JoHo World Su Summary of the book Learning the art of helping (Young, 5th edition) mmaries (International)
Auteur(s): M.E. Young
Druk/Jaar van uitgave: 5th edition, 2013
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Helping others professionally is both an internal and external journey. Externally, one needs to gain new knowledge and continue learning. Internally, one must commit to understanding oneself and one’s clients. It is natural to doubt one’s own abilities and experience frustration. It is important to keep one’s own prejudices and biases in mind in order to overcome hurdles and to help others.
One method to address issues that pose as roadblocks to helping others is called reflective practitioner. Reflective practitioners commit to being aware of their own biased or prejudicial reactions through reflection, keeping a journal, and discussions with one’s peers. This method also applies to one’s role as a student in this course. Everyone benefits from different learning techniques as not all students learn in the same ways. The key is to process knowledge and ask questions rather than to only absorb what one hears or reads. Additionally, not all rules are applicable in every situation. This makes it especially necessary to reevaluate paradigms and tailor them to individual clients and their specific situation. Through reflection, one can accommodate and incorporate information rather than reject it prematurely. This skill may be of particular benefit in cases where one does not share anything in common with the client. This difference can be cultural, socioeconomic, in terms of education, religion, etc. Through reflection one can distinguish personal prejudices and remain more objective and less judgmental. Reflection is also useful when processing information from others such as supervisors, peers, and clients. While it may be a natural reaction to act defensive in the face of criticism, a reflective practitioner will learn from the situation rather than blame their mistakes on others or make excuses.
A reflective practitioner can be proactive in several ways. The first method is to ask for supervision. A helper can discuss their client’s problems and successes with a supervisor. In such a conversation, the helper and supervisor can discuss potential courses of action, personal reactions, and ethical concerns. Regardless of the amount of experience a helper has, all helpers benefit from supervision as the reflective process is always important. Another method is to participate in a support group of helping peers. Meet regularly. Share information. Even therapists in private practice participate in support groups. Another method is to become a client. Over half of therapists also enter therapy and 90% of them consider the therapy helpful. Receiving therapy is one way to experience the client’s perspective. Additionally, one can reflect within the context of this book by reviewing one's attitudes through peer discussions and journaling.
Perry's Stages of Cognitive Development
It is common to feel both excited and anxious when taking on new challenges. This apprehension is normal in developing as a helper. In this section we will discuss Perry's stages of cognitive development. Through understanding these stages a developing helper can feel confident that he or she is on the correct path. The first stage is the dualistic stage. In this stage the helper believes that there is only one way to respond to their clients: the right way and the wrong way. This form of thinking leads to a strong feeling of internal pressure and an emphasis on performance. The desire to be right can interfere with one's ability to listen to the client. Helpers in this stage often ask for direct feedback on if their performance was right. The second stage is the multiplistic stage. In this stage a helper realizes that there is more than one correct response depending on the situation and the client. A helper in this stage may even feel like there are too many potentially correct responses to a given scenario and have difficulty choosing the best response. Additionally, helpers in this stage may feel defensive when they are corrected by their supervisor as they do not yet understand that there is a response system. The third and last stage is the relativistic stage. In this stage the helper is more skilled at choosing the most appropriate response out of many potential responses. For example, the helper is better able to use the information at hand to initiate a response that steers the session in the most beneficial direction. In this stage the helper has enough experience and knowledge to be confident in his or her effectiveness.
Hoffman's Guild Terminology
Developing as a helper can also be described as the development of expertise and the mastering of a set of skills. A master counselor or a master therapist does not result only from the proper education but from being mentored, through training, and possessing a passion for helping others. Robert Hoffman studied how expertise is gained and used guild terminology to define seven stages. The first stage is naivette where the student has no knowledge on helping or counseling. The second stage is novice where the student is a new trainee who has not yet been accepted. The third stage is initiate where the student has been accepted and is beginning training. The fourth stage is apprentice where the student is an assistant and begins the introduction stage. The fifth stage is journeyman where the student can now work a full day without supervision. In the counseling field this stage generally lasts two to three years between a student's graduation and a student becoming licensed. The sixth stage is expert where the journeyman is viewed as exceptional by his or her peers and can handle especially difficult cases. In this stage the journeyman may have a specific field of expertise. The seventh and final stage is master. The master is one of few experts who can teach others as their practice has become examples for others to follow.
Thus it becomes clear that it takes time to become a master helper. Additionally, it is also clear that a most helpers need supervision. Thirdly, people begin training to become helpers with different levels of experience. Many helpers are already journeymen when they register for training. They may feel they are wasting time reviewing information they already know. However, reviewing information one thinks one knows can also be helpful in reevaluating one's positions.
In their development as helpers, students are asked to practice scenarios and perform in front of others. Students should be open to constructive criticism and feedback to make the most of these sessions. Avoid comparing your performance with that of others. It is key that students take control of their education and continue to practice skills they need to fine tune. Do not be too embarrassed to ask questions or to ask for clarification. The skills you learn are necessary to effectively help your clients. Another challenge is to find a mentor. Having a good example is one key way to learn skills. A mentor can also give valuable feedback. However, finding a suitable mentor able to devote time to working with you may prove challenging. Another challenge is thinking that you will find a perfect technique. In reality you will need to learn many skills and have a collection of techniques at your disposal depending on the situation and on your client. It also natural to feel like you are in limbo in the beginning stages of training as you incorporate the skills you learn with your natural helping style. Often helpers go through a stage where they feel that their approach seems artificial and unnatural. It is important to not lose personal warmth and a sense of being genuine as helpers. Another challenge is learning to accept feedback. Your reactions to feedback will vary depending on your stage of training. Strive to openly share your work with others to gain constructive feedback. If you are a member of a minority group, are female, are the first in your family to attend college or if you are going through a stressful life event, you may experience heightened challenges.
Helpers should abide by the Hippocratic guideline to first do no harm. In Latin this is primum non nocere. While this is the most basic challenge of those in the helping professions there are also other rules and regulations in the form of ethical guidelines. Some guidelines which should be adopted in your group training will now be discussed in further detail. The first ethical guideline is to not discuss what other group members say during the sessions. This helps encourage trust in the group. The second guideline is to avoid giving advice. Giving advice can slow client progress. Additionally, you may not be qualified to give advice. The third guideline is to not force your value system and beliefs on others. It is important to be sensitive to and respectful of differences. The fourth guideline is to only give feedback when asked. Your feedback should also be delivered in a sensitive way to be constructive and specific. The fifth guideline is to only use the techniques discussed in this book or suggested by your instructor. Using techniques you aren't familiar with could be harmful and have adverse effects. The sixth guideline is to tell a instructor right away if someone in the group is thinking about hurting themselves or others. Tell an authority figure regardless of if you think a violent act is likely to occur.
It is important to stress that a helper's development is a lifelong process. While there is not one specific set of qualities that all helpers have, Carl Rogers suggested three traits as essential to an effective helper. The first is congruence. Congruence is the ability to be sincere and reflect what you say in how you act. This helps to build a client's trust.
The second characteristic is positive regard. This means that while a helper may not approve of how a client behaves, he or she is still respectful. The third characteristic is empathy. Emotional empathy is the ability to understand how another person feels. Cognitive empathy is the ability to understand another person's values and motivations. Rather than judge or evaluate a client, a helper should strive to understand. Empathy encourages clients to resolve their own problems. In addition to the three characteristics described by Rogers, the helper must not rely on gaining the client's approval. The helper may need to anger the client and bring up sensitive topics. Other authors suggest additional characteristics as being beneficial to helpers. A helper should have a positive outlook, want to help others, and be accepting. A helper should have good self esteem and be mentally secure and healthy to aim for cooperation rather than control. Effective helpers tend to also be able to help themselves by dealing with stress and managing their time well. He or she is creative and of high intellect and is both curious and flexible as they may need to come up with innovative strategies. A helper also needs courage to listen to the pain of others and to take risks. Keep in mind that these mentioned characteristics can be developed through training and practice. Additionally, a person's skills can be beneficial to helping others when utilized properly.
Helping is a term that includes all the things one does to assist others. Helping does not rely on a professional setting or a contract. It only requires one person willing to help, another person in need of help, and an appropriate setting. Even people outside of the helping profession can benefit from learning helping skills.
Interviewing is defined as a conversation between someone giving an interview and someone answering the questions posed. In this conversation, the person giving the interview poses questions in order to gather information and record information. The interview is one form of assessment. The aim of an interview is to gather data rather than to improve the client's situation. Interviews can be structured or non-structured depending on if there are predetermined questions. An interview can also help the person giving the interview make a decision regarding the person being interviewed. For example, employers interview job applicants and counselors conduct intake interviews. If an interview tests the interviewee in a real life situation, it is a situational interview. One type of situational interview is a stress interview where the person being interviewed is intentionally subjected to a stressful situation to gauge their reaction under pressure. Helpers conduct interviews for several reasons. They may interview to determine if someone is suited to counseling, to determine someone's skill level, or to confirm a diagnosis. The interviewing process can aid a helper in steering counseling in the right direction.
Counseling and psychology are professional forms of contracted helping aimed at helping clients realize their goals. Counselors and psychologists are trained to use certain techniques during regularly scheduled sessions which generally last one hour. Currently, the words counseling and psychotherapy mean the same thing. Historically, psychotherapy was intended for patients with mental disorders. Mental disorders are severe cognitive, emotional, or behavioral disturbances. Counseling was geared towards so called normal people and counselors avoided medical terminology. Additionally counseling focused on the relationship between the counselor and client rather than specific procedures or techniques. Now, counselors also work with people with mental disorders and are comfortable using medical terminology like treatment and diagnosis. Therapists nowadays also work with clients having marital problems and other issues not related to a mental disorder. While some people still do differentiate between counseling and psychotherapy, this summary will use the two terms interchangeably.
Coaching is a new practice where helpers do not aim to provide therapy but to be supportive and to encourage. Coaching is not regulated by licensing boards but in many other ways overlaps with the roles of counselors. Coaching does tend to be more encouragement based and goal specific.
Helping is different from friendship because the contract between participating individuals is different. Friendship is mutual helping where both individuals give and receive help. Professional helpers on the other hand give help in exchange for compensation. The focus is on the client. Additionally, a helper may ask very personal questions (regarding a traumatic childhood for example) that a friend would not breach. In the beginning stages of training it may be difficult to draw a distinction, but it is important to not treat clients as friends and friends as clients. It is also beneficial for counselors to clearly define what a client can expect from the helper/client relationship so there are no misunderstandings.
It is common for beginning helpers to have unrealistic expectations regarding what can be achieved in the relationship with clients. On average, helpers have six to ten sessions with a client. Most clients do not expect long term relationships with helpers but rather seek out helpers for specific issues. Helpers should be realistic and not expect to solve all a client's problems or try to instigate more changes than the client wants.
Additionally a helper should not feel at fault for unmotivated clients. Almost one-third of clients are referred by courts, government agencies, etc. and participate not by choice. A helper can only offer an opportunity for change but the client must make the choice to change. Some clients do not want to change their behavior even if it is destructive. Other clients do want to change but need motivation or support. A helper should help a client visualize an alternate lifestyle and try to convince them that it is preferable to their current lifestyle. A helper can do this by stressing the negative effects of current choices such as alcohol abuse. A helper should also stress the positive results of making different choices such as sobriety.
Another unrealistic expectation is that caring about clients and having experience is enough. A helper must also learn skills and be well trained in continuing education. Additionally a helper may have the unrealistic view that if they are good at their jobs, the client will not need help in the future. In reality, a helper should feel successful if the client consults them again if they have a similar problem. A helper should not expect to be able to help every client as they may not be the best match. There can be several reasons for this. The helper may remind the client of a person they don't like or a client may prefer a helper from a similar background. Helpers should also accept that they will make mistakes. The key is to learn from the mistakes you make. Finally, there will be times where a helper feels incompetent or not knowledgable about a topic. This should be seen as motivation to keep learning. You can ask for help from a supervisor or refer the client to someone more knowledgable about the problem.
Microskills are small units of basic skills. While this makes learning basic skills easier in someways, it also creates problems as students are not able to see the larger picture. Microskills bring about mega skills which are common curative factors. Common curative factors are viewed as the basic healing principles to effective theories and techniques in counseling. Jerome Frank conducted research to show how these factors where effective. He described six therapeutic factors. Factor one is to maintain a strong relationship with the client. Factor two is to increase the client's motivation and expectations of receiving help. Factor three is to encourage the client to be self-efficient. Factor four is to give the client new learning experiences. Factor five is to make the client more aware of his or her emotions as well as express emotions more. Factor six is to provide the client with chances to practice their new skills.
Therapeutic building blocks are essential to the helping interview and ad the fundamental skills used to change behavior. Factors can be combined into more complicated techniques. In this book we refer specifically to twenty-one therapeutic building blocks which are divided into six categories. We will address the categories ion more detail in future chapters. Table one shows an overview. See figure 1.
The first category is invitational skills. These are the skills a helper uses to invite a client to participate in helper/client relationship. These skills can be verbal or nonverbal and invite the client to share their story. The second category is reflecting skills. This is the skill set a helper uses to communicate that they've heard the client's story. A helper can summarize in "snapshots" what the client has said. When a client feels they are being listened to and understood they are likely to disclose more. The third category is advanced reflecting skills. These skills go beyond reflecting and include reflecting meaning and summarizing. Rather than restating want the client has said, a helper gets closer to the root of the problem. For example losing a job is not simply a loss of income but may be viewed as a sign of failure. Using this skillset helps the client arrive at a deeper understanding of his or her self. The fourth category is challenging skills. These skills are used to draw attention to discrepancies in what a client says. They can be helpful in discovering a client's strengths and weaknesses. Challenging a client can cause stress to the therapeutic relationship but also help the client realize that the relationship differs from a friendship. This skill set includes giving feedback and confrontation. The fifth category is goal-setting skills. These skills focus the discussion on what the client identifies as key issues. Theses skills include focusing on the client and boiling down the problem. The sixth category of skills is change techniques. These techniques are used to help a client reach the goals they've set. These skills include giving advice, giving information, using alternative techniques, and brainstorming. The helper helps the client think about new possibilities as well as develop a course of action. Through practicing and repeating these building block skills, they become second nature and can be combined into complex and sophisticated techniques.
The Helping Process
The helping process typically occurs in five sequential steps: relationship building, assessment, goal setting, intervention and action, and evaluation and reflection. To progress to the subsequent stage, both the helper and client must contribute something. For example, in the relationship building stage the helper builds trust in nonverbal ways and the client discloses. The helper uses invitational skills to show understanding and to provide a safe environment where the client is comfortable sharing personal information.This therapeutic relationship is the foundation of the helping process.
In the assessment stage the helper collects information while the client gives information. This second stage cannot be readily separated from the first stage as helpers are always observing their clients. In later sessions, the helper will continue to collect information, but most of the data is disclosed in the first few sessions. Some agencies require a diagnosis be made in the first session and ask clients to fill out an intake form to gather psychological history. The pitfall of this approach is that a client may not feel a connection with a helper if the conversation is focused on completely the form. The client may choose to not return for another session. Additionally, an assessment tends to be more complete when a trust relationship already exists. Gathering client history is also beneficial in determining if the service being offered is suitable to the client's situation.
In the goal setting stage the helper and client work together to shape goals. This book's position is that goals should result from a collaboration between helper and client. The attainment of goals do not necessary need to be measured by behavior, but it is helpful to have an observable outcome so it is clear when a goal has been achieved.
In the intervention stage the helper uses his or her training to suggest techniques to help the client achieve goals. The client contributes by doing homework and practicing skills. In this stage, a helper uses more advanced skills to push clients to take action. The necessity of a trust relationship is evident in this stage as a client will only listen to a helper if that trust exists.
In the evaluation and reflection stage the helper asks the client to reflect on any progress. The helper and client determine if the helping relationship should be continued. Helpers can ask clients to evaluate how they are progressing towards their goals. Clients can do this verbally, in writing, or with the use of self-report tests.
One challenge that helpers face is whether they should emphasize the relationship with the client or emphasize the techniques. There are now many standardized treatments for certain problems like anxiety, depression, or sexual abuse. These treatments are described in manuals. However, some people believe that too much focus is placed on helping techniques rather than the relationship between the helper and the client. Some research strongly suggests that the therapeutic relationship is essential. Lambert's study found that the helping relationship was accountable for the client's success twice as much as using techniques effectively. A strong working relationship is important to change behavior. Additionally, the achievement of goals is more likely in a good therapeutic relationship. The quality of the relationship is a bigger indicator of success than the helper's theoretical approach. The therapeutic relationship is also important since clients who do not like their helpers, or do not believe them to be capable of helping them, may drop out of therapy after a few sessions. It is necessary that the helper to be accepting and warm so that the client will be confident in the helper's abilities. The six common therapeutic factors discussed in chapter two all rely on a strong therapeutic relationship to be effective.
Characteristics of the Helping Relationship
Professional helping involves a client asking for help and a trained helper willing to assist. Professional helping is a specific therapeutic relationship. It is important to stress again that helping is different from befriending. We'll now discuss seven characteristics of the helping relationship. The first is that a mutual respect, or even mutual liking should exist. The helper should respect a client's autonomy just as a client should trust the helper’s knowledge and experience. While a client may still gain benefits without this component, any successes will be likely due to other curative factors. Second, the aim of the relationship is to resolve the client's problem. Thus the relationship is geared towards the client's interests and the focus is never on the helper's problems. Third, a sense of teamwork should exist. The helper and client work together to help the client achieve success. The helper should provide strength and encouragement. Fourth, a contract should be used to define what aspects of the sessions will be privileged information. This helps to clarify and build trust. Fifth, the client and helper agree on compensation. While some helpers are volunteers, most are paid for their services and this should be agreed upon in advance. Sixth, there is a defined boundary between helping sessions and personal lives. Generally, helpers schedule sessions with clients and have a procedure for emergencies. Helpers should not interact with clients in their personal time so that they may remain objective. The seventh and last characteristic that we'll discuss is that the therapeutic relationship is a contractual relationship and can be terminated by either client or helper. The relationship may end for several reasons: the client may achieve his or her goal, the client is making no progress, the agency may regulate the number of sessions, or the health insurance may only cover a limited number of sessions. Additionally, a helper may refer the client to a different helper who is more specifically able to help with certain issues that may arise.
The client's perspective on the therapeutic relationship is essential to his or her success in achieving goals. Bedi, Davis, and Williams conducted surveys in 2005 regarding the events that helped clients establish a strong relationship with their helpers. The clients mentioned several elements. The helper taught them techniques such as creating a list of their goals. The helper had good body language and made strong eye contact. The helper was a good listener. The helper shared if he or she had a similar experience. The helper encouraged the client by noticing their strengths. The helper respected the client as the decision maker. The helper used humor and was honest. The helper was recommended by others. Another study conducted by Lilliengren and Werbart in 2005 found that clients found labeling and sharing feelings, the relationship as being a nonjudgemental space, gaining self-awareness, answering questions, and discovering new ways to relate to others as the most helpful experiences.
Methods to Create a Therapeutic Relationship
Begin by reflecting on your natural abilities and what tends to attract people to ask you for help. Here are some suggestions for new behaviors to practice as well as behaviors to avoid when building a therapeutic relationship. Kanfer and Goldstein found that helping relationships are improved through certain relationship enhancers. Relationship enhancers lead to an environment conducive to emotional components of liking, trust, and respect. Trust results in relationship consequences where the client can share freely. In this way relationship enhancers pave the way for a trusting therapeutic relationship. Examples of relationship enhancers include non verbal communication in the form of physical closeness, posture, and warmth. These will be discussed in greater detail in the following chapter. For now, let's focus on two other relationship enhancers: empathy and disclosure.
Empathy is the ability to put yourself in another person's situation and understand their feelings, the facts, and the importance of their story. Sharing empathy also means that you can communicate your perceptions accurately to that person. Much has been written on empathy and its benefits to society. Daniel Goldman conducted a study which found that the ability to empathize is an important predictor of success, mental health, and happy relationships. Within the helper/client context, empathy includes the experiences of both parties. The helper must be able to communicate his or her understanding of the client's experience. Empathy also helps in relating to people from different backgrounds. Through empathy, we take a tutorial stance of learning rather than an authoritarian position. The tutorial stance of learning from clients helps us think beyond our own perspective and be tolerant of alternate perspectives. When a client senses that a helper empathizes they are less defensive as they understand that the help is not trying to convert the client to his or her perspective. While it is never truly possible to understand someone else's situation, it is important that the client recognizes the helper's effort.
It should be clarified that empathy in helping is not the same as supporting a client's decisions or agreeing with them. Many helpers may be reluctant to empathize because they think they will be taking sides. However, the helper can communicate that he or she understands the client's circumstances without supporting how the client chooses to deal with the circumstances. Additionally, empathy is not pretending to understand as it is ineffective if it is not sincere. In the beginning, a helper should try to be patient and invest time in listening carefully to the client before claiming to understand. Empathy is also not making the client's problems your own. Of course one may be affected by the pain of others, but it is necessary to separate it from your personal life and not be overwhelmed. Empathy is also different from sympathy. Sympathy means pity for someone and suggests that person is inferior to you. It is important to maintain a relationship without hierarchy. Finally, empathy is important throughout the therapeutic relationship and especially essential in the beginning relationship building stage.
Another key relationship enhancer is self-disclosure. However, it must be used with caution and must be appropriate. Some suggest that beginning helpers avoid self-disclosure entirely. When used properly, self-disclosure is associated with positive client outcomes and increased trust. Additionally, it makes the helper more attractive, and leads to more disclosure from the client. Moderate self-disclosure is preferable to mildly personal or highly personal disclosures. Self-disclosing statements are not the same as self-involving statements. The former relates facts about oneself while the latter relates thoughts and feelings. While research tends to encourage self-involving statements, self-disclosing statements are not as widely encouraged. This is likely due to their success being dependent on the client's response and preference. Every client is different regarding what they deem to be too much personal information from the helper which may cause the helper to appear unprofessional. It is important that the client does not feel sessions are too focused on the helper. Additionally, the helper should be sensitive. A client with low self-esteem may feel insecure hearing about the helper's successes. Too much self-disclosure can also threaten the helper's authority in the eyes of the client. A client may also become bored after hearing the same story several times. Helpers should avoid making self-disclosures that are too deep, timed poorly, or irrelevant to the client's situation. The aim of self-disclosure is to build a relationship, help the client feel less alone, help the client see a different perspective, or to help the client understand that his or her experience is normal. A helper must be aware when a client needs to focus on his or her issues rather than shift focus to someone else. It is a good idea to shift the focus back to the client after making a self-disclosure.
Other factors can also put stress on the helping relationship. The environment where sessions take place also has an effect. A helper's office should be comfortable, have good lighting, and be quiet. Soft lighting is preferable to bright fluorescent lights. The decor should be comfortable instead of cold and clinical. However, the office should not appear to be the helper's living room either. It should still be professional. Ideally, there should be no obstructions such as a desk between the helper and the client. The room should be properly insulated for sound to give the client privacy.
It should be stated that these are the ideal conditions. Many helpers give sessions via phone or Internet. Others who work for schools may not have their own office to meet with students. Still other helpers work in a cubicle setting without much privacy. In these cases, the helper will need to instigate creative solutions (a traveling kit with a clock and a box of tissues, for example).
Distractions such as outside noise can interfere with a session. A sign saying, "quiet please" or, "session in progress" should be placed on the outside of the door. A white noise machine or other sound canceling device may also be necessary. Others disruptions such as phone calls or knocks on the door should be avoided so it is clear to clients that they are the top priority during the session.
A helper should appear credible to the client. This may seem challenging when a helper is in the beginning stages of his or her training. A helper can reassure him or herself by remembering and using the skills they do know. A helper should not exaggerate his or her experience nor diminish it. Do not tell the client of your fears of inadequacy. Do not try to maintain professionalism by creating emotional distance through being too formal. You will appear more credible if you appear organized, confident, and interested. Strive to communicate this through nonverbal ways such as body language.
Twelve Roadblocks to Communication
Thomas Gordon describes twelve therapeutic faux-pas. In French, faux-pas means false steps or wrong turns. They should not be viewed as mistakes, but rather as detours that can be corrected later. They are roadblocks to communication. Gordon felt that these twelve roadblocks suggest that the client cannot solve his or her own problems and needs someone else to do it for them. This disempowers the client and transfers their responsibility to the helper. The first is to order, direct, or command. Examples include language such as: "you must,” "you cannot," "stop it," "I expect you to." The second faux pas is to warn, admonish, or threaten. Examples include: "if you don't do this, then..." and "do this or else..." The third faux pas is to moralize, preach, or implore. Examples include: "it is your responsibility to do this," and "I wish you would do this." The fourth faux pas is to advise, give suggestions, or solutions. Examples include "let me suggest," and "it is in your best interest to..." as well as "the best solution is..." The fifth faux pas is to persuade through logic, lecturing, or arguing. Examples include: "the right thing to do is..." and "the facts suggest you should..." The sixth faux pas is to judge, criticize, disagree or blame. Examples include: "you aren't thinking clearly" and "you are wrong". The seventh faux pas is to praise, agree, or butter up. For example: "you usually have good judgement." "You have so much potential." The eighth faux pas is to call names, to ridicule, or to shame. For example: "you really messed up this time," "you are a sloppy worker," "you're thinking like a lawyer." The ninth faux pas is to interpret, analyze, or diagnose. For example: "you are jealous," "you are paranoid." "What you need is..." The tenth faux pas is to reassure, sympathize, console, or support. For example: "you'll see it differently tomorrow," "It's not so bad," or "don't over think it" the eleventh faux pas is to probe, question, or interrogate.
Examples include: "why did you do that?" "When did you realize you felt this way?" The twelfth faux pas is to distract, to divert, or to joke. For example: "look on the bright side..." and "that reminds me of..." or "Wait tell you hear what happened to..."
Wolberg found other responses as also disruptive. These include an exclamation of surprise such as, "oh no! That's terrible," being punitive, falsely reassuring the client, overusing psychological terminology (also known as psychobabble), or coming to premature interpretations before enough information has been gathered. Finally, probing traumatic issues when a client is clearly resistant can also be detrimental to communication.
Transference and Countertransference
As the therapeutic relationship grows stronger, openness, respect, trust and liking will also grow. These feelings are generally encouraged as they promote positive change and increases the client's involvement with treatment as well as increases the likelihood that they will follow the treatment. Other strong feelings may also develop. Psychoanalysts use the terms transference and countertransference to describe these feelings. Transference occurs when a client bonds with a helper and the client feels the same feelings of self-doubt, fear being abandoned, and feel other feelings left over from romantic or parental relationships. Countertransference occurs when the helper associates the client with a past or present relationship or feels strong feelings for the client. When strong feelings interfere and disrupt the therapeutic relationship, the helper should consult his or her supervisor to address the issues. Feelings can be positive or negative. Negative transference may be the reason some treatments fail. In other situations, transference does not disrupt the relationship and can even be reflected upon and examined in relationship to the client's other relationships. See figure 2.
If a helper experiences countertransference and it affects the therapeutic sessions, a supervisor should be consulted. Negative emotional reactions towards a client may cause the helper to behave differently and be less effective. Some clients may illicit a strong negative reaction such as anger from helpers. While a helper may be tempted to simply share their feelings with the client, this is ill-advised if the aim is to relieve the helper's own anxiety. Disclosures should only be made if they are to the benefit of the client. See figure 3.
The way a client reacts to a helper can be due to transference or it can be a reaction to the helper's behavior. Regardless of the reason, the helper should help the client be more aware of the feelings and explore the source of those feelings. Here are some steps if a client expresses anger. First, communicate that you accept what the client is saying and do not be defensive or retaliate. The second step is to explore the client's feelings. After expressing anger, a client may withdraw because he or she fears punishment and abandonment. Encourage the client to explore his or her anger and get to the source. The third step is to use self-involving statements to share your thoughts and feelings about the client and his or her behavior. The fourth step is to make use of the client's expression of anger and relate it to other interpersonal relationships. Only do this if you can avoid shaming, blaming, or embarrassing the client.
Some psychoanalysts like Freud believe that transference results from unresolved issues in previous relationships and must be dealt with to address underlying emotional issues with parents or siblings. An alternate view of transference describes it as a series of cognitive distortions due to a pattern of thinking. Both these viewpoints stress the client as being focused on external (the helper's characteristics) rather than internal issues (self-awareness).
Humans have a need to communicate and be understood. This can be seen in practices like keeping a journal, religious confession, prayer, and having confidants. The therapeutic relationship also can serve this function. James Pennebaker studied how people benefit from self-disclosure. He found that college students who regularly kept diaries had stronger immune systems and better health than those who did not. When a client visits a therapist he or she wants to explain themselves to a listener who will not judge them. This chapter focuses on the first set of skills known as invitational skills that a helper should utilize. Invitational skills are divided into nonverbal skills and opening skills. Nonverbal skills are also called body language. Nonverbal skills communicates information in addition to the words being said.
There are seven main ways to communicate nonverbally. Direct eye contact with some breaks for the comfort of the client is the first and most important nonverbal skill since it indicates listening. In western cultures, people who maintain strong eye contact are seen as more honest and reliable. Keep in mind that people of some cultures are offended by direct eye contact. If this is of concern, a helper can discuss the issue with the client. If a direct discussion does not seem appropriate, the helper can try to mirror the client's eye contact. Eye contact is more useful in some situations than others. When the client is addressing a difficult issue, strong direct eye contact may be uncomfortable.
The next important way to communicate nonverbally is through body position. The helper should face the client squarely and have an open body position (no crossed arms or legs). When the helper has an open body position the client will be more relaxed and open up more. The helper should maintain a relaxed but assertive posture. To communicate that you are listening, you should lean forward slightly.
Third, the helper should use silence well to let the client fill in gaps in conversation. It is a social norm to fill awkward silences. When used well, silences encourage a client to continue speaking. It also allows the client time to reflect. However, silence tends to be used by more experienced helpers because if it is used too often or too early, a client may feel unsupported.
Fourth, the tone of voice should be of the right volume and be warm and supportive. A client may be emotionally distraught and visit a therapist as a result. A helper who communicates empathy through his or her tone if voice can help stabilize the client.
Fifth, a helper should use facial expressions and gestures such as head nodding to encourage the client to talk. The basic facial expressions for feelings of sadness, joy, anger, fear, surprise, and disgust are the same regardless of culture. Of the 5000 other discernible facial expressions, some are culturally specific. A helper should pay attention to a client's facial expressions. If it does not match what the client is saying, it may be a sign of dishonesty or conflict.
Gestures also provide important clues. Someone who does not gesture at all appears aloof whereas moving a lot may be a sign of anxiety. A helper should use moderately reactive gestures. Another way to communicate nonverbally is thorough physical distance. What is considered an individual's bubble or personal space differs between cultures. For example Americans feel comfortable when there is a distance of 1 to 4 feet between them while Italians still feel comfortable even when they are only a few inches apart. In a western setting, 5 feet is ideal. Additionally, physical barriers such as desks should be removed for a less formal setting.
The last nonverbal way of communicating we will discuss is touching and warmth. Touch has a long history in helping. It can show caring and support. Some writers feel that not using touch can hinder therapy. Holroyd and Brodsky view touch as especially helpful when working with socially immature clients or with clients who are depressed or experiencing grief. They also suggest using touch to emphasize a point and during greeting or termination of a session. Goldman and Fordyce state that by touching another person, we increase our ability to influence them. It should be noted that while touch has healing properties, there are taboos that should be respected. Touch can led to sexual and transference reactions from a client. A client who has been sexually abused may also respond negatively to touch. Some writers suggest a helper should only use touch when he or she knows the client well. Additionally, in some situations it may be best to restrict touch to communicate encouragement or concern. Fisher, Rytting, and Heslin give three guidelines to determine when to use touch. First of all, it should be appropriate to the specific context. Secondly, touch should not force a level of intimacy on the client that he or she is not comfortable with. Third, touch should not be used to communicate a negative message. Due to the risks of using touch, beginning helpers are advised to not use touch, but to communicate warmth.
It is estimated that only 7 percent of emotion is communicated in words, while 38 percent is communicated by a person's voice and 55 percent by his or her face. The importance of body language can be seen in how important decisions still tend to be handled in person rather than via email. The art of persuasion also works best face to face. A helper also must persuade a client to open up. However it should be noted that body language can be ambiguous at times. For example, a person who folds their arms in front of them is not necessarily closed off to what the helper is saying. He or she may simply feel cold. There are also cultural differences in how people express and interpret body language.
The second category, opening skills, act to encourage conversation. They ask the client to open up without being too invasive. They also help show the client that the helper is listening and understanding his or her story. Opening skills can include encouraging statements and open and closed questions. When used together, these two categories of skills help encourage the client to open up and show the helper is listening. Encouragement is the words a helper uses to get a client to have the courage to confide. Encouragement can be divided into two categories: door openers and minimal encouragers.
Encouragement: Door Openers and Minimal Encouragers
A door opener is a non-coercive invitation to talk. It is used by the helper to shows openness to discussion. Judgmental or evaluative responses on the other hand are door closers. It is important that the helper use door openers which are positive and non judgmental. It can include observations the helper has made. For example, "You look down today, would you like to talk about it?" Other door openers include "What's on your mind?", "Can you tell me more about that?", and "Tell me about that." Door openers are used by helpers to encourage a client to expand or elaborate on their story, to begin a conversation, and to gain more time for the helper to consider a response.
Minimal encouragers are short statements that show the helper is listening to and understanding the client. They are not invasive and allow the client to dictate the direction of the conversation. Examples include: "I see." "I hear you." "Mm-hmm." etc. Of course minimal encouragers will not solve a client's problems but if they are not used a client may feel unsupported. The essential function of minimal encouragers is to signal that the helper is present. They should not interrupt the flow of the story.
The second opening skill we will discuss is questions. This is also the most easily abused opening skill. If a helper asks too many questions he may signal to the client that he is not listening. Additionally, a client may feel evaluated or like he or she is being interrogated. Questions may also change the course of a client's story or interrupt their train of thought. In a helping session, the client should be learning how to express him or herself rather than learning to answer questions. Examples of unhelpful questions include: "How are you doing?" "How have things been?" and "How do you feel about that?" Of course, a helper will need to ask questions to gather important information. A few guidelines can help a helper determine when questions are appropriate. Questions should be specific and relate to facts. They are useful when an essential part of the story is unclear or to encourage a client to open up.
Questions to Avoid: Why Questions and Leading Questions
Common questions to avoid include why questions and leading questions. When people ask why, they assume that the other person knows why and that knowing why will help the client to solve the problem. This encourages people to over rationalize when responding. In most instances, the answer to a why question is "It seemed like the a good idea at the time." Helpers may revert to asking questions when listening to an angry or silent client becomes difficult. The better approach is to use attentive silence and encouragers. Another type of question to avoid is the leading question. This question suggests that the helper has the answer and if the client follows the helper's line of thinking he or she will discover the answer. A leading question is often a way to give advice or argue. Leading questions are often used with children or adolescents. Research shows that leading questions tend to shut down conversations.
Closed and Open Questions
Other questions include closed questions and open questions. Closed questions ask for information that is factual. Some closed questions or yes or no questions. Another example of a closed questions is to ask someone their age. Closed questions are important for gathering factual information and prove especially useful in emergencies or in complicated stories. As with other questions, asking too many closed questions, like a person's address, may lead a client to feel the helping relationship is based upon answering questions. As a result, the client may take a passive role and wait for questions. In these moments it is important to emphasize the collaborative nature of the helping relationship.
Open questions do not ask for specific information but encourages the client to disclose. Open questions allow to client to express him or herself more and are viewed as more helpful. Examples include: "Can you tell me about the types of problems you've been having?" "You say you have low-self esteem, what do you mean?" The difference between closed and open questions are similar to the difference between multiple choice exams and essay exams. While multiple choice exams test an understanding of the facts, essay responses all the respondent to show a more in depth and nuanced understanding. Responses to open questions tend to give more information than responses to closed questions. A helper who wants to ask a closed question should try to change it into an open question when possible.
A helper should strive to listen actively. Some feel that the act of listening fully can in itself be healing. To listen actively, one must give the speaker his or her full attention and communicate understanding without interrupting the speaker. There are several challenges to active listening. The first is our urge to help and listener the clients pain. Friends may give quick advice due to an urge to help and instigate a change. However, in a professional situation, a helper should let a client fully tell their story. When a person tells their story, they are expressing how they view the world. A helper who listens actively can better tailor an intervention unique to the specific client. All clients tell their narrative differently. Some will delve into their story during the first session, others have to be encouraged bit by bit.
While the invitational skills described in the last chapter show that the helper is present and listening, they do not show that the helper understands what the client is saying. Reflecting skills are interventions a helper uses to encourage a deeper exploration of feelings, meanings, and facts that may coexist in the way a client presents his or her problems. A client's telling of his or her story has three key aspects. The first is the client's understanding of his or her thoughts and the facts. This occurs on a cognitive level. Second is the underlying feelings of client. This is the emotional level. Third is the hidden meanings, or the existential level. In order to understand the whole story, all three aspects must be explored. This chapter focuses on the first aspect, the cognitive level. In order to reflect facts and the client's thinking, a helper must learn the skill of paraphrasing. We begin with a skill of responding to facts and thoughts because people tend to be more comfortable beginning a conversation by discussing facts than emotions. The level of comfort in discussing feelings differs from culture to culture and between genders. In helping relationships facts and feelings are both important and later chapters will focus on reflecting feeling and reflecting meaning.
Reflecting means repeating what the client has said in a condensed way and using different words. The tone should be nonjudgemental. Reflecting has four purposes. First, through reflecting we show empathy in a verbal way. Not only does the helper hear the facts, he or she hears the deep meaning and tries to share the experience. Second, reflecting is way to mirror to the client what he or she is communicating and give him or her the opportunity to correct the impression given. A beginning helper should not worry that every reflection is perfectly accurate. Be aware that you a client can correct your word choice and clarify the meaning. Third, reflecting encourages to client to explore the experience further. The client may delve into more personal details and discuss deeper feelings. Fourth, reflecting brings to light hidden messages that may otherwise stay hidden. A client may be uncomfortable disclosing feelings of fear or worry at the beginning of the helping relationship. Through reflecting, a helper can bring these feelings to the forefront.
Rather than asking questions to clarify a part of a story, a helper use paraphrasing to determine if he or she understood. Paraphrasing is not a word for word repetition of what the client said. It is a condensed version using different words and stated in a nonjudgemental way. It should be short and to the point so as not to distract the client from telling the story. In paraphrasing, the helper makes the client aware of his or her perceptions of an experience. This is one way where the therapeutic relationship differs from a friendship. The therapist is not just providing support but asks the client to reflect on his or her own perceptions.
Two Steps of Paraphrasing
Paraphrasing occurs in two steps. The first step is to listen carefully. The second step is to condense and reword. To carry out the second step, the helper must find the most important information in what the client has said. If the helper focuses too much on a less crucial detail, the client may become sidetracked. The helper should strive to subtly highlight a key issue in the client's statements.
Paraphrasing can be used as soon as the helper has a grasp of the facts or wants to make the facts more clear. As the session continues, paraphrasing is helpful in reflecting aspects beyond the facts such as how the client's thoughts and perceptions. It should be used after opening skills and invitational skills. A common order is invitational skills, opening, skills, encouragers, open questions, then paraphrasing. It is not necessary, and may even be counterproductive, to paraphrase every statement. Let the client speak for a while before paraphrasing.
The specific subject of discussion is referred to as a topic. In the early stages of a helping relationship, a client may discuss many topics during an hour long session. The early sessions tend to be assessment oriented so this is to be expected. Later sessions will focus on certain subjects closely related to the client's key problems, exploring each topic fully before moving on to the next. While a beginning helper may want to rush through topics, one should strive to ask open questions and paraphrase to be certain the topic has been explored and understood. After understanding the surface issues, the helper should delve deeper using reflecting feelings. To understand a topic, it is helpful to follow the typical sequence of skills using encouragers, then open questions, then paraphrasing. Again, the paraphrase acts as a summary of the client's statement (not only of the facts but of the client's feelings in that situation. All clients have depth and layers. Following the suggested sequence beginning at opening skills, going on to invitational skills, to paraphrasing, to reflecting feelings, to reflecting meaning is advised because you begin with the least invasive actions. Each client is different and will respond in different degrees to each skill-set. While some clients may be quite open about their feelings others may find it challenging.
It can be helpful to consider a depth scale for paraphrasing. Accurately paraphrasing a client's statement is given a 0 on the scale. If the helper's paraphrase moves the client to a more superficial level where the topic is less important, it is assigned a -1. If the helper is able to grasp a deeper meaning the client implied but did not state directly, the paraphrase can be assigned a +1.
Common Pitfalls of Paraphrasing
One mistake when paraphrasing is to only restate the facts. It is important that the helper try to grasp the client's thoughts and perceptions. Another problem may arise if there are too many distractions. These can be distractions in the surrounding environment. Most of the time, these distractions are mental noise or the helper's own thoughts which interfere with his or her focus on what the client is saying. This may happen if the client says something that brings up personal memories or something that evokes an emotional reaction. If this happens, the helper should ask the client to repeat the part of the story that the helper did not follow. The helper should then paraphrase the client's statement. It is important to learn to manage internal noise. One way is to identify triggers early and write about them in a journal. Another issue may be worrying about how to respond. This becomes less of an issue with practice. It helps to focus intently on the client and keep in mind that you need only respond to the last thing the client said. This will be a more natural flow of conversation and you will explore topics in more depth rather than jump to something new. Another challenge is that beginners may feel inclined to side with the client and assume others are at fault. It is important that a helper not paraphrase a judgmental statement. The last common pitfall is when a helper is judgmental of the client. This may be due to the helper seeing a behavior that she or he feels should be corrected. The helper should try to respond in a nonjudgemental way.
Now we move on to reflecting feelings. In order to reflect the feelings of others, it is essential to have emotional intelligence. Emotional intelligence is the ability to monitor your own feelings and the feelings of others and to use that awareness for guidance. Reflecting the feelings of a client requires recognizing their feelings and reflecting them back verbally. Through reflecting a client's feelings, helpers communicate to the client the recognition that a client's problems affect the client. The techniques of reflecting feelings is basically the same as paraphrasing. From the client's perspective, when their feelings are reflected they become more aware of their emotional responses to their problems. For example, if the helper reflects to the client, "I can see that this makes you very angry," the client may then recognize that emotion, "yeah, I guess I am angry." The reflection should be given without judgement to show that feelings that the client may be unaware of or feel guilty about having are understood. The most important reason the reflect a client's feelings is to help the client reach a deeper level of self-disclosure by focusing them on being more aware of their feelings and verbalizing them. Techniques that can help clients self disclose help them to express their feelings which is in itself therapeutic. Reflecting feelings also deepens the helper client relationship. Trust is built when the client knows he or she can express feelings and not be judged. This technique originates from Carl Rogers who was very client centered. It is now widely used. Helpers who are skilled at reflecting feelings accurately can support and counsel a client even if they lack other skills. Lastly, a client feels relief after expressing feelings and hearing them reflected. Clients can experience an emotional roller coaster through the course of one session. Thorough reflecting feelings, these feels are labeled and untangled. For example, a helper who responds, “you feel betrayed, but still have a strong connection," can help a client understand the coexistence of opposing feelings. In this way, a client can gain a sense of control.
Steps in Reflecting Feelings
Similarly to paraphrasing, reflecting feelings also occurs in two steps. Step one is to recognize the client's feelings. Step two is to articulate the feelings that are not being directly expressed but can be detected in what the client says and how he or she says it. One way to approach step one is to imagine yourself as the client. With the facts you know, your knowledge of the client's history, and your understanding of the client's personality, try to become the client (not think how you would feel in the client's situation).
See figure 4. The table above is useful in categorizing feelings into basic emotions. The primary emotions of joy, sadness, anger, guilt or shame, fear, disgust, surprise, and interest can be identified by people from all cultural backgrounds. Other categories of feelings include feelings of strength, feelings of weakness, and feelings of distress. Feelings range in intensity form mild, to moderate, to strong. In addition to correctly identifying a client's feelings, it is important to be aware of to what degree the client is experiencing the feeling. Words like a little, some, and a lot, should be used. Also keep in mind the client's own vocabulary when choosing how to label a feeling. Don't use words the client may not understand.
In step two, the helper makes a statement to mirror how the client feels. This may require identifying feelings that the client has not clearly expressed. This step is challenging in that one must try to verbalize these feelings correctly. Identifying feelings and reflecting them may be skills that are learned separately. Once you practice identifying feelings it will be easier to reflect them and verbalize them. Generally speaking, there are two basic formulas for statements used to reflect feelings. One formula is "You feel _____." In the following example, consider how reflecting feelings affects the client and the helper client relationship.
Client: "You can imagine how I felt when he got married so soon after he divorced my mom."
Helper: "It must have been a shock."
The second, more complex formula connects feelings and content. "You feel _________ because _______." As in the previous formula, the first blank is the reflection of the client's feelings. The second blank gives a reason for the feeling through paraphrasing the content of the client's statements. As the client and helper continue the session in the example above, the second formula is used.
Client: "I was completely taken off guard. I thought they had the ideal relationship."
Helper: "You feel disappointed because he didn't live up to your image."
Not every reflection must include a paraphrase. Some helpers feel it sounds fake to say, "You feel ____ because______. This is the basic formula which can be changed to feel more natural.
Challenges to Reflecting Feelings
The ability to clearly reflect feelings is one of the most important skills a helper needs to have. However, it is a difficult skill to learn. The analyst, Theodore Reik, said that helpers must listen with the "third ear" to hear what was left unsaid by the client as the client may not even be aware of those feelings. Different cultures have different norms regarding the expression of feelings. Some cultures may view it as rude or a weakness to state feelings openly. When a client is reluctant to show feelings, the helper may find it a frustrating and challenging experience to reflect the client's feelings. It may take more time and effort. Additionally, gender also has an effect. Men may find it hard to express their feelings because they may have been raised to see the showing of feeling as a sign of weakness or lack of control. Women tend to be encouraged to express their feelings but may be expected to hide certain feelings like anger which are perceived as not feminine.
Through practice beginning helpers can hone their skills reflecting feelings. If you have trouble reflecting feelings or find that a whole practice session goes by without reflecting a feeling, discuss your challenges with other students and teachers and ask for feedback during the practice sessions.
We will now discuss a few of the common hurdles in reflecting feelings. One common problem is when the helper asks the client "How did you feel?" when the helper is unable to reflect feeling. This is a closed question and does not build empathy. The client may also be unable to label the exact feeling. It is better for the helper to use open questions and door openers to encourage the client to disclose more. As the client continues to talk, you may be able to reflect their feelings.
Another common problem is to wait too long to reflect. At the beginning of a session, the helper should use invitational skills to get the client to start talking. However, try to reflect feelings early on. A helper should avoid waiting ten to fifteen minutes before reflecting feelings. It is preferable to reflect feelings inaccurately rather than not at all. To speed up your reflecting skills, it is helpful to practice identifying feelings. One way to practice is to review the conversations in this summary and try to identify the client's feelings. Another way is to watch television shows such as soap operas and other dramas and practice reflecting the feelings of the characters.
Another common mistake when reflecting feelings is to frame your reflection as a question instead of a statement. When the feeling is reflected as a question, the client only has to agree or disagree with the reflection rather than disclose more and expand on his or her statements. When a helper uses a statement rather than a question, it shows more confidence and also communicates understanding better. Some statements may sound like questions if they are stated by raising your voice at the end of the sentence. Practice with your fellow students to be aware if you do this and try to correct it.
Do not combine a reflection and a question. This is called a compound response. Give the client time to respond to the reflection before asking the question. Clients tend to respond to the last thing that was said. When you immediately follow a reflection with a question, the client will only answer the question. If you tend to give compound responses, practice not asking questions and only reflecting feelings.
One key aim of reflecting feelings is to make a client more aware of his or her emotional responses. One common error is to focus on someone else. A client may spend much time talking about people in their lives and delve into tangential stories. When a helper reflects the client's feelings about people in their lives, it is important to focus the reflection on the client's feelings rather than the other person. Focusing on the other person leads to judgmental statements and may be unfair or inaccurate as you have not spoken with the other person and heard their story. For example, if a client says, "My best friend doesn't try to spend time with me. She always cancels our plans, sometimes it seems like she only makes plans out of a sense of obligation," it is preferable to respond, "You miss your friendship," rather than, "Your friend is neglecting you."
Avoid letting the client speak too long without responding. Beginner helpers may feel awkward interrupting a client. However, it is important to paraphrase and reflect so the client recognizes you understand. Very talkative or anxious clients may not pause for the helpers to interject. It is important to discuss key issues in detail and not only superficially. The solution to this problem is to interrupt the client when necessary and be aware that the client can benefit by a more structured conversation with paraphrasing and reflections. You can use phrases such as,"Let me stop you for a second to make sure I understand," or "Sorry to interrupt, but let me tell you what I'm hearing." Also keep in mind that both parties should participate to build a trusting helping relationship.
Another mistake is to use the word "feel" instead of the word "think." Both the helper and the client make this mistake. A helper should not accept a client is feeling an emotion because they state it as such. It is important for the helper to identify and reflect the feelings that the client does not explicitly state. A client may say, "I feel like I am finally getting somewhere." It would be a mistake for the helper to reflect, "You feel you are making progress." This is not a reflection of feeling but is an incorrect paraphrase. A helper may also misuse the word "feel" for the word "think." A helper may say, "You feel your parents should respect your privacy more." This is not a reflection of a feeling as a helper should say, "You think your parents should respect your privacy more." When the word "feel" can be replaced with the word "think" in a statement without changing the meaning, this is not a reflection of a feeling but an inaccurate paraphrase. To reflect feeling a helper may say, "You feel hurt and angry because you think your parents should respect your privacy."
Undershooting and overshooting should also be avoided. They deal with the intensity of the feelings the helper reflects. When a helper reflects a feeling that is more intense than what the client expresses, this is overshooting. When a helper reflects a feeling that is less intense than what the client expresses, this is undershooting. These mistakes are often corrected as the helper expands their feeling vocabulary.
When a helper has a limited feeling vocabulary, they may be more likely to make another mistake, parroting. Parroting occurs when the helper restates what the client says, possibly in a more concise way. Essentially, rather than reflecting a feeling, you paraphrase. Parroting may happen when the client states directly how they feel. A helper may be at a loss to reflect a new feeling. The goal should be to delve into underlying feelings that the client has not stated clearly. The helper can also consider if the client's labeling of the feeling is accurate. There may be another more specific feeling the client has not recognized.
The final common error we will discuss is not using concise reflecting statements. In the beginning, a helper may try to reflect everything the client says in hopes that they will be correct at least some of the time. It is advisable to focus your reflections on key topics or phrases.
In contrast to invitational skills and reflecting skills which are supportive, challenging skills are more confrontational and are a big step for helpers. Every person responds to a situation or event with more than one perspective and more than one feeling. A client may have several stories to tell on one event or issue. Consider a client who was abused as a child, he or she may describe their childhood as loving. The client is focusing on voicing one feeling. However, there are other voices that the client is aware of that tells a different story. A helper may need to give feedback and confront the client with discrepancies in their stories. In doing so, a helper may shatter fantasies that have protected the client. This shift may lead to resentment or discomfort as other ways to view the story are discussed.
See figure 5. The figure above was adapted from research into managerial styles within different organizations and depicts the ratio of confrontation to support. Depending on the ratio, a helper may be viewed as critical, apathetic, helpful, or a friend. A helper should find a balance between being supportive and being challenging. This ratio affects how willing a client is to explore his or her thoughts, feelings, actions, and motivations. This ratio also influences the level of trust a client has for the helper and likelihood of the client discussing deep versus superficial topics. When a helper does not challenge the client, the client does not examine his or herself.
When a helper overly challenges a client, the client trusts the helper less. When trust is low, a client does not want to disclose or self examine. According to this figure, the worst situation for a helper client relationship is high confrontation and low support.
When To Use Challenging Skills
Once a helper begins to challenge the client, a shift occurs from relationship building to goals. This shift also makes it clear that the helping relationship is not a friendship. At the beginning of the helping relationship, the helper aims to encourage the client to disclose through use of the nonjudgemental listening cycle. As the helper goes through the cycle several times, certain discrepancies and gaps appear. A helper then uses challenging skills to help the client gain more self-awareness and function with a clear and unclouded self image. This allows the client to be empowered to reach goals through exploring his or her own thoughts, feelings, and actions.
Clients need to be challenged in several scenarios. One scenario is if the client has incorrect information about his or herself. For example, if a client thinks he or she is not intelligent when there is information which shows the contrary. Another scenario is when the client has irrational beliefs or ideas. A third scenario is when a client misreads the behavior of other people. For example, if a client acts on an assumption without first confirming the assumption. A statement that illustrates this is, "I could tell by his actions that he was not interested in me anymore." Another scenario is when a client blames someone else instead of looking at his or her own behavior. Additionally, a client should be challenged when there are inconsistencies between his or her thoughts, feelings, actions, and values. An example would be a client who speaks about the importance of honesty while hiding an affair from her husband. A client should also be challenged if they are not working in the direction of their goals. Helpers can use two basic skills to challenge the client. The first skill is to give your honest reaction in the form of feedback. The second skill is to use confrontation to draw attention to inconsistencies in the client's story.
Feedback and Confrontation
Feedback is essential to personal growth. It is important to be able to give feedback and to receive feedback. Studies show that individuals who can be more transparent with others have increased mental health. Often people seek help because they have problems in their interpersonal relationships. They may get confusing messages about themselves from others. Close friends and family are often reluctant to give honest feedback because they are worried about the negative affects for the relationship. The lack of willingness to give negative or critical feedback is called the "mum" effect. As a result, people often operate with an unclear idea of how we are viewed by others.
The Johari Window
See figure 6. The figure above is the Johari window. It shows that information about the self is a combination of what we perceive about ourselves and the feedback we get from others. The Johari window shows that thorough self-disclosure and feedback we learn about ourselves. The helping relationship seeks to lesson the unknown area. The window shows that self-disclosure shrinks the hidden area, and widens the public area. Individuals with a wider public area are able to disclose more, have better relationships, and can give the helper more information about his or her issues. The size of the window in relation to the three other windows will differ based on the client's personality and how open and transparent he or she is. Sometimes the public area can be too large. This can be seen in clients who talk too much about themselves and drive people away. Feedback shrinks the blindspot. Helping can also increase the unknown area by helping a client learn new things about him or herself. Techniques like using imagery, free association, and using creativity can help a client discover new things about themselves. The Johari window is useful when introducing clients to group therapy. The client can be asked to draw his or her own Johari window and label items in the public area and the hidden area. The client and helper can use the window to discuss what are appropriate disclosures. Additionally, the helper can discuss how giving and receiving feedback in a group setting can decrease blind spots.
Ways to Give Feedback
To give feedback means to give the client information on what you see, feel, or suspect about them. If the feedback is specific to the client and constructive it will help the client grow. Helpers give feedback for three main reasons. The first reason is to show the client how his or her behavior affects the helper. For example: "You say you want to be more confident, however I do not experience this when you do not make eye contact." The second reason a helper gives feedback is to evaluate how a client is progressing towards his or her goals. For example: "You have taken a big step in your fear of commitment by moving in with your boyfriend." The third reason to give feedback is to communicate to the client a helper's observations. For example: "I notice you never talk about your younger sister."
A client may reject feedback because it is too painful to see the truth, because the client thinks the feedback is not true, or because the feedback is too harsh. In his book PET: Parental Effectiveness Training, Thomas Gordon suggests using "I messages" to give feedback. Statements that begin with “I” show that the helper is expressing his or her take on the situation. This helps the client to feel less defensive. Several other suggestions on how to give feedback may be helpful as well. Try to not give feedback regarding a client's personality traits as it is difficult to change these traits and therefore easy for clients to reject the feedback. An example can be seen in the professional world of poor feedback if a boss says, "You procrastinate too much." Good feedback would be, "The second deadline has passed, and I do not have your report." Also, try to be nonjudgemental, concrete, and specific in the feedback you give. Poor feedback: "You are really annoying me." Good feedback: "I find it annoying when you talk so loudly while I'm reading." Ask permission before giving feedback. For example, "I've noticed something and would like to give you some feedback. Is that alright with you?" Additionally, some feedback may be especially difficult for the client to hear. These should be approached tentatively. For example, poor feedback: "During the last session you talked about feeling guilty for not spending enough time with your mother before she died. Now you don't seem to want to talk about it." Good feedback: "during our last conversation, I got the feeling that talking about your mother's death is very difficult for you. Maybe it is because you feel guilty, am I right?" Another good piece of advice is to give no more than one or two pieces of feedback at a time. When you give too much feedback at once, a client is likely to become defensive and not hear what you are saying. Also, remember to give positive feedback as well. It is good to point out a client's strengths as well. It helps a client to know what is working well and be reminded of the resources they have. The last piece of advice is to ask an open question to see how the client is responding to your feedback. For example, "I just gave you some feedback regarding_____, what is your reaction to what I said?"
Confrontation: Discrepancies and Cognitive Dissonance
Confrontation is a type of intervention that draws a client’s attention to a discrepancy (defined as an inconsistency or conflict in a client’s thoughts, feelings, or behavior). When confronted with a discrepancy in his or her beliefs, behaviors, words, or nonverbal messages, a client becomes aware of the discrepancy and hopefully will also become motivated to resolve the discrepancy. Discrepancies can be seen in all of a client’s problems. For example, a client who says he loves his job but constantly complains about it, or a highly intelligent client who feels inferior. According to some theorists such as Ivey and Simek-Downing, resolving discrepancies is the main goal of therapy. Therapists from Fritz Perls to Albert Ellis have used confrontation to varying degrees. Studies show that a consistently moderately confrontational style is more effective than a consistently highly confrontational style. Beginning helpers may be tempted to follow highly confrontational styles like that of Ellis. However, it is important to draw a client’s attention to an inconsistency without alienating the client. Confrontation should be used after skills like invitational skills and reflecting skills have been practiced. Research shows that more experienced helpers use confrontation more and speak less while still being able to provide support.
Cognitive dissonance theory posits that individuals are motivated to keep values, beliefs, and attitudes consistent. When an individual has some sort of inconsistency between their values, beliefs, actions, and thoughts, they experience tension and want to lessen the tension. As a result, the individual may say that the inconsistency doesn’t matter or even distort reality to reduce tension. This is a defense mechanism used by people to reduce dissonance and anxiety instead of move ahead by making choices through planning and thinking. While confrontation of a client’s discrepancies will cause tension, it will also make the client aware of the choices they have. Kiesler and Pallak researched studies on cognitive dissonance and discovered a connection between dissonance and physiological arousal. Ernst Beier refers to “beneficial uncertainty” which is a client becoming open to change or to a shift as he or she is made aware of two incompatibilities. While confrontation may be beneficial, a helper should keep in mind that the client does not find the experience enjoyable. If the helper is too confrontational, the client may reject the message as well as become less willing to trust the helper and disclose other feelings. For these reasons, helpers tend to use confrontation in small doses while giving the client a great deal of support.
Six Common Discrepancies
Keep in mind the following six common discrepancies. The first common discrepancy is between verbal and nonverbal messages.
Client: The situation is so awful it is almost funny (laughs). Sometimes he hates me, next he loves me.
Helper: Your laughing implies that this isn't serious, but I can tell but what you a saying that this is a painful situation for you. (Confrontation)
Another common discrepancy is between experiences and beliefs.
Client: I've been dating the same two guys these last two months. I do the best I can, though I'm not very good looking.
Helper: I hear you say you don't feel attractive but you tell me you date a lot. (Confrontation)
A third discrepancy is between how a client behaves and their values.
Client: My wife is the most important person to me, but I haven't been able to spend much time with her. If I want to get a promotion, I have to put in a lot of extra hours at work.
Helper: If I understand you right, you say that your relationship with your wife is important to you, but you've let your career get in the way. (Confrontation)
A fourth discrepancy is between how a client behaves and what the client says.
Client: I've been going to counseling for my alcoholism but it isn't helping. Whenever I see my old friends, we always end up at the bar.
Helper: I'm a bit confused. You say you want to stop drinking, yet you continue to see your old drinking buddies. (Confrontation)
A fifth discrepancy is between plans and experiences.
Client: Yes, my girlfriend and I have been arguing a lot lately, but I think if we go ahead and move in together then things will get better.
Helper: From what I've heard thus far, you and your girlfriend tend to fight more when you spend a lot of time together. How will living together and spending more time together help improve the relationship? (Confrontation)
The sixth discrepancy is between two verbal messages.
Client: I doesn't bother me that my wife makes a lot more money than I do. Though I do feel like she judges me for it. I've been thinking about switching careers.
Helper: So I hear you say that it doesn't bother you, but on the other hand you are affected enough to consider a big change like switching careers. (Confrontation)
Note that there are also ethical considerations when using confrontation. While ethical codes do not specifically address confrontation, codes do discuss using emotionally arousing techniques. For example, it is unethical to use a technique that you are not experienced in without supervision. Confrontation should be discussed with a supervisor before it is used. You should also be sensitive to a client's religious and cultural background before using a technique like confrontation. It is also unethical to use confrontation as a way to vent your own frustration. The client's needs should be considered before that of the helper.
Forms of Confrontation
Confrontation statements tend to follow the following forms.
Verbal versus nonverbal: you said _____ but your body language says_______.
Negative beliefs about self versus strengths: you believe _____ but you possess _______.
Values versus actions: you value _____ but you act ______.
Plans or beliefs versus experiences: you plan to do _____but your experiences tell you ____.
Verbal versus verbal: you said_____but you also say______.
It is helpful to keep in mind the statement, "On the one hand ________, yet on the other hand_______." Try not to overuse this statement but this formula is a good reminder for identifying discrepancies.
Four Steps in Confrontation
The first step in confrontation is to build a relationship prior to confronting. Trust can be built through using the nonjudgemental listening cycle. Take the time to listen to the client and fully understand the story before using confrontation techniques. It is important to time the confrontation well as it will put stress on a a relationship. Be sure that you have built enough of a rapport with the client to use confrontation techniques. The second step is to deliver the confrontation in the way the client will most likely accept it. A helper may need to ease into the confrontation to reduce the anxiety a client may feel when confronted. The third step is to observe how the client reacts to the confrontation. If you notice that the client does not accept the confrontation, you may need to repeat it in a different way. Step four is to follow up the confrontation in the form of further exploration, clarification, or another confrontation. The route will depend on how the client reacts to the confrontation.
Helpers can also help a client gain awareness of a discrepancy through other methods. These other methods include relationship immediacy, challenging irrational beliefs, and through using humor. Relationship immediacy is a technique whereby helpers give clients immediate feedback on how the client affects the helper. The helper comments on how he or she feels or what he or she thinks regarding what's taking place in the relationship. These statements should follow three key guidelines. The first guideline is that the statement should have the word "I" to make it clear that the statement is the helper's perspective. The second guideline is that the helper should talk about the client's behavior or the relationship in a nonjudgemental way. The third guideline is that the helper should communicate his or her thoughts or feelings without overloading the client. Refer to the following statement where each guideline is illustrated and labeled in parentheses. " (1) I notice that (2) when I make a suggestion, we seem to end up in a struggle until we drop the topic. (3) I am worried about this." It is useful to use the relationship immediacy technique because the relationship a client has with a helper may be indicative of other key relationships in the client's life.
Additionally, this technique involves a situation that is happening currently and is therefore more effective since it will be more powerful and memorable to the client. This technique asks the client to reflect on his or her relationship with the helper by processing the helper's feedback. This technique should be used when the relationship between the helper and client can be seen as a microcosm of other relationships the client has or if there is stress in the helping relationship that should be resolved. A helper should use this technique carefully and not use it as an excuse to vent his or her own frustration. A helper should consider if a statement he or she plans to make is for the helper's benefit or for the client's benefit. Again, the client's needs should take precedence over the helper's.
Another method to draw attention to a discrepancy is through challenging irrational beliefs. This involves making a client aware that a belief is irrational and teaching the client how to combat the irrational beliefs when they occur. While the helper draws attention to what beliefs are irrational, it is the client's role to confront the beliefs. This technique can also strain the helping relationship has beliefs are very personal and people may become defensive when their beliefs are questioned. See the following examples. The first example is shouldn't and musting: "I should have memorized the answers by now, I must get a perfect grade in the exam." A helper can respond with a more rational challenge, "Have you ever tried to say you would like to get a good grade rather than you must. I think using words like should and must lead to negative feelings if you don't achieve a perfect score." The second example is awfulizing. A client may say, "If it doesn't happen, it will be the end of the world, a tragedy. It will be awful." A helper can use a rational challenge, "Isn't it more accurate to say it will be a a letdown if it doesn't happen?" The next example is low frustration tolerance: "It's like I can't stand waiting, I must spend my paycheck right away even if I should save some of it." A helper can challenge, "It sounds to me like you are saying it is uncomfortable to wait, but is it really impossible?" Another example is rating and blaming: "It's their fault for not trying to help me apply to school." A helper can challenge, "I wonder about this responsibility you feel they had to help you apply to school when you never asked for their help." The fifth example is overgeneralizing or having an always or never attitude, "I tried going to the meeting, but it never helps, everyone just hangs out and smokes. The organization is useless." A helper may respond, "I'm not so sure that going to one meeting gives you enough of an experience to generalize. Did you really not get anything out of the meeting?"
Another method is to use humor. Humor in the form of exaggeration or storytelling can be a way to get around a client's defensiveness. A client may accept a funny story because humor is not typically viewed as mean or judgmental. But it is still important to have developed a relationship with the client so he or she does not interpret the humor as you making fun of them.
How to Evaluate A Client's Reaction To Confrontation
The first scale we'll discuss is the Helper Confrontation Scale (HCS). This three-point scale rates how effective a helper is in confronting the client. The lowest score is 1. At this level, the helper overlooks or does not recognize discrepancies or uses a style that is too harsh or negative. Helpers at this level also may deliver badly timed confrontations or confront too early in the relationship. At level 2, a helper recognizes and highlights inconsistencies. The timing of the confrontation is also correct. The style is appropriate. At level 3, a helper uses direct confrontation and will challenge a client to change his or her behavior while still protecting the client's self-esteem through being nonjudgemental and approaching the topic gently.
The second scale we will discuss is the Client Acceptance Scale (CAS). This is a training tool which helps beginning helpers evaluate how a client responds to confrontation. It is not used in normal practice but is helpful while a helper is learning confrontation techniques. This is also a three-point scale with ratings being given based on the extent to which the client recognizes the inconsistency highlighted. Level 1 of client acceptance occurs when a client denies the discrepancy. The client may try to change the topic, discredit the helper, look for support somewhere else, or falsely agree to the discrepancy. Level 2 of client acceptance occurs when the client accepts one aspect or one part of the discrepancy as being true but rejects another part of the confrontation. A helper should then focus on the areas of agreement and clarify the other aspects of disagreement to make sure the story is being understood. Level 3 occurs when the client fully accepts the confrontation, recognizes the discrepancy and agrees to resolve the discrepancy or attempt to change his or her behavior.
Another approach to confrontation is to encourage self-confrontation on the part of the client. In this way, the client directs the confrontation instead of the helper drawing attention to discrepancies. It is good for a client to develop the skill of self-confrontation since they will continue to benefit from it once the helping relationship ends. Motivational interviewing is a method to encourage self confrontation. In this method a helper asks the client a series of questions. The client experiences confrontation through being aware that they continue negative behavior patterns. While self-confrontation can be seen as a complex assessment and research tool, it can also be seen as a way for a client to conduct research on him or herself with the helper's support. A client can be asked to write down all the issues they think is a problem in their life. He or she can respond to questions like, "What are the things I really don't want to do?", "In what ways am I lying to myself?", "What are some possibilities in my life that I'm not aware of?", or "What conclusions am I coming to about my life that is not supported by evidence?" The helper can assist the client by guiding discussions and explorations of these topics. The helper and client collaborate to try to identify themes and discuss a plan to resolve discrepancies.
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