Skill Learning lab notes
Therapeutic Relationship
 First step of the client is to build the therapeutic relationship, and you also need to
maintain it.
 If you tried to do an intervention before you built the foundation of the therapeutic
relationship, it’s like building a house on sand.
 Regardless of your modality, therapeutic relationship offers 30% of the curative factors
in counselling office, that 30% of therapeutic relationship includes empathy, warmth,
and encouragement of risk taking.
Therapeutic Relationship: Inside of a trauma treatment context
 We always start with therapeutic relationship, safety and stabilization happens within
the context of the therapeutic relationship.
 When you outrun the relationship and run into interventions and stuff, without building
rapport (the relationship between the client and therapist), healing from trauma will not
happen
 When people have been traumatized, the part of their brain (the amygdala) is active,
the function of the amygdala is searching for threat (fight/flight)=> when client walks
into office, they are scanning their environment for threat (you don’t want the client to
perceive any sort of direct or indirect threats)
 If you pose a threat to client unintentionally (which might happen and its not the
psychotherapists’ faults, because your presence always represent something to
everyone), BUT there are aspects of the safety and stabilisation that you can work on by
working on your congruence and your unconditional positive regard.
 Setting the tone, taking a step down approach, and non anxious presence, micro
expression as they are related to trauma
 Robert Sapolsky (distress model): social support is the hugest impacting component to
wellness, it is also the hardest thing (we are in an era, where having true social support
and connected to this to someone is almost nonexistent=>social media presence makes
people mistaken it as true support that they have tons of friends and relationships)
 Relationship takes investment, time, repair, it takes a sense of vulnerability.
 Relational trauma: someone who was supposed to be closed to them and then turned
around and sexually abused them
 Phases of trauma treatment: make a relationship and then go to the next thing, it is not
linear, but it is fluid=> because the relationship is not just going to be established and
then we leave it, it must be maintained (constant maintaining)
 Safety and stabilization happens within an established and well maintained relationship.
Integrating client’s strengths into the session
 Assessment and utilization of client strengths and resources in treatment (strength
based approach/perspective)
 Strength base vs prescribed medical model approach
Good treatment planning
 Comprehensive: thinking about a client in a really holistic way, thinking about all the
different elements of their life.
 Evidence Based: Our ethics challenge us to do this, to lean into the professional
literature (it has limitation and there is more that we don’t know than we do know), we
have professional responsibility to be considering evidence based practices in the work
that we do.
 Individualized: (there is not a one size fits all model), we can lean on the literature on
evidence based research, but we need to tailor interventions and what we do to our
individual clients.
 Relational/humanistic: develop a good alliance, having a good relationship with our
client and being in an agreement of what and how you are going to address the problem
=> nothing will work if your clients feel like they can’t trust you or if they perceive that
you don’t care about them
 Contextually sensitive: Taking into account the things that are going on in the client’s life
that are impacting them (global and individual context (within their family and
community)
 Strength based: we do client disservice if we only focus on their problems, we also need
to focus on their strengths and resources and their capacity within themselves and
within their community.
I CAN START treatment planning model
I: individual counselor
C: contextual assessment
(what is going on around them: community, family, averse environment they experienced in
the past)
A: Assessment and diagnosis (thinking what assessment we need to, golden thread and then
the next step=> necessary level of care they need)
N:Necessay level of care (time and effort put into therapy)
S: Strength (what are their strength you can use)
T: Treatment approach (borderline and dialectic
A: Aim and objectives of treatment
R: research based intervention
T: Therapeutic support services (child with conduct disorder, they are at risk of being expelled,
pull in support serviced to help the child => pure mentoring=> thinking holistic about that)
What is the problem
 Problem saturated focus could be problematic: We are often bound by the medical
model, so we start asking questions like: “What is wrong with this person? What is
wrong with them? Whats wrong with you, we need to give you a diagnosis..
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Other than focusing and hone in on the clients’ issues and problems, their
symptomology, deficiencies or deficits, we miss out on clients’ resiliencies, fortitude,
strengths, resources and capabilities.
We need to work on seeing and hearing of these strengths, capabilities and resources.
Strength based philosophy and treatment goals
 Strength base approach is different from medical model, it focuses on identifying
strengths within and around an individual
 Helps the clients identifying their strengths, when clients come to us they are often
negative thinking (a cycle of negative thinking), about their lives and they are struggling,
they might not be able to find the good things in their lives.
 Enhancing and developing clients’ abilities to cope, tolerate and persevere.
 To foster their self esteem, self efficacies, and resilience, as to emphasizing that they are
broken
 Also to foster resiliency against future problem and challenges.
 Not by saying that “oh no, your life is great..blah blah” but you can emphasize their
strength and also validate the problems that they have, they got things that they are
dealing with.
Strength based work done:
 Invest equal time and energy in exploring a client’s assets and strength in addition to
their weaknesses, problems and deficits.
 Sessions can focus on any activities or engagements that enhance or highlight positive
subjective experiences and positive individual traits.
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Foster resiliency in their clients by intentionally enhancing individuals competencies
within the following areas: social competence, problem solving, autonomy and sense of
purpose.
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Clients usually come see us because they are in a crisis and they have problem, so its not
easy to do strength based work
Categories of client strength, capacities and resources
We need to identify clients’ strengths and pull into treatment plans
 We should first focus on client/individual’s strengths and resources, and then we extend
to their family and strengths of the family.
 If application, then we look at school resources for work with kids
 With all clients, we can focus on strengths of their community and resources that are
available to them as well.
Client Strengths and resources, we can look at a few things:
 Identity: self image, sense of purpose, confidence in one’s abilities, a sense of meaning,
spiritual or religious affiliations, cultural identity, individual roles that they play (teacher,
mother, friend, wife..)
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Interpersonal relationships: Do individuals have healthy and supportive relationships
with others (with their significant others, family members, friends, peers, co-workers
and other members in the community)
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Social skills: Does the person have appropriate relationship building skills, are they
friendly and easy to build a relationship with? Do they have good communication skills,
manners? Are they empathetic, good listeners? Are they sensitive to others people
feelings, able to manage conflicts and being willing to take responsibility for anything
that they may be at fault for, and easily forgiving others?
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Conflict management: Being able to forgive other people, being able to regulate your
own emotions when in situations like this
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Environmental resources: anything that surrounding the client that may be useful,
basic needs met? Safe shelter, food, water, transportation, healthcare, financial
support? If basic needs are not met, it is difficult to do deep psychological interventions
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Good character: Good integrity, bravery and standing up for their beliefs, advocating for
others, honesty, and their ability to use their strengths to help other people.
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Responsibility: Taking responsibilities for one’s actions, being able to have tasks
delegated to them and following through on those things, taking care of other people in
their lives, perhaps and themselves, having internal locus of control, being able to plan
for the future, having good decision making skills, having a sense of social responsibility.
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Optimistic outlook: being hopeful that someone can get better that things will get
better, having a positive outlook on situation and knowing that being able to look back
on past situations in which they’ve struggles, but develop resilience and enable to get
through those things.
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Connectedness with surrounding: Do they have a sense of belonging either with a peer
group, with their family, religious community or larger population in general,
volunteering activities that foster connectedness with others.
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Resistance to social pressure: maintaining one’s stance and in their beliefs and values
even it is something that is not popular with their peers or with others, and resist
pressure to engage in activities that may be delinquent and dangerous.
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Motivation: Individuals’ motivation to get better, and what motivates them (are they
motivated to get better? Themselves or for their family? Are they motivated in school
with different hobbies, opportunities to better themselves in different ways) In working
with substances treatment, we look at motivational interviewing, looking at people’s
motivations and enhancing those.
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Past accomplishment and achievement: when has that individual been able to
overcome things before? What are some of the accomplishment or things that they are
proud of? How were they able to use their strength to do so?
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Flexibility: looking at the ability to accept life’s uncertainties and being willing to make
changes based on different things that happen.
Family strength and resources
 Family relationships: does the client have supportive relationships with any individual In
the family, is the family functioning healthy and adaptive, is there healthy expression
between family members? Is there a level of respect between members? A sense of
belonging.
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Familial support and guidelines: encouragement and motivation, who to go for
supports, healthy communication
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Communication: someone they feel confide in and feel safe to discuss things with,
decision making.
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Bonding time: do they have bonding time, do they have tradition that bring family
together.
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Family involvement and interest: religious, homework, watching TV together, playing
games
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Modeling: Do they praise and acknowledge each other accomplishments? Is there
someone in the family that serves as a role model, who is adaptive and show
appropriate behaviors and positive traits.
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Traditions: Routine or events that tie the family together.
School based strength and resources
 Does the school have supportive staff? Teacher, staff who are supportive and interested
in the children? Are they trying to help them to succeed? Do they have communication
with other people=> safe and inclusive environment
 Communication Network: Do administrator communicate well with one another? Do
they communicate with other members of treatment team, manager or counsellor?
 Academic interest: Is the child interested in learning, are they active during class? Are
they challenged appropriately?
 Homework completion
 Rules and regulations
 Relationship to school
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Peer support (have friends and spends time with other friends who model positive
behaviors)
Community strength and resources
 Supportive organizations that provide help and resources (struggle financially, assisting
with clothing or foods)
 Neighborhood Support
 Religious community
 Cultural community => derived pride out of a shared cultural identity/experiences
 Co-workers=>a lot of time at our job, and people we are with.
 Support groups: groups that provide support for a specific group of people (12 steps
groups?)
 Programming and activities: summer camp, volunteer group, sport team and club
Words used to highlight strengths, capacities and resources
 Individual strengths, family strengths, cultural and community strengths, spirituality
strengths.
 When you ask clients: what strengths do you see in yourself?, they might have a difficult
time acknowledging their strengths
Examples of individual strength questions
When you ask for individual strength, it can provide a sense of resiliency and a sense of hope
for your clients
 clients might come in with a view that they might only have the opportunity to talk
about their struggles or deficits=> by exploring individual strength, you create a safe
space to explore the things that are going well, also strength and resources they might
have.
 It is important to validate and point out their successes and their progress, esp folks
who are experiencing depression (taking it step by step, slowly and provide a safe
space.
 Do you have any hobbies?
o this provides a lot of information they have done enjoyed in the past or
currently enjoying
o Ex: for a depressed individual, this question brings behavioural activation by
integrating their strength and hobbies.
o It provides a sense of excitement, sense of meaning (music, art, nature=>
provide a sense of purpose in life).
o It is important to validate and point out their successes, progress and esp those
with depression)
 Tell me something that you are proud of?
 With whom do you usually share problems?
 What are your best traits and abilities?
 Talk about your sense of humor
 In what ways have you coped with difficult emotions or experiences in the past? Or
how do you cope with difficult emotions/experiences in the past?
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Clients come in with already existing coping skills and already existing resources, its
important to explore that and point that out for your clients, and then build off of that.
Do people seek you out for help with tasks or problems?
How did you usually go about solving problems (physical, emotional, occupational)
Have you ever been supportive or encouraging to another person?
Talk about how you engage in self discipline
Talk about how you manage your emotions in stressful situations
What are your dreams for future?
How do you seek to find meaning and purpose in life?
Family of Origin strength questions
Our clients are greatly influenced by their families, both negatively and positively, so depending
on your work with client, if a child or a family session, exploring the strengths as a whole family
can provide a meaningful experience with enhancing positive interactions, communication and
a lot of times, children pick on strength and their family members, so exploring that can be
really important as well.
 Who in your family do you most admire?
o Depending on the situation or the case, this can provide different answers in
different directions.
o When a child have at least one positive relationship with an adult or family
member, this serves as a protective factor for positive mental health, especially
for children who have experienced abusive or difficult upbringing, exploring
those positive role model or family member in life can provide a sense of hope
and encourage that client to continue to utilize that person as a support and
keep enhancing that connection.
For people with low self-esteem, it might be difficult for them to come up with their own
individual strengths, but when they noticed and acknowledge the strength that they see in
another person ( a family member that they admire), they might realize that they can related to
that, and they have actually picked up some of the strength of their family members
 What was the role of parents/grandparents in your family?
 What role do other close family members play in your family?
 How frequently do you have contact with family?
 What kind of values were stressed in your family?
 Who are the special people in your life? What makes them special to you?
 What are some things you like about your family members?
 What are some strengths of your family?
 Have you ever collectively worked toward a goal as a family?
 How can your family members be helpful to you now?
 How has your family successfully dealt with a challenge together?
School/community/cultural strength questions
We are greatly influenced by our cultural, beliefs, the relationships that we have with people,
our community and context in which we live in.
Community care differs from self-care, and care comes from your community, comes from
meaningful relationships/connection with people. Those who belong to marginalized
populations => they can’t self care their way out of discrimination or oppression, thus
community strength and social justice becomes important.
 What is valued in your community?
 What resources have you used in the community?
o LGBTQ community=> this population comes with unique ranks and unique
challenges, a lot of time, its possible that client might feel isolated or abandoned
by their family members/feeling unaccepted=> provide a safe space, when you
instill support group or safe spaces for them to feel like they belong and to feel
supported and affirm their identity, can be helpful for their mental health.
o It’s our job as a counsellor to provide these resources, they might not realize the
resources that are in the community (provide organization, affirming support
groups, education..can be important)
 In what ways does your community support social justice? Work in oppression?
 How do you contribute to your community?
 What are some special or unique traits from your culture?
 What are some aspects of your culture that you value?
Spiritual strength questions
Spirituality serves as a predictive factor and protective factor for mental health.
o Ex: when someone close to our client has passed a way, religion or spirituality can
provide a sense of comfort
o Prayer, finding meaning in life, believe in higher power can provide a strength for client.
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What types of things do you consider of highest importance?
In what ways do you experience meaning in your life
What role does spirituality play for you? In what situations might you turn to your
spiritual beliefs?
 What kinds of things help you to feel that you are living your life to the fullest?
 In what ways does your spirituality provide comfort in times of suffering and sorrow?
 How can you spirituality or religion in helping you to achieve your goals?
 Do you have members of your religious community whom you can trust/depend on or
talk to in a time of need?
 How have members of your religious community helped you or others in the past?
Activities for use in clinical practice
Creative interventions: creativity will make it more memorable
Ask client to create a visual representation of the relationships in their lives, to help them
identify their strengths, resources within their environment/community to identify healthy and
supportive relationships to bring more attention on the positive aspects.
What is it like for you to see the support and resources you have?
Who can you lean on for support?
What other identified individuals or groups might you add to your current support network?
Are there any changes you would like to make to your support network?
How can you enhance your network to gain more support people and resources?
Counselling framework vs counselling theory
Counselling theory is a specific model of counselling that address the question of “How do I
help a client change?”
 Most theories involve the individualistic worldview when considering how to help a
client change and typically it does not take contextual or systemic factors into
consideration
 Theories are more focused on microlevel aspects of the change process
 Ex: person centered theory, existential theory, cognitive behavioral theory
Framework is a conceptual model that can be applied across theories, theories can be a part of
a framework in terms of thinking about clients and how they are behaving, and how to best
help them change.
 Culturally responsive and socially just counselling framework is not a theory, but a
conceptual model that can be used across theoretical orientations and it focuses on
culturally responsive and socially just application (being sensitive to cultural and social
issues that may be impacting our clients and their situation)
 Frame work are known as metatheoretical and transtheoretical in which you can use
different theory along with the larger framework.
 It is important when thinking about any of our clients that we consider their worldview
and their cultural experiences. This is where a framework model incorporate different
considerations such as ethnicity, gender, the country/area within which on live is
important.
Case conceptualization is the exploration of the nature and influences of presenting concerns
 Exploring client’s experiences of what they would like to change and provide a roadmap
for how to get there through interventions
 Developing an understanding of how they understand their experiences with HOW we
understand their experiences
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Best conceptualization should be done collaboratively with clients
How we think about our clients and how we conceptualize them and their situation will
determine how we work with them and how we approach them.
 It provides the foundation of your work with clients
 There are different conceptualization models, such as feminist, narrative, relational
cultural, most of which are culturally sensitive approach
Key components of case conceptualization
 Analyzing the contexts of clients’ lived experiences
 Understanding the etiology of clients’ concerns from micro, meso and macro level, the
relationship to their problem.
 Prioritizing client views of health and healing
 Should be done collaboratively with a client to map out counselling goals and potential
change processes
CRSJ case conceptualization
 Focus on biological, psychological and social issues, as well as different cultural issues.
 It takes into account how we can work with our client and conceptualize their situation,
taking into account all these different factors, such as their socioeconomic status,
oppression faced individually or collectivity depending on their ethnicity.
I can start model explore case conceptualization