive use, ensuring privacy during sessions, maintaining confidentiality, and applying skills to help the client. Lack of time and lack of concern are two major barriers to communicating a sense of com-mitment. Egan (2014) points out that commitment also involves a sense of being on the client's side. He states, “It is as if you are saying to the client, working with you is worth my time and energy” (p. 47). Nonjudgmental Attitude A nonjudgmental attitude is the helper's capacity to suspend judgment of the client's actions or motives and to avoid condemning or condoning the client's thoughts, feelings, or actions. It may also be described as the helper's acceptance of the client without conditions or reserva-tions, although it does not mean that the helper supports or agrees with all the client says or does. A helper con-veys a nonjudgmental attitude by warmly accepting the client's expressions and experiences without expressing disapproval or criticism. For example, suppose a client states, “I can't help cheating on my wife. I love her, but I've got this need to be with other women. ” The helper who responds with regard and respect might say something like, “You feel pulled between your feelings for your wife and your need for other women. ” This response neither condones nor criticizes the client's feelings and behaviors. In contrast, a helper who states, “What a mess! You got married because you love your wife. Now you're fool-ing around with other women,” conveys criticism and lack of respect for the client as a unique human being. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 89 The experience of having positive regard for clients can also be identified by the presence of certain (covert) thoughts and feelings, such as, “I feel good when I'm with this person,” or “I don't feel bothered or uncomfortable with what this person is telling me. ” Competence and Care As helpers, we convey positive regard and respect by taking steps to ensure that we are competent and able to work with the clients who come to us for help. This means that we get supervision, consultation, and continuing education to maintain and improve our skills. It also means under-standing that we are not know-it-alls and that we keep on learning and growing even after getting our degrees and working in the field. It also means that we act in principled ways with clients. When we are confronted with a client we cannot work with, we use an ethical referral process. Above all else, we do not use clients for our own needs, and we are careful not to behave in any way that would exploit clients. We also are careful to pursue agendas of the client rather than our own (Egan, 2014). Keeping the client's agenda in focus, as Egan (2014) states, is similar to not rushing to judgment about clients. Egan (2010) concludes that we are here to help clients pursue their agendas rather than pushing our own values and goals onto clients. We need to recognize that the latter instance is an ethical violation of all of the profes-sional codes for helping. Warmth In his earliest writings, Rogers spoke of positive regard as nonpossessive warmth. Although warmth is hard to define operationally, we can connote the meaning of the term through the various kinds of interactions we have with other people. All of us know persons with whom we interact and feel some immediate connection from being in their presence. Also, we can recollect a chill that comes over a room or surrounds us when interacting with other folks who may be cold and distant in their approach. A primary way in which warmth is communicated is by supporting nonverbal behaviors such as voice tone, eye contact, facial animation and expressions, gestures, and touch. Johnson (2014) describes some nonverbal cues that express warmth or coldness. For example, warmth is expressed with a soft tone of voice; a harsh tone of voice reflects coldness. Maintaining some eye contact, smil-ing, and using welcoming gestures also reflect warmth. Remember that these behaviors may be interpreted dif-ferently by clients from various ethnic, racial, and cultural groups. For example, in some cultures direct eye contact is considered disrespectful, particularly with a person of authority or an elder (Sue & Sue, 2013). An important aspect of the nonverbal dimension of warmth is touch. In times of emotional stress, many clients welcome a well-intentioned touch. The difficulty with touch is that it may have a different meaning to the client than the one you intended to convey. In deciding whether to use touch, it is important to consider the level of trust between you and the client, whether the client may perceive the touch as sexual, the client's history as-sociated with touch (occasionally a client will associate touch with punishment or abuse and will say, “I can't stand to be touched”), and the client's cultural group (whether touch is respectful and valued). Also, because of all the clients who present with trauma history, it is important to observe clear boundaries surrounding touch. Check with the client and discuss these boundaries first. Warmth can also be expressed to clients through selected verbal responses. One way to express warmth is to use enhanc-ing statements that portray some positive aspect or attribute about the client, such as, “It's great to see how well you're han-dling this situation,” “You're really expressing yourself well,” or “You've done a super job on this action plan. ” Enhancing statements offer positive reinforcement to clients and to be effective must be sincere, deserved, and accurate. Farber and Doolin (2011) conclude that it is probably insufficient for helpers to simply feel good about their clients. Instead, help-ers need to communicate these positive feelings verbally when they are in the client's presence (though without gushing). The belief that one's helper “cares about me” serves a critical function in the helping relationship, especially as Farber and Doolin (2011) point out, in times of stress. Caveats and Adaptations of Positive Regard All three of the facilitative conditions, but especially posi-tive regard, are related to the facilitation of the work-ing alliance and the development of trust as well as to relationship ruptures in the helping relationship. Farber and Doolin (2011) recommend that helpers monitor and adjust their contribution of positive regard and adjust it as a function of particular client needs and characteristics. They conclude that “the research demonstrates that thera-pists vary in the extent to which they are able to convey positive regard to their patients, and clients vary in the extent to which they need, elicit, and/or benefit from a therapist's positive regard. ” (p. 184). These authors believe that the inevitable ruptures that do occur in the thera-peutic alliance over the course of helping are not only the result of the helper's “technical errors” but also the helper's “occasional inability to demonstrate minimally facilitative levels of positive regard and support” (p. 184). In the next section, we explore how the working alliance is developed, tested, and sustained in the therapeutic process. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
90 Chapter 3 The Working Alliance Horvath, Del Re, Fluckiger, and Symonds (2011) point out that the therapeutic alliance has a lengthy history in psychotherapy, beginning with the work of Freud, although all therapeutic approaches consider the alliance to be very important. The term working alliance was coined by Greenson (1967), who viewed the relationship as a sort of therapeutic collaboration and partnership in which counselor and client pull together in a joint ven-ture, much like rowing a boat. It is important to note that the working alliance is related to but not synonymous with the therapeutic relationship. The working alliance can be thought of as what has been achieved between the helper and client as a result of the effective implementa-tion of the therapeutic relationship elements. The work-ing alliance is a way to think about how or in what ways the helper and client are working together (Muran and Barber, 2010). Three Parts of the Alliance Bordin (1994) expanded Greenson's work and noted spe-cifically that this alliance comprises three parts: 1. Agreement on therapeutic goals2. Agreement on therapeutic tasks3. An emotional bond between client and therapist Safran and Muran (2006) conceptualize the working alliance as an ongoing process of negotiation between the helper and the client that occurs at both conscious and unconscious levels. These more current conceptualizations of the working alliance emphasize the active collaboration between the helper and client, much like we emphasize in the practice nexus of this book. The alliance itself is not something that works independently of other processes in therapy. As Horvath et al. (2011) observe, the alliance is not really something the helper “builds,” but rather something that is “forged,” as it is “an essential and inseparable part of everything that happens in therapy” (p. 56). The alliance is also something that matters “in all forms of therapy, includ-ing treatments mediated through some media” such as the Internet, the telephone and so forth (Horvath et al., 2011, p. 56). Even when there is not face-to-face contact, as in distance counseling, the helper and client must establish a collaborative way to work together. Empirical Support for the Working Alliance Much research connects the quality of this working al-liance to therapeutic outcomes. In fact, the quality and strength of the working alliance is one of the “strongest and most robust predictors of treatment success” (Horvath et al., 2011, p. 56). Overall, these data, summarized by Horvath et al. (2011), suggest that such an alliance needs to be founded early in therapy, may wax and wane over time, re-emerges during times of crisis, and may be espe-cially influential with more severe client issues. Also, it may be more challenging for helpers to establish a sound working alliance with some kinds of clients, such as those who have high interpersonal anxiety or those diagnosed with personality disorders (Horvath et al., 2011). The working alliance is also impacted by the skills of the helper, particularly negative behaviors such as exhibiting a take-charge attitude early in the helping process, display-ing a lack of warmth, premature interpretation, and irri-tability. These data are underscored by interactional data suggesting that what is most important in establishing a positive working alliance is that the helper-client interac-tions are not hostile or negative (Horvath et al., 2011). In addition, therapists appear to vary in their capac-ity to foster an effective working alliance with clients (Nissen-Lie, Monsen, & Ronnestad, 2010). A recent study found that one explanation for this might be the quality of therapists' personal lives (Nissen-Lie, Hoglend, Monsen, & Ronnestad, 2013). The results of this study suggest that therapists have a greater capacity to establish a strong working alliance with clients when they are not hindered or burdened by negative events in their own lives (Nissen-Lie et al., 2013). Working Alliance and Client Feedback The data on the working alliance highlight the impor-tance of revisiting the strength of the alliance throughout the entire helping process, making sure that agreement on the therapeutic tasks and goals remains consistent and that the emotional connection between the helper and cli-ent remains strong. A critical element in the efficacy of the therapeutic alliance appears to involve client feedback to helpers about the way clients are experiencing the alliance. Miller, Duncan, Sorrell, and Brown (2005) found that when helpers get client feedback about the quality of the alliance, there is substantial improvement in the outcomes of treatment and in the retention of clients in treatment. These findings were especially true for mandated clients most at risk for treatment failure. Notably, the system developed by Miller, Duncan, Sorrell, and Brown (2005), called the Partners for Change Outcome Management System (PCOMS), involves a brief four-item adult or child Session Rating Scale (see www.-talkingcure. com) to assess the therapeutic alliance that can be used very easily and quickly by practitioners. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 91 Helper Skills and the Working Alliance What helper skills promote a strong working alliance? Clients report that feeling understood, supported, and hopeful is connected to the strength of the working alli-ance, particularly in the early part of the helping process. In addition, the working alliance is also impacted by the client's trust in the helper. As Safran and Muran (2006, p. 289) noted, the alliance highlights the fact that at the most basic level the client's ability to trust and have faith in the helper plays a pivotal role in the change process. Practitioners obviously also need to pay attention to the ways in which this working alliance is formed with various clients, particularly clients from various cultural groups (see Learning Activity 3. 2). The emotional bond reflected in the working alliance between the helper and client is greatly impacted by the level of trust between the two participants. In the follow-ing section, we discuss ways helpers develop and nurture trust within the working alliance. Trust Trust has been described by clients as a “core trait” in the helping relationship (Levitt, Butler, & Hill, 2006, p. 218). Johnson (2014) points out that trust is a complex construct and consists of multiple elements, including behaving in an ethically and morally justifiable manner, making a good-faith effort to honor one's commitments, and being reliable (p. 99). In a qualitative study, clients deepened their trust in their practitioner after taking a risk by revealing some personal vulnerability and experi-encing the therapist's response to the disclosure as caring and respectful (Levitt, Butler, & Hill, 2006). Like many other variables in the helping relationship, trust is an interactional and reciprocal process; the establishment and endurance of trust throughout the relationship can depend on the behaviors and responses of both helpers and clients. However, as with other relationship variables, the responsibility for creating and maintaining trust, es-pecially initially, is in the hands of the helper because the therapeutic relationship is not a symmetrical one and the helper role has some unique responsibilities associated with it. One of these responsibilities is to behave in ways that are more likely to engender trust. Establishing Trust with Clients Many clients are likely to find helpers trustworthy, at least at first, because of the status of helpers' role in society. Clients also are more likely to perceive a helper as trustworthy if she or he has acquired a reputation for honesty and for ethical and professional behavior. Likewise, a negative reputation can erode early trust in a helper. Thus, many clients, par-ticularly those from mainstream cultural groups, may put their faith in the helper initially on the basis of role and rep-utation and, over the course of time, continue to trust the helping professional unless the trust is in some way abused. Clients who are not from a mainstream cultural group may view trustworthiness differently. For these and some other clients, helpers may have to earn initial trust and work hard to sustain trust, especially as helping pro-gresses. T rust can be difficult to establish yet is easily destroyed. Initial trust based on external factors such as the helper's role and reputation must be solidified with appropriate actions and behaviors by the helper during successive interactions. Johnson (2014) points out that many successive con-sistent behaviors are necessary to establish trust, but just one inconsistent behavior is all it takes to destroy it. Once destroyed or diminished, trust is extremely difficult to rebuild. T rust also can be damaged when the helper acts in any way that abuses the inherent power ascribed to the role as helper. For example, if the helper makes unilateral decisions about the client and the helping process and does not collaborate with the client, this abuse of power will diminish trust. Abuse of power may be particularly damaging when you are working with clients who are from nonmainstream cultural groups and who have been disempowered because of their race, ethnicity, income level, sexual orientation, religion, disability, or gender. Learning Activity 3. 2 Working Alliance With a partner or in a small group, discuss how the working alliance may be affected by working with clients such as the following: 1. Children 2. Adolescents3. Older adults4. Persons with disabilities5. Men6. Women7. Clients of color8. LGBTQ clients9. Clients living in poverty 10. Refugee clients11. International clients Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
92 Chapter 3 Whether the helper's trustworthiness becomes an issue may also depend on the age of the client, the client's history with other helpers, and the client's trauma history. Chil-dren often trust helpers very readily unless they have had a prior bad experience with a helper in which their trust was violated or unless they have a trauma history. Regardless of age, almost all clients who have trauma histories will have greater issues in trusting a helper than clients who do not. The behaviors that contribute most importantly to trustworthiness include helper congruence or consistency of verbal and nonverbal behavior, nonverbal acceptance of client disclosures, nonverbal responsiveness and dyna-mism, dependability and consistency between talk and ac-tions, confidentiality, openness and honesty, accurate and reliable information giving, and nondefensive reflections/interpretations of clients' “tests of trust. ” Incongruence, judgmental or evaluative reactions, and passivity quickly erode any trust that has developed. Clients' Tests of Helper Trustworthiness T rust between helpers and clients does not always develop automatically. Clients need to be assured that the helping process will be structured to meet their needs and that the helper will not take advantage of their vulnerability (Johnson, 2014). Usually clients develop trust after they first scrutinize the helper by engaging in subtle maneuvers to determine the helper's trustworthiness (Levitt, Butler, & Hill, 2006). Fong and Cox (1983) call these maneuvers “tests of trust” and liken them to small trial balloons sent up to see how they fly before the client decides whether to send up the big balloon. Practitioners may be insensitive to such tests of trust and fail to realize that trust is the cli-ent's real concern. Instead of responding to the trust issue or to the process level of the message, helpers may respond just to the content, the surface level of the message. Another perspective on client tests of trust is offered by control-mastery theory (Silberschatz, 2005; Weiss, 2002). According to control-mastery theory, clients are motivated to pursue life-enhancing goals but also are afraid to do so because of “pathogenic beliefs” that tell them that in moving toward their goals, they will en-danger themselves or others (Weiss, 2002, p. 2). Weiss (2002) asserts that these pathogenic beliefs are developed in early childhood, usually through traumatic experiences between the child and the caregivers and siblings. For example, if parents neglect a child, then the child may develop the pathogenic belief that he or she would be and even should be neglected by other people as well, including, of course, the therapist. During the counseling process, clients work to disprove these pathogenic beliefs, which are usually unconscious (out of awareness), by test-ing them in relationship to the helper, hoping that the helper will pass these tests. Typically this testing unfolds in a series of trial actions, usually verbal ones, which, ac-cording to the client's beliefs, should impact the helper in a particular way. If the helper does not respond in the pre-dictable fashion, then the client will perceive the helper as passing the trust test and will feel safer to proceed. Weiss (2002, p. 2) provides the following example of how this testing may occur in the actual practice process: A female (client) who unconsciously believed that she had to comply with male authorities lest she hurt them, felt endangered by her therapy with a male therapist. She feared that she would have to accept poor interpretations or follow bad advice. Her plan for the opening days of therapy was to reassure herself against this danger. She tested her belief that she would hurt the therapist if she disagreed with him. First she tested indirectly, then pro-gressively more directly. The therapist passed her tests; he was not upset, and after about 6 months' time the (client) had largely overcome her fear of complying with the therapist, and so became relatively comfortable and cooperative. We hope that this example makes clear that the help-er's task is to decipher what the test of trust is and to respond so that the client's belief is not confirmed. If a client believes the helper will be judgmental and Learning Activity 3. 3 Trust With a partner or in a small group, develop responses to the following questions: 1. For clients belonging to a mainstream cultural group or from racial/cultural backgrounds similar to your own: a. How does trust develop during therapeutic interactions? b. How is trust violated during therapeutic interactions?c. How does it feel to have your trust in someone else violated? d. What are 10 things a helper can do (or 10 behaviors to engage in) to build trust? Of the 10, select 5 that are most important and rank these from 1 (most criti-cal or top priority to establish trust) to 5 (least critical or least priority to establish trust). 2. Complete the same 4 questions listed for clients of color or from a racial/cultural background distinctly different from your own. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 93 rejecting, then the helper will consistently show respect and acceptance. If a client believes that the helper will be domineering or autocratic, then the helper responds by being nonintrusive. Shilkret (2008) describes the use of control-mastery theory in the management of a long-term case in which she relates the client's test of trust via his pathogenic beliefs to the way in which he developed transference with her. She notes: “Clients in treatment will continuously, but unconsciously, assess the therapy relationship to determine if it is safe to recall traumatiz-ing memories and the powerful affects associated with those memories. The client will do this by unconsciously testing the therapist in the transference and watching the therapist's response. But the greater the trauma, the more evidence the client will need to feel unconsciously reassured that it is safe” (p. 289). We discuss more about transference in the next major section of the chapter, as well as its “cousin,” countertransference. Tests of Trust in Cross-Cultural Helping Tests of trust may occur more frequently and with more emotional intensity in cross-cultural helping, often be-cause clients from nondominant groups experienced or are experiencing oppression, discrimination, and overt and covert racism. As a result, these clients may feel more vulnerable in interpersonal interactions such as help-ing ones, which involve self-disclosure and an unequal power base. During initial helping interactions, clients with diverse backgrounds are likely to behave in ways that minimize their vulnerability and maximize their self-protection (Sue & Sue, 2013). In U. S. culture, European American helpers may be viewed automatically as mem-bers of the power elite. We take the position that it may be particularly unwise for clients to trust a helper initially until the helper behaviorally demonstrates trustworthiness and credibility—specifically until the helper shows that he or she: (1) will not recreate an oppressive atmosphere of any kind in the helping interaction; (2) does not engage in discrimination, racist attitudes, and behaviors; and (3) has some understanding and awareness of the client's racial and cultural affiliation (see Learning Activity 3. 3). The communication of facilitative conditions, particu-larly positive regard, seems critical in the development of the level of trust necessary for the effective formation of a sound working alliance. Farber and Doolin (2011) found that the presence of this relational factor was especially salient when nonminority helpers worked with minority clients. They assert that potential client mistrust of the therapist stemming both from societal racial history and also neglect of minority clients by mental health communi-ties may interfere with the formation of a working alliance. They conclude that “the possibility of such mistrust and of related difficulties forging an effective therapeutic relation-ship may well be attenuated by clear indications of the therapist's positive regard, in turn facilitating the likelihood of a positive outcome” (Farber & Doolin, 2011, p. 182). This assertion has been supported empirically in sev-eral studies of the impact of microaggressions in therapy (Owen, Tao, Imel, Wampold, & Rodolfa, 2014). In the most recent of these studies, the results echoed those of earlier studies that found that clients' perceptions of mi-croaggressions are negatively associated with the working alliance in the helping process presumably because these offenses impact clients' levels of trust “conveying the mes-sage that therapy is not emotionally safe” (Owen et al., 2014, p. 289). An important finding in this study was that it was not only the presence of a microaggression that re-sulted in poorer alliance ratings but also whether the ther-apist discussed or ignored the cultural rupture. For clients who experienced a microaggression with no discussion, alliance ratings were lower compared to clients who either did not experience a microaggression or experienced such an offense but had discussion of it in the helping session, “illuminating the power of addressing missteps that can occur in therapy” (Owen et al. 2014, p. 288). Transference and Countertransference In addition to the facilitative conditions and the work-ing alliance, the helping relationship includes elements of past relationships that both the client and the therapist bring to the current encounter. Historically, dynamically oriented helpers have referred to these components as trans-ference and countertransference (see Learning Activity 3. 4). Current interpretations of these two concepts are rooted in what is known as a relational model of helping. In a relational model, the emphasis is on the interaction be-tween the two people—for example, the client and the helper—not just on the client. In the helping process, both the helper and the client are seen as participants cocreat-ing enactments that represent configurations of transfer-ence and countertransference (Ornstein & Ganzer, 2005, p. 571). Relational models use the term dysfunctional relational schemas to describe transferential and countertrans-ferential notions. Our goal, as illustrated in the second Chap-ter Learning Outcome, is to help you identify issues related to both transference and countertransference that impact the helping relationship and working alliance with clients. Manifestations of Transference Contemporary definitions of transference suggest that it has two components. One component is the client and the LO2 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
94 Chapter 3 client's past. As Corey, Corey, Corey, and Callanan (2015) suggest, from this perspective transference is the client's projection of feelings and fantasies that are reactions to significant others in the client's past onto the helper (p. 47). The second component of transference is the inter-personal dynamic between the helper and client. As Orn-stein and Ganzer (2005) observe, from this perspective transference involves the “here-and-now experience of the client with the therapist who has a role in eliciting and shaping the transference” (p. 567). As an example, a client may have been raised by a caregiver who was emotionally distant and unavailable to respond to the child's feelings. In therapy, the client may be reluctant to deal with feel-ings. When encouraged to do so by the helper, the client may react by becoming angry or withdrawn. T ransference tends to occur regardless of the gender of the helper (Kahn, 1991) and, according to Kohut (1984), may occur because old unmet needs of the client resurface in the presence of an empathic helper. In addition, clients' transferential reactions can include any significant other, not just parents—such as siblings or anyone involved in an earlier and traumatic situation. T ransference can be positive, negative, or mixed. A positive transference can strengthen the helping relationship when the practitioner provides missing elements of understanding, impartiality, and reliability (Levitt, Butler, & Hill, 2006, p. 318). Often the transference (positive or negative) is a form of re-enactment of the client's familiar and old pattern or template of relating. The value of it is that through the transference clients may be trying to show how they felt at an earlier time when treated in a particular way. T rans-ference often occurs when the therapist (usually inadver-tently) does or says something that triggers unfinished business with the client, often with members of the client's family of origin—parents and siblings or significant oth-ers. Helpers can make use of the transference, especially a negative one, by helping clients see that what they expect of us, they also may expect of other people in their lives. If, for example, a client wants to make the helper look bad, then that could be the client's intent with other individuals as well. One study (Hoglend et al., 2006) found that cli-ents with troubled family-of-origin issues benefited more from therapy working with transference issues, lending support to the notion that transference is some form of re-enactment of impaired object relations. Management of Transference Gelso and colleagues (1999) found five consistent ways in which helpers worked with client transference: focusing, interpreting, questioning, teaching, and self-disclosing. These are summarized in Box 3. 1. Relational theorists also acknowledge a constructivist, narrative approach to working with client transference. Rather than responding to the client from an objective and detached position in which the client's reactions are analyzed and/or interpreted, the helper works collabora-tively with the client to co-construct a number of different possible realities instead of one “true” interpretation of the client's experience (Ornstein & Ganzer, 2005). Also, as these authors note, what is potentially transformative in handling the transference is that the helper “must always view the client's perceptions as plausible given the cli-ent's history and lived experience” (p. 567). For example, Renata discloses that she felt disregarded by her mother when growing up and believed that her needs were not important to her mother. Although this statement repre-sents some part of Renata's past experience, it would be wise to wonder aloud with Renata whether she has felt disregarded by the helper as well. Usually, as Teyber and Mc Clure (2011) point out, there is “a kernel of truth” in the client's reactions toward the helper, which have in part been evoked by some aspect of the helper's behavior (p. 340). In this way, as Teyber and Mc Clure (2011) Learning Activity 3. 4 Transference and Countertransference In a small group or with a partner, discuss the likely trans-ference and countertransference reactions you discover in these three cases. Feedback is provided on page 96. 1. The client is upset because you will not give her your home telephone number. She states that although you have a 24-hour on-call answering service, you are not really available to her unless you give her your home number. 2. You are an internship student, and your internship is coming to an end. You have been seeing a client for weekly sessions during your year-long internship. As termination approaches, the client becomes more and more anxious and angry with you and states that you are letting her down by forming this relationship with her and then leaving. 3. Your client has repeatedly invited you to his house for various social gatherings. Despite all you have said to him about “multiple nonprofessional relationships, ” he says he still feels that if you really cared about him you would be at his parties. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 95 conclude, current management of transference means both comprehending and changing something about the current and real interaction between the helper and client (p. 341). A final way in which helpers can work with transference issues is by empathically reflecting on the client's desire or wish—for example, the wish to be loved, the wish to be important, and the wish to control. (You may recall that this is, in fact, one of Neacsiu & Linehan's (2014) levels of empathic validation, articulating the unverbalized dimen-sion of the client's communication and experience. ) Often the transference acted out by the client not only includes a re-enactment of an earlier important relationship but also is a replay of how the client wishes it was (Kahn, 1991). With our client Renata in the example, the helper may say something such as the following: “Renata, I know how hard it was for you to feel overlooked by your mother. I can see that you wish you had been more important to her. ” Further, using a relational model, the helper may comment on what the client wishes or desires from the helper. With Renata, the helper may say something like, “Renata, I can see that in our work together it is important to you to be seen and heard and known accurately by me. Does this resonate with you as well?” Resolution of the transference process seems to occur with increased client insight, more realistic client expectations of the helper, and a more positive client view of himself or herself. Ethnocultural Transference Comas-Díaz (2014) has made an important contribu-tion to the discussion of transference by her discussion of ethnocultural transference. She states that each thera-peutic encounter involves potential projections of both “conscious and unconscious messages about the client's and the therapist's cultures” (p. 551). However, she goes on to point out that most mainstream helpers simply ignore transferential cultural issues. Alternatively, cultur-ally sensitive helpers manage the ethnocultural trans-ference by inquiring about similarities and differences between and among the client and helper. Comas-Díaz suggests inquiries such as, “How do you feel about my being from a different culture than you?'' or “How do you feel about our being from similar cultures as we work together?” (p. 552) Manifestations of Countertransference Sheree, a beginning practicum student, finds herself working with Ronnie, a teenage boy who has been mandated to see a counselor. She has seen Ronnie for six sessions. She describes him as “nonresponsive. ” She states that he sits with his cap down over his eyes so he can't really look at her directly and that he responds with, “I don't know” to her inquiries. Sheree feels more and more frustrated. She states that she has tried so hard to establish a good relationship with Ronnie but feels that everything she tries is useless. It seems that Ronnie has succeeded in challenging her need to be helpful to him, and she is finding herself becoming more impatient with him in the sessions. This is an example of countertransference. Countertransference includes feelings the therapist has about the client that are in some way atypical reac-tions either to a particular client or to clients in gen-eral (Nutt Williams, Hayes, & Fauth, 2008, p. 310). Such reactions may be covert and include thoughts, feelings, and visceral body sensations, or they may be overt behaviors (Gelso & Hayes, 2007). Nutt Williams, Hayes, and Fauth (2008) take the position, and we agree with it, that all helpers, “no matter how experi-enced, credentialed, or otherwise reputable, experience 1. Focusing on the immediate relationship: “I am aware that you seem to be feeling angry with me in today's session, and I am wondering what that means. ” 2. Interpreting the meaning of the transference: “Perhaps your feelings of anger toward me are related to the frus-tration of having your dad be so unavailable for you. And now I am telling you that I will be unavailable during the next month when I have surgery. ” 3. Using questions to promote insight: “Can you recall an earlier time in your life when you felt angry like you do now with me?” 4. Teaching, advising, and educating about the transference: “We all have times when we transfer emotional reactions from prior relationships onto other people who are sig-nificant to us. Sometimes this occurs in our helping rela-tionship as well. When it does, it is usually useful for us to process this in the session. As I am saying this, are you aware of any particular reactions you are having about me?” 5. Self-disclosing: “Sure, there are times for me, too, when I react to someone in my current life with some unresolved reactions from my past. Sometimes my partner says something that triggers such a response in me. Is this something you have noticed with your partner?”b OX 3. 1 Ways of Working with Client Transference Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
96 Chapter 3 countertransference with some frequency” (p. 310). Hayes, Gelso, and Hummel (2011) believe that unre-solved conflicts within the helper are at the heart of countertransference. The data on countertransference as summarized by Hayes and colleagues (2011) suggest that countertransference does adversely affect treatment outcomes in therapy. Hurtful countertransference that comes from our own woundedness occurs when: (1) we are blinded to an important area of exploration; (2) we focus on an issue more of our own than pertaining to the client; (3) we use the client for vicarious or real gratifica-tion; (4) we emit subtle cues that “lead” the client; (5) we make interventions not in the client's best interest; and, most importantly, (6) we adopt the roles the client wants us to play in his or her old script. However, as contemporary relational theorists note, not all countertransferential reactions are damaging, un-less they are acted out within the helping relationship. Countertransference can alert helpers to areas in which they feel stuck or puzzled and, as a result, helpers can begin to sort out what is going on rather than trying to “fix” the uncertainty (Ornstein & Ganzer, 2005). And in some situations it can even be helpful to self-disclose some of your countertransferential reactions in the client's pres-ence as long as this is done without blame for the client and conveyed with respect and regard. In the preceding example, Sheree might say something to Ronnie like the following: “You know, Ronnie, we have been working together now for approximately 6 weeks, and I feel like we are staying in the same place. I don't think we have moved backward, but I also don't think we have moved forward. I think we are just spinning our wheels in the same place, and I wish we could find some way to work together. I wish I could do or say something that would help you feel like coming to see me is worth it. ” This is a situation that requires much discernment, and for the beginning helper the decision to self-disclose needs to be talked through with a supervisor. Management of Countertransference Hayes, Gelso, and Hummel (2011) and Rosenberger and Hayes (2002) reviewed the research on counter-transference and concluded that uncontrolled counter-transference has an adverse effect on therapy outcome. Moreover, the data they summarize indicate that coun-tertransference management is effective in controlling the manifestation of negative helper reactions, and such management is also related somewhat to treatment outcome as well. Managing countertransference is an important clinical task for practitioners (Gelso, Latts, Gomez, & Fassinger, 2002). For us as helpers to man-age our countertransference responses therapeutically, we must become aware of what they are and what they mean to us. This self-awareness is depicted in what Gelso and Hayes (2007) refer to as the countertransference in-teraction hypothesis, simply meaning that counter-transference is the result between client material or attributes known as triggers and therapist conflicts and vulnerabilities known as origins. Support for this view of countertransference has been provided by Tishby and Wiseman (2014), who concluded that “it is this interac-tion between the client's responses as perceived by the therapist and the unresolved conflicts which produces CT dynamics that are unique to a therapeutic dyad” (p. 371). Gaining awareness is a useful initial step in managing countertransference. When we are unaware of our responses, they may get projected onto or acted out in the therapy session. For example, if Tia is unaware of her covert feelings of aggressiveness surrounding “help-less females,” when she encounters a needy, dependent female client she may behave in a way that conveys dis-respect and dislike for the client. Sometimes a sort of role reversal occurs, and the cli-ent is more aware of our own woundedness than we are. In these situations, the client unknowingly becomes the healer and the therapist inappropriately benefits, but the client's growth is stymied. For example, Ricardo may be unaware of his need to talk about himself, fueled by growing up with an inattentive and depressed care-giver. When his client Anna detects Ricardo's tendency to turn the focus onto himself during the session, she provides support for him to do so! 3. 4 Feedback Transference and Countertransference 1. The transference is the client's emotional reaction to not having you available to her at all times. Possible countertransference reactions by you include frustra-tion, anger, and feelings of failure. 2. The transference is the client's feeling of abandon-ment as termination approaches. Potential counter-transference includes sadness, irritation, and pressure. 3. The transference is the client's expectation for you to be socially involved with him. Possible countertrans-ference includes feelings of letting him down, being upset, and impatience. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 97 Countertransference and Self-insight Often a clue that we are having a countertransference reaction comes from our awareness of strong emotions such as those we described in the case involving Sheree. Awareness of countertransference is also dependent on self-insight—that is, intentional attention to what is going on inside us (Gelso & Hayes, 2002). One of the main reasons why, during and after training, helpers seek and receive individual and group con-sultation and supervision is that countertransference is inevitable and will occur throughout each helper's professional career. In Box 3. 2 we present examples of interpersonal process notes derived from M. Marshak (personal communication, May 11, 1999) that you may find useful for developing awareness of your own reactions to clients. When consultation and supervi-sion do not resolve a helper's reaction, a subsequent step in managing countertransference is to seek per-sonal counseling. It is important for helpers in train-ing to make a lifelong commitment to self-awareness. As Nutt Williams, Hayes, and Fauth (2008) note, experiencing countertransference is a fact of life for helpers: “To avoid countertransference reactions al-together, a therapist would either need to stop see-ing clients or overcome the basic human condition” (p. 310). Consultation, supervision, and personal coun-seling are important components of the self-awareness process. This is especially important in working with your own unresolved conflicts. Countertransference and Conceptual Understanding Being aware of our reactions is the important first step in managing countertransference. A second step is to develop what Gelso et al. (2002, p. 862) call concep-tual understanding: hunches about what is occurring in the moment in the relationship with the client. This kind of understanding helps to prevent an automatic or reflexive response that may be counterproductive (Teyber & Mc Clure, 2011). For instance, Tia, in the previous example, blurts out to a dependent female client, “Hannah, I am sure that you can figure this one out on your own. ” Alternatively, she may act out her covert aggression by terminating the session early or by being dismissive of the client's concerns. In act-ing or speaking thoughtlessly, she may inadvertently trigger a re-enactment of her client's history—that is, a relational pattern that is similar to an unproductive pattern with a significant person in Hannah's past or current life. In this way, the client's transference During sessions, jot down your thoughts, feelings, intu-itions, sensations, and dreams. How do feel when you're with this client? How and where are you blocked with this client?What is going on between the two of you?What is going on inside of you when there is a blockage or an issue? What keeps you from saying what you want to—what you feel?What keeps you from sitting still and being silent?How is your therapist activity maintaining the status quo— or moving the client? What stops the flow in your session?What disables you?How is the client using you?What are the client's expectations that force you into a cer-tain mold or way of being with him or her? What are you doing to the client—are you forcing him or her into a certain way of being with you?What do your imagination and your reveries tell you about this client? What symbols come to your mind to describe the process with this client? (Draw something. ) What about this client and session make you come alive? Make you go dead? How are you afraid of disappointing the client?What is lying behind the client's words?How do you create reflective space in and around the ses-sion for both you and the client? Where does play (in the best sense of the word) occur in this session? Does the language you use reflect your own voice, or does it reflect more of a textbook voice? What goes on in your body during this session with this client? What do you do to be seen as an ideal person, to avoid car-rying a shadow? How are you taking care of yourself in this session with this client?b OX 3. 2 Interpersonal Process Notes Source: Abridged from the presentation “The Person of the Analyst,” by Mel Marshak, Ph. D., May 11, 1999, Pittsburgh, Jung Society. Used with permission of Mel Marshak, Ph. D. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
98 Chapter 3 may become evoked. For example, the client may feel dismissed by Tia in same way in which the client felt dismissed by her primary caregiver and by her partner and other significant people in her life. (This is an example of the way in which transference and countertransference are often related in the helping relationship. ) Self-insight without this second step of conceptual understanding is limited in prevent-ing negative countertransferential reactions. By the same token, conceptual understanding without self-insight and awareness also seems ineffective at manag-ing countertransference (Hofness & T racey, 2010). As Nutt Williams, Hayes, and Fauth (2008) point out, to prevent negative countertransferential reactions from popping up, “therapists may need to have enough self-insight to know that they are experiencing coun-tertransference feelings and also to have sufficient conceptualizing skills to know what to do with their reactions” (p. 311). Countertransference and Helper Responsibility This scenario points to a third step in the management of countertransference: the helper needs to be willing to examine and to take responsibility for his or her possible contributions to the issues that are emerging between the helper and client. At this point, Tia may say something to her client like the following: “Hannah, I feel like what I just said to you about your concern may have sounded dismissive. I am sorry if this is so. Can you tell me what you experienced when you heard me say that?” Obviously, such a response requires a great deal of empathy from the helper. Empathic attun-ement, both to oneself and to the client, is a fourth step in managing countertransference (Gelso et al., 2002). When the helper's anxiety and/or shame get triggered, however, the helper is likely to respond defensively to the client and to perpetuate the transferential-counter-transferential conflict, thus masking any empathy the helper may feel. An important consideration in managing our coun-tertransferential reactions is to engage in practices that foster our self-awareness and self-insight such as self-care behaviors and reflective thinking. Meditation/mindful-ness by helpers also has been found to be a great way to develop such self-awareness (Nutt Williams, Hayes, & Fauth, 2008). As these authors explain, “Mindfulness includes not just awareness but also acceptance of your experiences and acceptance may be a pivotal component in managing countertransference. When therapists are able to recognize, without judgment, their reactions to clients, no matter how unpleasant or painful, several benefits may ensue. Therapists are less likely to act out on countertransference thoughts and feelings” (p. 312). In short, mindfulness is a skill that allows us as helpers to be less reactive, not only to clients but also to ourselves as well. Countertransference and Boundaries The final step in managing both transference and coun-tertransference is to develop and use boundaries. Gelso and Hayes (2002) refer to this step as “self-integration” and say that in the helping process it “manifests itself as a recognition of ego boundaries or an ability to differ-entiate self from other” (p. 297). When we are without boundaries in the helping process, we either let too much in from the client's transference reactions or send out too much from ourselves to the client, causing the client discomfort and pain. In the first case, we fail to protect ourselves; in the second, we fail to protect the client. Both scenarios can be managed with the use of internal protective and containing boundaries (Mellody, 2003). A protective boundary allows you to hold yourself in high esteem even when a client is saying something negative to you. When a client expresses a negative transferential reac-tion, you can establish a protective boundary for yourself by asking yourself whether the client's reaction is true for you and whether you contributed to the reaction. If you did, it is important to take the client's reaction in and be responsive to it while recognizing that it does not lessen your self-worth. Establishing a protective boundary is not the same as walling yourself off. If you withdraw behind a wall of anger, preoccupation, silence, worry, sadness, and so on, then nothing the client says or does reaches you (Mellody, 2003). Such a response is tantamount to being dismissive of the client's concern. Walling yourself off is appropriate only when a client is being clearly offensive to you, perhaps shouting an obscenity or a racial slur, and you cannot leave or you choose not to leave (Mellody, 2003). Protective boundaries are also important to empathic understanding. They allow you to feel the client's feelings without reacting to the feelings as if they belong to you. The containing boundary is what helps us avoid leaking our countertransferential reactions onto the client. Tia, for example, lacked a containing boundary and leaked her feelings of impatience to her client. When we do not have good containing boundaries, it is difficult to provide the sort of holding environment that our clients need, because we have difficulty containing emotional reactions. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. 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Ingredients of an Effective Helping Relationship 99 Ethnocultural Countertransference Comas-Díaz (2014) also discusses ethnocultural counter-transference. Recall from our discussion that she believes many clinicians, especially those from dominant cultural groups, simply ignore cultural manifestations of transfer-ence and countertransference. Yet, as she points out, both practitioners and clients imprint their ethnic, cultural, and racial experiences into the helping process. A very real part of self-awareness becomes cultural awareness. She de-scribes some common ethnocultural countertransferen-tial reactions in interethnic helping dyads. These include denial of cultural differences, excessive curiosity from the helper about some aspect of the client's culture, guilt, pity, aggression, and ambivalence. Comas-Díaz (2014) also points out that ethnocultural countertransference occurs within intraethnic cultural dyads as well. Forms of ethnocultural countertransference within intraethnic cultural dyads include: overidentification; shared victim-ization; distancing; survivor guilt; multicultural myopia; ambivalence; and anger. Ruptures in the Alliance At times, tears and ruptures occur in the course of the working alliance. These relationship ruptures are defined as tension or breakdown in the collaborative relationship between the helper and client (Safran & Muran, 2006). Ruptures can range from very minor tensions to some-thing much more dramatic and are currently thought to revolve around disagreements about the tasks and/or goals of helping and strains in the helper-client bond (Safran, Muran, & Eubanks-Carter, 2011). Also, cross-racial tensions can result in relationship ruptures. As we mentioned, when clients experience racial or other kinds of microaggressions, relationship ruptures are likely to occur. As Owen et al. (2014) indicate, “(c)onceptually, microaggressions can be thought of as a special case of ruptures in therapy wherein experiences of discrimination and oppression from the larger society are recapitulated which places the therapeutic relationship under duress and strain” (p. 287). Research on the effects of relationship ruptures is some-what limited, but Safran et al. (2011) argue that because much data link the quality of the therapeutic alliance to outcome, the process of repairing relationship rup-tures is important and is also supported by increasing evidence. Ruptures provide indicators about times when the strength of the working alliance may have waned or instances when agreement on the therapeutic tasks and goals may have drifted. Safran and Muran (2000) originally viewed ruptures as windows that let helpers see something about the client's interpersonal relationships (p. 85). Safran and Muran (2006) now describe relationship ruptures as “transference-countertransference enactments” by both the client and the therapist (p. 288). As they explain, clients often re-enact an early, difficult, perhaps trau-matic life experience and try to pull the helper into assuming a particular role that confirms the client's early experience (p. 85). When helpers allow themselves to get pulled into this role, ruptures result. When a rupture occurs, it can be repaired and begin to heal if the helper can recognize her or his contributions to the rupture and then acknowledge them directly to the client. This acknowledgment provides a new relational experience for the client and is a major way in which the therapeutic relationship becomes healing (Safran & Muran, 2000, p. 88). Two Types of Relationship Ruptures Safran and Muran (2006) distinguish between two types of ruptures in the therapeutic relationship: confronta-tion ruptures and withdrawal ruptures. In a confron-tation rupture, the client deals directly with concerns about the relationship by confronting the helper. For example, Francine, the client, has been describing her history with her depressed and unavailable caregiver as well as current events with the same caregiver. Her helper emotionally retreats, shuts down, and does not validate her feelings about these experiences. As a result, Francine asks her practitioner directly why she seems so “nonresponsive. ” Safran, Muran, and Eubanks-Carter (2011) note that the type of rupture suggests differences in how the rupture is resolved. In the confrontation rupture described, the resolution “consists of moving through feelings of anger, to feelings of disappointment and hurt over having been failed by the therapist, to contacting vulnerability and the wish to be nurtured and taken care of” (Safran, Muran, & Eubanks-Carter, 2011, p. 234). In this example, healing of the rupture would move forward by having the practi-tioner help Francine express her feelings of anger and hurt over the helper's lack of responsiveness and also express her desire to be more nurtured by the helper. In a withdrawal rupture, clients express their concern about the relationship by “withdrawing, deferring, or even complying” (Safran & Muran, 2006, p. 287). For example, the client, Tepe, has been describing his experi-ences of being sexually abused by a priest while grow-ing up. Tepe's pain and sadness overwhelm his helper, who jumps in and tries to “fix” his feelings. Tepe's fail-ure to show up for the next session signifies an intense withdrawal rupture. In a withdrawal rupture such as this instance, the resolution “consists of moving through Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
100 Chapter 3 increasingly clearer articulations of discontent to self-assertion, in which the need for agency is realized and validated by the therapist” (Safran, Muran, & Eubanks-Carter, 2011, p. 234). In this example, healing of the rupture would be assisted by having the practitioner help Tepe articulate and assert what he wants and needs from the helper in ensuing sessions. Summarization of Steps for Repairing Ruptures What do the helpers we described here do now about the ruptures? First, they examine their responses to their clients in their last session. This exploration may occur alone or in consultation with a colleague, a super-visor, or a personal therapist. When they realize their contribution to the rupture, they in some way take re-sponsibility for it. When Francine confronts the helper about her lack of responsiveness, the helper addresses the experience directly, saying something like, “You know, it's true. When you were talking about all those times your parent was not there for you, I realized that I went away from you and shut down, and in doing so, I also was not there for you. I am sorry about this. ” Developing awareness about ways in which we may invalidate clients with cultural messages is particularly important and finding ways to directly address the cultural invalidation or misunderstanding is critical for the healing of rupture due to microaggressions (Owen et al., 2014). Helpers also can repair ruptures by empa-thizing with the client's experience of or reaction to the rupture (Safran & Muran, 2000, p. 102). For example, Tepe's helper could say, “I can understand that in our last session I failed to really communicate my accep-tance of your pain and sadness about the abuse. Instead I tried to think of a solution. This must have felt like I, too, was not there for you in some fundamental way because I tuned in to myself then instead of you. I apologize for my lapse. ” Other common rupture-repair interventions that Saf-ran, Muran, and Eubanks-Carter (2011) recommend in-clude the following: Repeat the therapeutic rationale, Change the therapeutic task or re-address the treatment goals, Clarify misunderstandings at a surface level,Explore relational themes associated with the rupture, and Link the alliance rupture to common patterns in a client's life (p. 228). To respond effectively to ruptures, we, as helpers, need to remain open to ourselves and to our own deepest feel-ings, both past and present, happy and difficult (Safran & Muran, 2000, p. 75). This process of staying open to ourselves requires us to find time or make space in our lives to stay attuned to ourselves and to feel our feelings. Activities such as meditating, deep breathing, and move-ment can assist in this process. For a list of additional ways to repair relationship ruptures, see Table 3. 2. Learning Activity 3. 5 presents guided imagery for working through relationship ruptures. TAb LE 3. 2 Interventions for Repairing Relationship Ruptures Discuss the here-and-now relationship with your client as it is occurring in the session. Invite and provide feedback on the therapeutic relationship. Intentionally explore the client's experiences in therapy. Attend carefully to the agreement, explicit and implicit, that you and the client make regarding the outcomes of treatment and the strategies designed to achieve these outcomes. Take responsibility for your contribution to the relationship rupture. Attend carefully to informed consent; provide a careful rationale for everything you do in the helping process. Revisit the therapeutic rationale frequently. Give the client time and space to express negative feelings about the relationship. Allow the client an opportunity to reveal fears about expressing negative feelings to you. Empathize with the client's experience and validate the client when he or she does express a disagreement or a negative feeling. Provide more positive feedback to the client. Process issues related to transference. Be aware of your own countertransference reactions, and seek consultation and supervision to process them. Source: Harmon et al., 2005, p. 175; Safran et al., 2002; Safran, Muran, & Eubanks-Carter, 2011. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 101 CHAPTER SUMMARY This chapter describes three major components of the helping relationship: the facilitative conditions of empa-thy, genuineness, and positive regard; the working alliance; and transference and countertransference. None of these components operates independently from the others, and during the course of therapy they are connected to and in-fluenced by one another. The three components also are, to some degree, affected by client variables such as type and severity of problem, gender, race, and cultural affiliation, because all helping relationships are also cross-cultural ones. These components contribute to both the effective process and the outcome of therapy and are considered important in all theoretical approaches to helping. In the past decade much empirical support for these aspects of the therapeutic relationship has emerged. Whatever else may happen in the helping process, the relationship be-tween therapist and client is always present. As Norcross and Wampold (2011) observe, “Psychotherapy is at root a human relationship. Even when 'delivered' via distance or on a computer, psychotherapy is an irreducibly human encounter. Both parties bring themselves—their origins, culture, personalities, psychopathology, expectations, bi-ases, defenses, and strengths—to the human relationship. Some will judge the relationship as a precondition of change and others a process of change, but all agree that it is a relational enterprise” (p. 429). Visit Cengage Brain. com for a variety of study tools and useful resources such as video exam-ples, case studies, interactive exercises, flash-cards, and quizzes. Learning Activity 3. 5 Relationship Ruptures This activity uses guided imagery to deal with a rupture in a therapeutic relationship. To complete this activity, go through each step in your imagination, or have a partner read the steps to you and close your eyes and go through each step. Then, trade roles with your partner. 1. Bring your attention to yourself. What are you currently experiencing? 2. Bring your attention to your breath. Breathe in peace, and breathe out tension. 3. When you feel ready, picture the last client you saw with whom there was some kind of tension or some breakdown in communication. If you are not yet see-ing clients, then picture some other person with whom you've had such an experience. 4. In your mind's eye, recall how you knew a rupture was going on in the relationship. What were the clues or cues?5. In your mind's eye, focus on how you responded to the rupture. 6. What happened after your response? See and feel this. 7. Focus on anything you could have done or said to repair the rupture. See and feel this. 8. Bring your attention back to yourself and your breath, and notice how you are feeling now. 9. When you are ready, bring your energy back to the environment and the room, and open your eyes if they were closed. If you are working with a partner, then we suggest you process this imagery with that person. Otherwise, you can process it with yourself. What did you learn from this imagery about ruptures? From this activity can you take something into another relationship to help you repair a rupture? If so, what would it be? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
102 Chapter 3 3 Knowledge and Skill Builder Part One According to Learning Outcome 1 for this chapter, you will be able to communicate the three facilitative conditions to a client, given a role-play situation. Complete this activity in triads, with one person assuming the role of the helper, another assuming the role of client, and the third assuming the role of the observer. The helper's task is to communicate the behavioral aspects of empathy, genuineness, and posi-tive regard to the client. The client shares a concern with the helper. The observer monitors the interaction, using the ac-companying Checklist for Facilitative Conditions as a guide, and provides feedback after completion of the session. Each role play can last 10-15 minutes. Switch roles so each person has an opportunity to play each of the three roles. If you do not have access to another person to serve as an observer, find someone with whom you can engage in a role-played helping interaction. Record your interaction and use the ac-companying checklist as a guide to reviewing your tape. Checklist for Facilitative Conditions Helper Observer Instructions: Assess the helper's communication of the three fa-cilitative conditions by circling the number and word that best represent the helper's overall behavior during this session. Empathy 1. Did the helper indicate a desire to comprehend the client? 1 2 3 4 A little Somewhat A great deal Almost always 2. Did the helper refer to the client's feelings? 1 2 3 4 A little Somewhat A great deal Almost always 3. Did the helper discuss what appeared to be important to the client? 1 2 3 4 A little Somewhat A great deal Almost always 4. Did the helper pace (match) the client's nonverbal behavior? 1 2 3 4 A little Somewhat A great deal Almost always 5. Did the helper show understanding of the client's historical/cultural/ethnic background? 1 2 3 4 A little Somewhat A great deal Almost always 6. Did the helper validate the client's experience? 1 2 3 4 A little Somewhat A great deal Almost always Genuineness 7. Did the helper avoid overemphasizing her or his role, position, and status? 1 2 3 4 A little Somewhat A great deal Almost always 8. Did the helper exhibit congruence, or consistency, among feelings, words, nonverbal behavior, and actions? 1 2 3 4 A little Somewhat A great deal Almost always 9. Was the helper appropriately spontaneous (for example, also tactful)? 1 2 3 4 A little Somewhat A great deal Almost always 10. Did the helper demonstrate supporting nonverbal be-haviors appropriate to the client's culture? 1 2 3 4 A little Somewhat A great deal Almost always Positive Regard 11. Did the helper demonstrate behaviors related to commitment and willingness to see the client (for ex-ample, starting on time, responding with appropriate intensity)? 1 2 3 4 A little Somewhat A great deal Almost always 12. Did the helper respond verbally and nonverbally to the client without judging or evaluating the client? 1 2 3 4 A little Somewhat A great deal Almost always 13. Did the helper convey warmth to the client with sup-porting nonverbal behaviors (soft voice tone, smiling, eye contact, touch) and verbal responses (enhancing statements)? 1 2 3 4 A little Somewhat A great deal Almost always Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Ingredients of an Effective Helping Relationship 103 Observer comments: Part Two Learning Outcome 2 asks you to identify issues related to transference and countertransference that might affect the development of the helping relationship, given five written case descriptions. Read each case carefully and then identify in writing the transference/countertransference issue that is reflected in the case description. Feedback follows below. 1. You are leading a problem-solving group in a high school. The members are spending a lot of time talking about the flak they get from their parents. After a while, they start to “get the leader” and complain about all the flak they get from you. 2. You are counseling a person of the other sex who is the same age as yourself. After several weeks of seeing the client, you feel extremely disappointed and let down when the client postpones the next session. 3. You find yourself needing to terminate with a client, but you are reluctant to do so. When the client presses you for a termination date, you find yourself overcome with sadness. 4. One of your clients is constantly writing you little notes and sending you cards basically saying what a wonder-ful person you are. 5. You are a straight, heterosexual helper working with a gay client. Your client indicates that he has experienced discrimination at his church, which he attributes to his being gay. You ignore this comment and steer the dis-cussion back to his presenting concern of feeling con-flicted about his career choice. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
104 Chapter 3 3 Knowledge and Skill Builder Feedback Part Two 1. Transference: The group members seem to be transfer-ring their angry feelings toward their parents onto you. 2. Countertransference: You are having an unusually in-tense emotional reaction to this client (disappoint-ment), which suggests that you are developing some affectionate feelings for the client and countertransfer-ence is occurring. 3. Countertransference: Some emotional attachment on your part is making it hard for you to let go of this particular client (although termination usually does in-volve a little sadness for all parties). 4. Transference: The client is allowing herself to idealize you. At this point, the transference is positive, although it could change. 5. Countertransference: Your silence and omission of re-sponding to the client's experience of discrimination about being gay indicate something has been trig-gered in you, resulting in silence and failure to respond to this stated concern. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
105 The quieter you become, the more you are able to hear. (Rumi) Lindahl (2003) observes that true listening involves our “whole being” (p. 29). The all-encompassing nature of listening is depicted in the Chinese symbol for listening shown in Figure 4. 1. In the upper left side are squares that represent two ears. Squares in the upper right side represent two eyes. Underneath the “eye” squares is a line that represents “undivided attention,” and in the lower right side of the symbol is a curved line that represents the heart. As Lindahl (2003) notes, this symbol “indicates that listening is more than hearing words; it encompasses our ears, eyes, undivided attention, and heart” (p. 29). When someone truly hears us, it is a special gift. We can all recall times when we felt wonderful simply because someone who means something to us stood or sat with us and really listened. Conversely, we also can remember instances in which we felt frustration because someone close to us was inattentive and distracted, perhaps check-ing their text messages! Nichols (2009) has referred to listening as a “lost art” because of time pressures that shorten our attention span and impoverish the quality of listening in our lives (p. 2). Lindahl (2003) observes that many of us, including high-powered executives, engage in a great deal of preparation prior to speaking but less than 5 percent of us do a similar amount of preparation prior to listening. This lack of listening can undermine our most prized relationships, contribute to interpersonal conflict, and leave us with a sense of loss. Nichols (2009) observes that this loss is most severe when lack of listening occurs in relationships in which we count on the listener to pay attention, such as in a helping relationship. From a neuroscience perspective, listening responses are critical Listening Eyes Undivided attention Heart Ear Figure 4. 1 Chinese Symbol for Listening Learning Outcomes After completing this chapter, you will be able to: 1. In an interview situation, identify nonverbal behaviors of the person with whom you are communicating. Describe the possible meanings associated with these behaviors. The nonverbal behaviors you identify may come from any one or a combination of these four categories: (a) kinesics, or body motion; (b) paralinguistics, or voice qualities; (c) proxemics, or spatial distance in interactions; and (d) the person's general appearance. 2. From a list of three client statements, write an example of each of the four listening responses for each client statement. 3. In a 15-minute helping interview in which you function as an observer, listen for and record five key aspects of client mes-sages that the helper needs to attend to ensure effective listening. 4. In a 15-minute role-play interview or a conversation in which you function as a listener, demonstrate at least two accurate examples of each of the four listening responses. chapter 4 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
106 Chapter 4 components of the helping process because these support-ive kinds of helper responses activate both “clients execu-tive networks and their self-reflective abilities” (Cozolino, 2010, p. 38). Three Steps of Listening Listening is a prerequisite for all other helping responses and strategies. Listening should precede whatever else is done. When a helper fails to listen, the client may be discouraged from self-exploring, the wrong issue may be discussed, or a strategy may be proposed prematurely. Listening involves three steps: receiving a mes-sage, processing a message, and sending a message (see Figure 4. 2). Each client message (verbal or nonverbal) is a stimulus to be received and processed by the helper. When a client sends a message, the helper receives it. Reception of a message is a covert process—that is, we cannot see how or what the helper receives. Failure to receive the entire mes-sage may occur when the helper stops attending. Reception of a message may be thought of as contemplative listening (Lindahl, 2003). A prerequisite for contemplative listening is the ability to be silent! Interestingly enough, the letters that spell listen also spell silent (Lindahl, 2003). When we are truly silent, we are not focused on what we are going to say next. Instead, we are creating space for ourselves to receive a message and for clients to send a message. Unfortunately, because our world is so noisy, true silence is uncomfortable for many of us and must be cultivated with daily practice. T urning off cell phones and pagers and sitting silently with oneself for a few minutes every day is a great way to develop contemplative listening skills. Once a message is received, it must be processed in some way. Processing, like reception, is covert: it goes on within the helper's mind and is not visible to the out-side world—except, perhaps, from the helper's nonverbal cues. Processing includes thinking about the message and pondering its meaning. Processing is important because a helper's cognitions, self-talk, and mental (covert) prepara-tion and visualization set the stage for overt responding. Errors in message processing often occur when helpers' biases or blind spots prevent them from acknowledging parts of a message or from interpreting a message with-out distortion. Helpers may hear what they want to hear instead of the actual message sent. Processing a message may be thought of as reflective listening (Lindahl, 2003). In reflective listening, we are listening to ourselves and focusing our attention inward to develop sensitivity to our internal voice. How do we cultivate reflective listen-ing? Like achieving the silence of contemplative listening, reflective listening also requires practice. Lindahl (2003) recommends taking a few breaths before responding to a client's message and then, after the breaths, asking oneself, “What wants to be said next?” (instead of “What do I want to say?”) (p. 32). The third step of listening involves the verbal and non-verbal messages sent by a helper. Sometimes a helper may receive and process a message accurately but has difficulty sending a message because of lack of skills. Fortunately, you can learn to use listening responses to send mes-sages. When sending messages back to our clients, we are engaging in listening that is connective listening—that is, listening that in some way connects us with our clients (Lindahl, 2003). This chapter is designed to help you develop verbal and nonverbal communication skills to facilitate the listening process with clients. Part of the chapter will assist you in becoming more attuned and receptive to client nonverbal messages. The other part of the chapter is intended to help you acquire four verbal listening responses that you can use to send messages to a client: clarification, paraphrase, reflection, and summarization. Such responses convey that you are listening to and understanding client mes-sages. Understanding what any client says can be difficult. When you are working with clients who are culturally different from you, understanding may be even more challenging because of cultural nuances in communica-tion and expression. Sue and Sue (2013) illustrate the complexities in this process by noting that focusing on the accuracy of messages sent and received is incomplete without simultaneously also considering the appropriate-ness of the message (p. 213). They conclude that “effective multicultural counseling occurs when the counselor and client are able to send and receive both verbal and non-verbal messages appropriately and accurately” (p. 229). Client message(1) Receiving message (covert)(2) Processing message (covert)(3) Sending message (overt) Figure 4. 2 Three Steps of Listening Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 107 Listening to Clients' Stories Ivey, D'Andrea, Ivey, and Simek-Morgan (2007) note that listening by the helper helps to bring out the client's story. Listening is healing because it encourages clients to tell their stories. Clients' stories are narratives about their lives and current experiences. From these narratives clients construct their identities and infuse their lives with mean-ing and purpose (White, 2007). A good therapist listens to these accounts to help clients recognize how they construct meaning and whether they help or hurt the development of client identity. Telling one's own story can also provide emotional relief to clients who have suffered trauma, even clients who are very young or old. Stories provide a way for clients who are suffering from loss—such as a separation or divorce, loss of a job, or death of a significant other—to make sense of the loss (Sedney, Baker, & Gross, 1994). For clients who are dying, stories can bring a sense of closure and also feelings of liberation. Healing is particu-larly evident if clients describe for the first time “hidden difficulties” or “shame” (Ostaseski, 1994). Each time a story is told, something new is learned, a wound is healed, another part of the story is remembered, or the story teller gains new insight (Lindahl, 2003). Client narratives are stories that provide both historical and cohesive meaning to clients' lives, a link from the past to the present and the future, and a mechanism by which clients not only explain themselves to themselves but also introduce themselves to helpers (Arden & Linford, 2009, p. 111). Narratives also give clients a structure by which to organize their emotional experience. Generally speaking, the narrative approach moves away from negative themes in the story and helps clients reshape the story into more posi-tive themes (White, 2007). Together, the client and helper can co-construct a new narrative, and it is this new narrative that actually strengthens new neural networks in the brain. Arden and Linford (2009) describe the process like this: Therapists utilize language and its associated left-hemispheric neural nets to co-construct positive and adaptive narratives. Originally, narratives are self-stories shaped by interactions with parents, peers, and the context of one's culture. When those narratives do not serve a person well in adolescence or adulthood, the therapist's job is to help the patient reconstruct those narratives so that he or she can live with diminished anxiety, depression, or other psychological problems. (p. 112) Stories are almost universally present and relevant in various ethnic cultural groups. Helpers need to tune in to many aspects of clients' stories. Ivey and colleagues (2007) recommend listening for the facts of the story, for the cli-ent's feelings about the story, and for the way in which the client organizes the story. Sedney and colleagues (1994) recommend listening for how the story is started, for the sequences in the story, and for “hints of anger, regret, and what ifs,” as well as for the client's understanding of the story and the role the client plays in it (p. 291). Significant omissions also may provide clues. Ostaseski (1994) com-ments that helpers must simply trust that some insight will arise for clients just from the telling of the story: “Often the story will deliver what is needed. So pay close attention to whatever you are presented with. Start with that. Take it. Believe it, and see where it leads you” (p. 11). Listening to Clients' Nonverbal Behavior Clients tell us stories in many different ways. As we noted, part of their story is expressed through words, language, and meaning. However, part of their story is expressed through nonverbal communication and body language. Even silence is often a powerful punctuation to a client narrative. Sometimes a client's story is so powerful that there are no real words to express what has happened. Anyone who witnessed the daring and successful October 2010 rescue of the 33 Chilean miners realizes that when they embraced their families after 70 days of being 2,300 feet underground, the initial communication was much more about body language than words. Hugs, tears, and embraces came first. Nonverbal Communication, Culture, and Microaggressions It is important to note that clients from some cultural groups place greater emphasis on nonverbal than on ver-bal behavior in themselves and their helper. In part, these clients have learned to rely more on nonverbal com-munication and less on verbal elaborations to explain something or to get a point across (Sue & Sue, 2013). Moreover, many racial/ethnic minority clients are very attuned to nonverbal behavior, particularly as a way to sense bias. As Sue and Sue observe (2013), often racial/ethnic minority clients feel that “nonverbal behaviors are more accurate reflections of what a white person is think-ing or feeling than is what they say” (p. 221). No doubt this is because nonverbal cues often represent more “leak-age” than verbal ones. Anyone who has seen the televi-sion show “Lie to Me,” based on the work of nonverbal theorist Paul Ekman (Ekman and Rosenberg, 2005), can understand what we mean by this statement. Leakage is the communication of nonverbal messages that are valid yet are not sent intentionally. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
108 Chapter 4 Nonverbal leakages can also constitute subtle micro-aggressions that are likely to occur in cross-cultural counseling—such as dismissive looks, gestures, and tones—and are so pervasive and automatic that they are often ignored or denied (Sue & Sue, 2013; Sue, 2010). Some microaggressions may be directed toward race, such as when a white practitioner stammers and avoids eye con-tact when working with a client who is not white. Others may be directed toward other aspects of culture, such as gender, such as when a male practitioner says something to a female client that implies her opinion about an issue is not important. When a straight practitioner refuses to see a lesbian or gay client, a microaggression has been committed in the area of sexual orientation. Similar mi-croaggressions occur when an able-bodied practitioner speaks more loudly when working with a client who has a visual impairment. This implies that because the client has an impairment in one sensory modality, the visual modality, it affects other sensory modalities and means that the client cannot hear well. Neurobiology and Nonverbal Behavior The brain is heavily involved in the communication of non-verbal behavior. This is true of the client who is sending nonverbal information all the time when communicating, and also of the helper who is using parts of the brain, par-ticularly mirror neurons, to receive and process the nonverbal communications of the client. Generally speaking, we “read” nonverbal communication with the right hemisphere of our brains. Different areas of the brain become activated when we respond nonverbally, such as when we look directly at another person. Through the mirror neuron system we described in the prior chapter, clients often will unconsciously mimic the facial expressions of their helpers. Moreover, as Arden and Linford (2009) point out, some aspects of implicit racial bias that are demonstrated through nonverbal channels are linked to the brain, particularly the structure in the emotional brain area that is called the amygdala. This is probably why many racial/ethnic minority clients are so attuned to nonverbal communication and facial expressions of helpers—because they have learned that “actions speak louder than words. ” Relationship of Nonverbal and Verbal Communication Nonverbal behavior has been defined as “communication affected by means other than words, assuming words are the verbal element” (Knapp, Hall, & Horgan, 2014, p. 8). Nonverbal and verbal behavior are interrelated because each channel of communication supports the other. In reality, neither dimension, verbal or nonverbal, can be separated. (In current thinking, some scholars even use the term face-to-face interaction in lieu of nonverbal behavior because of this relationship between the two dimensions. ) In the helping process, each channel of communication provides important information to helpers assuming we are attuned enough to receive and decode messages si-multaneously from both channels. Like verbal behavior, nonverbal actions “may communicate more than one mes-sage at a time” (Knapp, Hall, & Horgan, 2014, p. 14). Identifying the relationship between the client's verbal and nonverbal communication may yield a more accurate picture of the client, the client's feelings, and the concerns that have led the client to seek help. In addition, the helper can detect the extent to which the client's nonverbal be-havior and verbal behavior match or are congruent. In the helping process, clients' early experiences that have been encoded in the brain often get played out in non-verbal communication but are “made sense of” through words and language. Note, for example, the way this inter-relationship exists in the following short therapist-client dialogue described by Safran and Muran (2000): T: It's like you're really struggling internally right now. C: (sobbing in a controlled fashion and looking down-ward): Yeah, I guess, you know, I just think that for whatever reason this situation has brought out so much of my sadness and loss and disappointment, and that instead of me feeling like I'm going forward, I just feel like I keep on uncovering things that I'm not even aware of. I mean, I know you're there... but I don't know. T: So a couple of things come to mind, but one is... you know... I'm very aware that in this moment you're looking down... looking away from me. Do you have a sense of that? C: Well, yeah. T: Yeah? C: I mean I do... because I just... I want to push it back in, and it just feels so umm... I mean, I feel it's about nothing. It just seems like this endless self-pity or something and umm... T: So what would happen if you didn't push your experi-ence back in there? (p. 195) In this dialogue, can you see the practitioner's sensi-tivity to the client's nonverbal cues? Arden and Linford (2009) comment on this vignette that “because so much of what we experience and respond to is based on im-plicit memories and nonverbal emotional experience, the patient here may be responding as much to the therapist noticing her gaze as anything that's said in the hour. On the other hand... this therapist uses the therapeutic dia-logue... to enhance the patient's affect regulation... by putting nonverbal cues into language” (p. 117). Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 109 Three Categories of Nonverbal Behavior There are three aspects of nonverbal behavior that can aid us in listening to clients. These include kinesics, paralinguistics, and proxemics. (See also the Nonverbal Checklist on page 111. ) Kinesics, or body motion, in-cludes gestures, body movements, posture, touch, facial expressions, and eye behavior. In this area, helpers can listen to messages communicated by clients through non-verbal behaviors such as eye contact, facial expressions, and posture. For example, in talking about his reluctance to engage in counseling, the practitioner notes that the cli-ent, Roberto, looks away, sits sideways not facing the prac-titioner, and frequently frowns. In this instance, Roberto's nonverbal behavior seems to support his verbal message. Paralinguistics refers to the vocal cues—or the “how” of the communication. Paralinguistics includes vocal quali-ties, vocalizations, silent pauses, and speech errors, too. As Roberto continues to talk with his helper, James, at times his voice gets louder and higher in pitch. Occasion-ally, Roberto uses Spanish phrases to convey something with accentuated meaning. Also of interest to helpers is the area of proxemics—that is, one's use of personal and social space. In the context of the helping relationship, proxemics involves the size of the room, seating arrange-ments, the distance between helper and client, and the use of touch. Roberto sits down and pushes his chair farther away from James as he continues to reveal that he does not feel comfortable talking about his problems with a stranger. In listening to these dimensions of client nonverbal be-havior, it is important to note that the specific meanings of nonverbal behavior will vary with individuals, situa-tions, and the meaning of the verbal messages. Further, the nonverbal behaviors of one culture may have differ-ent or even opposite meanings in another culture. For example, in some cultures, the avoidance of eye contact is regarded as an indication of respect. And, as Knapp et al. (2014) conclude, rarely does a nonverbal message have a single meaning. In the example with Roberto and James, an added dimension is the cultural difference in the help-ing dyad. For example, some of Roberto's nonverbal be-havior may not be just about his reluctance to seek help in general, but his reluctance to seek help from a practitioner of a different culture, perhaps even one who is not bilin-gual and who does not understand his Spanish phrases. It would be interesting to see if and how Roberto's nonverbal behavior shifted with a Spanish-speaking helper or with a Latino male practitioner. Keep in mind that all com-munication, verbal and nonverbal, is contextual and, as helpers, we listen for the context embedded within each client's story. Silence and Nonverbal Behavior An important part of nonverbal communication involves silence. Silence and pauses are considered part of paralin-guistics. Silence and pauses in communication are impor-tant in the helping process for several reasons. First, they help regulate the course of the conversation. When a helper and client are interacting, they are basically engaged in a dialogue (hopefully, anyway) in which silence and pauses help to regulate “turn taking”—that is, the exchange of who talks and who listens. Pauses and silence also give the helper important information about the client. Unfilled pauses, or periods of silence, serve various functions in a helping interview. The purpose of silence often depends on whether the pause is initiated by the helper or by the client. Clients use silence to express emotions, to reflect on an issue, to recall an idea or feeling, to avoid a topic, or to catch up on the progress of the moment. Sue and Sue (2008) note that “there are complex rules regarding when to speak or yield to another person” and these rules vary with cultural groups. For example, U. S. Americans frequently feel uncomfortable with a pause or silent stretch in the conversation, feeling obligated to fill it in with more talk. Silence is not always a sign for the listener to take up the conversation. While it may be viewed negatively by many, other cultures interpret the use of silence differently. The British and Arabs use silence for privacy, while the Russians, French, and Spanish read it as agreement among the parties. In Asian cultures, silence is traditionally a sign of respect for elders. Furthermore, silence by many Chinese and Japanese is not a floor-yielding signal inviting others to pick up the conversation. Rather, it may indicate a desire to continue speaking after making a particular point. Often silence is a sign of politeness and respect rather than a lack of desire to continue speaking. (p. 166) The appropriateness of silence and verbal expressiveness varies among cultures (Sue and Sue, 2013; Sue, 2010). Although people living in the United States often value a high degree of verbal expressiveness, it is essential not to assume this is the norm for all clients. This assumption in and of itself constitutes a kind of cultural microaggression because it devalues the experience of other cultural groups who are comfortable with more silence and less verbal expressiveness. As you can see, like the other listening responses in this chapter, silence can have differential effects and purposes depending on the client. Many helpers, especially begin-ning ones, are so uncomfortable with this dimension of listening that their tendency is to fill in the conversa-tion and prevent the client from elaborating or express-ing something important or useful. Generally speaking, LO1 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
110 Chapter 4 instead of jumping in and saying the first thing that comes to mind, the helper needs to keep in mind that it is im-portant to allow silences to occur and to develop during a helping session. It is during the development of the silence that clients may reveal their innermost feelings, often conveyed nonverbally rather than with words. Helper-initiated silences are most effective when used with a particular purpose in mind, such as reducing the helper's level of activity, slowing the pace of the session, giving the client time to think, or transferring some responsibility to the client through turn-taking. An occasion when silence would not be useful, even in the context of listening to clients, would be when a client discloses something very precious and signifi-cant, often revealing information that takes great vul-nerability on the client's part. For example, Paul may share with you that he was recently diagnosed as HIV-positive, or Mariko may disclose something about the pain of being the only Japanese American student in her school. In instances like these, the helper's silence often makes the client feel ashamed of the revelation and misunderstood by the helper. Validation of the client's disclosure is essential. Particularly when clients self-disclose something that involves cultural vulner-abilities, being silent is the worst response a helper can make because it communicates invalidation and denial. In these instances, the verbal listening responses we describe later in the chapter such as paraphrasing and reflection are more useful because they tell clients you have heard something about their disclosure and you understand how much courage the disclosure represents for them. (See Learning Activity 4. 1. ) Learning Activity 4. 1 Nonverbal Communication Part One This activity will help you develop greater sensitivity to nonverbal behaviors of clients. It can be done in dyads or triads. Select one person to assume the role of the com-municator and another to assume the role of the listener. A third person can act as observer. As the communicator, recall recent times when you felt: (1) very happy, (2) very sad, and (3) very angry. Your task is to retrieve that experi-ence nonverbally. Do not say anything to the listener, and do not tell the listener in advance which of the three emo-tions you are going to recall. Simply decide which of the three you will recall; then tell the listener when to begin. The listener's task is to observe the communicator, to note nonverbal behaviors and changes during the recall, and from these to guess which of the three emotional experi-ences the person was retrieving. After approximately 3 to 4 minutes, stop the interaction to process it. Observers can add behaviors and changes they noted at this time. After the communicator retrieves one of the emotions, switch roles. Part Two In a role-play interaction or helping session in which you function as the helper, watch for some significant nonver-bal behavior from the client, such as change in breathing, eye contact, voice tone, and proxemics. (Do not focus on a small nonverbal behavior out of context with the spoken words. ) Focus on this behavior by asking the client whether she or he is aware of what is happening to her or his voice, body posture, eyes, or whatever. Do not interpret or assign meaning to the behavior for the client. Notice where your focus takes the client. Part Three Consider the aspects of culture that we have described in this chapter and also in Chapter 2—such as race, ethnicity, gen-der, sexual orientation, religious affiliation and faith heritage, social and economic class, ability/disability status, and so on. Construct a list of potential microaggressions in these areas that have to do with the helper's nonverbal behavior toward the client. Part Four This activity is designed to help you develop a better com-fort level with pauses and silences that occur during client sessions. Role-play a helping session with a classmate. One of you can be the helper first, and the other can be the client first. After engaging in a short role-play ses-sion, switch roles. During the role-play as the helper, your task is to desensitize yourself to the discomfort of having longer and longer periods of silence. After the client says something, wait about 5 seconds before responding the first time. The second time, wait about 10 seconds, and increase to 15 seconds for the third response. See if you can wait for up to 30 seconds before responding to the client. Note how you are feeling inside during the silences and also observe what the silences allow you to notice about the client. Part Five The purpose of this activity is to apply the material presented in this chapter in an interview setting. Using the Nonverbal Behavior Checklist that follows, observe a helper and deter-mine how many behaviors listed on the checklist the helper demonstrates. In addition, see how much you can identify about the client's nonverbal behaviors in the role play. Finally, Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 111 in your interview, look for mirroring, ways in which the helper and client's nonverbal communication mirrors each other. Nonverbal Behavior Checklist Name of Helper Name of Observer Instructions: During a recorded or a live interview, use the categories listed as guides for observing nonverbal behav-ior. You can use the checklist to observe the helper, the cli-ent, or both. Behaviors to be observed are listed in the first column. Check off a behavior when you observe it, and add descriptive comments about it—for example, “Blinking—excessive” or “Smiling—infrequently. ” Kinesics (✓) Comments 1. Eyes Eyebrows raised, lowered, or drawn together Staring or “glazed” quality Blinking—excessive, moder-ate, or slight Moisture, tears Pupil dilation 2. Face, mouth, head Continuity or changes in facial expression Smiling Swelling, tightening, or quiv-ering lips Changes in skin color Flushing, rashes on upper neck, face Appearance of sweat beads Head nodding 3. Body movements, posture, gestures Body posture—rigid or relaxed Continuity or shifts in body posture Kinesics (✓) Comments Frequency of body move-ments—excessive, mod-erate, or slight Gestures—open or closed Frequency of nonverbal adaptors (distracting mannerisms)— excessive, moderate, or slight Body orientation—direct (facing each other) or sideways Breathing—shallow or deep, fast or slow Continuity or changes in breathing depth and rate Crossed arms or legs Paralinguistics (✓) Comments 1. Continuity or changes in voice level, pitch, rate of speech 2. Verbal underlining—voice emphasis of particular words/phrases 3. Whispering, inaudibility 4. Directness or lack of direct-ness in speech 5. Speech errors—excessive, moderate, or slight 6. Pauses initiated by helper 7. Pauses initiated by client Proxemics 1. Continuity or shifts in distance (closer, farther away) 2. Position in room— behind or next to object or person Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
112 Chapter 4 Four Listening Responses This chapter presents four listening responses: LO2 LO3 LO4 clarification, paraphrase, reflection, and summariza-tion. Clarification begins with a question, often posed after an ambiguous client message. It starts with “Do you mean that... ” or “Are you saying that... ”, followed by a repetition or rephrasing of all or part of the client's previ-ous message. A paraphrase is a 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—the part that reveals the client's feelings about the content. For example, a client may feel discouraged (affect) about not doing well in a class (content). Summarization is an extension of the paraphrase and reflection responses; it is a tying together and rephrasing of two or more parts of a message or messages. To illustrate these four listening responses, here is a client message followed by an example of each response: Client, a 35-year-old Latina widow, mother of two young children (says in a soft, halting voice, with downcast eyes, and corners of the mouth turned down, also accompanied by occasional tears): My whole life fell apart when my husband died. I keep feeling so unsure about my ability to make it on my own and to support my kids. My husband always made all the decisions for me and brought home money every week. Now I haven't slept well for so long, and I'm drinking more heavily—I can't even think straight. My relatives help me as much as they can, but I still feel scared. Helper clarification: Are you saying that one of the hard-est things facing you now is to have enough confidence in yourself? Helper paraphrase: Since your husband's death you have more responsibilities and decisions on your shoulders, even with the support of relatives. Helper reflection: You feel worried about having to shoul-der all the family responsibilities now. Helper summarization: Now that your husband has died, you're facing some things that are very difficult for you right now... handling the family responsibilities, mak-ing the decisions, trying to take better care of yourself, and dealing with fears that have come up as a result. Table 4. 1 presents definitions and lists the intended or hypothesized purposes of the four listening responses. These responses may not produce the same results with all clients. For example, a practitioner may find that re-flecting feelings prompts some clients to discuss feelings but that other clients do not even acknowledge the coun-selor's statement. Our point is that we are presenting some “modal” intentions for each listening response; there TABLe 4. 1 Definitions and Intended Purposes of Listening Responses Response Definition Intended Purpose Clarification A question beginning with, for example, “Do you mean that... ” or “Are you saying that... ” followed by a rephrasing of the client's message1. To encourage client elaboration 2. To check out the accuracy of what you think you heard the client say 3. To clear up vague, confusing messages Paraphrase (responding to content)A rephrasing of the content of the client's message1. To help the client focus on the content of his or her message 2. To highlight content when attention to feelings is premature or self-defeating Reflection (responding to feelings)A rephrasing of the affect part of the client's message1. To encourage the client to express more of his or her feelings 2. To help the client become more aware of the feelings that dominate him or her 3. To help the client acknowledge and manage feelings4. To help the client discriminate accurately among feelings 5. To help the client feel understood Summarization Two or more paraphrases or reflections that condense the client's messages or the session1. To tie together multiple elements of client messages 2. To identify a common theme or pattern3. To interrupt excessive rambling4. To review progress5. To slow the pace of a session Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 113 are exceptions. The listening responses will achieve their intended purposes most of the time. However, other dy-namics within an interview may give rise to different client outcomes. Moreover, the effects of these verbal messages may vary because of nonverbal cues that accompany the message. It is helpful to have some rationale in mind for using a response. However, always remember that the effect a response has on the client may not be what you intended to achieve. The guidelines in Table 4. 1 should be used tentatively, subject to modification, depending on particular client reactions. Remember Sue and Sue's (2013) advice at the beginning of this chapter—consider not only the accuracy of responses but also the appropriateness of responses. The appropriateness of responses is most often determined by the client reactions to the message. Sequencing of Listening Responses It is not accidental that we have listed the four listening responses in the following particular order: clarification, paraphrase, reflection, and summarization. Because every helping session is different, and because every client is unique, it is not possible to predict an exact sequence to the listening responses. However, as Young (2013) points out, within these variations, there is sufficient predictability between helping sessions to estimate some sequencing of various listening responses. He refers to this as “the nonjudgmental listening cycle or NLC”— described as “a set of sequential procedures to be followed as each topic emerges, is discussed, and comes to closure” (p. 152). In essence, each new topic forms a circle begin-ning with clarifying questions and proceeding through to summarization. The clarifying response opens the topic, the paraphrasing and reflecting responses move the topic to deeper levels, and the summarization either makes a transition from one topic to another or ends the session. Think of this sequence, however, as a guide map and not as a prescription for what always occurs in sessions, be-cause each session and each client are somewhat different. In the next three sections we describe the listening responses and present model examples of each response. Opportunities for you to practice each one and receive feedback follow the examples. The Clarification Response: Listening for Accuracy Because most messages are expressed from the speaker's internal frame of reference, they may seem vague or con-fusing to the listener. Messages that are particularly likely to be confusing are those that include inclusive terms (they and them), ambiguous phrases (you know), and words with a double meaning (stoned, trip). When you aren't sure of the meaning of a message, it is helpful to clarify it. A clarification asks the client to elaborate on a vague, ambiguous, or implied statement. The request for clari-fication is usually expressed as a question and may begin with phrases such as “Are you saying... ” or “Could you try to describe... ” or “Can you clarify... ”. Purposes of Clarification Clarification may be used to make the client's previous message explicit and to confirm the accuracy of your perceptions about the message. Clarification is appropri-ate whenever you aren't sure whether you understand the client's message and you need more elaboration. A second purpose of clarification is to check out what you heard of the client's message. Particularly in the beginning stages of helping, it is important to verify client messages instead of jumping to conclusions. This is a primary reason why the clarifying question is a good response with which to begin the nonjudgmental listening cycle described. The following example may help you see the value of the clari-fication response: Client: Sometimes I just want to get away from it all. Helper: It sounds like you have to split and be on your own. Client: No, it's not that. I don't want to be alone. It's just that I wish I could get out from under all this work I have to do. In that example, the helper drew a quick conclusion about the initial client message that turned out to be inaccurate. The session might have gone more smoothly if the helper had requested clarification before assuming some-thing about the client, as in this example: Client: Sometimes I just want to get away from it all. Helper: Could you describe for me what you mean by “getting away from it all?” Client: Well, I just have so much work to do—I'm always feeling behind and overloaded. I'd like to get out from under that miserable feeling. In that case, the clarification helped both persons to establish exactly what was being said and felt. Neither the client nor the helper had to rely on assumptions and infer-ences that were not explored and confirmed. A skilled helper uses clarification responses to determine the accuracy of messages as they are received and processed. Otherwise, inaccurate information may not be corrected, and distorted assumptions may remain untested. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
114 Chapter 4 Steps in Clarifying There are four steps in clarifying for accuracy. First, identify the content of the client's verbal and nonverbal messages. Ask yourself, “What has the client told me?” Pay attention not only to the client's words but also to the client's nonverbal messages. Second, identify any vague or confusing parts of the verbal or nonverbal message that you need to check out for accuracy or elaboration. Third, decide on an appropriate begin-ning, or sentence stem, for your clarification, such as “Could you describe... ”, “Could you clarify... ”, or “Are you saying... ”. In addition, use your voice to deliver the clarification as a question, not a statement. Fourth, remember to assess the effectiveness of your clarification by listening to and observing the client's response. If your clarification is useful, then the cli-ent will elaborate on the ambiguous or confusing part of the message. If it is not useful, then the client will clam up, ignore your request for clarification, and/or continue to reveal deletions or omissions. At this point, you can attempt a subsequent clarification or switch to an alternative response. To decide whether to use clarification, to formulate this response, and to assess its effectiveness, consider the fol-lowing cognitive learning strategy: 1. What has this client told me?2. Are there any vague parts or missing pictures in the message that I need to check out? If so, what? If not, then I need to decide on another, more suitable response. 3. How can I hear, see, or grasp a way to start this response? 4. How will I know whether my clarification is useful? Notice how the helper applies this cognitive learning strategy to clarify the client's message in the second ex-ample above: Client (says with downcast eyes, looking at the floor): Some-times I just want to get away from it all. Helper (asks and answers covertly): Self-question 1: What has this client told me? That she wants to get away from something. Downcast eyes support the verbal idea. Self-question 2: Are there any vague parts or missing pictures in her message? If so, what? (If not, then I'll decide on a more suitable response. ) Yes—I need to check out what she means by “getting away from it all. ”Self-question 3: How can I begin a clarification response?I can see the start of it, hear the start of it, or grasp the start of it. Something like “Well, could you tell me, or could you describe... ?” Self-question 4: How will I know that the response will be helpful? I'll have to see, hear, and grasp whether she elaborates or not. Let's try it... At this juncture, the helper's covert visualization or self-talk ends, the helper addresses the client, and the client responds: Helper clarification: Could you describe for me what you mean by “getting away from it all”? Client response: Well, I just have so much work to do— I'm always feeling behind and overloaded. I'd like to get out from under that miserable feeling. From the client's response, the helper can determine that the clarification was effective because the client elab-orated and added the parts or pictures missing from her previous message. The helper can covertly congratulate himself or herself for not jumping ahead too quickly and for taking the time to check out the client's omission and the resulting ambiguity. Learning Activity 4. 2 gives you an opportunity to try this cognitive learning strategy to develop the skill of clarification. Paraphrase and Reflection: Listening for Facts and Feelings The practitioner needs to listen for information revealed in messages about significant situations and events in the client's life—and for the client's feelings about these events. Ivey and colleagues (2007) talk about this as lis-tening for the main facts of the client's story and for the client's feelings about his or her story. Each client mes-sage expresses (directly or indirectly) some information about client situations or concerns and client feelings. The portion of the message that expresses information or describes a situation or event is called the content, or cognitive part, of the message. The cognitive part of a message includes references to a situation or event, people, objects, or ideas. Another portion of the mes-sage may reveal how the client feels about the content; the expression of feelings or emotional tone is called the affective part of the message (Cormier, 2016). Generally, the affective part of the verbal message is distinguished Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 115 by the client's use of an affect or feeling word, such as happy, angry, or sad. However, clients may also express their feelings in less obvious ways, particularly via nonverbal behaviors. For example, “evidence of decreased general movement, decreased expressiveness, decreased speech, gestures, eye contact, and smiling; halting speech, have all been documented in depressed persons” (Knapp et al., 2014, p. 412). Facial cues from clients are important indica-tors of emotions and helpers can usually accurately infer emotions from the clients' facial expressions, particularly the six basic emotions of happiness, anger, sadness, dis-gust, surprise, and fear (Knapp et al., 2014). Moreover, facial indicators of emotions are considered to be more universal rather than culture specific. Clients also reveal something about their feelings through their voice. And while there is no dictionary of emotion cues for the voice, we do rely on some consistent vocal indicators to identify client emotional states (Knapp et al., 2014, p. 341). For example, anxiety is often associated with Learning Activity 4. 2 Clarification In this activity, you are presented with three client prac-tice messages. For each message, develop an example of a clarification response using the cognitive learning strategy described and outlined in the following example. To inter-nalize this learning strategy, you may wish to talk through these self-questions overtly (aloud) and then covertly (silently to yourself). The end product will be a clarifica-tion response that you can say aloud or write down. An example precedes the three practice messages. Feedback is provided on page 118. example Client, a 15-year-old high school student (says in a slow, low voice tone while looking down at the floor): My grades have really slipped. I don't know why; I just feel so down about everything. Self-question 1: What has this client told me?That she feels down and rather discouraged. Self-question 2: Are there any vague parts or missing pic-tures to the message that I need to check out? If so, what? If not, decide on a different response. Yes, several—one is what she feels so down about. Another is what this feeling of being down is like for her. Self-question 3: How can I hear, see, or grasp a way to start this response? “Are you saying there's something specific?” or “Can you describe this feeling... ?” Self-question 4: How will I know whether my clarifica-tion is useful? Say aloud or write an actual clarification response: “Are you saying there is something specific you feel down about?” or “Could you describe what this feeling of be-ing down is like for you?” Client Practice Messages Client 1, a fourth-grader (says with a frown on the face and downcast corners of the mouth): I don't want to do this dumb homework anyway. I don't care about learning these math problems. Girls don't need to know this anyway. Self-question 1: What has this client told me? Self-question 2: Are there any vague parts or missing pictures I need to check out? If so, what? Self-question 3: How can I hear, see, or grasp a way to start my response? Actual clarification response : Client 2, a middle-aged man (says with lowered eyes, look-ing away from helper, low, soft voice, corners of the mouth turned down): I'm really discouraged with this physical disability now. I feel like I can't do anything the way I used to. It has affected me not only at my job but also at home. I just don't feel like I have anything good to offer anyone. Self-question 1: What has this client told me?Self-question 2: Are there any vague parts or missing pic-tures I need to check out? If so, what? Self-question 3: How can I hear, see, or grasp a way to start my response? Actual clarification response: Client 3, an older person (says with fast-paced, high-pitched voice, direct eye contact, excessive body motion): Umm, well the company is going to make me retire even though I don't want to. What will I do with myself then? I find myself just thinking—thinking over the good times of the past, not wanting to face the future at all. Some-times retirement makes me so nervous I can't sleep or eat. My family suggested I see someone about this. Self-question 1: What has this client told me?Self-question 2: Are there any vague parts or missing pic-tures I need to check out? If so, what? Self-question 3: How can I hear, see, or grasp a way to start my response? Actual clarification response: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
116 Chapter 4 speech disruptions or errors, happiness and joy are asso-ciated with a higher pitch of the voice, anger is conveyed by more intensity and a faster speech rate, and sadness is reflected in a quieter voice and slower speech (Knapp et al., 2014). The following illustrations may help you distinguish between the content and affective parts of a client's verbal message: Client, a 6-year-old first-grader: I don't like school. It isn't much fun. The first sentence (“I don't like school”) is the affective part of the message. The client's feelings are suggested by the words “don't like. ” The second sentence (“It isn't much fun”) is the content part of the message because it refers to a situation or an event in this child's life—not having fun at school. Here is another example: Client, a 20-year-old woman: How can I tell my boyfriend I want to break off our relationship? He will be very upset. I guess I'm afraid to tell him. In that example, the first two sentences are the con-tent because they describe the situation of wanting to break off a relationship. The third sentence, the affective part, indicates the client's feelings about this situation—being afraid to tell the boyfriend of her intentions. See whether you can distinguish between the content and affective parts of the next two client messages: Client 1, a young man: I can't satisfy my partner sexually. It's very frustrating for me. In that example, the content part is “I can't satisfy my partner sexually. ” The affective part, or Client 1's feelings about the content, is “It's very frustrating for me. ” Client 2, an institutionalized man: This place is a trap. It seems like I've been here forever. I'd feel much better if I weren't here. In that example, Client 2's statements referring to the institution as a trap and being there forever are the content parts of the message. The statement of “feeling better” is the affective part. The skilled helper tries to listen for both the content and the affective parts of client messages because it is important to deal with significant situations or rela-tionships and with the client's feelings about the situ-ations. Responding to cognitive or affective messages will direct the focus of the session in different ways. At some points, the helper will respond to content by focusing on events, objects, people, or ideas. At other times, the helper will respond to affect by focusing on the client's feelings and emotions. Generally, the helper can respond to content by using a paraphrase and can respond to affect with a reflection. It is helpful to be able to use both of these responses skillfully because focusing on content can be important if the therapeu-tic relationship is not strong enough to process affect or if focusing on feelings may overwhelm the client. However, focusing on emotion is very important when clients are explaining their feelings away or exhibiting a lack of awareness of feelings, and the therapeutic rela-tionship is strong enough to provide safety (Greenberg, 2010). Paraphrasing A paraphrase is a rephrasing of the client's primary words and thoughts. Paraphrasing requires selective attention to the content part of the message and translating the client's key ideas into your own words. An effective paraphrase does more than just parrot the words of the client. The rephrase should be carefully worded to lead to further discussion or to increased understanding by the client. It is helpful to stress the most important words and ideas expressed by the client. Consider this example: Client: I know it doesn't help my depression to sit around or stay in bed all day. Helper: You know that to help your depression you need to avoid staying in bed or sitting around all day. The helper merely parroted the client's message. The likely outcome is that the client may respond with a minimal answer such as, “I agree,” or “That's right,” and not elaborate further, or that the client may feel ridiculed by what seems to be an obvious or mimick-ing response. Here is a more effective paraphrase: “You are aware that you need to get up and move around to minimize being depressed. ” Purposes of Paraphrasing The paraphrase serves several purposes in client interactions. First, the paraphrase tells clients that you have understood their communication. If your understanding is complete, then clients can expand or clarify their ideas. Second, paraphrasing can encourage client elaboration of a key idea or thought. Clients may talk about an important topic in greater depth. A third reason for using the paraphrase is to help the client focus on a particular situation or event, idea, or behavior. Some-times, by increasing focus, paraphrasing can help get a cli-ent on track. For example, accurate paraphrasing can help Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 117 stop a client from merely repeating a “story” (Ivey, Ivey, & Zalaquett, 2014). A fourth purpose is to help clients who need to make decisions. As Ivey and colleagues (2014) observe, paraphrasing is often helpful to clients who have a decision to make, because the repetition of key ideas and phrases clarifies the essence of the problem. Paraphrasing to emphasize content is also useful if attention to affect is likely to be premature or counterproductive. Steps in Paraphrasing There are five steps in paraphras-ing content. First, attend to and recall the message by restating it to yourself covertly. Ask yourself, “What has the client told me?” Second, identify the content part of the message by asking yourself, “What situation, person, object, or idea is discussed in this message?” Third, select an appropriate beginning, or sentence stem, for your paraphrase. Paraphrases can begin with many possible sentence stems. See Table 4. 2 for a list of phrases and sentence stems useful for beginning paraphrase and reflection responses. Fourth, using the sentence stem you selected, translate the key content or constructs into your own words and express the key content in a paraphrase that you can say aloud. Remember to use your voice so that the paraphrase sounds like a statement, not a question. Fifth, assess the effectiveness of your paraphrase by listening to and observing the client's response. If your paraphrase is ac-curate, then the client will in some way—verbally and/or nonverbally—confirm its accuracy and usefulness. Consider in the following example the way a helper uses the cognitive learning strategy to formulate a paraphrase: Client, a 40-year-old Asian American woman (says in a level, monotone voice): How can I tell my husband I want a divorce? He'll think I'm crazy. I guess I'm just afraid to tell him. Helper (asks and answers covertly): Self-question 1: What has this client told me?That she wants a divorce and she's afraid to tell her husband because he will think she's crazy. Self-question 2: What is the content of this message—what person, object, idea, or situation is the client discussing? She wants a divorce but hasn't told husband because hus-band will think she's crazy. Self-question 3: What is an appropriate sentence stem?I'll go with a stem such as “You think...,” “I hear you saying...,” or “It sounds like... ”. Self-question 4: How can I translate the client's key content into my own words? Want a divorce = break off, terminate the relationship, split. Self-question 5: How will I know whether my paraphrase is helpful? Listen and notice whether the client confirms its accuracy. At this point the helper's self-talk stops, and the following dialogue ensues: Helper paraphrase: It sounds like you haven't found a way to tell your husband you want to end the relation-ship because of his possible reaction. Is that right? Client: Yeah—I've decided—I've even been to see a law-yer. But I just don't know how to approach him with this. He thinks things are wonderful, and I don't want to dishonor him by divorcing him. That paraphrase encouraged both client elaboration and focus on a main issue. Learning Activity 4. 3 gives you an opportunity to de-velop your own paraphrase responses. Reflection and Basic Empathy The paraphrase is used to restate the content part of the message. Although paraphrase and reflection of feelings are not mutually exclusive responses, the reflection of feel-ings is used to rephrase the affective part of the message, the client's emotional tone. A reflection is similar to a paraphrase but different in that a reflection adds to the message an emotional tone or component that is lacking in a paraphrase. TAb Le 4. 2 Phrases and Sentence Stems to Introduce Paraphrase and Reflection Responses It seems like It appears as though From my perspective As I see it I see what you mean It looks like Sounds like As I hear it What you're saying is I hear you saying Something tells you You're telling me that You feel From my standpoint I sense that I have the feeling that Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
118 Chapter 4 Here are two examples that may illustrate the difference between a paraphrase and a reflection of feelings: Client: Everything is humdrum. There's nothing new go-ing on, nothing exciting. All my friends are away. I wish I had some money to do something different. Helper paraphrase: With your friends gone and no money around, there is nothing for you to do right now. Helper reflection: You feel bored with the way things are for you right now. Notice the helper's use of the affect word bored in the reflection response to tune in to the feelings of the client created by the particular situation. Purposes of Reflection The reflection of feelings has five in-tended purposes. First, reflection is used to encourage clients to express their feelings (both positive and negative) about a particular situation, person, or whatever. Some clients do not readily reveal feelings because they have never learned to do so; other clients hold back feelings until the helper gives permission to focus on them. Expression of feelings is not usually an end in itself; rather, it is a means of helping clients and practitioners understand the scope of the issues or situation. Most, if not all, of the concerns presented by clients involve underlying emotional factors to be resolved. For example, in focusing on affect, the client may become more aware of lingering feelings about an unfinished situa-tion or of intense feelings that seem to dominate his or her reaction to a situation. Clients may also become aware of mixed, or conflicting, feelings. Clients often express ambivalence about prob-lematic issues. Teyber and Mc Clure (2011) identify two common affective constructions with mixed components: anger-sadness-shame and sadness-anger-guilt. In the first sequence, the primary feeling is often anger, but it is a negative response to hurt or sadness. Often, the experi-encing of the anger and sadness provokes shame. In the second sequence, the predominant feeling is sadness, but it is often connected to anger that has been denied because the expression of it produces guilt. These two affective 4. 2 Feedback Clarification Client 1 Question 1. What did the client say? That she doesn't want to do her math homework—that she thinks it's not important for girls. Question 2. Are there any vague parts or missing pic-tures?Yes—whether she really doesn't care about math or whether she's had a bad experience with it and is denying her concern. Question 3. How can I see, hear, or grasp a way to start my response? examples of Clarification Responses “Are you saying that... ?”“Are you saying that you really dislike math or that it's not going as well as you would like?”“Are you saying that math is not too important for you or that it is hard for you?” Client 2 Question 1. What did the client say?That he feels useless to himself and others. Question 2. Are there any vague parts or missing pictures?Yes—it's not clear exactly how things are different for him now and also whether it's the disability itself that's bother-ing him or its effects (inability to get around, reactions of others, and so on). Question 3. How can I see, hear, or grasp a way to start my response?examples of Clarification Responses “Could you clarify... ?”“Could you clarify exactly how things are different for you now from the way they used to be?”“Are you saying you feel discouraged about having the disability—or about the effects and constraints from it?”“Are you saying you feel differently about yourself now from the way you used to?” Client 3 Question 1. What did the client say?He is going to have to retire because of company policy. He doesn't want to retire now and feels upset about this. He's here at his family's suggestion. Question 2. Are there any vague parts or missing pictures?Yes—he says he feels nervous, although from his descrip-tion of not eating and sleeping it may be sadness or de-pression. Also, is he here only because his family sent him or because he feels a need, too? Finally, what specifically bothers him about retirement?Question 3. How can I hear, see, or grasp a way to start my response? examples of Clarification Responses “Could you describe... ?”“Would you say you're feeling more nervous or more depressed about your upcoming retirement?”“Are you saying you're here just because of your family's feelings or because of your feelings, too?”“Could you describe what it is about retiring that worries you?” Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 119 sequences are typically acquired in childhood and are a result of both the rules and the interactions of the fam-ily of origin. These affective elements are also strongly influenced by cultural affiliation. As Sue and Sue (2013) note, in Western cultures, which emphasize individual-ism, the predominant affective reaction following wrong-ful behavior is guilt. However, in some U. S. subcultures, such as Asian, Hispanic, and African American, where the psychosocial unit is the family, group, or collective society, the primary affective reaction to wrongful behavior is not guilt but shame. A second purpose of reflection is to help clients manage feelings. Learning to deal with feelings is especially impor-tant when a client experiences an intense emotion such as fear, dependency, or anger. Strong emotions can inter-fere with a client's ability to produce a rational response (cognitive or behavioral) to pressure. Also, when clients are given permission to reveal and release feelings, their energy and well-being are often increased. For example, during and after a crisis or disaster such as an earthquake, terrorist attack, plane crash, or bomb scare, people feel overwhelmed by the intensity of their emotions. This feel-ing can persist for months or even years after the event. Practitioners who help clients in these sorts of situations do so in part by encouraging them to name, validate, and express their emotions in a safe context (Halpern & T ramontin, 2007). A third use of reflection is with clients who express negative feelings about therapy or about the helper. When a client becomes angry or upset with the helper or with the help being offered, there is a tendency for the helper to take the client's remarks personally and become defensive. Learning Activity 4. 3 Paraphrase In this activity, you are presented with three client practice messages. For each one, develop a paraphrase response using the cognitive learning strategy outlined in the follow-ing example. To internalize this learning strategy, you may wish to talk through these self-questions overtly (aloud) and then covertly (silently). The end product will be a para-phrase response that you can say aloud or write down. Feedback is given on page 121. example Client, a middle-aged graduate student (says in a level, monotone voice): It's just a rough time for me—trying to work, keeping up with graduate school, and spending time with my family. I keep telling myself it will slow down someday. Self-question 1: What has this client told me?That it's hard to keep up with everything he has to do. Self-question 2: What is the content of this message—what person, object, idea, or situation is the client discussing? Trying to keep up with work, school, and family. Self-question 3: What is an appropriate sentence stem?I'll try a stem like “It sounds like... ” or “There are... ”Actual paraphrase response: “It sounds like you're hav-ing a tough time balancing all your commitments” or “There are a lot of demands on your time right now. ” Client Practice Statements Client 1, a 30-year-old woman (says in a level tone with-out much variation in pitch or tempo): My husband and I argue all the time about how to manage our kids. He says I always interfere with his discipline. I think he is too harsh with them. Self-question 1: What has this client told me?Self-question 2: What is the content of this message— what person, object, idea, or situation is the client discussing? Self-question 3: What is an appropriate sentence stem? Actual paraphrase response: Client 2, a 6-year-old boy (says in slow, soft voice with downcast eyes): I wish I didn't have a little sister. I know my parents love her more than me. Self-question 1: What has this client told me? Self-question 2: What is the content of this message—what person, object, idea, or situation is this client discussing? Self-question 3: What is an appropriate sentence stem? Actual paraphrase response: Client 3, a college student (says in a level tone with mea-sured words and little change in pitch and inflection): I've said to my family before, I just can't compete with the other students who aren't blind. There's no way I can keep up with this kind of handicap. I've told them it's natural to be behind and do more poorly. Self-question 1: What has this client told me?Self-question 2: What is the content of this message— what person, object, idea, or situation is the client discussing? Self-question 3: What is a useful sentence stem? Actual paraphrase response: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
120 Chapter 4 Using reflection in these instances helps to address and defuse inevitable misunderstandings that arise in the course of the helping process. This use of reflection lets clients know that the helper understands their feelings in such a way that the intensity of the anger is usually diminished. As anger subsides, the client may become more receptive, and the helper can again initiate action-oriented responses or intervention strategies. In this sense, reflection is used to defuse client resistance and is an im-portant component of motivational interviewing (see also Chapter 10). Reflection also helps clients discriminate accurately among various feelings. Clients often use feeling words like anxious or nervous that, on occasion, mask deeper or more intense feelings. Clients may also use an affect word that does not really portray their emotional state accurately. For instance, it is common for a client to say “It's my nerves” or “I'm nervous” to depict other feelings, such as resentment and depression. Other clients may reveal feelings through the use of metaphors. For example, a client may say “I feel like the person who plunged over Niagara Falls in a barrel” or “I feel like I just got hit by a Mack truck. ” Metaphors are important indicators of client emotion. As Ivey, Gluckstern Packard, and Ivey (2006) note, metaphors suggest that much more is go-ing on with the client than just the “surface expression” (p. 73). Accurate reflections of feelings help clients to refine their understanding of various emotional moods. Finally, reflection of feelings, if used effectively and accurately, helps clients to feel understood. Clients tend to communicate more freely with persons who they feel try to understand them. As Teyber and Mc Clure (2011) observe, when understanding is present, “Clients feel that they have been seen and are no longer invisible or alone, different or defective, dismissed or unimportant, and so forth. At that moment, the client begins to perceive the therapist as someone who is different from many others in her life and possibly as someone who can help” (p. 72). The reflection-of-feelings response is the primary verbal tool used to convey basic empathy. Verbal Means of Conveying Empathy Consider the follow-ing four verbal strategies for conveying empathy: 1. Show desire to comprehend. It is necessary not only to convey an accurate understanding from the client's perspective but also to convey your desire to compre-hend from the client's frame of reference. Recall from our discussion of cultural empathy that this desire includes an understanding not only of the individual but also of the person's worldview: his or her environ-mental and sociopolitical context and cultural group. Mc Gill (1992) offers the idea of the cultural story as a way to open communication and develop understand-ing about the client's cultural group: The cultural story refers to an ethnic or cultural group's origin, migration, and identity. Within the family, it is used to tell where one's ancestors came from, what kind of people they were and that current members are, what issues are important to the family, what good and bad things have happened over time, and what lessons have been learned from their experiences. At the ethnic level, a cultural story tells the group's collective story of how to cope with life and how to respond to pain and trouble. It teaches people how to thrive in a multicultural society and what children should be taught so that they can sustain their ethnic and cultural story. (p. 340) Your desire to comprehend is evidenced by statements indicating your attempts to make sense of the client's world and by clarification and questions about the cli-ent's experiences and feelings. 2. Discuss what is important to the client. Show by your questions and statements that you are aware of what is most important to the client. Respond in ways that relate to the client's basic problem or complaint. For-mulate a brief statement that captures the thoughts and feelings of the client and that is directly related to the client's concerns. 3. Use verbal responses that refer to client feelings. One way to define verbal empathy is through the reflection-of-feelings response, which reflects the client's feelings and conveys your awareness of them. This response allows you to focus on the client's feelings by naming or labeling them. It is sometimes called interchange-able (Carkhuff, 1969), basic (Egan, 2014), or re-ciprocal (Hepworth, Rooney, Dewberry Rooney, & Strom-Gottfried, 2013) empathy. In motivational in-terviewing terms, these reflections are known as simple reflections. 4. Use verbal responses that bridge or add on to implicit client messages. Empathy also involves comprehension of the client's innermost thoughts and perspectives even when they are unspoken and implicit. According to Rogers (1977), “The therapist is so much inside the private world of the other that she can clarify not only the messages of which the client is aware but even those just below the level of awareness” (p. 11). The counselor bridges or adds to client messages by conveying understanding of what the client implies or infers to add to the client's frame of reference or to draw out implications of the issue. This is sometimes Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 121 called additive empathy (Carkhuff, 1969, Hepworth et al., 2013) or advanced empathy (Egan, 2014). At this level of empathy, the helper uses mild to mod-erate interpretations of the client's inferred feelings (Hepworth et al., 2013). In motivational interviewing, these reflections are known as complex reflections. Carkhuff and Pierce (1975) developed a Discrimination Inventory that presents a scale for assessing both basic and additive empathy messages. Although this scale has been around for a number of years, it is still heavily used in training, especially as a way to help novice practition-ers make discriminations about their level of empathic understanding. On this scale, helper responses are rated according to one of five levels. Level 3 is considered the minimally acceptable response. Level 3 responses on this scale correspond to Carkhuff and Pierce's concept of in-terchangeable empathy and to Egan's (2014) concept of basic-level empathy. Level 4 corresponds to additive em-pathy (Carkhuff, 1969) and to advanced empathy (Egan, 2014). Level 5 represents facilitating action. Carkhuff and Pierce's Discrimination Inventory can be used to discriminate among levels of responses or to rate levels of helper communication. Here are examples of verbal empathic responses at each level: Client: I've tried to get along with my father, but it doesn't work out. He's too hard on me. Helper at Level 1: I'm sure it will all work out in time [reas-surance and denial], or You should try harder to see his point of view [advice], or Why can't you two get along? [question]. The Level 1 response is a question, reassurance and denial, or advice. Helper at Level 2: You're having a hard time getting along with your father. At Level 2, the response is made to the content or cogni-tive portion of the message; feelings are ignored. Helper at Level 3: You feel discouraged because your attempts to get along with your father have not been very successful. 4. 3 Feedback Paraphrase Client 1 Question 1: What has the client said? That she and her husband argue over child rearing. Question 2: What is the content of her message?As a couple, they have different ideas on who should disci-pline their kids and how. Question 3: What is a useful sentence stem?Try “It sounds like... ” or “Your ideas about discipline are... ” example of Paraphrase Responses “It sounds like you and your husband disagree a great deal on which one of you should discipline your kids and how it should be done. ” “Your ideas about discipline for your kids are really different from your husband's, and this creates disagreements between the two of you. ” Client 2 Question 1: What has this client said?He believes his little sister is loved more by his parents than he is, and he wishes she weren't around. Question 2: What is the content of this message?Client feels “dethroned”—wishes the new “princess” would go away. Question 3: What is an appropriate sentence stem?I'll try “It seems that... ” or “I sense that... ”examples of Paraphrase Responses “It seems that you'd like to be 'number one' again in your family. ” “I sense you are not sure of your place in your family since your little sister arrived. ” Client 3 Question 1: What has this client said?He is behind in school and is not doing as well as his peers because he is blind—a point he has emphasized to his family. Question 2: What is the content of this message?Client wants to impress on his family that to him his blind-ness is a handicap that interferes with his doing as much or as well as other students. Question 3: What is an appropriate sentence stem?“It sounds like..., ” “I hear you saying..., ” or “You'd like... ” examples of Paraphrase Responses “It sounds like it's very important to you for your family to realize how tough it is for you to do well in your studies here. ” “You'd like your family to realize how difficult it is for you to keep up academically with people who don't have the added problem of being visually impaired. ” Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
122 Chapter 4 The Level 3 response indicates understanding but pro-vides no direction; it is a reflection of feeling and meaning based on the client's explicit message. In other words, a Level 3 response reflects both the feeling and the situa-tion. In this example, “You feel discouraged” is the reflec-tion of the feeling, and “because... not very successful” is the reflection of the situation. Helper at Level 4: You feel discouraged because you can't seem to reach your father. You want him to let up on you. The Level 4 response indicates understanding and pro-vides some direction. A Level 4 response identifies not only the client's feelings but also the client's deficit that is implied. In a Level 4 response, the client's deficit is personalized—that is, the helper identifies the deficit, as in “you can't reach. ” Helper at Level 5: You feel discouraged because you can't seem to reach your father. You want him to let up on you. One step could be to express your feelings about this to your father. A Level 5 response contains all elements of a Level 4 re-sponse plus at least one action step that the client can take to master the deficit and attain the goal. In this example, the action step is, “One step could be to express your feel-ings about this to your father. ” Next, we present information about how to reflect feel-ings to convey basic empathy. Steps in Reflection of Feelings Reflecting feelings can be a difficult skill to learn because feelings are often ignored or misunderstood. The reflection of feelings involves six steps, which include identifying the emotional tone of the communication and verbally reflecting the cli-ent's feelings in your own words. 1. Listen for feeling words, or affect words, in the client's messages. Positive, negative, and ambivalent feelings are expressed by affect words falling into one of five major categories: anger, fear, conflict, sadness, and happiness. Table 4. 3 lists commonly used affect words at three levels of intensity. Becoming acquainted with such words may help you to recognize them in client communications and to expand your own vocabulary for describing emotions. Table 4. 4 lists affect words to use with children and teens. With very young children, Relative intensity of words Anger Conflict Fear Happiness Sadness Mild feeling Annoyed Bothered Bugged Irked Irritated Peeved Ticked Blocked Bound Caught Caught in a bind Pulled Apprehensive Concerned Tense Tight Uneasy Amused Anticipating Comfortable Confident Contented Glad Pleased Relieved Apathetic Bored Confused Disappointed Discontented Mixed up Resigned Unsure Moderate feeling Disgusted Hacked Harassed Mad Provoked Put upon Resentful Set up Spiteful Used Locked Pressured Strained Torn Afraid Alarmed Anxious Fearful Frightened Shook Threatened Worried Delighted Eager Happy Hopeful Joyful Surprised Up Abandoned Burdened Discouraged Distressed Down Drained Empty Hurt Lonely Lost Sad Unhappy Weighted TABLe 4. 3 Words That express Feelings Feeling category Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 123 TABLe 4. 4 Affect Words and Phrases for Children and Teens Anxious Bored Childish Contented or fulfilled Curious Depressed Determined Disgusted Doubtful Embarrassed Empty Envious of others Excited Furious Guilty Hopeful Humble Hurt Irritated Jealous Lovable Mean and destructive Nervous Optimistic Proud Rebellious Sad Safe and secure Scared or afraid Silly Sorry Strong and capable Terrified Thrilled Warm and cozy Worried Source: Adapted from Group Activities for Counselors, by Eliot, Inner Choice Publishing, 1994. Relative intensity of words Anger Conflict Fear Happiness Sadness Intense feeling Angry Boiled Burned Contemptuous Enraged Fuming Furious Hateful Hot Infuriated Pissed Smoldering Steamed Coerced Ripped Wrenched Desperate Overwhelmed Panicky Petrified Scared Terrified Terror-stricken Tortured Bursting Ecstatic Elated Enthusiastic Enthralled Excited Free Fulfilled Moved Proud Terrific Thrilled Turned on Anguished Crushed Deadened Depressed Despairing Helpless Hopeless Humiliated Miserable Overwhelmed Smothered Tortured Source: From Hutchins & Cole. Helping Relationships and Strategies, 3e. Copyright © 1997 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission. www. cengage. com/permissions TABLe 4. 3 Words That express Feelings (continued) we recommend using face symbols such as those de-picted in Figure 4. 3. 2. Watch the client's nonverbal behavior while he or she is delivering the verbal message. Recall our earlier dis-cussion about the ways in which nonverbal cues such as body posture, facial expression, and voice quality are important indicators of client emotion. Observing nonverbal behavior is particularly important when the client's feelings are implied or expressed very subtly. 3. After the feelings reflected by the client's words and nonverbal behavior have been identified, reflect the feel-ings back to the client using different words. The choice of words is critical to the effectiveness of this response. Suppose a client feels “annoyed. ” Interchangeable af-fect words would be bothered, irritated, and hassled. Words such as angry, mad, and outraged probably would convey greater intensity than the client intends to ex-press. With adult clients, it is important for the helper to select affect words that accurately match not only the type but also the intensity of feeling; otherwise, the helper produces an understatement, which can make a client feel ridiculed, or an overstatement, which can make a client feel put off or intimidated. Notice the three levels of feeling in Table 4. 3: mild, moderate, and intense. You can also control the intensity of the expressed affect by your choice of a preceding adverb—for example, somewhat (weak), quite (moderate), or very (strong) upset. With children, use a word or a symbol that captures their feelings as closely as possible. Study Table 4. 3 and Table 4. 4 carefully so that you can de-velop an extensive vocabulary of affect words. If you overuse a few common affect words, then you will miss the nuances of clients' emotional experiences. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
124 Chapter 4 4. Start your reflection statement with an appropriate sentence stem, such as one of the following: “It appears that you are angry now. ” “It looks like you are angry now. ” “It is clear to me that you are angry now. ” “It sounds like you are angry now. ” “I hear you saying you are angry now. ” “My ears tell me that you are angry now. ” “I can grasp your anger. ” “You are feeling angry now. ”“Let's get in touch with your anger. ” For more sentence stems, refer to Table 4. 2. 5. Add the context of the feelings or the situation in which they occur. This addition takes the form of a brief paraphrase. Usually the context can be deter-mined from the content part of the client's message. For example, a client might say, “I just can't take tests. I get so anxious I never do well even though I study a lot. ” In this message, the affect is anxiety and the con-text is test-taking. The helper reflects both the affect (“You feel uptight”) and the context (“whenever you have to take a test”). 6. Assess the effectiveness of your reflection after deliver-ing it. Usually, if your reflection accurately identifies the client's feelings, then the client will confirm your response by saying something like “Yes, that's right,” or “Yes, that's exactly how I feel. ” If your response is off target, then the client may reply with “Well, it's not quite like that,” “I don't feel exactly that way,” or “No, I don't feel that way. ” When the client responds by denying feelings, it may mean your reflection was inaccurate or ill timed. It is very important for helpers to decide when to respond to emotions. Reflection of feelings may be too powerful to be used frequently in the very early stage of helping. At that time, overuse of this response may make the client feel uncomfort-able, a situation that can result in denial rather than acknowledgment of emotions. But do not ignore the potential impact or usefulness of reflection later on, when focusing on the client's feelings would promote the goals of the session. In the following example, notice the way in which a helper uses a cognitive learning strategy (adapted from Richardson & Stone, 1981) to formulate a reflection of client feelings: Client, a white middle-aged man (says in loud, shrill, high-pitched voice, with clenched fists): You can't imagine what it was like when I found out my wife was cheating on me. I saw red! What should I do—get even, leave her? I'm not sure. Helper (asks and answers covertly): Self-question 1: What overt feeling words has this client used?None—except for the suggested affect phrase “saw red. ” Self-question 2: What feelings are implied in the client's voice and nonverbal behavior? Anger, outrage, hostility. Self-question 3: What affect words accurately describe this cli-ent's feelings at a similar level of intensity? “Furious,” “angry,” “vindictive,” “outraged. ”Self-question 4: What is an appropriate sentence stem? Given the client's use of “imagine” and “saw red,” I'll try sen-tence stems like “It seems,” “It appears,” and “It looks like. ” Self-question 5: What is the context, or situation, surrounding his feelings that I'll paraphrase? The client's discovery that his wife was unfaithful. Self-question 6: How will I know whether my reflection is accurate and helpful? Watch and listen for the client's response—whether he con-firms or denies the feeling of being angry and vindictive. Actual Examples of Reflection “It looks like you're very angry now about your wife's going out on you. ” “It appears that you're furious with your wife's actions. ” “It seems like you're both angry and vindictive now that you've discovered your wife has been going out with other men. ”Strong Happy Sad Angr y S cared Confused Weak Figure 4. 3 Feeling Symbols for Children Source: From Henderson & Thompson. Counseling Children, 8e. Copyright © 2011 Cengage Learning. Reproduced with permission. www. cengage. com/permissions Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 125 Learning Activity 4. 4 Reflection of Feelings In this activity, you are presented with three client prac-tice messages. For each message, develop a reflection-of-feelings response using the cognitive learning strategy (Richardson & Stone, 1981) described previously and out-lined here. To internalize this learning strategy, you may wish to talk through the self-questions overtly (aloud) and then covertly (silently to yourself). The end product will be a reflection-of-feelings response that you can say aloud or write down. An example precedes the practice messages. Feedback is given on page 128. example Client, a 50-year-old worker now laid off (says in a loud, critical voice, staring at the ceiling, brow furrowed, eyes squinting): Now look. What can I do? I've been laid off over a year. I've got no money, no job, and a family to take care of. We lost our house to foreclosure. It's also clear to me that my mind and skills are just wasting away. Self-question 1: What overt feeling words did the client use?None. Self-question 2: What feelings are implied in the client's non-verbal behavior? Disgust, anger, upset, frustration, resentment, disillusion-ment, discouragement. Self-question 3: What affect words accurately describe the client's feelings at a similar level of intensity? There seem to be two feelings: anger and discouragement. Anger seems to be the stronger emotion of the two. Self-question 4: What is an appropriate sentence stem?Use stems like “I see you, ” or “It's clear to me that you, ” or “From where I'm looking, you. ” These are similar to the client phrases “Now look” and “It's also clear. ” Self-question 5: What is the context, or situation, surround-ing his feelings that I'll paraphrase? Loss of job and home, no resources, no job prospects in sight. Reflection-of-feelings response: “I can see you're angry about being out of work and discouraged about the future, ” or “It looks like you're very upset about having your job, home, and stability taken away from you. ” Client Practice Statements Client 1, an 8-year-old girl (says in a level tone, with mea-sured words, glancing from side to side, lips drawn tightly together, face flushed): I'm telling you I don't like living at home anymore. I wish I could live with my friend and her parents. I told my mommy that one day I'm going to run away, but she doesn't listen to me. Self-question 1: What overt feeling words did the client use?Self-question 2: What feelings are implied in the client's non-verbal behavior? Self-question 3: What are accurate and similar interchange-able affect words? Self-question 4: What is an appropriate sentence stem?Self-question 5: What is the context, or situation, surround-ing her feelings that I'll paraphrase? Actual reflection response: Client 2, a middle-aged man in marital therapy (says in a soft voice with eyes downcast): As far as I'm concerned, our marriage turned sour last year when my wife went back to work. She's more in touch with her work than with me. Self-question 1: What overt feeling words did the client use?Self-question 2: What feelings are implied in the client's non-verbal behavior? Self-question 3: What are accurate and similar interchange-able affect words? Self-question 4: What is an appropriate sentence stem?Self-question 5: What is the context, or situation, surround-ing his feelings that I'll paraphrase? Actual reflection response: Client 3, an adolescent (says in loud, harsh voice): Now look, we have too damn many rules around this school. I'm getting the hell out of here. As far as I can see, this place is a dump. Self-question 1: What overt feeling words has this client used?Self-question 2: What feelings are implied in the client's non-verbal behavior? Self-question 3: What are accurate and similar interchange-able affect words? Self-question 4: What is an appropriate sentence stem?Self-question 5: What is the context, or situation, surround-ing his feelings that I'll paraphrase? Actual reflection response: Suppose that following the reflection, the client says, “Yes, I'm very angry, for sure. But I don't know about vindictive, although I guess I'd like to make her feel as awful as I do. ” The client has confirmed the helper's reflection of the feelings of anger and vindictiveness but also has given a clue that he finds the word vindictive too strong at this time. The helper picks up on the feelings, noting that the word vindictive might be used again later, after the client has sorted through his mixed feelings about his wife's behavior. Learning Activity 4. 4 gives you an opportunity to prac-tice with reflection-of-feelings responses. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
126 Chapter 4 Summarization: Listening for Patterns and Themes Usually, after a client expresses several messages or talks for a while, the helper is able to spot in the client's messages' certain consistencies or patterns, which we refer to as themes. The themes of a client's messages are evident in topics that the client continually refers to or brings up in some way. The helper can identify themes by listening to what the client repeats over and over and with the most intensity (Carkhuff, Pierce, & Cannon, 1977). The themes indicate what the client is trying to tell us and what the client needs to focus on in the helping sessions. Ivey and colleagues (2007) recommend listening to the way the client organizes his or her story. The counselor can respond to client themes by using a summarization response. Suppose that you have been working with a young man who, during the last three sessions, has made repeated references to rela-tionships with gay men yet has not really identified this issue intentionally. You could use a summarization to identify the theme from his repeated references by say-ing something like, “I'm aware that during our last few sessions you've spoken consistently about relationships with gay men. Perhaps this could be an issue that we choose to focus on?” Or suppose that in one session a client has given you several descriptions of different situations in which he feels concerned about how other people perceive him. You might discern that the theme common to all these situations is the client's need for approval from others, or “other-directedness. ” You could use a summarization such as this to identify this theme: “One thing I see in all three situations you've described is that you seem quite concerned about having the approval of other people. Is this accurate?” A summarization can be defined as two or more para-phrases or reflections that condense the client's messages or the session. Summarization “involves listening to a cli-ent over a period of time (from 3 minutes to a complete session or more), picking out relationships among key issues, and restating them back accurately to the client” (Ivey et al., 2006, p. 94). Purposes of Summarization One purpose of summarization is to tie together multiple elements of client messages. In this case, by extracting meaning from vague and ambiguous messages, summari-zation can serve as a good feedback tool for the client. A second purpose of summarization is to identify a common theme or pattern that becomes apparent after several mes-sages or sometimes after several sessions. Occasionally, a helper may summarize to interrupt a client's incessant rambling or “storytelling. ” At such times, summarization is an important focusing tool that brings direction to the interview. A fourth use of summarization is to slow the pace of a session that is moving too quickly. In such instances, sum-maries provide psychological breathing space during the session. A final purpose of a summary is to review progress that has been made during one or more interviews. You can probably see from these purposes why summarization is the last response in the nonjudgmental listening cycle we described earlier in the chapter. A summarization may represent collective rephras-ings of either cognitive or affective data, but most summarization responses include references to both cognitive and affective messages, as in the following four examples. Summarization to Tie Together Multiple Elements of a Client Message Client, a Native American young medical student: All my life I thought I wanted to become a doctor and go back to work on my reservation. Now that I've left home, I'm not sure. I still feel strong ties there that are pulling me back. I hate to let my people down, yet I also feel like there's a lot out here I want to explore first. Summarization: You're away from the reservation now and are finding so much in this place to explore. At the same time, you're feeling pulled by your lifelong ties to your people and your dream of returning as a doctor. Summarization to Identify a Theme Client, a 35-year-old European American male: One of the reasons we divorced was because she always pushed me. I could never say “no” to her; I always gave in. I guess it's hard for me just to say “no” to requests people make. Summarization: You're discovering that you tend to give in or not do what you want in many of your significant relationships, not just with your ex-wife. Summarization to Regulate the Pace of a Session and to Give Focus Client, a young European American woman: What a terrible week I had! The water heater broke, the dog got lost, someone stole my wallet, my car ran out of gas, and Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 127 to top it all off, I gained 5 pounds. I can't stand myself. It seems like it shows all over me. Summarization: Let's stop for just a minute before we go on. It seems like you've encountered an unending series of bad events this week. Summarization to Review Progress Summarization: Monique, we've got about 5 minutes left today. It seems like most of the time we've been work-ing on the ways you find to sabotage yourself from doing things you want to do but feel are out of your control. This week I'd like you to work on the following home-work before our next session... That type of summarization is often used as a termina-tion strategy near the end of a session. Steps in Summarizing Summarizing requires careful attention to and concentra-tion on the client's verbal and nonverbal messages. Accurate use of this listening response depends on good recall of client behavior, not only within a session but over time—across several sessions or even several months of therapy. De-veloping a summarization involves the following four steps: 1. Attend to and recall the message or series of messages by restating them to yourself covertly. What has the client been telling you, focusing on, working on? This is a key and difficult step because it requires you to be aware of many varying verbal and nonverbal messages you have processed over time. 2. Identify any apparent patterns, themes, or multiple ele-ments of these messages by asking yourself questions like, “What has the client repeated over and over?” and “What are the different parts of this puzzle?” 3. Using the sentence stem you've selected, select words to describe the theme or to tie together multiple ele-ments, and say this aloud as your summarization response. Remember to use your voice so that the sum-marization sounds like a statement, not a question. 4. Assess the effectiveness of your summarization by lis-tening for and observing whether the client confirms or denies the theme or whether the summary adds to or detracts from the focus of the session. To formulate a summarization, consider the following cognitive learning strategy (Learning Activity 4. 5 gives you a chance to try this strategy): 1. What was the client telling me and working on today and over time—that is, what are the key content and key affect?2. What has the client repeated over and over today and over time? What patterns or themes am I seeing? 3. How will I know whether my summarization is useful? Notice how a helper applies this cognitive learning strategy when developing a summarization in the follow-ing example, where the client has told you for the past three sessions that his drinking is ruining his family life but he can't stop because it makes him feel better and helps him handle job stress: Client, a white male fighting alcoholism (says in low, soft voice, with downcast eyes and stooped shoulders): I know drinking doesn't really help me in the long run. And it sure doesn't help my family. My wife keeps threatening to leave. I know all this. But it's hard to stay away from the booze. Having a drink makes me feel relieved. Helper (asks and answers covertly): Self-question 1: What has the client been telling me today and over time? Key content: Results of drinking aren't good for him or his family. Key affect: Drinking makes him feel better, less anxious. Self-question 2: What has the client repeated over and over today and over time? What patterns or themes am I seeing? Despite adverse effects and family deterioration, he con-tinues to drink for stress reduction and “medicating” of feelings. Stress reduction through alcohol seems worth more than losing his family. Suppose that at this time the helper delivered one of the following summarizations to the client: “Jerry, I sense that you feel it's worth having the hassle of family problems because of the good, calm feelings you get whenever you drink. ” “Jerry, you feel that your persistent drinking is creating a lot of difficulties for you in your family, and I sense your reluctance to stop drinking despite these adverse effects. ” “Jerry, I sense that despite everything, alcohol feels more satisfying (rewarding) to you than your own family. ” If Jerry confirms the theme that alcohol is more impor-tant now than his family, the helper can conclude that the summarization was useful. If Jerry denies the theme or issue summarized, the helper can ask Jerry to clarify how the summarization was inaccurate, remembering that the summary may indeed be inaccurate or that Jerry may not be ready to acknowledge the issue at this time. (See Learn-ing Activity 4. 5 on page 130. ) Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
128 Chapter 4 Listening to Diverse Groups of Clients The listening process in a helping relationship is affected by factors such as the client's age, ethnicity, gender, sexual orientation, ability status, and languages. Active listening can be a useful way to establish rapport with children and adolescent clients (Henderson & Thompson, 2011). Elderly clients who lack social contacts often long for a good listener. Schoenbeck (2010) developed a project with elderly persons known as the Remembrance Project designed to help persons engage in conversations with elderly people about what they want to be remembered for in their lives and what was and is most important to them. The listening process itself may conflict with the ba-sic values of some clients of color. For example, client behaviors such as unresponsiveness to inquiries, minimal self-disclosure, lack of eye contact, and avoidance of feel-ing statements may not be an indication that the client is “resistant,” “depressed,” “unassertive,” or “unemotional,” but rather that the client is simply communicating in ways that are consistent with the client's culture. As an example of this, traditional Chinese culture “values re-straint of strong feelings, and eye contact is avoided in the presence of higher-status individuals. Further... in many cultures similar to the Chinese, subtlety and indirectness in discussing delicate matters are highly valued attributes of communication. Discussion of personal and private matters is done indirectly rather than directly” (Sue & Sue, 2013, p. 212). Sue and Sue (2013) note that those helping profes-sionals reared in a European American middle-class society may assume “that certain behaviors or rules of speaking are universal and possess the same meaning” 4. 4 Feedback Reflection of Feelings Client 1 Question 1: What overt feeling words did the client use? “Don't like. ”Question 2: What feelings are implied in the client's nonver-bal behavior?Upset, irritation, resentment. Question 3: What are interchangeable affect words?“Bothered, ” “perturbed, ” “irritated, ” “upset. ”Question 4: What sentence stem will I use?“Seems like, ” “It sounds like, ” or “I hear you saying that. ”Question 5: What is the context, or situation, surrounding her feelings?Living at home with her parents. Actual examples of reflection “It sounds like you're upset about some things going on at your home now. ” “I hear you saying you're bothered about your parents. ” Client 2 Question 1: What overt feeling words did the client use?No obvious ones except for the phrases “turned sour” and “more in touch with. ”Question 2: What feelings are implied in the client's nonver-bal behavior?Sadness, loneliness, hurt. Question 3: What are interchangeable affect words?“Hurt, ” “lonely, ” “left out, ” “unhappy. ”Question 4: What sentence stem is appropriate?“I sense” or “You feel. ”Question 5: What is the context, or situation, surrounding his feelings?Wife's return to work. Actual examples of reflection “You're feeling left out and lonely since your wife has gone back to work. ” I sense you're feeling hurt and unhappy because your wife seems so interested in her work. ” Client 3 Question 1: What overt feeling words did the client use?No obvious ones, but words like “damn, ” “hell, ” and “dump” suggest intensity of emotions. Question 2: What feelings are implied in the client's nonver-bal behavior?Anger, frustration. Question 3: What are interchangeable affect words?“Angry, ” “offended, ” “disgusted. ”Question 4: What sentence stem will I use?Stems such as “It seems, ” “It appears, ” “It looks like, ” and “I can see. ”Question 5: What is the context, or situation, surrounding the feelings?School rules. Actual examples of reflection “It looks like you're disgusted now because you see these rules restricting you. ” “It seems like you're very angry about having all these rules here at school. ” Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 129 (p. 213). This assumption violates the idiographic practice that we discussed in Chapter 2. In general, the practitioner needs to be able to be somewhat flex-ible to adapt one's communication style to the cultural frame of reference of the client. In nonverbal commu-nication in particular, aspects of nonverbal attentive-ness may need adaptations for various kinds of clients. With children, elderly clients, clients with hearing impairments, clients from contact cultures such as Latin Americans, Africans, African Americans, Arabs, French, South Americans, and so on, conversing with the client may dictate a much closer physical distance and space than the white helper may be comfortable with. Issues in listening and understanding can arise when cultural differences in proxemics are ignored. For example, the helper may view the client's physical closeness as intrusive or aggressive, whereas the client may view the helper's lack of physical closeness as ar-rogant or aloof. Because proxemics research concludes that conversational distances are a function of the eth-nic and cultural background of the individual, “both the therapist and the culturally different client may benefit from understanding that their reactions and behaviors are attempts to create the spatial dimension to which they are culturally conditioned” (Sue & Sue, 2013, p. 215). Kinesics also appears to be culturally conditioned to some degree. While some clients smile when they are happy, some Asian clients smile when they are em-barrassed or experiencing apprehension. Other Asian clients have learned to have almost inscrutable facial expressions in recognition of the cultural value of re-straint of strong feelings. Even something as simple as a handshake can be easily misunderstood. While most cultures use the right hand when shaking someone else's hand, in some Muslim and Asian countries extending the left hand could be a grave offense and insult because touching anyone with the left hand is considered an obscenity. Eye contact and head motion represent other parts of kinesics frequently misinterpreted in the listen-ing process. Clients from some cultural groups avoid eye contact as a sign of respect. Some black clients may not nod their heads to indicate they are listening, but the absence of eye contact or head nodding should not be construed by the helper to mean the client is not paying attention! In terms of paralinguistics, volume, pitch, intensity, and frequency of speech are influenced by culture. Eu-ropean Americans often speak more quickly and with more force than Asians do, for example, whereas many Arabs speak even more loudly than U. S. Americans. Sue and Sue (2013, p. 218) conclude that a practitioner “working with clients would be well advised to be aware of possible cultural misinterpretations as a function of speech volume. Speaking loudly may not indicate anger and hostility, and speaking in a soft voice may not be a sign of weakness, shyness, or depression. ” Similarly, the directness of communication in a helping session also will vary a great deal among clients of various cultural groups. Sue and Sue (2013) observe that “since many mi-nority groups may value indirectness, the U. S. emphasis on 'getting to the point' and 'not beating around the bush' may alienate others. Asian Americans, American Indians, and some Latino/Hispanic Americans may see this behavior as immature, rude, and lacking in finesse. However, clients from different cultures may be nega-tively labeled as evasive and afraid to confront the prob-lem” (p. 219). Gender differences also play a role. Gender has been linked to communication variables such as amount of talk time, swearing, interrupting, and use of silence. Some men tend to have a more directive style, ask-ing more questions and doing more interrupting and problem-solving than some women, who may make more reflective statements (Ivey et al., 2007). Male cli-ents may be viewed by practitioners as lacking in emo-tion compared to female clients, and so some forms of communication between genders in the helping process may not be male-friendly. However, practitioners may intentionally or unintentionally promote gender-based bias in power differentials by using language in listening to clients that conveys standards and expectations based on the norms of male experience (and privilege) rather than female experience. Some practitioners will also experience challenges to listening and communication in working with gay cli-ents. A common mistake that many practitioners make in listening to clients is to assume heterosexuality. The assumption of heterosexuality is often referred to as the heterosexual privilege. Even after listening to clients describe a prior or current relationship with someone of the opposite sex, it is biased to assume without self-identification of sexual orientation that the client is heterosexual (Lyons et al., 2010). Sue (2010) defines heterosexism as “a sexual orientation worldview that contains beliefs and attitudes that (a) all people are/or should be heterosexual, (b) it is more desirable to be heterosexual, and (c) it represents the norm of both gender identity and sexual attraction. By implication, then, nonheterosexuals do not exist or should become heterosexual, are undesirable, and are considered abnor-mal” (p. 190). As Sue (2010) notes, the implications of Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
130 Chapter 4 Learning Activity 4. 5 Summarization In this activity you are presented with three client prac-tice messages. For each message, develop a summari-zation response using the cognitive learning strategy described earlier and outlined here. To internalize this learning strategy, you may wish to talk through the self-questions overtly (aloud) and then covertly (silently to yourself). The end product will be a summarization re-sponse that you can say aloud or write down. An example precedes the practice messages. Feedback is given on page 132. example Client, a 10-year-old girl, at the beginning of the ses-sion (says in low, soft voice, with lowered, moist eyes): I don't understand why my parents can't live together anymore. I'm not blaming anybody, but it just feels very confusing to me. Same client, near the middle of the same session: I wish they could keep it together. I guess I feel like they can't because they fight about me so much. Maybe I'm the reason they don't want to live together anymore. Self-question 1: What has the client been telling me and working on today? Key content: She wants her parents to stay together. Key affect: She feels sad, upset, and responsible. Self-question 2: What has the client repeated over and over today and over time? What patterns and themes am I see-ing? That she's the one who's responsible for her parents' breakup. examples of Summarization Response “Joan, at the start of our talk today, you were feeling like no one person was responsible for your parents' separation. Now I sense you're saying that you feel responsible. ” “Joan, earlier today you indicated you didn't feel like blam-ing anyone for what's happening to your folks. Now I'm sensing that you're feeling like you're responsible for their breakup. ” Client Practice Messages Client 1, a 30-year-old man who has been blaming him-self for his wife's unhappiness (says in low, soft voice with lowered eyes): I really feel guilty about marrying her in the first place. It wasn't really for love. It was just a convenient thing to do. I feel like I've messed up her life really badly. I also feel obliged to her. Self-question 1: What has the client been telling me and working on today? Key content: Key affect: Self-question 2: What has the client repeated over and over today and over time? What patterns or themes am I seeing? Summarization response: Client 2, a 35-year-old woman who focuses on how her life has improved since having children (says with alertness and animation): I never thought I would feel this great. I always thought being a par-ent would be boring and terribly difficult. It's not, for me. It's fascinating and easy. It makes everything worthwhile. Self-question 1: What has this client been telling me and working on today? Key content: Key affect: Self-question 2: What has this client repeated over and over today or over time? What patterns or themes am I seeing? Summarization response: Client 3, a 27-year-old woman who has continually focused on her relationships with men and her needs for excitement and stability, at the first ses-sion (says with bright eyes and facial animation and in a high-pitched voice): I've been dating lots and lots of men for the past few years. Most of them have been married. That's great because there are no demands on me. Same client, at the fourth session (says in a soft voice, with lowered eyes): It doesn't feel so good anymore. It's not so much fun. Now I guess I miss having some commitment and stability in my life. Self-question 1: What has the client been telling me and working on today? Key content: Key affect: Self-question 2: What has the client repeated over and over today or over time. What patterns or themes am I seeing? Summarization response: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 131 heterosexual privilege for LGBT clients constitute a large part of sexual orientation microaggressions. Listening and understanding with LGBT clients are often absent when helpers use biased language to describe LGBT clients, such as referring to them as “homosexuals” or using terminology that is derogatory or demeaning (e. g., “That was so gay”). Practitioners contribute to this in very subtle ways in practice by using terms such as boyfriend, girlfriend, wife, husband, or marriage instead of partner, spouse, significant other, and so on. Asking a LGBT client about his or her “sexual preference” instead of asking about “sexual orientation” also constitutes a microaggression in the listening process because it com-municates an underlying value that the LGBT client has chosen an alternative lifestyle. Lyons and colleagues (2010) note that listening and understanding are promoted when helpers are able to use language free of heterosexist bias and to have welcoming office environments for clients. Sue (2010) recommends that all practitioners should be-come aware of ethnocentric heterosexist language and vocabulary in our everyday use and be vigilant about our own words and those of others, too. Persons with disabilities also present unique challenges for listening and empathy from practitioners who may be ill-prepared in the way of specialized training to respond appropriately. As Artman and Daniels (2010, p. 444) note, “most perceptions of disabilities are negative, and are fre-quently reflected in language. ” For example, they recom-mend the use of person first language to communicate with clients with disabilities, referring to the client as a person with schizophrenia, for example, rather than as a schizo-phrenic. Similarly, “people who use wheelchairs” is meant to replace phrases such as “confined to a wheelchair” or “wheelchair bound. ” These latter phrases represent the projections of able-bodied practitioners and are actually expressions of negativity toward clients with disabilities (Artman & Daniels, 2010, p. 444). Using negative lan-guage such as this in communicating with and listening to clients with disabilities simply perpetuates negative ste-reotyping that someone with a disability automatically is miserable, depressed, grief stricken, and so forth. Another situation in which listening can pose special issues in the helping process arises when clients do not speak standard English, use English as a second language, or do not speak English at all. The helper may feel that he or she has more trouble listening to such clients, although it is really the clients who suffer. Sue and Sue (2013) note that the reliance on standard English in counseling and therapy can discriminate against clients from a bilin-gual or lower socioeconomic environment (p. 196). In other instances language may pose a listening challenge for helpers when clients use words or phrases that are unknown to them. For example, a client who is French Canadian may exclaim, “Mon Dieu!” when expressing distress about a situation, while another client who is Jew-ish may use a Yiddish phrase to describe something like “this week I did a mitzvah for someone. ” In general, listening to diverse groups of clients is facilitated when, as practitioners, we are both open and flexible in our approach to communicating with clients. We strive to listen to clients, and the worldviews and factors that make each client unique, by using listening responses and communication styles that consider all aspects of the client sitting in front of us at the moment. You can work with these concepts in Learning Activity 4. 6 on page 134. Distractions and Distractability: Listening to Yourself Egan (2014) discusses what he calls the “shadow side” of listening—that is, ways in which the listening process may fail. As he notes, active listening sounds good in theory but in practice is not without “obstacles and dis-tractions” (p. 100). Egan (2014) points out that evaluations and filters can be obstacles to effective listening. Although it is not pos-sible to suspend judgment completely, most clients have finely tuned antennae that detect evaluative responses—perhaps because they have heard judgment so often in their lives. Clients who experience individual or cultural shame are especially likely to shut down when they hear evaluative listening from counselors. Labels and biases may cause filtered listening (Egan, 2014, pp. 100-101). For example, if you are required to give your client a diagnosis, you may run through possible labels in your head while you are simultaneously trying to listen to the client. Or perhaps someone already labeled the client you are seeing as the “borderline” client or the “dysthymic” client, or the “oppositional” kid. An obstacle to listening in each instance is the temptation to look for corroborative behaviors while listening to the client. All of us use filters to structure our worlds, but these filters, if very strong, can inject biased listening into the helping process and foster stereotyping (Egan, 2014, p. 101). Fil-ters often come into play when we are listening to clients who are culturally different from ourselves in some way. Clients who detect “filtered listening” are likely to shut down, feeling it isn't safe to open their hearts and souls to us (Lindahl, 2003). Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
132 Chapter 4 4. 5 Feedback Summarization Client 1 Question 1: What has the client told me? Key content: He married for convenience, not love. Key affect: Now he feels both guilty and indebted. Question 2: What has the client repeated over and over? What patterns or themes do I see? Conflicting feelings—feels a strong desire to get out of the marriage yet feels a need to keep relationship going because he feels responsible for his wife's unhappiness. examples of Summarization Response “I sense you're feeling pulled in two different directions. For yourself, you want out of the relationship. For her sake, you feel you should stay in the relationship. ” “You're feeling like you've used her for your convenience and because of this you think you owe it to her to keep the relationship going. ” “I can grasp how very much you want to pull yourself out of the marriage and also how responsible you feel for your wife's present unhappiness. ” Client 2 Question 1: What has the client told me?Key content: Children have made her life better, more worthwhile. Key affect: Surprise and pleasure. Question 2: What has the client repeated over and over? What patterns or themes do I see? Being a parent is uplifting and rewarding even though she didn't expect it to be. In addition, her children are very important to her. To some extent, they define her worth and value as a person. examples of Summarization Response “It seems like you're feeling surprise, satisfaction, and relief about finding parenting so much easier and more rewarding than you had expected it would be. ” “I hear feelings of surprise and pleasure in your voice as you reveal how great it is to be a parent and how important your children are to you. ” “You seem so happy about the way your life is going since you've had children—as if they make you and your life more worthwhile. ” Client 3 Question 1: What has the client told me?Key content: She has been dating lots of men who have their own commitments. Key affect: It used to feel great; now she feels a sense of loss and emptiness. Question 2: What has the client repeated over and over? What patterns or themes do I see? At first she had feelings of pleasure and relief not to have demands in close relationships. Now, feelings are changing and she feels less satisfied; she wants more stability in close relationships. examples of Summarization Response “Lee Ann, originally you said it was great to be going out with a lot of different men who didn't ask much of you. Now you're also feeling it's not so great—it's keeping you from finding some purpose and stability in your life. ” “In our first session, you were feeling 'up' about all those relationships with noncommittal men. Now you're feel-ing like this is interfering with the stability you need and haven't yet found. ” “At first it was great to have all this excitement and few demands. Now you're feeling some loss from lack of a more stable, involved relationship. ” Sullivan (2004) describes three obstacles to deep listening. One is playing tapes—as he notes, like a jukebox, helpers often have prerecorded opinions on a variety of topics. Often beginning helpers do not realize that counseling is not a soapbox! T rue dialogue reverts to a monologue. As Sullivan (2004) states, “playing tapes requires minimal attention” and minimal presence (p. 190). A second obstacle Sullivan (2004) describes is checklist listening— outwardly we look like we are listening, but inwardly we are “checking” to see if we agree or disagree with what our clients say and believe rather than being re-ally present to their communication and ideas. The third obstacle he mentions is being oppositional—listening that is clouded by our labels and judgments. Sullivan recommends the use of a mnemonic to help us identify when we move into oppositional listening— JUDABC—Justifying, Defending, Attacking, Blaming, and Complaining (p. 191). Another obstacle to listening is tension. When we are tense as helpers, this tension diminishes our ability to listen to and feel with our clients. Think of the last Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 133 time you sat with a client and felt the distraction of a tension headache in your neck. Or the last time you were with someone close to you and you felt tense about an upcoming test or work deadline. Physical and mental tension preclude deep listening. As the famous cellist Yo-Yo Ma put it, “With every year (of playing) you want to relax one more muscle. Why? Because the more tense you are, the less you can hear. So the more you can collect that energy and be unblocked and be totally present, the more you can say 'I'm here'” (Mermelstein, 2010, p. D8). As an antidote to distractions and barriers to listening, consider slowing the pace of the session and even slowing the pace of your own mental activity as the helper. Resist the urge to “fix” the client, to rush in to problem-solve for the client. A general guideline for deep listening is there is no rush to action. A metaphor for this is the idea of stand-ing still for a few moments with the client instead of running forward with great speed. Sullivan (2004) points out that being too quick to offer suggestions is akin to what acupuncturists describe as “a rush to early ripening” (p. 189). As he notes, this quickness to discover solutions or to “fix” the client often encour-ages helpers to listen only to problems. Strengths and resources are then often overlooked or missed in the client's narrative. In this chapter, we have described various listening responses that will help you become a good listener if you learn them. T ruly effective listening, however, requires even more from you. It requires you to be fully present to the client and oblivious to distractions—both internal and external. It requires you to create a “holding environ-ment” for clients. The helpers who listen best usually have developed this sort of “mindfulness. ” They are able to focus very intently on the client. Such mindfulness is especially well developed in Eastern cultures, where peo-ple rise at dawn to practice tai chi. Perhaps nowhere is this quality more evident than among helpers who work with dying persons. Frank Ostaseski (1994), director of the San Francisco Zen Hospice Project, discusses mindfulness in the following way: We sit at the bedside and we listen. We try to listen with our whole body, not just with our ears. We must perpetu-ally ask ourselves, “Am I fully here? Or am I checking my watch or looking out the window?” At the heart of it, all we can really offer each other is our full attention. When people are dying, their toler-ance for bullshit is minimal. They will quickly sniff out insincerity. Material may arise that we don't particularly like or even strongly dislike. Just as we do in meditation, we need to sit still and listen, not knowing what will come next, to suspend judgment—at least for the mo-ment—so that whatever needs to evolve will be able to do so (p. 11). If you feel that mindfulness is a quality you need to develop further in yourself, we encourage you to practice Learning Activity 4. 7 to learn to listen to yourself. Ch APTe R Summ ARY We often hear these questions: “What good does all this listening do? How does just rephrasing client messages really help?” In response, let us reiterate the rationale for using listening responses in helping: 1. Listening to clients is a very powerful reinforcer and may strengthen clients' desire to talk about themselves and their concerns. Not listening may prevent clients from sharing relevant information. 2. Listening to a client first may mean a greater chance of responding accurately to the client in later stages of helping, such as problem-solving. By jumping to quick solutions without laying a founda-tion of listening, you may inadvertently ignore the primary issue or propose inadequate and ill-timed action steps (Sommers-Flanagan & Sommers-Flana-gan, 2014). 3. Listening encourages the client to assume responsibil-ity for selecting the topic and focus of an interview. Simply asking a series of questions or proposing a series of action steps in the initial phase of helping can cause the client to perceive you as the expert and can hinder proper development of client self-responsibility in the interview. 4. Good listening and attending skills model socially appropriate behavior for clients. Many clients have not yet learned to use the art of listening in their own rela-tionships and social contacts. They are more likely to incorporate these skills to improve their interpersonal relationships when they experience them firsthand through their contact with a significant other, such as a skilled helper. All these reasons take into account both the gender and the cultural affiliation of the client. Listening may have a differential effect depending on the client's gender and cultural affiliation. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
134 Chapter 4 Some helpers can articulate a clear rationale for listen-ing but cannot listen during an interview because of blocks that inhibit effective listening. Some of the most common blocks to listening are these: 1. The tendency to judge and evaluate the client's messages. 2. The tendency to stop attending because of the topic, the time of day, or distractions such as noise. 3. The temptation to ask questions about “missing” pieces of information. 4. The temptation or the pressure that you put on your-self to solve problems, find answers, or somehow “fix” the situation. 5. Your preoccupation with yourself as you try to acquire the skills. Your preoccupation shifts the focus away from the client and actually reduces, rather than in-creases, your potential for listening. Preparation for ef-fective listening is crucial, but being preoccupied with the technique of listening is not. Preoccupation with listening skills may lessen when you are able to engage Cultivating the Listening Mind Part One* Obtain three small objects to eat, such as raisins or M&Ms. Sit in a comfortable position, close your eyes, and focus on your teeth. If wandering thoughts come, let them flow by. Starting with one raisin, slowly lift it to your mouth. Chew it very slowly. Observe your arm lifting the raisin to your mouth. Think about how your hand holds it. Notice how it feels in your mouth. Savor it as you chew it ever so slowly. While doing this, notice your tongue and throat as you very slowly swallow the raisin. Repeat this process with the next two objects. Afterward, notice what you realize about eating and raisins. What do you usually tune out? Part Two Lie still in a comfortable position. Tune into your body, starting with your toes and moving very slowly up to the top of your head. Direct your attention to the spot that feels most tense or painful. Put your hand on that spot. Leave it there for a few minutes. Breathe with it. Notice what happens as you go into this part of your body with your breathing and your awareness. You are not trying to change anything. Simply be aware of this place and accept it. Stay with this for a little while, and see what happens to this spot. Part Three It can be hard to listen to someone who is saying some-thing to you that is difficult for you to hear! In order to be able to listen effectively in these contexts, engage intention-ally in conversations with people or classmates who have a point of view different from your own. When responding, do so without defending or justifying your own opinion or position. One choice you have is to acknowledge the other per-son's communication. You might say something like, “I can see your perspective on this. ” Or you can let go of the need to respond at all and listen without saying anything in re-sponse. As an additional step, try to hold the other person “in the light” and respond with compassion. One way to work around any listening barrier is to cre-ate good protective boundaries for yourself. That way, when someone says something that is hard for you to hear, you can hear it, but the words have no impact on your sense of self-worth. Regardless of whether the mes-sage feels true for you or not, it does not undermine your self-esteem. Learning Activity 4. 7Learning Activity 4. 6 Listening to Diverse Groups of Clients Contrast the areas we have discussed— kinesics, prox-emics, and paralinguistics—for both European American and non-European American clients. Describe examples of times when helpers may misconstrue meanings of certain communications in these three areas. Also, become aware of language usage on your part. Pay at-tention to the language you use in conversations with others and with clients. Do you use words that convey sexism? Het-erosexism? Racism? Ageism? Or other biases that may have to do with able-bodiedness, geography, economic status and so on? How is privilege reflected in the words that you use? *Adapted from Kabat-Zinn, 1993. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 135 in what Lindahl (2003) refers to as contemplative listening, reflective listening, and connective listening. Effective listening requires an involved yet contained sort of energy that allows you to be fully present to the client. Listening is a process that does not stop after the initial session but continues throughout the entire thera-peutic relationship with each client. Listening is a process that not only impacts clients but also impacts ourselves as helpers. We as listeners can be nourished by the listening process and deepen our connectedness to ourselves and to our clients (Lindahl, 2003). Nepo (2012) describes deep listening as a process that requires “immersion, absorption, and presence” (p. 99). He mentions that counters to deep listening are “noises of the modern world, where the tasks and passwords keep multiplying” (p. 152). Nepo (2012. p. 84) con-cludes that: Deep listening requires letting go of our internal argument with the world. Letting go of my internal argument with the world means not pushing off of everything that comes my way. It requires my looking at you as a sudden fish that has surfaced from the deep. It requires bringing you water rather than my judgments. Visit Cengage Brain. com for a variety of study tools and useful resources such as video exam-ples, case studies, interactive exercises, flashcards, and quizzes. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
136 Chapter 4 4 Knowledge and Skill Builder Part One Conduct a short interview as a helper and see how many client nonverbal behaviors of kinesics (body motion), paralinguistics (voice qualities), and proxemics (space) you can identify by debriefing with an observer after the session (Learning Outcome 1). Describe the possible effects or mean-ings associated with each behavior you identify. Confer with the observer about which nonverbal client behaviors you identified and which you missed. Part Two For each of the following three client statements, Learning Outcome 2 asks you to write an example of each of the four lis-tening responses. In developing these responses, you may find it helpful to use the cognitive learning strategy you practiced earlier for each response. Feedback is provided on page 138. client 1, a 28-year-old woman (says in a high-pitched voice, with crossed legs and lots of nervous twitching in her hands and face): My life is a shambles. I lost my job. My friends never come around anymore. It's been months now, but I still can't seem to cut down. I can't see clearly. It seems hopeless. Clarification: Paraphrase: Reflection: Summarization: client 2, an african american high school sophomore: I can't seem to get along with my mom. She's always harassing me, telling me what to do. Sometimes I get so mad I feel like hitting her, but I don't because it would only make the situation worse. Clarification: Paraphrase: Reflection: Summarization: client 3, a 54-year-old man: Ever since my wife died 4 months ago, I can't get interested in anything. I don't want to eat or sleep. I'm losing weight. Sometimes I just tell myself I'd be better off if I were dead, too. Clarification: Paraphrase: Reflection: Summarization: Part Three Part Three gives you an opportunity to develop your ability to observe key aspects of client behavior that must be attended to if you are going to listen effectively: 1. Vague or confusing phrases and messages 2. expression of key content3. Use of affect words 4. Nonverbal behavior illustrative of feeling or mood states 5. Presence of themes or patterns Learning Outcome 3 asks you to observe these five as-pects of a client's behavior during a 15-minute interview conducted by someone else. Record your observations on the accompanying Client Observation Checklist. You can obtain feedback for this activity by having two or more persons observe and rate the same session and comparing your responses. Client Observation Checklist Name of Helper Name(s) of Observer(s) Instructions: For each of the five categories of client behavior, write down key client words and descriptions of behavior as it occurs during a short helping interview. (If observers are not available, then record your sessions and complete the checklist while reviewing the tape. ) 1. Vague or confusing phrases and messagesa. b. c. d. e. 2. expression of key content (situa-tion, event, idea, person) a. b. c. d. e. 3. Affect words used a. b. c. d. e. 4. Nonverbal behavior indicative of certain feelings or mood states a. b. c. d. e. 5. Presence of themes or patterns a. b. c. d. e. Observer impressions and comments: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Listening 137 Part Four Part Four gives you a chance to demonstrate the four listening responses. Learning Outcome 4 asks you to conduct a 15-min-ute role-play interview in which you use at least two examples of each of the four listening responses. Someone can observe your performance, or you can assess yourself from a recording of the interview. You or the observer can classify your responses and judge their effectiveness by using the accompanying Lis-tening Checklist. Try to select listening responses to achieve specific purposes. Remember, to listen effectively, it is helpful to 1. Refrain from making judgments 2. Resist distractions 3. Avoid asking questions 4. Avoid giving advice 5. Stay focused on the client Obtain feedback for this activity by noting the categories of responses on the table and their judged effectiveness. Listening Checklist Name of Helper Name of Observer Instructions: In the “helper response” column of the table, jot down a few key words from each statement. In the “client responses” column, insert a brief notation of the client's verbal and nonverbal responses. Then, use a check ( ✓) to classify the helper response as a clarification, paraphrase, reflection of feeling, summarization, or other. Finally, rate the effectiveness of each helper response, using the following scale: 1. = Not effective. Client ignored helper's message or gave some verbal and nonverbal indication that helper's message was inaccurate, off target, or premature. 2. = Somewhat effective. Client gave some verbal or non-verbal indication that helper's message was partly ac-curate and on target. 3. = Very effective. Client's verbal and nonverbal behavior confirmed that helper's response was very accurate, on target, and well-timed. Helper response (key words)Client response (key words)Type of helper listening response Effectiveness of re-sponse (determined by client response) Rate from 1 to 3 (3 = high)Clarification Paraphrase Reflection of feelings Summarization Other 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Observer comments and general observations: Remember to watch and listen for the client's reaction to the response for your effectiveness rating. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
138 Chapter 4 4 Knowledge and Skill Builder Feedback Part One Have the observer debrief you for feedback, or use the Non-verbal Behavior Checklist to recall which nonverbal behav-iors you identified. Part Two Here are some examples of listening responses. See whether yours are similar. Client Statement 1 Clarification: “Can you describe what you mean by 'cutting down'?” Paraphrase: “You seem to realize that your life is not going the way you want it to. ” Reflection: “You appear frightened about the chaos in your life, and you seem uncertain of what you can do to straighten it out. ” Summarization: “Your whole life seems to be falling apart. Your friends are avoiding you, and now you don't even have a job to go to. even though you've tried to solve the problem, you can't seem to handle it alone. Coming here to talk is a useful first step in 'clearing up the water' for you. ”Client Statement 2 Clarification: “Can you describe what it's like when you don't get along with her?” Paraphrase: “It appears that your relationship with your mom is deteriorating to the point that you feel you may lose control of yourself. ” Reflection: “You feel frustrated and angry with your mom because she's always giving you orders. ” Summarization: “It seems like the situation at home with your mom has become intolerable. You can't stand her badgering, and you feel afraid that you might do something you would later regret. ” Client Statement 3 Clarification: “Are you saying that since the death of your wife, life has become so miserable that you think of taking your own life?” Paraphrase: “Your life has lost much of its meaning since your wife's recent death. ” Reflection: “It sounds like you're very lonely and depressed since your wife died. ” Summarization: “Since your wife died, you've lost interest in living. There's no fun or excitement anymore and, further, you're telling yourself that it's not going to get any better. ” Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
139 chapter 5 Listening responses are responses to client messages made primarily from the client's point of view or frame of refer-ence. At times in the helping process it is legitimate to move beyond the client's frame of reference and to use responses that include clinician-generated data and perceptions. These influencing responses are active rather than pas-sive, and they reflect a helper-directed more than a client- centered style (Ivey, Ivey, & Zalaquett, 2014). Whereas listening responses from a helper influence the client indi-rectly, influencing responses from a helper exert a more di-rect influence on the client. Influencing responses are based as much on the helper's perceptions and hypotheses as on the client's messages and behavior. In this chapter, we pres-ent six influencing responses: questions, information giving, self-disclosure, immediacy, interpretations (also called addi-tive or advanced empathy), and confrontation/challenge. The general purpose of influencing responses, according to Egan (2014), is to help clients see the need for change and action through a more objective frame of reference. Social Influence In Helping Underlying the six influencing responses is a helping rela-tionship characterized by mutual and complementary in-fluence processes. Over the past several decades the helping process has been described as a social influence process. Based on the work of Strong (1968) and Strong, Welsh, Corco-ran, and Hoyt (1992), and drawing from social psychol-ogy literature, the social influence model of counseling presumes three factors at work in the helping process: 1. The practitioner establishes a base of influence with cli-ents by the use of legitimate, expert, and referent power to effect attitude change with clients. Legitimate power is power that occurs as a result of the helper's role and trustworthiness. Expert power results from the helper's competence and expertness. Referent power is drawn from dimensions such as interpersonal attractiveness, friendliness, and similarity between helper and client (such as is found in “indigenous” helpers). 2. The practitioner actively uses this influence base to effect attitudinal and behavioral change in clients through the use of behaviors and tools that enhance the helper's trustworthiness, expertness, and interper-sonal attractiveness with clients. 3. Clients are responsive to the ideas and recommenda-tions set forth by the practitioners as a function of their sense of dependence on the helper. Dependence is considered to be a motivational factor in this model. Influencing Responses Learning Outcomes After completing this chapter, you will be able to 1. From a written list of 12 influencing responses, identify the six influencing responses by type, with at least nine accurate classifications. 2. With a written list of three client statements, write an example of each of the six influencing responses for each client statement. 3. In a 30-minute helping interview in which you are an observer, listen for and record six key aspects of client behavior that form the basis for influencing responses. 4. Conduct at least one 30-minute helping interview in which you integrate the core skills and knowledge you have acquired so far in the areas of ethics, multicultural competencies, relationship variables, nonverbal behavior, listening responses, and influencing responses. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
140 Chapter 5 Influencing Responses and Timing The most difficult part of using influencing responses is timing (deciding when to use these responses in the interview). Some helpers tend to jump into influencing responses before they listen and establish rapport with the client. Listening responses generally reflect clients' understanding of themselves. In contrast, influenc-ing responses reflect the helper's understanding of the client. Influencing responses can be used moderately in the interview with most clients as long as the helper is careful to lay the foundation with attending and listen-ing. The listening base can heighten the client's recep-tivity to an influencing message. If the helper voices his or her opinions and perceptions too quickly, then the client may respond with denial, with defensiveness, or even by dropping out of counseling. When this hap-pens, often the helper needs to retreat to a less obtrusive level of influence and do more listening, at least until a strong base of client trust and confidence has been developed. Influencing responses are considered more directive than listening responses, which are classified as indi-rective. The directiveness associated with influencing responses has varying effects on clients. Client-related variables that impact the timing and effects of influenc-ing responses include reactance and race and ethnicity. Reactance has to do with the need to preserve a sense of freedom (J. W. Brehm, 1966; S. S. Brehm, 1976). More recent conceptualizations of reactance describe it as a “state” rather than a “trait,” meaning that it is sub-ject to change (Beutler, Harwood, Michelson, Song, & Holman, 2011). Clients may exhibit a great deal of reac-tance toward some things in counseling but not others, or around some issues but not others. When clients are high in reactance, they are generally oppositional and are motivated to do the opposite of whatever the helper suggests. (See also Chapter 10. ) Thus, clients who are high in reactance are likely to be more allergic to influ-encing responses regardless of the point at which they are introduced in the helping process. With highly reactant behavior, usually less directive responses are associated with better therapeutic outcomes (Beutler & Harwood, 2000). A recent study found this to be true for clients with high alcohol use even across different counseling sessions (Karno & Longabaugh, 2005). Some clients, however, may actually be more com-fortable with an active and directive communication style because it is more consistent with their cultural values. Sue and Sue (2013) conclude that “the literature on multicultural counseling/therapy strongly suggests that American Indians, Asian Americans, Black Americans, and Hispanic Americans tend to prefer more active- directive forms of helping than nondirective ones” (p. 228). Some clients of color may feel more comfortable with the use of directive and active skills because these responses provide them with data about the practitioner's orienta-tion. Moreover, the use of influencing responses connotes a locus of responsibility that is perhaps more systemic and less person-or individual-centered. This kind of focus is more consistent with the philosophy of many minority clients who have encountered societal discrimination and oppression. Other clients may benefit more from a directive, in-fluencing approach because of certain characteristics. For example, due to their limited personal-social develop-ment, children and adolescents as well as adults who are developmentally challenged may respond better to a more active influencing style than the passive attending style we described in the prior chapter. What Does Influencing Require of Helpers? Accurate and effective listening depends on the ability of helpers to listen to the client and to restrain some of their own energy and expressiveness. In contrast, influ-encing responses require the helper to be more expressive and more challenging. Egan (2014) describes the use of influencing responses as responding to “sour notes” present in the client's communication and behavior. To use influencing responses effectively, helpers must first provide a supportive and safe environment by listening carefully, and then they must feel comfortable enough with themselves to provide feedback or amplification to the client that the client may not like. Helpers who have esteem issues of their own may find the use of influenc-ing responses difficult, because these responses carry the risk of upsetting a client by what is said or challenged. Ultimately, the use of effective influencing responses requires helpers to feel secure enough about themselves to have their own voice and to tolerate client disapproval and disagreement. Some helpers prefer to stay in the safety net of a more passive attending style. This strategy may be acceptable to some clients, but it may also mean that the helper and client have entered into a covert collusion with each other not to say anything that expresses displeasure or disappointment. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 141 Six Influencing Responses We have selected six influencing responses to describe in this chapter. Questions are open or closed queries that seek elaboration or information from cli-ents. Information giving is the communication of data or facts about experiences, events, alternatives, or people. Self-disclosure involves sharing of personal information or experiences with the client. Immediacy is an extension of self-disclosure and is a verbal response that describes something while it is occurring within the helping inter-view. Interpretations are responses that identify themes and patterns, make implied client messages explicit, and often are based on the helper's ideas or hunches about the client. Interpretations are sometimes referred to as advanced em-pathic responses (Egan, 2014) or as additive empathy (Hep-worth, Rooney, Dewberry Rooney, & Strom-Gottfried, 2013). Confrontation, also called challenging, describes patterns of discrepancies and inconsistencies in client be-havior and communication. Notice how these six influencing responses differ in the following example: Client, a 35-year-old widow of a deployed soldier, mother of two young children: My whole life fell apart when my husband was killed in Afghanistan. I keep feel-ing so unsure about my ability to make it on my own and to support my kids. My husband always made all the decisions for me. Now, I haven't slept well for so long, and I'm drinking more heavily—I can't even think straight. My relatives help me as much as they can, but I still feel scared. Helper questions: What sorts of experiences have you had in being on your own—if any—prior to your husband being deployed? What feels most scary about this? Helper information giving: Perhaps you are still grieving over the loss of your husband. I'm wondering whether you have made use of grief support or recovery groups or used other military resources to help you cope with your loss. Helper self-disclosure: I think I can really understand what you are facing and trying to cope with since your husband died. I also went through a period in my life when I was on my own and responsible for the well-being of my two children and me, and it was a tough time—lots to deal with at once. In your situation, I think it has got to be even tougher, because I know that losing a spouse in a war zone is very challenging on so many levels. Helper immediacy: I can sense your vulnerability as you share this with me, and I'm glad you feel com-LO1 LO2 LO3fortable enough with me to let me in on some of it. I think that might help ease some of the burden you are carrying. Helper interpretation: When your husband was alive, before deployment, you relied on him to take care of you and your children. Now it's up to you, but taking on this role is uncomfortable and also unfamiliar. Perhaps your increased drinking is a way to keep from having to face this. What do you think? Helper confrontation: It seems as if you're dealing with two things in this situation: first, the experience of being on your own for the first time, which feels so new and scary that you're unsure you can do it; and second, the reality that although your relatives help out, with your husband's passing the responsibility for you and your children does now rest on your shoulders. Table 5. 1 provides brief definitions and summarizes the intended purposes of those six influencing responses. The intended purposes are presented as tentative guidelines, not as the sole truth. In the remainder of this chapter we describe and present model examples of each response and provide opportunities for you to practice each one and receive feedback about your level of skill. Sequencing of Influencing Responses In Interviews Although there is no “set” or predefined sequence of influencing responses in interviews, there is some logical progression from certain influencing responses to others. For example, questions usually come earlier in the inter-view and in the initial stage of the helping process because they are used to begin interviews and to seek pertinent information from clients. And while information giving can be used at varying points in helping interviews, this response also is used early on to provide information to clients about the process at the outset of helping and also to guide key transition points during the process, too. Another influencing response that is used earlier in the process to create and build rapport is self-disclosure. Self-disclosure promotes universality and provides normaliza-tion and hope for clients. In this chapter we describe these three influencing responses first and in this order. The other three influencing responses we describe in this chapter—immediacy, interpretation, and con-frontation/challenge—are what we call more advanced influencing skills. These three responses are more dif-ficult to use, require more judicious thinking about their use, and are used less frequently than the first three Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
142 Chapter 5 Table 5. 1 Definitions and Intended Purposes of Helper Influencing Responses Response Definition Intended Purposes Questions Open-ended or closed query or inquiry Open-ended questions 1. To begin an interview2. To encourage client elaboration or to obtain information 3. To elicit specific examples of client's behaviors, feelings, or thoughts Closed questions1. To narrow the topic of discussion2. To obtain specific information3. To elicit specific examples of client's behaviors, feelings, or thoughts 4. To motivate client to communicate Information giving Communication of data or facts 1. To identify alternatives 2. To evaluate alternatives3. To dispel myths4. To motivate clients to examine issues they may have been avoiding 5. To provide structure at the outset and major transition points in the helping process Self-disclosure Purposeful revelation of information about oneself through verbal and nonverbal behaviors 1. To build rapport, safety, and trust 2. To convey genuineness3. To model self-disclosure for the client4. To instill hope and promote feelings of universality 5. To help clients consider other alternatives and views Immediacy Description of feelings or process issues as they are occurring within the helping interview1. To open up discussion about covert or unexpressed feelings or issues 2. To provide feedback about process or interactions as they occur 3. To help client self-disclosure Interpretation (advanced or additive empathy)Mirroring of client behaviors, patterns, and feelings, based on implied client messages and the helper's hunches1. To identify the client's implicit messages 2. To examine client behavior from an alternative view 3. To add to client self-understanding and influence client action Confrontation Description of discrepancy/distortions1. To identify client's mixed (incongruent) messages or distortions 2. To explore other ways of perceiving client's self or situation 3. To influence client to take action described. They are powerful enough in their impact on clients that less frequent use is usually warranted. We begin the discussion of these more advanced influ-encing skills with immediacy, which may be thought of as an extension of self-disclosure, a special kind of self-disclosure in which the helper discloses something currently being experienced in the session. We follow this with discussion of interpretation and confrontation, two responses that are designed to promote insight and exploration and are usually used later in the helping process after a sound, therapeutic relationship has been established. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 143 Questions Questions are an indispensable part of the interview pro-cess. Their effectiveness depends on the types of questions asked and the frequency of their use. Questions have the potential for establishing desirable or undesirable patterns of interpersonal exchange, depending on the skill of the therapist. Beginning interviewers are prone to err by as-suming that a helping interview is a series of questions and answers or by asking the wrong kind of question at a particular time. These practices are likely to make the client feel interrogated rather than understood. However, even experienced helpers overuse this potentially valuable influencing response. Although asking a question is all too easy to do during silence or when you are at a loss for words, you should not ask questions unless you have in mind a particular purpose for the question. For example, if you are using a question as an open invitation to talk, realize that you are in fact asking the client to initiate a dialogue, and be sure to allow the client to respond. Open and Closed Questions Most effective questions are open-ended questions; they begin with words such as what, how, when, where, or who and they encourage client elaboration. According to Ivey, D'Andrea, Ivey, and Simek-Morgan (2007), the particular word that is used to begin an open-ended question is im-portant. Research has shown that what questions tend to elicit facts and information, how questions are associated with sequence and process or emotions, and why ques-tions produce reasons. Similarly, when and where ques-tions elicit information about time and place, and who questions are associated with information about people. Open-ended questions serve a number of purposes in dif-ferent situations (Cormier, 2016; Ivey, Ivey, & Zalaquett, 2014): 1. Beginning an interview2. Encouraging the client to convey more information3. Eliciting examples of particular behaviors, thoughts, or feelings so that the helper can better understand the conditions contributing to the client's concerns 4. Developing client commitment to communicate by inviting the client to talk and guiding the client along a focused interaction In contrast to open-ended questions, closed (focused) questions can be useful if the practitioner needs a par-ticular fact or seeks a particular bit of information. These questions begin with words such as is, are, do, did, can, and which, and they can be answered with “yes,” “no,” or some other short response. Closed questions are a major tool for obtaining information during the assessment pro-cess. Here are three examples of closed questions: 1. Of all the issues we discussed, which bothers you the most? 2. Is there a history of depression in your family? 3. Are you planning to look for a job in the next few months? Closed questions serve the following purposes: 1. Narrowing the area of discussion by asking the client for a specific response 2. Gathering specific information 3. Identifying parameters of concerns4. Interrupting an overly talkative client who rambles or “storytells” Closed questions must be used sparingly within an interview. Too many closed questions may discourage discussion and may subtly give the client permission to avoid sensitive or important topics. Hepworth and col-leagues (2013), however, mention an exception to this general guideline. They note that it may be necessary to use more closed questions if the client is unresponsive, withholds information, or has limited “conceptual and mental abilities” (p. 143). Guidelines for the Use of Questions You will use questions more effectively and efficiently if you remember some important guidelines for their use. First, develop questions that center on the client's concerns. Effective questions arise from what the client has already said, not from the helper's curiosity or need for closure. Second, after a question, use a pause to give the client sufficient time to respond. Remember that the client may not have a ready response. The feeling of having to supply a quick answer may be threatening and may encourage the client to give a response that pleases the helper. Third, ask only one question at a time. Some inter-viewers tend to ask multiple questions (two or more) before allowing the client time to respond. We call this tactic stacking questions. It confuses the client, who may respond only to the least important question in the series. This guideline is especially important when you are working with children, the elderly, and developmentally challenged persons, because these clients may need more information-processing time. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
144 Chapter 5 Fourth, avoid accusatory or antagonistic questions. These are questions that reflect antagonism either be-cause of the helper's voice tone or because of use of the word why. You can obtain the same information by ask-ing what instead of why. Young (2013) points out that “asking the client why they behaved or felt a particular way is very enticing because this inquiry seems very psychological and appears to be getting to the root of a problem” (p. 92). Yet, often, clients do not really know the reasons behind their feelings or behaviors, and ac-cusatory questions like why ones can put the client on the defensive. As Ivey, Ivey, and Zalaquett (2014) note, why questions also are lacking in respect, empathy, and positive regard. This caution about why questions does not mean that exploring reasons for client behavior is unimportant, but as Young (2013) observes, such infor-mation is usually better extracted “from the whole of the client's story” (p. 93). Finally, avoid relying on questions as a primary re-sponse mode during an interview (unless you are doing an intake, taking a history, or conducting an assessment session). Remember that some cultural groups may find questions offensive, intrusive, and lacking in respect. In any culture, consistent overuse of questions can create problems in the therapeutic relationship, such as fos-tering dependency, promoting the helper as an expert, reducing responsibility and involvement by the client, and creating resentment (Gazda et al., 2005). The feel-ing of being interrogated may be especially harmful with “reluctant” clients. Questions are most effective when they provoke new insights and yield new information. To determine whether it is really necessary to use a question at any particular time during a session, ask the question co-vertly to yourself and see whether you can answer it for the client. If you can, then the question is probably unnecessary and a different response would be more productive. Steps in the Use of Questions There are four steps in formulating effective questions. First, determine the purpose of your question. Is it le-gitimate and therapeutically useful? Often, before you probe for information, it is of therapeutic value to dem-onstrate first that you actually heard the client's message. Listening before questioning is particularly important when clients reveal strong emotions. It also helps clients to feel understood rather than interrogated. For this reason, before each of our example questions we use a paraphrase or a reflection response. In actual practice, this bridging of listening and influencing responses is very important because it balances the attending and action modes in the interview. Second, decide what type of question would be most helpful. Open-ended questions foster client exploration. Closed or focused questions should be reserved for times when you want specific information or you need to nar-row the area of discussion. Make sure that your question centers on concerns of the client, not issues of interest only to you. Third, remember to assess the effectiveness of your questioning by determining whether its purpose was achieved. A question is not useful simply because the client answered or responded to it. Fourth, examine how the client responded and the overall explanation, inquiry, and dialogue that ensued as a result of particular questions. Those four steps are summarized in the following cog-nitive learning strategy: 1. What is the purpose of my question, and is it thera-peutically useful? 2. Can I anticipate the client's answer? 3. Given the purpose, how can I start the wording of my question to be most effective? 4. How will I know whether my question is effective? Notice how the helper applies this cognitive learning strategy in the following example: Client: I just don't know where to start. My marriage is falling apart. My mom recently died. And I've been hav-ing some difficulties at work. Helper (asks and answers covertly): Self-question 1: What is the purpose of my question—and is it therapeutically useful? To get the client to focus more specifically on an issue of great concern to her. Self-question 2: Can I anticipate the client's answer? No. Self-question 3: Given the purpose, how can I start the wording of my question to be most effective? “Which one of these... ?” “Do you want to discuss... ?”Self-question 4: How will I know whether my question is effective? Examine the client's verbal and nonverbal response and the resulting dialogue, as well as whether the purpose Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 145 was achieved (whether the client starts to focus on the specific concern). At this time the helper's covert visualization or self-talk ends, and the following dialogue ensues: Helper question: Things must feel overwhelming to you right now [reflection]. Of the three concerns you just men-tioned, which one is of most concern to you now? [ques-tion]. Client response (accompanied by direct eye contact; body posture, which had been tense, now starts to relax): My marriage. I want to keep it together, but I don't think my husband does. From the client's verbal and nonverbal responses, the helper can conclude that the question was effective be-cause the client focused on a specific concern and did not appear to be threatened by the question. The therapist can now covertly congratulate herself or himself for for-mulating an effective question with this client. Learning Activity 5. 1 gives you an opportunity to try out this cognitive learning strategy to develop effective questions. learning activity 5. 1 Questions In this activity, you are given three client practice state-ments. For each client message, develop an example of a question using the cognitive learning strategy described previously and outlined here. To internalize this learning strategy, you may wish to talk through the self-questions overtly (aloud) and then covertly (silently). The end product will be a question that you can say aloud or write down. An example precedes the practice messages. Feedback is provided on page 147. Example Client 1, a middle-aged white woman: I get so nervous. I'm just a bunch of nerves. Self-question 1: What is the purpose of my question—and is it therapeutically useful? The purpose is to ask for examples of times when she is nervous. This is therapeutically useful because it con-tributes to increased understanding of the problem. Self-question 2: Can I anticipate the client's answer? No. Self-question 3: Given the purpose, how can I start the word-ing of my question to be most effective? “When... ?” or “What... ?”Actual questions: You say you're feeling pretty upset [re-flection]. When do you feel this way? or What are some times when you get this feeling? [question]. Client Practice Messages The purpose of the question is given to you for each mes-sage. Try to develop questions that relate to the stated pur-poses. Remember to precede your question with a listening response such as a paraphrase or reflection. Client 1, an older woman who is retired from the work-force: To be frank about it, it's been pure hell around my house the last year. Self-question 1: What is the purpose of my question? To encourage client to elaborate on how and what has been hell for her. Self-question 2: Can I anticipate the client's answer?Self-question 3: Given the purpose, how can I start the word-ing of my question to be most effective? Actual questions: Client 2, a 40-year-old physically challenged man: Sometimes I feel kind of blue. It goes on for a while. Not every day but sometimes. Self-question 1: What is the purpose of my question? To find out whether client has noticed anything that makes the “blueness” better. Self-question 2: Can I anticipate the client's answer? Self-question 3: Given the purpose, how can I start the wording of my question to be most effective? Actual questions: Client 3, a 35-year-old African American woman: I feel overwhelmed right now. Too many kids underfoot. Not enough time for me. Self-question 1: What is the purpose of my question? To find out how many kids are underfoot and in what capacity client is responsible for them. Self-question 2: Can I anticipate the client's answer? Self-question 3: Given the purpose, how can I start the wording of my question to be most effective? Actual questions: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
146 Chapter 5 Information Giving There are many times in the helping interview when a cli-ent may have a legitimate need for information. A client who reports being abused by her partner may need infor-mation about her legal rights and alternatives. A client who has recently become physically challenged may need some information about employment and about lifestyle adaptations such as performing domestic chores or en-gaging in sexual relationships. Information giving is an important tool of feminist therapy approaches. Feminist therapists may give information to clients about gender role stereotyping, the impact of cultural conditioning on gender roles, strategies for empowerment, and social/political structures that contribute to disempowerment. We define information giving as the communication of data or facts about experiences, events, alternatives, or people, and we identify five intended purposes of information giving (see Table 5. 1 for a summary). First, information is necessary when clients do not know their options. Giving information is a way to help them iden-tify possible alternatives. For example, you may be coun-seling a pregnant client who says she is going to have an abortion because it is her only choice. Although she may eventually decide to pursue this choice, she should be aware of other options before making a final decision. Second, information giving is helpful when clients are not aware of the possible outcomes of a particular choice or plan of action. Giving information can help them evaluate different choices and actions. For example, if the client is a minor and is not aware that she may need her parents' consent for an abortion, then this information may influence her choice. In the preceding two kinds of situations, information is given to counteract ignorance. Information giving can also be useful to correct invalid or unreliable data or to dispel a myth. In other words, information giving may be necessary when clients are misinformed about something. For example, a pregnant client may decide to have an abortion based on the erroneous assumption that an abor-tion is also a means of subsequent birth control. A fourth purpose of information giving is to help cli-ents examine issues they have been successfully avoiding. For example, a client who hasn't felt physically well for a year may be prompted to explore this problem when confronted with information about possible effects of neglected treatment for various illnesses. A fifth purpose of information giving is to provide cli-ents with structure at major transition points in the help-ing process such as beginnings and endings. At the outset of counseling, providing information fulfills the ethical responsibility of helpers to inform clients of things such as the purposes, goals, techniques, and benefits and limi-tations of counseling. Another important component of information giving during the beginning stage of counsel-ing has to do with therapeutic boundaries, confidentiality, limits of confidentiality, and HIPAA (the federal Health Insurance Portability and Accountability Act of 1996 and extensions thereafter). Provision of this kind of informa-tion at the outset helps to reduce potential ambiguity and anxiety that clients may feel as they approach a helper for the first time. A qualitative study found that clients experienced such structure as providing safety and em-powerment (Levitt, Butler, & Hill, 2006). As counseling ensues, practitioners provide structure to clients through information giving at different points in the process. For example, helpers need to provide information about any assessment measures or standardized tests to be used as well as about potential treatment goals and treatment plans. Practitioners also are ethically obligated to provide structure and information to clients as termination of the helping process approaches and/or as referrals are needed to other practitioners. Differences between Giving Information and Giving Advice It is important to note that giving information differs from giving advice. A person giving advice usually rec-ommends or prescribes a particular solution or course of action for the listener to follow. In contrast, information giving consists of presenting relevant information about an issue or problem. The decision concerning the final course of action—if any—is made by the client. Consider the differences between the following two helper responses: Client, a young mother: I find it so difficult to refuse requests made by my child—to say “no” to her—even when I know they are unreasonable requests or could even be dangerous to her. Helper (advice giving): Why don't you start by saying “no” to her just on one request per day for now— anything that you feel comfortable with refusing—and then see what happens? Helper (information giving): I think there are two things we could discuss that may be affecting the way you are handling this situation. First, we could talk about what you feel might happen if you say “no. ” We also need to ex-amine how your requests were handled in your own fam-ily when you were a child. Very often as parents we repeat with our children the way we were parented in such an automatic way that we don't even realize it's happening. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 147 In the first example, the practitioner recommends ac-tion that may or may not be successful. If it works, then the client may feel elated and expect the helper to have other magical solutions. If it fails, then the client may feel even more discouraged and question whether counsel-ing can really help her resolve this problem. Appropriate and effective information giving indicates what the cli-ent could ponder or do, not what the client should do, and it indicates what the client might consider, not must consider. Several dangers associated with advice giving make it a potential trap for helpers. First, the client may reject not only this piece of advice but also any other ideas presented by the helper in an effort to establish independence and thwart any conspicuous efforts by the helper to influence or coerce. Second, if the client accepts the advice and the advice leads to an unsatisfactory action, then the client is likely to blame the helper and may terminate therapy prematurely. Third, if the client follows the advice and is pleased with the action, then the client may become overly dependent on the practitioner and expect, if not demand, more advice in subsequent sessions. Finally, there is always the possibility that an occasional client may misinterpret the advice and may cause injury to himself or to herself or to others in trying to comply with it. Sommers-Flanagan and Sommers-Flanagan (2014) point out that in almost all cases, advice giving meets more of the needs of the helper than of the client. Ground Rules for Giving Information Information giving is generally considered appropriate when the need for information is directly related to the client's concerns and goals and when the presentation and discussion of information are used to help the client achieve these goals. To use information giving appropri-ately, a helper should consider: (1) when to give informa-tion; (2) what information is needed; and (3) how the information should be delivered. Table 5. 2 summarizes the when, what, and how guidelines for information giv-ing in counseling. The first guideline, the when, involves recognizing the client's need for information. If the client does not have all the data or has invalid data, then a need exists. To be effective, information giving also must be well timed. The client should indicate receptivity to the information Table 5. 2 The When, What, and How of Information Giving in Helping When: Recognizing client's need for information What: Identifying type of information How: Delivery of information in an interview 1. Identify information presently available to client. 2. Evaluate client's present information. Is it valid? Data-based? Sufficient? 3. Wait for client cues of readiness to avoid giving information prematurely. 1. Identify kind of information useful to client. 2. Identify reliable sources of information to validate accuracy of information, including computer sources. 3. Identify any sequencing of information (option A before option B). 4. Identify cultural relevance of information. 1. Avoid jargon. 2. Present all the relevant facts; don't protect client from negative information. 3. Limit amount of information given at one time; don't overload. 4. Ask for and discuss client's feelings and biases about information. 5. Know when to stop giving information so action isn't avoided. 6. Use paper and pencil to highlight key ideas or facts. 5. 1 Feedback Questions Client 1 Sample questions based on defined purpose: It sounds like things have gotten out of hand [paraphrase]. What ex-actly has been going on that's been so bad for you? or How has it been like hell for you? [question]. Client 2 Sample questions based on defined purpose: Now and then you feel kind of down [reflection]. What have you noticed that makes this feeling go away? or Have you noticed anything in particular that makes you feel bet-ter? [question]. Client 3 Sample questions based on defined purpose: With every-one else to take care of, there's not much time left for you [paraphrase]. Exactly how many kids are underfoot? or How many kids are you responsible for? [question]. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
148 Chapter 5 before it is delivered. A client may ignore information if it is introduced too early in the interaction. The helper also needs to determine what information is useful and relevant to clients. Generally, information is useful if it is something clients are not likely to find on their own and if they have the resources to act on the information. The helper also needs to determine whether the information must be presented sequentially to make the most sense to the client. Because clients may re-member initial information best, presenting the most significant information first may be a good rule of thumb in sequencing information. Finally, in selecting informa-tion to give, be careful not to impose information on clients who are ultimately responsible for deciding what information to use and act on. In other words, informa-tion giving should not be used as a forum for the helper to subtly push his or her own values on clients (Egan, 2014). One of the critical facets of giving information has to do with the cultural appropriateness of the information be-ing given. Lum (2011) observes that much cross-cultural contact involves communicating with people who do not share the same types of information. Also, people in different cultures vary in the types of information they attend to. For example, providing information to a sick client about a traditional physician and medical care set-ting may be useful if the client is European American. Many non-European American clients, however, may find such information so far removed from their own cultural practices regarding health and illness that the information is simply not useful. Other cultural mismatches in information giving abound in family therapy. Enmeshment—the concept of a family system lacking clear boundaries between and among individuals—is a prime example. For some Euro-pean American families, enmeshment is considered a sign of pathology because in enmeshed families the autonomy of individual members is considered hampered. However, for many Asian families and for some rural European American families, enmeshment is so completely the norm that any other structure of family living is foreign to them; in many of these families, the prevailing culture dictates that the good of the family comes before the in-dividual members' needs and wishes (Sue & Sue, 2013). If the helper assumes that this behavior is pathological and gives the client information about becoming more “individuated” or “establishing clearer boundaries,” then the client may feel misunderstood and greatly offended. Sue (2010) characterizes this kind of helper behavior as another example of a “racial microaggression”—that is, a brief and common yet derogatory indignity based on the notion that the values and communication styles of the dominant/white culture are the ones that are the standard-bearer and hence are preferred. Therefore, the following important questions need to be addressed. Given the cli-ent's ethnic, racial, and cultural affiliations, what cultural biases are reflected in the information I will give the client? Is this information culturally relevant and appropriate? If you are not careful to assess the assumptions reflected in the information you share with clients, then your informa-tion may seem irrelevant and your credibility in the client's eyes may be diminished. Because of the effects of global-ization, we cannot afford to be culturally obtuse about the kinds of information we make available to clients. In the interview itself, the actual delivery of informa-tion, the “how” of information giving, is crucial. The information should be discussed in a way that makes it usable to the client and encourages the client to hear and apply the information. Moreover, information should be presented objectively. Don't leave out facts simply because they aren't pleasant. Watch out for information overload as well. Most people cannot assimilate a great deal of information at one time. Usually, the more information you give clients, the less they remember. Clients recall information best when you give no more than five or six pieces at one time. Be aware that information differs in depth and may have an emotional impact on clients. Clients may not react emotionally to relatively simple or factual informa-tion such as information about a helping intervention, an occupation, or a résumé. However, clients may react with anger, anxiety, or relief to information that has more depth or far-reaching consequences, such as information about a biopsy or an HIV test. Ask about and discuss the client's reactions to the information you give. In addition, make an effort to promote client understanding of the informa-tion. Avoid jargon in offering explanations. Use paper and pencil as you're giving information to draw a picture or a diagram highlighting the most important points, or give clients paper and pencil so they can write down key ideas. Remember to ask clients to verify their impression of your information either by summarizing it or by repeating it to you. Also, try to determine when it's time to stop dealing with information. Continued information giving may re-inforce a client's tendency to avoid taking action. Information Giving through Technology Information is given to clients not only during sessions but also by digital means. For example, a client who is struggling with having just learned about her malignant brain tumor can benefit from electronic information as well as from what the helper provides during the session. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 149 We don't believe that all information should be given to clients in this way, but digital information is increasingly important in the helping process. Many useful websites are now available for clients; also, many community services, referral sources, and information services are now available online. In addition, many types of support groups are avail-able online and may be especially useful for homebound clients. Currently, the Internet is developing rapidly with Google-targeted search engines for clients, social network-ing such as Facebook, video sharing via You T ube, and user-developed resource repositories such as Wikipedia. A number of websites deal with information that may be especially pertinent to diverse groups of clients. How-ever, many clients who are outside of mainstream groups, such as some rural, low-income clients, do not have ready access to computer technology. Across the globe, broadband coverage is uneven. In addition, there are also emerging ethical, legal, and regulatory issues related to providing information by means of computers. The qual-ity and accuracy of web technology vary tremendously. Some sites may not be suitable for child clients, and many chat rooms contain offensive language. In addition, secu-rity issues often arise. Professional organizations in human services now provide standards on the use of information technology in the helping process, and the provision of Internet-based information is likely to be more regulated in the future. Many of these issues are summarized in a special issue of the Journal of T echnology in Human Services (Finn and Schoech 2008). We have found an excellent resource on online mental health resources at psychcentral. com/resources. These mental health resources are personally reviewed by Dr. John M. Grohol and are updated constantly. Other examples of online services include relationship help (http://thecoupleconnection. net/), information about PTSD (http://ptsd. va. gov), information about anxiety and panic (http://panicattacks. com. au/anxdis/index. html), information about moods (https://moodgym. anu. edu. au /welcome), and a variety of online support groups (e. g., http://www. mentalhealthamerica. net/find-supportgroups). There are also a number of mental health resources now available on smart phones and tablets. Some current exam-ples of these include Mood 24/7, PTSD Coach, Personal Zen, Optimism, and Crisis Text Line. Steps in Information Giving There are six steps in formulating the what, when, and how of presenting information to clients. First, assess what information the client lacks about the issue. Second, determine the cultural relevance of any information you plan to share. Third, decide how the information can be sequenced in a way that aids client comprehension and retention. Fourth, consider how you can deliver the information in such a way that the client is likely to com-prehend it. Keep in mind that in cross-cultural helping situations, effective delivery requires you to communicate in a language and style that the client can understand. Fifth, assess the emotional impact the information is likely to have on the client. Sixth, determine whether your information giving was effective. Note client reactions to it, and follow-up on client use of the information in a subsequent session. Remember that some clients may store information and act on it at a much later date—often even after therapy has terminated. If you have provided informa-tion via technology, remember to follow-up on it and to ask for the client's reactions, questions, and concerns about it. To help with your use of the strategy of information giving, we have put these six steps in the form of questions that you can use as a cognitive learning strategy: 1. What information does this client lack about the issue? 2. Given the client's ethnic, racial, and cultural affilia-tions, 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? Consider the way a helper uses this cognitive learning strategy in the first example of Learning Activity 5. 2 on page 150. Self-Disclosure Self-disclosure can be defined in a variety of ways, but one useful definition is the revelation of personal infor-mation about the helper to the client. Generally, when a practitioner's disclosure “goes beyond the basic profes-sional disclosure of name, credentials, fees, emergency contacts, cancellation polices, and similar information that appears in the office policies or informed consent to treatment, it is considered self-disclosure” (Zur, Williams, Lehavot, & Knapp, 2009, p. 22). Zur and colleagues (2009) also note that self-disclosure can be intentional or unintentional. For example, unintentional disclosures can occur when a client notices the practitioner has a cold, Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
150 Chapter 5 learning activity 5. 2 Information Giving In this activity, three client situations are presented. For each situation, determine what information the client lacks and develop a suitable information-giving response using the cognitive learning strategy described previ-ously and outlined here. To internalize this learning strat-egy, you may want to talk through these self-questions overtly (aloud) and then covertly. The end product will be an information-giving response that you can say aloud or write down. An example precedes the practice situations. Feedback follows on page 152. Example The clients are a married couple in their 30s. Gus is a Euro-pean American man, and his wife, Asani, is an Asian Ameri-can woman. They disagree about the way to handle their 4-year-old son. The father believes the boy is a “spoiled brat” and thinks the best way to keep him in line is to give him a spanking. The mother believes that her son is just a “typical boy” and that the best way to handle him is to be respectful. The couple admit that there is little consistency in the way the two of them deal with their son. The typical pattern is for the father to reprimand him and swat him while the mother watches, comforts him, and often inter-cedes on the child's behalf. Self-question 1: What information do these clients lack about this issue? Information about effective parenting and child-rearing skills. Self-question 2: Given the clients' ethnic, racial, and cultural affiliations, is this information relevant and appropriate? I have to recognize that the mother and father probably bring different cultural values to this parenting situa-tion. I'm going to have to find information that is ap-propriate to both value systems, such as the following: a. All children need some limits at some times. b. There is a hierarchy in parent/child relationships; chil-dren are taught to respect parents, and vice versa. c. Children function better when their parents work together on their behalf rather than disagreeing all the time, especially in front of the child. Self-question 3: How can I best sequence this information?Discuss item 3 first—working together on the child's behalf—and note how each parent's approach reflects his or her own cultural background. Stress that neither approach is right or wrong, but that the approaches are different. Highlight points of agreement. Self-question 4: How can I deliver this information so that the clients are likely to comprehend it? Present the information in such a way that it appeals to the values of both parents. The mother values understand-ing, support, and respect; the father values authority, respect, and control. Self-question 5: What emotional impact is this information likely to have on these clients? If I frame the information positively, it will appeal to both parents. I have to be careful not to take sides or to cause one parent to feel relieved while the other feels anxious, guilty, or put down. Self-question 6: How will I know whether my information giving has been effective? I'll watch and listen to their nonverbal and verbal reactions to it to see whether they support the idea. I'll also fol-low up on their use of the information in a later session. Example of information-giving response: You know, Asani and Gus, I sense that you are in agreement on the fact that you love your child and want what is best for him. So, what I'm going to say next is based on this idea that you are both trying to find a way to do what is best for Timmy. In discussing how you feel about Timmy and his behavior—and this is most important—remember that Timmy will do better if you two can find a way to agree on parenting. I think part of your struggle is that you come from cultures where parenting is viewed in different ways. Perhaps we could talk first about these differences and then find areas where you can agree. Client Practice Situations Client 1 is a young Native American man whose driver's license was taken away because of several arrests for driving under the influence of alcohol. He is irate be-cause he doesn't believe drinking a six-pack of beer can interfere with his driving ability. After all, as he says, he has never had an accident. Moreover, he has seen many of his male relatives drive drunk for years without any problem. He believes that losing his license is just another instance of the white man trying to take away something that justifiably belongs to him. Information-giving response: Client 2 is an African American male who has been or-dered by the court to come in for treatment of heroin addiction. At one point in your treatment group, he talks about his drug use with several of his sexual part-ners. When you mention something about the risk of AIDS, his response is that it could never happen to him. Information-giving response: Client 3 is a 35-year-old European American woman with two teenage daughters. She is employed as an execu-tive secretary in a large engineering firm. Her husband Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 151 when the helper tells a client about a change in schedule due to surgery, when a practitioner sees a client at an event, perhaps with one or more significant others, or when a client reveals something they found out about the practitioner through an online search. Zur and colleagues (2009) observe that in the current Internet age, “with the click of a mouse, most psychotherapists' personal lives can be easily viewed” (p. 24). As a result, “clinicians must be aware that all their online postings, blogs, or chats may be viewed by their clients and will stay online, in some form, forever” (Zur et al., p. 25). Other examples of un-intentional disclosures involve what the client notices in the office environment as well as spontaneous expressions or body language of the helper. Environment, Clinical Settings, and Disclosure Helping occurs in an environment and a particular setting—typically an office, although other indoor and outdoor environments can be used. The same environment and setting can impact clients in varying ways. Levitt, But-ler, and Hill (2006) created a hierarchy of categories that represented what clients found important in therapy. One of the most important categories that emerged from this study was the office environment. Clients indicated that the office environment was a reflection of the care they experienced with the helper. Clients also noted that they viewed the therapy room as a “projection of the therapist,” from objects in the room such as pictures, furniture, and background music (Levitt et al., 2006, p. 317). As Zur and colleagues (2009) note, most helping settings and environments foster unavoidable disclosure, particularly around issues of the helper's personal taste and perhaps even around family information and economic status. Disclosure that occurs through helping environments and settings also has implications for working with cul-turally diverse clients. It is important to think about how suitable your helping environment and setting are for diverse kinds of clients. Cultural microaggressions can occur when clients are exposed to helping environments and settings that minimize or devalue the client's race such as the “exclusion of decorations or literature” that repre-sent various aspects of cultural diversity (Sue et al., 2007, p. 274). A recent study involving Euro American college students and Latino community residents explored the impact of multicultural welcomeness through types and number of art objects displayed in a therapy office (Dev-lin, Borenstein, Finch, Hassan, Iannotti, & Koufopoulos, 2013). This study revealed that “a therapist whose office included art and artifacts from a variety of cultures was judged to be more open to multiculturalism than was the therapist whose office displayed objects from a tradition that could be categorized as more western” (pp. 173-174). Results from this study also suggested that the number of art objects is a factor because the therapy office with a larger number of multicultural art objects received higher ratings than the office with only a few items. The authors concluded, “it appears that the message communicated by the display of objects grows stronger with more items” (Devlin et al., 2013, p. 174). In addition, for clients with physical challenges, environments also need to be acces-sible and barrier-free. Helper Nonverbal Behavior: Congruence and Disclosure Nonverbal behavior of the helper represents another way in which unintentional and often unavoidable self- disclosures can occur in helping. Body language and spontaneous expressions such as a frown, a smile, and tapping of the hands or feet, all convey disclosures that “are neither always deliberate nor always under the psy-chotherapist's full control” (Zur et al., 2009, p. 23). Congruence between the helper's body language and ver-bal messages is important because incongruence conveys mixed messages to clients that are confusing. For ex-ample, suppose a practitioner says to a client, “I am really interested in how you feel about your parents,” while looking away from the client and turning away as well. The client may respond to inconsistent or incongruent counselor messages such as these by increasing interper-sonal distance and may view such messages as indicators of counselor deception. Further, when verbal and nonver-bal messages are incongruent or contradict one another, usually the client believes the nonverbal disclosure more strongly than the verbal one. is a department store manager. She and her husband have had a stormy relationship for several years. She wants to get a divorce but is hesitant to do so for fear that she will be labeled a troublemaker and will lose her job. She is also afraid that she will not be able to sup-port her daughters financially on her limited income. However, she indicates that she believes getting a di-vorce will make her happy and will essentially solve all her own internal conflicts. Information-giving response: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
152 Chapter 5 Lack of congruence between helper verbal and nonver-bal messages and resulting disclosures to clients can be es-pecially detrimental in cross-cultural helping interactions. Sue and Sue (2013) observe that for many racial/ethnic minority clients, there is a sociopolitical facet to nonver-bal communication. Minority clients may intentionally challenge a helper to discern the disclosure revealed by the helper's nonverbal message, because such disclosures often represent clues about bias on the part of the helper. For ex-ample, when topics related to a minority client's identity, such as race, are brought up in the session, what the helper says may often be negated by his or her nonverbal com-munication. If this is the case, then the minority client will quickly perceive the inconsistency and may conclude that the helper is incapable of dealing with cultural and racial diversity issues. Intentional, Direct Self-Disclosure Intentional self-disclosure, also called direct self-disclosure, is the form of self-disclosure that most practi-tioners define in their repertoire of responses with clients. Direct disclosure “refers to the intentional disclosure by the clinician of personal information and can be verbal or nonverbal” (Zur et al., 2009, p. 23). Our focus in the remainder of this section is on the use of purposeful and direct self-disclosure as a verbal influencing response to achieve certain purposes in the helping process. Direct self-disclosure is used with clients for several reasons. Conscious use of self-disclosure can build rapport and foster the working alliance by increasing the helper's authenticity, by promoting feelings of universality, and by increasing trust. This purpose of self-disclosure is im-portant with all clients and is perhaps critical with clients from various racial and ethnic groups who may depend on some helper self-disclosure to feel safe. The whole idea of self-disclosing intimate aspects of one's life to a stranger such as a therapist may seem inappropriate to clients from some cultural groups who stress friendship as a precondi-tion to self-disclosure (Sue & Sue, 2013). Another purpose of self-disclosure is to instill hope in clients and to help clients who may feel alone. Also, self-disclosure can be used to help clients consider other and different alternatives and views, and it may be especially suitable to move clients who are stuck in a rut to take some action. Empirical Evidence for Self-Disclosure Henretty and Levitt (2010) have provided an exhaustive review of the empirical evidence surrounding the use of self-disclosure in psychotherapy. In general, their review of quantitative studies about this helper response found the following: 1. self-disclosure (versus nondisclosure) has positive ef-fects on clients 2. clients liked helpers who self-disclosed more than those who did not disclose5. 2 Feedback Information Giving Client 1 Example of information-giving response: I realize this seems to you to be just another example of what white men do to people of your nation that is unjust and unfair. I also realize that you are following what you've seen many of your male relatives do. So I'm sure, based on all this, it does seem hard to believe that drinking a six-pack of beer can interfere with the way you drive. In fact, it can and does affect how you judge things and how quickly you react. Would you be willing to watch a short film clip with me or check out a website to get some additional information? Client 2 Example of information-giving response: Kevin, when you say this could never happen to you, it makes me wonder what you know about HIV. Do you know any black men who have tested positive for HIV? And are you aware that the virus can be spread easily through shared needles and also through semen? Client 3 Example of information-giving response: Leslie, in discuss-ing your situation with you, there are a couple of things I want to mention. First, it might be useful for you to consider seeing a competent lawyer who specializes in divorce mediation. This person could give you detailed information about the legal effects and processes of a divorce. Usually, a person does not lose a job because of a divorce. In many instances, the husband is required to make support payments as long as the children are of minor age, depending on the custody arrangements. I would encourage you to express these same concerns to the lawyer. The other thing I'd like to spend some time discussing is your belief that you will feel very happy after the divorce. That might be very true. It is also important to remember, though, that just the process of ending a relationship—even a bad relationship—can be very unsettling and can bring not only relief but also some feelings of loss and maybe sadness for you and for your children. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 153 3. clients perceived helpers who self-disclosed as warmer 4. client's level of self-disclosure increased with helpers who self-disclosed. Also, the following variables did not impact or were not impacted by helper self-disclosure: helper's education, client's age, helper and client gender, and client's percep-tions of helper's levels of trustworthiness, regard, empathy, congruence, and unconditionality. Although to date there are few studies exploring self-disclosure and ethnicity, the results of these few studies support the conclusion that culture does interact with self-disclosure in the helping process. Specifically, clients from some ethnic origins may prefer helper self-disclosure, whereas clients from other ethnic origins do not (Henretty & Levitt, 2010, p. 69). We discuss some of the clinical implications from these findings in the following section on Ground Rules and Client Reactions to Self-Disclosure. Ground Rules and Client Reactions to Self-Disclosure Self-disclosure is a complex skill. There are ethical issues surrounding the use of it. As Henretty and Levitt (2010) point out, the issues surrounding nondisclosure require as much scrutiny as self-disclosure, because both the “theoreti-cal and empirical research suggests that nondisclosure has risks and benefits that need to be weighed” (p. 71). At the same time, intentional use of self-disclosure requires critical thinking and judicious adaptation, too. In part, this degree of forethought is necessary because it is often very tempt-ing for helpers to disclose something about themselves that meets more of their own needs for expression and valida-tion than the client's needs. Such disclosure constitutes a sort of role reversal. There is also the risk of a helper overidentifying with a client and projecting his or her own experiences and feelings onto the client in the self-disclosed material. For example, a client comes in and reports she is in a second marriage and comments, “Aren't second mar-riages great?” In response the helper self-discloses and says, “Yes, I think so, too. I have no regrets about having divorced my first husband. What about you?” The client looks sad and puzzled by this: “Well, my first husband died in a car wreck. ” In an example such as this, the thoughtless use of self-disclosure could get the helper into a lot of difficulty. Here we provide some ground rules to help you think critically about self-disclosure. The first ground rule per-tains to the timing or the decision about when to self- disclose to a client. Hepworth and colleagues (2013) sug-gest that self-disclosure in most instances is not useful until rapport has been established with the client. They note that “the danger in premature self-disclosure is that such responses can threaten clients and lead to emotional retreat at the very time when it is vital to reduce threat and defensiveness” (p. 114). Remember that self-disclosure is an influencing response, so building a good prelimi-nary base of listening responses with clients is usually a good idea. At the same time, though, low levels of self- disclosure can be useful in the early stages of helping as a way to build the alliance and relieve client apprehensions (Henretty & Levitt, 2010, p. 72). These authors recom-mend that a pragmatic way to deal with the timing of self-disclosure may simply be to inform clients at the be-ginning of the process that helpers will at times reveal their own thoughts, feelings, and information about themselves as appropriate (Henretty & Levitt, 2010, p. 72). The second ground rule has to do with the breadth of the disclosure, or how much disclosure to provide: the amount of helper information shared. Most of the evi-dence indicates that a moderate amount of disclosure has more positive effects than no disclosure or too much dis-closure (Levitt, Butler, & Hill, 2006; Henretty & Levitt, 2010). Some self-disclosure may indicate a desire for a close relationship and may increase the client's estimate of the helper's trustworthiness. Some self-disclosure can provide role modeling for clients from cultures with a low level of emotional expressiveness (Lum, 2011). Helpers who disclose very little could add to the role distance between themselves and their clients. At the other extreme, too much disclosure may be counterproductive. The helper who discloses too much may be perceived as lacking in discretion, being untrustworthy, seeming self-preoccupied, or needing assistance. A real danger in overdisclosing is the risk of being perceived as needing as much help as the client. This perception could undermine the client's confidence in the helper's ability to be helpful. Also, too much self-disclosure can lead clients who are from cultures unaccustomed to personal sharing to retreat (Lum, 2011). Excessive self-disclosure may represent a blurring of good treatment boundaries. Greenberg, Rice, and Elliott (1993) refer to the process of too much helper self-disclosure and not enough attention to boundary issues as promiscuous self-disclosure. They note that effective use of self-disclosure is based on the helper's accurate aware-ness of his or her own inner experience (Greenberg et al., 1993). Also, excessive self-disclosure is the most common boundary violation that precedes unethical sexual contact between therapist and client (Smith & Fitzpatrick, 1995). Another ground rule pertains to the duration of self-disclosure—the amount of time used to give infor-mation about yourself. Extended periods of helper dis-closure will consume time that could be spent in client disclosure. As one person reveals more, the other person will necessarily reveal less. From this perspective, some Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
154 Chapter 5 conciseness in the length of self-disclosing statements seems warranted. Another consideration in duration of self-disclosure is the capacity of the client to use and benefit from the information shared. As Egan (2014) observes, helpers should avoid self-disclosing to the point of adding a burden to an already overwhelmed client. Of course, if the client doesn't seem to respond positively to the self-disclosure, then it is best not to use any more of it. And after the self-disclosure, it is wise to make sure that the focus doesn't stay on you but goes back to the client. A fourth ground rule to consider in using self-disclosure concerns the depth, or intimacy, of the information re-vealed. You should try to make your statements simi-lar in content and mood to the client's messages. Ivey, Gluckstern, and Ivey (1997) suggest that the practitioner's self-disclosure should be closely linked to the client's state-ments. For example: Client: I feel so down on myself. My partner is so critical of me, and often I think she's right. I really can't do much of anything well. Helper similar: There have been times when I've also felt down on myself, so I can sense how discouraged you are. Sometimes, too, criticism from someone close to me has made me feel even worse, although I'm learning how to value myself regardless of critical comments from those I care about. Helper dissimilar: I've felt bummed out, too. Sometimes the day just doesn't go well. Also, there is some evidence that disclosures of a moder-ate amount of intimacy are linked to more positive effects on the helping process (Kim et al., 2003). This same study found that to some degree counselors are able to deter-mine how clients may perceive a particular disclosure and can therefore judge the appropriate amount of disclosure to make (Kim et al., 2003). The final ground rule involves with whom self-disclosure may or may not be feasible. The nature of the client's problems, the client's ego strength, and any diagnoses are all relevant factors to consider. Hepworth and associ-ates (2013) recommend very limited and concrete self-disclosure with clients who are psychotic or have severe and ongoing mental illness. Similarly, Henretty and Levitt (2010) found that self-disclosure is not used much with clients with poor boundaries or with those diagnosed with personality disorders. Self-disclosure is also used less with clients who have been diagnosed with disruptive, impulse control, and conduct disorders. For some clients, however, the use of self-disclosure is highly indicated. These include clients who are adolescents and some clients of color, who may feel more comfortable and trusting of practitioners who self-disclose. Self-disclosure is also a primary action tool in both individual and group counseling for clients with substance abuse problems. Steps in Self-Disclosure There are four steps in developing a self-disclosure response. First, assess the purpose of using self-disclosure at this time, and make sure that you're disclosing for the client's benefit and not your own. Simone and colleagues (1998) suggest a series of questions to help you think through the benefits and risks of self-disclosure with a client: Will my disclosure pull the focus from the client? Will it blur boundaries?Will it make the client focus on my needs or feel frightened about my vulnerability? Will my disclosure cause the client concern about my abil-ity to help? Will this disclosure improve or diminish our rapport?Will it help the client look at different viewpoints, or will it confuse the client? Will the disclosure help the client feel more hopeful and less alone, or could it demoralize the client? Does this client need me to model disclosure behavior? (p. 182) Second, assess whether you know enough about the client (and/or the client's diagnosis) to determine if this client can use your self-disclosure to add to insight and to take action. Consider the nature of the client's prob-lems and diagnoses and how this situation may affect the client's ability to use your self-disclosure effectively. Third, assess the timing of the self-disclosure. Note what indica-tors you have that suggest whether the client is ready to accept your self-disclosure or be put off by it. Fourth, remember to assess the effectiveness of your self-disclosure. You can follow-up on the client's reactions by paraphrasing and reflecting and by open questions. Ob-serve whether the client is receptive to your self-disclosure or seems shut down by it. If the client seems uncomfort-able with your self-disclosure or doesn't acknowledge any similarity with his or her own situation, then it is best not to make additional self-disclosures—at least in this session and perhaps not with this client. To formulate an effective self-disclosure response, con-sider the following cognitive learning strategy: 1. 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? 2. What do I know about this client and the nature of the client's problems and diagnoses? Can this client use the self-disclosure? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 155 3. How do I know if the timing is right for using self-disclosure with this client? 4. How will I know if my self-disclosure is effective? Notice how the practitioner uses this cognitive learning strategy for self-disclosure in the following example: Client, a 45-year-old gay man whose partner recently left him: My partner of 20 years has recently left me for another man. I can't help but wonder if he didn't find me attractive anymore. I have been feeling so disgusted with myself. I keep wondering if I should have been doing things differently—if somehow it was entirely my fault. It just makes me feel that I must have done something wrong. I keep thinking if only I had done this or done that, he wouldn't have left. Helper (asks and answers covertly): Self-question 1: What is my reason for disclosing now?My reason for disclosing now is to instill hope in this dis-couraged client. It is linked to his statements of feeling totally responsible for the breakup of his relationship. Self-question 2: What do I know about this client and the nature of his problems? Can he effectively use the self-disclosure?The client is not psychotic or severely mentally ill and does not appear to have an impulse or conduct disorder. I will keep my response short and get the focus back to the client after it. Self-question 3: How do I know if the timing for self-disclosure is right? The timing seems okay because the client seems very dis-couraged and stuck in his discouragement and self-blame. Self-question 4: How will I know if my self-disclosure is effective?I will follow-up my self-disclosure with a response that re-turns the focus to the client and checks out his reaction to the self-disclosure. Helper self-disclosure: Rich, I have been in a similar situ-ation, and it took me a long time to realize that it wasn't my fault, that no matter what or how much I did, my partner still would have left. Does my experience have any usefulness for you? Rich's response seems to confirm the helper's intent of instilling hope and moving him out of his discourage-ment. In this situation, the use of self-disclosure seemed to be effective. Learning Activity 5. 3 gives you the oppor-tunity to develop and practice the skill of self-disclosure. learning activity 5. 3 Self-Disclosure Respond to the following three client situations with a self-disclosing response using the cognitive learning strategy described previously and outlined here. Make sure you re-veal something about yourself. It might help you to start your statements with “I. ” Also, try to make your statements concise and similar in content and depth to the client mes-sages and situations. An example is given first, and feed-back is provided on page 157. Example The client is having a hard time stating specific reasons for seeking counseling, and you have the feeling that a big part of this difficulty may be due to cultural differences between you and the client. Client Practice Messages Self-question 1: What is my reason for disclosing now? Is it linked to the client's needs and statements rather than my own needs and projections? Self-question 2: What do I know about this client and the nature of the client's problems? Can this client use the self-disclosure? Self-question 3: How do I know if the timing is right for using self-disclosure with this client? Self-question 4: How will I know if my self-disclosure is effective?Actual self-disclosure: I know it takes time to get started. I'm reluctant at times to share something that is per-sonal about myself with someone I don't know, and we come from different ethnic groups. I'm wondering if you feel this way, too? Client 1 is feeling like a failure because nothing seems to be going well. She states that she “works herself to death” but never feels as though she measures up. Actual self-disclosure: Client 2 is hinting that he has some concerns about sex but does not seem to know how to introduce this concern in the session. Actual self-disclosure: Client 3 has started to become aware of feelings of an-ger because of racist remarks being made at work and is questioning whether such feelings are legitimate or whether something is wrong with him. Actual self-disclosure: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
156 Chapter 5 Immediacy Immediacy is a characteristic of a helper verbal response that describes something as it occurs within a session. Imme-diacy involves self-disclosure but is limited to self-disclosure of current feelings or what is occurring at the present in the relationship or the session. When persons avoid being immediate with each other over the course of a developing relationship, distance sets in. Immediacy is a useful way to focus on the here and now in the helping relationship and, as Yalom (2009) advises, checking frequently on the here and now in the helping process is useful. He notes that he usually does one or more immediacy checks during any given session, at least at the very end of the session by say-ing the following to the client: “We are close to the end of the hour today and I want to focus a bit on how the two of us are working together today. How do you feel about the space between us today, or how well did we work to-gether today?” (pp. 228-229). Sometimes Yalom (2009) adds observations, as in the following immediacy response example he provides: “I notice that we're circling the same things we talked about last week. Do you feel that way too?” (p. 229). As Yalom observes, sometimes nothing arises from this immediacy other than establishing a norm that both helper and client observe what happens between them in the helping relationship. At other times, the use of the here-and-now immediacy yields something very profound. In using immediacy in counseling, the practitioner re-flects on the current aspect of: (1) some thought, feeling, or behavior of the counselor; (2) some thought, feeling, or behavior of the client; or (3) some aspect of the relationship. Here are examples of these three categories of immediacy: 1. Helper immediacy. The helper reveals his or her own thoughts or feelings in the helping process as they oc-cur in the moment: “I'm glad to see you today. ” “I'm sorry, I am having difficulty focusing. Let's go over that again. ” 2. Client immediacy. The practitioner provides feed-back to the client about some client behavior or feeling as it occurs in the interview: “You're fidgeting and seem uncomfortable here right now. ” “You're really smiling now—you must be very pleased about it. ” 3. Relationship immediacy. The helper reveals feel-ings or thoughts about how he or she experiences the relationship: “I'm glad that you're able to share that with me. ” “It makes me feel good that we're getting somewhere today. ”Relationship immediacy may include references to spe-cific here-and-now transactions or to the overall pattern or development of the relationship. For example, “I'm aware that right now as I'm talking again, you are looking away and tapping your feet and fingers. I'm wondering if you're feeling impatient with me or if I'm talking too much” (specific transaction). Consider another example in which immediacy is used to focus on the development and pattern of the relationship: “This session feels so good to me. I remember when we first started a few months ago, and it seemed we were both being very careful and having trouble expressing what was on our minds. Today, I'm aware we're not measuring our words so carefully. It feels like there's more comfort between us. ” Immediacy is not an end but rather a means of helping the practitioner and client work together better. If allowed to become a goal for its own sake, then immediacy can be distracting rather than helpful. It is primarily used to address issues in the relationship that, if left unresolved, would interfere with the helping relationship and the therapeutic alliance. Examples of instances in which im-mediacy might be useful include the following (Egan, 2010): 1. Hesitancy or “carefulness” in speech or behavior (“Juanita, I'm aware that you [or I] seem to be choos-ing words very carefully right now—as if you [or I] might say something wrong”). 2. Feeling of being “stuck”—lack of focus or direction (“Right now I feel like our session is sort of a bro-ken record. We're just like a needle tracking in the same groove without really making any music or going anywhere”). 3. Tension and trust (“I'm aware there's some discomfort and tension we're both feeling now—about who we are as people and where this is going and what's going to happen”) (p. 250). Immediacy can also be used to deal with the issues of transference and countertransference we discussed in Chapter 3. Immediacy has three purposes. One purpose is to bring out in the open something that you feel about yourself, about the client, or about the relationship that has not been expressed directly. Generally, it is assumed that co-vert (unexpressed) feelings about the relationship may inhibit effective communication or may prevent further development of the relationship unless the helper recog-nizes and responds to these feelings. This may be especially important for negative feelings. In this way, immediacy may reduce the distance that overshadows the relationship because of unacknowledged underlying issues. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. 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Influencing Responses 157 A second purpose of immediacy is to generate dis-cussion or to provide feedback about some aspects of the relationship or the interactions as they occur. This feedback may include verbal sharing of the helper's feel-ings or of something the helper sees going on in the interactive process. Immediacy is not used to describe every passing feeling or observation to the client. But when something happens in the process that influences the client's feelings toward counseling, as surmised by the helper, then dealing openly with this issue has high priority. Usually it is up to the helper to initiate discus-sion of unresolved feelings or issues. Immediacy can be a way to begin such discussion and, if used properly, can strengthen the working alliance. A third purpose of immediacy is to help clients gain awareness of their relationships to other people and of issues that may be causing problems for them with other people. Teyber and Mc Clure (2011) describe this as the client's interpersonal style and they identify three predomi-nant kinds of interpersonal styles: moving toward others; moving away from others; and moving against others. The rationale for this use of immediacy is that clients usually respond to helpers the way they respond to other people in their lives. For example, if Butler is oppositional with the helper, then he is perhaps also oppositional with significant others in his life. If Catherina idealizes the helper, then she probably also idealizes other people in her life who are important to her. If Jorge goes out of his way to please the therapist, then he most likely works hard to please other people as well. Immediacy can provide a model for clients of how to address and resolve problems in their interpersonal relationships outside of therapy. Individual clients, as well as couples, families, and groups, usually follow the interpersonal model set by the practi-tioner (Hepworth et al., 2013). A naturalistic field study involving 16 cases of individual psychodynamic psycho-therapy conducted by doctoral students with adult clients found that immediacy appeared to be an effective helping skill used to facilitate a corrective emotional experience for the clients, establish or negotiate boundaries, foster client disclosure, and promote client insight (Hill, Gelso, Chui, Spangler, Hummel, Huang, Jackson, Jones, Palma, Bhatia, Gupta, Ain, Klingaman, Lim, Liu, Hui, Jezzi, & Miles, 2013). Ground Rules and Client Reactions to Immediacy Several ground rules can help practitioners use immediacy effectively. First, the helper should describe what she or he sees as it happens. If the helper waits until later in the ses-sion or until the next interview to describe a feeling or ex-perience, the impact is lost. In addition, feelings about the relationship that are discounted or ignored may build up and eventually be expressed in more intense or distorted ways. The helper who puts off using immediacy to initi-ate a needed discussion runs the risk of having unresolved feelings or issues damage the relationship. Second, to reflect the here and now of the experi-ence, any immediacy statement should be in the present tense—“I'm feeling confused now” rather than “I just felt confused. ” This models expression of current rather than past feelings for the client. Further, when referring to your feelings and percep-tions, take responsibility for them by using the personal pronoun I, me, or mine, as in “I'm feeling concerned about you now” instead of “You're making me feel concerned. ” Expressing your current feelings with “I” language com-municates that you are responsible for your feelings and observations, and this may increase the client's receptivity to your immediacy expressions. Also, as in using all other responses, the helper should consider timing. Using a lot of immediacy in an early session may be overwhelming for some clients and can elicit anxiety in either the helper or client. Cultural differences also play a role in the decision to use immediacy. Some clients may feel awkward discuss-ing personal feelings or be unwilling to give feedback if solicited by the helper. As Gazda and associates (2005, p. 205) observe, “It is highly desirable that a strong base relationship exists 5. 3 Feedback Self-Disclosure Here are some possible examples of counselor self- disclosure for the three client situations. See whether your responses are similar. Your statements will probably reflect more of your own feelings and experiences. Are your statements fairly concise? Are they similar to the client messages in content and intensity? To Client 1: I sense how difficult it is for you to work so hard and not feel successful. I have also struggled at times with my own high standards and gradually have learned to be more gentle and easier on myself. Is this something you can relate to? To Client 2: Sometimes I find it hard to start talking about really personal things like sex. I wonder if this is what's happening to you right now. To Client 3: I can remember times when it has been hard to admit I feel angry. I always used to control it by telling myself I really wasn't angry or that someone really didn't mean to say something offensive to me. Does this feel like what is happening with you? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
158 Chapter 5 before using the dimension of immediacy. ” If a helper uses immediacy and senses that this has threatened or scared the client, then the helper may discern that the client is not yet ready to handle these feelings or issues. And not every feeling or observation a helper has needs to be ver-balized to a client. The session does not need to turn into a “heavy” discussion, nor should it resemble a confessional. Generally, immediacy is reserved for initiating exploration of the most significant or most influential feelings or is-sues. Of course, a helper who never expresses immediacy may be avoiding issues that have a significant effect on the relationship. Some preliminary research suggests that with fearfully/insecurely attached clients, helpers may need to tread more carefully in the use of immediacy, particularly in using this skill to discuss relationship issues or ruptures (Hill et al., 2013). Finally, in using immediacy, even if it is well timed, helpers have to be careful that the immediacy response is based on what is actually happening in the relationship rather than being a reflection of their countertransfer-ence response to something occurring with the client. For example, Antony is a beginning helper who has just seen Marisa, one of his very first clients. Marisa is very depressed, so Antony suggests a consultation with the staff psychiatrist. Marisa is receptive to this idea, and Antony schedules this consultation for her after their session the following week. When the time arrives for the consultation, Antony takes Marisa over to the psychiatrist's waiting room, and Marisa is told that due to some scheduling problems she will have to wait at least an hour or longer before the consultation. Marisa becomes upset and lashes out at Antony, saying that she has taken extra time off from work for this consultation and is losing money because of it. Antony reacts on the basis of his first impulse: “Well, if that's the way you feel, you might as well not come back to see me next week. ” Fortunately, Antony has a safe and trusting rela-tionship with his supervisor and discusses this situation in supervision. His supervisor helps Antony to see that what he blurted out was more a reflection of his coun-tertransference and not truly based on what he really felt about Marisa and their relationship. In fact, he likes working with Marisa very much and she is important to him, but his response was based on his own feeling that he and the helping process were, in his eyes, not more important to her. One way to prevent a situation like Antony's is to reach for feelings that underlie your immediate experiencing. For example, you may have a superficial level of a feeling such as dislike or boredom but, reaching underneath, discover curiosity or compassion. Or you may feel an-noyed at the client for being late but, reaching deeper, feel disappointment that the client isn't more committed to the helping process (Hepworth et al., 2013). Hill (2014) describes this process as recognizing when you are being “hooked” by the client's behavior and then learning how to pull out of being hooked. Steps in Immediacy The immediacy influencing response requires a com-plex set of skills applied in the context of both critical thinking and judicious adaptation. The first step toward immediacy—and an important prerequisite of the actual verbal response—calls for awareness, or the ability to sense what is happening in the interaction. To develop this awareness, you must monitor the flow of the interac-tion to process what is happening to you, to the client, and to your developing relationship. Awareness also im-plies that you can read the clues without a great number of decoding errors and without projecting your own biases and blind spots into the interaction. After developing awareness, the next step is to formu-late a verbal response that somehow shares your sense or picture of the process with the client. Sometimes this may include sharing more than one feeling or sharing conflicting feelings. The critical feature of immediacy is its emphasis on the here and now—the present. The third step is to describe the situation or targeted behavior in neutral or descriptive rather than evaluative terms (Hepworth et al., 2013). The fourth step is to identify the specific effect of the problem situation, of the relationship issue, or of the client's behavior on others and on you (Hepworth et al., 2013). You help the client take action by authentically sharing how the client affects you instead of cajoling, pleading, or directing the client to change, which usually backfires. The last step is to get the client's reactions to your immediacy response. For example, you can ask the client something like, “What is your reaction to what I just shared?” If your response is not helpful, then the client will most likely shut down, retreat, or even lash out at you. If immediacy is helpful, then the client will provide feedback and engage in more exploration. To formulate an effective immediacy response, consider the following cognitive learning strategy: 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 ad-dresses this issue in the here and now? 3. How can I describe the situation or behavior in a de-scriptive rather than an evaluative way? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 159 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? Notice how the helper uses this cognitive learning strat-egy for immediacy in the following example. The client, Isabella, is struggling with a decision about whether to get a job or go back to school. She has been in-undating you with e-mails and phone calls between your weekly sessions. This has gone on for several weeks. You are feeling put off by this. You decide during the session to use immediacy to respond because she is also talking about how much difficulty she seems to have in making connections with other people—who just don't seem to be responsive to her. Helper (asks and answers covertly):Self-question 1: What is going on right now that needs to be addressed? With me—my feelings of moving away from Isabella. With her—her pattern of inundating me with e-mails and phone calls during the week, which I suspect may be happening with other people in her life. Underneath this are probably feelings of anxiety and uncertainty. With the interaction between us—as she increases her requests for my time and energy, I find myself pulling back and giving less. Self-question 2: How can I formulate an immediacy response that addresses this issue in the here and now? Use the present tense, and start first with what I'm aware of, such as, “I'm aware of some feelings that I'm having that might be related to your experiences in connecting with other people. ” Self-question 3: How can I describe the situation or behavior in a descriptive rather than an evaluative way? Take responsibility for my feelings by using an “I” message, describing her behaviors with the e-mails and phone calls without blaming her. Self-question 4: How can I identify the specific effect of this situation or behavior? Describe what I see happening in the process—as she re-quests more of my time and energy with the e-mails and phone calls, I find myself pulling back, giving less, and wondering if this is part of her difficulty in connecting with other people as well. Self-question 5: How will I know if my immediacy response is useful to her? I will ask for her feedback at the very end of my immediacy response. Immediacy response: Isabella, I'm aware of some feel-ings I'm having that may relate to both your school and work decision and also to your feeling a lack of responsiveness from other people you try to connect with. If you feel willing to hear them, I'd like to share them with you now (pause to get an indicator of her willingness, which often may be nonverbal)... Okay. Well, I'm finding myself pulling back from you and giving you less of my time and energy as you are making more requests of me through daily e-mails and phone calls asking me what you should do. I'm guessing you're feeling a lot more anxious about this decision than I know. As a result, you are moving toward me with such intensity that I find myself moving back from you when this happens. I wonder if this might also be going on with some of the people in your life you are having trouble connecting with (pause). What's your reaction to this? Isabella's response: Well, that's a lot to think about. I guess I never thought of myself in that way, and I didn't real-ize I would be having that effect on other people. But you are right in that I am feeling very uncertain and unsure about what step to take next and I have never had much confidence in my ability to make decisions, so getting tons of input from others is the way I deal with this. Isabella's response suggests she has benefited from the helper's immediacy response in that she is able to begin to explore the idea of having trouble relying on herself for decisions. Although she did not respond to the part about the other people in her life, this may come at a later time in the session or in a subsequent session. Learning Activity 5. 4 gives you the opportunity to develop and practice the skills for immediacy using the cognitive learning strategy described earlier. Interpretations and Additive/ Advanced Empathy Interpretation is a response that calls for understanding and being able to communicate the meaning of a client's messages. In making interpretive statements, the helper uses her or his hunches or ideas to identify patterns and to make implied client messages more explicit. Interpretive responses can be defined in a variety of ways. We define an interpretation as a statement that—based on the helper's hunches—identifies behaviors, patterns, goals, wishes, and feelings that are suggested or implied by the client's communication. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
160 Chapter 5 Interpretation deals with the implicit part of a message—the part the client does not talk about ex-plicitly or directly. As Brammer, Abrego, and Shostrom (1993) note, when interpreting, a helper will often ver-balize issues that the client may have felt only vaguely. Our concept of interpretation is similar to what Egan (2014) calls advanced accurate empathy, because this response challenges clients to look deeper. Hepworth and associates (2013) refer to interpretive responses as additive empathy. They note that at this level of empa-thy the practitioner uses mild to moderate interpretive responses that accurately identify implicit underlying feelings and/or aspects of the problem, thus enabling the client to get in touch with somewhat deeper feelings and unexplained meanings and purposes of behavior. Further, these interpretive responses may also iden-tify “implicit goals” or actions desired by but perhaps unacknowledged by the client (p. 523). These inter-pretive responses go beyond the expressed meaning of client messages to partially expressed and implied messages—hence, the term additive empathy. If these responses are accurate and well timed, clients will gain a new and fresh perspective. There are many benefits and purposes for which interpretation can be used appropriately in a helping interview. First, effective interpretations can contribute to the development of a positive therapeutic relation-ship by reinforcing client self-disclosure, enhancing the credibility of the therapist, and communicating therapeutic attitudes to the client. Another purpose of interpretation is to identify patterns between cli-ents' explicit and implicit messages and behaviors. A third purpose is to help clients examine their behavior from a different frame of reference to achieve a bet-ter understanding of the problem. Finally, almost all interpretations are offered to promote insight. Johnson (2014) observes that interpretation is useful for clients because it leads to insight, and insight is a key to bet-ter psychological living and a precursor to effective behavior change. learning activity 5. 4 Immediacy In this activity, you are given three client practice state-ments. For each client message, develop an example of an immediacy response. Apply the cognitive learning strategy and the five self-questions listed here to each client state-ment. Feedback follows on page 162. Example The client has come in late for the third time, and you have concerns about this behavior. One concern is that the cli-ent's lateness affects your whole schedule, and another is that you feel uncertainty about the client's commitment to the helping process. Immediacy response: I'm aware that you're having dif-ficulty getting here on time, and I'm feeling uncomfortable about this. I feel uncertain about when or whether to ex-pect you for your session. I guess I'm also wondering about your commitment to being here. What is your take on this? Apply the five self-questions to the following three client examples in formulating your immediacy response. Self-question 1: What is going on right now that needs to be addressed? Self-question 2: How can I formulate an immediacy response that addresses this issue in the here-and-now? Self-question 3: How can I describe the situation or behavior in a descriptive versus an evaluative way?Self-question 4: How can I identify the specific effect of this situation or behavior? Self-question 5: How will I know if my immediacy response is effective? Client Examples Client 1 stops talking whenever you bring up the subject of her academic performance. Y our immediacy response: Client 2 has asked you several questions about your com-petence and qualifications. Y our immediacy response: Client 3 and you are experiencing a great deal of tension and caution; the two of you seem to be treating each other with kid gloves. You notice physical sensations of tension in your body, and signs of tension are also ap-parent in the client. Y our immediacy response: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 161 Here is an example that may help you understand the nature of the interpretation response more clearly: Client 1, a young soldier after deployment: Well, I sur-vived three deployments over there. I have seen it all, buddies killed, some so severely injured they will never really recover. So in light of this, my habit of porn doesn't seem so bad, given all I have been through in the past 10 years. Interpretation: Tomas, I can tell from what you are say-ing and how you are saying it that you have really been through a lot—multiple deployments, witnessing the death and injuries of close friends and comrades. Could it be, though, that you are using this as a reason to justify continuing your porn habit? Sometimes the implicit response may have to do with a cultural aspect of the client's message. Consider the voice of Thad, the only African American student in his com-munications class: “This is the first class I have ever had to stand up and give a real speech to. And I just feel like I can't do it, it won't be good enough, it won't meet stan-dards, it won't be as good as the other speeches are... It just won't be good enough. ” The sensitive helper may hear the implied cultural aspect of Thad's message and give an interpretive response similar to the following: “Giving this speech is a first for you, and you feel gripped with doubt and fear about it—in part because this is a new experience for you and also perhaps because you're the only person of color in the room and you're holding yourself to a higher standard. ” Ground Rules for Interpreting and Cautionary Notes The overall quality of the therapeutic relationship affects the degree to which an interpretation is likely to be use-ful to the client. Interpretations need to be offered in the context of a safe and empathic contact with the client. For this reason, as Hepworth and associates (2013) note, interpretive responses are used “sparingly” with clients un-til a sound working alliance has been developed (p. 541). As you can imagine, interpretive responses are not used a great deal in brief therapy. Another important aspect of the content of the interpre-tation is whether your interpretation is based on the client's actual message rather than on your own biases and values projected onto the client. You need to be aware of your own blind spots. For example, if you had a bad experience with marriage and are biased against people getting or staying married, you need to be aware of how this opinion could affect the way you interpret client statements about marriage. If you aren't careful, you could easily advise all marital counseling clients away from marriage, a bias that might not be in the best interests of many of them. A third guideline and cautionary note for the in-terpretation response is the way in which the helper phrases the interpretation and offers it to the client. In most cases, interpretations should be phrased ten-tatively. Tentative rather than absolute phrasing helps prevent the helper from engaging in one-upmanship and engendering client resistance or defensiveness to the interpretation. After responding with an interpre-tation, check out the accuracy of your interpretive response by asking the client whether your message fits. Returning to a clarification is always a useful way to determine whether you have interpreted the message accurately. The content of an interpretation must be congru-ent with the client's cultural affiliations. Because many counseling theories are based on Eurocentric assump-tions, achieving congruence can be a thought-provoking task. It is most important not to assume that an inter-pretation that makes sense to you will make the same sort of sense to a client whose racial, ethnic, and cultural backgrounds vary from your own. Also remember that a primary goal of the interpretive response is to pro-mote client insight and that even the goal of promoting insight is a “culture bound value” (Sue & Sue, 2013, p. 188). The depth of the interpretation you offer to the client is another factor related both to usage and cau-tion regarding this influencing response. Depth is the degree of discrepancy between the viewpoint expressed by the helper and the client's beliefs. Presenting cli-ents with a viewpoint discrepant from their own is believed to facilitate change by providing clients with a reconceptualization of the problem. An important question is to what extent the helper's communicated conceptualization of the issue should differ from the client's beliefs. Highly discrepant or very deep inter-pretations are more likely to be rejected by the cli-ent, possibly because they are unacceptable, seem too speculative, or evoke resistance. In contrast, interpre-tations that are either congruent with or only slightly discrepant from the client's viewpoint are most likely to prompt change. Hepworth and colleagues (2013) conclude that practitioners should avoid making any interpretive responses that are “far removed from the awareness of clients” (p. 542). Also, because interpre-tive responses can facilitate deeper self-exploration by clients, the quantity of these responses is also an im-portant guideline. It is generally ill-advised to offer Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
162 Chapter 5 too many interpretive responses in a single session, or for that matter even during the course of the helping process. It is far better to offer a few on-target, accurate interpretations that really create movement for the cli-ent from superficial to deep exploration than to try to push this movement by overinterpreting. The depth of the interpretation also has some impact on the time at which an interpretation is offered—both within a session and within the overall context of treat-ment. The client should show some degree of readiness to explore or examine himself or herself before you use interpretation. Generally, an interpretation response is reserved for later, rather than initial, sessions because some data must be gathered as a basis for an interpretive response and because the typical client requires several sessions to become accustomed to the type of material discussed in counseling. The client may be more receptive to your interpretation if she or he is comfortable with the topics being explored and shows some readiness to accept the interpretive response. As Brammer and colleagues (1993, p. 181) note, a helper usually does not inter-pret until the time when the client can almost formulate the interpretation for herself or himself. Timing within a session is also important. If the helper suspects that the interpretation may produce anxiety or resistance or break the client's “emotional dam,” it may be a good idea to postpone it until the beginning of the next session (Brammer et al., 1993). Client Reactions to Interpretation Client reactions to interpretation may range from expres-sion of greater self-understanding and release of emotions to less verbal expression and more silence and even more outright hostility and resentment of the helper. Accord-ing to Cozolino (2010), these reactions occur because a number of things are occurring in the client's brain both during and after an interpretation, especially an accurate one. Specifically, both the cortical networks and subcorti-cal networks in the brain are activated, ultimately allow-ing for “plasticity and new learning in prefrontal regions” (p. 295). In other words, of all the verbal responses, interpretive responses perhaps have the greatest potential to promote new neural networking and integration in the client's brain. If your interpretation is met initially with defensiveness or hostility, it may be best to drop the issue temporarily and introduce it again later. However, don't push an inter-pretation on a resistant client without first re-examining the accuracy of your response. However, if the client responds to the interpretation affirmatively, as in venting feelings, confirming greater understanding, and bringing up additional related content, then the helper can proceed in the same direction. Remember that client reactions may be not only verbal responses but also nonverbal reactions. Clients may react simply by shutting down, becoming less verbally active, and even pulling their chair away from the helper. In a few extreme cases, clients may get up and walk out of the office, perhaps returning later or perhaps discontinuing therapy altogether. This is not necessarily a bad thing in the long term, because interpre-tations need time to be worked through by clients, but it is an indicator that your interpretation released some emotions in the client that he or she was unprepared to cope with at the time (Cozolino, 2010, p. 295). Client reactions to interpretation also vary with cul-tural characteristics. Although the concept of promot-ing insight, a goal of interpretation, is compatible for some European American clients, insight may not be so valued by other clients. As Sue and Sue (2013) note, “When survival on a day-to-day basis is important, it seems inappropriate for the therapist to use insightful processes” (p. 188). Also, some cultural groups simply do not feel the need to engage in contemplative reflec-tion. The very notion of thinking about oneself or one's issues too much is inconsistent for some clients, who may have been taught not to dwell on themselves and their 5. 4 Feedback Immediacy Here are some expressions of immediacy. See how they compare with yours. To Client 1: Every time I mention academic performance, like now, you seem to back off from this topic. I'm aware that during this session, you stop talking when the topic of your grades comes up. Am I hitting a nerve there, or is there something else going on that would help me understand this better? To Client 2: I'm aware that right now it seems very im-portant to you to find out more about me and my background and qualifications. I'm sensing that you're concerned about how helpful I can be to you and how comfortable you're feeling with me. What's your reaction to this? Maybe you have something you want to share, and, if so, I'd like to hear it. To Client 3: I'm aware of how physically tight I feel now and how tense you look to me. I'm sensing that we're just not too comfortable with each other yet. We seem to be treating each other in a very fragile and cautious way right now. I'm not sure what this is about. What reactions do you have to this? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 163 thoughts. Other clients may have learned to gain insight in a solitary manner, as in a “vision quest,” rather than with another person such as a helper. In actual practice, you can try to assess the client's receptivity by using a trial interpretation, bearing in mind that the client's initial reaction may change over time. Steps in Interpreting There are three steps in formulating effective interpreta-tions. First, listen for and identify the implicit meaning of the client's communication—what the client conveys sub-tly and indirectly. Listen for behaviors, patterns, and feel-ings, as well as for implied goals, actions, and wishes. Be sure to take into account the client's nonverbal messages as well. Second, make sure that your view of the issue, your frame of reference, is relevant to the client's cultural background, keeping in mind some of the precautions we addressed earlier. Finally, examine the effectiveness of your interpretation by assessing the client's reaction to it. Look for nonverbal recognition signs such as a smile or contemplative look as well as verbal and behavioral cues that indicate the client is considering the issue from a different frame of reference or that the client may not understand or agree with you. To formulate an effective interpretation and assess its use-fulness, consider the following cognitive learning strategy: 1. What is the implicit part of the client's message?2. Is my view of this issue culturally relevant for this client? 3. How will I know whether my interpretation is useful? Notice how a therapist applies this cognitive learning strategy in the following example: Client, a European American woman: I really don't un-derstand it myself. I can always have good sex whenever we're not at home—even in the car. But at home it's never too good. Helper ( asks and answers covertly): Self-question 1: What is the implicit part of the client's message? That sex is not good or fulfilling unless it occurs in special, out-of-the-ordinary circumstances or places. Also that the client doesn't understand what exactly is going on with her sexually and perhaps wishes she could have good sex at home as well as in other places. Self-question 2: Is my view of this issue culturally relevant for this client? This client seems relatively comfortable in talking about and disclosing information about her sexual feelings and behaviors. However, be careful not to make any assump-tions about the client's sexual orientation. At this point we do not know whether this person is lesbian, bisexual, or straight. At this point the helper's covert visualization or self-talk ends, and the following dialogue ensues:Helper interpretation: Ann, I might be wrong about this—it seems that you get psyched up for sex only when it occurs in out-of-the-ordinary places where you feel there's a lot of novelty and excitement. You don't quite understand this yet and perhaps wish you could have great sex at home, too. Does that sound accurate? Client (lips part, smiles slightly, eyes widen): Well, I never thought about it quite that way. I guess I do need to feel like there are some thrills around when I do have sex—maybe it's that I find unusual places like the elevator a challenge. At this point, the practitioner can conclude that the interpretation was effective because of the client's nonver-bal recognition behavior and because of the client's ver-bal response suggesting the interpretation was on target. The therapist might continue to help the client explore whether she needs thrills and challenge to function satis-factorily in other areas of her life as well. Learning Activity 5. 5 gives you an opportunity to try out the interpretation response. Confrontation/Challenge Confrontation, also known as challenge, is an influenc-ing response in which the helper describes discrepancies, conflicts, and mixed messages apparent in the client's feelings, thoughts, and actions. Hepworth and associates (2013) describe this response as follows: “Similar to in-terpretation and additive empathy it is a tool to enhance clients' self-awareness and to promote change. Confronta-tion however involves facing clients with some aspect of their thoughts, feelings, or behaviors that is contributing to or maintaining their difficulties” (pp. 542-543). Al-though some other authors prefer the term challenge over confrontation, we use these terms interchangeably because they both have the same function in the helping pro-cess, and that is to support and move the client forward simultaneously. Confrontation/challenge has several purposes. One purpose is to help clients explore other ways of perceiv-ing themselves or an issue, leading ultimately to different actions or behaviors. Egan (2014) refers to this purpose Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
164 Chapter 5 as challenging the client's “blind spots,” things the cli-ent fails to see or chooses to ignore (p. 172). This may involve challenging distortions as well as discrepancies. These distortions may be cognitive ones (often the result of inaccurate, incomplete, or erroneous beliefs and in-formation) or affective ones, involving attributions made from inaccurate or erroneous perceptions (Hepworth et al., 2013). A second purpose of the confrontation/challenge re-sponse is to help the client become more aware of dis-crepancies or incongruities in thoughts, feelings, and actions. This is important because discrepancies can be indicators of unresolved, contradictory, or suppressed feelings. Many times during an interview a client may say or do something that is inconsistent. For example, a client says she doesn't want to talk to you because you are a male but then goes ahead and talks to you. In this case, the client's verbal message is inconsistent with her actual behavior. This is an example of an inconsistent, or mixed, message. The purpose of using a confronta-tion to deal with a mixed message is to describe the discrepancy or contradiction to the client. Often the client is unaware or only vaguely aware of the conflict before the helper points it out. In describing the dis-crepancy, you will find it helpful to use a confrontation that presents or connects both parts of the discrepancy. Motivational interviewing theory describes this as a double-sided reflection. Six major types of mixed messages and accompanying descriptions of confrontations are presented as examples (see also Egan, 2014; Ivey, Ivey, & Zalaquett, 2014). learning activity 5. 5 Interpretation Three client practice statements are given in this activity. For each message, develop an example of an interpre-tation using the cognitive learning strategy described previously and outlined here. To internalize this learning strategy, you may want to talk through the self-questions overtly (aloud) and then covertly. The end product will be an interpretation that you can say aloud or write down. An example precedes the practice messages. Feedback follows on page 166. Example Client, a young Asian American woman: I don't know what to do. I guess I never thought I'd ever be asked to be a supervisor. I feel so content just being part of the group I work with. Self-question 1: What is the implicit part of the client's message? She feels uncertain and perhaps overwhelmed by the thought of this job transition—and perhaps is con-cerned about losing her place in the group if she moves out of it to become a supervisor. Self-question 2: Is my view of this issue culturally relevant for this client? With her Asian American background, the client may feel more comfortable working in and with a collective group of people. Actual interpretation response: Despite your obvious success on the job, you seem to be reluctant to move up to a position that requires you to work by yourself. I'm wondering if you are responding in any part to your cul-tural background, which stresses belonging to a group, and working for the good of the group rather than promoting yourself. Have I heard you accurately or not? Client Practice Statements Client 1, a young, Native American woman: I can't stand to be touched anymore by a man. And after I was raped, they wanted me to go see a doctor in this hospital. When I wouldn't, they thought I was crazy. I hope you don't think I'm crazy for that. Actual interpretation response: Client 2, a 50-year-old Jordanian man: Sure, I seemed upset when I got laid off several years ago. After all, I'd been an industrial engineer for almost 23 years. But I can support my family with my job supervising these custodial workers. So I should be very thankful. Then why do I seem so down? Actual interpretation response: Client 3, a young white man: I have a great time with Susie (his girlfriend), but I've told her I don't want to settle down. She's always so bossy and tries to tell me what to do. She always decides what we're going to do and when and where and so on. I get really upset at her. Actual interpretation response: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 165 1. Verbal and nonverbal behavior a. Client says, “I feel comfortable” (verbal message) but at the same time is fidgeting and twisting her hands (nonverbal message). Helper confrontation: You say you feel comfortable, and you're also fidgeting and twisting your hands. b. Client says, “I feel happy about the relationship be-ing over—it's better this way” (verbal message) but is talking in a slow, low-pitched voice (nonverbal message). Helper confrontation: You say you're happy it's over, and at the same time your voice suggests you have some other feelings too. 2. Verbal messages and action steps or behaviors a. Client says, “I'm going to call her” (verbal message) but reports the next week that he did not make the call (action step). Helper confrontation: You said you would call her, and as of now you are reporting that you haven't done so yet. b. Client says, “Counseling is very important to me” (verbal message) but calls off the next two sessions (behavior). Helper confrontation: Several weeks ago you said how important counseling is to you; now I'm also aware that you called off our last two meetings. 3. Two verbal messages (stated inconsistencies) a. Client says, “He's sleeping around with other peo-ple. I don't feel bothered (verbal message 1), but I think our relationship should mean more to him than it does” (verbal message 2). Helper confrontation: First you say you feel okay about his behavior; now you're feeling upset that your relationship is not as important to him as it is to you. b. Client says, “I really do love little Georgie (verbal message 1), although he often bugs the hell out of me” (verbal message 2). Helper confrontation: You seem to be aware that much of the time you love him, and at other times you feel very irritated toward him, too. 4. Two nonverbal messages (apparent inconsistencies) a. Client is smiling (nonverbal message 1) and crying (nonverbal message 2) at the same time. Helper confrontation: You're smiling and also crying at the same time. b. Client is looking directly at helper (nonverbal mes-sage 1) and has just moved chair back from helper (nonverbal message 2). Helper confrontation: You're looking at me while you say this, and at the same time you also moved away. 5. Two persons (helper/client, parent/child, teacher/stu-dent, spouse/spouse, and so on) a. Client's husband lost his job 2 years ago. Client wants to move; husband wants to stick around near his family. Helper confrontation: Edie, you'd like to move. Mar-shall, you're feeling family ties and want to stick around. b. A woman presents anxiety, depression, and mem-ory loss. You suggest a medical workup to rule out any organic dysfunction, and the client refuses. Helper confrontation: Irene, I feel it's very important for us to have a medical workup so we know what to do that will be most helpful for you. You seem to feel very reluctant to have the workup done. How can we work this out? 6. Verbal message and context or situation a. A child deplores her parents' divorce and states that she wants to help her parents get back together. Helper confrontation: Sierra, you say you want to help your parents get back together. At the same time, you had no role in their breakup. How do you put these two things together? b. A young couple has had severe conflicts for the past 3 years, but still they want to have a baby to improve their relationship. Helper confrontation: The two of you have sepa-rated three times since I've been seeing you in therapy. Now you're saying you want to use a child to improve your relationship. Many couples indi-cate that stress increases from having a child and being parents. How do you put this together? Ground Rules for Challenging Confrontation needs to be offered in a way that helps clients examine the consequences of their behavior rather than defending their actions (Johnson, 2014). In other words, confrontation must be used carefully not to in-crease the very behavior or pattern that the helper feels may need to be diminished or modified. The following ground rules may assist you in using this response to help rather than to harm. First, be aware of your own motives for challenging at any particular time. Although the word itself has a punitive or emotionally charged sound, confrontation/challenging in the helping process is not an attack on or Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
166 Chapter 5 want people to like you, and at the same time you make frequent remarks about yourself that seem to get in the way and turn people off. ” Moreover, before a helper tries to confront a client, rapport and trust should be established. Confrontation probably should not be used unless you, the helper, are willing to maintain or increase your involvement in or commitment to the helping relationship (Johnson, 2014). The primary consideration is to judge what your level of involvement seems to be with each client and adapt accordingly. The stronger the relationship is, the more receptive the client may be to a confrontation. The timing of a confrontation is very important. Be-cause the purpose is to help the person engage in self-examination, try to offer the confrontation at a time when the client is likely to use it. The perceived ability of the client to act on the confrontation should be a major guideline in deciding when to challenge. In other words, before you jump in and confront, determine the person's attention level, anxiety level, desire to change, and ability to listen. A confrontation is most likely to be heard when the client feels safe with you; it is less likely to be heard when it occurs early in the relationship. An exception to this general ground rule is in instances of legal violations and danger to self or to others, when confrontation would be mandated earlier in the helping process (Hepworth et al., 2013). Appropriate use of timing also means that the helper does not challenge clients on a “hit-and-run” basis (John-son, 2014). Ample time should be given after the confron-tation to allow the client to react to and discuss the effects of this response. For this reason, helpers should avoid confronting near the end of a session. It is also a good idea not to overload the client with con-frontations that make heavy demands in a short time. The rule of successive approximations suggests that gradual learning undertaken via small steps in implementing new behaviors is much easier than trying to make big changes overnight. Initially, you may want to challenge the person with something that can be managed fairly easily and with some success. Carkhuff (1987) suggests that two successive confrontations may be too intense and should be avoided. With clients who are fragile or clients who are experiencing severe stress or emotional strain, it is wise to avoid using confrontation altogether (Hepworth et al., 2013). The gender and cultural affiliations of clients also have an impact on the usefulness of the confrontation/chal-lenge response. This response may be more suitable for European American male clients, particularly manipula-tive and acting-out ones (Ivey, Ivey, & Zalaquett, 2014). an opportunity to badger the client (Welfel & Patterson, 2005). Confrontation also is not to be used as a way to ventilate or dump your frustration onto the client. It is a means of offering constructive, growth-directed feedback that is positive in context and intent, not disapproving or critical (Welfel & Patterson, 2005). Ivey, Ivey, and Zalaquett (2014) describe confrontation as a “supportive” kind of challenge and a “gentle skill that involves first lis-tening to client stories carefully and respectfully, and then encouraging the client to examine self and/or situation more fully... it is not going against the client, it is going with the client” (p. 236). To avoid blame, focus on the incongruity as the problem, not on the person, and make sure your sup-portive stance is reflected in your tone of voice and body language. In describing the distortion or discrepancy, the confrontation should cite a specific example of the behavior rather than make a vague inference. A poor confrontation might be, “You want people to like you, but your personality turns them off. ” In this case, the practitioner is making a general inference about the client's personality and also is implying that the cli-ent must undergo a major overhaul to get along with others. A more helpful confrontation would be, “You 5. 5 Feedback Interpretation Client 1 Interpretation example: I'm guessing that the rape af-fected your trust of other men—even doctors—and also that your cultural background is having some effect, too. I'm wondering if you would feel safe going to a traditional healer, one that you know, instead. Client 2 Interpretation example: It sounds as though when you lost your job as an engineer, you also lost some parts of the role you have learned from your culture about being a man, a husband, and a father. Even though you're glad to have a job, you're sad about these losses and what they mean for you as a man, and as a husband, father, and pro-vider for your family. Does that seem accurate? Client 3 Interpretation example: You like spending time with Su-sie, but you feel pressured to settle down with her and are also put off by her bossiness. It sounds like you wish you had more of the control in the relationship. Does that fit with what you are saying? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 167 Some traditional Asian and Native American clients may view confrontation as disrespectful and insensitive (Sue & Sue, 2013). For all clients, it is important to use this re-sponse in such a way that the client views you as an ally, not an adversary (Welfel & Patterson, 2005). Finally, acknowledge the limits of the confrontation/ challenge response. Confrontation usually brings about client awareness of a discrepancy or conflict. Awareness of discrepancies is an initial step in resolving conflicts. Confrontation, as a single response, may not always bring about resolution of the discrepancy without additional discussion or intervention strategies. Genuine client awareness is often difficult to detect because it may be not an immediate reaction, but rather one that occurs over a period of time. According to Strong and Zeman (2010), the interactional process that occurs between helper and client when confrontation is used is more important than any other verbal skill because confronta-tion is part of a dialogic or relationally responsive way of communicating and interacting. They assert that “a skill such as confrontation tends to be inadequately depicted in the literature given that the counselor's utterance is only one part of a dialogic exchange between client and counselor. Thus, confrontation combines timing, perspi-cacity, careful delivery, equally careful responses to client responses when confronted, and talking until both client and counselor adequately accomplish the aim of the con-frontation” (p. 332). Client Reactions to Challenge Sometimes helpers are afraid to challenge because they are uncertain how to handle the client's reactions to the con-frontation. Even clients who hear and acknowledge the confrontation may be anxious or upset about the implica-tions. Further, as Strong and Zeman (2010) note, clients will “do things with counselor confrontations, not simply receive them” (p. 333). From their dialogic perspective, what matters most is not only what the helper says in the challenge/confrontational response but also what the clients do with the challenge. Hill and Nutt-Williams (2000) note that the empirical evidence surrounding client reactions to confrontation is mixed. A qualitative study also found mixed reviews for the effects of confrontation on clients (Levitt et al., 2006). In this study, many clients did not have a positive reaction to being challenged by their helper, but there were two notable exceptions: clients who were being manipulative and clients who were avoiding difficult material. These clients felt that being challenged was useful for them. One client noted that it was extremely helpful to have a therapist who was “stronger than her eating disorder” (p. 320). For clients who have reasons (often cultural ones) to distrust helpers, or for clients such as some adolescents who may be oppositional, challenging can produce resistance and lead to poorer client outcomes. Some evidence suggests that in these cases, a process called motivational interviewing, which is based on the client-centered listening responses and basic empathy, may yield better client outcomes (Miller & Rollnick, 2013) (see Chapter 10). Generally, a practitioner can expect four types of client reaction to a confrontation: denial, confusion, false ac-ceptance, or genuine acceptance. In denial of the confrontation, the client does not want to acknowledge or agree with the helper's message. Denial may indicate that the client is not ready or tolerant enough to face the discrepant or distorted behavior. Egan (2007) lists some specific ways in which the client might deny the confrontation: 1. Discrediting the helper (e. g., “How do you know when you don't even have kids?”) 2. Persuading the helper that his or her views are wrong or based on misinterpretation (e. g., “I didn't mean it that way. ”) 3. Devaluing the importance of the topic (e. g., “This isn't worth all this time anyway. ”) 4. Seeking support elsewhere (e. g., “I told my friends about your comment last week, and none of them had ever noticed that. ”) 5. Agreeing with the challenger but not acting on the challenge (e. g., “I think you're right. I should speak up and tell how I feel, but I'm not sure I can do that. ”) (pp. 157-158). At other times, the client may indicate confusion or uncertainty about the meaning of the challenge. In some cases, the client may be genuinely confused about what the practitioner is saying. This reaction may indicate that your confrontation was not concise and specific. At other times, the client may use a lack of understanding as a smoke screen—that is, as a way to avoid dealing with the impact of the confrontation. Sometimes the client may seem to accept the confronta-tion. Acceptance is usually genuine if the client responds with a sincere desire to examine her or his behavior. Eventually such clients may be able to catch their own dis-crepancies and challenge themselves. But false acceptance also can occur. In this case, the client verbally agrees with the helper. However, instead of pursuing the confronta-tion, the client agrees only to get the helper to leave “well Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. 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168 Chapter 5 enough” alone. The risk of having confrontation rejected is greatest among clients who need to be challenged the most but, because they are less likely to engage in self-confrontation and may have lower self-esteem, are more likely to read criticism or blame into this response when none is intended (Hepworth et al., 2013). There is no set way of dealing with client reactions to confrontation/challenge. However, a general guideline is to follow-up with basic empathy and go back to the client-oriented listening responses of paraphrase and reflection. As Strong and Zeman (2010) note, follow-ing a challenge response, returning to core listening skills is a critical part of the dialogic process that occurs surrounding the confrontation process in helping. A helper can use these responses to lay the foundation before the confrontation and return to this foundation after the challenge. The sequence might go something like this: Helper: You seem to feel concerned about your parents' divorce. [reflection] Client (says in a low, sad voice): Actually, I feel pretty happy. I'm glad for their sake they got a divorce. [mixed mes-sage] Helper: You say you're happy, and at the same time, from your voice I sense that you feel unhappy. [confrontation] Client: I don't know what you're talking about, really. [denial] Helper: I feel that what I just said has upset you. [reflection] Steps in Confronting/Challenging There are four steps in developing effective confrontations or challenge responses. 1. Observe the client carefully to identify the type of dis-crepancy or distortions that the client presents. Listen for a period of time so that you can detect several in-consistencies before jumping in with a confrontation response. 2. Assess the purpose of your confrontation. Make sure that it is based on the client's need to be challenged in some way and not on your need to challenge. Assess whether the relationship is perceived to be sufficiently safe enough by the client for him or her to be able to benefit from the confrontation. Also assess whether the confrontation is appropriate based on the client's race and ethnicity, gender, and age. 3. Summarize the different elements of the discrepancy. In doing so, use a statement that connects the parts of the conflict rather than disputes any one part, because the overall aim of confrontation is to resolve conflicts and to achieve integration. A useful summary is “On one hand, you ___, and on the other hand, ___. ” No-tice that the elements are connected with the word and rather than with but or yet. This approach helps you present your confrontation in a descriptive rather than a judgmental way. Make sure that your tone of voice and nonverbal behavior convey concern and caring for the client as well. 4. Remember to assess the effectiveness of your con-frontation. A confrontation is effective whenever the client acknowledges the existence of the incongruity or conflict. However, keep in mind that the effective-ness of your confrontation might not be immediate. Watch also for cues that the client may feel defensive or signs indicating indirect reactions to your con-frontation. Remember that the client may be adept at masking an overt negative reaction but may subtly withdraw or shut down in the rest of the session if the confrontation has not been well received. Also, bear in mind that “confronting can bring with it breaches not only in the flow of conversation but also in the rapport established in the counselling relationship... What comes after a confrontation is, for us, analytically, a very interesting and often artful rhetorical improvisation by client and counsellor as they talk through where to go thereafter” (Strong & Zeman, 2010, p. 337). To formulate a confrontation, consider the following cognitive learning strategy: 1. What discrepancy or distortion do I see, hear, or grasp in this client's communication? 2. What is my purpose in challenging 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? Notice how a helper uses this cognitive learning strategy for confrontation in the following example: Client (says in low, soft voice): It's hard for me to discipline my son. I know I'm too indulgent. I know he needs lim-its. But I just don't give him any. I let him do basically whatever he feels like doing. Helper (asks and answers covertly): Self-question 1: What discrepancy or distortion do I see, hear, or grasp in this client's communication? A discrepancy between two verbal messages and between verbal cues and behavior: client knows son needs limits but doesn't give him any. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 169 Self-question 2: What is my purpose in challenging the client, and is it useful for this client at this time? My purpose is to challenge the inconsistencies between what this parent actually does with his son and what he wants to do but has not yet been able to do, and to support him in engaging in the desired action. There doesn't appear to be anything about the client that would make him more defensive with the use of this response at this time. Self-question 3: How can I summarize the various elements of the discrepancy or distortion? Client believes limits would help son; at the same time, client doesn't follow through. Self-question 4: How will I know whether my confrontation is effective? Observe the client's response and see whether he acknowl-edges the discrepancy. At this point the helper's self-talk or covert visualization ends, and the following dialogue occurs: Helper confrontation: William, on one hand, you feel like having limits would really help your son, and at the same time he can do whatever he pleases with you. How do you put this together? Client response: Well, I guess that's right. I do feel strongly that he would benefit from having limits. He gets away with a lot. He's going to become very spoiled, I know. But I just can't seem to put my foot down or make him do something. From the client's response, which confirms the dis-crepancy, the helper can conclude that the confrontation was initially useful (further discussion of the discrepancy seems necessary to help the client resolve the conflict be-tween feelings and actions). Learning Activity 5. 6 gives you an opportunity to ap-ply this cognitive learning strategy to develop the skill of confrontation. learning activity 5. 6 Confrontation/Challenge We give you three client practice statements in this activity. For each message, develop an example of a confrontation using the cognitive learning strategy described previously and outlined here. To internalize this learning strategy, you may wish to talk through these self-questions overtly (aloud) and then covertly. The end product will be a confrontation that you can say aloud or write down. An example precedes the practice messages. Feedback follows on page 170. Example Client, a Latino college student: I'd like to get through medical school with a flourish. I want to be at the top of my class and achieve a lot. All this partying is getting in my way and preventing me from doing my best work. Self-question 1: What discrepancy or distortions do I see, hear, or grasp in this client's communication? A discrepancy between verbal message and behavior. He says he wants to be at the top of his class and at the same time is doing a lot of partying. Self-question 2: What is my purpose in challenging the cli-ent, and is it useful for this client at this time? My purpose is to help him explore the two different messages in his communication and to do so with sensitivity and respect. Self-question 3: How can I summarize the various elements of the discrepancy or distortion? He wants to be at the top of his class and at the same time is doing a lot of partying, which is interfering with his goal. Actual confrontation response: You're saying that you feel like achieving a lot and being at the top of your class and also that you're doing a lot of partying, which appears to be interfering with this goal. Or Eduardo, you're saying that doing well in medical school is very important to you. You have also indicated you are partying instead of studying. How important is being at the top for you? Client Practice Messages Client 1, an Asian American graduate student: My wife and child are very important to me. They make me feel it's all worth it. It's just that I know I have to work all the time if I want to make it in my field, and right now I can't be with them as much as I'd like. Actual confrontation response: Client 2, a 13-year-old African American girl: Sure, it would be nice to have Mom at home when I get there after school. I don't feel lonely. It's just that it would feel so good to have someone close to me there and not have to spend a couple of hours every day by myself. Actual confrontation response: Client 3, a European American high school student: My dad thinks it's terribly important for me to get all As. He thinks I'm not working up to my potential if I get a B. I told him I'd much rather be well rounded and get a few Bs and also have time to talk to my friends and play basketball. Actual confrontation response: Copyright 2017 Cengage Learning. 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170 Chapter 5 Skill Integration: Putting it all Together! Up until this point in the book you have been exposed to a number of elements and skills associated with the helping and interviewing process—including attention to ethical issues, development of multicultural competence, therapeutic relationship variables, nonverbal attending skills, and verbal listening and influencing responses. Of course there is something to be said for learning and ap-plying these skills in a somewhat isolated fashion. When you're a novice helper, it's often easier to develop com-petence and acquire skills by learning them in a singular way to prevent being overwhelmed! Ultimately, however, your goal is to use all your developing competence and helping skills in combination and in concert with one another. This requires sufficient practice so that doing so LO4becomes almost second nature to you and you experience “flow” rather than self-conscious awkwardness during your sessions. In Learning Outcome 4, and Part 4 of the Knowledge and Skill Builder, we give you an opportunity to integrate all of these developing skills by conducting an extended role-play interview. Of course we suggest doing this as many times as possible to “grow” your comfort level with all of these interviewing and helping skills you have learned so far on your journey to becoming a profi-cient professional helper! Another way that you can integrate all of these skills into a cohesive pattern is to develop good observational skills. Seek out as many opportunities as you can to observe your colleagues' efforts at their integrative inter-views. Watching others practice skill integration gives you additional ways to incorporate and internalize the reper-toire of skills into your own style of working with clients! CHAPTER SUMMARY Listening responses reflect clients' perceptions of their world. Influencing responses provide alternative ways for clients to view themselves and their world. A change in the client's way of viewing and explaining things may be one indication of positive movement in counseling. According to Egan (2014), helper statements that move beyond the client's frame of reference are a bridge between listening responses and concrete change programs. To be used effectively, influencing responses require a great deal of helper concern and judgment. Listening responses and influencing responses reflect two different sorts of helper communication styles. Part of the decision about the timing of these responses involves the helper's awareness of the client's cultural affiliations. As Sue and Sue (2013) note, it is important for helpers to be able to shift their communication style to meet the unique cultural dimensions of every client. For the most part, although with some exceptions, clients from some culturally diverse groups value influencing responses because they are more directive in nature than listening responses. However, for clients who are highly reactant, the directiveness reflected in influencing responses may thwart therapeutic progress. Part of the practitioner's task is to discern the effects of these responses on clients and to adjust his or her counseling style appropriately. Visit Cengage Brain. com for a variety of study tools and useful resources such as video exam-ples, case studies, interactive exercises, flash-cards, and quizzes. 5. 6 Feedback Confrontation/Challenge Client 1 Examples of confrontation responses: “David, on one hand, you feel your family is very important, and on the other, you feel your work takes priority over them. How do you put this together?” or “You're saying that your family makes things feel worthwhile for you. At the same time you're indicating you must make it in your field to feel worthwhile. How do these two things fit for you?” Client 2 Examples of confrontation responses: “Denise, you're saying that you don't feel lonely and also that you wish someone like your mom could be home with you. How do you put this together?” or “It seems as though you're trying to accept your mom's absence and at the same time still feeling like you'd rather have her home with you. I wonder if it does feel kind of lonely sometimes?” Client 3 Examples of confrontation responses: “Gary, you're say-ing that doing a variety of things is more important than getting all As, whereas your father believes that all As should be your top priority. ” or “Gary, you're saying you value variety and balance in your life and your father be-lieves high grades come first. ” or “Gary, you want to please your father and make good grades, and at the same time you want to spend time according to your priorities and values. ” (Note: Do not attempt to confront both discrep-ancies at once!) Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
5 Knowledge and Skill Builder Influencing Responses 171 Part One Part One is designed to help you assess your performance on Learning Outcome 1. Identify the type of influencing response—question, information giving, self-disclosure, immediacy, interpretation, confrontation—that is evident in each helper response. Each helper response may be an example of one type of influencing response. If you accu-rately label nine out of 12 responses, you will have met this objective. Check your answers against those provided in the feedback on page 176. 1. Client [talking rapidly, with pressured speech]: The pressure from my job is starting to get to me. I'm al-ways in a constant rush, trying to hurry and get several things done at the same time. There's never enough time. a. Yeah, it sounds like that saying of “The hurrieder I go, the behinder I get. ” and in your situation, the more you rush, the more pressure you feel, and the more pressure you feel, the more you rush. So you're sort of caught in this ongoing process, and it barely feels tolerable. You'd like to find a way out of it. b. It's important you are aware of this. Continued anxi-ety and stress like this can lead to health problems if they go unchecked. c. Now that you are mentioning this, I'm noticing how pressured you seem with me, partly from how fast you're talking and also from how you seem to be hurrying through the session. Does that feel accu-rate to you? 2. Client: I'm tired of sitting home alone, but I feel so up-tight when I ask a girl for a date. a. You seem to be saying that you feel lonely and also that you're not willing to risk asking a girl to go out with you. b. What makes you so anxious when you speak with girls? c. I can relate to what you are saying in that I, too, have had to deal with some fears of my own in meeting new people. One thing that helped me was to join a couple of social and community groups where everyone was new to each other. This helped me practice meeting new people in a low-risk situation—if they didn't like me, I didn't lose much. although this example isn't specific to dating, I think some of the principles are similar. What do you think? 3. Client: I don't know why I tolerate his abuse. I really don't love him. a. On one hand you say that you don't love him, and on the other hand you remain in the house and allow him to beat you. How do you put these two things together? b. You may be caught up in a vicious cycle about whether your feelings for him, even though they're not love, outweigh your regard for yourself. Does this seem to fit you? c. It might be helpful for you to know the process that other women in your shoes go through before they finally get enough courage to leave for good. I'd like to give you the name of someone to talk to at our local domestic violence agency. also, there are sev-eral websites I can give you if you have access to and would like to use the Internet. 4. Client: I don't know why we ever got married in the first place. Things were fine for a while, but since we moved, things have just started to fall apart in our marriage. a. What qualities attracted you to each other originally? b. You're having a difficult time right now, which has led you to question the entire marriage. I wonder whether you would react this way if this present problem wasn't causing such distress. c. I, too, have been in situations like this. When one thing goes wrong, it makes me feel like throwing the whole thing away. Is this something you can re-late to in what you are experiencing now with your marriage? Part Two For each of the following three client statements, Learning Outcome 2 asks you to write an example of each of the six influencing responses. In developing these responses, you may find it helpful to use the cognitive learning strategy you practiced earlier for each response. Feedback is provided on page 176. Client 1, a European American parent (says with loud sighs): My house looks like a mess. I can't seem to get anything done with these kids always under my feet. I'm afraid that I may lose my temper and hit them one of these days. I just feel so stressed out. Question: Information giving: Self-disclosure: Immediacy: Interpretation: Confrontation: Client 2, an African American graduate student: I feel so overwhelmed. I've got books to read, papers to write. (continued) Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
172 Chapter 5 5 Knowledge and Skill Builder (continued) My money is running low, and I don't even have a job. Plus, my roommate is thinking of moving out. I just can't seem to get a break—no one goes out of their way to lift a finger to help me. Question: Information giving: Self-disclosure: Immediacy: Interpretation: Confrontation: Client 3, a young, Native American man: I haven't gotten hooked on this stuff. It doesn't make me feel high, though, just good. all my bad thoughts and all the pain go away when I take it. So why should I give it up? You're not here to make me do it, are you? Question: Information giving: Self-disclosure: Immediacy: Interpretation: Confrontation: Part Three Part Three gives you an opportunity to develop your skills in observing six key aspects of client behavior that a helper must attend to in order to develop effective and accurate influencing responses. 1. Issues and messages that need more elaboration, infor-mation, or examples 2. Implicit messages and themes 3. Myths and inaccurate information 4. Feelings and process issues 5. Distorted perceptions and ideas 6. Discrepancies and incongruities Learning Outcome 3 asks you to observe those six aspects of client behavior during a 30-minute interview. Record your observations on the Client Observation Checklist. You can obtain feedback for this activity by having two or more persons observe and rate the same session and then compare your responses. Client Observation Checklist Name of helper Name(s) of observer(s) Instructions: Write down separate occurrences of each of the six categories of client behavior as they occur during a 30-minute helping interview. (If observers are not avail-able, audiotape or videotape your sessions and complete the checklist while reviewing the tape. )1. Issues and messages that need more elaboration, infor-mation, or examples a. b. c. d. 2. Implicit messages and themesa. b. c. d. 3. Myths and inaccurate informationa. b. c. d. 4. Feelings and process issuesa. b. c. d. 5. Distorted perceptions and ideasa. b. c. d. 6. Discrepancies and incongruitiesa. b. c. d. Part Four Learning Outcome 4 provides you with an opportunity to integrate the core skills and knowledge you have acquired so far from working with this book. To begin this process, conduct one 30-minute role-play interview. You may want to consider this an initial helping interview in which you are creating rapport and getting to know the “client. ” Here are the specific tasks for this integrative helping session: 1. be alert to ethical situations and issues that arise and how you resolve them. 2. assess the degree to which you are able to conduct this interview in a culturally competent way. be sensi-tive not only to cultural competencies but also to any communication and behavior that may be pejorative, biased, or insulting. be especially alert to the possibili-ties of microaggressions. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 173 3. Assess the key aspects of your nonverbal behavior in the interview. 4. Pay attention to the quality of the helping relationship and specifically to your demonstration of the facilitative conditions of empathy, genuineness, and positive regard. 5. Use as many of the listening and influencing verbal re-sponses as seem appropriate within the time span of this session. Try to regard this interview as an opportunity to get in-volved with the person in front of you, not as just another practice. If you feel some discomfort, you may wish to do several more interviews with different kinds of clients. To assess the overall effectiveness of your interview, use the Interview Inventory, which follows. You may wish to make some copies of it. This inventory has six parts. Ethical Issues assesses any ethical issues that arose during the interview and how these were resolved. Multicultural Competence assesses 10 aspects of culturally competent interview behaviors. Nonverbal Be-havior evaluates your use of various nonverbal behaviors. Relationship Variables measures aspects of establishing and enhancing a therapeutic relationship. Verbal Behavior as-sesses listening and influencing responses. Overall Effective-ness summarizes these preceding parts. To use the inventory for rating, follow the instructions for each part. Interview Inventory Interview Number ___ Helper ___Client ___ Rater ___ Date ___ Ethical Issues Instructions: List any ethical issues that came up during the interview, and note how the helper responded to them. Ethical Issue Helper Response 1. 2. 3. 4. Multicultural Competence 1. Was able to identify and discuss issues related to race/ ethnicity/culture during the interview. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 2. Was aware of his or her own racial and cultural iden-tity and the client's level of racial and cultural identity awareness and its impact on the helping process. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 3. Conveyed respect for and sensitivity to cultural differ-ences among clients. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 4. Showed awareness of and sensitivity to the cultural values of each client as well as the uniqueness of each client within the client's racial and cultural group identification. Avoided language and responses that clashed with these cultural values. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 5. Was sensitive to nonverbal and paralanguage cross-cultural communication clues. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 6. Was able to use both nonverbal and verbal responses that conveyed acceptance of the client and the client's culture. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 7. Displayed an understanding of how race, ethnicity, and culture and sociopolitical influences can impinge on the life of clients. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 8. Was able to help the client sort out the degree to which the client's issues or problems are exacerbated by the larger society, racism, and/or biases of others. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 9. Was able to help the client deal with environmental frustration and oppression. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 10. Was alert to cultural biases, prejudices, discriminatory practices, and microaggressions. Not A Great Almost at All Minimally Somewhat Deal Always 1 2 3 4 5 Nonverbal Behavior Instructions: Listed below are significant dimensions of nonverbal behavior. Check (✓ ) any that you observe of the (continued) Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
174 Chapter 5 5 Knowledge and Skill Builder (continued) helper, and provide a brief description of the key aspects and appropriateness of the behavior. The first item serves as an example. Behavior Check (✓ ) if observed Key aspects of behavior 1. 1. body posture Tense, rigid until last part of session, then relaxed 2. eye contact 3. Facial expression 4. Head nodding 5. body movements 6. body orientation 7. Gestures 8. Voice level and pitch 9. Rate of speech 10. Verbal underlining (voice emphasis) 11. Speech errors 12. Pauses, silence 13. Distance 14. Position in room 15. autonomic response (e. g., breathing, sweat, skin flush, rash) 16. Congruence/incongruence between helper verbal and nonverbal behavior 17. environmental sensitivity to diverse kinds of clients Relationship Variables Instructions: Circle the number that best represents the help-er's behavior during the observed interaction. 1. Conveyed accurate understanding of the client and the client's worldview. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 2. Conveyed support and warmth without approving or disapproving of the client. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 3. Focused on the person rather than on the procedure or on the helper's professional role. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 4. Conveyed spontaneity, was not mechanical when re-sponding to the client. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 5. Responded to feelings and issues as they occurred within the session (i. e., in the here-and-now). Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 6. Displayed comfort and confidence in working with the client. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 7. Responded with dynamism and frequency; was not passive. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 8. Displayed sincerity in intentions and responses. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 9. Conveyed friendliness and goodwill in interacting with the client. Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 10. Informed the client about expectations and what would or would not happen in the session (i. e., structuring). Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 11. Shared similar attitudes, opinions, and experiences with the client when appropriate (i. e., when such sharing added to and/or did not detract from the client focus). Not a Great almost at all Minimally Somewhat Deal always 1 2 3 4 5 Observer comments: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Influencing Responses 175 Verbal Behavior Instructions: Check (✓ ) the type of verbal response repre-sented by each helper statement in the corresponding category on the rating form. At the end of the observation period, tally the total number of checks associated with each verbal response on the chart below. Listening responses Influencing responses Clarification Paraphrase Reflecting feeling (basic empathy) Summarization Open question Closed question Information giving Self-disclosure Immediacy Interpretation Confrontation1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Total Overall Effectiveness Instructions: After all the ratings are completed, look at your ratings in the light of these questions. 1. What ethical dilemmas arose for you, and how did you resolve them? 2. What aspects of multicultural competence do you feel most comfortable with? What parts are still hard for you? 3. Which nonverbal skills were easiest for you to demon-strate? Which ones did you find most difficult to use in the interview?4. Which relationship variables were easiest for you to demonstrate? Hardest? 5. Examine the total number of verbal responses you used in each category. Did you use responses from each category with the same frequency? Did most of your responses come from one category? Did you seem to avoid using responses from one category? If so, for what reason? 6. What have you learned about the effectiveness of your interview behavior so far? What do you think you need to improve? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
176 Chapter 5 Part One 1. a. Interpretation b. Information giving c. Immediacy and closed question2. a. Confrontation b. Open question c. Self-disclosure and open question3. a. Confrontation b. Interpretation and closed question c. Information giving4. a. Open question b. Interpretation c. Self-disclosure and closed question Part Two Here are some examples of influencing responses. See whether yours are similar. Client Statement 1 Question: “What exactly would you like to be able to accomplish during the day?” or “How could you keep the kids occupied while you do some of your housework?” or “When do you feel most like striking the children?” or “How could you control your anger?” Information giving: “If you believe your problem would be solved by having more time alone, we could discuss some options that seemed to help other women in this situation—things to give you more time alone as well as ways to cope with your anger. ” Self-disclosure: “I know what it is like to feel like your life is spinning out of control, and it's not a pleasant state to be in—for me, it's pretty stressful. How about for you?” Immediacy: “I can tell from the way you're talking and breathing right now that this stress is very much with you—not just at home but even as we are working together here today. ” Interpretation: “I wonder whether you would be able to accomplish what seems important to you even if the kids weren't always underfoot. Perhaps it's easy to use their presence to account for your lack of accomplishment. ” Confrontation: “On the one hand, you seem to be saying the kids are responsible for your difficulties, and on the other, it appears as if you feel you are the one who is out of control. ” Client Statement 2 Question: “How could you organize yourself better so that you wouldn't feel so overcome by your studies?” or “What kind of work might you do that would fit in with your class schedule?” or “How might you cope with these feelings of being so over- whelmed?” Information giving: “Perhaps it would be helpful if we talked about some ways to help you with your time and money problems. ” Self-disclosure: “Wow. I think I know something about what you are saying, how it feels to have the whole world cave in on you at once. It's an awful lot to try to handle. ” Immediacy: “I'm sensing how frustrated you're feeling right now as you talk, and I'm wondering if you're seeing me as someone unwilling to help y o u. ” Interpretation: “You seem to feel so discouraged with everything that I imagine it would be easy now to feel justified in giving it all up, quitting grad school altogether. ” Confrontation: “You've mentioned several reasons that you feel so overwhelmed now, and at the same time I don't think you mentioned anything you're doing to relieve these feelings. ” Client Statement 3 Question: “What do you feel comfortable sharing with me about your pain?” Information giving: “I'm wondering what you would think of the idea of our spending some time talking about other ways to deal with the pain—such as practices and rituals consistent with your own cultural and ethnic background. ” Self-disclosure: “I went through a similar way of thinking when I gave up smoking. Cigarettes were always there for me—when nothing else was, they were. In that way, it was hard for me to see what could be so bad about continuing to smoke. Does this fit with what you're feeling in your situation?” Immediacy: “I'm wondering if there is something I'm saying or doing to make you feel like I'm going to be policing your actions as we work together. ” Interpretation: “even though you don't feel hooked on this substance, it seems as if using it helps you avoid certain things. Do you think this is so?” Confrontation: “You're telling me that you're pretty sure you're not hooked on this, and at the same time you recognize it seems to medicate your pain. How do you put these two things together?” 5 Knowledge and Skill Builder Feedback Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
177 Assessing and Conceptualizing Client Problems and Contexts Client Statements Institutionalized patient: Why are people always out to get me? Student: I can't even talk to my mom. What a hassle! Physically challenged person: Ever since I had that auto-mobile accident and had to change jobs, I don't seem to be able to get it together. Older person: I didn't used to worry this much, but with our failing health and the skyrocketing medical costs, I am concerned now. These client statements are representative of the types of concerns that clients bring to helpers every day. One thing these clients and others have in common is that their initial problem presentation is often vague. A helper can translate vague client concerns into specific problem statements by using certain skills associated with assess-ment. This chapter presents a conceptual framework that a helper can use to assess clients. What Is Clinical Assessment? Clinical assessment is about helping a client tell and develop a story. The story involves a number of details and plots, including why the client is coming to see you now, what the client wants from you, and how you can help the client get there. Haynes, Smith, & Hunsley (2011) define clinical assessment as a process “that provides essential information to help identify a client's behavior problems and treatment goals, to determine if the client's behavior problems are consistent with di-agnostic criteria, and to specify the variables that affect those problems and goals... ” (p. 1). Such information is used to design and subsequently evaluate the most effective intervention procedures for the client (Haynes et al., 2011). Clinical assessment involves methods, procedures, and tools that are used to collect and process information from which the entire helping program is developed. Interviewing the client and having the client engage in other assessment procedures are only part of the overall assessment process in counseling and therapy. Equally important is the helper's own mental (covert) activity that goes on during the process. The helper typically gathers a great amount of information from clients during this stage of helping. Unless the helper can Learning Outcomes After completing this chapter, you will be able to 1. Identify each of the following, in writing, using a client case description: a. The client's behaviors b. Whether the client's behaviors are overt or covert c. The client's individual and environmental strengths and resources d. Antecedent contributing conditions e. Consequences and secondary gains f. The way each consequence influences the behaviors g. The developmental context of the issue h. The sociopolitical and cultural context of the issue2. Given a role-play interview, you will be able to conduct a history-taking session with the client. chapter 6 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
178 Chapter 6 describes the implementation of the model in a clinical interview setting. Our Assumptions About Clinical Assessment Our model of assessment in helping rests on several as-sumptions about clients, issues, and behavior. This model integrates a number of theoretical approaches including learning theory, both operant and respondent, observa-tional learning, cognitive theory, emotion theory, and developmental/ecological theory. Because both space and the purpose of the book preclude us from helping the reader learn about these various theories in depth, we suggest you consult Haynes, O'Brien, and Kaholokula (2011), Persons (2008), and Bronfenbrenner (1979, 2005) for more detailed information about these theories as well as additional citations in the rest of this chapter. Our major assumptions about therapeutic assessment are as follows. The Role of Learning Undesired (maladaptive) behavior is developed, main-tained, and subject to alteration or modification in the same manner as normal (adaptive) behavior. Both prosocial and maladaptive behaviors are assumed to be developed and maintained by external environmental events or cues, by external reinforcers, and/or by internal processes such as cognition, mediation, and problem-solving. For the most part, maladaptive behavior is learned through operant conditioning, respondent conditioning, and social learning or modeling. This fundamental as-sumption means that we do not spend a great deal of time in sorting out or focusing on possible unresolved early conflicts or underlying pathological states in the client's story. However, this assumption does not mean that we rule out or overlook possible physiological conditions that can also impact undesired behavior. For example, clients who complain of “anxiety” and report primarily somatic (body-related) symptoms such as heart palpita-tions, stomach upset, chest pains, and breathlessness may be chronic hyperventilators or have mitral valve prolapse, hypoglycemia, or a thyroid or other endocrine disorder. This physiological response is usually not the primary cause of the anxiety disorder that is more likely created by anxiety sensitivity. However, these physiologic conditions can be an important contributing factor that may have bearing on the treatment and resolution of the presenting issue. Because learning can also influence behaviors that integrate and synthesize this information, it is of little value and use. The helper's tasks during the assessment process include identifying what information to obtain and how to obtain it, putting the information together in some meaningful way, and using it to generate clini-cal hunches, or hypotheses, about client issues, hunches that lead to tentative ideas for treatment planning. This mental activity of the helper is called conceptualization or formulation—which means the way the helper thinks about the client's presenting concerns. It is impossible to conceptualize or formulate hypotheses about client issues without a thorough assessment process. Similarly, it is impossible to develop outcome goals and treatment plans without a conceptualization process. Although these processes of assessment, conceptualization, goal setting, and treatment planning are described in this and the next three chapters, in practice they are not discrete processes. Moreover, in the best of helping environ-ments, these activities occur in a collaborative manner between the helper and the client. Hunsley and Mash (2010) note that in the past 15 years there have been some rather dramatic changes in the field of clinical assessment. The changes they describe include the following: 1. A decreasing emphasis on the use of complex, multi-dimensional instruments 2. A corresponding increasing emphasis on the use of brief, focused instruments 3. The development and use of appropriate instruments for a diverse range of clients including the availabil-ity of culturally appropriate norms and linguistic adaptations 4. The incorporation of behavioral assessment principles into most areas of clinical assessment 5. The use of information technology to facilitate the collection, scoring, and interpretation of assessment data (pp. 8-9). As these authors indicate, for most helping profes-sionals, the effect of these changes translates into “an enhanced focus on how scientifically sound assessment data can meaningfully inform treatment decisions, plans, and processes” (p. 9). The assessment methods we describe later in this chap-ter, and our interview assessment model in particular (see Chapter 7), are based on an integrated model that we have used over the years in our teaching and in clinical practice. This chapter describes the concepts associated with our assessment model and the following chapter Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Assessing and Conceptualizing Client Problems and Contexts 179 highly plastic, and affected by multiple interacting forces (Berk, 2013). According to the lifespan model of human development, no single age period is more important in its impact on the course of one's life than another. As Berk (2013) notes, in each of the major periods of human development, ranging from infancy to late adult-hood, events occur that can have a major impact on future change. Typically these changes occur in physical, cognitive, and emotional domains (Berk, 2013). Such changes can be described as developmental transitions and usually are triggered by physical growth, psychologi-cal maturation, social pressures, and life events (Ingram, 2012). As Seabury, Seabury, and Garvin (2011) observe pragmatically, “development can be conceptualized as a long line drawn down a sheet of paper. On the top of the line is birth and on the bottom of the line is death. All along the life line, individuals are faced with transition after transition, from one role to another. Role transitions are a continuous process for individu-als and later life has as many transitions as does infancy and childhood” (p. 252). All developmental and role transitions are potentially stressful and some, such as death of a child or spouse, divorce, and loss of job and income, are “particularly overwhelming and may create serious social dysfunction for the individual” (p. 254). Although we do not recommend spending a great deal of time in assessment and intervention on focusing on the client's past, some basic understanding of the client's developmental history and current developmental tran-sitions are important factors in forming hypotheses and conceptualizing issues in sufficient depth to make well-informed treatment decisions. In part, this is because assumptions and core beliefs (or schemas) tend to persist across situations and time and are often learned through key developmental experiences (Kuyken, Padesky, & Dudley, 2009). Beck (1995) places a great deal of importance on the client's developmental history to determine the etiology of cognitions and schemas. Beck recommends asking cli-ents to recall the events in childhood associated with a particular target feeling and/or thought (feelings and beliefs about not being good enough when parents were constantly critical of one's efforts, for example). In addi-tion to core beliefs and schemas, family history, parenting styles, and attachment history are all important influences on developmental processes. Conditions for Healthy Development and Attachment Ingram (2012) summarizes conditions for healthy devel-opment. She notes that the desired qualities and functions have biological or genetic components, we also consider the increasingly important role of neurobiology in assess-ing client concerns. The Role of Neurobiology Physiological variables should always be explored in the client's story, particularly when the results of the as-sessment do not suggest the presence of other specific stimuli associated with the problem behavior (Arden & Linford, 2009; Cozolino, 2010). Many psychological dis-orders have a biological component as well as a learning component. For example, the neurotransmitter serotonin is implicated in both depression and anxiety disorders. Further, the cycling rate of serotonin is affected by genetic markers. Some disorders such as alcoholism, schizophre-nia, and autism spectrum disorders have both genetic and biochemical markers that can increase a person's vulner-ability to such a disorder. This is one reason why medical history is assessed during an initial interview. In these situ-ations, evaluation of the client by a physician is warranted. It is also important to recognize the need for physiologi-cal management of psychological issues. For example, in the kinds of disorders mentioned, medications may be necessary in addition to psychological intervention. An-tidepressants are often recommended for depression in conjunction with cognitive behavioral and interpersonal therapies. Furthermore, a biological element seems to be present in many of the psychoses, such as schizophrenia, and these conditions usually require antipsychotic drugs to improve the client's overall level of functioning. Similarly, children with attention-deficit disorder may need a stimulant or other medication to optimize treatment response. The field of neurobiology is rapidly expanding. As Cozolino (2010) points out, linkages between clinical disorders and symptomatic behaviors and changes in the relative metabolism of different areas of the brain are already being uncovered (p. 345). In addition, consider-able evidence is accruing that supports the assumption “that reregulation of neural networks parallels some of the symptomatic changes we witness in psychotherapy” (Cozolino, 2010, p. 346). In the future, assessment and diagnoses aided by neural network activity could well improve the accuracy of assessment and conceptualization with clients. The Role of Human Development From infancy to old age, clients experience both change and constancy throughout the lifespan. Human develop-ment is lifelong, multidimensional and multidirectional, Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
180 Chapter 6 of a good enough parent are similar to those provided by a good therapist. These include: 1. Being in tune with the child, experiencing the child as separate from the adult, accepting and labeling feel-ings, and not trying to shape the child into something she or he is not. 2. Being able to meet one's own needs as an adult, not expecting a reciprocal relationship with the child, and not looking to the child to meet one's adult needs. 3. Being able to adapt to the developing child's chang-ing needs—particularly in the areas of dependence and autonomy. The adult does not feel threatened or rejected by the child's increasing sense of separateness and autonomy. 4. Being able to provide optimum levels of frustra-tion that are tolerable and challenging rather than overwhelming and traumatic to support the child's capacity for increased independence and self-soothing (p. 316). These characteristics of healthy parenting styles and healthy developmental environments form the basis of childhood attachment styles, that is, whether the child, and subsequently the child maturing into adulthood, is securely attached or whether the child (and later adult) exhibits anxious or disorganized attachment (Ainsworth, 1982; Main & Solomon, 1990). Although we now know that these attachments are demonstrated in a wide variety of cultures, there also are cultural differences in attachment that are impacted by the environments in which the child-caretaker inter-actions and relationship occur (Gardiner & Kosmitzki, 2011). This underscores the fact that human development issues in general vary across cultures, and what may be considered normative human development in one culture is not necessarily the same in another culture. Although developmental transitions may vary in differing cultural environments, “the reality of continuous transitions is present in all cultural contexts” (Seabury, Seabury, & Garvin, 2011, p. 252). Furthermore, some individuals may find themselves in developmental, and specifically role, transitions that, in their cultural context, are stigma-tized—for example, a formerly middle-class individual who has lost his job now finds himself standing in line for food bank supplies. As Seabury, Seabury, and Garvin (2011) note, the stigmatization of this developmental role transition compounds the natural stress arising from the transition itself. Also, some developmental environments are more priv-ileged than others. Theokas and Lerner (2006) describe what they call “optimal contexts of development” (p. 62). In optimal contexts of development, clients have access to opportunities and resources and, as a result, may ex-perience better mental and physical health than clients who are impacted by less privileged or less than optimal contexts of development. The role of development provides information in the assessment process about both predisposing and protec-tive factors that have contributed to presenting issues. Predisposing factors describe elements that make one client more likely to respond in a particular way to a life circumstance. Protective factors such as client strengths often have prevented the presenting issue from becoming worse or more intense. As Kuyken, Padesky, and Dudley (2009, p. 40) note, “protective factors interact with pre-disposing factors in complex ways to affect vulnerability and resilience. ” A final way in which development plays a role in the assessment of client concerns is the consideration that there are certain risk factors, cultural issues, and system variables that are associated with the later development of mental health disorders. Jones (2010) lists a number of known child and adolescent risk factors associated with the subsequent development of mental health disorders in adulthood. These areas to assess include the following: Behavior problems in childhood Poor school performance (including failed grades)Childhood diagnosis of attention deficit/hyperactivity disorder (ADHD) Childhood depression Child abuse T rauma and/or losses during childhood. (p. 223) The Role of Social Context and Culture: Ecological/Person in Environment Client problems usually do not occur in a vacuum but are related to observable events (verbal, nonverbal, and mo-toric responses) and to less visible covert or indirect events (thoughts, images, moods and feelings, body sensations) that precipitate and maintain the problem. Simply put, in assessing a client's story it is crucial to note how the client's behavior affects the environment and vice versa—how the environment impacts the client's behavior. This functional relationship of the individual and the environ-ment reflects an ecological view; it was articulated as early as 1979 and again in 2005 by Bronfenbrenner, as well as by Walsh, Craik, and Price (2000). In an ecological view, the individual client and his or her environment are linked together, so assessment includes not only an individual focus but also a contextual focus, including key Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Assessing and Conceptualizing Client Problems and Contexts 181 social settings, events, and resources. Practitioners need to examine the social and cultural contexts of relationships among these key social settings, events, and resources. Whereas the ecological context of issues is important to consider for all clients, the sociopolitical context sur-rounding the client is especially important for clients who feel marginalized, such as clients of color and clients from minority and oppressed groups. This ecological systems theory, articulated by Bron-frenbrenner (1979; 2005) and now characterized as bioecological (Bronfenbrenner & Evans, 2000), delin-eates the varying kinds of systems that appear in and impact client lives. There are four systems or levels within Bronfenbrenner's approach; each level has an effect on human development. Changes in one level also impact the other levels as well. The first level, the microsystem, the innermost level, consists of activities and interaction patterns in the person's immediate surroundings. Struc-tures within the microsystem include family, school, work, neighborhood, or child-care environments. More recently, Bronfenbrenner and Evans (2000) also included the bio-logical context as a contributing factor in development. The second level, the mesosystem, comprises two or more microsystems; this level focuses on the interrelationships or connections between the microsystems. With a child client, examples of the mesosystem might be the involve-ment of the parents and the home in the child's academic progress at school. For an adult client, an example of a me-sosystem could be the interaction between the adult's role in the home environment as a spouse and the adult's role as a teacher in the school or work environment. The third layer, the exosystem, is defined as the larger social system that impacts the person more indirectly than directly. This may include formal organizations, extended family, and community services. The fourth layer, the macrosystem, the outermost layer, is not considered a specific context but rather an overarching system comprising customs, cultural values, laws, and resources considered important in the individual's culture. An example of this would be the way an adolescent client's culture views education. All four of these levels within an environment exert influence on the development of the individual. Assessing for Contextual and Relational Dimensions of the Problem In our model of assessment, we refer to environmental and cultural variables that affect client issues as contextual and relational dimensions associated with the problem. It is important to assess the impact of these dimensions because “the reason for the client's problems may lie in the context rather than with the client” (Summers, 2012, p. 75). The larger social context also may have affected the client's presenting concerns For example, one client may have experienced loss of employment, disenfranchisement in voting, a poor health care system, and a barely adequate school system. Another client may have experienced a boom in the stock market, preferential political treatment, a first-rate health care system, and a private school (Sum-mers, 2012). In assessing for contextual and relational dimensions of the client's issues, we look for areas of environmen-tal supports and stressors, risks, and protective factors, including places, settings, events, and people who are sources of empowerment and disempowerment (Ungar, 2011). For example, one might ask about the strengths and assets and the weaknesses and barriers of the client's environment, and about the extent and availability of family and community resources. If the client is an immi-grant or refugee, then one might ask how his or her status has been affected by the move. Are there ways to maximize the client's strengths within the environmental context? We cannot overemphasize the importance of assessing the contribution of these environmental variables to identi-fied issues. This sort of assessment helps determine, for example, whether an issue may stem from racism and prejudice in other persons so that clients or helpers do not inappropriately personalize their concerns. Another aspect of assessing the context includes a cultural analysis of client issues. Assessing for cultural data directly from clients is an ethical responsibility of helpers. And, further, if it is necessary to ask clients to clarify cultural data for your own understanding, then it is important to do so in a way that doesn't burden the client. A model to conduct a thorough and culturally sensitive assessment has been developed by White Kress, Eriksen, Rayle, and Ford (2005). In this model, the following areas are explored by the clinician with the client: ● ●Assessment of the client's worldview—that is, how the client sees the world and through what perspectives and lenses. ● ●Assessment of the client's cultural identity—that is, how the client makes sense of himself or herself cultur-ally and what the client's understanding is (as well as your own understanding) of his or her own level or stage of cultural identity awareness. ● ●Assessment of the client's level of acculturation—that is, how the client identifies with both former and cur-rent cultures and how the client moves through these cultures with resources and/or barriers. ● ●Assessment of the cultural meaning of the client's is-sues and presenting symptoms—that is, what the presenting problem means to the client and how the Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
182 Chapter 6 client views it, and what cultural context surrounds the client's concerns. ● ●Assessment of sources of cultural information avail-able to the client—that is, what information the client reports about areas of his or her life related to both cultural history and current culture. ● ●Assessment of any stigmas associated with the client's concern—that is, what the cultural meaning of the concern is to the client and to his or her cultural com-munity, how the client views seeking help for such con-cerns, and what the client's experiences are with stigma, prejudice, and discrimination. Some literature also describes the ecological view as a person-in-environment approach. Moscript (2011) de-fines the person-in-environment approach as a “ho-listic, interactional model that stresses the impact of both environment and biology on an individual's social and psychological processes” (p. 47). The person-in-environment approach is a central feature of the growing edge of practice today (Neufeld et al., 2006). In the fol-lowing section, we describe an assessment tool based on the ecological/person-in-environment model called the PIE (Person-In-Environment) Classification System. The Person-in-Environment (PIE) Classification System The person-in-environment (PIE) classification system, developed by Karls and Wandrei (1994), is an assessment/ classification system that helps practitioners understand the interrelationships between individual clients and the system or environment in which clients reside. The PIE is a tool that practitioners use to collect relevant assessment information about the client and the client's environment for the express purpose of facilitating the planning of successful treatment interventions. The updated edition of the PIE (Karls & O'Keefe, 2008) also includes a strengths assessment. Overall, the PIE is used in a variety of practice settings and with a vari-ety of theoretical orientations to assess the social functioning problems and strengths experienced by adult clients. The PIE assesses these four factors for adult clients (Karls & O'Keefe, 2008): Factor I: Social Functioning Problems and Strengths Factor II: Environmental Problems and Strengths Factor III: Mental Health Problems and Strengths Factor IV: Physical Health Problems and Strengths Factors I and II constitute the bulk of the PIE clas-sification. Factor I comprises identification of social role problems and identification of the type of interactional difficulty with social role. Factor II comprises identifica-tion of type of environmental problem area. (See Table 6. 1 for a listing of the dimensions assessed by Factors I and II. ) Factor III borrows from the DSM-IV by using Axes I and II of the DSM-IV, and Factor IV lists physical health prob-lems using the International Classification of Diseases and is the equivalent of Axis III of the DSM-IV. In addition, for all four factors there are four additional assessment indices: severity, duration, coping, and strengths. Several considerations are worth noting when contem-plating the use of the PIE classification system. One is that this system avoids classifying social roles in a culturally specific context. As a result, Factor I in particular is some-what limited in clarifying some problems faced by certain culturally diverse groups of people (Appleby, Colon, & Hamilton, 2011). However, Factor II does consider cultur-ally relevant dimensions of environmental problems by assessing the discrimination status of each. Second, the judgments involved in the classification and coding are based on the practitioner's perception rather than the cli-ent's perceptions. Third, the delineation of the types of problems is based on the person presenting for treatment—that is, the identified client—and not on other persons who may be contributing to the client's difficulties. Finally, the current PIE manual is not consistent with the latest diag-nostic manual of clinical disorders, the DSM-5, which we present later in this chapter. The PIE is used around the globe and has been translated into a number of languages. We illustrate the use of the PIE in our model case of Isabella near the end of this chapter. To fully learn how to apply the PIE system with clients, you would need to consult the conceptual book (Karls & Wandrei, 1994) and the manual (Karls & O'Keefe, 2008). The manual contains both non-copyrighted, reproducible printed worksheets for PIE anal-ysis that practitioners can complete following an assessment interview and also a CD called the Compu PIE©, which is a copyrighted software program for recording assessments based on the PIE system. When assessment is conducted at the levels of both the individual client and the client's environment, practitio-ners obtain a more balanced and comprehensive story or picture about what is going on in terms of the present-ing issues and concerns. The person-in-environment ap-proach is based on the following two notions: 1. Client concerns do not reside solely within an individ-ual but are embedded within cultural, environmental, developmental, and social systems or contexts. 2. There is a movement to incorporate a focus on strengths, resources, and coping skills of clients into the assessment and treatment process. This movement is also known as a strengths perspective (Saleebey, 2012), which is affiliated with the positive psychology movement (Seligman & Csikszentmihalyi, 2000). Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Assessing and Conceptualizing Client Problems and Contexts 183 These two assumptions are consistent with current and emerging policy guides on psychology, social work, coun-seling, and human services curricula as well as multicul-tural competencies. The Role of Strengths Clients and also their communities and environments can be assessed and conceptualized with a strengths-based model (Jones-Smith, 2014; Snyder, Lopez, & Pedrotti, 2014). Saleebey (2013) discusses a number of features of strength-based assessment. Among these features are: 1. Listening for hints and harbingers of strength, resilience, and rebound in the client's narrative of problems; naming and inquiring about the client's areas of competence and resourcefulness; and utilizing a vocabulary of strengths-based talk in the assessment process. 2. Assessing both natural and formal resources that may be available to the client and exploring to what extent they are adequate and acceptable to the client. As Ungar (2011) asserts, “people need resources, provided in ways that are meaningful to them, that are relevant to the context in which they live and the culture with which they identify themselves” (p. 44). In research that Un-gar and his colleagues conducted internationally, they identified seven common categories of resources related specifically to well-being. These include: a. Access to material resources b. Relationships c. Identity d. Power and control e. Cultural adherence Table 6. 1 Summary of Factor I and Factor II of the PIe Classification System Factor I: Social Role Problem Identification Type of Problem Family roles (parent, spouse, child, sibling, other family member, significant other)Interpersonal roles (lover, friend, neighbor, member, other)Occupational roles (worker-paid economy, worker-home, worker-volunteer, student, other)Special life situation roles (consumer, caretaker, inpatient/client, outpatient/client, probationer/parolee/prisoner, immigrant-legal, immigrant-undocumented, immigrant-refugee, other) Type of Interactional Difficulty Power, ambivalence, responsibility, dependency, loss, isolation, oppression, mixed, undetermined, other Level of Severity: 1 to 5 scale 1 = low, 2 = moderate, 3 = high, 4 = very high, 5 = catastrophic Duration Index: 1 to 5 scale 1 = more than 5 years, 2 = 1 to 5 years, 3 = 6 months to 1 year, 4 = 1 to 6 months, 5 = 1 week to 1 month Coping Index: 1 to 6 scale 1 = outstanding, 2 = above average, 3 = adequate, 4 = somewhat inadequate, 5 = inadequate, and 6 = unable to judge at this time Strength Index: 1 to 2 scale1 = notable strengths, 2 = possible strengths Factor II: Environmental Problem Identification Type of Environmental Problem Area Economic/basic needs system, education and training system, judicial and legal system, health, safety, and social services system, voluntary association system, and affectional support system Discrimination codes for any of these types of environmental problems Coded by age, ethnicity, color, language, religion, gender, sexual orientation, lifestyle, noncitizen, veteran, dependency status, disability status, marital status, body size, political affiliation Severity, Duration, and Strengths Indices: Identical to Factor I. Source: Karls & O'Keefe (2008). Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
184 Chapter 6 f. Social justice g. Cohesion Levels of resources can be assessed for an individual client, for a family, and for a community and cultural group as well. Jones-Smith (2014) comments that a strength-based assessment is founded on the premise that most clients are not that aware of their strengths but are acutely aware of their deficits! If a client is hesitant to discuss or identify strengths, then the practitioner may introduce a strengths assessment checklist such as the Clifton Strengths Finder (Rath 2007), the VIA Signature Strengths Survey (Pe-terson & Seligman, 2004), or the Behavioral and Emo-tional Rating Scale (BERS-2) for children and teenagers (Epstein and Sharma, 1998). Anderson, Cowger, and Snively (2009) also discuss the process of assessing strengths. Their model is one that encourages practitioners to help clients identify acts of resistance to both violence and oppression as part of a strength-based assessment process. They contend that the current practice of assessing client “deficits” results in a number of issues, including generating obstacles to the “exercise of personal and social power,” reinforc-ing “social structures that generate and regulate the unequal power relationship,” fostering a “victimization model” of assessment, targeting the help seeker as the “problem” since “the context of oppression is stripped,” and reinforcing the status quo “in a manner that is in-congruent with the promotion of social and economic justice” (p. 182). Their model broadens the more tradi-tional definition of resiliency from competency despite enduring adversity to focusing on individuals' survival strengths that develop as a means to protect themselves from oppression. They suggest that to anchor a problem definition within a strengths perspective, “it is particularly impor-tant at the beginning of the assessment to acknowledge that the person seeking help is in charge of telling his or her story” so that the meaning of the client's nar-rative is not displaced by the practitioner's perspective (p. 189). A second step in their strengths-based model of assessment is to help the client uncover strengths and to make strengths more accessible to the client in some useful way. As Anderson and colleagues note, “since individuals often internalize shame and blame about their victimization experiences, providing a view of themselves as resourceful gives credit to their ability to persevere despite insurmountable odds. Consequently, they may view themselves differently, particularly their strengths, by recognizing how they actively responded to adversity in the past and may now channel their survival strategies into confronting present struggles” (p. 189). Finally, during the assessment process, these authors recommend that practitioners “merge an understanding of individual issues with an awareness of power relation-ships that are embedded in the larger social environ-ment” (p. 191). The evidence base surrounding the strengths-based model is promising but mixed. In part, this may be due to the lack of consistent definitions of the meaning and function of strengths-based constructs (Oko, 2006). Tay-lor (2006) notes that the strengths perspective should not be an “end in and of itself,” nor should it be used to argue against the neuroscience of mental illness. He advocates for the judicious use of strengths-oriented assessment and treatment in a differential manner. Saleebey (2013) argues that both quantitative and qualitative research shows that the strengths perspective has a degree of power that sup-ports its usefulness (p. 293). Although empirical data are still accumulating, there is some support to suggest that when used in helping, the strengths perspective consis-tently achieves a reduction in symptoms and improved social functioning of clients. The Role of Evidence In prior chapters, we have discussed evidence-based helping relationships and also evidence-based treatments (EBTs). Equally important is the degree to which the as-sessment instruments used in studies of evidence-based relationships and treatments are valid and reliable since practitioners rely on the accuracy of these measures for diagnostic and conceptualization purposes. In general, though, the literature base for evidence-based assess-ment (EBA) has lagged behind the literature base for EBTs. This gap between scientifically sound assessment data and empirically supported treatments has put the evidence-based practice movement in some jeopardy, because an inaccurate or incomplete assessment can lead to the inappropriate or ineffective use of an EBT (Hun-sley & Mash, 2010). Hunsley and Lee (2014) define evidence-based as-sessment as an approach that uses research and theory to guide 1. the selection of variables to be assessed for a specific assessment purpose 2. the methods and measure to be used in the assessment 3. the manner in which the assessment process unfolds (p. 159) Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
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