•
01ces
INTERVIEWING AND COUNSELLING SKILLS
FOR CANADIANS
SEVENTH EDITION
BOB SHEBIB
This ]Xlge in1en1ionally left blank
This document was created using Kindle to PDF
github.com/pustaks/kindle-to-pdf
If you found it helpful, please consider uploading your
resources to Libgen or Z-Library
Seventh Canadian Edition
Choices
Interviewing and Counselling Skills for Canadians
Bob Sh ebib
Facull)' Emerit11s
Douglas College
@ Pearson
PC"arson Canad:a Inc.• 26 Prin« Andre\\· Place. North \'or\. Ontario ~1.3C 2H4.
CoP)-riarht O 2020. 201 i. 201+ Pe:auon Can:ad., Inc. All riarht,. rntt'\'ed.
Printed in the United S tate$ of America. Thi:1 public:ation i, pmttt.ted ~· cop)Tight, and permiuion ,00.UL:1 be obtained
from the publisher prior to any prohibited rq,mduttion. :1tor.15,e in :a rl'tric\'lll $)'.$1:l'm. o r tr.m,mi.ssion in any form o r by
:any mean~ d«tronk. m«h.:anic:d. photoco~·inar,. r«ordins, o r othc-no.·i:1e. For inform:ation rl'sardins pC"rmi.ssion~
rcque.$1: formit and the appwpriatt' conta~ pka$C' contact Pl"ar.ion Canada•, Rights and Pnmiuion:1 Oepartmt'nt b}·
vi:1itin1
pear.ion.com/eJC"n/contact-uJpc-rmiu-ionithtml.
•·w•··
Attrib ution, of th ird,pany contt:nt appe"ar on the appropriate'
pll,iC'
•·ithin the tt'xt.
PEARSON is an exdu,ive tndemar\. mo.-ned h,· Pt"arson Can:ad:a Inc .• or it, :afli.liate$ in Canada :andfor o thc-r countric,.
U nk" o thc-rwi,c- indicated hc-n-in. :any third p.:art)' tr.tdemarb th.:at may appear in this \\'OC'k ate' the- propc-rt)' of the-it
respective ovtnt'u :and any rd't'n-n«, to third p.:art)' tr.Ide.marks, lo10~ o r othc-r tr...:k dtl'$$ :an- for dc-mon:1tr.1ti\'C' oc
Je,criptive purpo$C':1 onJy. S uch rd't:n-n«:1 :an- not intt:ndW to imp ly any :1ponsorship. c-ndoc:IC'mt'nt. autho rCation . oc
promotion of PC"arson Can ad:a products ~· the mo.-nt"u of ,uch m.:arb. or :any n-latioruhip he'!t\Oo"N"n the ov.T'IC'r and
Pt"arson Can ad:a o r it, :afli.liatt'~ :author,, li«rutt,. or distrib uto rit
If you purch:a,cd this~ ouuidc- tht" United State, o r Can ad:a. you should be avr.are that it has bttn imponed
,,dthout the- a pprm·al of the p ubli:1hc-r or the :author.
ISBN 13: 9?S..0..ll-484248,6
20
Libr.uy :md Archive, C-1nad.:i Cat:alOJUinar in Public:ation
She-bib , Bob, author
Choice, : intt'r,•it'wins and coun,c-lli"i, s:kill:1 for Can.;tdian,
/Bob She-bib . - Se\'C'nth edition.
ISBN 9?S..0..ll-4842.fs..6 (,oftrn,·t'r)
1. Coun$C'linJ"'Textboob. 2. lntt'rYic-•·inJ"'T t'xtbook,.
3. Textbook,. I. Tide.
8F636.6 .S48 2019
158.3
@ Pearson
C201S..90364S.I
For my children and grandchildren.,
Ke•vin, Jodie, Eli, and Audrey.
iii
This ]Xlge in1en1ionally left blank
Chapter
Professional Identity: Ethics, Values, and Self.Awareness
Chapter 2 The Skills, Process, and Pitfalls of Counselling
33
Chapter 3 Relationship: The Foundation for Change
66
Chapter 4 Listening & Responding: The Basis for Understanding
95
Chapter 5 Asking Questions: The Search for Meaning
126
Chapter 6 Empathic Coonectioos
161
Chapter 7 Supporting Empowerment and Change
192
Chapter 8 Difficult Situations: Engaging with Hard. to-Reach Clients
235
Chapter 9 Mental Disorders and Substance Misuse
271
Chapter 10 Cultural Intelligence
310
Chapter 11 Neuroscience and Counselling
342
•
This ]Xlge in1en1ionally left blank
Preface xiii
Acknou-iedgme-nu
Trauma-lnfo1med Practice
xxiii
BRAIN BYTE Trauma
BRAIN BYTE Strqths·Based Counselling
Professional Identity: Ethics, Values, and
Self-Awareness 1
LEARNING OBJECTIVES
Relationship Issue!?
3
Dual Rebtionship!l 5
Pro(es!lional Bound2de!l
ConOdent iality 6
5
CONVERSATION l.l G~Hu mour
11
Ett.cs and Neuoscience
11
CONVERSATION 2.4 Resruiog and Supporting
15
The Compttent Counseuo,
16
18
18
2
De:Onition
Cart Roge,s and the Core Conditions
28
29
32
CONVERSATION 3.2 Genuineness
Counselling Contracts
68
69
33
Choices: The Need fo1 Versatlllty
36
Brie( Eneounter!l
3S
73
74
76
INTERVIEW 3.1 Conlractiog
3·3
36
79
Ena,aain¥ with Seniors
3S
73
73
Purpose o( Contraeth1¥
Relationship Contr2Cts
Antieip,:nory Contr3ets
Work Contr3ets I f
Counselling and the Brain
Music
68
Relationship and the Phases o( Counsellina
CONVERSATION 3.1 Uncondi!ional PosiM Regard
34
CONVERSATION 2.1 Cooosellingand Psychotherapy
em
67
71
Core Condit ions: ltnplieat.Ons for Counse1lors
Whal Is Couns.ellfna?
BRAIN
66
67
BRAIN BYTE Oxylocin
26
LEARNING OBJECTIVES
em
66
66
The Counselling Relatfonsblp
The Skills, Process, and Pitfalls
of Counselling 33
BRAIN
Relationship: The Foundation for Change
BRAIN BYTE The Brainoo Rela1ionship
The lmpor121l«' o( SeJ(,Aware1lt".$$ 20
lnere:asina Sel(,Aw:1reness 2 1
Who A1n I! How Do O ther!? See Me-! 22
Penonal Needs 23
Penonal and C uh ural V2lue!l 25
Sumtn2r)'
Exereises
Weblinb
62
20
20
Professional Survival
3
LEARNING OBJECTIVES
CONVERSATION 1.4 I'm Just a Be.gimer
Selt-Awa,eness
57
Sunun:l.r)' 64
Exerd.ses 64
Weblinks 65
13
CONVERSATION 1.2 Personal Feel~Ge'li'llheWa,;
CONVERSATION 1.3 Personal lrr.dvement 'Mlh Clents
SO
53
Client ¼riab1es 58
Counsellor V2riables 58
Common ?l.•Hstakes 59
11
Ob,eet ivity
50
COunselllng Ptualls.: Banlers to Success
Tn~so( EthicaJ 01lenunas 12
Reso1vina Ethkal Dile.nunas 12
em
The PrelimiMr)' Phase
46
The 8¢innin~ Phase 53
The Aetion Phase 56
The End in¥ Phase 57
8
11
BRAIN BYTE Ett.cal and Moral Oecisi:)n Maq
BRAIN
47
CONVERSATION 2.3 Should I Read the File?
8
Belie( in the Oiiflhy and Worth o( People
Client Sel(,Detenninaoon 9
Ethical Dilemmas
The Phases of Counselling
CONVERSATION 2.2 ~ ul Friends and Counsellors
ValuH fo, Profeulonal Practice
R~ts o( ChiJdren
41
Relationship,BuiJdu~ Skills 43
Explorin~ and Probi~ Skills 45
Ernpowerina Skills 46
Promotma Chaf1¥e Skills 2nd Str:ue.:ies
2
Soc:ial Work and Soda! Justice
40
40
Counselling Ski lls and S1ra1eglH
1
Professional Couns.ello,s In Canada
Ethics
38
39
81
Sustaining the Counselling Relatfonsblp
82
l mmed1ae)' 82
T r.u,slerenee and Countertr.u,slerenee
I NTERVIEW 3.2 Immediacy
84
vii
84
72
5 Asking Questions: The Search
for Meaning 126
BRAIN BYTE Transference 86
BRAIN BYTE Childhood Abuse and Intimate
Rela!ionships 87
CONVERSATIOH 3.3 Counsea:>r Self-Oisclosixe
Endln& the Couns.ellfn& Relationship
LEARNING OBJECTIVES
8·7
The Art of Aski n& Questions
88
89
Oe:alu,i with End1~
90
INTERVIEW 3.3 Emings. 9 1
Sum m::ary 9 2
E.xerdses 92
\Veblinh
94
BRAIN BYTE En:Ungs.
4
Essential Queitlon.s: Some Options
95
TI,e Power o( UsteninK
96
Listening Barriers
Questlonlnc Pitfalls
97
97
O,.,e~om inK Lis teninK BarrierS 98
BRAIN BYTE The Auci!ory A1atm System 98
BRAIN BYTE The Righi Ear Advan.iage 100
Anendlnc
102
Taflorlnc tile Interview 10 tile Client
103
Selective Attention
BRAIN BYTE Multitasq
Honverbal Communication
104
lOS
106
Meanina o( Nom~rbo.l Conununic:uion 107
CONVERSATIOH 4.1 Problems with Lis.1eningand
Responding 107
BRAIN BYTE Nonvetbal Processing: 109
\ \1o rkl'l,i with Nom,erba! Communie:u.On
110
Met~mmuniea11on
11 1
SIience
111
TI,e Person.31 ?l.•1eanlfl¥ o( SUen« 111
Sileo« in Counsellina 112
BRAIN BYTE Sienoe 112
Nom,erba! Q.es and Sllenee 116
Eneour.¢ina Sllenee 116
CONVERSATIOH 4.2 Leam~ to Oeal"1th Sienoe
Paraphra.sln&
117
Par.1phraSinK2nd Empoth)'
Summarizi ng
135
Le:.dina(Biased) Quest ions 135
E>:eessh,e Quest ionlfl¥ 136
CONVERSATIOH 5.1 Alternatives to ()Jestions 137
Multiple Q uestions 138
lrreLe\+::tnt 2nd Poorly Timed Quest ions 139
Wh)' Questions 140
BRAIN BYTE Listeni"€
Active Listeni ng
130
Quest ions for Establlshmi Purpose 13 1
Quest ions to Def'lne the Counsellifl¥
Rel::at ionship !JI
Quest ions for E.xpl<>rinK and
U nde-rstandinK 13 1
Quest ion!? for Problem Sol"ina
133
Quest ion!? for Ev2lu:.tini
134
BRAIN BYTE The Impact of Questions 135
95
Listening for Understandi ng
126
Quest ions Support Counsellina
Godil!i 126
T)•peso(Quesiions 127
BRAIN BYTE Memory 127
Listening & Responding: The Basis
for Understanding 95
LEARNING OBJECTIVES
126
119
119
CONVERSATIOH 4.3 Effective Paraph'asing 119
INTERVIEW 4.1 Listen~ Silence, and Summarizing
Skills 122
Sum m::ary 123
E.xerdses 12-1
\Veblinh
125
viii
Con1en1s
140
\\'he:!, Clients Do Kot AnS\\~r
Quest ions 140
Man:1.:mi the Ramblh,i lnter\+iew 1-12
lnt ervie"'ina Yo uth
143
BRAIN BYTE The Adolescent Brain 143
lnt ervie"''11'{t and Counselli1'{t Se:niorS 145
Senior Abuse 14 5
Coss.Cuh ural lnt(".fviewinK 1-17
Beyond tile Surface: lnterwlewlnc to,
Conereteneu
147
TI,e Keed lor Conereu•ness
147
BRAIN BYTE Neu-al Development and
Marginalzation 14 7
Str.u~ies for Aehie,•i1'{t Conereceness
Mald1'{t Cl,oiees 152
116
Interview Transitions
153
Natur2I T r2nsition!l 153
Str.u~ie Tr3n!lit ions 154
Control Tr2nsit ions 154
Phase T r2nsitions 155
CONVERSATIOH S.2 Note-Taq
156
Conneet (Linkh,K) T r2nsit ions 156
INTERVIEW 5.1 lnterviewing: Skills 156
Sum m3r)' 158
E.xerd.ses 158
\Veblinh
160
150
6
Empathic Connections
161
LEARNI NG OBJECTIVES
The Emotional Domain
BRAIN
em
De"eloph,i OtSerepcancy 201
"Rollina with Resistanee" 202
Support Sel(-E(t"te:1er 203
161
161
Stages ot Change
Emotional Memories
BRAIN BYTE Mi'ra Neurons
162
163
The Un¥U3~ o( Emotions 164
Individual D1((ere:nces and C ultu~I Context
Ambi\':lle:i,ee
A((..,
16S
Empathy
Cog·nltlve Behavioural Counselling
166
168
CONVERSATION 6.1 Increasing Empathic Vocabula,y
173
173
lnvita11on::'1 Empoth)'
B:ask Empothy
Helping Cllt11S Make Bellavlolnl Changes
IH
175
Jn(ern>d Emp,uhy
Four Gene,allzatlons about Empathy
178
The Problem•SolVlng Proces.s
179
Emp::athk Response Leads 181
Whr Achievin¥ Emp::athk Underu2ndu)¥ Is So
Oi(t"trult 181
Poor Substitutes for Empcuhy 182
INTERVIEW 6.1 Poor Substitutes for Empathy 183
Touah Emp:uhr 184
CONVERSATION 6.3 How Can I Be Empathic If I Have Nol Had
the Same Experience? 18S
INTERVIEW 6.2 Effecti-.<e Useof Empathy 186
Sumtiurr 187
Exereises I88
Weblinb 191
7
Supporting Empowerment and Change
LEARNI NG OBJECTIVES
192
192
192
Hoo• Counsellina Promotes Em?O">ennent
AntU)ppressiv~ Praettee 194
The S1rengU1.s Approach
194
196
BRAIN BYTE Stress and Crisis
Empowerment and Seniors
197
Emp::ath)'
201
225
Brief Counselling
228
Se.lected Brie( CounsellinK Techniques
Sumtiurr 233
Exerdses 2 33
Weblmb 23-1
8
LEARNI NG OBJECTIVES
235
235
Slans o( Resim1n« 236
UnderSC:ind10i and Respond10i to
Reslsc:inee 237
BRAIN BYTE Resis:iance 241
Reslruu,ce and Counsellor Sel(,Aw:ireness
CONVERSATION 8.1 Worq with "ll'l'YCbltary"
Clients 242
INTERVIEW 8.1 Oealing"'11h Resis:1ance 243
CONVERSATION 8.2 Sa.)ing No
199
228
Difficult Situations: Engaging with
Hard-to-Reach Clients 235
Confrontation: Proceed with Caution
Crisi s Intervention and
Empowerment 197
Motivati onal Interviewing (Ml)
193
220
St ep I: ldent i(r Alternath'i's 225
St ep 2: Choose :m Action Strate-a)' 225
St ep J : De"elop and Implement Pl.:ms 226
St ep 4: Ev:ilu::ue Outeon~ 227
CONVERSATION 7.3 l'\-e Tried Everything 228
Resistance
Empowerment: Mobilizi ng Suengtti.s for
Chante
219
Goal Sett ina 219
De"eloph,i Effecth~ God!! Stuemenu
INTERVIEW 7.2 Goal Setting 223
176
Pre-por.uor)' Emp:tth)' I 77
CONVERSATION 6.2 When Net 10 Use Empathy
203
207
HelpinK Clients Reeoani:e ThinkinK P::attenu 209
Unhelp(ul ThinkinK P::atterns 210
BRAIN BYTE The Emcdonal Brain 210
Per(ectionism 211
HelpinK Clients Jnere:3se Helpfol 11,inkh,K 212
Re(r3mll1i 214
BRAIN BYTE Mindfulness 21S
BRAIN BYTE Creating New Neu-al Patt,,.,ays 21S
BRAIN BYTE Cognitive Behavicual Counselling 217
INTERVIEW 7.1 Cognitive Behavicual Tech,..,.es 217
CONVERSATION 7.2 When BunonsarePushed 219
166
Emp::ath)' Oeflned 169
The lmpor121l«' o( Emp:lth)' 169
BRAINBYTE LocationofEmpathy 171
BRAIN BYTE Selective Empathy 171
Client Reactions t'O Empcuhy I i l
Types of Empathy
203
203
CONVERSATION 7.1 Worq with "t..aJY Clients
Risk T2kinK
244
245
Tn,es o( Conlront3tion 245
The Misuse o( Confront::nion 24-6
Principles for E((enh'i' Conlront3t ion
Contents
ix
H7
241
Argresslon and Vi olence
249
Risk Assessment for Violenee 251
Violenee and Mental Illness 253
BRAIN BYTE Head Trauma and Vdenoe 254
Violenee Risk Assessment: Ker Quest ions 254
Man:1.:u-1¥ An&r)' :and Potent ially Violent
Beha\+iOUr 255
BRAIN BYTE ~sion 255
BRAIN BYTE Fligl,t « F'€11t 2S6
TI,e Phases o( V1olenee 25 7
CA-i1kal lnddent Oebrie01'{t 263
INTERVIEW 8.2 Violent Incident Follow-up 264
CONVERSATIOH 8.3 HON to Handle an Assault 265
Counselling Angry and Violent Clients
266
Pre,'e11t.On 266
Assertiveness Trainin.: 266
Co.:nit h'e Beh:wiou rat Counsellu,i (Ther2p)')
An~r ?1-faM~'\"lnent 267
Substanee Misuse lnten'i":111.0ns 267
Psrthi.atrk lnu·n'ent ion 26 7
Reduet ion o( Streuors 267
Counsellifl¥ Vietims 267
BRAIN BYTE Children and Abuse 268
Surnm::ary 269
E.xerdses 269
\Veblinh 2i0
9
Mental Disorders and Substance Misuse
LEARNING OBJECTIVES
Mental Health In Canada
267
271
272
Wlthdr.tw31frorn Dru~ Detoxif'.e2tion 296
Substanee U se Disorders and the DSM 298
Bra.in Pbstkity 3nd Addtetion 298
SupportinK Recover)' from Addiction 199
x
Con1en1s
302
Warnin& Sl,ans a.nd Risk A!lse-ss-ment
Sutnm3r)' 307
E.xerd.ses 307
Weblinlcs 309
10 Cultural Intelligence
LEARNING OBJECTIVES
302
310
310
Cultural Intelligence and Diversi ty: Working wllh
Competence 310
3 12
The tanadlan C - CulttJre :.-.I Dl,.r>ly 312
313
BRAIN BYTE Cultural Neuroscience
CaMdia.n l nuni&r,nion 315
Problems F:ieed by Jn,ml,ir3nt'S ::and
Refu{ti'e!l 316
Sodopo.Jitieal R~bt ie!l 318
Key Elements of Cullural Understanding
271
295
Suicide Counselling
299
JOI
TI,e ltnporta.nee o( M ulttruhural lnvol,'ement
Mental He,ihh Asses!lment 272
TI,e 01;::1.:oosuc and Smistical Mani.di o( Mental
D1sorderS (DSM) 274
~fa,or Men1~I Oisorde-rs 277
CONVERSATIOH 9.1 Paranoia 281
BRAIN BYTE Neurotransmitters and Mental lloess 282
CONVERSATIOH 9.2 How to Respond 10 Hallucinations 283
BRAIN BYTE Depression 284
BRAIN BYTE Attentbn-OeficitJHyperaaivity Oisotder
CAOHO) 289
Ould ::and Youth Mental Health 289
BRAIN BYTE Adolesa!nl Marijuana Use 289
BRAIN BYTE Adolesa!nl Drug Use 291
Counsellifl¥ a.nd Workh,i with People W ho Ha,~
Mental D1sorderS 291
BRAIN BYTE Psychotropic Medication 293
CONVERSATIOH 9.3 When Clients Don't Take Their
Medcation 294
Substance Use DlsordeJS
BRAIN BYTE Pleasure Pathway
Co-oeturrin& Oisorde-rS
319
\\'orkJview 3 19
Personal Priorities. Values. and Belie(s 321
Identity: lndwklu::dism ,'erSUS Collectivism 32 1
BRAIN BYTE Culture and the Pleasure Centre 321
BRAIN BYTE Individualism and Collec!Msm 323
Verbal a.nd Emotion:111 Expressiveness 3H
CommunK"21tion St)1le 325
L311iu~e 325
Rel:1tionship E.xpea:1tions 326
Belie(s about How People Sho uld Aet 327
Time Onentation 317
Counselling Immigrants and Mulllcullural
Clients 328
BarnerS to C ultu~ll)' lntell.i~-e:in Practice 328
Cont rollu,i 1he- Tendency to Stereot)'Pf' 329
Respeet i1'{t Oiver!lity and lndwkll.dl
D1(lerences 330
L~minK from Oienu 330
Counsellif)¥ Senior!? 332
TI,e ltnporta.nee o( Counsellor
Sel(,Awareness 332
Indigenous Clients
3-3-3
lnd¢eoous Value!l 3nd World-.•iew!l 333
WorkinK with lnd1~nous People 335
Tradition31 H~bfl¥ Pr3ctkes 336
Splrft1tallty and Counselling
336
CONVERSATIOH 10.1 Praying 'Mlh Clients
Sutnm3r)'
E.xerd.ses
Weblinlcs
339
3.W
341
339
11 Neuroscience and Counselling
LEARNING OBJECTIVES
342
342
The Remarkable and M·ys1erlous Brain
BRAIN
em
The NorH.;op B<ain
344
BRAIN BYTE The Amazing: B<ain
344
Mirror Neurons 3H
Glial Cells 374
Rew:tr<I PathW3)' 374
342
B1aln Problems
Neuroscience: An Emerging Force In Counselling
CONVERSATION 11. 1 Mind and Stain
345
Why Neuroscience Is Important for Coun.sello,s
Neuroscience Endorses Counsellu,i
346
3-16
351
Br3in lnu¥U1i 35 1
BRAIN BYTE Types ol Oepces.sicn
353
Neuroplastl city: An Empowering Discovery
How to Stilnul.:ue Neuropbstkity
Structure of the Brain
353
354
355
BRAIN BYTE Sundowning 378
BRAIN BYTE Is it No-mal or Dementia? 379
CONVERSATION 11.3 CoullSeq People with
INTERVIEW 11. 1 Helping Clients Harness
NeuroJ:Mstay
3 56
Hemispheres
358
BRAIN BYTE Ri5,flt Braivl.eft Brain
Br3in Lobes
359
Br3in Lobes 2nd Counsellini
The Limbk S)·Stem
361
361
362
CONVERSATION 11.2 Male and Female Brains
BRAIN
em
Dementia 380
St roke 3SO
Tr.-unutie Br.I.in lnJUr )' (TB)) and Acquired Brain
Injuries (ABI) 382
Sumnurr 383
Exerdses 384
Weblmks 384
359
BRAIN BYTE While and Grey Matter 359
BRAIN BYTE Broca's and Wernidle's Areas
Psychopathic B<ains
363
364
365
The Endocrine System 365
BRAIN BYTE Endocrine System versus Nervous Sys'lem
Gl•=r,
Cr3nfaJ Nen't:S
Neuron,: Tile Brain' s Information System
Major Keurotransrnitters
370
375
Ment3I Oison:lerS 375
Meninttitis 375
Eneepha!itis 375
Br3in Tumours 376
A1nyotrophie fater.l! sclerosis (ALS o r Lou Ge.hriK'S
d1se::3se) 376
Cerebral pllsy 376
Epilepsr 376
Huntin~1.on'sdise:ase 376
M ultiple sclerosis (MS) 376
Parkinson's d1se::3se 377
Tourette srndrome 377
Dementi.:1 377
344
344
Six Key Forces in Counsellin&
Studying the Brain
BRAIN BYTE Endorphins 370
BRAIN BYTE Dopamine 371
366
36S
385
References 392
Tables. Figures. Contoe1StUions. huenrietvs,
and Brain B1res Index 408
.A.urhor Index 410
Subjecr Index 414
Contents
xi
This ]Xlge in1en1ionally left blank
"There is a crack in et,-erything,
rhar's how the light gets in"
uonmd Cohen (1968)
Cohen's iconic words arc a messa,;c of hope reminding us that hardship, setbacks., and
obstacles arc opportunities for growth, change, and learning. His poetic insight inspires
us to believe that we need not fear our imperfections because resilience and empowerment can grow from obstacles and hardships.
"Cracks" in Choices have enabled the evolution of seven editions and left me with
the inescapable conclusion chat it will forever remain a work in progress.. (n cu.h new
edition, user feedback, cmc.r,;ent research, and practice experience have helped me to
re-examine my beliefs., discard outmoded ideas, and replace them with fresh pc.rspectives.
The seventh edition of Choices maintains its basic format and its objective as an
introductory textbook for students in counselling training programs and a practice
reference for professionals in social work, criminology, nursing, child and youth care,
addictions, psychology as well as professionaJs and voluntec.rs in other professions
whose work involves interviewing and counselling. A continuing bcst.-scJler in Canada,
Choices combines theory, practice examples with sample interviews, and challenging
self-awareness c.xc.rcises in a comprehensive, yet readable format. Jt is aimed at professionals aspiring to gain a wide ran,;e of skills based on supported theory and evidencebased best practices. Although framed in the Canndian ethical and cultural context,
the content of the book is designed to appeal to a broad international audience of
professionaJs.
This book aims to contribute to the development of professional competence in
five
\\--U)'S:
t. lnmxlucing basic concepts and models to hcJp learners understand the theory and
philosophy of effective counselling intervention skills.
2. Providing rc3Jistic examples to illustrate concepts in action.
3. Offering challenging exercises that prom(){C skill development, conceptual understanding, and self-awareness.
4. Promoting the importance of a range of skill choices for interviewing. rather than
rules and recipes.
5. Presenting connections to relewm neuroscience research.
In the seventh edition of Choices., all chapters have been rewritten to improve clarity
and include current research, with updated references and wcblinks. This edition
continues my commitment to producing a readable and practical text. As muc.h as
possible, J have avoided the use of unnecessary jargon, and I have tried to be transparent and explicit regarding m'>' assumptions, a practice chat para.Jlels my approach
to counselling.
xrn
Signif,cant changes and enhancements to the seventh OOition include:
■
A new Chapter 11 exploring neuroscience and counselling
■
Significant new content in many chapters related to understanding and working
with seniors
■
Updated rderences and content in all chapters
■
New and/or updated success tips
■
New and/or revised conversations., BRAIN BYTES. and sample interviews induding the addition of a "reflections" section
■
New material on counsellor burnout, vicarious tTil.uma, and wcJlness
■
AdditionaJ content on substance misuse including drug withdraw·a.1, detox, and the
opioid crisis
■
Content related to understanding and working with paranoia
■
R«onfigurcd Chapter 10: Cultura.J Intelligence
THEORY AND PHILOSOPHY
Choice-5 promotes an eclectic approoch that encourai;es counsellors to draw techniques
and ideas from various theoretical models depending on the spccif,c needs of the diem
and situation, not the comfort level of the counsellor. Counselling is a complex blend
of skill, attitude, and creativity, with the work based on bcst.-practice tcdmiques that
a.re supported by research. Core skills can be learned and practi~. but they arc not
recipes. Based on individual diem need and context, high.-level professionals create,
adapt, and cusromi!c skills and strategics, thus a.voiding any "one-site-fits-a.JI" approach.
Among the modcJs that have hC11.vil-.• influenced this book's content are the following:
■
Person<cntred counseJling, pioneered by Carl Rogers
■
T rauma, informed practice
■
Cognitive behavioural therapy/counselling (CB1)
■
Motivational interviewing
■
Short-term and solution-focused counselling
■
Emergent insights from neuroscience
The term "cognitive reserve" describes the brain's capacity to creative],.• find Wtt)'S to
cope with life's chaJlenges. Socia.1 workers and other counsellors who have high level of
cognitive reserve om "switch gears" when one way of solving a. problem does not
work. Put simply, they have choices and they arc not disc.oura,;ed or defeated when one
approach to working with clients fails. They can vary their approach to meet the unique
needs of different diem~ cultures., and situations. Over a lifetime of a professional
career, through reflection, education and practice experience that builds on success and
learns from failure, they can grow their counscJling skills and cognitive reserve.
Every interview requires an intcJligent choice of skHls and stnnegies. To make
wise choices, counseJlors need to develop a wide range of practice skills based on sup.ported theory (science) and proven practice (cvidcncc.-bnsed best practice). When
counsellors have a rcpenoire of skills, they can make knowledgeable choices based on
the unique needs of clients and situations., rather than their own personal comfon
levels or established routines. In simplest terms, the more choices counsellors have,
the grcnter their ability to match their work to the needs and wants of their clients, and
the less their need to repeatedly use the same skill. Effective counsellors a.re wise
enough to know when to-and when not ttruse pa.rriculnr skills. Similarly, the goal of
)UV
Preface
counseJling is to help diems achieve ve.rsatility in their capacity to solve problems and
achieve goals.
Slcill and to::hnique can be impressive, but n1one thq•arc insufficient. Compassion, car•
ing, empathy, an ability to suspend judgment, objectivity, professionalism, sclfowarcncss,
and sufficient psychologicnJ health arc some of the personal qualities and commitments
that must operate in tandem with knowlo:Jge and skill. Counscllors need to be genuine,
maintain warm and caring rqprd for the.ir clients, and rccogni:e the inhe.rent worth of
people Kadushin (1990) discusses the impormnt mix of skill and feeling:
?I.fan)' midit s::1y th:u i( they h::.d to choose between (eelinK and technique they
would choose (ee1m~ as the more important pre-requisite. Perh::tps so. but i( one has
to make a choice between these qu2lif"teations. an injustke has 2lre::.dr been done 10
the client. It shouJd be p<,SSlble to offer the client an inter\'iev.'er who is both 3ttitu,
dinally oorreet and ttthnk3lly prot"teient. (p. xii)
Respect for Diversity and Culture
Diversity includes differences in such major va.riablcs as race, religion, 3ge, sex, se>.."Ual
oriem3tion, physical and mental ability, economic capacity, language, culrurc, vaJues.,
belief~ prcfc.renccs, and ways of think in a and behaving. The diversity of today's counselling cascloods requires th3t counscJlors develop a ranae of interviewing and counsellina skills. Competent counsellors arc able to vary their style dependina on the unique
culture and ,vorldviews of their clients.
Choices cmphasi:es culrural competence. Since everyone is unique, each with
his or her own mix of values and belief~ culture is a varinble for work with all clients. \Vhen working with clients from visible minorities and those who arc marginakcd by poverty or discrimination, counsellors must examine the sociopolitical
realities that frame the clients' circumstances. They also need to develop sufficient
sclf-aw3renes.s to escape or manage any tendency to be culrurc-bound-thc assumption that aJI clients share their values, perspectives, and ambitions or, worse still,
that client differences represent deficiencies. By sust3ining a multiculturaJ perspective that rccogni!es and prizes diversity, counsellors can avoid the pitfalls of ethnocentrism (the belief thu one's own views and culture are superior). Culturally
competent counsellors view cultur3J differences as opportunities to widen their
horizons and deepen their vers3tility. They remember to be humble enough to learn
from their clients.
Phases of Counselling
This book divides the counsellina rclntionship into four phases: prcliminnry, beainning, action, and cndina. E3ch phase involves common as weJI as unique tasks and
skills. For example, the beginning phase focuses on rclntionship development and
problem exploration. Predict3bl)•, skills for devclopina relationships, like active listenina, arc most useful in the beginning phase, whereas skills such as confrontation arc
not recommended. But the subsequent action ph3sc focuses on helping clients develop
new perspectives, set goal~ nnd implement change strategics; thu~ skills such as reframina and confronting 3re used extensively in this ph3sc.
The four phases 3re devclopmcntaJ, with success u one ph3sc dependent in part
on success at previous phases. For example, clients arc more willing to accept confront3tion in the 3ction phase if a solid rcl3tionship or trust has already been established in
the beainnina phase. In genera], reference to the four~phasc model nJlows counseJlors
to mnke some predictions about the climate of the interview and to determine which
Preface
xv
skills and casks will be needed. However, practitioners must be cautious in applying the
modcJ too rii;orously to every counselling intc.rvicw because there arc ah\-"n)'S circum,.
stances for which the sequence of events will differ sharply from the model
Values and Ethics
Edtics are principles of acceptable conduct. Professional associations sud,. as the Cann,.
dian Association of Soc:iaJ Workc.rs and the Canadian Counselling and Psychotherapy
Association Juve formal statements tlut define cc.hies and standards of practice for thc.ir
members. Similarl'>', mfues arc ideas and principles that individunJs and groups considc.r
import:mtor worthwhile. In counselling, cc.rtain core wlucs arc of pnnicula.r importance:
I . BcJief in the dignity and worth of people
2. Respect for the client's right to self-determination (i.e., for freedom of choice and
the right to control one's own life)
3. Commitment to work for social justice
The Counselling Relationship
All editions, including this one, have prioriti!cd the importance of the client/counsel..
lor relationship as a major dcterminam of success. The counselling relationship is
something very special. lt's negotiated. It's non..rcciprocaJ. lt has a purpose. lt is
dcsianed to rccogni!c and mobili:e srrengths. 1t requires counsellors to abandon their
biases and suspend any tendency to give advice in order to listen and respond in a man..
nc.r that crcn.tcs the conditions for trust, growth, and change.
Counselling should empower clients and strengthen their self-esteem. It has very
little to do with giving "good advice," but it might involve providing information and
assisting clients to evaluate alternatives in ordc.r to support them to make informed and
scJf-Octcrmincd choices. Best-practice counselling draws on the expertise of clients to
participate in decisions related to the goals and process of counscJling, For this reason,
counsellors should demystify their worlc through open discussion of their methodologies, assumptions, and intentions. Moreover, commitment to client scJf-Octenninntion
restrains counsellors from abuse of power or control. In promoting client self-Octcrmi..
nation, counsellors use a strcngrhs approach that empowers clients by assuming their
capacity to cope and change.
The counselling relationship crcn.tes the conditions for c.hani;c to occur and the
motivation for change to proceed. The counscJling relationship nurtures the natural
need that everyone has to grow and change. The cornerstone of this is empathy, a
unique and powerful way of listening chat alone is sufficient to help many people. 1t
is nor a technique that we nctiv:nc when counselling, bur rathc.r an empathic approach
to life that Roger's describes as a ",'",.'>' of being,"
Counsellor Self-Awareness
Effective counsellors arc scJf.awarc, open to feedback, and willing to learn. As counsel..
tors become deeply involved in a relationship with their clients, they need to control
their own biases, and constantly monitor thc.ir feelings and thoughts so that they are
able to separate their cxpc.ricnces and feelings from those of their clients.
Knowlcdi;c of self, including consciousness of one's values and bcJicfs and the
impact of one's behaviour on others, is a prerequisite for effective counselling. Coun..
sellors who lack scJf-awarcncss may confuse their clients' feelings with their own.
\Vhcn counsellors are unaware of their own needs, including those that are unmet,
ll.Yi
Preface
they risk unconsciously using thc.ir counscJling relationships to meet ~rsonal goaJs
instC3d of client goals. In addition, without sclf-awarenes~ counsellors will be ignorant
of those arc3s of practice in which they arc competent and those in whic.h it will be
difficult for them to ,vork with objectivity.
Competent professionals know thcmscJvcs, and they ensure that their vnJucs and
beliefs do not become a burden to thc.ir clients. They acc:cJX that exploring and rdlccting on one's competence and the limits of one's role and expertise are fundamental to
professionaJ practice. For counscJlors, this process of self-examination continues
throughout their oi.rcc.rs.
Neuroscience and Counselling
In r«cnt years, neuroscience has emerged as an important new force in counselling.
Since the 1990s new technologies have spawned an explosive interest in the brain.
These imaging technologies have resulted in enormous progress in our understanding
of the brain. One of the most rclevant and exciting findings is the discovery that our
brains arc "plastic" and in a constant state of change. lifcexpc.ricnce, adversity, trauma,
risk taking, and learning shape and reshape the brain in ways that help us co~ with the
chaJlenges in our lives. Or. alternatively, they ma)' drive us to depression, anxiety, and
substance abuse.
A growing body of neuroscience research has confirmed the validity of counselling by demonstrating in dramatic ways how counselling changes the brain. Counselling works! Now, we have the science to prove it. \\:le have IC3rncd how counselling
basics such as listening, empathy, asking questions, and the establishment of relationship counselling harness brain plasticity and promote positive brain growth. It's aJrcady
exciting, even thouWl we arc still at the beginning stages of what is certain to be an
avalanche of profound dcvcJopmcnts in coming years. Neuroscience is providing
answers to the question, "How can counscJling help create conditions that promote
positive, empowering brain growth or repair?" As a result, I think that in the near
future college and university counscJling programs will require courses on the brain
and neuroscience.
Social Justice and Advocacy
Although the topic is beyond the scope of this te>..'t, counsellors should also consider
their responsibility to extend beyond thc.ir role as counsellors to social and politicaJ
action. As advocates for sociaJ justice, they should strive to reduce gender, cultural,
and other forms of discrimination. They should aJso promote changes in social policy
as well as modification in the functioning of formaJ org:inimtions and institutions to
meet the needs of clients.
STRUCTURE OF THE BOOK
The book is divided into 11 chapters.
Chapter I explores professional identity and introduces readers to the basic concepts of ethics, values, and self-awareness.
Chapter 2 explores the basic nature of counselling skills and strategies. Jn this
chapter, four major skill dusters arc introduced: relationship building. explorinw'probing, empowering, and challenging. The four-phase model of counselling (preliminary,
beginning, action, and ending) is proposed as a model for understanding the evolution
of the counselling relationship. As well, the important components of a traumn,infonncd approach are introduced and discussed.
Preface
xvii
Chapter 3 examines the heJping relationship and considers the core conditions
of effective counseJling. Scs.sional and reJacionship contracting arc featured in this
chapter.
Chapters 4, 5, and 6 explore the active listening skills of attending. silence,
paraphrasing, and summari! ing (Chapter 4), questioning (Chapter 5), and empa.thy (Chapter 6). Specific ideas for interviewing and working with )'OUth arc discussed
in these chapters.
Chapter 7 is concerned with action-phase skills chat motivate clients to think dif,.
fercndy and make changes in their lives. Two important theoretical model~ cognitive
behavioural counselling and motivational interviewing, are fenrurcd.
Chapter 8 presents information on working in difficult situation~ such as when
clients arc resistant or potcntia11)• violent.
Chapter 9 looks at concepts for working with various populations, including those
who arc dealing with mental disorders., contemplating suicide, or who have addictions.
Chapter 10 explores important concepts and is.sues rcJatcd to counselling clients
from different cultures. This chapter includes a discussion of spirituality and counsel.ling, reflecting a growing interest in and acceptance of spiritual issues in counselling. In
this chapter, multiculrural competencies for Canadian counsellors arc introduced.
Chapter 11 , new to chis edition, explores issues related to neuroscience and coun.scJling including a discussion of brain problems.
Features
People learn in different ways, so this book includes a range of features designed to
assist learners in understanding at the cognitive, emotional, and behavioural lcvcls.
Each chapter contains the following clements:
■
Lcarnini Objectives: key concepts that will be addressed in the chapter
■
Summary: a short review at the end of each chapter chat summari:es important
ideas
■
Conversations: a unique feature presenting teacher- student dialogues about
frequently asked questions
■
Sample Interviews: annotated interview excerpts chat illustrate and explain
chapter concepts
■
Success T ips: short, practical ideas for counselling success
■
Illustrative Figures: diagrams that support or embellish chapter concepts
■
Brain Bytes: short links to interesting and relcwnt neuroscience
■
Exerci,;;es: end-of-c.hapte.r rdlcctivc questions to give readers practice developing
self-awareness, practice skills, and conceptual knowledge
■
Weblinks: links to websites related to the chapter's material
■
Glossary: definitions of key terms
SUGGESTIONS FOR STUDEN TS
If you are studying this book as part of a course on counselling skills, you will probn.bly have the opportunity to develop skill competence in a number of different ways:
x,,m
■
Watching instructor demonstrations
■
Conducting practice interviews using role-played or (preferably) real-life .scenarios
■
Completing the chapter exe.rciscs
Preface
■
Rcce.iving fcedb3ck and evaluation from instructors and student colleagues who
obse.rve your work
■
Using audio and video recordings to understand and assess your verbal and nonverb3J responses
■
\Vorbng with clients in practicum fie.Id settings
ln most counselling skills courses, learning groups are u~ to practise skills. Usually, these learning groups use classroom simulations and practice interviews in which
you assume the roles of dient, counsellor, and observer. Each of these roles offers
unique chnJlenges and opportunities for learning.
Practice Interviewing: When You Are the Client
The client's role offers a powerful opportunity for you to understand diem feelings
and expectations. You may find that your rc3ctions arc similnr to those that clients you
will worlc with in the field experience:
■
Ambivalence about sharing fceJings or details about pe.rsonaJ issues
■
Feelings of vulnerability and fear of be.ing judged, cmba.rras~. or ridiculed
As a dicnt, it will be up to you to control how much you wish to disclose; however, by taking reasonable risks, you can enhance your learning opportunities and
insights. However, )'OU should remember that a training environment docs not pro\tidc
the time or setting to address complex problems.
Practice Interviewing: When You Are the Counsellor
When you are asked to practise )'Our newly lc3rncd skills as a counsellor, you may
fee] dumsy and insecure as you take risks to chani;c established communication patterns or experiment with new skills and strategics. As a student with limited training.
you may be reluctant to ask questions that seem to invade the privacy of your colleagues. Moreover, when dealing with sensitive issues you may fear that your lack of
experience will damai;c your clients. You may aJso fear that your colleagues will judge
you as inept. As weJI, when you arc being observed by others, the intense focus on
your worlc can be unsenling and anxiety-provoking. But all these reactions a.re common, and you will probably find that your colleagues fed the same wa't'· Most profcssionaJ counsellors take many yc3rs of practice and stud,., to become competent and
comfortable using a full range of skills. What is important is that you persist and
avoid the natural temptation to stick with familiar patterns of communicating. Skills
that are awkward in the beginning will, with practice, become part of your natural
and preferred style.
SUCCESS TIP
If you ere-ate the right conditions, othe-rs wiU help you wrth foodbaek that w,II support thedieve-bpment of you, skits and self-awareness.
Practice Interviewing: When You Are the Observer
Student observers are responsible for watching the interview and providing feedback
to student colleagues who are practising their counseJling skills. At first, you may be
reluctant to offer feedback, perhaps ,vorrying that your remarks will generate anger or
Preface
xix
hurt fcdings. But keep in mind that the obsc.rvcr's role gives 't'OU an exceJlcnt opportunity to develop the skill of giving feedback 3nd practise this skill.
Helpful focdb3ck is energizing and does not detract from 3nothcr person's se.lfe.steem. As people lc3rn and practise interviewing and counselling skills. they may feel
vulnerable and awkw3.rd. Hence, it is important to re.main sensitive to their emotional
and psychologicaJ needs, while balancing their needs for inform3tion 3nd correction.
Obscrve.r feedback ma't' be of two types: supportive or corrective.
■
Supporth-c feedback reoogni:cs screngcM. Consider how you respond diffcre.ndy whm
your st~hs arc 3ckno\\'lo:Jge;J rather than when your \\"t'3knesscs 3re targcto:J. Yet
despite how obvious this idea seems, m3ny srudents and professional counsellors are
very problem,oricnted 3nd fail to ocknowlooge client or colleague ~ h s . Supponive
fttdback m~t be ,;cnuinc (rruc) and dclivem:J without rescuing or patronizing. If you lie
to others to 3Void hutting them, your credibility 3S a source of feedbade will diminish.
■
Corrective feedbac k challenges others to ex3mine or change behaviour. But
before giving corrective feedback, consider your rel3tionship with the othe.r person. If 't'OUr relationship is based on trust and caring, corrective feedb3c.k has the.
potenti31 to be effective. Ho\\'evcr, if your relationship has unresolved conflict,
corrective feedback is more likely to be: perceived 3S an attack. lf people think
your feedback is h3rsh, demanding, or cont·rolling. there is a higher probability
that they will resist. Here arc some general feo:lbock guidelines:
■
Be sp«ific. Avoid generalities such 3S. "Your interview was gre3t." Anchor
your assessment by identifying the specific beh3viours and responses that 't'OU
observed that contributed to the success of the interview.
■
Don't use corrective feedb3c.k as a means to control, impress., or punish. Pay
3ttemion to your tone of voice and other nonverbal behaviour. N13ke sure
that you avoid lecturing and pointing fingers.
■
Timing and P3cing 3rc important vari3ble.s. Supportive feo:lbac:.k is more useful when self-esteem is low. In 3ddition, feedback is most effective when given
3S soon as possible, but ensure th3t you protect personal privacy.
■
Avoid ove.rwhelming student counsellors by providing too much feedback.
Watch for nonverbal cues or 3sk them to let you know when they would like
to stop the process.
■
Ask people to self-evaluate. before offering your opinions. You may be surprised to find that they already h3vc insight into the problem are.as; thereby
reducing the number of are3s in which 't'OU h3ve to provide direct feedb3ck.
■
Feedback has the most potential for success if it is invited or tari;:cccd to perceived areas of need. Contract with others to deliver feedback. Ask questions
such 3s "\Vould 't'OU like me to offer my ideas on wh3t h3ppene.d!" or ''Are
there specific issues that 't'ou're concerned about?"
■
Everyone is different. Some people pre.for feedb3ck to be direct and to the
point. Orhe.rs may prefer it "sandwiched" between positives. Orhe.rs need time
to re.fleet before responding, or they may profit from visual and written illusmv
tions. Discuss preferences with student counsellors, then respond 3ccordingi)•.
Some people h3vc an immediate reu:tion to feedback that will differ from their
reaction once they h3ve h3d time to ponder wh3t you have said. For example, 3 person
who responds defensively or C'Ven with 3nger may, on reflection, come to 3ccept your
input and see things differently. The opposite can 3Jso be true-people who rc3ct
favourably may later develop other feelings, such 3S resentment or confusion. Checking
b3ck during future encounters is one strategy for keeping abreast of others' re3ctions.
a
Preface
Remember thnt giving helpful nnd caring feo:lback is one way of developing and
strengthening relationships. 1f you are honest and supportive with others, you greatly
incrc3sc the probability they will be honest and supportive with you when you ask for
their helpful feedback.
Developing an Effective Learning Group
When you worlc with student collcngucs in each of the three roles, discuss 't'Our
fears 3S well as 't'Our expectations of one another. You will need to work to develop
3 contract or agreement on how 't'OU will work together. Practice interviews arc
powerful Je3rning opportunities when they are based on rcnl rather th3n role-pfoycd
feelings 3nd issues. Consequently, it will be important to est3blish a climate of
safety, where confidentinlity will be respected. Some important principles to
remember:
■
Colleagues who nrc in the client's role are disdosina pe.rson3l is.sues and foclina~
so it is essential to respect their dignity and right to privacy.
■
Everyone h3s different cnpncities for intim3cy. Do not expect that all members of
a learning group will disclose 3t the same level. Accept individunl differences.
■
Learning the skills of counscJling requires a willinaness to aive up familiar patterns of communication and attempt new npproaches. Expand your limits by mk.ing appropriate risks to try new skills 3nd be tolerant of collcngucs who 3rc
engaged in similar risk~taking.
■
Fccdbaclc from others is nn import3nt pnrt of IC3rning. Therefore. try to make it
easy for others to give you focdb3ck by consistently responding nondcfensivcJy.
Hdp others give specific focdbaclc by 3slcina targ,eted questions.
SUCCESS TIP
Ext,ec1 that lhe ptocess of learning and experimenting wrth new Slull:S WIii res.un i"I a petiod
of awkwardness and self<onsdousooss. FOr' a lime, ,t may seem as though your capaoly
to counsel othet'S is rewessing.
Keeping a Personal Journal
A personal "for your eyes ont,.," jour03l can be 3 signific3m adjunct to 't'OUr learning.
The journal is a tool for introspection th3t provides a private means for documenting
3nd exploring your thouahts and fodings related to the development of your counsdlina skills. There are no rules for journnl writing other th3n the need to make entries on
3 regular basis and to try to avoid sclf<ensorship.
Using This Book
If you arc using this book as P3rt of a course on counselling, your instructor will propose 3 su~cstcd rending schedule that srructurcs your reading over the semester, and he
or she will assign or 3d3pt the ch3ptcr exercises to fit your learning needs. Another way
to use the book is on 3n "as you need it" basis. using the index or ch3ptcr hC3dings to
locate specific content. As wcll, you 3rc encourag,ed to use other books, journals, 3nd
tools. such as lnte.rnct research, to supplement your learning. However, you should rend
this boolc (or any boolc) critic3lly and sce.k to undcrsmnd and explore the kfe3s and try
them out.
Preface
ai
Counselling Skills as a Way of Life
You m3y be surprised to discover that the skills of counselling are also the skills of
dfcctivc cvef)tdny communication, and that the process of developing your counscJ.ling competence ma'>' begin to influence )'Our pc.rsonaJ relationships. As counscJling:
skills become part of your style, 't'OU may find '>'ourself becoming a linle more inquisi.tivc and more sensitive to the feelings of others. However, you may find that others in
)'Our life do not welcome the changes in 't'OUr manner and St)•le. When you change,
others around you have to accommodate '>'our changes. ff you become more probing in
'>'our questions. they must be forthcoming: with their answers. \Vhcn you become more
empathic, their feelings become more transP3rcm. These changes move rhc relation.ship to a deeper level of intimacy, which ma'>' be friWltcning for some, particularly if
the pace is too fast for their comfon level.
an
Preface
I have appreciated the help offered by the editorial and production staff at Pearson
Canad3, who have been very helpful in guiding this book through the m3ny steps
required to bring the manuscript to publication:
■
Portfolio l\•fanage.r: Keriann McGoogan
■
Marketing Manager: Euan \Vhite
■
Content Developer: Eileen Magill
■
Content Manager: Madhu Ranadive
■
Project Man3ger: Susan Johnson
■
Copyeditor: Susan Adlam
■
Cover Designer: SPI GlobaJ
Thank you to Venkat Perl3 R3mesh 3nd Aishwary3 P3nday for their terrifc copy
edit of this edition. A special thanks to Collen Murphy and John Fox from Dougl3s
College 3nd Joyce Shebib for their comprehensive review of the new Chapter 11.
An adapted version of Chapter 11 was published in the online journal, The Neuropsychotherapist (2017), and I am grateful to its' editiors, Manhew Dahliu. and Richard Hill for their assistance in m3king this happen.
All editions of this book have benefited from the feedback provided by reviewe.r~ reader~ colleagues, clients, and students. Over the year~ students from Dougl3s
College, have offered candid and helpful feedback, and profession3f collengues who
have contributed ideas and suggestions th3t I have assisted me. Thanks to Andrew
Buntin, Barbara Picton, Irene Carter, Jason C3rte.r, Michelle Gibbs, Winnie Benton,
Irene C3rter, Susan Davis, Karen Marr, Sheri McConnell, Sar3 Memel, K3ren
Moreau, Neil Madu, Robert Owen~ Alyson Quinn, Melissa Medjuck, John Fox,
Doug Este.rgaard, Bruce Hardy, Lawrence Becker, Elizabeth Jones, Colleen Murphy,
3nd Tabitha Brown.
Each edition of Choices h3s included reviews from professionals in the field. In
this seventh edition, 10 reviewers, each of who was intimately familiar with the content of the book, offered their perspectives on how the book could be improved.
Their invaluable 3nd intelligent suggestions helped to shape this 3ddition. Thank )'OU
to these colleagues who reviewed the seventh edition:
Alana Abramson, Kmmden Pol)redmic Unitff.Sit1
Andrew Buntin, George Brown College
Barbara Picton, Vancout'ff Communiry College
Irene Caner, Uniomi1y of \Vind.sor
Jason C3rter, Fleming College
Michelle Gibb~ Mohawk College
P3trici3 Miller, Mounr RO'J(ll Unit'ffSi1y
Sue Davis-Mendelow, Humber College
As 31ways, a special thanks to my wife, Joyce Shebib, who continues to offer support
and very helpful critical comments.
Readc.r comments and critical fccdb3c.k arc always welcomed. Please email me at
shebib@tdus.ca.
Bob Shebib
f21C'ult)' En~ritus
0ou{tla$ ColLes:e
Kew \Vestrninst~r. BC
Customi:~ workshops and staff training based on this boolc arc available. Contact the
author at shcbibb@tdus.net for details.
niv
Acknowledgments
Stuart Miesfl23RF
■
Identify the Canadian professionals thnt provide counsellina services.
■
Identify how counsellors can work within the limits of their competence.
■
Define and describe professional ethics, indudina standards related to duaJ rela,
tionships and confidentiaJity.
■
List and describe- the core va.Jues of counsdlina.
■
Identify principles for underst:mdina and resolvina ethical dilemmas.
■
Understand the importance of counsellor objectivity :md self-awareness.
■
Understand and manage personal needs and values in counsdlina.
■
Recoani:e and address burnout and vicarious trnuma as W'Orkplace hn:ards.
PROFESSIONAL COUNSELLORS IN CANADA
Many professional~ such as social workers, child and youth care workers, ps)•chologist~
psychiatrists, nurse~ and psychiatric nurse~ do counsdlina work. Most are members
of professionaJ associations like the Canadian Association of Social \\:1orke.rs (CAS\\:' )
and the Canadian Counselling and Psychotherapy Association (CCPA: see Table 1. 1).
TABLE 1.1
Professional Associations in Canada
canae1ian Addi:tioo Counseuors Ce-rtification fedemtion
w.-.w.caccf.ca
C3nadian Art Ther.1py Association
C3nadian Assoc:ial:ioo of Music The-rapists
w.-.w.catas"lto.ca
canae1ian Assoc:ialioo of Rehabilitation PtofessionalS
tanadian Assoc:ialioo of Soda! WorM-rs
w.-.w.musiclher'aP'f.ca
w.-.w.carpoational.Of'g
w.-.w.casw..acts.ca
C3nadian Counse-t.ling and Psychotherapy Associatbn
canae1ian C(.-ninal Justice Association
tanadian Indigenous Nurses Association
w.-.w.ccpa-accp.ca
C3nadian NurSeS Association
C3nadian Psychiattic Association
w.-.w.cna-a6c.ca
w.-.w.cpa-apc.org
w.-.w.ccja..acjp.ca
w.-.w.anac.on.ca
canae1ian PsychOlogical Association
w.-.w.cpa.ca
C3nadian Thetape:utic Recmatbn Association
CouOOI ot canadian Chad and Youth care- Associations
w.-.w.canadian-lt.org
w.-.w.cyceanada.ca
PsychOsocial Rehabilitation canada
w.-.w.ps«pscanada.com
As members, they are subject to codes of ethics governing acceptable professionaJ
behaviour. Membership in these associations usually requires a university degree and,
in some cases, a maste.r's degree or Ph.D.
Social ,vorke.rs gene.raJ)y have university training with a bachelor's degree in social
work (BS'W) or a master's degree in social ,vork (MS\\:r). (n addition, they may have speciali.!cd training in are3s such as family the.rapy or group ,vork. Social workers might work
in private practice or be employed in hospitals, prisons, schools, or community social
service agencies. Many social workers also ,vork for government agencies invcstig:iting
incidents of child abuse and neglect. Social ,vorke.rs arc the largest profossionaJ group
providing support and counseJling to people with psychiatric disorde.rs. lncrcasingly, with
the aging of the Canadian population, social workers are deployed to work with seniors.
CounseJling psychologists are usuaJly qualified at the Ph.D. lcvcl, but some jurisdictions allow registration for those with a master's degree. They may ,vork as counsellors
or may spcciaJi.!e in other are3s, such as in administering and interpreting psychological
tests. Psychologists arc often employed in private practice, but they ma,., also work in
settings such as prisons, hospitals, schools. and private industry.
In contrast, psychiatrists arc mcdicnl doctors with advanced training in psyc.hiatf')t
They are specialists in the treatment of people with menral disorders. Ps,.•chiatrists are the
only counselling professionaJs licensed to prescribe medication. Psychiatric nurses generally have two to four years of training. Historical!,.,, they worked in psychiatric hospitals and
wards., but today. increasingly, they arc working in community based mental health settings.
Community college graduates with one to two years of college training aJso provide
counselling services in senings such as transition homes, addiction centres, employment
counselling agencies, and community mental he~dth. The nonprofit social service sec•
tor also uses volunteers to deliver services in settings such as crisis phone lines, where
people in distress call for assistance or referral. In addition, the professionaJ counselling
community is often supported or replaced b\• an array of sclf-hclp support groups, such
as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
Social Work and Social Justice
Like other professionals in the helping professions, social workers counsel clients to
help them develop insight, solve problems, deal with emotionaJ p3in, and enhance
2
Chap1er 1
rcJationships. They may also suppondients by providing information, social skills trnining, or resources. One speci3l feature that d istinguishes social work counselling from that
performed by other professionals is itsdunJ focus on W'Orking with individuals as well as
the.ir sociaJ environment (DaJe, Smith, Norlin, & Chess., 2009). SociaJ W'Orkers assume
that an individuaJ can be u nderstood only in the context of his o r her environment;
thus, they pay particular attention to the interaction of the person and the environment.
Unique to social W'Ork is the important professional responsibility to promote social
justice or "fairness and moraJ riahtness in how social institutions such as government,
co rporations, and powerful groups rccogni!c and support the basic human rights o f all
people" (Shcafor & Horcjsi, 2008, p. 6). Social justice commitment involves advocacy
to promote human rights and more equitable income redistribution, political action to
change oppressive legislation o r policy, public education to shnpe public opinion, and
efforts to build community. Social workers recognize that social problems arise, at least
in pan, from ineffective socinJ systems.
\Vhile counselling is important in helping individunJs cope, it is insufficient in deaLing completdy with these great cha.Jlenges. Thus, because this boolc explores onh• the
counselling component of social work practice, practitioners arc autioncd to approach
this taslc with the broader mission of social ,vork in mind. Valu e 2 of the Code of Edtia
of the Canadian Association of SociaJ ·workers (2005) o udincs the obligations o f social
workers to advoc:ne for social change:
Purjult of Soci::ll Justice
All 2 result. !lod:lJ workers belie--.-e in the obii¥"3tion of people. individual!)' and eol,
!ttth-e1y. to provide resour«.s. services and opportunities for the over111l benef'h of
humanity and l'O a(ford them procect.On from h::arm. Soefa1 workers promote social
fairncss and the equitable discribut.On of reSOurees. and take ::.et.On to redu~ barri.erS
2nd eicpc:md eho-iee for all persons. with !ipecM R1t3rd for those who 3re marttln::ii:ed.,
di~dv:tnta~d, vulnerable. and/or h::1:\'e e,:eeption::111 nee<k Soei::111 workers oppose prt'Ju.diee and d1serimination 21.'.ainsc any person or aroup o( persons on ::ti1)' arounds. and
spedf"te:!111)' eh:t!Len~-e views and aet ion!l that stereotype p.,rtkular persons or $tr0u pi.
Prindples.:
■
Soeial workers uphold the ril.'.111 of people to h:t,-e ae«ss to resourees to meet lxlsk
hunun needs.
■
Soda! Yi'Orkers 2dl.'Oc."21te for l2ir and equitable~ l'O pu blk servieesand bene:flu.
■
Soeial workerS ac.h'()("3te for equal t re::atment and proteetion under the law and ehal~
le~e injustiees,. especially inJuStkes that 2(fect the vulncr.ible and d1S:ld\'an1a~-ed.
■
Soeial workerS promote soc:ial de,'1?1opment 2nd e,wironment:lJ mai1::1:~1ne:i1t in the
intereru o( all people. (p. 5)
ETHICS
Ethics arc the p rinciples and rules o f acceptable o r proper conduct. All professions hnvc
ethical guidelines, desianed to protect both clients and members. Ethical codes define
the limits of pe.rmissiblc behaviour and the sanctions o r remedies for member violations
of ethicaJ standards. Codes of ethics serve the following b ro3d purposes:
■
Professionals can use their codes to assist them with d ecision m31cing and as a reference for the.ir practice.
■
Ethical codes help shdtcr clients from incompetent and unethical practice by mcm.be.rs of the p ro fession. Ethical codes r«ogni:e that clients may be vulnerable and
subject to manipulntion and abuse o f power by profossiona]s, so thq• constrain
professionals from taking 3dvantage of clients.
Protesslonal Identity: Ethics, Values , and Self-Awareness
ethics: Ouidelilies that define the limits
d pennissible behariour.
3
■
Ethical codes nlso provide guidance on how counscJlors can dc3l fairly with col.leagues and their cmplO)'Crs, including the responsibility to address the unethical
conduct of colleagues.
■
Codes outline the philosophical and vnluc principles of the profession. For exam,.
pie, the code of the Canadian Association of Social \\:1otkers has six core social
wotk values:
Value I: Respect for the Inherent Dignity and \Vorth of Persons
Value 2: Pursuit of Socinl Justice
Value 3: Service to Humanity
Value 4: lntea:rity of Professional Practice
Value 5: Confidcntinlit)• in Professional Practice
Value 6: Competence in Professional Practice (CAS\\:I, 2005, p. 4)
These ideals arc echoed by the Canadian Counsellina: and Psrchothcrapy
Association, which articulates the following fundamental principles as the b3sis
for cthicnJ conduct:
a. Bendiccnce: be.ina: pro3ctivc in promoting clients' best interests
b. Fidelity: honouring commitments
counsellina: rcJationships
to
clients and maintaining integrity in
c. Nonmalefkence: not willfully harming clients and refraining from actions that
risk harm
d. Autonom)•: respecting the rights of clients to self-determination
c. Justice: respecting the dignity and just treatment of all persons
f. Societal interest: respecting the need to be responsible to society (CCPA, 2007, p. 2)
Unethical behaviour typicaJly arises from issues related to one or more of the
following: brcakina: confidentiality; misreprescntina: or worldna: beyond one's level of
expertise; conducting improper relationships. including scxuaJ activity with clients; and
causing conflicts of interest, such as emerina: into business or other dual relationships
with clients.
ProfessionaJ associations arc responsible for monitoring their mvn policies and for
investigating and resolving violations of cthicnJ conduct. The CAS\\:I and CCPA arc
examples of professionaJ bodies that can formnll)• discipline members who violate their
codes of ethics. As weJI, counsellors who are 00( members of professional assocuttions
may work with agencies that provide guidelines for ethical behaviour and decision makina:.
In addition, legislation defines and restricts the use of certain tide~ such as social
worker, psychologist, and psychiatrist, to those who have the appropriate degree or
training. The clients of these professionals can report misconduct or concerns to the
appropriate professional association: however, the.re may be no legislation preventing
people from offering counselling services under 3 wide nma:e of other title~ such as
counsellor, personal therapist, family and marital counsellor, and personal growth con,.
sulmnt. These practitioners ma)' not have had formal preparation or training, and clients
should be cautious when they seek their services.
Although the codes arc the primary source for professional decision makina:, coun.seJlors should also consider relevant theory, research, laws, regulation~ and agency
policy. \Vhcn faced with ethicaJ dilemma~ they should consider consultation with
collc3gucs, supervisors, professional associations, and lea:al counsel In addition, the
CCPA has published an ethics casebook (Shuh, 2000) designed to assist counsellors in
clarifying ethics and standards of practice, and the CAS\V has published Guidelines for
Ethical Practice (2005) as a reference point for social workers on cthicaJ practice.
4
Chap1er 1
Dual Relationships
A dual re.larion.,;hip is a rcJationship in which the.re is both 3 counselling relationship and
another type of relationship. such as a business relationship. a friendship, or one of scxu:.d
intimacy. The essential purpose of counsclling is to meet dlC' needs of client~ but dual rein,.
tionships IC3d to the risk th.nt counsellors could misuse (or be pc.rceivcd to be misusing)
thc.ir professional relationships for pc.rsonaJ gain. In duaJ relationships, the counsellor has
a persona] interest th.nt may con6ict with the client's interests. This may lead to intended
or unintended exploitation, harm, manipulnrion, or coercion of clients. To prevent these
problems and an,.•conflict of interest, dual rcJationships must be 3voidcd because of their
potcntiru hnrm to clients and the risk of damage to rhe image of the profession.
Not surprising),.,, the codes of ethics for the various counselling professions strictly
prohibit certain types of dual rel.ntionships., especially those of scxunJ involvement.
Generally, they also prohibit sexual intimacies with former clients for a specified period
after terminating the counseJling relationship, but this injunction ma'>' extend indcfinitdy "if the client is dearly vulnerable, by reason of emotionnJ or cognitive disorder, to
exploitative influence by the counseJlor. Counsellor~ in nJI such circumstances, clearly
bear the burden to ensure that no such exploitative influence has occurred and to seek
consultative assistance" (CCPA, 2007, p. Bil).
Cl.Iii relatiooship: Aieb.~iooslip ii
*h thEfe is bot!I aauasellillg ieb.~i>Rship
-6 anctte ~ of retr.i>nship, sud! u
~«sa:aal ir.imacy.
Professional Boundaries
Despite ethical guideline~ boundary \•iolations and abuses do occur. Reviewing the
available research, (Thoreson and colleagues 1993) found thal the incidence of se>..'Ual
contact between counsellors and clients ranges from 3.6 to 12.1 percent. Conducting
their own srud'>', the researchers found after surveying 1000 randomly seJectcd male
members of the American CounseJing Association (ACA) that 1.7 percent of the
respondents reported engaging in sexual contact with a client during a professional
reJationship. and 7 percent reported engaging in sexual contact after a professional relationship (Thoreson ct al., 1993).
Physical Contact The CAS\\:l's Guidelines {qr Eihical Pmaice (2005) offers this guid~
ancc on the issue of physical contact with clients:
Sodd1I v.'Ork.ers a"oid e0$:aaina in ph)'Sical cont::.ct with cl1enu whe:i, there is a possibility
of harm to the client as a result of tilt contact. Soeial Yi'Orkn'l who e0$:a~ in approprldlte
physical contact with dients21re rttponSlbLe for settina dear, appropriate and cuhura.lJy
sensitive bound:u-ieii to '-•oven, iiudi cont~. (p. 12)
\Vhile the CASW guidelines do not de.fine appropriate physical contact, common
sense neo:ls to prevail. Fear of the impliations and repercussions of touching has led
some settings to become "no touch" environments; however, this practice may negate
the needs of some clients, particular!'>' children who need physical conmct. In an editorial on the importance of touching in child and youth care sertings., Tom Garfat (2008)
emphasi!ed the importance of touch when working with youth, but he also stressed
that workers need to learn when not to touch. He distinguishes "between those who
would touch youth in the most normnJ and healthy of ways; a pat on the back, a touch
on the shoulder, a comforting hug when the world is a difficult place, a hand held in a
moment of crisis, and those who use the opportunity to touch a young person as an
opportunity to satisfy their °"'n needs and desires" (p. iii). Garfat strongly endorses the
elimination of inappropriate touching, but urges us to remember that "touch is P3rt of
human nature, touch is dcvclopmentnJI'>' necessary, touch is part of healing, touch is a
form of communication, and touch builds bridi;cs" (p. x).
Protesslonal Identity: Ethics, Values, and Self-Awareness
5
While sexual intimacy is de~uly unethical, the appropriate boundaries of other
relationships may be less dear. As Reamer (2002) observe~
Other dual 3nd 1nuhiple refationships3re more 31nb~uous and require e2reful an:11lysis
and eonsuh:nion. Examples include $0Cla! v.-·orkers in rural communities who cannot
3\'0id cont~ with dienu in social settin~s. soeial workers who ue in\'hed br clients
to attend an important li(e e"ent, soek.11 v.-·orkers' rebtionships with forn~rclients, and
soeial workerS' unantidpcatc-d e:ncounterS with cbe:nts 3t 3n Aleoho!ics Anonymous
n~tinK when both parties 3R' in rttO\>ery. (p. 66)
Miller (2007)discusses the chaJlenges that profossionaJs who work in rural or smaJI
towns face when applying and interpreting ethical standards such as "the need to main.tain professional boundaries and at the same time achieve a sense of personal belonging
in the community" (p. 168). She aJso notes the vulnerability that workers foci, due to their
high visibility, when their actions are scrutini!cd by members of the community.
Pierce and Schmidt (2012) sugi;est that rural dynamics and culture affect how professional boundaries are de.fined:
For example, over time. the pro(essional m3)' be invited to 001nmunity e"\>ents. 3 we'd,
din¥, or a eelebr.uion for "-hkh attend3nce is viewed 3S SiKnif'lcant by the community.
Not attendina m3)' cause disharmony <>r barderS between the practitioner and the
community. (p. HS)
Confidentiality
absolute confidentiality: ,.
assur•e that dient disclosures are not
shared 'llih an)1)fle.
~&alive confidentiality: The
assumpti)n that client disctlsures my be
shared 'llihin the ,.ency • idl supervisors
or ailleapes. Clllsi:\e the ,.ency -.idl
client peraissia.. or _., odlers bec-.-se
of lea..ahequiremeaa. s.a::h as those
contailed .ithin ctid abuse legisbtica.
6
The rules rq:ardingconfidentialit)• are integral co every code of ethics. EthicaJ guidelines
stress that the confidentiality of clients must be protected. Indeed, most clients enter
counselling with an expectation that what they S3Y will be kept private. For the most
part, counsellors can assure clients that they will keep their disclosures confidenriaJ;
hO\\tC\-er, often it is not so simple. Absolute confidentiality mC3ns that client disclosures
are not shared with anyone. Rclati\'e confidentiality means that information is shared
within the a,;ency with supervisors or colleagues, outside the agency with the client's
permission, or in courts of law owing to legal requirement~ such as child abuse legisla.tion. UsuaJI)•, clients can be assured only of relative confidentiality.
To provide optimum service to clients., counseJlors must share information about
them within the agency. To monitor the quality of ,vork and help counsellors improve
their skills, supervisors need to review client files or consult with counsellors by review~
ing audio and video recordings of their interviews. Other counseJlors within the agency
also have access to files.
Many people believe that counsellors and other professionals enjoy "privileged
communication," that is, thq• are lega]ly protected from having to share information
that they have obtain~ while exercising their professional duties. Ho\\'e\'er, the courts
can subpoena counseJlors' records because Canada has no legislative protection for
licensed or unlicensed psychotherapists.
There are valid reason~ including some legal requirements, for sharing informa,.
tion. For example, aJI jurisdictions in Canada have legislation that rttauires counseJ.lors to report suspicions of child abuse and neglect to the appropriate authorities.
Similarly, counseJlors might have to break confidentiality when thq• believe that clients
might harm themseJves or others. Counsellors need to become familiar with the pre.cise wording of relevant statutes in their area since laws may vary significantly among
jurisdictions.
One often-quoted legal precroent is the 1976 Tarasoff case, in which the client told
his counsellor of his intent to lcill his girlfriend, Tatiana Tarasoff. The counseJlor cold
the campus police of the threat, but he did not warn his diem's girlfriend or her family.
Chap1er 1
The client, a student at the school, subsequent!)• carried out his thrcnt and killed the
young woman. The young woman's parents brought a successful lawsuit against the
counsellor and the university. This litigation established that, when counsellors believe
that a client represents "a serious danj;er of violence to another," they have a duty to
warn potential victims (cited in Nesbitt, 2017.).
duty to warn: The profmional
responsibility that uunsellors haw to
infora P!(lple . , . they baiew a di.may harm.
SUCCESS TIP
Become familiar wdh the legj:slatbn in you( a(ea that (eQuires you to (eport suspected cases
of child abuse Or' neglect but remember it is not you(job to conduct an k\vestigation unless
you are legally assigned thi:s (de.
Since the Tarasoff decision, there have been numerous Canadian applications and
legal precedents that address the duty to warn issue. The CASW's G11idelines for Ethiail
Pmcrice (2005) allows for disclosure when "necessary to prevent serious, foreseeable, and
imminent harm to a client or others" (p. 6). The guideJines also obligate social workers
in such circumstances to notify "both the person who ma'>' be at risk (if possible) as
weJI as the police" (p. 8). The CCPA Code of Ethics (2007) has a similar duty to w-arn
obligation that requires counsellors to "use reasonable care to give threatened ~rsons
such warnings as arc essential to avert foreseeable dangers" (p. 7).
Clients have a right to be fully informed regarding the limits of confidemiality,
including any legal or ethical responsibilities that require counsellors to share informa•
tion. Through discussions rq:ardingconfidentiality. counsdlors can reassure clients that
computer and file records arc safe.
Counsellors can take a number of steps to protect client confidentiaJity. They
should discipline themselves not to discuss clients in public plnc:cs and at parties or
other social events. Counselling work is demanding, and an important part of dealing
with the stress of the job is to unwind by talking about difficult cases and ~rsonal
reactions with colleagues and supervisors. This is a healthy and necessary component
of professional wellness. Unfortunately, time pressures and large caseloads may leave
little or no time for this process during the working day, so it is easy to fall into the trap
of discussing clients over lunch or in other settings where confidemiality cannot be
ensured. The obvious risk is that the conversation will be overheard. Even when names
are not used, accidentaJ listeners may think that they know the person being discussed.
In addition, they ma'>' decide that they will never go for counseJling because what they
Sil)' would soon be spread all over town.
Although it is tempting for counsellors to discuss clients with family and friends
because they arc awilable as supportive listeners, they should avoid doing so. Family and
friends are not bound by the same ethics as counsclling profcssionaJs. They could easily
disclose what they have heard, perhaps with a seemingly innocent observation or comment.
Sometimes counsellors breach confidentiality b\• failing to take simple precautions.
For example, taking phonecaJls during a counselling session can lead to careless breaches
of confidentiality and suggest to clients that the counsellor treats their private matters
casuaJly. In addition, counsellors should remove all case records, phone message~ and
notes from their desk. This prevents clients from seeing the names of oth~r clients and
reinforces the fact that the counsellor will not leave private r«ords in public plnces.
SUCCESS TIP
Yv'hen leaving phOOO messages fOr' d ients, give jusa your firsa name and say nothing abOut
the nature of lhe call. Clients may 001 have informed room-mates or famity members that
they are seeing a counselb.
Protesslortal Identity: Ethics, Values, and Self-Awareness
7
TABLE 1.2 Confidentiality Guidelines
Review ptofessional guidelines such as lhe C/JSWs Guidelines lot £1/'Jk:al Practice and 100
CCPA's COde of £tNcs.
l.nveive clients. Keep lhem infol'rned and seek lhei( permissio.n to retease information.
Remembef' 1hat freeoom of rntotmatio.n sa.ah.ies may give cliMts 1he ~ t to access you( files.
Become familiar with televant legal statutes (e.g., chtk1 abuSe or mental health legislation)
that defW'le and limit conftdentiality. OisclOSe onfy lhe information that is (e.::iuir'ed.
Pr·Olec:I dient (ec:ords Mh secure filing systems. Do not leave flies, notes. or poon,e messages
aOOUt dients out vd'lem they may be read by others. Ensure tr.at etectronicaly stored data is
protected.
• Etls...-e lhat consultatio.ns with others concet'ni~ clients are legitimate and conducted in
a private and ptofessional manner. This ptecludes co.nverSatioos abOut clients at soda!
gatherings ot k'I public places such as resta...-ants.
Etls...-e that interviews are private and free from inte(tuprio.ns.
Discuss dieots only with supervisors and use only support staff for ptocessi~ necessary
paperwor'k and documentation.
Nevet use client names., k'llials, or identifying data in emails Or' text messages.
E.xceprio.ns to the rules may, and sometimes must be made when thet'e a(e suspicions of
child abuse or negtect when re.::iuited b-f law (such as a subpoena), and wtlen them is a
risk to self Or' others (suicide lhmat or thteat of vidence).
Nevet use soda! media to discuss dieots, even if you change names and identifying
infor"mation.
T he inte.rview it.self should be conducted in priwte, 00( whereothe.r sroff o r clients
m3y overhear. \Vhen greeting a diem in the w3iting room, counsellors should rdrain
from using surnames; however, they need to be sensitive to the fact th.nt many seniors
and people from some cultures are insulted by the casu3l use of their fi rst names.
Sometimes counseJlors meet clients by chance in public places. \\:'hen this h3p,pens, counsellors should ensure that they maintain conftdentiality, even when the client
appears unconcc.rned. They should gently shift the conwrsation to 3 neutral topic or
SllfiCSt a private time and place to continue the discussion. At th.nt time, counsellors
can explain why they avoided a public discussion.
Tab le 1. 2 outlines some important conftdemiality guidelines.
VALUES FOR PROFESSIONAL PRACTICE
Talues: 'MaM individuals and g,oups
consider iapcrual or 11uth.tlile.
Values arc principles or qualities that individuals 3nd groups consider important or
worthwhile. Ethics are de.rived from values. Values represent beliefs about what is desir~
able and good. Personal values describe what individuals consider desirable and what
they believe is riWlt and wrong. Professional values describe fundnmemal beliefs that
the profession holds about people nnd Wtt)'S the worlc of rhc profession ought to be
conducted. Clc3rly, professional values (as reflected in ethical codes of conduct) and
personal wlues have a major impact on shaping the practice of counselling profession.als. T,vo key vaJucs of counselling 3re the belief in the dignit)• 3nd worth of people and
the diem's riaht to self.-dete.rmination.
Belief in the Dignity and Worth of People
Belief in the dignity and wonh of people is the core vaJuc of counselling. This value
commits counsellors to ensuring that their clients nrc t:rC1tted with rcgnrd for their rights.
lt obligates counsellors to demonstrate accept3nce of the individuaJ and to uphold
8
Chap1er 1
confidentiality. Counsellors who wJuc the dignity of their clients apprccintc diversity
3nd reject stcrtt>typing, labelling, and other dehum3ni! ing practices.
Counsellors must treat clients fnirl't', regardless of pcrson3l feelings to\\'ard them. For
example, counsellors must resist the nnturaJ temptation to spend more time with clients
they favour nnd less rime with those whom they find difficult. Counscllors arc expected
to npply their skills and lcnm\-·ledge 3t 3n optimum levcl for eadl client, regardless of their
personal rcaction townrd 3n)' client. Clients may hnvc behaved in \\'ays that counsellors pc.rceivc to be offensive, but this belief does not give counscllors licence to be disrespectful or
to withhold services. Discriminatory practices arc srricdy prohibited by both mnjor codes:
■
Counsellors actively work to undc.rstand the diverse c.ulturaJ bnckground of the
clients with whom they work, and do not condone or engage in discrimination
b3sed on 3ge, colour, culture, ethnicity, dis3bility, gender, religion, scxunl oricma,
tion, mnrit3l, or socioeconomic status. (CCPA, 2007, p. 9)
■
Social workers recogni.!c and respect the diversity of C3nadinn society, taking into
nc.c.ount the breadth of differences that exist among individunJs, families, groups
nnd communities. (CAS\X~ 2005, p. 4)
These ethic.al guidelines underscore the need for professionals to le3m 3bout other
cultures. Such le3ming increases sensitivity nnd 3w3rencss of how values, beliefs, and
worldview define one's behaviour 3nd thinking. This topic will be explor~ in more
depth in Chnpter I0.
Counsellors, espcci31l)• tho.sc who \\'Orie with high-risk clients (such 3S those with
chronic nddic.tion problems) nttd to be careful that their view of, 3nd attitudes toward,
clients do not b«omc jnded. Jad~ counsellors often hnvc 3 cynic.al and pessimistic.
perspective on the willingness 3nd otpacity of their clients to c.h3nJ;e 3nd grow. Counsellors who believe thnt clients arc inapablc of grmvth nrc likely to invest less energy in
supporting c.h3nJ;c. Moreover, they m3y be more prone to using controlling responses
because of their expectation that the "clients c3nnot do it on their mvn." \Vh.nt would
you pr~ict to be the likcJ,.•outcome of 3 counselling session when the counsellor labels
the client "3 hopeless nkoholic''! Conversely, belief in the dignit)• and \\'Orth of people
is expressed through positive practices:
■
involving clients in decision making, g<>3l setting, and problem solving
■
ndopting n strengths appro3ch
■
m3intaining an optimistic view of human n3turc, including the belief that people
nrc c3pable of change nnd growth
Client Self-Determination
Self-determination is the principle thnt clients h3vc 3 right to autonomy and freedom
of choice to make thc.ir own decisions, insofar ns is possible. Counsellors h3ve 3 duty
to respect nnd promote this right even when they disagree with the decisions of their
clients. Moreover, choice is 3n integraJ part of client self-dcterminnrion. \Xfhen clients
h.nve no choices, or believe th.nt they have none, self-determination is not possible;
however, adherence to the principle docs not pre-.'Cnt counsellors from hcJping clients
understand how their 3ctions might violnte the rights of others. Nor docs it prevent
counsellors from helping clients 3pprccinte the potentiaJ consequences of their actions.
Some clients, such as p«>ple with mental disabilities and young children, mny be unnble
to make competent choices. (f so, counsellors m3y need to prevent them from acting in
ways that nrc potentiaJJ,., harmful to themselves or othc.rs.
Sometimes beginning counsellors 3re misinformed about the n3ture of counselling.
They believe th3t their role is to listen to their clients' problems nnd then offer helpful
Protesslortal lden111y: Ethics, Values, and Self-Awareness
self-detennNtion: De pri~
t!l.i'! promffl the rill's ol dients to hM
auton-, and freedom al choice.
9
control
& Informed
coo....
Acuuto
Resources
Kno~ge&
lnfOl'l'l'lation
ltWOl~rMnt in
DecisiOn
Mak»g
Figure 1.1 Essential Elements of Self.Determination
advice or solutions. The principle of sdf~focermination oblig3tes counsellors co avoid
behaviours that control and manipulate clients. lnstead, they must employ strategies
that empo\\'er clients to make independent and informed decisions. The counsellor 's
expertise lies n()( in knowing what is best for the diem, but in being able co manage
the process through which problems arc solved, feelings are managed, o r decisions are
m3de. Empower ment is the process of assisting clients to discover personal strengths
and capacities. In oche.r \\'Ords, through empowerment, counsellors seek to help clients
take control of their lives and rcnli.!e that thq• can improve their situ3tion through their
actions. (&e Figure 1. 1 and Table 1.3.)
Effective counsellors accept chat clients have a r ight to be involved in
counsdling decision making. They have d"K" right to be tre3ted as active pan-ncrs in the coun-sclling process and to participate in decisions affecting their lives. This right is underscored
in the CCPA's Code of &hics(2007}.
C lients' Ritch.ts and l nfor-m~ Con:l:ent. When counsetlu)¥ is initiated, and throu~,.
out the oounsellin¥ pro«>ss as necess:arr, counsellorS inform clients o( the purposes.
¥°"ls. tttbntques. pro«dures. limit3tions. potential risks and btneflts of SeF\+keS t'O be
performed, and other s ueh pertinent in(onnation. CounselLorS m.:tl:e sure that clients
underStand the imphc::uions of di3¥00SiS, (~s and fee. collection arf30$:ements,. record
TABLE 1.3 Strategy Choices for Promoting Cl ient Self-Determination
Use advOCaey skills to help clients access reSOU""ces Or' remove ba(rie<s to existi~ options.
Avoid pfe-scriptive advice and other contr·oiI.-ig responses.
Help clients identify, access. and explOr'e options.
Encou(age clients to make thei( own decisions based on infOfmed chOices of the costs and
benefits ot any cou(se of actbn.
Assist clients in evaluati~ the conseciuences ot thei( actions on others.
Fuly infOfm clients abOut counsel.ling Sltategjes and 100 JX)tential (ISkS. P(omOle
couatx>rative deeision making on goats. Whooeve( possible, pfovide acooss to (ecorcts..
Invite clients to evaluate the progess of counsem~ and the counse!Mog (elatiooship.
When unde< eowt Or'de< or simila, nonvoluntary conditions, provide information on the
client's right to decline semce, as well as 100 JX)SSible conseciuences ot such denial
Whenevef JX)SSible, em(X)wet d ients with chOices.
Adopt a minctset 1r.a1 (ecogni?es the client as the ·ex.pe<r on his or her own problems.
feelings. and ptefet(ed solutions.
Avoid dependency-promoting behaviours, such as dOing fOr' d ients Vtt'lat they can do fo(
themselves, e.xcessive involvement, and indisc(iminate advice givi~.
Encou,age optimism and fostet a relationship of safety to help clients lake (is.ks.
Honou( client lifestyle chcices.
10
Chap1er 1
" ~ • CONVERSATION 1.1
STUDENT: I have just started my field placement, and I am
disturbed by wtlat is happe-ni~. When the team goes for
coffee, ever)()(le jOkeS and makes fun of the clients. If they
Quit.· Such Mg.allows humou'. is one of the ways many ~
pie deal with 100 e-nOfmous sttess of their jobS. Jokes abOut
tr~ ENents 0t client misfortunes help counsellors sustain
tnell emotional wet-being. It ooes n01 mean that they have
beeorne hardened°' uncari~ towatd lheit clients; mthet ii is
a W:¥f of unwiOOingand relievi~ consrant pressu-e. As you\.e
koow how their counseuors talked about them, they would
never come back. I did 001 know lhat professionalS could be
so Cdd-hearted. ts tnell behaviout unethic:ar?
discovered. one of the dangers of gallows humour is lhat others wdl over-hear ii and draw conclusions abOut the person's
attituOOS. ts it uoothi:.al? What dO you think.?
TEACHER, Just before t,;sexecutial by haogj~. a c:oodetMed
man is offered a cigatette. MNo thanks,.· hes.a~ M1•m trying to
keepifl$:. 21nd limit'S o( ronf"tdentiality. Chenu h::n,e the ri$:ht
t'O
pc:uuc:ipote in the on~-o-
re(use 2111)' reeommended servke!l. 3nd to be 3dvi.sed o( the
consequence!? o( soch refuS3.L (pp. 7~)
in~ counsellin& phms.
t'O
Rights of Children
As a rule, "cnpable" children arc entitled to confidentiaJity unless there is n reason
to suspect that the child might harm himself or herself or others. As wcll, situations
involving child abuse or neglect must be reported. In this respect, a child can rccejvc
medical treatment or consultation on is.sues such as binh control/abortion, mental
health problems, and addictions counselling Ousticc Education Society, 2015).
In 1991, Cannda signed the United Nations Oeclnration of the Rights of the Child,
which oblig3tes it to enforce children's rights as outlined in the Declaration. Nevertheless., United Nations officials hnvc criticized the country for its failure to adequately
address the needs of Aboriginal.disabled, and immigramchildren asweJI as those living
in poverty (ScoffieJd, 2008).
ETHICAL DILEMMAS
An ethical dilemma exists when a choice must be mndc between competing wJucs and
potcntl31 courses of action. A decision to remove a child from a home where there is
ob-.•ious nnd significant abuse is 00( an ethical dilemmn since the gravity of the situation
gives no room for choice. On the other hand, removing a child when the home situa,
tion is marginal requires weighing the risks of potential abuse against the drawbacks of
separating a child from his parents.
By virtue of their role, counsellors may have simultaneous obligations to different
people and groups., including the agency that employs them, their clients, the community at large, and the lcg3J system. When oblig3tions conflict, an ethical dilemma is
created with risks and benefits to ench potential solution.
)}t) BRAIN
ethical dilemma: Asiluati>n invdving
a,mpeting « ccaHictilc values or
prilciples.
BYTE
functional magnetic f&S003r')C8 imagk'lg <fMRO has enabled
researchers to identify afeas of the brain that are active when
pooJje addmss m0tal and ethical dilemmas. The msu1ts
sho.-.ed that amas of the brain associated with etnations tend
to predOminate. particulatly when the-re is a more perSOoal
involvement in 100 dtk>mtna (Science Dail'j, 2001). Aoothef
study re(X)fted by Riddle (2013) in ScientifJC: American con-
cluded lhat "out pfofessed mOr'al principleS can be shifted
by subtle differences in mOOd and how a question is JX)Sed.•
These findings underscOr'e the value of counsellors consulting
with others and avoiding iinplJSive actions when confronted
with diffreult ethical decisions.
Protesslortal lden111y: Ethics, Values, and Self-Awareness
11
While ethical codes that are based on the vnJucs of the profession attempt to define
acceptable behaviour, they usually do not offor answers about specific situations that
arise for counselling profossionnls. Even though they do 00( provide precise guidelines
for resolving aJI dilemma~ codes arc an important reference aid for decision making.
Types of Ethical Dilemmas
I . Distribution of scarce resources (rime, money, and opportunity to participate
in a pros:ram)
■ An agency has limited funds available to assist clients with retraining. \Vho
should get the money- the client with the greatest potential for success or the
diem who needs it most?
2. Professional competence and e thical bcha,four of colleas:ues
■ A student on internship (fidd placement) becomes a"'"Urc that her supervisor is
attending an AA meeting with one of he.r clients.
■ One of the staff informs you of his intemion to phone in side to extend his
vacation a few more da)'S.
3. Policies and procedures of the as:cncy setting that appear oppr~sh'e or inscnsith<e
to the cultural/dh·ersity needs of the clients it ser,-es
■ A worker has information about a client that, if made known to the ai;cncy,
would make her ineligible for services that she badly needs.
■ You become aware that your client, a single mothe.r on wdfare srrus.,tling to care
for her four children on a meagre budg,et, received a cheque from her mothe.r to
hclp with expenses. Legally, she is obligated to declare this income, which will
be fully deducted from her next welfare P3yment, thus, depriving her and he.r
children of much•nccded assistance.
4 . Behaviour of clients
■ A 17-year-old girl asks for your help to obtain an abortion without involving
her pnrcnts.
■ Your client informs you that he has tested positive for HIV, but he hasn't
informed his parcne.r.
■ A 16-year-old boy tc11s you that he is working as a p~titute.
■ Your client casually mentions that he robbed a bank several months ago but was
not caught.
5. Competing values, needs, procedures, or leRal requirements
■ A IS..)'C3r-0ld girl discloses that her father has been abusive, but in recent wedcs, he
seems to have changed. She asks that you do not make a report to the authorities.
She says she knows her father will retaliate if he finds out that she has told anyone.
■ A young J6.ycar-old Jehovah's \Virncss as.sens her belief that she should not be
given a blood transfusion to deal with a terminaJ illness.
■ An abused child S3YS he will 00( cooperate with removal from his parents and
that he will run away from any foster home.
Resolving Ethical Dilemmas
Erford (2010) describes five ethic.al rules or principles that can be used to help resolve
ethicaJ dilemmas:
I. Amonomy: Honour clients' self-determination and the.ir frttdom to make their own
decisions.
2. Beneficence: Pursue the welfare and benefit of others.
3. Nonmalef,cf!'nu: In simple term~ do no harm to others.
12
Chap1er 1
4. )1urice: Strive for an equal distribution of resources and equitable effort among
p3rticipants.
5. Fideliry: Be loyal 3nd honest and keep promises.
Under idea] conditions, counsellors c3n honour all five principles, but ethic3l dile.mmas by nature represent competing principle~ 3nd C3ch choice involves unique consequences. Ethic31 decision making involves identifying 3nd we.ighing which of the five
principles ought to take priority in any given situ3tion.
The application of any modcJ for ethical decision making docs not mC3n that resolution of ethical dilemm3s will be easy. When values and ethics compete, deciding which
one should h3\'C priority c3n be painfully diff1euk Consider 3 case where an individu3l
in remission from cance.r stipulates th3t if his cancer rerurns he docs not want further
surge.ry or other invasive tre3tment. Suppose yc3.rs later, he devcJops dementia and
his cancer returns. He now asserts that he wants trc3nncnt. \\:fhich "pc.rson 's" wishes
should a c3regivcr honour, the one with sound mind from the past or the current one
with diminished capacity! (Adapt~ from Locke, 2014.)
lntimate knowledge of cthic3J principles and legal guidelines can make the decision.making process dearer, albe.it no less difficult. For example, 3 client's right mconfidenti3fity 3nd self-determin3tion must be given up when that client discloses child abuse, 3nd
the duty to warn principle means that profcssion3fs must brc3k conftdentiality to warn
potential \•ictim.s. However, it is not a1wa\'S dear when a client's bch3viour constitutes
dange.r to the safety of others.
The principle of sdf-determin3tion protects the right of people to make errors and
c3rry out 3ctions that others might consider wrong. Counsellors must consider when
the applic3tion of this principle must be abandoned because the individu3f 's behaviour
might result in death, such 3s in a case where 3 client threatens suicide. \\:lhile counsellors have a clear legal and ethical responsibility to inte.rvcnc to prevent suicide, their
responsibilities arc not as dear for other ch3llen,;cs. For example, the lifestyles of homeless persons m3y reach the point where their h\'gicne, living, and C3ting h3bits become
dangc.rous for them. The point 3t which their right to self..dete.rmin3tion should )tield
to their right to health and well-being is not easy to establish. An ethic3J dilemma exists.
There 3re four steps counsellors c3n take to resolve ethical dilemmas(scc Figure 1.2).
Step 1: Gather Fads During this stage, it is important to controJ 3ny tendency
to act impulsively. Remembe.r that assumptions 3nd hears3y 3re not the s3mc 3S facts.
Most ethic3J codes require that profcssion3ls s«k resolution with colleagues before
procttding. For e.x3mplc, the CCPA code advises a counsellor who has concerns 3bout
the ethical beh3viour of another counsellor "to s«k an informal resolution with the
counsellor, when fe3sible 3nd appropriate" (2007, p. 6). In many case~ frank discussion
with colleagues revc3fs additional information or results in a S3tisfactory solution.
Step 2: Identify Ethical Issues and Potential Violations At this point, r<fer
to the appropriate code of ethics (CASW, CCPA, etc.) to identify whether the matter unde.r question is addressed in the code. If the person in question is not govc.rn~
by 3 professional code, then 3gency policies and procedures or local legislation m3y
))t) BRAIN
BYTE
[ lI
, ,, I 1 .• ·
JI, ,
Curr'ent and emerging oour'oimagi~ techniques raise 100
possibility that one day lhese lOOIS could be used to (83d
minds. perhaps to deternine if a per-son is tying 0r harbOur'·
ing prejudicial views. In fact, rudimeniary toolS to do lhis are
· · I ,_
already being used. This raises rn'lportant ethical Questions:
to what ex.tant migt\t neuroscience be used in le-gal settings to
determine guilt 0t whether 0r not a person ShOulcl be gr'anted
paroo CSmm,. 201311
Protesslonal Identity: Ethics, Values, and Self-Awareness
13
l.Galher
FaclS
...
2 . Identify
Ethical Issues
Pocential
3. Identify
and Evaluate
Options and
Strategjes
V.outions
Figure 12
Model for Resolving Ethical Dilemmas
provide important reference points. For example, m3tte.rs of discrimination in Canada
are 3ddressed under the Canadian Human Righu Acr (1985).
Step 3: Identify and Evaluate Options and Strategies
Here the goal is to list the
potential action strategies. \Vhere appropriate, consulting with colleague~ professional
ori:ani.z3tions, 3nd supervisors c3n assist in generating altern3tives.
Reflective questions help you consider the merits and ramifte3tions of any action
pl3n. He.re are some S3mple questions:
■
What 3re the 3dvant3ges and dis3dvant3ges of not taking action?
■
What 3re the 3dvant3ges and dis3dvant3ges of taking 3ction?
■
What are the potenti31 consequences (short-term and long-term) of 3ction or
inaction!
■
Who might gain or lose?
■
What other individuals or org:.mi:rations 3re likely to be affected?
■
To what extent might other factors be influencing my judgment (e.g., unresolved
relationship problem~ bias, and hidden agendas)?
■
Wh3t values 3nd principles have priority? Boyle and colle:igues (2006) suggest 3 rank
order of echicaJ principles (s« Figure 1.3). They identify seven ethicaJ principles,
Figure 1..3
Ethical Princip les Hierarchy
Adapt@d r,om so-,,1e e1 at. 2006. p. 97.
14
Chap1er 1
-- Ceetr,.._
..,_
..,_
No
Figure 1.4 Matrix Oecision•Making Chart for Ethical Dilemmas
giving the highest priority to protection of life, which su~rsedcs 3JI of the other
rights. The equality nnd inequality principle entitles people to be treated equaJly,
and this right supersedes an individual's right to autonomy and freedom. The least
harm principle aims to minimi:c the advc.rsc consequences of any course of action.
The quaJity of life principle SUjlRCSts that counsellors should choose aJtc.rnativcs
that enhance quality of life over those that diminish it. Privacy and confidc:ntin1it)•,
while important, arc given lesser priority than those rights higher on the hierarchy.
Similarly, truthfulness and full disclosure arc important ethical principles, but they
may be compromised if overridden by other, higher-mt~ principles.
A matrix chart, such as that illustrated in Figure 1.4, can be used as a tool to compile
and compare the bcndits and risks of the a1tc.rnatives. A ~parate anaJ,.•sis should be
done for each choice. Entries should consider both the short.- and long-term costs and
benefits of a given cour~ of action. Consult with experts and others when completing
this task.
Step 4: Take Action A ~ action plan should include details of the intended outcome. a list of the people who neo:I to be involved, required resources (e.g., information,
mttt:ing space, and cxte.rnal facilitator), and the JittlUCnce of events that must be accomplished. A concrete timetable with dearly defined steps ensures that you will not lose time
wondering what to do next. The action plan should also anticipate obstacles and identify
strategies for addressing them. For example, if )'OU are confronting a colleague on a breach
of ethical behaviour, it would be wise to consider what you might do if the colleague
■
launches a counteranac.k.
■
reacts with feelings such as anger, remorse, or shame.
■
denies that the behaviour occurred.
■
asks that you keep your lcnO'l.\rledge of the breach confidential between the two of you.
SUCCESS TIP
Resolution of ethical dilemmas is lntellectualy challenging and emotionaly &axing,. Seek
appcopri".ate consultation and supervision for ~noing and debriefing.
Objectivity
Effective counseJlors ma)' become intimardy familiar with the lives of their diem~ )'et
they arc required to remain objective. O bjectivity is defined as the capacity to understand situations and people without bias or distortion. \Vhcn counsellors are objective,
Protesslonal Identity: Ethic s, Values, and Self-Awareness
objectivity: ne ability to understad
ree.p, thoclpas. and bdt.lriour without
al~
penonal values, belit.ls. •d
bias.es to interfere.
15
assumptions: Oistottions oc lalst c:icadusicm bas!d on siapliv.ic teasoning.
ilcomp~e inforaution. • bias.
they understand their clients' fccJings. thoughts, and behaviours without aJlowing their
pc.rsonal values, belief~ and biases to contaminate that understanding. They aJso do not
directly or subtly cry to impose their prefcrr~ solutions on clients.
CounseJlors can fail to be objective in a number of ways. The first is to make
assumptions. Assumptions arc distortions or false conclusions based on simplistic rc3,.
soning, incomplete information, or bias. Counsellors who have had similar experiences
to their clients' may assume that the.ir clients' problems and fttlings arc the same as their
own. Conscquendy, they don()( take the time to investigate the distinctive viewpoints of
their clients. Counsellors aJso may make assumptions about the meaning of words, but
this danger cnn be avoided if counscJlors remain alert to the need to probe for individuaJ
client definition and meaning, as in the following example:
Client (spe:a.kina tet a Fir;;t N3detns <:eturuellor): I moved here :.bout (h~ )'l":arS ~o.
I Kuess you know how t'O~ it is (m- an Indian in this dty.
CetunseUor (Choke I): I sure do. PreJudiee i.!l e\'e:r)•where.
CetunseUor (Choke?): As you say. it is not e:3Sy. But it's di((erent for e\'eryone. I need
your help to understand better what it' s be<en like (or )Ou.
CONVERSATION 1.2
ST\JDENT: I know vd'lat I'm supposed to do, but I'm wOfrted
abOut hO'N Ican conttol my personal feelings vd'len I'm intetviewing SOO"MlOOO who haS done sornethi~ te(tible. sud'I as
tape a ctltk:1 ot beat up his wife. How do you Slay objective in
situations •ke those?
SUPERVISOR: Tel me a bit about what you think you a(e sup.
posed todo.
ST\JDENT: 1need to make SU(e that I am obj,e,ctive and that I
do not let my personal feelings interle-re.
SUPERVISOR: Sure, that is the ovetaU goal. Ho-.veve-r, au of
us wdl have some pel"S0031 feelings about \\tlat die-nts have
done. Your fears a(e very normal fOr' someone just saarti~ in
the field. usuatty, with a bit of expe(aence, most people a(e
able to manage their footings.
ST\JDENT: What if the client's behaviou( iovotve-s 1r.iogs that
do not allow me to get past my initial (eYulsion?
SUPERVISOR: If that happened to me. I would have to ask
myse-if, ·can I be sufficiently in conttol of my own feeli~
to wOl'k effectivety with this person?'" In some case-s, I can
compensate fOI' a bias, and in Olhet cases, 1ptObably should
nol be iOVOl\l&d in the the-rapeutic (elationship. However, I am
no1 sure tr.at anyone is at,e tosaay truly objective in situations
whete they are iovotved with someooo who has pe(petrated
a violent c,irne or hatmed a young chlld. The big questions
fOI' me are, "How do I maintain an awareness and openne-ss
abOut my personal feeli~r and "HON dO I mitigate those
footings W'he-n deali~ with a pe(S()O \\tlo has done such a
16
Chap1er 1
thing?'" S0tnetime-s suctl cases bri~ up untesolved issues
from our O'Nf'I past that need to be te-e-.Karnined 01' p t ~
flXthe-r. Sometime-s we simpty need toacknowtedg,e that the-re
are certain practice a(e.as tr.at are not the be-sl fit• foe us
individually as ptaCbtioners. The value of supervision in suctl
clfcumstances rS Clea(.
8
STUDENT: Do I have to like my clients W'I orde( to wOr'k wilh
them?
COUNSEllOR: The-re will always be clients who rub us the
wrong way. Some a(e demanding. insuting, Or' threatening.
and it's a challe-nge to fe-e-1 any (e-al empathy. If that's part
of the c~nt's usual style (and it oft.en is), then this pt'O\lide-s
impor&ant information that can be addtessed in counse-tliog.
If a client Mpushe-s our buttons_· some-time-s a lltue introspection is in Ol'de(. Do OU( (e-actions ttlgge( memorie-s of Othe-r
unresdved issues 01' experiences in our lives?
STUDENT: Transfe-rence?
COUNSULOR: Yes, it sure could be. We atsoneed to deal wilh
a range of olhet fee-tings that can a(.se such as feellngs of
overp(otectivene-ss toward a client. Ct, when we have strong
positive fee-tings. These tesponses may need to be managed
just as much as. \\tle-n we wol'k with clients. \\tlo aro~ our
disgust, a•(· 01' frusuation.
STUDENT: from what you've been saying, in au cases, the
goal is the same. Be aware of out personal teactions, 100n
manage the-m. If this isn'I possible, (,efe, the Client Ol se-ek
s.upel"Vision and support f0t youn;e-lf.
(n this examp le, C hoice I cuts o ff th e discussion, and the counseJlor loses a vnJuable
o pponunit)' to ap preciate the client's exper ie nce. Choice 2, on the o ther hand, o ffers
gen tle e mpathy and then p robes for m ore detail. This second response reduces the risk
that the cou nscllo r will make e.rrors o f assumption.
A second way chat cou nscllo rs can lose objectiv ity is by over -ide ntify ing with clien ts. Whe n ove.r-ide ncification occurs, counsellors lose their capacity to keep sufficie nt
emotio nal d istance fro m th eir clients. Their o"'n feelings a nd reactions become mixed
up with those of their clients, cloud ing che.ir jud gment. C ounsellors who fin d th emselves in this position ma)' find chat persona] cou nsclling or consultation with a su per•
visor is sufficient to help the m regain objectivity, or they may condude th at referral to
another co unsellor is necessary.
A third Wtt)' chat counsellors can lose objectivity is by becoming ove.rly involved
with clients. This over-involvem ent includes duaJ relationships prohibited by ethical
codes, as wdl as relationships in which cou nscllo rs rdy on clients to meet their social
and psychological needs. To prevent chis from happening, cou nsello rs n eo:I to make sure
that th ey are meeting the.ir personal needs in other W'n)' S. As weJI, co u nsellors should be
alert to signs th at they ma y be ove r-involved with particular clients.
SUCCESS TIP
Waming signs of O\let◄nvotvement: Interviews that consistently run O\let lime, tefief when a
client misses an appointment, excessive worry abOut clients, teluc&ance 10 end a counselling tetationship that haS reached a point of tennination, M~ttons• being pushed, 0t strong
feelings (negative 0t positive) toNard the client evOk.ed.
Tab le 1.4 summ ari!es p rotective strategies counseJlo rs ca n u se co avoid loss of
objectivity.
TABLE 1.4 Mai ntaining Objectivity
Loss of Objectivity
Pto1ective Stratery Choices
Making assump(ions
• Attempt to understand and monit0r you- prejudices. preferences.,
and biases (e.g., cullural, gender, and teli~us).
• Develop setf-awareooss regarding personal needS and values.
• Listen to but do not be contrOlled by the opinions of otherS.
• Be k'lquisilive. Uptore ead'I client's situation to discover his 0t
het unique perspective.
• 8tainstOl'm 0t seek infotmation frOO'l all perspectives.
• Check your conclusions with clients 10 see if they match lheil'sseek definition. detail, and examples.
• Monit0r reactions and discover areas of vufnietability; be alert to
strong negative Or positive reactions 10 clients.
• Refer d ients vd'len you are not impartial ot able to conttol )'OIX
Over-identification
leeti~
• Know why you want to be a eounsettor- underStand your needs.
• use COiieagues to analyie your reactions and give you feedbaek.
• use toots sud'I as video rec0tdi~ to review interviews lot
inappropriate attemprs to influence or contror.
• Avdd promoting d ient dependency.
• Develop a wellness program to ensure that you are not rel'jing
on youf clients to meet )'OIX needs f0r social and psychOlogical
i.nvolvement and acceptance.
• Recognize wani ng signs of over◄nVOlvement.
Prot esslortal Identity: Ethic s, Values, a nd Self-Awareness
17
CONVERSATION 1.3
ST\JOENT: ts it ever- Okay to be sexualty intimate with clients?
TEACHER: No! Uni"8(S31Iy, ethical Coeles ot behaviou( PfO•
hibil sexual intimacies 'Mth clients. for example, 100 CASN's
Guide/it)es for £Jflical Ptactic.e (2005) succinctly states that
•social WOr'k.ers dO not engage in romantic relations.lips. sexual activities 0t sexual contact with clients. even if such con1ac1 is sougt\t by dients· (p. 12). A similar iniunction ex,:ilic:itty
stated i"I the CCPA's Code of Ethics (2007) prOhibits any type
of sexual relationship with clients aoo any counsem.ng relationship with clients with whOm they ha\18 had prior sexual
relationstips.
STUDENT: That seems str-aightiorward. What about beCOming
involved with f0tme-r clients?
TUCH£R: That's a mOl'e diffieult question. My opinion is that
you never Should. but you ShOuld consult indi\lidual cOdes of
ethics fOr' specific guidelines.. For example, 100 CCPA code
reciutes a minimum of 1r.ree years between the end of the
counselling relationShip and the begjnn.-ig of a sexual relationship. The petiod is ex.1e-nded indefinitely if 100 client is
cl8ar1y vlJnerable. In any case, counseUOrs Mcl8ar1y bear the
b1Xden to ensure that no such explodati\'e influence has
occu«ed" (2007, p. 9). A review of the liter-ature concludes
that harm to clients does occur when p(ofessiooalS have
sexual contact wtlh clients.,. including "denial, guilt Shame,
isolation, a•(· deptession, impaired ability to trust, loss of
self-esteem, difficulty ex.ptessing anger, emotional liabtlily,
psycMsomalic disorders, sexual confusion, and increased
risk of suk:;oo· (Beckman et al., 2000, p. 223).
STUDENT: What about Other- types of involvement? If you are
a counse!IOr' in a s.mal to-M'I, it's impossible to avoid social
contact wtth clients.. Your client migf\t be the owner ot the onl'j
grocery store in town.
TUCH£R: COdes of ethics fo( the various counselling professions (e.g., psycholOgy or social wo,k) frown upon dual
relationships when there is a possibility that counsenors wil
lose obfe(::tMty or where there is potential fOr' client exploitation. In large cities, it's usualty easy to refer clients to avoid the
conflict of i"lteresl of dual relationships.. As you point out it's
much more difficult in a small town, and some dual relatiol\Shiparra~ments may be inevitable. Howe\18r, relationships
Should oover include sexual intimacy wtth cu«ent clients.
THE COMPETENT COUNSELLOR
A high level of sc]f.3wareness enables counsellors to make important decisions regarding
arc3s in which they arc competent 3nd those in which reforraJ to other professionaJs is
warranted. Counsellors must practise only within the range of their competence, and
they should not misrepresent their training o r c:xpc.ricncc. This helps to ensure that
they do no harm to clients. T he following guidcJines provide reference for working
with competence:
I. \Vork within rhe limiu of competence. Counsellors should offer counselling services
that arc within the limits of thc.ir professional competence, as measured by edu.cation and professional standards. Competent counsellors use only chose cc-ch.niquc-s and strategies that they have been adequately trained to appl)•. They know
that the support and assistance- of other professionals is necessary for issu es that
exceed their expertise. Until counsellors have received the necessary training and
supervised practice, they should not work in specialized arC3s of practice, such
as interviewing children in abuse situations o r administering or interpreting pS)•,.
chological tests. For example, re3ding a boolc or attending a ,vo rkshop on mcmal
health does not qualify untrained counsellors to make psychiatric diagnoses, nor
would attendance at a short seminar on hypnosis qualify them to use hypnosis in
their work. Such speci3Ji!ed interventions usually require certification b)• their
professional body.
CounscJling requires skilled interviewing but includes the additional goal of
helping clients with such activities as problem solving, dealing with p3inful fee],.
ings., and de-vcJoping new skills. Psychotherapy involves intensive counselling with
emphasis on persona1it)• change o r the treatment of more severe mental disorders.
18
Chap1er 1
2. Pursm~ professional rraining and detelopment. CounseJlors should monitor their w-ork
and scclc supervision, training, or consultation to evaluate their effectiveness. They
should pursue continued profession:.d development to increase the.ir competence
and kttp their knowledge current. This helps to ensure that their work is based on
evidence-based best practice derived from accepted theory supported b)• empirical
research. People would not want to Stt a doctor whose most r«ent training was
decades ago in medical school. Similarly, clients should not be expected to work
with counsellors who are not current in their ficld.
Professional counsellors need a core lcnowledi;c base, which typicall)• requires
nvo or more years of academic training:, including supervised clinical o:pcrie.ncc in a
recognized counselling or social service serting. Moreover, throughout their career~
counsellors should expect to spend time in reading books and journals to increase
their knowledge. As well, regular attendance at courses, seminar~ and conferences
should be a part of everyone's professional career.
By keeping the.ir knowledge base current, counsellors arc better able to be
empathic because they arc more aware of the issues and feelings that their clients
face. Moreover, keeping up to date helps counsellors avoid judgmental responses
based on only their O\\•n frames of reference. The range of knowledge that counsellors need to pursue includes the following:
■ Specific is.sues, problems, and c.halleni;cs that the.ir clients arc facing. For example, counseJlors ,vorking: in corrections need to know something about finding a
job if one has a criminal r«ord and coping with the stigma of a criminal record.
As another o:amplc, many clients arc dealing: with poverty, and counsellors nttd
to be aware of its social and psychological effects.
■ Relevant medical and psychiarric conditions (e.g., attention deficit disorder, multiple
sclerosis, schi:ophrcnia, bipolar disorder, and autism). Counsellors credibility and
competence is greatly enhanced if their lcnO\\•ledge of these conditions is current.
■ Lifcst)•le wriations(c.g.., same-sex relationships, single P3rents, extended families,
and blended families).
■ Cultural awareness about the values, belief~ and customs of others.
■ Lifespan development (i.e., developmental chani;cs and milestones from birth to
death). Life experience can greatly increase a counsellor's capacity for empathy
and understanding. Of course, life experience may also cloud judgment and
objectivity, so it is important that counsellors scclc training and consultation to
increase their understanding of others' experiences.
■ Monitoring: emerging trends in neuroscience.
3. Be self-au,areof personal reactions and 1mresolt\!d issues. CounseJlors need to be aw-nrc
of situations where their clients' problems parallel unresolved issues in the.ir O\\•n
lives. This awareness is important to help counsellors lcnow when to scclc consultation or supervision, when to refer clients to other ,vorkers, and when to enter
counselling to address their own needs. Clients have a right to expect that their
counsellors are objective about the is.sues being discussed and that their judgment is
not imP3ired by bias. unresolved personal problems, or ph)•sical illness. If counsellors have emotional or physical problems that affect the.ir ability to give competent
se.rviccs., thq• should discontinue se.rvicc to the client.
In addition, large caseloads and the emotional demands of counselling: worlc may
result in emotional and ph)•sical fatigue, the.reby weakening: a counsellor's competence.
Competent counsellors monitor their emotional health: by setting limits on their
amount of worlc, they arc able to leave time to pursue personal wellness and balance
in their lives. Familiar with the dangers of burnout and vicarious trauma, they de,.•c-lop
strategics to prevent these career threatening reactions.
Protesslonal Identity: Ethics, Values, and Self-Awareness
19
CONVERSATION 1.4
ST\JOENT: I'm just a begj.nnet. So, if I am supposed to work
withrl the limits of my competence, I ShOt.ldn't do anything.
TUCH£R: Like many counseltors whO a(e just starting. you
may feel a bit overwhelmed.
ST\JOENT: I cSon't want to say or do the wro~ thi~. What if
I doni know the right answers. Or' I oon·1 say the right thing
to clients?
TEACHER:
flrst lhe(e is rarety a single rigt\t way to respond.
Most often, them is a range of d'IOices ot thires to say Or' oo in
any situation. Second, no one kroNS all lhe rigl\t answers. Be
hOoost with diants abOut the fact that you are stll a Sh.dent and
oon1 be afraid to adnil )(II.I' limitations, as this i:,ovi:Ses we.at
modelli~ for clients. One goal of ttaini~ is fOr' you to ~ d
your r'af'@e ot d'IOices so lhat you can respond based on the
needS ot your clients and thes situations. Remember', leami~ to
be an effeclMl c:ounseno, Isa lilOIOngproooss. At this Sfall!!. you,
professional responsibility is to make effectf\18 use d supervisors
to monitor' )(IU' \\O'k. use them to oovelOp you Skits. Make it
easy f0t them 10 flve you feedback. Seek 1t out. an:S then try 10
be noroefensM>. l.OOk fat oppcrl\Jntties 10 •Pl'IY you, deYelopir'e
k ~ base b'f &aki~ some risks 10 k>am re1t Skins.
wren I first srarted k'I the flel:j_ I aaso feared sayk'lg something that would damage my client When I shated this feeling
with one ot my prolessors. he put 1t in perspective by saying.
"What makeS you think you're so important to the d ient?·
In general, interviewing is 3 process of gathering inform3tion without any expectation of influencing or changing clients. Competent interviewing rttauir-cs an 3bility
to explore 3nd understand clients' attitudes, fttlings, nnd perspectives. The basis for
this competence is 3 nonjudgmental attitude 3nd intelligent application of the 3ctivc
listen in a: sic ills of attending. using silence, paraphrasing, summ3rizing, and asking ques..tions (sec Ch3ptc.rs 4 to 6). Although the principal goal of interviewing is information
gathering, the process of interviewing ma)' IC3d clients to rcJcasc P3inful or forgotten
fttlings. Thus, adept interviewers 3re capable of dealing with unpredictable re3ctions
th:.n the interview elicits or of referring clients to 3pproprinte altern3tivc resources.
Moreover. they know when and how to probe effective!)•.
SELF-AWARENESS
Everything rhat irritares us a.bow others can lead us to an under.ttanding
of ourselt.1es.
--Ca,f )uns (publ lcdoma en)
The Importance of Self-Awareness
Compctent counscJlors need to acquire a high level of 3Wareness of who they arc. Until
counsellors develop self-awareness of their own needs, fccJings. thoughts, 3nd behaviours, including their personaJ problems and their 3reas of vulnerability, they will be
unable to respond to their clients with objectivity. T3ble 1.5 contrasts the characteristics
of counsellors who h3ve high levels of self-awareness with those who have low Jc,.'Cls
of self-awareness.
CounscJlors who lack self-aw-arcness and 3re not motivat~ to pursue it arc destined
to rem3in un3ware of the ways they influence clients. For c.x3mple, they may be un3ware
of how their nonvcrbaJ reactions to controversial topics betra)' their biases 3nd discomfort. Capuzzi 3nd Gross (2009) highlight the importance of counsellors developing
awareness of thc.ir own spiritu3I and religious beliefs to 3ppropriatcly engage with their
clients' spiritual issues: "Counsellors m3y not pick up on their clients' concerns because
of their own bi3s or may piclc up on these themes too rc1ldily to the exclusion of other
issues" (p. 304). They m3y avoid pnrricul3r topics, or they may behave in cenain wa)'S to
m3slc their in~uritie.s. As another o:3mple, counsc-llors with personal needs for control
m3y meet this need through excessive and inappropriate advice giving.
20
Chap1er 1
TABLE 1.5 Self-Awareness
counsellors with Setf-Awarei,e:ss
• Recog.-.ze and underslancl their emotional (eactioos.
• Accept tr.at everyone's experience is different
• Know where tneil' foof~ end and those ot theit clients begin.
• Recog.-.ze and accepa a(eas ot vulnerability and un(&SOl\ied
issues.
• Unde<staOCI pe-rsonal vah.Jes and their inftue~ on the
counselling telationst-.p.
CounsellOrs without Selt-Awarenes.s
• Avoid ot ate unaware of theit feeli~.
• Assume clients wi• resJX)nd ot f/MII the same as lhem
• Project pe-rsonal feelings onto d ients.
• R&SJX>nd inappropriately because unresolved prot,ems
inte-rfete with theit capacity to be ot:;ective.
• Unde<staOCI and conttOI personal defence mechanisms.
• React emotionally to tnelr clients but don't uOClerStand
why or how.
• uncoosciousty use cliMts to WOr'k out looir o,m personal
difficulties.
• Remain blind to defensive reactions.
• Recog.-.ze and manage internal diatogue.
• Know hOw they influence clients and counselling outcomes.
• Remain una-Nar"e ot how their behaviour inft~oces Olhers.
• MOClify beha'Jiout baSed on teactioos of clients..
• Behave based oo personal needs and styte rather tr.an in
response to the needS and feacl:.ions of clients.
• Set prolessional goats based oo knowledge ot perSOoal and
• Avoid Of limit goal setting beeause they are unaware of
personal and protessi::>nal needs.
skill SlrMgthS and limitati:)ns.
• Accutatety identify and apptaise counselling skill competence.
• Overestimate Or' underestimate eounseni~ Slul
• Know those areas that are llk.ely to lrigger unhelpflA feelings
• Are reactive without i.nsigt\t.
competence.
0t responses.
Increasing Self-Awareness
Counsellors who 3rc serious about dcvcJoping their self.awareness are secure enough
to rislc exploring their strengths and limitations. Self.awareness means becoming
3Jcrt and lcnowlcdgcable 3bout personal W3)'S of thinking. acting, and feeling.
ScJf.3w3re counscJlors arc strong enough to be open to discovering 3spccts of
themselves that they might prefer to keep hidden. This is 3 continuing, c3reer•long
process that requires courage as counsellors loolc at thcmscJves and their ability to
relate to others.
Colleague~ supervisor~ and clients can be extreme!)• hcJpful sources of informa,
tion, but their feedback needs to be cultivated. Generally, people 3re reluctant to deliver
critic31 feedback, hO\\•e-vcr hcJpful it ma,., be. Therefore, it is important that counscJ.lors create the conditions th3t encourage feedback. They can invite input from others
through a number of srrntegics.
The first strategy is to create a safe climate. People balk at giving feedback to other~
because they fear how it will be rccejvcd. One concern is the rislc of retaliation: "If 1 SU)'
something, will I be annckcd or m3dc to foci guilty?" Another common worry is th3t
feedback will damage the relationship. The major conce.rn also might be that feedback
will cripple the other person's sclf•cstecm.
Therefore, counsellors must demonstrate th3l they arc read)•, willing, and able to
respond nondefcnsivcly to focdbaclc. They have a responsibility to consider feedback
3nd, when 3ppropriate, to nct on it. They don't h3VC to 3grcc unconditionally with what
has been s3id to them, but they must listen 3nd give nonaggrcs.sive responses-in other
words, without blame or excuses. Sometimes such control can be difficult to sustain,
pnrticula.rly if feedback is delivered in an uncaring 3nd hostile m3nne.r. A gencrnJ rule
when denJing with clients is that, no m3ttcr what clients say or do, counsellors must
maintain a professional role. Of course, this docs not preclude setting appropr13tc limits,
nor docs it mean th3t counseJlors have to tolerate personaJ or physical abuse. lt means
Protesslonal Identity: Ethics, Values, and Selt•Awareneu
21
stayina calm, beina nondcfensivc, and rcfrainina from rctaJiatory responses, such as
name callina or makina punishing statements.
The second StTil.teay is to use active listening skills to ensure that feedback is con.crctc or spccifte. CounscJlors can ask questions to J;Ct derails, definitions, examples, and
clarification. Summari!ing and paraphrasina can also be u~ to confirm underst:mdina.
Who Am I? How Do Others See Me?
Self.awareness for counsellors involves answerina nvo basic questions: Who nm I! and
How do o the.rs see me! These questions require co unseJlors to explore and understand
their pe.rsonal feelings, thoughts, and behaviour.
Feelings Effective counsellors arc comfortable discussina a wide range of emotions.
They do not avoid feelings; in fact, they recognize that, for many clients, understand·
ing and mannging painful emotions is the greatest o utcome o f counselling. To under•
stand client emotions, co unseJlors must be in rune with their own emotional reactions.
Empathy, the basic tool for unde.rstandina the feelings of o thers, will be contaminated
unless counsellors are fully in touch with their own feeJings. This includes knowing
whe.re their feelings end and those of their clients begin.
Work and personal srress may also ncg3tively affect a counsellor's capacity to relate
effectively to clients. Counsellors must be aware of stressful situations and understand
how they react to them. Self.aware counseJlors avoid o r reduce strcs.sors b\• developing
pe.rsonal wellness plans for coping with the inevitable demands of the job.
Thoughts Counsellors need to be aware of their own inte.rnal d ialogue-the inner
voices that evaluate their actions. Counsellors with low self.worth t)tpically find that
the inner voice is c ritical, issuing mes.sages such as "J'm no good." Negative seJf-talk can
lead to emotional d istress and interfere with co unseJling performance in several ways:
■
Counsellors may be reluctant to be assertive with clients and may be excessively
gentle o r nonconfrontational.
■
Counsellors mn't' be unable to assess counselling relationship outcomes objectively
if they tend to interpret problems as personal failures and to discount positive
feedback or o utcomes.
Counsellors need to become watchful of negative seJf-talk as a crucial first step in
developing a program to combat its effects. Subscqucndy, systematic techniques such
as tho ugln•stoppina can be used to replace depreciating self-talk with affirmations o r
positive st:nemcnts.
defence mechani sms: Mealal process
or teadion t!lat shields a Pff'S• ffOffl
~ble orunaa:•able thCtlgllts,
feelings. or COlldssioa t!lat. ii a«:ep:fd,
'Mlllkl aeate allliety•dlallerips toone's
s.e of sfff. Coaaon deieace media•
lisms ilclude deaial displaa!fflffll. tati>
ama~ioo. StWtSsion, and ie,pession.
22
Behaviour Counsellors need to take time to discover how clients arc reacting to them.
Personal needs and defence mechanisms may lead counsellors to assume blindly that
problems in thecounsclling relationship arise from their clients' inndequades or failings.
Although effective counsello rs have confidence in their own abilities, they have to accept
that occasionally they may say or do the wrong thing. Counscllors neo:I to be m:nure and
open enough to evaluate their work and to cake responsibility for their errors and insen.sitivitics. For example, o pen minded counseJlorsconsider the possibility that clients may
be angry for J;ood reason, perhaps because of o ppressive agency routines.
Counsello rs who lack seJf awareness m3y foil to understand or accept the needs
o f their clients and are more likeJy to take their clients' behaviour too personally. UJti,.
mntcl't', counsellors need to be se.lf aware enough to know which client reactions are
reactions to their behaviour o r personalities and which arc the result of other variables
beyond their control.
Sigmund Freud first described defence mechanisms in 1894. A defence mechani-.m
is a mental process or reaction that shields a person from undesirable or unacceptable
Chap1er 1
thought~ feelings. or conclusions that, if ncccpccd, would crcnte nnxicty or dnmnac
one's seJf-cstecm. Defence mechanism~ which arc unconsciou~ distort reality and serve
to protect people from perceived threats. S imple defences include bfomina ochers or
making excuses for the.ir own failures. For example, counscllors might take credit for
counselling successes but blame failure on their clients. Common defence mechanisms
used by counscllors include the followina:
■
Denial: Rdusina to acknowledge the existence of feclinas or problems. \Vhen counseJlors use denial, they fail to conside.r that their actions might be the reason for
their clients' inapproprinte behaviour.
■
Displacement: Shift of emotions o r desires from one person or object to another
person or object. For uamplc, counseJlors deal with their own work stress b\•
behnvina aagressivdy with clients.
■
Rarionalhation: Developing excuses or explnn:nions to protect their self image. For
exnmple, counscllors justify their inability to confront clients b\• concluding that it
is best to offer only positive feedback.
■
Suppression; Averting stressful thoughts by not thinking about them. For example,
counsello rs refuse to conside.r that personal biases might be affecting the.ir decisions.
■
Regression: Dealing with conflict o r stress by rcturnina to behaviour from an enrlier
stage of life. For example, counseJlors deaJ with aggressive clients by becoming
overly compliant or ove.rl)• pleasing.
Counsellors should be alert to circumstances where they use defence mechanisms
instead of confronting reality. Facing reality requires courage and mking risks because
givina up one's defences means sacrificing safety. Moreover, feedback from oche.rs can
be threatening because it challenges counsellors to let down the.ir defences by addressing
aspects o f their situations that they might prefer to avoid.
\Vhen counsellors unde.rstand themselve~ they r«ogni:e when their defences are
up and can ta.kc steps to chanae the.ir reactions nnd behaviour. They know when and
wlu~re they are vulnerable; then, they use this knowledge to cue or trigge.r noodefensive
alternatives. For example, when clients are angry o r hostile, rather than yielding to the
natural impulse to fight back, counsellors can d iscipline themselves to cake time to
empathi!e and encourage clients to ventilate.
&If awarecounscllors know their skill strengths nnd limitations. This se]f n\\--areness
enables them to avoid overusing particular skills simpl)• because they arc strengths, and
it helps them to know when it is appropriate to refer clients to other counsellors. Jt also
helps them to set goals for professional skill development. Knowing the limits of one's
ab ility is a measure of competence.
Personal Needs
Counsellors have the same basic nttds as ewryone dse, including the nttd to be loved,
respected, nnd wlued b\• others. This is natural; however, counsellors must understand
how their personal needs can adversely affect counselling outcomes. Lacie of sdfowarcness
rcgnrding: personal needs can lead to unconscious structurina of the session to meet the
counsellor's nttds instead of the client's. One srudent was told b\• her supervisor that
her clients really liked her as a pe.rson, but when they had a problem, they would go to
someone clse beotuse thq• did not believe she was apnble of dealing with tough issues o r
giving critical feedback. Throuah supervision and rc.flection this srudent learned how her
need to be: liked left he.r vulnerable and ovc.rh• sensitive to client reactions. As a defence,
she avoided doing anything that might arouse anxiety.
Protesslortal Identity: Ethics, Values, and Self-Awareness
23
SUCCESS TIP
Even positive feedback frOO'l clients must be interpreted cautiously. Clients may lty to pla
cate counsenors ot use k'lgratiating 1actk::s to manipl.Aate, Or' ,t may be theit way of t elating
to authOrity.
4
A range of counscJlor needs m3y interfere with counscJling, inclu ding the need to
be liked: the need to achieve status or prestige, control, and perfection; and the need
to cultiwtc soci3l relationships. Table 1.6 summari!cs the major wnrning signs and risks
of these needs.
Need to Be Liked
In Cluptc:r 3, we will explore the importance of a w·arm and trust-
ing counselling relationship. lnrgcl'>'• counselling depends on c.smblishing and maintaining a
safe cnvironn'litm, one in which dicnts feel safe enough to take risks. Obviously. this is ca~
ier if clients lilce thc.ir counsellors: hm, -e\-er, counsellors need to remembc.r that h.nving di,.
ent:s like them is not the p rimary goa1 of counselling. The aim of counselling is to support
dimt change o r problem mana~ment. This mC3ns th3t counsellors have to be nssc.rtive
enough to risk makina rc3sonable dem3nds on their clients, which, in rum, may generate
tension and anxiety. Otherwise, clients c3n ClSil)• sray locko:J imo established but unhealthy
pancrns. The need to be- liked becomes problem:nic when it becomes more important dun
ndiieving the goals of counscllina. One beginning counscllo r, 3 )-OUng m3Jc, wrote in h is
;ourn:.ll: "\\:rhen 3 client S3ys something negative o r bcluwes in a sclf-Ocscructive way, I real,.
i.!e I hold b3ck. I don't S3Y anythina because I want to be liked. J want the client to like me,
00( ~meas an authority figure. I'd rathe.r be- seen as a pal or a friend." This journnl encry
hiahliahts the dangers of this counsellor's need to be liked and sianal.s an important insiaht
that will help him question some of his assumptions 3bout counselling. He will need to
rc-cvalunte how his behavio ur may be saboroging client progress.
TABLE 1.6 Managing Personal Needs in Counsel! ing
Personal Need
To be liked and to
be helplul
Warnlna Signs and Risks
• WithhOICli~ potentially helpful but critical feedbaek
• lnapptoprlately a\lOidlng controversy Or' conffict
• Trying to ingratiate (e.g.• excessivety praistng. tem~ clie-nts wtlat
lhey wan1 IO hear)
• Acti~ w'ilh rescuing behaviour
• Expecting or re-act-.~ for compliments from clients
Status or prestige
Control
Perlect;on;sm
Trying to imptess with "exotic• ted'lnklues or t'.:l'iltiant interpmtations
Taking credit for client success
Na~roppiog
Stagging abOut successes
Advice givlflg
lnterfe-ri~ with client se-tf~ete(minatioo (e.g., unnecessarily using
authority, manipulating. and dominating)
• lmposs"lg per'SOoal values
• Stefe-otyping clients as needy and inadequate (which ere-ates a tde
f0t someone to be "helpful")
•
•
•
•
•
•
• focusi~ on mistakes
• Pushi~ d ie-nts toward unrealistic goats
• Re-sJX)ndlng with self-deprecation to mistakes (e.g., ..,,ma failure")
Social relationst-.ps
24
Chap1er 1
• Becoming OYef-involved with clients (e.g., mee-1ing clients socialy,
contS\uing counselling relationships beyond the nonnal point ot
ctosure)
• Indiscriminate setf-disclos...-e-
Need for Status or Prestige Counsellors who have an excessive need to impress
others. perhaps bcotuse of insecurity, may b«omc technique-centred instead of clientcentred. \Vith this switch in prioritic~ the nttds of the client ma'>' be overlooked as
counsellors net to impress clients or others. The priority of counselling should be to
bolster the self-esteem of clients.
Need for Control Codes of ethics recogni!e that clients are vulnerable to exploita,
tion. Consequently, counsellors need to pay substantial attention to refraining from
behaviours that result in undue control of clients. The principle of self-dete.rmination
(inmxluced earlier in this chapter) is a basic value that upholds the right of clients to
make independent decisions. Counsellors interfere with this right when they attempt to
take over clients' problems and orchcsrrate their solutions.
ln some setting~ such as government agencie~ counsellors may have the legal mandate to impose their services. This siruation requires counsellors to be especially \'lgilam. As Brammer and MacDonald (1999) obse.rve, helpers in these settings "must be
wary of identifying too closely with the power of the agency under the guise of carrying out the ai;cncy's mission. Often the helpec becomes lost in such settings, and the
helping services tend to suppon the power of the organization. The result may be an
exagg,erared emphasis on adjustment or pacification rather than on ac:rualization and
liberation" (p. 40).
Perfectionism Perfectionism, an unrealistic pursuit of exceJlence, can negatively
affect counselling. Counsellors who are pe.rfectionists ma'>' be unable to appraise their
work accurateJ'>', and they may have an unjustified tendency to blame thcmseJvcs for
client failures. Sometimes counsellors who are perfectionists push clients toward unrealistic ,;oaJs or challen,;c them to move at too fast a pace.
Need for Social Relationships Counsellors with unmet social needs risk overinvolvement with clicnts. Jf counsellors do not have outlets in their own lives for social
interaction, they may misuse the counselling relationship for that purpose.
Personal and Cultural Values
Counsellor seJf-knowledi;c of personal values and preferences is indispensable for cff~
tive counselling. Values constitute a frame of reference for understanding and assessing
clients and for making decisions and choices.
Self-awareness of personal values is an important element of competence. All counsellors have personaJ values, and it is crucial that they understand what these values arc
to avoid imposing them on clients. Self-awareness of personal values is a first step for
counsellors to take to manage the bias that comes from inte.rprcting clients' behaviour
from their own perspectives or cultures rather than from the clients'.
Cultural self-awareness refers to knowled,;c of the custom~ traditions, role o:pccta,
tion~ and values of one's culture of origin. Language is a particularly important variable. The word aurhorir1 will have a ve.ry different meaning for individuals who come
from totalitarian countries and for those who come from egalitarian societies. Cultural
self-awareness prepares counsellors to recognize and value the diversity of other cuLtures. Such awareness needs to be accompanied b)• a belief that one's own ethnic group
is only one of many and that there are othe.r appropriate beliefs and behaviours.
(ncvicably, the personaJ values of counsellors influence the way they assess client~
the tedmiques and procedures they use, and the goals that they deem reasonable, includ~
ing which topics will get more or less attention. Moreover, ce.rcain topics arc more valuecharged (e.g., abortion, assisted suicide, sexual orientation, religion, and abuse), and the
beliefs of counsellors may bias their work in these areas. For example, counsellors who
find that they never discuss sexua1it)• in their counselling work need to dete.rmine why.
Protesslortal lden111y: Ethics, Values, and Self-Awareness
25
TABLE 1.7 Values, Bel iefs, and Attit udes That Help and Hi nder Counsellors'
Effectiveness
Unhelpful Yali,es & Beliefs
Helpful Values & Beliefs
To accept help from 01oors is a sign ot
weakooss.
Some people are jUSI not d&Sef'Ving of OU(
respect or cari~.
People are inherently evil. Unless you a(e
ca(eful, they wil take advantage of you.
I ktlow what is best fot my clients.
To accepa help is a sign of stte~.
Everyone haS intrinsic worth and lhe capacity
kl be P,Oductive.
People are essential~ gpOd.
People a(e capable of finding their o-,m
It is essential that my clients llk.e me.
answers and making decisions.
The pu(pose of counselling is to help clients
exe(cise d'loice, not to make clients ti.ke me.
I've been there myself, so I kOowwhat my
clients are leeli~.
I can'I koow wtlat my clients are feelW'lg untJ
I take the Ume to let them teach me.
People are incapable of cha~iog,
My religjoo/cult...-elviewpoint is lhe besl
People can and dO cha~.
In this wOr'ld, it is survival of the fittest
We depend on one anOlhe(, and we have a
respoosibiity to help Olhers.
CounsetJors have a rigt\t to impose service
Wrth some exceptions. clients can eho:>se to
refuse service.
wtlen it is in their clients' beSt interest
I can accept a wide variety of cultures.,
refigfons. and viewpoints.
Are they avoiding this topic because of pc.rsonal inhib itions? Are they unconsciously
judging the sexual behaviour of their clients?
One W'U)' for counscllors to address this problem is to disclose their values to their
clients; however, they should do this in such a way that clients do not feel pressured to
adopt similar values. Clients should feel free to maintain their own values without fear
that they are in some way disappointing their counsellors.
A counsellor's value S)'Stem is an important variable that influences the methods
and outcomes of counselling. In general, counsellors are most effective when their wJ,.
ues reflect an optimistic and nonjudgmental view of peoplc. lntcllectuaJly and emotionally, they accept and treasure the widest possible variations in lifestyle. They believe in
the inherent strength and capacity of people and in their intrinsic right to freedom of
choice. Table 1.7 examines some of the values that might impede or enhance counseJ,.
lors' cffoctivcncs.s. \Vhcn counsellors have values that hinder effcctivencs~ they are
more lilccly to find themselves behaving contrary to the ethics of the field , such as acting
in wa)•s that inhib it self-determination or failing to respect the dignity of their clients.
Conversely, counsellors who have w1ucs chat enhance che.ir ability arc more naturally
inclined to support the ethics of the profession and arc more likeJy to behave in ways
that empower che.ir cliems.
PROFESSIONAL SURVIVAL
Burnout: A state of emational, ment,l
•d p~al aba11stion tut reduces •
pew:nts peqi:le froa pe,fo,aing tlleir ;co.
26
\Vorking as a counsellor can be immenscly stressful and, for some, emotionaJly dangerous, p3.rticularly for chose who arc working with clients who have experienced trauma
and abuse. People who work in hospitals and mental hc3lth settings. as well as those who
work with children are P3.rticularly vulnerable. Continued exposure to client troubles
can leave counsellors with little patience and resilience for deaJing with their own issues.
Some experience burnout or vicarious rrauma.
Burnout is a state of emotional, mcnml, and ph)•sical exhaustion that hinders or
prevents people from performing their jobs. Burnout may affect people in different
Chap1er 1
wa)'s, but certain symptoms arc typical T he stress of burnout may show itself as a
genera] state of physical exhau stion, includina signs o f diminished health, such as
headache~ sleep d isruptions, and d iacst ive upset . Emotional and mental burnout
may reveaJ itself as increased anxiety, inability to cope with the normal demands
of worlc, depression, excessive worry, discouraaement, pessimism toward clients,
loss of a sense of purpose, general irritab ility, and an inability to find joy in one's
career o r life.
Vicarious trauma is a risk for anyone in the helping professions who wo rks with
people who have been traumati:ed. Shea for and Horejsi (2008) offer this caution:
After repe::ued exposures to clients who ha"e been tr.aum::ui:ed and 21re i.n areat distress.
sod:)) worke-rs and o ther helperS 11\3)' de...elop symptoms o( tr.au ma themselve!l. sueh as
intruSi\'e thou~,u and im~e!l. s leeplessness,. brstander auilt, (eelin,iS o( vuJner21bility,
helplessnes!l. sel(.-doubt, 21nd r3~'C'. Workers who (eel especially 01:erwheln~ b)' d1saster, those who have h::.d a prior b:perience o( severe emotional tr.auma, 21nd those who
21re inexperien.e«I in di~ster,related work 21re espedall)' vulner:lhle to devtfopin& these
S)•mptoms. (p. 57 I)
vicarious trauma: An oa:upalional
hazard for people in the llelpint prvlessions. ii wbQ they dMlop the same
s,wrp:cai as llieir dents llflo haw beea
traumatiHd.
Counsello rs who suspect that they suffer from burnout or vicarious trauma should
first consult a physician to rule out any medical condition that might be a factor. Obvi•
ousl)•, the best way to deal with burnout is to prevent it from happening. For counsel•
lors, this means balancing the demands of the.ir worlc life b\• taking care of thcmscJvcs.
CounseJlors need to d evelop personaJ wellness pl.nns that address their own emotional,
physical, and spiritual needs. An essemial part o f this p lan is time away from the job.
Counsellors need to avoid b«omingovcr~involved by ,vorking unreasonably long hours
and weekends or by skipping wcations. They need to make intelligent decisions about
the limits of what they can do.
CounseJlo rs can also prevent burnout by setting up and using a support system
of fam ily, friend~ supervisor~ and colleagues. By doina so, they ensure that they have
people to whom they can turn for assistance a nd emotionaJ support. \\:1o rk collea,iues
and supervisors arc essential for hclpina counsellors manage their emotional reactions
to clients. such as fear and anae.r. Counsellors nttd to r«ogni!e that being ab le co ncccJX
help from others is a sian of strength and that they should model this bcJief in the.ir
O\\•n behaviour. TaJking to others reduces isolation and allows for team participation
and support with difficult decisions or situations. Jc is particularly important for co unse.llors to have someone to debrief with after stressful inter views, such as those with
angry or abusive clients.
Continued profcssionaJ d evelopment is another important strnteay for prcvcntina
burnout. Seminar~ co urses, and conferences expose co unseJlors to new ideas and the
latest research and can help them renew their enthusiasm and c reativity.
SUCCESS TIP
Preventin& Workplace Burnout
Am:>ng the many p(oven strategj,es foe p(eventing btXnout a(&: a,Nareness and eatly inte(.
vention to deal with symptOO'ls, exercise, nutrition, healthy personal relationsi-.ps, lifestyle
balance, laughtet/having fun, mindful b(eathi.ng, mindh.Aness, debriefing wtth trusted COi·
leagues and supervisors, use of a mentor or r·01e model. distancing oneself from negative
cow0tkers, sleep, rec,eation, spirituality, taking a vacation, ensuring wofk.Jjace bl"eakS,
maintaining teasonable office hours, scheduling chent interviews to mini.mile sustained
perkx:ls of stress, wor1dng wtthin the limits ot one's cotnpetence, and accepting 1001 you
can'I help everyone.
Protesslonal Identity: Ethics, Values, and Self-Awareness
2·7
Cynicism •
.........nt
&
......
...
._..,
pe,sonal life
Figure 1.5 Common Symptoms of Workplace Burnout
SUMMARY
28
■
CounscJling sc.rvices arc provided by a wide range of diffe.rent professional~ indud..
ing soci:.d workc.rs., nurses, psychologists., and others.
■
Professiona.1 codes of ethics define the acceptable limits of behaviour for profcs.sionals who provide counseJling services. They aim to protect clients from misuse
of position and pcm"er by profcssiona.Js. and they strictly prohibit dunJ relationships
that arc sexual or exploitive.
■
Ethics, derived from vn.Jucs., arc the principles and rules of acceptable conduct. The
values of the counselling profession arc rooted in a few basic principles: belief in
the dignity and worth of people, respect for divc.rsity, and respect for the client's
right to self-determination.
■
An ethicaJ dilemma exists when a choice must be made between competing values.
Five principles can help resolve ethical dilemmas: autonomy, beneficence, non..
maleficence, justice, and ftdcliry. EthicaJ decision making involves weighing the five
principles and deciding which ought to have priority in a given situation.
■
Objectivity is the oi.paciry to undcrsmnd situations and people without bias or
distortion. CounseJlors can lose their objectivity by making assumptions., ove.r..
identifying with clients, or becoming overly involved with their clients.
■
Sclf-:n\--nrcncss is esscmial for counsellors to work with objectivity. Self-aware coun.scllors know rhemsclv~heir feelings. thoughts, behaviour, personal needs, and
areas of vulnerability. They understand how they affect clients, and they know the
limits of their competence. They can answer the question, "Who am If'
Chap1er 1
■
Burnout and vicarious trauma. arc workplace ha: nrds that can b e addressed using
a. variety of strategics such as lifcst)•le balance, nutrition, exercise, and effective
use of trusti.XI colleagues and supervisors.
EXERCISES
Sett-Awareness
I. What strong beliefs do memberS of youf clJturaVethnic
g(OUJ) hcjd?
4. ExptOr'e yout perSOOal sttengths and limitations. Use lhe
foHO\\;~ topi,'.:;s to structure your assessment:
• capacity to be assertive (as opposed to Shy or agwessive)
2. Use the ciuestions and situations belOW to ex.-amioo your
values in (elation to sexual orientation issues.
a. If a client of yourS i:S gay Of lesbian, how might it inftu.
ence the way you WOrk with him or her?
b. What would you do if a friend told you an anti-homosex-
ual joke or sto,y? What if the pe,-son teting the joke was
a dient Or' a COiieague?
•
degfee of self-confidence
• comforl dealing wilh a fflde range ot emotions
•
need to control
ot be i"I Chafg,e
• capacity to (elate to drverse populations (age, gender,
cllture. fetigjon, etc.)
•
ability to give and feceive fOOClbaek (positive and c,iticaO
•
need to be helJ)fLI
d. Do you think ho.inosexuality is an illness? How do the
teachi~ of your religion mesh 'lfith youf pe,-son.al values and beliefs?
•
anxieties and fearS
•
ability to deal with conflicl
e.
YotX daugf\tef discloses lhat She is lesbian. Pfedid hOw
you might feel, think, and behave.
•
self-awareness fegatding how Others see you
•
overau awafeness of pel'SOOal strengths and limitations
f. YotX best friend confides lhat he feels he is lhe Wf'~
gender- and that he is in the early stages ot transitioning,.
How do you r'e'SJX)nd?
•
c. Do you have gay Or' tesbian friends?
g. What afe your views on same--sex. marriage?
3. Write an essay lhat explores yout values and beliefs. Explore
issues and ci uestions such as:
Why dO you want to oocome a counseltor'?
What ~ s dO you expect to meet through your work? In
vd'lat w:¥yS might your personal needs be an impechment?
Ate people inherantty good or bad?
What is youf understanding of the meaning ot life?
Should people have the right to take theit own lives?
ShotAcl immigrants be required to speak one ot Canada's
two official languages?
What are the char'3cieristics of lhe dient you \\()ul(I most
and least want to w0tk with? (Be spe,cifac regarding as
many variables as possible. such as age, gender, p(lf'·
sonatity, cllture. and religion.) Why would you choose
these characte-tistics?
What topics Or' issues afe tikely to evoke strong personal
reactions from you?
What does authority mean to you? How dO you behave
and feel when you are relating to people in authority?
Whefe do you draw )'Ouf strength?
When you die. what do you most want to be remembered
fa<?
• competance in initiating (elations.hips (beginnings)
values and attitudes that will help Or' hindef yotX WOrk
as a counseltor
•
caJ)aCity and willingness to cha~
Based on yout answers, identify what you coosi:Jer your five
major stfengthS and yout five major limitations to be.
5. Evaluate your capacity for handlrlg feedback from Others..
Ate you geneta:lly open and nondefensive when Others criticaly evab.Jate your behaviout or perfOr'mance? Do you tend
to avdd asking fot leedbaek? Do you acrivefy SOlkit feedback? lntef'Jiew friends and coneagues for theit opinions.
6. Ate you excessively dependent on your clients? Rate )'Ouf•
self fof ead'I statement below using lhe folto.vi~ scale:
4 = always
3 = frequentty
2 = sometimes
1 = rarely
0 = neverI feel (esponsible for lhe feelings, lhOughts, and
behaviouf ot my clients.
I get ang,y when my help is ,ejected.
I feel worthle'Ss or depressed when dients dOn'I
d'lange.
_ _ _ I feel compeUed to help people SOive problems by
offering unwanted ad\lice.
I want to lake cate of my dients and pr·otect them
from painful feermgs.
Protesslonat Identity: Ethics, Values, and Seit-Awareness
29
_ _ _ When clients don't like me, I feel rejected or
inacl«:iuate.
___ I do lhings to make my clients like me, even if
wtlat I do is 001 helpful.
c. A ll>year-0k:I mate client roasts lhat if hisgjrtfriend tries
to leave him, he 'liill kill her.
d. A client from a counselling relationship that terminated
six months ago phOOOS to ask you f0t a date.
I a\'Oid confronting 0t ehafleogi.ng clients..
___ I tell clients wtiat they want to hear.
e. YOIX client leaves your office in a~t. determined to
~teach my ~fe a lesson tot the way She treated me.·
_ _ _ I fOOI most safe when I'm gjving to Olher'S.
f. Kno-/Mg that you ace in the macket fOt a new car, yout
_ _ _ When clients fail. I take it personally.
___ I spend too much time proving to myself and my
dients that I'm good enough.
I tend to be very contrOIJiog with dients.
___ I tolerate abuse from dients to eosl.l'e lhey like me.
___ I feel responsible f0t soM~ my dients· prOblems.
caretulty retJiew any siatements wtle-re you sc0ted 4 or 3.
use your awareness of problem areas to develop a program
ol self-dlange.
client, a used-car saleSperson, otters to help you buy a
car at the whOleSate price.
g. Yout clWlnt is a young woman (age 17) who is questioning her sexual identity. She .-iqlires abOUt yout sex.ual
orientation.
II. Yout dient ask.S for yout email address so that he can
keep in touch
I. Yout client, a bisexual male, has tested HIV-positive, but
he informs you that he ooes not wish to tel his wife. He
says that he wll practise safe sex.
7. Imagine that you are a dient What migr\t your counsetlOr'
need to knON abOut you (e.g., values, needs, and preJer.
ences) to wot'k effeclM!ly 'lfith you?
j. You receive a catl fromi a client's wife. She says She is
concemed abOut het husband and asks wtlether you
lhink her hUSbar\CI migtll be gay.
8. Take an inventOcy of )'OIX frienclShip clfcte. To what extent
dO your Mends come from lhe same cultural group and
have the same values baSe as your own? Predkt what might
haPPM if you broadened your circle to include mor'e diversity. DIM!lop a plan to learn abOut the cultures and warld
religions in yolM' community.
k. Yout cOleagues begin to &atkabOut a dient. You are~th
lhem at a local restaumnL
9. What pel'SOOal and religious values do you have that would
gener-ate ethical dilemmas?
a client. You notice lhat they are drinking a tx>ttte of wine.
I. One of yout colleagues tells you that she has just
re1urned from a one--day works.hop on hypoosis. She
says that She can hardly wait to tty it oo some clients.
m. You encounter one ot yout COiieagues having lunctl with
n. You have an erotic dream abOut one of your clients.
o. While you are counselling a student (in yout role as
Skill Practice
1. Interview one 0t m::,re colleagues who deltiemtety introduce
issues, leeli~. 0t behaviours that represent "tf.gg.ers• fOr'
you. What did you learn from this interview?
2. Imagine that )<Ill are addressing a situation wher-e you believe
a COiieague haS acted uoethi:.ally, for example. by breaching
confidentiality Or' speaking rudely to a client. Assume that
you have decided to approach 100 colleague informally to
shate yout obServation.. Rol&-play what you migt\t say.
Concepts
1. can we promise our clients abSOlute confidentiality? Why
0t wtly not?
2. What are some advantages and disadvantages to atlowing
clients access to files?
3. Under- what conditions wouk:I you make exceptions to the
principle of self~etermination?
4. use the concepts in this chapter to explore ethical issues
and s1mtegies for each ot the fallowing situations:
a. AA elderly, frail woman sufferi~ from inoperable cancer
decides to lull herself.
b. A client deddes to give his other life's savi~ to his Or'
her church.
30
Chap1er 1
school counselbr), he discloses that he is selling marijuana to ctassmates. (Would your response be different
if you were a counsetlOt in a community agency unconnected to the schOOr?>
p. You are a counselbr wocking with a you~ gay client in
dawn.town Toronto. He has been socialy isolated and is
slow to trust anyone, but ovet time, you have managed
to form a stro~ WOtklflg relationship. Imagine lhat he
appr·oaches you with a request that you walk with him
in Toronto's aMual gay pride parade. What variables
would you consider in makW'lg your decision? What are
lhe implicatbnsof going 'ldth him?Whatare the implications of not gc::i~?
q. Yout client is do-.-m to her- last two dOltars. She offers to
buy you a coffee.
r. YOIX car is btoken and tequites an ex.pensive repair.
Yout dient has been struggling to set up a mobile repait
service. but business has been SIOw. He otfel'S to fix yout
car fOr' a discounted price.
5. A gOOO friand invites you to a small dinnet party. When
you arfrve, you are intrOduced to lhe Other- guests, includi~ a mar'ital<0unsem~ dient wtlom you have been WOrking with foc the past year. You oote lhat her companion
fof the eve-nlng i:S not her' husband. F'rom obSeNing lheir
behaviour', lhere i:S no dOubt that this i:S a roman.tic telationShip. She has oevef mentioned this telationship in the past.
What would you dO lot the rest of the evening? Shouk:1 you
disclOSe lhis relationship to lhe \\()man's husband? If she
aSkS you to keep youf knowledge of this relationship from
her husband, couk:I you continue to see the-m for marital
counselling?
___ te11W'€; a dienl's partMt that he Or'She is HIVi'.X)Sithie
___ advising a client 10 le-ave an abusive marriage
_ _ _ oyi~ in the pfe-sence of a client
°'
___ counsem~ a friend ~igt\bOur at your agency
(adapted from Shebib, 1997)
6. Assess lhe ex.tent 10 which you bel~e that each of the lol~
7. Give ex.amJje-s of appfopri:ate physical con.tact between
counse-tlOr'S and clients. How might clJttXal, age. Of genclef
variableS affect your an.swe-t'?
lawing counse-lOr' behaviourS night be acce-p&able usi~ the
fOllo-lMg tating scale:
8. The case be-tow is baSed on a case fe-cor'd completed by
a sodal \\()rk student. Use the- CCPA and CASW c:odes to
evaluate the apptopriate-ne-ss of the language used.
S = alway<
4 = often
3 = sometimes
2 = seldom
1 = oevef
Be prepafed tode-fe-od you, answe,. How migN your answer
vary depencli~ on lhe citcumstan.ces?
___ see-i~ a client afte, having had one alCOholic
drink
___ accepting an invitation fof din.oo, at a client's
home
___ hugging a client
___ inviting a fo«nef client to a party at yotX home
___ dating a formef client
___ havi~ se-x with a client
___ driving yotX client hOme
___ discussi~ you, dient with a supervisor
___ assistrlg a client to e-nd his o, her life
___ accepting a client's decision. to commit suicide
___ a!IOwing you, teen.age( to babySit fOr' your client
buyrlg a car from yout client
lending money to a client
reporting you, die-nt to the po6ce (after the client
tell$ you lhat he Of She committed a crime)
reporting suspected chtld abuSe by you, die-nt
Sharing pel'SOnal expe(~n.ces., fe-etings, ptot,ems,
and so oo with youf client
- - - ge-nrlg angry with yOU( Client
___ discussing a client with youf famity Of Mends
('Mthout mentionlng names)
___ giving a present to a client or receiving a pfe-se-nt
from a client
___ shating in.f0<mation. abOut clients with other
counse-llOr'S
___ wamlng a person lhat your client has threatened
to harm himself Or' he-t'se-lf
I visited lhe Smith hOme to investigate atJegations of chik:I
~
. I was met at the dOO( by Mrs.. Smith, a single pa(.
ent. I was s....-prise-d by hef size; she was m0tbid ly obese
and smelted as if She had not Sho-.ve-red in weekS. Roll:S of
fat hung out of MtS. Smith's Shirt, and portions of he-r le-gs
were covered with dirt. Mrs. Smith's SIOven.ly appea,ance
suggests She is unable to care fOr' he-t'setf, much less he-r
children (Reamef, 1998, p. 93).
9. Expl0<e the issues involved in discussing clients with
Mends and relatives. Is it acceptable to discuss clients if
you change the-it names and Other' identifyi~ data? Defend
your answet.
1O. Shouk:1 some clients be fOr'ced to attend counse-ttiog?
11. Do you think gaUo-hS humour i:S ethical? Defend youf
answer.
12. Review the cooes of ethics for three o, fou( diffe-ren.t canadian ptofessional Or'gan.izat.ions. What common and uniique
featufe-s can you identify?
13. W0tk in a small g(oup to d8V't'IOI) confidentiality guidelines
fOr' electr•onic stOr"agE! and Shari~ of data. What are the risks
of Sharing infOr'rnation with othef ptofessionalS usa"lg email?
14. Social Media
a.
Discuss the ethics of using Google or other se.atch
e~ioos to ftnd posted information abOUt a client without
the-.' consent. Supi:ose a sea,d'I fe-Yea~ infOf'mation that
is contradictory to discussions he-Id during a counseling
session. Of, 'lff'lat if a se.a,ch ftnds posted inf0tmation
crH.ic:al of the counse-tlOr?
b. What personal infotmation abOut themselves is
approptlate and inappfopti:ate to, counseltor'S to post
on.line?
c. Explore the approptiateoess of counse-tlOtS conn.,e,cting
with Clients on Face-bOOk. What abOUt fO«ne( Clients?
15. Imagine lhat you afe directof of a social service agency.
With limited funding. you have to make a difficult deei:Sion
to fund on.,e pr·c ~am and te:fminate another'. Both programs
have been successful. Discuss how you might approad'I the
resolution of this ethical Challenge.
Protesslonat Identity: Ethics, Values, and Seit-Awareness
31
WEBLINKS
The Canadian Counselling and Psychotherapy Association
webSite has links to notes on ethics, leg.al issues,. and standards
The Markkula Cent~ fOr Applied Ethics at Santa Clara Uni ~ty
website p,ovides articles and links on the toplc of ethics
for counsenors
www.stu.edu!ethics
www.ccpa-accp.ca/eth1cs/
The canadian Association of Social Wor'ke:rs website has links
This website has links to resources.. articles, and discussions
on the topic of dual relationships and bounda,y issues
and infoimation fOt social WOfkers
http://kspope.comlduaVindex.ph p
www.casw-acts.ca
32
Chap1er 1
&ives sped.Pie
covnsel
Oiuiin/Shunerstod(
■
Define what is meant by counselling,
■
Describe the n«cs.sary range of skill versatility for counscJlors.
■
Describe the csscmial clements of 3 trauma.-informed 3pprooch to counscJling,
■
Identify and classify the skills and strategics of counsdlina
■
Summari!c the dcvclopmcmaJ objectives of rhc four phases of counscJling.
■
Describe counscllina pitfalls.
WHAT IS COUN SELLING?
Coun....eUins: is a time-limited relationship in which counsellors hclp clients increase
their ability to deal with the demands of life. Typically, people arc rcfc.rrcd to or seek
counselling because of an unmanaacablc crisi~ such as the loss of a job, rcfationship
problems, or feelings of disrress.. The immediate goa.1 of counsclling is to provide assistance so that people seeking help (clients) c:m g3in some control over chc.ir problems.
The long-tc.rm gooJ of counselling is to restore or devdop a client's 3bility to cope with
the changing dem3nds of their lives (empowerment).
counselli,_-; MempOlleffflent prixess
d ~gdients to lea,. skills.deal rib
ree.,s, and aana,e pntil.tns.
33
Recen1 researd'I and developments in oouroscience confirm
that counsetling has the potential to change client brains in
ry positive ways. This research sup(X)rts the value of core
ounsefling skill$ such as listening and empathy. Research
ISO enclorSeS placi~ an emphasis on client stre~s and
the centrality of 100 d ienvcounseuor relations.hip as a basis
for d'laoge. Counselling enhances neurogenesis (the ptOCluction of new netXons in the bt'ain) and it takeS advantage of 100
bfain's neuropfastidty (the capacity ot the brain to change)
(Mly, tv,)y, & Zalaquett 2010).
T he Canadian Counselling and PsychotheraJ)\' Association (CCPA, 2012) offers
this pe.rspcctive:
CounselIin¥ is the s.ki!Led and p rindpled useo( rel.:ttionship l'O hieiliuu, sel(, Jmowled~
ernotional :)C'Co?p-tanee and ¥r0w1h and the optinul de,'eloprnent o( personal resources.
The overall aim o( eounsellors is 10 provide an opportunity (or people 10 v.'Ork toward
livi1'{t more sat id)·i~)' 2nd resoureelully. Counsellin¥ relat ionships w1II ,'3ry aeeord,
i1'{t to nn'.'d but ,nay be ooneerncd with de\'t:loprnent~I issue~ addressh,i 2nd resol\'i.n~
specJf"K" problems. makinK decisions. oopi1'{t with erisis. de\'t:lopinK person:11I insi¥1u..s
and kno,1;,led~-e, workinK throu,ah (eeli1l{tS o( inner contliet or improvi1'{t relationships
with otherS..
Counselling is de.fined b\• three var iables: the needs and wnnts of the client, the
mandate of the counsellina setting:, and the expertise o r competence of the counsellor.
As discussed in Chapter I, profos.sionaJ counsellors a.re aware of the limits of their
competence and know when to refer the.ir clients to other appropriate services. They are
also aware of their own needs and unresolved issues and they r~fer clients to othe.r professionals when they cannot worlc with reasonable objectivity. In addition, they acc~pt
that no one counsellor is qualified to work with all clients. Table 2. 1 summarizes how
counselling: knowledge and skills e,.•o lve from beginning to advanced Jc,.'Cls.
The work of counselling may entail a brood range of octivicics., indudina the followina:
■
hclpina clients cope with painful feelings
■
tC3ching clients new problem-solvina skills
TABLE 2.1
34
Counselling Skill Levels
Beglnnina Level COunullors
Advanced Level COunullo.-s
Bask:: use of core listening and
reSJX)ndS'lg Skills
Exemplary use of a t:t"oad range of listening and
counsem~ skills and strategies.; capacity to be creative
to meet the unique needs ot indMClual clients
Sensitivity to cwert
nonverbal cues
Responsiveness to subtle nonverbal cues and themes
Basic content knowledge ot
field of practice
ln<lepth knoldedge of evidence-oosed best practices;
abiity to analyZe and adapt published material
Rudimentary unclerStanding
of self
Sophisl:ic:ated kr10\\tedge of setf and cultural world'Jiew,
one's in1pac1oo others, and one's abiity to selectM!ly use
aspects of self to influence OlherS
Tendency to •mimic" mentors
and textbOOk responses
capacity to eustOO'li?e tnetr apptoach; devetopment of
individual Styles
Slt'uggte to manage biases.
personal reactbns
Selkonscious
"Second nature· capacity to stay appropriately detached
and in contrOI of self even wtlen Mtested" by d ients
F'oeus on d ients
Tendency to want to fix., rescue.
or solve client prOblerns
Acceptance of the d ient as ·expert;- locus on client
em(X)werment
Chap1er 2
■
mediating relationship communication difficulties
■
aiding clients in identifying and accessing resources
■
helping clients make decisions and implement action plans
■
supporting or motivating clients
Interviewing skills are indispensable to effective counselling. The goal of
imerviewins: is to acquire and organize rcJevant information through timely listening
and responding skilJs. The primary goal is information gathering: however, clients
may foe] rcJicf from sharing and organi!ing their thoughts in response to systematic
interviewing.
Good interviewers are comfortable with silence and know when to listen without
interrupting. CounscJlors who listen to their clients give them a chance to air their
foding~ and this step can be therapeutic in itself. Patient listening shows clients that
counsellors arc willing to accept them without judgment and without burdening them
with quick.fix solutions to complex problems and feelings.
At the beginning of counsclling sessions or inte.rview~ silent listening may also give
counsellors valuable dues about the potential focus of the interview. Listening also helps
counseJlors IC3rn about their clients' priorities; it reve3Js which methods clients ma'>'
have used and not used to try to solve their problems.
interviewing: A•irint -.:J«ganiling
relMnl inforlUlion u~ a«ive listening sliHs. inct.il:g al.1eading. sieooe.
parapnsing. s.marizitg. questionini,
and eafatlly.
SUCCESS TIP
However self-defeating ,t may appear, au human social behaviour has a purpose.
Good listeners nJso know when and how to respond. Paraphrasing, summari!ing,
questioning, and showing empathy constitute the foundation of effective listening.
These skills enable counscllors to focus and deepen the interview. Good listeners usc
questions to cfarify meaning and seek details and examples; whereas they pnraphra.sc and
summari:e respon.scs to confirm understanding and highlight important information.
A good interview involves methodical questioning and exploration of issue~ a process
that can help dientsclarify and org:ini!e their thoughts. Finally, counscllors usc empathy
skills to confirm their understanding of the client's feelings.
psychotherapy: Ad\'af!Ctd CCllaselilg
tatgtting S!'Me emotilflal or behaviCIJral
diffltlllies « lisortlers.
CONVERSATION 2.1
STUDENT: What is 100 difference between counselling and
psychotherapy?
TEACHER: The te-tms psychotherapy and counselling are
often used interchangeabty, and the-re is no accepted dis.
tinct.ion between 100m. 801h counselling and psych01oorapy
a,e used to help clients learn Slulls, deal wilh fee:U~.
and manage prot,ems. In counselling and psychotherapy,
appcoprt.ate relationslips with dients are the crucial success
medtum that establishes a foundation of safety and securily
for clients to undertake the d'lange process.
Although there is nociea, d,vi:iing Nne between the two terms.
the major difference between counse:m.ngand psyd'IOIOOrapy
is that psychotherapy tends to be more long. term 1rian counselling, with an emphasis on severe em01ional and behavblxal difftl.Aties or disorders. On 1he 01oor hand, counse:m.ng
is targeted at assisting dients in managing siluational prob~ms. Whde psychotherapy can weatty assist people. 1t can
be harmful if undertaken withoul appropriate araining, ex.pe-rience, 0t supervision. Attending a short wOr'kShop 0t reading
a bOOk is tnsufftdent preparation.
Currentfy, there are hundreds of different 1oorapeutic
approaches., such as Gesa.at. transactional anatysis, psyc~
drama, rational emottve. Roge:rtan or person-centred, motrva.
tional intervie-.ttng, cognitive behavioural. music therapy, art
therapy, and Adle:rt.an.
The Skills, Process, and Pitfalls 01 Counselling
35
CHOICES : THE NEED FOR VERSATILITY
diversity: Vari,a~icm in wmuf
ilestyle.. culture, bSl\lour, semal
orialtati>n, ag_e, a ~ility, religion. and a!her
!actors.
wersatility: TlleneedlorcoaseUcn
to deYetop a broad range GI slills so
theyca adapt ttlEli a~h to frt the
listin«ive ccmpt!liti.s GI each itdNidual
•dCORtell.
The typical counselling cascJoad is ch3ractcri.!cd by its d iversity. Culture, gender, a,;c,
rdiaion, sc>.."Ual orientation, language, education, economic abilit)•, and intcllectual capacity, as wcJI as beliefs, value~ prcfc.renccs, and personal style, malcc every client different.
Skill versatility mC3ns that counsellors have choices that give them the freedom to adapt
to individual diffe.renccs--vcrsatilit)• enables counsellors to customize their approach.
For example, although most clients respond favourably to empathy, some clients see
empathy 3S intrusive and respond with dcfonsivcncs~ preferring to k«p their feelings
private. Effective counsellors are aJert to such re3ctions and h3ve the 3bility to use sic ills
other th3n empathy with these clients.
Brill and Le..,ine (2005) stress the importance of the counsellor's pe.rson3J in6uence
in the counselling process. Counsellors "must consider the.ir weaknesses as well as their
capacities and strengths in seJecring methods, technique~ 3nd procedures. Bec3use each
individual is different, aJI workers must develop their °"'n styles 3nd che.ir own w3ys of
handling the tools of the trade. This is the element of artistry chal is a vital pan of such
work" (p. 175). Successful counsellors model high congruence between who they 3re
and how they act. They are sincere and real in the way they relate to diems.
In order to work effectivcly with diversity. the following key principles 3re essential:
I . There is no "one-si:._e-{iu,,all" model of counselling. Respect for diem diversity requires
counsellors to be ve.rS3tile in adapting their methods to fit the needs of ench diem
or context. They may worlc from a modcl or process for exploring problems and
helping clients build solutions. but they adapt that model to each dient situation.
Most counsellors now accept that no single counselling appronc.h is best, and they
are willing to draw ideas from different thtt>rctical schools. In the proces~ they learn
to use an assortment of counselling cool~ including drnm3, role pin)•, toy~ music,
3rt, films. \•isunl ch3rts such ns geneaJogicaJ diagram~ personality tests, and audio
or visu3l r«ordings.
2. Experr cott1UtllON draw on ellidence-ba.sed beSL pracrice5 and experience a.s g11ides in determining uihich skills and procedures tdll besL meer rheir dienu' needs. Evidence-based
empirical dam can heJp counsellors predict which skills and approaches have the
highest likelihood of success with particular problems.
3. Adapration of skills for individual clients and cirmmsrances i.s required. Counsellors
who persist in using the same strategy for 31) clients, without regard to individual
difference~ will never become effective. Skill versatility gives counsellors choices
and the freedom to adapt to individual differences. \\:fhen one strategy foils or
is inappropriate, another can be utilized. Culnm; spiritual values, gender, devcl.opmentaJ level, the presence of mental disorders or addiction, the narure of the
problem, and the capacity of the diem are some of the variables to be considered
when 3dapting skills.
))t) BRAIN
BYTE
By using a range ot counselling sttategies. counseuors can
activate different afeas of lheit clients· bl'ains and stimulate
the development ot oow neut'3I pathways 0r even the wowth
of new neur'Ons. fot e.xample, feseatch has demonsuated
thal using music. dance, and &efcise with Alzheimef's
patients helps them to mcatl memories and em::>tions. Drawing on a different part of the brain (music tS one ot the last
36
Chap1er 2
parts of the brain to go with Alzheimer's), physical and em::>lional connections with the person are made possible that
would 001 be available thfough 1alk alone. Music can atso
be used to •Shift mood. manage stfes.s-incluced agitation.
stimulate positive interactions, factlftate cognitive fuoction
and c00tdinate mot0r movements· (Allheimer's Foundation
of America, 2015).
Versatility means bc.ing flexible rcgardina vari3blcs such as the location of
the interview, the duration, the pace, the fee~ and the people involved. Although
some counscllors work in office settings with scheduled 4S•minute or hour•long
interviews, many work in settings where counscJling interviews arc less structured.
Process vc.rsntiliry aivcs counsellors choices rcgardina the sequence and pace of
counselling activities. \Vich most clients, the bejpnning ph3Sc is concerned with
explorina problems and fcelina~ but with other diem~ counsellors may move
immediately to action and prob lem sohtina. \\:lith some client~ counscJlors spend
a great deaJ of time helping them explore their fcelinas, but with other~ counscJlors
spend little or no time in this activity.
Vc.rsntilit)' also extends to other facto.rs, such as the amount of expected or
desired eye contact, the seating arrangements, and the physic.a] distance. Some
clients are comfortable in an office serrina. but others prefer to work in thc.ir °"'n
home or to meet in a neutral scttina. Adolescent boy~ for example, might prove
more approachable if counsclling interventions arc combined with some activit)•.
Some clients favour an open seating arrani;cment with no desk or obstacle between
them and their counsellors. Others prefer to work over the corner of a desk.
4. Adaprilie counsellO'N know how and u,hen rouse skills, and rhey know tt--hen ro refrain
frc,m using rhem. This rttauircs intelligent consideration of a wide range of variables.,
including setting, prob lem, client capacity and receptivity, time available, and so
on. For example, at the beginning of a counsellina relationship. counscJlo.rs usually
want to use skills chat promote the development of the working alliance, so they
avoid more demandina stratejpes such as confrontation. Once th~• have estab lished
a firm working relncionship. counsellors will want to use skills that hclp clients g3in
new perspectives, so confrontation ma'>' be warranttXI. As another example, empa•
thy often encouraaes clients to share deeper feelings. Therefore, counsellors who
use empathy should be willing to invest the time that this sharina requires; how•
ever, if the interview is nenr an end, the counscJlor might decide to avoid cmP3thic
responses that stimulate emotions that cannot be dealt with in the time avail3ble.
5. Clienu a.re at diffnem sragesof morilYUion and each srage s,,uesr.s unique counsellor skills
and strategies. For example, clients who are prccontcmplntivc (not thinking about
change in their behaviour) will not respond to approaches that might work very well
with clients who arc in the midst of chan,;c.
6. Effenil'e coun.sellmsare "m,drifinguaf." They adnpt their use of lanaunge and idiom
to match the lanauage of thc.ir clients. Careful listening helps counscJlors learn their
clients' communicative languai;c and metaphors, which helps counscJlors modify
their language to fit thnt of thc.ir clients. Counsellors will find it easier to establish
rapport and build crust when they match their clients' words with similar language.
The following examples illustrate:
Client I: ?l.·1'>' \'iew o( the problem is . . .
Coun.seltor I: I( I~~ the pkture oorrectl)·, the war rou see it is . .
Client 2: When I listen to m)•sel(. I know what I h::t\'e to do.
Coun.se.U.or 2: Teti me more about what )'Ou are S3)'i"¥ l'O )OurSelf.
Counsellors need to p3y attention to variables such as voice tone, volume, and
tempo and then respond appropriately. To a depressed client, a high,-cnergy, fast•
taJking counsellor might be annoyina. Similnrly, the counscllor who responds in a
monotone to a client who is ecstatic about find in a a job might come across as cold
and indifferent. There arc constraints on this principle, thouah: Counsellors should
not yell at clients who yell at them, nor is it necessary for counscllo.rs to use vulgar
language to march their clients.
The Skills, Ptocess, and Pitfalls 01 Counselling
37
The challen,;es of tod3y's diverse c3seload m3y require 3 counsellor to inte.ract
in one interview with a client who has 3 sophistic3tcd and 3rticulate command of
English, then meet with 3 client whose lnngua,;e skills 3re rudimentary. For each, a
different \'OC3bul3ry is appropri3te 3nd necessary.
SUCCESS TIP
Although counseling s.kill:S and strategies a(e to be adapted to meet iOCIMClual needs and
d (cumsrance-s, p(ofessionat ethics, attitudes, value-s, and behaviou( must remain constant
Brief Encounters
Some counseJlors worlc in settings where they are able to schOOule clients with pr(){ected
time over a period of many months; however, in m3ny soci3J service and community
centres, inter3ctions are brief, limited to a single encounter or even a few minutes.
NevenhcJes.s, the potenti3l impact of this work, however brief, should not be discounted (Presbury, Ecluerling, & McKee, 2008: Carpeno, 2008). Among the possible
positive outcomes are the following:
■
When clients 3re 3mbivalent 3bout change, support from the relationship c3n tip
the sc3Jcs in favour of change by creating an 3tmosphere of rrust and s3foty.
■
Counsellors can m(){ivate by conveying optimism th3t change can occur, particu.larly when they focus on client strength~ not weaknesses.
■
Short sessions can provide an outlet for clients to vemil3te feelings.
■
CounseJlor empathy and nonjudgmental responses help clients accept the.ir feelings
3S normal.
■
Questions 3nd reflective responses can help clients organi!e ideas and plan for systematic change.
■
A client's way of thinking about a problem and its resolution can shift when coun.sdlors offer fresh ideas or re.framed reffections (i.e., looking 3t a problem from a
new perspective).
■
Counsellors c3n help remove barriers to change through information or the pro\tj,.
sion of resources.
TRAUMA- INFORMED PRACTICE
Traum3tic experiences can include single events such as violence/rape or n3tural
disaster~ as well as those that arise from ongoing abuse or neglect. A person can also
experience trauma from witnessing, reading, or hearing about the experiences of others.
(n foct. counsellors m3y experience vic3rious traum3 from exposure to the stories of
traum3 from their clients.
People respond in unique ways to traum3. Some continue their lives with linle
or no emotional disruptions while others experience "anxiety, terror, shock, sh3.me,
emotion3l numbness, disconnection, intrusive thoughts, helplessness and powerlessness" (BC Provincial Mental Hea.Jth and Substance Use Pl3nning Council, 2013, p. I I).
Counsellors c3n expect that a significant proportion of their client caseJoad h3s experienced traum3, as 76 percent of C3nadians h3ve experienced trauma at some point in
their lives. Moreover. up to 90 percent of women in treatment for substance abuse h3ve
been subject to 3buse-refatcd trauma (BC Pro\tinci3l Mental Health 3nd Substance Use.
Pl3nning Council, 2013), for which their use of substances is a w3y of coping.
38
Chap1er 2
After trauma or oog0rng suess. the ~ppoc.ampus, a part of
IM btain associated with memory, may be damaged and
become smaller, which leads to more difficulty in prOblem
solving. Al the same lime, tne amygdata, a part of the limbic
system mspoosible f0r emol.ioos such as danger and fear.
oocomes larger and mOl'e sensitive. which helps explain 100
hypersensitivity and paraooia lhat develOps after trauma.
Damage to the prefrontex. cortex. after trauma may impair lhe
individual's abtfity to plan and make apptopriate decisions
(Bremner-, 2006).
The BC Provincial Mental Health and Substance Use Planning Council (2013) has
identified four essentiaJ clements of a trauma.-informed approach: trauma awareness,
emphasis on safety and trustworthiness. opporrunity for choice, collaboration and
conn«tion, and strengths-based skill building.
t. Trauma Awareness
Here, the focus is on building both client and counsellor knowledge about trauma and
how it can affect one's life (mental, emotional, and behavioural), including chronic
pain, slttp difficulties, depression, anxiety, e.motional numbnes~ memory problems,
loss of life meaning, feelings of shamc/sclf-hate, inab ility to trust in relntionship~
difficulty sening boundaries, substance misuse, self-harm, high,-rislc sexual behaviour, suicide, isolation, and criminaJ behaviour (sec BC Provincial Mental Health and
Substance Use Planning Council (2013, p. 22) for a complete list). The N-ational Child
Traumatic Stress Network (2015) n()(CS that children may respond to trauma with
a wide range of reactions. including difficult)• artaching, increased vulnerab ility to
stress, relationship problems (e.g., friends and teachers), trouble with authority fiJ;ures (police), and problems expressing or managing emotions. Post-traumatic stress
disorder (PTSD) is one common result of the rmuma of experiencing or witnessing
a traumatic event. Jts symptoms may include a wide range of symptoms, including
uncontrollab le flashbacks. distressing thoughts and nighnnares about the event, a
need to avoid people and plnces associated with the mtuma, severe anxict)•, emotional
numbnes~ inability to form trusting relationship~ slttp problem~ substance misuse,
guilt, sham,; and anJ;cr (Mayo Clinic, 2017b; American Psyd1.iatric Association, 2013).
2. Emphasis on Safety and Trustworthiness
The immediate focus follo"•ing any traumatic experience is to make sure that
the person is safe, that basic needs are met, and that he or she is able to connect
with supportive people and resources. Trauma upsets one's sense of physical and
emotional security so it is esscntiaJ that the counselling environment be structured
in a way that contributes to the restoration of safe()•. Establishing a wekoming
environment from reception to physical space to service delivery that involves
and keeps clients informed is important. CounseJlors need to be predictab le and
reliable with consistent follow throuJ;h. The S ubstance Abuse and Mental Health
Services Administration (2014) emphasi!es the importance of offering cultural and
gender responsive service, including utilizing cultural connections and rccogni.!ing
and addressing historical trauma. An important part of this practice is to use, or
support clients to use, culturally appropriate healing practices.
3. Opportunit)' for Choice., Collaboration, and Connection
Trauma dise.mpowers people. Trauma.-informed practice aims to restore client
power and control in their lives and as participants in the counseJling reJationship. Open communication, freedom for clients to express opinions and feeling~
nonjudgmental counsellor attitude~ support of diem choice~ and collaborative
work with clients all contribute to this clement.
The Skills, Process, and Pitfalls 01 Counselling
39
Focusing on strengths helps to change the foctJS of the
prefronlal C<><tex (tne part oflhe btain responsible lo< judw,,er,,
~nning. aoo decision mak.i~) from negative to J)OSitive
thinlung (tvey, 1\/ey, & Zalaquett. 2010). Tlis find-,g has huge
implications fOr' counselling clients with IOw seff.image and
pessimistic thought pattems. Counsem~ from a sttengths
perspective takes advantage of 100 btain's neufoi::i)sticity to
enhanice imJX)rtant determinants of cha~, such as capacity
to take appropriate risks, optimism abOut one's ability, and
resiience to handle obSlaeles wiloout damage to self.esteem.
4. Strengths-Based Counscllina and Skill Buildina
Strengrhs.-based practice shifts the focus from problems to opportu nities a nd sofu,.
tions. Counsellors "hold the bclief that children, youth, and their families have
strengths, rc:sourcc:s and the ab ility to recover from adversity (as opposc:d memphasi!ing problem~ vulnerab ilitic:s, a nd deficits)" (Hammond, 2010, p. 4). Clients and
counsellors work as partners, and the "expertise" o f clients to make their o"'n
decisions is rc:sp«t~.
Relationsh i p Issues
People "'ho have been traumatl!c:d often have difficulties in their per sonal and fam ily
rc:lationships. Sensitive counsellors who utili.!e a trauma-informc:d approach r«ogni:e
that some of thc:sc same d ifft eulties may emerge in the client/counsellor relationship.
Some of thc:se problems indude the following:
■
difficulties trusting others and a. rclucmnce to share foc:lings
■
generoJ loss of interest in establishing intimate rc:lationships
■
hypersensitivity and a tendency to be suspicious about the motives of others
■
tendency to bc:come easily frustrated and tro uble managing ani;er
It is critical chat co u nseJlors manng:e the.ir own fc:c:lings when working "'ith people
who have bc:en traumati!c:d to ensure chat they do not respond defensivdy to d iem
behaviours that arc provocative. They need to communicate to their clients chat the
counselling relationship is safe and that counseJling will not exacerbate their trauma➔
Consequ ently, patience, empathy, honesty, and procttding at an appropriate p3ce for
each client are particularly important when working with clients who have been trau.mnti!c:d. Fully involving clients and rcsp«ting their rights to self..dctermination and
decision making will hc:Jp to restore a sense of control, so crucial to recover y from
trauma➔ As a result, clients who achieve intimacy and find suppo rt in a counseJling rcJa,.
tionship find that they arc also more able tocommunicnte in their persona.J relationships.
Counsello rs "'ho have their own history of trauma. nttd to ensure chat this docs not
ncgntivc:J,., impact their ability to counsel clients who have been tmumnti!c:d. Utilizing
supervision as a tool to increase self-awareness of their behavio ur, emotion~ and impnct
on clients is recommended.
SUCCESS TIP
With a trauma-infofmed app(oach, counsellors uooerstancl that lheir clients' behaviour,
thO~IS and emotions, ho-.-.evet troubling. misguided, or confusi.ng, are copi~ sttategjes
that enable them to deal with and sur'Vive lhe impact of lheif trauma. Counseth.ng can help
dients deV80I) more effective chOie:es-for ex.ample, healthy communication s.kill:S, anxiety
or an.get management, assertiveness, aoo inter-personal fetationshi!Y"uUimacy skills.
40
Chap1er 2
Treating Post•Traumatic Stress Disorder The ,;03J of post-traum3tic stress d isorder trcntmc nt is to help clients rcgnin control b)•dealing with those emotion~ behaviour,
3nd thoughts that 3re intcrfc.ring with thc.ir qua.Jit)• of life. Counselling (psychotherapy)
is the primary trc3tmc nt. but this m3y be suppleme nted with 3ntideprcsS3m or 3nti•
3n.xiet)• medication. Medication, b)• itself, is insufficient. Comb ining medication with
meditation and wellness initiatives such as exercise and nutrition will h elp with recovc.ry. The principles of traumn.-informed cou nscJling d iscu ssed in this section a re the
foundation fo r 3ny intervention. A number of d ifferent counselling strategics have
proven effective, in cluding the following:
■
Cos:n itive behaviou raJ chera~• (CBn to hcJp clients deal with unhelpful thinking
p3ttcrns. (Sec Chapter 7.)
■
Exposure therapy, wh ic.h involves revisiting trauma.tic eve nts until they 3rc no
lon,;cr troublesome.
■
Eye movement d esensitizatio n a nd r eprocessing (EMOR) a ver y spcci3Ji!ed
nppro 3ch designed to help d icms process trau matic memories. (Shapiro, 200 1).
■
Use of s:roups fo r support and sharing o f coping skills.
COUNSELLING SKILLS AND STRATEGIES
T here is no stand3rdi!cd met.hod for cl3ssifying counselling skills 3nd strategics.
Nevertheless, it is usefu l to think 3bou t skills and strategics in ter ms of their function
o r intended purpose. Jn this book, four major skill and strategy d uste rs a.re d iscu ssed
(sec Tab les 2.2, 2.3, 2.4, and 2.5),
s.kill and strategy
d us.ters.: Catepes of ~ and
strl'teffes based on tileir intendei:f purpose
« ~ . aNiliy.
t. Relationship build ing
2. Exploring & p ro b ing
3. Empowc.ring & strength b uilding
4. Promoting change
Some skills achieve multiple purposes. Sensitive active listening, for cx3mplc,
contributes to the development of the rcl3tionship because it commu nicates acceptance
3nd the since.re desire to understand. At the same rime, 3ctivc liste ning is essenti31 for
getting inform3tion, so this skill c3n a.Jso be cl3ssificd as an exploring and probing skill.
Re.framing is both an empowc.ring 3nd a challe nging: skill. It serves to empower when
it shifts a client's attention to something positive (emotion, perception, o r expc.ric nce)
th3t has been overlooked o r never interp reted 3S such, but it challenges by influencing
the clie nt to enter tain n ew interpretations that generate new behaviours o r changes in
TABLE 2.2
Relationship Building
Goal: EstabliSh a productive and professionally intimate relationship, sustain trust
Sklll-S
Stratt(IH
• Active Uste-ntng: Altendiog. silence,
paraphtasing, summartzrng. empathy, and
asklrlg questions
• Core Conditions: Congruence. positive regard,
and warmth
• Oeftne and Sustain Relationship; Conttaetiog.
ln-.nediacy, and Retatioos.hip PrOblem
• Maintain a safe, confidential, and
professional envirorunent
• F'oc:us on collabO<atioo
• Be ltust\\()rthy, relia ble, a nd consistent
• Help c~nts Mtetl their stones· without
judgment
• Re-member im(X)rtant details
SoMog
• Appfoptiate counsell0t self~iSdOsufe
• Hurnou(
The Skills, Proc ess, and Pitfalls 01 Counselling
41
TABLE 2.3
Explori ng & Probing
Goal: Acquire and deepe:n understanding and motivate clients to "tell their stories.··
Skills
• Active Listening; Attending, silence,
par.1phrasiog. summarizing. empathy, and
as.king <i u&Stioos
Seek e.ampleS
Oifectives
Simple encourage<s
0,::.M-ended sentence completbn state~nts
Pay attentbn to nonverbal channel of
Stratet1es
• Maintain focus oo key issues
• Manage interview transitions
(Cllange of 1opk:)
• MonitOr' padng to flt individual client
needS
communication
TABLE 2.4
Empoweri ng & Strengt h Building
Goal: lnc,ease client choice, conhol, and opportunity.
Skills
• Recogriize and sea,ch b client strengths
• Refr'aming fOr' new pe:r'Speclive such as
viewing prOblems as op(X)ftunities for cha•
Identify (&SOufces to assist client (rete«an
Provide inf0tmatbn
Teaching; tole playing, modemng
Positive feinforcement: pt'3ise, reassurance,
and tewatd
TABLE 2.5
Stratet1es
• Prioritize coltatx,ration
• foster optimism
• focus on growth and potential
tot d'lange
• Advocate oo behalf of dieot
• UtJize s.Jults training progr'arns
• use ot mentors
Promoting Change
Goal: Focus on solution and the PoSSibtlities for feeling and problem man.a@ement
Skills
• Challe~~: confronti~ and corr'ecti~
distortions
Providing feedback
• Using mftami~ to add oow pe-rspectives on
problems and Sdutions
• Aclbn Plannu,g; defring dear goals, exp!Oring
alte«la!M!: chanfJ!: c¥itbns.. aoo maki~ char'@eS
Hetpi~ die-nts i:1entify and modify unhelpful
thiO!u~ patterns (see Chapter 7)
Hetpi~ die-nts manage- problematic fee-lings:
relax.at.ion and mindfulness
Using JX)wer and authority
Stratet1es
• focusi~ on helping clients change:
goal se-tting. e-xplOr"mg/evaluating
alterr\atives., and implementing action
plans b cha•
• UtJizing client strengths
emotional pe.rspective (see Chal){cr 7 for an in-depth discussion of this skill). CounseJ,.
lors do not use skills compulsively. They have the knowledi;c, ability, and assertiveness
to use a skill when necessary, but they a.Jso use selfoestraint to avoid using a skill when
it is not in the client's best interest. Counsellor self.-disc:losure, for example, is an option,
not a requirement.
SUCCESS TIP
A tr-auma inf0fmed approach features core conditions, tel3tionship building SkillS, and
empowerment skJls as lhis combination of skillS and attJtudes \\()rk$ beSI to provide safe-ty
and ensure coltabOtation with die-nts.
4
42
Chap1er 2
4
Practitioners need to be versatile, building skill competence based on knowledge
of the following:
t. Skills and strategics and their intended purpose
2. Best methods and situations for using each skill
3. Self-awareness of personaJ strengths and limitations with each skill
4. Acquired understanding of each client's caP3Cit)•, need, and willingness
Relationship-Building Ski 11s
Relarionship-buildini skills and strau.• iies arc the basic tools for engaging clients. developing crust. and defining the purpooc of the counselling. A strong counselling relationship is
universally accepted as essential for counselling success. The relationship establishes and sustnins the ncccsS3ry 53fecy, trust, and intimacy for clients to explore their issues and feelings,
then deal with the challenges and emotions associated with change. The strength and support of the relationship provides a base for clients to risk engagement in chc change process.
Relationship-building worlc is of central importance during the beginning phase
of hcJping. b ut effective counseJling requires chat the rcJationship be sustained and
dttpened through all phases of helping.
Core Cond itions Rogers ( 1951 , 1961 , 1980) and others have written cxtensivdy about
the core condition.'> necesS3ry for forming a helping rclntionship--namdy, congruence
or genuineness, empathy, and positive regard. Rogoers believed chat people are essentiaJly
good, self-deterministic (able to make the.ir O\\•n decisions), and goaklirccted. Thu~ he
believed that these core conditions are necessary for establishing the rapport and therapeutic alliance needed in a purposeful counselling relationship. Central to his theory
was the notion that the core conditions create the emtironmcm within which change and
growth will occur with the client seen as "the cxpen on his or her own life ... responsible
for the direction of change and growth within counselling" (Erford, 2010, p. 16).
Cons:rucncc, or jtenuincn~s, is the capocity to be real and consistent with clients. Con,
gruent counsellors arc open with their reactions and feelings and demonstrate consistency in
what they believe, say, and do. Congruency also requires counsellors to be "tTIUl.Sparent"\\tithout hidden agendas or false dcmc.mours. Rog:c.rs believed that the more counsellors arc
:.n\--are of the.ir feelings and the more they genuinely express these feelings in the counselling
relationship, the more effective their counselling will become. An important part of congruence is counsellor self-disclosure, patticularly with their "here and now'' feelings.
Empathy is the most important core condition. ln simple terms, it means being
ab le to sec the world through the eyes of the client. Essential to empathic understanding
is the ab ilit)• to understand feelings without imposing one's own fttlings or reactions.
Counsellor experiences have the potential to increase emP3thic understanding, providing
counsellors arc on guard to ensure that they do n()( become prescriptive of hCM• the client
must feel. Positive re-,:ard, or respect for clients, is the ability to recogni!e the inherent
worth of people, rcg:irdlcss of their behaviour.
relationship-buildirc skills and
strategies: lids for enppig dents
and dM.iop.g trust.
core conditions: W.wmtt.. anpathy,
posiweiegard.and ~ m.
coogruence: ne capaciytobe real
and consist• .ith clients; m.l~dling
bebl'iour. ~ s . .tacticm.
genuM!ess: Aaeasure al ho"•
allllientic or teal me is ii a ielati>nship.
empathy: The po:ess ol accurately
undefs!and-i the emoti>nal perspecth-e
d anather persca, and die ccmllllicatica
d tiis understaading ■itklll imposing
me's Otlll feelings• readions.
pos.itire regard: Theabilityof
uunsellors to ~ lite inlleienl ~
d people.
acti're listeni,.-.: Atn descliling a
dvster of skills that are uS!d to ilcrease
tile accuracy of • ndentanding.. Attendi-,..
usilc silefltf. paraphrasing. summarilina.
questioning.a. sha• ing empatt,,aie die
basi:: stills GI adi,,,e istening..
attending: Atera used to descril:e
tile •ar that caselkn communicate to
tlleir clients tut they an te:ady. Milling.
and a~le to listta. Vefba:1. ncaverbal. a.
attitmal nes aie die esv.ece of effec.
ti...e attend-,.
Active Listening Active lisccn ini is crucial for building rclntionships and for understanding. If counsellors arc preoccupied with what to S3Y in reply, they cannot truly listen.
Until they listen the.re is no way for them to understand the complexities and uniqueness
of their clients' situations. Active listening is an interactive process involving six slcms:
attending, using silence, paraphrasing, summari! ing, questioning, and showing empathy:
silence: Ato:il used in a.selling
■
whel the dent is thin~. tile client is
a,nfssed and unsuie GI l'lflat to say«
■
Anendini is the manner in whidi. counsellors communicate that they are physically
and psychologically interested in what their clients arc S3ying or doing.
Appropriate silence gives clients time to think and respond. Effective counsellors understand the multiple meanings of silence. Is the client confused! Have
The Skills, Ptocess, and Pitfalls 01 Counselling
di. or the dent It.as entOUntffl'd paint.I
ree.p. Because ii is c11l11111t, defined.
silence can also signal trust iss.a!'s «
d...._
43
we renched the end of the topid ls the client thinlcing! Slcillcd counsellors know
when to intcrruJ)( 3 silence and when to allow it to continue.
paraphrasing:: Atonjudg_•ntal
mtatemeat of the client's ..on:ls and
Gas in lie ~Elor's 0111n w.ords.
sunvnarizing: A•ar of ccadensing
content (See also CIXtMt SamMJtY•d
TlwttSamM~
■
Paraphrasing involves restating (usu3Jly in shortened form) the client's thoughts to
clnrify the essence of wh:.n he or she has said.
■
Summari::ina mC3ns condensing the csscmial content and identifying important
themes and ideas.
■
Questioning involves probing for information to confirm understanding and seek
clnrific3tion, such 3S by saying, "Do you mc3n that . .. ?" \\:fhen combined with
nonjudgmental counsellor responses that confirm understanding. questioning
provides an opportunity for clients to "tell their stories," 3 process which is often
cathartic and therapeutic.
(J.teStioning: An actm lis,~
skill tu inYdvtS probing I• infcma•
tion to confinn ~ rstanding_ and seek
clari!icati>n.
•
EmP3thy is "the process of nccuratd)• understanding the emotional pe.rspectivc of
3nothtr person and dlC' communiattion of this understanding" (Shfflib, 1997, p. 177).
Active listening is the psychologic3l incentive for clients to open up with further
disclosure. \Vhen clients sense deeply that they have been heard, th3t the.ir ideas are
not judged or rejected, that the.ir feelings 3rc accepted 3nd validated, trust develops.
Active listening makes it safe for clients to explore ideas and feelings. Together with the
core conditions, 3ctive listening says to the client, "I have heard you,'' "( am willing to
understand 't'our feelings 3nd problems without judgment," and "I accept you." Active
listening is a powerful tool for est3blishing rapport and undcrst3nding. the basis for
strong working relationships.
Defining and Sustaining the Relationship
Roge.rs (1961) emph3si!es the importance of a.voiding moral judgment of the diem. He vividly C3prurcs the signific3nce of
nonjudgmental exploration to the development of the rcfotionship:
It is only as I undersu.nd the (eelin¥S 2nd thoud,ts whieh seem so horrible to )Ou. or
so weak, or so sentiment31. or so bi:a.rre-it is onlr 2s I see them as )'Ou se,e them. and
~ept them and you, th::u rou (eel really ( ~ to ~pl ore all the h.icklen nooks and lr~t•
enin~crannie!l o( )'Our inner 2nd often buried ~rience. (p. 34)
Two major skills 3rc associated with defining and sustaining the rcfotionship:
contracting 3nd immediacy. Counselling contracts ma)' ch3nge, sometimes frequently,
as the ,vork proceeds.
relationship contracting::
Hegcti~ the intended purpost of
the uunselling Rbtion- ildu-,:
a i ~ on the apa:ted des« both
counsell« and cli.-.
■
Relation.,;hip contracting involves negoti3tingthc intended purpose of the counsel,.
ling relationship. including agrtting on the expected roles of both counsellor and
client.
■
Sessional contracting is concerned with setting the purpose of an individual
session. Scssional contracting defines a work plan th3t is individu3li!ed to meet
the needs of the client. Consider, for example, three women who seek counselling
for the s3mc problem-a relationship brc3kdown. Bcc3use of contrncting, the first
client may conclude that she needs help in m3na.ging her stress and P3in. The second
client may wam to focus on developing her 3ssenive communication slcills for dC3l•
ing with an 3busivc spouse. The third diem might want hclp with decision ma.king
in choosing between leaving the rcfationship 3nd remaining in hopes of solving the
relationship problems. (See Chapter 3 for a det3iled discussion of refotionship and
scssion31 contracts.)
■
Anticipatory contracrina focuses on planning strategics and responses for events
that ma)' occur during counselling, such as how co give fecdbaclc or how to respond
to a drug use relapse. Clients 3rc often able to give counsellors valuable input and
3cfvice on how they (counseJlors) can best de3l with these events.
session.al contract._-; An agree.Mt
between counS!lor and client rega'-t
the topic •d exieued ClllkOme GI
• intervit'# « session. ('See also
Ctx,;rx.tiRg.)
anticipatory contracting:: Al~
• nl bE1~ ODaSellon-1 dients that
plans kif predictable ew:nts. Antqii.;orr
contracts prom!! g_uidance ICJ ~ • s
•d ansv.er the questioo. '"M.at shNld I
doif .. !"'
44
Chap1er 2
Immediacy (Eg:in & Schroeder, 2009) is a tool for examining and deepening the
counselling relationship. It involves a process of evaluation that addresses the qmllity
of the relationship in terms of its conmtcted objectives. The skill of immediacy can be
used to troubleshoot rcJationship prob lems. 1t promotes candid discussion rcg:irding
ways the reJationship might be changed to fulfill its objectives. \\:'Ith immediacy, relationship problems and feelings are addressed before they have a chance to have a lasting
destructive impact. (Sec Chapter 3 for an extensive discussion of this skill.)
immediacy: Atool t« exiforing,
walualing. and deE1)erting CC11asEting
ielati>nships.
Exploring and Probing Skills
Explorini a nd probini skills arc basic tools of interviewing that counsellors use to
g:ithc.r information, clarify definitions, seek examples, and obtain necessary detail.
These skills enable counsellors to avoid making assumptions. Active listening skills arc
the primary tools of exploration and prob ing. ~ausc they communicate counsellor
willingness to listen nonjudgmentally, they motivate and encourage dicms to tcll thc.ir
stories. When clients arc helped to explore their problem~ they often g:iin insight from
questions that provoke thinking in areas that may have been overlooked. As wcJI, reflec•
tive responses such as empathy help them g:iin perspective on emotions.
Directives, such as "Tell me more" or " Please expand on )'Our feeling~" control
the direction and pace of the interview. Directives can also be used to focus the client
on reJcvam priorities. Directives arc the " road signs" of the interview.
Simple encouragers are short verbal and nonvcrbaJ cues that motivate clients to
continue. Verba] stntemcms such as "Uh.-huh" or " Yes" and short directives such as
" Please continue." a]ong with nonvcrbaJ signals such as head nods and an attentive
posture, make up this skill set.
Counsellor self-disclosure, used sparingly, can be a useful tool that models appropriate sharing of feelings. Counsellor self-disclosure ma)' reduce the clients' sense that
their experiences or feelings are strange or abnormal. Subsequent],.•, when experiences
are "normalized," clients arc more apt to open up and share. Jn this way, counsellor
self.-disclosurc acts as an exploring/probing skill.
Humour, if timcJy, can be used to r~ucc tension or encourage clients to take a
lighter view of their situation, but humour must be used cnutioust,., so that it docs 00(
offend clients or trivia.kc their problems.
Opcn.-cnded sentence completion statements give clicms an opportunity to "fill
in the blanks." The counsellor presents an incomplete statement, then pauses to allow
the diem to complete the thought. Almost a.Jwa)'S, clients will finish the statement with
thc.ir own content. This is a p0\\terful strategy that gives clients full control of the answer
while the counscJlor controls the focus area. Here arc some examples:
How might you finish this statement?
■
The one thing I need most from my husband is .
■
You're feeling .. .
■
So, the options 't'ou'vc considered arc .. .
■
Finish this statement. The one thing I nttd most is .
■
The next step is .
&ploring and probing: skills: S~
uunsellors us.e to pth« inf«mali>n,
d Mify definiti>n, S£ek w mples. •d
dltain necessary dftail.
directives: Sllott state.nts that
promi!' directi>n to tlieals • s .
inforaution. and pace (e.g.•"Tell me
°'
_,.I
simple encouragers: Short phrases
and gestuiessuch as •1e1 me Ml!:
"Co
'Uh-huh: and head nods that
enocuage dients to ocaiinue widl their
stclfies.
on:
counsellor self-disclosure: Whal
uunsellors disclose personal opinions.
ree.p, or aae<dctes, it can be a usfful
toct that med.ls appropriite wring. ud
norauite the clients· feelilgs oc
~noes. CounS!lor self-di!dlsure
shooId be used spari. ,solety to Met
tile needsoldientsiu way tu does IIOl
shift the foc.s to the a.selkll
it..-
humour: a uunselling tool that 'lltlen
appropriate and ~ II tiaed, ffl..l)' SU~
PM the dewl>pment ol the relati>nship,
iedlltf taasia.. encc.age tile dient to
talle a lght.erviewol tilleir problem, or
prom! an at.ernate perspective • tlleir
si1Ualion.
By responding to nonverbaJ cues, counsellors pay attention to such things as voice
tone, posture, eye contact, and facial expressions. Sometimes the content expressed
by a client's words is sufficient for undc.rstanding. But not infrequently, the major meaning or intent of a client's message comes through the nonverbal channel CounscJlors
should never ignore the nonverbaJ channel, which enhance~ contradict~ or embellishes
verbal messages.
The Skills, Pt oc:es.s, a nd Pitfalls 01 Counselling
45
Managing transitions involves paying attention to or suggesting shifts between
phases or topics. This skill can be used to organi:e the flow of the intc.rvicw or to link
themes and ideas (see Chapter 5 for an e>..'tensivc discussion.)
Empowering Skills
empowering skills: S~ us!dto~p
clients mobilile ocafidefltf, self-esteEa.
•d contnf c,,,e, tileir lires..
Empowerins: skilJs help clients mobili.!cconfidcnce, self-esteem, and control over their
lives. Counsellors who arc committed to empowering their clients must start with a
basic be.lief that their clients arc capable of managing their own lives. They must relin.quish the mistaken notion that clients depend on them for advice, decision making,
and problem solving. Clients are empowc.red when they participate in decisions about
counselling goals and procedures.
The principle of sclf--dctcrmination introduced in Chapter I promotes empowerment by helping clients recognize choices and encouraging them to make independent
decisions. To avoid promoting unhcaJthy client dependency, counscJlors should not
do for clients what clients can, and should, do for themselves. CounscJlors should
acknowledge and give clients credit for their success. When clients arc successful and
they "own" their success, their confidence and self-esteem increase.
Four skill sub clusters are the essence of empowering: teaching, giving information,
supporting, and above all searching for strengths.
Teaching Teaching may be used in counselling as a way to assist clients in developing strengths. Skills training, rolc.-playing, and other tools can be used to hcJp clients
develop their capacities.
Giving Information
lnformation giving empowers clients with knowledge of altc.rnativc courses of action, including resources that might assist them in dealing with
their problems. Counsellors may also offer suggestions and advice regarding problem
management.
Supporting Supporting is used to bolster clients' energy and optimism. To some
e:r...'tent, all counselling skills are supportive. Supporting reduces clients' feelings of
isolation and provides them with incentives to address their problems, express their
feelings. and begin a process of change. Supporting can also be used to tell clients
that they arc on the right track and that their feelings and reactions arc normal. As
well, supporting hcJps clients manage anxiety and stress, thus, incrc3sing their enc.rgy,
scJf<onfidencc, and capacity for problem solving.
streng_ths approach.: Acounselilc
perspe«iw that asSllmes tile inherent
capacity of people. lldimaals and
communities are seen to haw assets
•d iesoun:es that can be mobililed tw
Searching for Strengths Clients arc often besieged by debilitating problems and
chaos. Counsellors cannot ignore rc3l problems, but in the process, they should not
focus all their attention on problem situations and what is d't•sfunctional in their clients'
lives. The strens:ths approach assumes the inherent capacity of peoplc. Jndividuals and
communities arc seen to have assets and resources that can be mobili!cd for problem
solving(Shcafor & Horcjsi, 2008; SaJceby, 2009: Glicken, 2004). Empowering skills and
principles will be explored in more detail in Chapter 7.
poblea scf\ing.
Promoting Change Skills and Strategies
chal~ng skills: S~ us!dto
e11CC1Jrageclients to critic-.a9/ e,aluate
their beha\tCIUr and ideas.
confrontation: Counstllint iliiiatiws
that <Wlenp dients to criicall1 ex..ine
their acti>ns andfor consiier other
vitr11pciills.
46
Challenjpng s k ills arc used to encourage clients to e\laluate their behaviour and ideas.
They push clients toward change and growth to fulfill the fundamental reason for the
counselling relationship; hO\\•evcr, excessive or premature reliance on challenging skills
may strain the counselling relationship.
Confrontation prods clients to critically examine thc.ir actions or consider other
viewpoints. CounscJlors may need to provide critical or corrective feedback, identify
overlooked strength~ correct distortion~ suggest other viewpoints (rdraming), or
Chap1er 2
request that clients assume responsibility. Confrontation skills arc: most c:ffoctive when
there: is a strong relationship of trust and when clients understand and accc:J)( the va.Juc:
of their use. Brill and Levine: (2005) offer this perspective on the challenging skill of
confrontation:
?l.·1isuse of oonfront2tion c:u, be de\'astat intt, dest ro,.,i,l{t all previous e(foru.. \Vorke-rS
must assess the 3tnount and quality o( eonfrontation the elient is willin& or able to use,
2nd they rnust be 2ble to Ki"e- support if the re:U1ty is overwheltnini.::. Worke-rS must
noc use confrontation l'O express their own an~-e-r and frustr2t.On. 2hhou,ah these 3re
etrt,iinl)' 2 part of the re:U1ty with whieh both workers 2nd dienu 1nust deal. (p. 186)
Ideally. confronrotion skills incre3sc: clients' motiwtion for change. The counselling
relationship provides the necessary base for confrontation. Clients are more likeJy to
accept confrontation as credible when counscllors have: first listened and folly understood them. Clients may be appropriately confronted when they:
■
are working from false assumptions or incomplete information.
■
misread the actions of others.
•
•
lack self~awarenes.,;; regarding the: impact of their actions (e.g., when they blame
others for the.ir problems rather than examining their own responsibility).
■
demonstrate contradictions in their behaviour, thoughts, and feelings.
self-awareness: The pocesso! be::oming atfrt and ~ 1edgeatle atout one's
~ WJ// d ttilling. acc.,. and feeling.
den)' or do not recognize their personal strengths, capacities, or resources.
Ac.rion p la n nini is a wa't' of helping clients bring about changes in the.ir lives.
These changes may include: finding new ways of managing feelings, forming strategies
for modifying ways of thinking, or developing new skills or behaviours. Action planning
helps clients define dear and measurable targets for change(Koals), identify and evaluate
alternative: strntegies, and select and develop plans for reaching these goals.
action ptanning: flelping cli• s make
dl.-ges in tilleir liws.: ll'lolws setting
fOib, identi!Jing strategies t.Wn,e..
and dmlopilc ,.aans kif ieathing goals.
Use of Power and Authority Counsellors derive or are given power by virtue:
of their position. Such pO\\•er comes from man)' sources: competence, knowledge,
education, control of resources, position in the: agency or status in the community, or
simply the fact that the: client is the one who is in the: position of needing or seeking
help. Counsellors are also rc:prc:sc:ntntivcs of agencies that wield power. For example,
child protection social ,vorkc:rs frequently make decisions and judgments that have:
a large impact on clients' lives. However gentle and caring counsellors arc:, clients
may perceive them as pe.rsons with power and influence:, and often as people: to be:
feared. Comp(on and GnJaway (2004) note: that families may have "negative expec:ro•
tions, lack of trust, and fear of commitment" (p. 152) because of experiences where:
they perceived professional authority to have been misused. Miller (2007) advocates
the importance of an anti-oppressive model of practice that recognizes the inherent imbalance: of powe.r between clients and professionals. She promotes the use of
methods such as the: strengths approach, transferring power to clients, and involving
them in decisions (i.e., an anti-oppressive approach). As well, she invites dialogue:
on the important issue: of what professionaJs "can or should do in the presence of
organi!ationnJ and societal policies that do not support practising according to the:
frame,vork" (p. 132).
THE PHASES OF COUNSELLING
Counselling relationships can vary gre3tl)• in te.rms of time. Some evolve: over a long
period, but others may be limited to a few or even a single session while some may
last for only a few minutes. Counselling inte.rventions usually move through a planned
change: process involving sequentinJ steps or phases, each characte.rized b\•unique: as wcll
The Skills, Pt ocess, and Pitfalls 01 Counselling
47
phases of comselling: SEqtential
steps tk(qh whi~ uuns.elling teads to
eYOl\'e. The four ,US.es are peliminary.
begin-.g.
ending.
act•
as common objectives and skills. For our purposes, four ph a.«?s of counselling will be
discussed: (I) preliminary, (2) beginning, (3) action, and (4) ending. This model builds on
similar modcls present~ by others such as Eg3n and Shroeder (2009), Shulman (2009),
and Young (1998).
Each phase is distinguished by its focus on different activities. The preliminary
phase is essentially for planning. Proper planning increases the likelihood that clients
will perceive chat their nttds can be met through counselling. The beginning phase is
a time of engagement, when both the client and the counseJlor make decisions about
whether they will work togcthe.r and, if so, under what structure. The beginning phase
is also a time for exploring problems and feelings. Although clients ma'>' begin to change
their behaviour or manage che.ir feeJings more effectively during the beginning ph3Sc,
the action phase is more concerned with initiating change. During the ending phase, the
working rclationship is brought to a close, perhaps with a referral to another resource
or counsellor.
SUCCESS TIP
£very counselling relat.ionship wiU have many begiMings and endings and lhe presence
and dynamics of each ShOuld be consider-eel. The most significant beginning is the start of
the rel3tionship, bul each session Or' encounte( also has a beginning. When the focus of
discussion Shifts to a diffemn1 topi:, lhis is at:so a beginning. Sirnilatly, ead'I encounte( also
has an ending and as each topic draws to a ctose, thi:s is also an ending. The end of lhe
relationshiJ) is a inJ)Ortanl enchng that deserves the hJI attention of the counsellOt.
One common objective of each phase is forming and sustaining a working relation.ship. Thiscounsclling relationship is the vehicle for change and pro\tidcs a base of safety
and security for clients to explore and understand their emotions and difficulties. The
counseJling contract, an agreement on the goals and roles of the participants, is the
reference point for the relationship. lt is continunJI)• reviewed and revised as the work
progresses.
A second common objective of aJI phases is to establish open, honest, and productive communication. Effective communication enables counseJlors to learn about their
clients' needs and feelings. As well, it empowers clients to learn new ways of handling
old problems.
The third common objective of 31) phases is evaluation. Ongoing cvaJuation can
review the esscntin1 eJements of the counselling plan (goals and methods), the ,vorking
relationship, or the overall satisfaction of aJI particip3nts with the P3Ce of the work and
its results. By using a problem.solving approach, counsellors and clients can explore
ways to ensure that the work is relevant and efficient.
Skill dusters heJp organize skills based on function. Since each ph3se of counselling
supports different acti\'ltics, each ph3se 3lso favours different skills. For example, dur•
ing the beginning phase of counseJling, relationship-building skills are the priority, and
ch3llenging skills arc usu31Jy avoided, al IC3st until a foundation of crust and safety h3s
been established. Exploration/probing skills arc also \•ital during the beginning ph3se.
They enable counsellors to acquire information for understanding. thu~ heJping them
avoid assumptions. Challenging and directing/te3ching skills tend to be more effective
in the action phase, when a strong relationship and a solid b3sc of understanding have
been established. T3blc 2.6 summa.ri:es the principal activities and priority skills of
each ph3sc.
Counselling tends to move through the phases sequentially, with success at
each ph3sc depending, in pa.rt, on the success of preceding phases. For example, the
48
Chap1er 2
TABLE 2.6
Counsel! ing Activities and Skills
Pbase
Preliminary
P1lnclpal AtdwitlH
Prlodty Skills
• lntefView pre~Mtng
• Reviewi~ files and othef infOl'mation
• Planning
• Establishi~ Self-awareness
sources
• P(eparing the interview setttng
Begj.nning
• Establishi~ a eollabOtative,
professional worktng relationship
• lntefVieNi~ for understanding
• Evab.Jating
• Active listening
• P(ornoting c0te cooelitioos
• Defini~ the relationsl-.p
(comracli~)
• Searching fot St(engthS
Action
• Goal setting
• Action ~nni~
• Helping clients change behaviow',
manage f/Mlfiogs, and cha~
unhelphA think.i~ pattems
• Revi:ss"lg lhe contract deepeni~
the relationship, and managi~
communication difficulties
• Evab.Jating goal progress and lhe
o~ing (elations.hip
• Ending the helping relationship
• Referri~ client to other fesotJfOOS
• Evaluating goal achievement
• Te.act-.~
£tiding
•
•
•
•
lnfOl'mation giving
Sup(X)rting
Confronting
Action planni~
• Giving information
• Sup(X)rting
preliminary phase is designed to support the w-ork of the be-ginning phase. Jt allows the
counsellor to complete the prcp3rations th3t will help welcome chcdicnt to the ai;ency.
As wcll, it works as a lcind of warm,-up, so counsellors can be ready and sensitive to the
needs of their clients. Wc31c planning results in weak beginnings. Similarly, dfoctivc
work in the action phase is C3sicr when the beginning phase has be-en successful. A solid
base of understanding permits counsellors and clients to set more goals, and a foundation of trust allows counscJlors to be more challenging in chc.ir approach. (n contrast,
counsellors who attempt to chaJlcngc dicms from a thin b3sc of trust arc likely to meet
with resistance or rejection. Even in the action phase, it is important to cry to sequence
the steps. Jf clients cry to dcvcJop action plans before they have set dear goal~ their
action plans are more likcJy to be vague and dircctionlcss.
Although counselling work tends to evolve sequentially through the four phase~
usuaJt,., it docs not move fonvard in a neat and ordcrt,., manner:
The loaiC:U Pf"OKn'SSion of these ph:lSt'S makes the p ~ appear to be 21 linear, step,by,
step Seto( 3Ctivities. In reality. chai,~-e, rarelr proceeds in ai, orded)• fashion~ r.tthe-r. it is
more o( 21 spi~I, with frequent return!? l'O pr.Or phases for cl::adf'.e2tion or 2 rev.>0rki1'{t
o( \':l.riOU!l tasks and ::.etwitie!l. (Shea(or &. Horej!li. 200S.
p. 126)
The phases of counselling also provide a systematic and useful checklist of the key
activities and logical steps chat arc p3rt of the change or problem-solving process. By
referring to the phases of counselling, counsellors and clients can remain dear on where
they are in the counselling process, what has be-en done, what remains to be accomplished, and what options re.main open. However, as 30)' experienced counsellor will
attest, "cu.h counselling encounter is different, C3ch relationship is uniquely complex,
and the work may evolve in unpredictable ways" (Shebib, 1997, p. 71).
Sometimes dc3r dh•isions between the phases of counselling arc app3rcnt. But
more frequently, the.re arc overlaps between the phases and shifts forward and backward
The Skills, Pt ocess, and Pitfalls 01 Counselling
49
between one phase and another, and, in some cases, phases may be skipped altogethe.r.
Some typical counselling scenarios arc provided here:
■
■
Jessica, a very private pe.rson, was distraught ove.r the breakup of her marriage.
Aw-arc of her inability to cope and 00( knowing what to do, she attended scve.ral
sessions with a counsellor. He.r counsellor proceeded slowly, gently encouraging
Jessica to mlk about her fccJings. Jessica was surprised that during the second counselling session, she began to weep. Afte.rward, she remarked that she felt as if a great
weight had been lifted from her shoulders. She never felt the need to rerurn for a
third session.
Be.rt was n()( interested in exploring his problem beyond a superficial level. Anxious
to effect change in his life, he wanted to brainstorm ideas for dealing with his problems. Counselling worlc focused on helping him set goaJs. As this work progressed,
client became more trusting, and the sessions began to focus on exploring his
feelings.
■
When )O)'Ce was challenged by her counseJlor to examine how she might be
contributing to the problems she blamed on her boss, she became angry and
stormed out the office, never returning. A year later, a series of events caused
her to recall her shore-lived counselling experience, and she decided to cake some
responsibility for he.r difficulties. The counsellor never lcnew about the ultimate
positive outcome of the relationship that appeared to end so badly.
■
As Fernando mJked about his problem, he suddenly realized chat his siruation was
not as hopeless as he thought. Discovering another way to look at his problem
allowed him to identify several new ways to solve it.
■
After a single session, Bob remarked to his counsellor, "My problem is the same as
when I came in here, but somehow it doesn't seem to bother me as much."
The Preliminary Phase
The preliminary phase of counselling is essentially a time of planning with a focus on
nvo central casks. First, the agency setting is made attractive for clients so they are mori.vatcd to eng3ge and remain with the agency. Second, counsellors prepare themselves
for the interview.
CONVERSATION 2.2
STUDENT: What is the difference between a conversation with
a helpful friend and a counsem~ interview?
TEACHER: The goat of a ftiendShip is to meet the needs
of bolh people. Frtends (and fanity) are important. If they
are undetstanding. caring. and supportive, they can be an
effective source ot help. As With a cour\Selll.ng felationslip,
just taik.i~ to a Mend can be cathartic to IM indrvidual.
TM fe.ality is that lhefe a,e lim,ts. to what Mends can
offer. Sometimes friends. and famtly dOn't have speciali:zed
knowledge, Ot lhey may OOI know what (esotJ(ceS Ol se!'Vioos
are available to deal with specific pfoblems. F' riends and
famity may alSO be so emotionalty involved With you that it is
hard f0t them to be obi('ctive.
50
Chap1er 2
STUDENT: You're rigt\t. I find my famtfy can'I sepatate their
feelings from mine, and they atways end up givi~ me weUintentiooed but not very helpful advice.
TEACHER: Effective counsetors are comiortable d1scussi~
feeti~. and they dOn't tell c~nts. hoN they ShOl.,jj feet Goad
counselb"S are excellent listeners_ and they .West time to make
SUfe they accurately understaoo clients' feeli~ and concerns.
Counsellors know hOw to sys.tematicalty expl0te ptoblems.
set goal~ and develOp plans f0t action. They assisl dients: in
identifyi~ and evaluati~ altef'natives. 'llf'tile recognlzklg that
the clients must cooose f0t themselves. Thefef0te, counsellors do no1 impose advi:e or by to rescue dients: btf taklng on
theif problems. Unltke friendstips. counselling retationslips
am dttected to meet 1rie needs of one person only-the dienl.
The Agency Setting Jdcally, the 3gency is set up to appc3J to the client groups that it
serves. A drop,-in counselling centre for teens should look different from 3 d3y program
centre for seniors. Dim lighting 3nd be3nbag chairs meet the needs of tee.ns but present
3 safet)• hazard for seniors. TC3 is 3ppropriatc for senior~ but a soft drink m3kcs more
sense when the clients 3re tttns. ldea.Jly, the agency should:
■
h3ve uncrowded waiting rooms.
■
allow for reception and interview space that is private and confidential.
■
greet clients in a w3rm and friendly manner.
■
provide for the needs of children (e.g., by supplying a pin)• are3 with agc-appropri3tc
tO)'S).
■
allow for wheelchair access.
■
h3ve posters and other art th3t do not violnte the value~ religion, or culture of the
ai;cnq's clients (generally, they should also be politically neutral).
■
h3ve up-to-date rc3ding m3tcrial in the waiting room.
But often counseJlors fail to ensure that their interviews arc protected from phone
calls 3nd other interruptions that impede the flow of conversation. When interruptions
3re allowed, the mcss3ge to clients is, "I have other concerns that arc more important
th3n you. Hurry up and finish."
Moreover, flexible office arrani;cmcnts arc best. Some clients and m3ny counsel,.
!ors prefor 3n unobstructed arrangement without 3 desk between the p3rticipants, but
others favour working over the desk. The office needs to be 3rranged with c3rcful
consideration to the mcsS3ges that the design communicates. Chairs 3nd desks should
be arr3ngcd so that no psychological advantage or power is given to the counsellor.
Seating 3rrang:cments should allow for adequate personal sp3ce between counscllors 3nd
clients. A comfort zone of about I to 2 metres (4 to 7 feet) is 3dcquatc for most client~
but other factors might result in 3 nttd for more or less distance.
CounseJlors also need to be c3rcful in choosing personal items to displa)•. Picrurcs
3nd memorabilia that punctuate differences between counsellors and their clients
should be avoided. Of course, clients may have different reactions. For example,
some clients expect and appreciate seeing their counsellor's degrees or diplom3s hung
on the wall. For these client~ knowing something about the tr3ining and crcdcnti3Js
of their counsellors helps to establish confidence and credibility. Other clients, however, may react negatively to such a display. For them, the display sets up soci3J and
inteJlcc:tual b3rricrs. GeneraJly, counsellors should structure their offices with the
needs 3nd background of their clients in mind. Jn this respect, clients can be an
invaluable source of consultation. Their opinions on office decor and (3yout should
be solicited.
Figure 2.1
The Skills, Pt ocess, and Pitfalls 01 Counselling
51
Interview Preparation
Counsellors can use the preliminary phase to predict how
the interview time will be used and to make decisions related to the time, place, and
structure of the interview. As well, counsellors can think about specific questions and
responses for working with particular clients, without setting up a script or rigid agenda.
Shulman (2009) suggests that for a variety of reasons, clients often do not share
feelings and concerns directly. They may be ambivalent about sharing, or they may
hold back because of socictaJ and cultural taboos about talking about sex, authority, or
money. As a result, clients may raise these concerns indirectly, and counsellors must be
alert to recogni!e dues about their clients' concerns. For example, a single parent who
asks her welfare worker if he has ever been on weJfare may be indirecth• expressing her
fear that the worker will be insensitive to the stress she faces in trying to cope with a
limited budget. Sometimes questions regarding personal background or circumst:mces
may be indirect ways for clients to explore concerns about trust.
Shulman (2009) recommends the preliminary phase skill of nming fn as a tool for
anticipating the feelings and concerns that clients might bring to the interview. By runing
in, counsellors can think about what clients might express and how they will do so. The
preliminary phase is also a time when counsellors examine their own readiness. For
example, counsellors should take a few moments prior to each interview to self-examine
through questions such as the following:
■
Am 1 dealing with persona] stress or problems that might make me less effective or
more vulnerable?
■
Am 1 sufficiently disengaged from my last client to be open and objective!
■
What personal biases do I need to mana,;e to work effectively with this client!
■
What reservations do J have about meeting this diem?
■
Do J have unfinished business with this client that J have not addressed!
■
What feelings do I have toward the client that might impo:le my objectivit)•!
Client Files The preliminary phase is aJso a time for fact-finding to hclp understand a
client's situation. For example, a counsellor could research Tourene's syndrome in preparation for meeting a client with a child who has been diagnosed with this condition.
TypicaJly, most agencies have files on eac.h client that may contain considerable
information regarding the client's age, place of birth, address, marital status, work
history, educational background, prior experiences with counselling, and assessments
of personality, values, past problems, ability to handle stress, communication pane.rns,
and so on. Cliem files can also alert counsellors to any past incidents of violence and
point out any neo:l to take special precautions.
A review of client files can gready speed the intake process, but it is important to
maintain an open mind and avoid prejudgment, particularly with respect to the assessments other counsellors have made regarding the client's manner and personality. Client
reactions are influenced in part (and occasionally) by the personality and behaviour of
their counsellors, as shown in the following example:
Russ waited for his counsellor, who was h:U( an hour l.:ue for the scheduled inter\'iiew.
Russ wu sc res.std bee1use o( pe-rsona! problems 2nd w3:S anxious l'O ~et home l'O ea.re for
his sick cluldren. Estelle. his counse1lor, was also stressed bec3use o( a di((kult v.--eek o(
work. Durin& her inter\+iev.> with Russ she wu 2lso 2w::are that her next 2ppointmen1 was
already w::aitina for her l'O l'rnish with Russ. Determined l'O c::atd, up. she ,newed quid.I)'
with questions 10 complete her assessment o( Russ·s situ:u.On. Russ, uiken aooek b),
Estelle·s ::abrupt style. proceeded cautiously. hesit2tin¥ 10 share person:U in(orm::ation
qukl.1,·. Later, when rompletif)¥ her Ole notes on the interview. Estelle: wrote: "Client
was defe:nslve and. ¥u:trded. He ::appeared unusl.l211)' reslrumt 10 ~plorinK his (ee11~"
52
Chap1er 2
_ CONVERSATION 2.3
STUDE:NT: If lhem's already a file on lhe clW!nl. ShOuld I read
it be:fom seeing the client fOr' 100 first lime?
TEACHER: Thete are ptos and cons to reading clie-nt flleS in
ad\tance. It's important to be awate of the risks of either route.
Some counselt)rs pre-fe-r toconducl lheil' first interviews wtthout reacfi~ lheil' clients' flleS. They argue that by not re.acfi~
the flies, they are prevented from being unduly influenced
(biased) by prior in.format.ion. After a fU'St k'lte-rview, they feel
mote able to evaluate 100 validity ot previous rec0r'dS. I.n add~
lion, they argue that clients can cha~, and approachi~ the
interview with a freSh perspective makes it easier to relate to
the dient's present condition.
STUDENT: But suppose 100 client has a histOf')' ot violance
that rS reported in the file. How wolld I be able to get that
inf0tmation to protect myself wtltle stil keepU'lg an open
mind? Is there a w.ry of getti~ onty the pertinent information
from the flle that would allow me to identify 1oose prOblems?
TEACHER, Tharsane ol the d,a-NbaCkSof not madir,g the file.
I like your idea of setting up some ldncl of pfocess fOr' ide-nt~
fying clients whO might be dangefous. Clients wtlo pfe-sent
safety concerns could be "fed-flagged'" in SCll'ne way.
ST\J0ENT: I think anOlhet drawback is that If you do OOI IOOk
at the ftle, you wtU miss out on 11.nc:,m~ what's bee-n done,
'llf\at wol'ked, wt1a1 issues are key, and so lorth. ts the-re a W:¥f
of teading a file- withOut be-i~ in.fh.Jenced by othe-t writers?
TEACH£R: Being awafe of the potential fof in.fl~n:e rS crucial. II is important to f&mind ourselves that opinions in ftles
are not the clients' opinions but those of 100 pe-rson writing
the rec0td. Ideally, fe-co<dS ShOuld be shelfed with clients and
the conclusions pn.ttysupported. Of course, thi.s is n01 at.vays
poss,i:.e.
ST\J0ENT: Could I share- the- file with lhe client to ge-t his Or'
he-t reactions?
TEACH£R: Probably 001, at least nOI wdhOUI the- pe-rmission
of the- pe-rson W'ho wrote- 100 fecOtd. De-pe-nding on whefeyou live, freedom of access to infofmation legislation may
give dients the- rigf\t to petition for access to 100 file. Usu-
ally, the- onus rS on the agency 0t govemment department
to pcovide a reason fOr' wtthhOlding in.formation. Counsellors
need to be famtfiat wtth 100 regulations in theit area.
The Beginning Phase
Successful prdiminnry phase work establishes a base for the first mnjor cask of the
beginning phasc--namet,.,, developing n safe and trusting helping relationship through
which clients can work toward their ,;oaJs. This relationship between counsellors and
their clients influences whether clients will be willing to risk disclosure and is n signifi•
cant variable that determines whcthe.r clients will continue with counselling. The coon•
selling relationship is time~limitcd nnd based on a contract that outlines the objectives
and terms of the relationship.
Some clients come willingly to counselling, perhaps because of an unresolved
crisis or because they hnve been persundcd by others to seek help. Other clients arc
involuntary and, in some case~ overtly nntagonisric to the counsellor. They may also
be coming because of n current crisis or pressure from others. An employer, for
exnmple, may insist thnt a staff member seek counselling to nddres.s attitudinal or
addiction problems.
Many clients are also under considerable stress, and this stress is intensified if
the clients perceive counsellors neg:itivcly. Predictabt,.,, clients' experiences with other
agencies and counsellors shape their perceptions nnd expectations. Clients who have
had bad experiences with counsellors will understnndnbly be guarded ag:iinst further
disappointment. In addition, because counsellors arc often in n position of authority,
or clients Stt them in such a position, clients' experiences with ochers in nuthorit)• will
come into play. Most clients, however strongly they mn't' be mociwt~, will have some
degree of resistance or ambivaJence to change. Involuntary clients may be especially
resistant and, in some cases, hostile. They may perceive any initiative by their counsellors as a hostile act, however, weJI mC3ning it w·a.s.
The Skills, Pt ocess, and Pitfalls 01 Counselling
53
SUCCESS TIP
The clie-nl's reason f0t corning to counseling may 001 reveal itself until much later-. fear,
emba(rassment, trust issues, and ocher factors can impede irrwnedi:.ate intrOduction of lhe
problem. In lhe beginning, it is the counsellor"s job to engage with the Mpresenting prOblem.•
Successful engagement wilh this d'lalleoge helps to c,eate the conditions f0t mor'e intimate
discussion ot ocher issues.
The counselling relationship is fundamental to counscJling success. Even in short,
one-session encounters., when a high lcvcJ of intimacy is 00( crucial, clients will be more
apt to engage 3nd share when the counscllor gives some attention to dcvdoping the
relationship. Ch.nptcr 3 more fully explores the importance of the helping relationship
and specific skills for developing and maintaining it.
A second major task of the beginning phase is to acquire and deepen an under~
standing of the client's situntion or problem. ln rhe beginning phase, clients arc asked
to teJI their stories, describe their feelings. and explore their problems and dilemmas.
For their P3.rt, counsellors must be prepared to listen, and this mC3ns be.ing prepared
to learn. Preliminary phase worlc ma,., help counseJlors predict possible theme~ and
experience may tC3ch counsellors a g.rent dC3l about common needs and issues; however,
in the beginning phase, counsellors need to put aside all assumptions as they attempt
to appreciate the unique nature of ench client. The active listening skills of attending, using silence, summarizing, paraphrasing, questioning, and showing emP3thy are
the basic tools for this exploration. These skills tend to motivate clients to graduaJt,.,
open up, organi!e their thoughts, and identify their feelings. They move the relationship
beyond superficiality and hcJp both the counsdlor and the diem achieve shared understanding. Active listening also enables counscJlors to probe for detail~ definition~ and
examplcs--information that is essential for preventing assumptions.
The Therapeutic Value of the Beginning Phase The therapeutic value of coun.seJlors listening without judgment c3n be enormous. Active listening enables what is
often the most important pan of any counselling encounter- the opportunity to tcll
one's story and express feelings without interference. Since incense listening is rare in
eve.ryday encounters, clients ma)' be visibly moved when they fed heard. Moreover,
when counscJlors accept clients without judgment, clients become better able to accept
themselves. Effective counsellors aJso encourage clients to explore the emotional com.ponents of the.ir lives. \Vhen clients share emotion~ counsellors need to be c3reful not
to sabot:.lge this sharing by rescuing, telling clients not to fed as they do, changing the
subject, or conveying discomfort or judgment. In addition, as clients ta1k, they may
rdC3se a flood of emotions. A client might remark, "I've told )'OU things that no one
Figure 2.2
54
Chap1er 2
else knows." As clients open up, they may begin to fed unburdened, a process that is
known as catharsis or ventilation.
Effective: counsellors probe: for detail by askina questions systematicaJly. They
identify fodings and mirror them with empathic statements. This work enables clients
to organize: the.ir thinking and to explore: and accept their feelings. \Vhen clients are
confused or indecisive, orderly questioning helps them cateaorize information and
pinpoint details or is.sues that they may have ove.rlooked.
catharsis: An eaotiooJI tell!'aS! of
~ about put «wrMI experifflces
t!l.i'! iesults in a po-«ml telei.se ol peal·
up feelilgs su~ as aaiiety« ang$.
Cautions
For some clients, a sinale session may be sufficient to meet their need~
and they may not return for the next scheduled interview. Sometimes they decide 00(
to return because they feel they do not need to. The cathartic release of emotions in a
single session empowers them enough to dC31 with their problems.
Other clients may quickly respond to the pO\\•er of the: counselling relationship
and disclose at a level they would 00( have predicted. Later, they ma't' fed embarrassed,
fearing that they have gone: too far, or they may resent their counsellors for probina into
areas they would have preferred to keep private. ln response, clients may cut off the:
counsellina reJationship prematurely, or they may come to the: next session but remain
distant and guarded to protect themselves from over...disclosina.
One: way to prevent problems is to be sensitive to individual pacing needs. Clients
may give dues that the session is moving too quickly. The counsellor should watch for
indicators such as hesitation, questioning why the: counsellor w-ants to know something,
or st:ne.mc:nts that the client would rather not discuss particular issues.
Another strategy is to discuss with clients how they fed about the session. The
following excerpt illustrates this technique::
CounseU.or: Later h'.)n.i~u, when )'Ou think about our time tOiether. how do )'Ou think
)'Ou
·u (eel?
Client: I think I w1II have mixed (eel in~ It was reall't' ~-ood to talk, but I wonder 1( I told
)'Ou mo much. I hope you will not think less o( me.
Counsellor: You took a real risk "'1th me in s~rinK your pri\'ate thou,ahu a.nd (~lu~j.
I think it's reason:able to worry about how I re:l.l!ted. Would )'Ou like to know!
Client: Ye~ verr much.
Coun.~ellor : Do you trust me enou,ah to belie"e th::u I will not he to you or tell )'Ou
somethin& Just t'O m.:tl:.e you (eel better!
(f the client SU)'S 't'CS. the counseJlor might candidly share: his or her reaction to the:
client disclosure:
Counsello r: I admire your coura~-t to Nice such painful issues.. As 2 result, I (e,el closer
to )'Ou 2nd beuer ::ible to underS12nd )'Our stru~e. Ko,. I don't think less o( )'Ou.
(f the client s3ys no, the counsellor initiates discussion of wh3t work nttds to be
done: to establish trust:
Counsellor: Perhaps w~ could ~lk. 2 bit about w~t needs to happen betwttn you and
me in order for )'Ou to trust me.
ln the pre-.•ious example, the: counsellor helps the client anticipate feelings that
miW't 3risc after the session. By doing so, thecounscllor can help pre-.•c:nt the client from
renching false: conclusions or making erroneous assumptions about wh3l happened.
For counsellors to h3vc: such discussions with clients, 3 hiah level o( counsellor sel{3w3reness is crucial. Counsellors need to be willina to examine: how they are refatina
to their clients. They should be adept at identifying any pc:rson3J biases (positive or
neaative) th3t they nttd to manage to work effcctiw.ly with their clients.
The Skills, Pt ocess, and Pitfalls 01 Counselling
55
The Action Phase
(n the beginning phase, counscJlors work to understand their clients' perspectives,
and clients organize their thinking and express their feelings. The action phase
focuses on soh•ing problems, managing fttling.s, setting goals. and exploring altcrna.tivc strategics.
In practice, action•phasc work ma'>' happen simultaneously with beginning-phase
work, as clients ma'>' make discovc.rics or achieve insiaht from o:ploring issues, feelings,
and problems. Slcillcd interviewers ask questions systematically, probing for detail 3S
approprhne. This process aJone hcJps clients organi:e their thoughts on complex issues.
As wdl, summari! ing. paraphrasing, and responding with cmP3thy provide an impor•
tant mirror for reflecting clients' feelings and ideas. As a result, clients may Stt their
problems in a different light, or they ma.'>' discover choices for nction that they had
overlooked.
In the action phase, counseJlors pin)• a. key role by providing new information,
ideas, or perspectives. This involves challenging distortions of problems and encouraging clients to consider issues they may have overlooked. As well, counsellors need
to encourage the worlc of change b)• ensuring that clients set dear and specific goals,
which form the basis for the development of realistic action plans. Subsequently, coun.sellors may assist clients in implementing their plans. This assist:mcc includes hclping
them anticipate and address potentiaJ problems, as wd) as supporting them through the
struggles of the change process.. Counsellors aJso help clients develop new strategics for
coping through skill acquisition strategies such as role-playing or techniques for managing self-defeating thought patterns.
When clients experience the core conditions of congruence, empathy, and positive
regard, they become better able to accept themsdve~ less defensive, and more open to
expe.ricncing and accepting their feelings. Client attitudes and feelings change as coun.selling progresses successfully. Some of the important signals that clients are changing
and growing include the following:
■
cues that they feel less apprehensive about counselling and the counseJling
relationship
■
increased acceptance of feelings and more honest expression of previously denied
foclings
■
diminished negativism, seJf<loubt, and blaming of others, and increased optimism
and sdf-accepmnce
■
increased acceptance of responsibility for behaviours or choices
■
reduced sense of responsibility for the actions and choices of others
■
increased empathy for others (Gilliland & James, 1998, p. 115)
Figure 2 ..3
56
Chap1er 2
Figure 2.4
As noted earlier, bcginning•phase and action.-phasc activities can happen simul,.
taneously. Shifts between bcginning•phase and action-phase work arc also common.
For example, clients may explore a problem in depth, begin a change program, and
then revert to beginning-phase work to rocklc another problem area. Some common
scenarios include the following:
AO$;elo's counsellor ene<)U~e<l him to deseribe his situ::ation. As he ~lk.ed. he disrov..
ere<! :lSpttt.S o( his problem th:u he h::.d overlooked :md that su~sted new possibilities
for immediate ::.etion.
P2ri,·ash tended to keep her (ee:11~ so v.--ell hklden th::u she w:u unav.>2re o( their effet!t
or intensity. \(i ith iti>ntle encour2~-e.ment from her counsellor. she be~a.n t'O open up.
Talki0$: about her (eeli0$;$ represented a dramatic s.hi(t in her beh::tviour. The therapeutic
value o( this than,Ki' was enonnous, as she unburdened hel"Sel( from a lifetime o(
pent-up emotions..
Chapter 7 will explore how to assist clients through the worlc o( the action phase.
The Ending Phase
Successful termination starts in the beginning phase, when the nature and limits o( the
counselling contract are defined. When counsellors and clients agree on the 3ctivities
3nd goals o( counseJling, they have defined a point of termination. This point becomes
the target o( 31) counselling work. Although the target may change as client needs and
progress arc rc-evalu3tcd, counsellors should reinforce that termination is 3 reality o(
the counseJling relationship.
Although evnlu3tion is 3 component of all phases of counselling, the ending phase
is 3 major opportunity to 3ssess what h3s been accomplished and what remains to be
done. 1t is a time to help clients make the step to independence and to consider new
directions 3nd goals. It may 3fso occ3sion3lly be a point of transition. such as when a
counsellor refers 3 client to another service. The ending phase is also a time to cvaJuatc
the counselling rc1ationship. This e\laluation ma)' involve addressing any unresolved
concerns and expressing feelings 3bout the ending o( the rel3tionship. See Chapter 3
for a more complete discussion of endings.
COUNSELLING PITFALLS: BARRIERS
TO SUCCESS
CounseJling rcJationships 3re formed to 3ssist people to reach goals such as making a
decision, dealing with painful feeling~ improving interpcrson31 skills, or man3ging an
3ddiction. Outcome success is easy to define: lt is measured by the extent th3t goaJs
3re reached. Me3suring the success of an interview or communic3tion momem in the
The Skills, Pt ocess, and Pitfalls 01 Counselling
S7
interview is more difficult since much of the ch.nnac w-ork happens outside the interview.
An example illustnnes:
Jerome stom~ out of the inten•iew when hii counsie1lor21sked him to consider how his
drinkh,i n,iaJu be afftttifl¥ his family. His 3.11i r)' w<>n:ls 21s he sl.:unmed the door left the
eounsellorleelinK r21ttlOO: "You're just hke ::.11 the rest. I thou~t '>·ou v.--ere on my side.
but it's dear my wife hasp to )'Ou... Six months later, Jerome' s situ:uion deteriorated
10 the point where he was re::.clr to re6eet on his ::.cldietion. The counsellor's ehallen{ti'
bee.me an important p3rt of his ri'(".(J\~ry.
NevcrcheJess, counselling can and docs fail, so counscJlors neo:I to develop their
capacity to S)'Stcmatically investig3te and review failure. They need to be able to distin.guish between failures thal arc beyond their control and those aused by their own mis.takes. Failure may originate with the client; it ma'>' arise from pcrsonaJ issues associated
with the counscJlor, such as faulty technique or lade of skill; or it may stem from factors
that arc outside both the client's and the counsellor's control. Eg3n and Schroeder
(2CX>9) put it bluntly when they described what they call the shadow side of helping:
Helph,i mode.ls ::are fb,,,,.ed~ helpeTS are sometimes selAsh and e\'en predator'>' and the,.,
::are prone 10 burnout. Clients ::are sometimes se!Osh. la:r, and pred::amry. e\'e n in the
helpina rel::ationship. (p. JI)
Client Variables
Substance abuse or menta1 disorders may make it difficult or impossible for clients to
enga,;c with the work of counselling. Clients may resist or undermine counselling because
of secondary g3in, whe.re the payoffs from maintaining the problem outweigh the benefits
of change Or clients may resist change because of an unconscious foar of success, because
they expect to fail, or because the risks of chan,;c arc too frightening to face.
Counsellor Variables
lntdlectually and emotionally secure counscJlors are willing to examine their methods
and attitude~ and they are willing to take their share of responsibility for poor counscJling outcomes. Counsellor variables include mental attitudes, mood~ and behaviours,
all of which an dramaricaJly affect how counsellors relate to and assess their clients.
Some counsellor variables that affect counselling outcomes arc burnout and vicarious
trauma, personal problems, and loss of objectivity.
Burnout and Vicarious Trauma
A career working with people in crisis may be
intenscJy satisfying, but it can also be emotionaJly srressful and draining. Counsellors
may experience unrelenting pressure in worlcplace demands, including high caselo3ds,
limited resources, and crushing paperwork. Counsellors can become depleted from
trying to respond to the needs of their clients and the organization. ln addition, coun.seJlors arc subject to the.ir own famil)• and economic stress and trauma. Counsellors
may be resilient, but even the sturdiest person can become debilitated by stress.
Personal P·roblems
Counsellors are subject to the same stresses in lifo as other
people. They can become depressed, their children an become ill, their marriages can
foil, or they can become responsible for caring for ailing or elderly parents. Responsible
counsellors accept that there ma'>' be times when they need help too. They recognize the
importance of having people in the.ir lives to whom they an ask for assistance. \\:fhen
counsellors have healthy reciprocal relationships with others, they arc less likely to use
(subconsciously) the.ir clients to meet these needs.
During acute periods of stress, counsellors need to recogni!e their vulnerability
and take steps to protect their clients. These steps might include taking a temporary
58
Chap1er 2
reduction in workload, shifting to a less demanding caseload, caking a "mentaJ health"
break, or s«king increa~ supervis ion or consultation to monitor their worlc. Jn
extreme circumstances, they may choose to take an extended IC3ve or switch careers.
SUCCESS TIP
Asking for help is a sign of strength, nor weakness. This rS true foe d ients, and it is alSO 1rue
to( counsetlOl's..
Loss of Objectivity Objectivity is a measure of counseJlors' capacity to relate
to clients without allowing their °"'n feelings and biases to distort their judgment
(see Chapter I for a detailed d iscussion). A number of facto rs can lead to a loss of
objectivity, including unresolved persona] problems. difficulty dC3Jing with panicu•
Jar emotions or topics, attraction or revulsion to clients, over-identification with di•
ent~ and excessive or unrealistic fear of particular clients.
Counsellors who are not aware of their values and beliefs and the impact of their
behaviour on o thers are limited in their ability to monitor their levcl of objectivity.
CounseJlors who are committed to increasing the.ir objectiv ity make themselves avail•
ab le for foedbaclc o r supervision. Moreover, they recogni:e their personal limitations
and their inab ility to wo rlc objectively with every client. They know when to refer clients
to other professionals.
Common Mistakes
CounseJlors are constantly ma.king choices. They must decide which of the three
domains to exp lore (feeJing, thinking. or behaviour). They must choose which skills to
use, how much to probe and cha.Henge, how fast to move the process forward, and which
materiaJ is relevant to pursue. A ll of this happens in an environment (reJationship) that
is often ambiguou~ o ccasionally hostile, frequent!)• complex, and constantly changing.
Tab le 2. 7 o utlines the top 10 most common counselling errors.
Pseudo-Counselling: The Illusion of Work The goal of every counselling relationship is to improve the q uality of life for the client. Achieving this goal may invo lve
problem resolution, assistance with decision making, or management of painful feelings. Counsellors nttd to screen their responses and activities to ensure that the.ir work
supports the objectives of counselling.
Pseudo-counselling involves what Shu lman (2009) describes as the illusion of
work-co unselling sessions are animated a nd active, but they are essentially empty and
TABLE 2.7
Top 10 Counselling Errors
1. Rigidity and use of a "one-si:ze-fits-a11· apptoach
2. Insufficient attention to the counseflOl'~lient relationship
3. A<Mce givk\g
4. Absence of com conditions---empathy, unconditional positive fegar'd, and genuriooess
p ~ l i n g {illusion of
WOltc): Apoces.s ifl .tlith tile w.o!Mf and
tile ciefll ~ ifl a ccaversati>n that
is empty and tut has no teal me.ing.
Counselling -.,1Nskrelevan1e,:ilorati:in
d is.sues. use ol diches and p;r.roniliflt
platiudes. iMelectu.al esploratio. ol
is.sues, and a-,Odaf!Cf ol subf.d.S or
~ lhat-.,oh~ paifl ifl fl\'Otlr d
'"safe·1opits.
5. Missing the opportunities offered b-f paying attention to the nonverbal channel
6. Loss of Ol>jectM1y and judg,nenlal responses
7. Pad~ ptoblems (too fast, too stow. and i.napproptiate timing of resJX)nses)
8. lnapptoptiate use of self~isclOSure (too mud'I. too little, and poor1y lmt:?d)
9. Rescui~. fatse re.assurance, and minimi:zing prOble-ms
10. Cultural insensitivity
The Skills, Process, and Pitfalls 01 Counselling
59
without rcaJ me3ning. Shulman makes this important observation: "For the illusion to
take place, however, two must engage in the ritual. The worker must be willing to allow
the illusion to be created, thus, participating in its maintenance" (p. I 54). The illusion
of work can be Crc3tcd through the following:
■
interesting but irrelevant exploration of is.sues that do not contribute to problem
sohting. including an excessive focus on finding the root causes of problems
■
use of dichi:s and patroni! ing platitudes
■
overly intellectual exploration of is.sues
■
avoidance of subjects or ftt.lings that involve pain in favour of S3fc topics. Of course,
it is sometimes appropriate to shift the focus to S3fc arc.ls of discussion (e.g., if the
interview is almost over, or if clients are dearly unable to handle additionaJ stress).
Inappropriate Advice Giving Society conditions us to seek advice from expert~ so
it's not surprising that many clients come to counsellors expecting "expert advice" on
how to mana,;e their lives and solve their problems. Students and beginning counsellors
often believe that counselling rttauires them to listen P3tiemi)• to their clients' problems
and then offer advice on what they should do. However, they nttd to learn that this
approach is rare]y helpful and is sometimes harmful to clients. p3rticularly when such
acktice is based on vaJues that arc inconsistent with the client's lifestyle or culture.
Clients often s«k advice even when they know what to do to m3na,;e the.ir problems.
Sec.king advice cnn be a way of expressing dependency or transferring responsibility for
decisions and outcomes to someone cJsc. This dependency inhibits the riWlt of clients
to make choices, and it may le3ve clients fccJing resentful or frustrated, particularly if
the advice was unsolicit~.
Advice giving ma'>' incrc3se counsellors' self-esteem by underscoring their ability
to be resourceful and helpful, but it may also undermine clients' self-esteem, leaving
them feeling inadequate bee.awe they have been unable to figure out their problems
for themscJves or bc-c.ausc they lade the will or resources to act on the "good advice."
Counscllors who tend to give advice can become overly concerned about whether clients
follow their advice, and if so, whethe.r the advice is successful. They can also become
disappointed when clients do not follow advice.
As Compton and GaJaway (2004)condude: "it is n()( your job to 'fix' clients. Rather,
)'OU help them set and work toward goals. You assist them to recognize and use person.in-situation strengths and resources for problem solving and go3l atminment" (p. 82). \\:le
arc in a better position to empower and promote client scJf-Oetennination if we refrain
from giving advice and if we honour what clients bring to the rcJationship:
■
knowledge regarding themsc]ves and the siruation
■
knowledge about the origin and devcJopment of the problem
■
expectations about how you can hcJp
■
a network of social rcJationships
■
views about what they would like to accomplish
■
strengths for use in pursuing goals (Compton & G31away, 2004, p. 82)
This injunction ag3inst ad,tice giving does not me3n that counsellors should with.hold information or ideas that might benefit their clients. Herc are some examples of
information or ad,tice that counsellors might provide:
■
60
tentative suggestions regarding alternative courses of action that the client has
overlooked: however, "when counscllors are unwilling or unable to present and
explore all ,tiable alternatives neutrally, they have an ethical responsibility to refer
Chap1er 2
the diem to another counsellor, or at the very least, to make their biases or limita,
tions explicit" (Shebib, 1997, p. 33)
■
ex-pert information based on resC3rch or knowledge (e.g., job-sC3rch techniques and
child-rearing principles)
■
ideas for improving communication or problem solving
■
sugi;estions regarding the process of problem resolution
■
opinions and information that will help clients avoid unforeseen consequences
(dangers) to themsdves or impulsive or poorly considered action
\Vhere there is a range of individual choices, such as decisions related to marriage
or career, advice giving is inappropriate. In such circumstances, the role of counsellors is
to assist clients in identifying alternative courses of action, then to help them weigh the
advantages and disadvantages of each alternative. Counsellors may suggest alternatives,
but they should do this in such a way that clients feel frtt to reject their suggestions. As
a rule, counsellors should probe for client ideas first with questions such as "\Vhat are
your thouRJus on what to do?" "\\:fhat arc your choices?'' "\\:'hat advice could you give
yourself?" "\Vhat idC3s have you considered but rejected!"
Rescuing R escuing, or "band-aiding," involves actions that prevent or pr()(ect
clients from dealing with issues or feelings. Rescuing arises from the counseJlor's need
to avoid tension and keep the session cheerful, but it is misguided because rescuing
diverts clients from addressing important though difficult issues in their lives. Rescuing is therefore a misuse of the support function of helping. Counsellors may become
so preoccupied with avoiding or reducing tension that they interfere with their clients'
ability to cope or to solve problems. Jf problem situations arc to be worked through
successfully, clients must be allowed to experience and express painful emotions. For
their part, counsellors must develop their ability to be present for such work without
their °"'n needs and anxiety interfering or becoming a burden to their clients.
rescu~ Alsoc-.iled ~ aiding, dlis
irm:ilws acounsellor's adionsthat pre•
wnt or piotea diffl1s from dealing Mith
issues or ffflings. Rescuing arises frcm
tile counS!lor's need to a-,oid tensioo ud
keep the sessicadleeml
SUCCESS TIP
Advice giving and tescui.ng arise more from the counsellOf's ooed to be helpful, intelligent,
to receive ad\lk::e o, be mscued.
Or' powerful lhan thQ client's nQQd
There are three major types of rescue bdi.aviour:
t. Ten.sion reducer.s: Avoiding cough but otherwise timely and important topics and
feelings by changing the subject, using humour to cut off discussion, or suggesting
a coffee break.
Rodney MIS On:11Ur willina to ::.ddress his sadness O\'er the death o( his l2theT. As
he ~ n to talk. he cried so(tly. As he d,d so. his counsellor reached out and put
her hands on his shouJden. reassurinSt him that his ariel would P3SS.
Par hcsi121td lor 2 1noment as he stru~ed to collect his thol¢hts. ScnsinSt t~t
tl,is miaht be a p.,inful moment for him. his counse.lJor s~ested that he miaht
prefer to ~lk about somethina else.
CounscJlor responses such as these impede the work of counselling b\• preventing or discouraging clients from dealing with their feelings. For clients to learn to
manaae their emotion~ they must be allowed to experience the.ir pain. If counsellors communicate discomfort or disapproval with expressed em()(ions, important
opportunities for work may be lost.
The Skills, Pt ocess, and Pitfalls 01 Counselling
61
2. Placaring: \Vithholding potentinJly helpful but criticaJ confrontation or offering
false feo:lback and empty reassurance.
T::u·a expresud fear 3bout c:on1,iC'tin~ her l:1the-r, with whom she h:td not ~d
oon1:v!t for llve )'e3rs. Her oounsellor offered support: "Everythll,i is it(>ina to
work out v.--ell. J'n, sure )'Our father will be tts:t3tk 10 see you...
Shirtq· decided oot 10 oonlront herd1e:n1 O\'e-r an obvious h)'pe:ne problem. She
oonduded that it would be be-st not to upset he-r die:nt 3nd jeop:u-di:e- a stroll¥
rel::n ions.I, i p.
3. Beh.a,.,iours rMr impede independence: Speaking for clients and doing for clients what
they are able to do for rhemsdvcs.
Jessie's C'OunselLor w3nted to be seen :u helpful and resourceful. She offered to
rewrite her d1e:n1's r&:unW, 3nd pkk up :lpplk::nion lonns from ~ I emplO)-e-rS.
Jolie was h::1:vh1i t rouble- unde-rstandini 2 school :usi~nrne:nt. His C'hild C'areoounsellor phoned his te-::iC'her to ,isk lor c:13ri(k3tion. e\'e:n thoud, Jose w3s
C':2EX'ble o( talkina to the te-::id,er himsel(
For clients to become independent. they need to dcvdop the skills and srrength to
dcaJ with their lives on the.ir own. This ma)' be a difficult process for diem~ requiring
counsellors to be supportive without stifling their clients' growth. Counsellors must
avoid unduly protecting their clients by inte.rforing with their opportunities and capnc:it)•
to face their diffteultics. This requires counsellors to be full)• aware of their own need
for power and control and to accept th:.n successful counselling requires clients to be
their own problem solvers. Furthermore, counsellors must rid themselves of an)' fnnmsy
that only they can save their clients.
Communication Stoppers Some responses tend to bring communication to a hair.
Rescuing and advice giving arc two prime examples, but others th:.n have the same
effect include name cnJling, "pln)ting psychologist" by offering clever but unsolicited
assessments, commanding, morali!ing, minimi!ing the fcdings or concerns of others,
using platitudes or clichCS, and excessive use of interrogating question~ cspcciaJly urhy
questions that tend to aslc for justification or communicate subtle judgment. Abrupt
subject changes are aJso communication stoppers. They may communicate that the
counsellor is uncomfortable with the topic or feelings expressed.
Faulty Technique Some of the problems that a.rise in counselling can be attributed
to counsdlors' inept use of skills. Poor technique can lend to missed opportunities
-
CONVERSATION 2.4
ST\JOENT: What rS the diffetence between supporting clients
and f&Seuiog them?
TEACHER: Rescuitlg robS c~nts of legtt.imate opportunities
f0t gro-.,h. Support;~ promotes self-ooterminauon by prov;ditlg encoufagen-.ent 0t resoufces to motivate clients toward
growth and cha~. Tuning is atso a factOr'. Rescuing OCCU(S
when clients have the srre~ to deal with difficult areas Of
feelings, but theif counseuors avoid the wor'k paitl that this
woukS entail. On the othef hand, if clients are overwhelmed,
some direc1 assistance by counsenor-s to leSSen their bu(den
rS supportive. It may be wise to avoid excessive intimacy in
°'
62
Chap1er 2
the begk\niog of a relationslip, and it may be hazardous to
expt)fe highty em::>t.ional topics ne.af the end ot an interview.
AA imporiant quest.ion fof counsetl0ts to considef is ·Whose
needs are being met, mine or the client's?· Rescuing behaviour moots counsenors' ooeds undef IM guise of helping
clients, but supportive behavio1S helps clients realile IMir
objecti\les. In the loog run, thefe are limes when it rS m0te
supporti\ie to anow clients to face lheir struggtes and experience tnek parl. Effective counsetlors afe courageous en~
to alloN clients to express their paitl and accept the feality
that they cannot pfovide solutions to al problems.
and, in c:xtrc:mc: cases, can be: harmful to dic:nts. For example:, counsc:llors might foil to
respond to individual diffc:rc:ncc:s (c:.g., gendc:r and culture), or thc:y may ding to a rigid
"one: style fits all" approach to counselling. They may also be: poor listcnc:rs, or they
may lack empathy. They might push clients too quid:J,.,, or they might allow them to
stagnate by neglecting to motivate them to make: changes.
Uncontrollable Variables
largecasc:loods may precludc:counseJlors from spending sufficient time: with thc.ir dicms. Resources may 00( be: available: to support
clients in thc:ir change process, such as at a detox facility. ln addition, unexpected
evc:nts and crisc:s such as illness, dc:ath, or job loss may frustrate progress. (n some:
cases, clic:nt changes ma't' be subverted by family and friends who are unprepared to
support change.
Defence Mechanisms Sigmund Frc:ud (185~1939) first used the: tc:rm defence
mech a n ism to describe how people protect thc:mseJvc:s from aru:ic:ty, unpleasant
thoughts, and persona] threat. To some c:xtc:nt, the: use of defence mechanisms is
normal and healthy; it nJlows us to cope with the demands of life. But dc:fc:nce mecha,
nisms are problematic when they are overused or when they prevent us from dealing
with problems that should be addressed. Herc: are some: common dc:fc:nce mechanisms
that counscJlors are likc:ly to see in their clients.
■
Acting Om. Expressing emotionnJ distress behaviourally. Example: A 't'oung child
deals with hc:.r frustration by breaking her doll.
■
Denial. Refusing to accept or admowlcdi;c: what may be dc:arl't' c:vidcm to others.
Example: A man with a drug addiction will not admit he: has a problem despite:
considerable evidence: and feedback from othc:rs.
■
Displacement. Transfer.ring fc:c:lings to a less thrc:atc:ning person or object. Example::
A man who is angry at himsclf for losing his monc:y at the casino talcc:s his anger
out on his wife.
■
Diuociacion. Separating or disconnecting from reality. Example: Amnesia as a reaction to a trauma.; daydreaming.
■
Humour. Avoiding c:motionaJ conflict by looking at the humorous aspects of the
situation.
■
lncdlecmalitacion. Avoiding fc:c:lings through excessive abstract thinking. such as
focusing on the details of an event, while losing touch with the: associated feelings.
■
Passit-e Aggre.uion. lndirccth• expressing aggression. Example:: Withholding hc:lpful
ideas or information from someone you dislike.
■
Projection. FnJsdy assigning our own unacceptable fccJings to othc:rs. Example: An
ajlR'..ressivc: person sees othc:rs as hostile and angry.
■
Rarionalitacion. Using sclf/4crving but incorrect explanations to avoid emotional
rurmoil. Example: A woman who did not get a job promotion rationali:es that she:
did not want the job anyway.
■
Reaction Formation. Substituting behaviour, thoughts, or feelings that arc the opposite of those that are unaccc:ptablc:. Example:: Being overly friendly or hc:lpful co
someone you dislike.
■
RegTeuion. Reverting to an c:a.rlic:r form of coping.. Example: An adult sulks rather
than using problem solving to dc:al with a diffteult situation.
■
R$ression. Keeping fc:c:lings and mc:moric:s out of conscious awareness (but they
still continue: to influence: behaviour). Example: A ,voman who was sexually abused
as a child may have: no memory of the: c:vcnt, but she: re.mains uncomfortable with
physicaJ touch as an adult.
The Skills, Pt ocess, and Pitfalls 01 Counselling
defencunechanisms: ._.al
pnnss or teaeli>n that shields a P£fSOfl
frca•O.Sirable or.acceptable
t!loughts. f.eelings. • to11tlusi:ins
tll.tt. if acoeptei 'llcd:I create _,.ty
« euleng_es toone·s s-.eet self.
Common de.ieace m.chanisms ilclude
dellial dispbc-=at. r;11ionalilatiln,
suppessia..-6 regrmion.
63
■
Spliuing. Stting or experiencing things only as polar opposites. Example: Seeing
others as either perfect or totally inadequate. This defence: prevents people: from
considering more balanced views and expectations of self and others.
■
Sublimation. Involves converting unacceptable feelings or impulses into more acceptable
behaviour. Example:: Dealing with anger through involvement in martial arts.
■
Suppreuion. Dc:liberatc:ly avoiding thinking about feelings or thoughts that provoke
anxiety.
(Smm't': A1ne-rica.n Pi<)~.hfatrie A$$0Cfa.tion. 2COO. Grohol, 2015. Mcleod, 2008)
SUMMARY
■
Counselling involves a tim~limitc:d relationship designed to hcJp clients increase
their capacity todea.1 with the demands of life such as dcnJing with fcdings, learning
new skills, making decision~ and accessing resources.
■
Counselling case.loads arc: characte.ri:cd by diversity in culture, gender, age:. religion,
sexual orientation, language. education, economic ability, and so on. \\:forking with
diversity requires counseJlors to be: adaptive and to be able to use: rcsc:arch throry
and experience: as guides to determine which skills and procedures best meet the
needs of their clients.
■
There: arc: four essc:ntia.1 clements of a trauma~informc:d approach: trauma aware~
ness., emphasis on safety and trustworthiness, opportunity for choice, collaboration
and connection, and srrengths-baS(Xf counselling and skill building.
■
Four major skill and strategy dusters define the: range of necessary skills for coun~
sc:llors are ( I) rc:lationship~building, (2) exploring/probing. (3) empowering and
strength building, (4) promoting change.
■
The: four counseJling phases arc: (I) preliminary, (2) beginning. (3) action, and
(4) ending. Each phase: is charactc:rizc:d by unique tasks and skills. During different
phases of the relationship. different skill dusters assume priority.
■
Many variables can lead to poor outcomes in counselling. C lient variables include
unrealistic expectations and poor motivation. Counsellor factors such as burn~
out, pc:rsona.J problems, and loss of objectivity can also lead to failure:. Process
or faulty techniques, including pseudo-counselling, advice giving, and rescuing, can
contribute: to failure. Finally, failure may arise from factors outside the: control of
counseJlors and clients.
EXERCISES
Self-Awareness
1. Think of a recent o, current prObtem that you are fac~g.
Oescr'ibe the ways lhat counselling might be used to assist
you rn addressrng this prOblem. Usi~ concepts from this
chapter, identify what mighl be the maj0t activities lot ead'I
phase of counselling.
2. Review the taskS of ead'I of the phases ot helping. With whi:::tl
phase oo you feel most comfortable? Least comforta~?
64
Chap1er 2
3. Desctibe a situation in which you gave advice to or rescued
someone. Do you have a tendency to give advice 0t rescue
others? Seek feedback from Olhe:r'S who know you to see if
theit perceptions agree with your setf-evatuation.
Skill Practice
I. Imagine thal you are teSJX)ncling to lhe foUo-Ning dient
questions: What is counselling? HON does ii WOrk?
2. lnter'View cOleagues or counseltorS fonn the field. Explore
the.' answel'S to lhe fellowing question: What are some of
yout bigg&St counselling mistakes.? What did you leam from
the-m?
Concepts
1. Rate 100 extent that you think each of the fOflowk'lg srate-ments is ttue usi~ lhe foltowing scale (be ptepared to
defend yout answel'S):
_ _ _ The counselling ptocess evOfves sequentially
through a number of phases, ~th each phase having specifte taskS an.d te,ciuiring specific skills..
___ Effective counsenors are consistent. They use the
same Skills in lhe same way throughout the counselling
process.
___ If the pr1n.dples of counselling are applied effectively, all clients wil be helped.
___ Eve,ything that happens in the counselling interview muSI be treated as confidential and Shared with no
one. Thi:S is the law in C3nada.
___ Effective counsetling invdveS bleoeli~ the client's
OOeds with tt'IOse of the counsellor so that everyone invcived
is satisf~.
4 = always
3 = fre,ciuently
2 = sometimes
1 = tarely
0 = never
_ _ _ It is important for counsetor'Stodevelo,:, a personal
Sl)te so that they 1reat all clients the same way.
___ The counsem~ process has a IOt in. common. with
the processes used by other professionalS, such as doctorS
an.d lawyerS; lhus, competent counseltors gather- information, diagoose the problem, and offer- SOiutions or advice
to their clients on the beSt tesdution.
_ _ _ Usualty, clients W'ho seek help are in ctisis, and
theit ability to make decisions is significantly impaited.
Ther-efO(e, it is im(X)l'&ant lhat counsellOrS are comfortable
with maklrlg Ul1portant decisions on behalf of theit clients.
_ _ _ The application of sktlls or techniques deltacts
from spontaootty.
Prolessional counsellors sttive to be free of biases
___ The Skills of counselling are also the skills of effective ev«yday communication.
2. Write a Short essay supporting lhe follo-/Mg atgument: The
capacity to accepa help from an01her- person is a sign of
sueogth.
3. In 'lff'lat ways might advice giving di:Semi»NEr clients?
4. What do you think are the advantages and disadvantages of
wot'Jd~ from a fout-phase mo:Jel of counsem~
5. Identify and ex.ptore clients' legal rights to access fde infor-
mation in your jurisdiction.
6. List the pros an.d coos of displaying ead'I of the tonowing
in yout office:
a.
famlly phOtos
b. motivational JX)Stel'S
___ CounsellOl'S wM have perSOl'lal expe-rieoce wilh the
ptoblem or issues that their c~n.ts are experiend~ 'liifl be
more effective.
WEBLINKS
This site offM links to a wide range of resou1ces on a variety
of psychOlogy topics
www.psywww.com/resource/bytOPfC.htm
Government of Manitoba manual on trauma-info,med p,actice
http:/lltauma-tn fo,med.catwp..contenVuploads/'2013/ 10/
Trauma-tnf01med_Toolkit.pdf
Article that ext,IOres 15 Common Defence Mechan isms
http://psychcentral.com/
lib/ 15-common~efense-mechanismsl
Rep,int of a classic article by Cati Rogers, the founder of
Person-Centred Counselling..
http://psychclassiC$.yorku.ca1RogerSltherapy.htm
l he Skills, Process, a nd Pitfalls ol Counselling
65
Designer49 I/Shutte,s;o:k
■
Explore the features of a counselling relationship.
■
Explain the importance of the core conditions of warmth, empathy, and
genuineness..
■
Oemonstr:ne ability to negotiate relationship. anticiP3tory, and work contracts.
■
Demonstrate skills for maintainina the counscJling relationship.
■
Examine relationship endings.
THE COUNSELLING RELATIONSHIP
One of the most well-documented findina in counsellina is the fact that devclopina and
sustainina an effective counselling relationship is widely accepted as critical to success
(Cochran & Cochran, 2015; C ozolino & Santos. 2014; Heinonen & Spenrman, 2010;
Nystul, 201 I; Rogers, 1980; and Shulman, 2CX>9). In fact, the rcJntionship itself is often
the central reason for client chan,;e, and it can be " more important than any informa.tion aiven, rderrals made, or practice approaches used . . ." (He.inonen & Spearman,
2010, p. IOI). Research by Kivliahan, Celso, Ain, Hummel, and Markin, (2015)demon.stratcd that counsellors with better relationships have clients who make better progress.
66
Having a sttong relationship can activate lhe brain's
tewatd system in the same way as a dtug by teleasing
lhe oourotr'ansmittet dOS)amine, which is associated with
pleasute and feeling good. Conver'Sety, the loss of lhe
tel3tionship can lead 10 dep,-ession and anxiely (Jantz,
2015).
Capuz! i and Gross (2009) conclude, "specific proc~urcs and techniques arc much less
important than the alliance between counsellor and diem" (p. 65). Significant]}•, "even
clients whose lives have predisposed them to distrust and suspicion often remain :.de rt
to dues that this professional relationship may hold promise" (Miley, O'Melia, &
Dubois, 2004, p. 130).
Rather than focus on technique, wise counsellors make the helping relationship the
centre of their ,vork. Over 50 rears ago. Rogers ( 1961) emphasized that a counsellor's
attitudes and feeJing.s are more important than technique and noted that the client's
perception of the counsellor's attitudes is what is most crucial. Re0ecting on this he
wrote, "In my early professionaJ rears 1 was asking the question: How can I treat. or
cure, or change this person? Now J would phrase the question in this way: How can I
provide a refotionship which this person ma'>' use for his own personaJ growth!" (p. 32).
The expertise that counsellors bring to the relationship lies less in the.ir ability to solve
problems than in their capacity to recoanizc and mobili.!c diem strengths and resources.
When strenai:hs are revealed and resources identified, clients become empowered with
new choices and rcvitali!ed optimism.
Definition
A coun....ellin,: relationship is a time-limited period of consultation between a counsellor and one or more clients for assisting the client in achieving a defined goal.
Counselling refotionships have some of the same components of intimacy, caring.
and support that characteri:e deep personal relationships. High-level communication
skills are as important to friendships as they are to counselling. Moreover, many of the
skills of counselling arc aJso the skills of effective everydaycommuniation. Friendships
grow out of mutual attraction and common interests., whereas counselling relationships
focus on heJping clients achieve goaJs such as resolving crises, making decisions. and
learning new skills. Counselling relationships are structured for the primary purpose of
reuhing these goals, and once the clients have achieved them, the counseJling relation•
ship is terminated. There is no expectation of reciprocity.
Personal relationships can be terminated for personal reasons. Counsellors, how•
ever, arc expected to persist in their efforts on behalf of clients even when they arc
frustrated by l.ac:k of progress or client resistance. Counselling may be ended when there
is little likelihood of reu.hing its goals, but not simply because the counsellor prefers
other diems. One measure of professionalism is the capacity of the practitioner to
sustain commitment. patience, and caring despite frusrrating obstacles. Many clients
come to counselling with impaired ability to form or sustain health)• relationships.,
so counseJlors must remain sensitive to this fact and not allow their own emotions or
"bunons to be pushed."
Rogcrs's counselling classic, Cliem.-Cenrered Therapy (1951), describes the experience of a client who successfully completed counselling following an unsuccessful
experience with another counsellor. The second counsellor asked the diem wh'>' he had
been able to work through his problems on his second attempt. The client responded,
"You did about the same things he did, but you seemed reaJly interest~ in me" (p. 69).
Relationship: The Foundation lor Change
c:ounselli,_ relationsh.,: Ali, .
limited peri>d al coosultation bE1~
a toonsfflor W a dient dedicated to
lldliMlg a de.fined f(lal
67
))t) BRAIN
n,, '. ,
BYTE
11
Oxytocin is a hormone and a ne-urotransmittef that plays a
sigrlifacant tole in telationship t:X>ndi~. Both sex. and bitth
inctease levets ot ox.ytoc:in, and it appears that strong telalionships atso increase ox.ytodn lew!ls. There is evidence
that increased ox.ytocin levels reduce stress, anxiety, depression, and also increase empathy and one's geooral abtfity
to communicate emotions (Gravotta, 2013; Simon-Dack &
Marmarosh, 2014). 0ur brain/bOdy releases ox.ytocin to
8
strengthen relations.hips. Oxytocin gets released duri~ light
caresses. sex., wtlen someone ShO'hS they trust you. and
sometimes even simi;::iywith talking. When released, ox.ytocin
increases feelings ot attachment for another- perSOO, as well
as feelings ot trUSI. It also decreases feelings of stress. fear
and pain· (Korb, 2014: onlioo). These findi~ undetscore
100 importance of payingattantion to the counsem~ r'ela~
ship and avoiding a strict taSk or prOble-m-sol\'ing orientation.
The heJping relationship provides rhe necessary security for clients to disclose the.ir
fttling.s and ideas. As rrust develops in refationship~ so docs the caP3cit)• of clients to
become increasing),., open to revealing themseJves. Drawing from the srrength of their
relationships with counsellor~ clients may rislc new ways of thinking and behaving, and
in this way, the relationship becomes the medium for chanae. In positive counselling
relationship~ clients perceive their counsellors as a.Hies. They become increasingly will.ing to disclose because they do not fear that they will be rejected, judi;cd, or c~rced to
change in ways that they find unacceptable. Jn its purest form, the counselling reJntion.ship becomes a collaborative endeavour.
CounseJling sessions a.re not always comfortable or pleasant. The process may
involve exploration of painful feelings or o:pe.riences. Personal change involves risk
and modification of one's usual way of thinking or behaving, and this can be stressful.
Counsellors who a.re intent on kttping the counselling rclntionship pleasant ma,., com,.
municate reluct:mce to deal with sensitive issue~ or they may withdraw at the first sign
of difficulty by changing the topic or rescuing.
SUCCESS TIP
If you want to inftuence sotneone, fifSl pay anent.ion to the relatiotlsi-.p.
Relationship and the Phases of Counselling
Each of the four phases of counseJling-prcliminary, beginning, action, and endinghas associated relationship tasks and cha.Jlenges (Shcbib, 1997). In all phases, counseJlors
need todcvclop effective skills and attitudes for engaging and retaining clients, including
sincerity, perceptivencs~ honesty, respect for dive.rsit)', capncity to initiate conversa.,.
tions, ability to be a good listene.r, comfon with discussing feelings, emP3th't', ability to
communicate confidence without conceit, and warmth. The essential clements of the
counselling relationship include core condition~ contract~ goals, and immediacy, with
the worlc conducted within professional boundaries and time limits (Figure 3.1).
Preliminary Phase
The gool of the preJiminary phase is to create the necessary
physical and pS)'Chological conditions for the relationship to begin. The counselling
environment (e.g., ni;ency setting, office ln)'OUt, and reception procedures) can have
a dramatic impact on the client's mood and expcctntions even before the interview
begins (Knapp & Hall, 2006; Shebib, 1997). Preliminary phase work attempts to create
first impressions that say to clients, "You will be respected here. You a.re important.
This is a place where you will be supponed."
68
Chap1er 3
Co<e
Conditions
Immediacy
Contrac1s
Sooodaries
& Time
Goals
limits
Figure 3.1
The Essential Elements of a Counselling Relationship
SUCCESS TIP
The stage for the relationship is set long befom you moot your client. Upe-riences wdh past
counsetJors, ext,ectations abOut lhe pcocess, factOr'S such as tM waiting room, hOw the client is greeted, and waiting time mean lhe relationship has already started befOr'e )'Our fllSt
encounte-r. TM relatiotlsi-.p is further predefined by issues such as culture, gender, sexual
Orientatbn, reactions to autnority, and the presence ot mental disor'dets.
Beginning Phase The relationship g,c,al in the beginning ph3sc is co dcvcJop rapport, trust, and a working contract or agreement reg3rding the purpose of the work
and the roles of rhc participants. The relationship at this phase must provide enough
safety for clients that they will engage and continue with counselling. Counsellors create this c:nvironmcm of safety b)• communicating that they do 00( judge the diem and
that change can occur. The relationship enables clients to fee] sufficientJ,., free to take on
the first risks of counselling-sharing their feelings and concerns. Neverthcles~ some
clients are poorly equipped to do this. and they may remain guarded or suspicious
throughout the whole process.
Action Phase Ideally, in the action phase, the reJationship continues to dcvdop and
strengthen. Clients take new risks as they find the courage and strength to examine and
change their wa)'S of thinking, feeling, and behaving. During this phase, reJationship
work may need to focus on addressing communication problems including. at time~
tension or conflict.
Ending P hase
Termination of the counselling relationship comes when counselling has ~rved its purpose and clients have reached their goa.Js. Termination focuses
on reviewing the work accomplished, helping clients consolidate learning. and SU)ting
goodbye. Ending phase work will be discussed in more depth later in this chapter.
CARL ROGERS AND THE CORE CONDITIONS
Carl Rogers (1902- 1987). the founder of dicnt<entred therapy (later known as person•
centred therapy), has exerted an enormous in6ucncc on the counseJling profession for
the last 65 't'ears.
Rogers (I 951, 1961 , and 1980) asserted the importance of s«ing others as "becoming." This notion underscores a fundamental belief in the capacity of people to change.
Clients arc not bound b)• their past, and counsellors should not use diagnosis and das•
sification as tools for depersonalizing clients and treating them as objects. In counseJling,
Relationship: Tile Foundation lor Change
69
clients need to be seen for their potcntiru, strength, inner p0\\'Ct, and ai.pacity to change.
Rogcrs's nondircctivc methods are based on the premise that if core conditions are
present, then change is possible. The core conditions act to speed the natural process
of healing or recovery from psychologicaJ pain or problems.
The essential core conditions arc unconditionaJ positive regard, empathy, and
genuineness. Core conditions arc aspects of attitude that are prerequisites to forming
and maintaining effective hclping relationships. Although counsellors can use certain
behnviours and skills to demonstrate core conditions. the conditions must represent
the authentic values and attitudes of counseJlors. \Vhen counseJlors exhibit these core
conditions. the potentinJ for chnnge and positive relationships with clients is incre3scd.
However, there is no guarantee that clients will interpret warmth, aenuinenes~ and
empathy (or any communication) in the way that they were intended. Prior cxperi.ences and expectations, as wdl as cultural and individunJ differences, can easily lead
to discrepancies in the way communication is perceived. Counsellors can expect to
be rejected at least some of the time, despite their best cffons. Moreover, a client may
perceive empathy as an intrusive attempt to "get into my head" and may interpret caring
attitudes as manipulation. Secure professionals accept this re3lity, knowing that considerable resistance may be encountered as they work to develop the heJping relationship.
Unconditional Positive Regard
warmth: M espressi>n of 10npomssitt
caring tut reqlllies genuin•n-.:J
• olwm•, the acoeptafltf of the equal
YIOrt!I of oeks.. a IOflju~ntal attihlde,
•d avoidance of tuaing.
70
UnconditionnJ positive rcg3.rd accepts the diem as
a person of wonh and dignity. This acceptance is felt and communicated by counsel.tors without condition, judgment, or expectation. Rogoers beJieved that such uncon.ditionaJ rcg3rd creates the very best conditions for client growth to occur. Essential
components of unconditional positive regard include caring., respect, warmth, and
compassion.
Rogers (1961) urged counsellors to shun any tendency to keep clients at a distance
by tre3ting them as objects with detailed diagnostic labels. Instead, he ari:ued thnt coun•
sellors neo:I to learn that it is safe to express their warmth and to let clients know th.nt
they care.
Warmth is difficult to define; yet its presence or absence can be fclt immediatdy.
\Varmth communicates comfort and trust, and it is a precursor to trust. It attracts
clients to take risks because it indicates the goodwill and motivation of the.ir counseJ,.
lors. In the beginning, clients often come to counselling reluctantly, perhaps driven by
external pres.sure or by the weight of their problems. Counsellors need to engage or
connect with clients to hdp them find enough acceptance so that they return and suf,.
ficient safety so that they can take appropriate risks. Warmth say~ "I'm approachnblc.
You do 00( need to be afraid of me. I won't take advantage of your vulnerability. J'm
a kind person." As a result, warmth is particularly important during the formative or
beginning stage of the relationship. Warmth is also crucial for supporting clients dur.ing a crisis, and it is a necessary partner to ai.ring confrontation. Clients will be more
receptive to feedback if it originates from a warm and caring attitude.
Although warmth can to some extent be defined behaviouraJly, it must arise from
genuine fodings of caring for the client. Otherwise, the counsellor's actions will appear
lacking in genuineness. ·warmth is demonstrated by smiling appropriatdy and by show.ing since.re interest in the comfort of the diem. Counsellors show warmth when they
communicate nonverbally that they are totaJly focused on their clients. Simple coune.sies, such as eliminating distractions from the interview, asking clients if they are physi.cally comfortable, offering them a beverage, and making e)'C contact all convey warmth.
\VelL-timed humour can nJso add a warm touch to the interview.
Counsellors need to be flexib le with their lcvcl of expressed warmth and caring.
Highly suspicious clients may interpret warmth as manipulative, and some clients are not
comfortable with a high levd of expressed emotion. As \\'di, gender may be a variable.
Chap1er 3
Being warm docs not prec.ludedC3ling with difficult topics; in foct, w-amnh provides
the neccss3ry found3tion for such ta1k. Nor docs it imply that a grc3t deaJ of the interview needs to be spent making small mlk, 3S one might do during a social visit.
Sometimes in busy social service aJ;encic~ c3sdoads become unmanagC3ble and the
pace of the work frantic. Constant crises and unrelenting papcnvork exhaust even the
most energetic and caring workers, who m3y begin to lose the "spark" they h3d when
they first entered the field. Unless controlled, the office routine can begin to feel more
like an 3ssembly line th3n a counseJling service, as clients become numbers and the
worlc becomes increasing),., m.sk.-oriented. How docs one continue to focl and express
warmth under such conditions! The answer must be discovered individually, but we
c3n learn something from the observations of one worker, a senior caseworker with
over 25 years' experience:
What works for me is to remind 1n)'SeJ( that no matter how overwhelmed I feel. it's
worse lor in)' clienu. O(ten. they're broke. in crisis and not sure wbethe-r they w;,int to
live or die. Tih~)' don't need me to be p::arc o( the problem. \V~c doesn·c work lor 1ne
is to s.et cau¥ht up in oo(fee room neK"3ti\'ism. You know what it's like-the ones who
ne\'er h::a"e ::anythina '--ood co 53)' ::and ::always expect thina,i co s.et worse. It :Uso helps if
I take a few moments. sornecirnes precious se«>nds. between interviews to rned1t2te.
When I n~t mr chent. I tr)' to spend some time just heh,¥ (riendl)·.
Empathy Empath)• describes the capnc:it)• to understand the feelings 3nd \'lews of
3nothe.r person. Emp3thic 3ttitudes and skills can generntc powerful bonds of trust 3nd
rapport. Emp3thy communicates understanding and acceptance. An cmpuhic artitudc
is ch3rncteri:ed by one's willingness to IC3rn about the world of another and begins with
suspending judgment. To be nonjudgmcntn1 rttauircs considerable discipline in controlling personal bi3sc~ assumptions, and reactions thu might contaminate understanding.
CONVERSATION 3.1
COUNSEllOR 1: Maybe C3fl Rogers COUkS do ii, but I find 1t
difficult, somethnes impossible, to have fespect and cari~
fof someone whO has oon,e something h0tfend0us, such as
raping a Child.
P1108ATION OFFICER: Even Rogers admitted to bei~ challenged. Sotnelimes he'd Share his oogative teactions ot
feelings with his clients-maybe that's why he identified
genllneness as a core condition.
COUNS£UOR 2: Eyen if I have strong negati\le feelings toward
my client, I can stil controt my behaviour. I can listen; I can
~ my active listeni~ skill$ to try to undersaand. I can empa
thize, which doesni mt.an I awee with the client Of sanction
the behaviouf.
4
P1108ATION OFFICER: One of 100 fitst people I wOt'ked with
was a man whO was so abusive and he put his wife in the
hospital. I dtShked him befor'e I even met him. But as I gOI to
know him, 1found myself softeni~ a bit. I still was fepu~d
by what he did, but I also came to understand his depression,
his inabiity to get a job, and his own abuse asa chitd. He was
much mofe complicated than I imagined. NON, I've wOt'ked
in the Alber&a correctional system tot 1S years, and I've~
met anyone who is pufe evil. 31th~ some psyd'lopaths can
come clOSe.
COUNSELLOR 3: We have a professional t'de to play, and it's
n01 out job to condemn Of put.Sh, but the feality is that we
won'I •ke or tespect eitety dient we moot; howevet, we have a
much better d'lance of helping the client cha• if we have a
WOl'kiog felationSl'lip. This increases the poss,ibiity that clients
'Ifill trust us so that they can ex,:ife-ss and discuss important
feelings and ideas. The bouom Ii~ fot me is this: fes,)ecl the
dient, but reject the behaviout. When you do that the client
has a safe relationslip, and often that alOne can generate
movement to consttucli've change. If the client ex.pcesses
remofSe ot self~oubt about his behaviout 0t if he hints at
some de-sil'e to d'lange, we can buitd m::,mentum tot change
with encOU'agi~ questions and feflections sud'I as ·Sou nets
•ke there's a part ot you that WOlJd 1tke to be different,· Of
"Suppose you wefe to make a change in the difection you
describe. How WOUid you do if?•
COUNS£UOR 2: Hefe's anolhef thought. I think 1t rS jUSI as
important to unders&and and controt out strong pos,tive feeli ~ oocause lhese have the same potential to clOud ouf
ObjeclMly.
Relationshi p: Tile Foundation lor Change
71
In addition, counscllors need co be able to enter the emotional world of their di.ents without fear of b«oming crapped in their pain. CounseJlors who arc secure with
themselves and their feelings have the capacity to enter their clients' worlds without
fear of losing their own identity. Brill and Levine (2005) note that when a counscllor
communicates acceptance. there is the "freedom to be oneself--to express one's fears,
angers, joy, rage, to grow, develop. and change--without conce.rn that doing so will
jcopardi:e the refationship" (p. I 18).
Empathy has cwo components. First, counsellors must be able to perceive their di.ents' feelings and pc.rspecrivcs. This rcquircscounscllors to have abundant S(".lf•awarencss
and emotional maturity so that they do not contaminate their clients' cxpe.ricnce with
their own. The second component of empathy is to make an empathic response. This
involves putting in words the feelings thnt the client has expressed. This task cnn be particularly difficult, since clients often communicate their feelings in abstract, ambiguous,
or nonverbal ,.,,.,._,.,s. Empathic responses rttauirc a vocabulary of w-ords and phrases that
can be used to define feelings. At a basic level, empathic responses adcnowlcdge obvious
and dearly expressed feelings. At a more advanced or inferred level, e.mP3thic responses
are framed from hints and nonverbnJ cues. An empathic response proves to clients that
they have been hcard, unde.rstood, and accepted. Chapter 6 focuses on this critical skill.
Genuineness Being genuine mcans being authentic and real in a relationship. Coun.sellors who arc ,;cnuine show high consistency between what they think and do, and
between what they feel and express. Rogers ( 1961) used the term congmenr to describe
this quality and emphasi:ed the importance of self-awareness to unambiguous com.munication. To avoid giving contradictory messages., counscllors need to be aware of
how they arc feeling and how they are transmitting their feelings.
Genuine counscllors are also hight,., trustwonhy. Thq•do noc lie to dien~ and they arc
willing to provide feedback that is cimel'>' and helpfuJ. They sho,,v respect for clients ~• bc.ing
open and honest while maintaining warmth and emP3thy in the relationship. They do not
w-orlc from hidden a,;cndas., nor do they put on "masks" or play roles to hide their true feel,.
ings. As weJI, ,;cnuine counscllors arc reliable. They do what thq• say they arc going to do.
Core Conditions: Implications for Counsellors
Rog,ers's philosophy suggests a number of introspective questions for counsellors to
consider rcg:irding che.ir attitudes and behaviour in hcJping relationships:
■
Houican I acr so that dienu will perceil't' me as rmsru,onhy! This means counscllors do
what they say they will do and net in a way that is consistent with how they feel. It
requires counsellors to communicate without ambiguity and contradiction.
■
Can I permir m,"$e'lf ro experience positive arrirude:s of u,armrh, caring, liking, intereSL,
and re:spec.r rOlmrd clienu!
Can I be :srrong enough a:s a per.son to be :sepamte from my clients! This requires a high
level of maturity, self.awareness. and courage. Ro,;crs summarizes this chaJlenge:
''Am J strong enough in my own ~parnccness that I will not be downcast by his
depression, frightened by his fear, nor engulfed by his dependency! Is my inner sclf
hard'>' enough to rcali.!e that I am not destroyed by his ang~r, taken over by his need
for dependence, nor enslaved by his love, but thnt 1 exist scP3rate from him with
feelings and rights of my own?" ( 1961, p. 52)
■
■
Am I :secure enough ro permit clienu their separarene:s.s! Clients are not under their
counscJlor's control, nor are they to be molded as modcJs of what counsellors feel
they should be.
■
Can I le, mysclf fully emparhhe urirh my dienu' feelings and world per:spenil'eS without
e,ialuaring c,,- j1Klging!
72
Chap1er 3
CONVERSATION 3.2
STUDE:NT: How far ShOuld I go With genuiooooss? What if I'm
a~ry with my client? Should I say so? Or suppose I find my
client disgustk"lg. Shouk1 1ex.press that too?
TEACHER: You've identified an impoftant dilemma. On the
one hand, the need for genuineness suggests that we ShOuld
be open and hooost with our clients. We Shouldn't put on
false fronts, lie to clients. Or' fake OU( feelings. Al the same
time, ethical principres dear1y prOhibit us ftom dc::i~ hafm.
Being genuine ooesn1 entitle counsetors to "dump· on tnell
clients. Genuioo counsellors are truthful, but they ate alSO
timely. They share personal petceptions and footings in an
asserti\18 way to meet their clients' neoos. They night ex.press
theit anger, but they dO so withOut intending to punish, rid~
cute, or trap the.' clients. As f0t feeli~ diSgtJSl toward a client,
I can'I see hoN sharing thal information would sel'\le any pur.
pose. On 100 other hand. it may be useful 10 the client if you
explored the specific behaviou's or attttudes that gave rise to
thOse feelings. With sensitive feedbaek, your client can have
the benefit of leamk'lg abOut his or her impac1on others. Once
you put 1t on the &able foe discussion., you no ~
( have to
hide )'OU' reactions. One final poi.nl: Strong react.ions toward
our clients may hi.I'll at OU( own vlJnerabirrties. If you find a
d ient disgusti~. I'd want to ask you. MWhem does that feeling come from? Are you sure 1t is related onfy to the d ient?·
ST\J0ENT: Maybe the client Mpushes my buttons" the same
way my pa(ents did.
TEACHER, Exactly.
COUNSELLING CONTRACTS
A contract is n negotint~ agreement between the counsellor and the client reg3rding
important variables that define the worlc. Counsellors typicaJl't' begin contracting enrly
in the first interview; however, contracting is continuous throughout the life of the
helping relationship. Rigid adherence to ne,;otiatcd conrracts is hazardous. Counselling
contracts nttd to be pcriodicaJl't' revisited and updated, sometimes even severnJ times
during a single session. The reasons for amending contracts include the following:
■
Exploration of problems nnd feelings ma,., promote insight. and this may lead
changed expectations and revised goals.
■
(ncrcascd rrust may enable clients to address more difficult topics and feelings that
they were unwilling to consider at the beginning of the relationship.
■
New problems and issues may emerge because of changing circumstances.
c:ontr~t: Aneiomted agieemeai
bE1•een coaselCl'i . t clients ieprding
tile purpose of the 'llllfk. their ,espectiw
soles, and the •Uiojs and f'Clllllines that
• ill be 11sed to ieat h tileir agreed-on
ct;e«ive. ('Seealso sessitxtJIGMlflt:t
and wri GMtnct)
to
SUCCESS TIP
Variables suctl as clJtu(e, level of t(uS'l, timlflg, mood, and stress can affecl a client's wflingness and capacity to address topics. Similarly, unresdved conftkl .-i 100 client~setlOr'
(elat.ionship can dramatically affect the contract. Unless these variables are considered and
until conflicl is resolved, the client may not cooperate or fulty participate.
Purpose of Contracting
Contracting ensures that clients and counsellors arc on the same page with respect
to the goals of the w-ork and the counselling methods that will be used. Contracting
3fso involves discussion that defines the counscJlor~ lient relationship, including role~
right~ and responsibilities. Good counscJlors adjust their style to meet the need~ culture, and personality of their clients. They consult and negotiate with their clients to
identify and understand these variables. Effective contracting respects clients' freedom
to choose, and it gives them knowledge and control of the helping process. \Vhen
counsellors and their clients are ,vorking toward agreed-upon objectives, it is much
Relationship: Tile Fo undation lor Change
73
more liket,., that clients will "own" the ,vork rather th3n see it as somethina th3t h3s
been imposed on them. Contractina reduces suspicions that counsellors may have hid•
den ai;endas.
Contrnctina directly addresses the reality that there may be (and often an~) sharp
differences among the follO\\•ing:
■
the problem as perceived by 3ny referring source (e.g., another aaency, family,
employer, etc.)
■
the problem as perceived b)• the client
■
your perception (as counscJlor) of the problem
The contract is like a road map that provides i;enerol directions on how to get
from A to B. Jr confirms that all parries are ,vorking tow3rd the same end. A counscJ.ling contract also predicts an end to the relationship. Defining tasks and goals makes it
dear when the relationship should be ended. Jo this Wtt)', the counselling relationship is
deart,., distinauished from a friendship. whidi may last for 3 lifetime.
SUCCESS TIP
ContracUng may change ave( the life of lhe relationship Or' even during a single session.
Client insigrlt, changed priOl"ities, moo:J, ttust k!WI. capacity, and eme(gent issues arQ
variables that drfvQ changes in tM contr'3Ct.
Contracts may be formal and sianed by both the counsellor and the client, but more
frequent])• they are informal and ratified with verbal agreement or a handshake. The.re
are three types of contracts: relationship, 3nticipatory, 3nd work.
Relationsh i p Contracts
~lationship contract: ANftotulion
of tbe intended purp>S! of the uunselling
telationsllii>. inc:Wiig an ag,ee~ •
the ~Ed soles al bo1' counselklf and
dient
The relation.,;hip contract outlines how the counsellor and the client will work together.
lt results in a cusromi:ed relationship th3t is uniquely respectful and responsive to the
client's expectations, W3nts, and needs. The process involves candid discussion and
exploration of client issues, such 3S the followina:
■
communication style (e.g., prefe.rred ways to communicate, problem solve, resolve
conflict, and give and rcce.ive feedback)
■
personal wlues, worldview, and culture
■
exploration of how differences (e.g., gender, aae, race, and sexual orientation) might
help or hinder the counselling work
■
past experiences with counselling
The relationship contract, b)• its nature, honours diversity and individual differences in communication styles and patterns. The process signals to clients that their
needs and wants will be respected and th3t counsellors are willing to adjust the.ir st)•le
to accommodate clients.
Pan of the relationship contractina process is discus.sing the methods 3nd process
of counsellina. Counsellors should be open about what they are doina and not work
from 3 sec.ret script with myste.rious techniques that they hide from clients. They should
be willing 3nd able to describe their worlc in simple, non-jargonistic langu3ge. (n this
way, clients can know something about what is happening, the direction of the work,
and wh3t remains to be done.
Shulman (2009) emphasi!es the need for workers to provide dear, non-ja.rgonistic
st3tements th3t describe the rani;e of services available. This is particul3.rly important
74
Chap1er 3
in settings where the counseJlor ma.'>' be the one who initiates first contact. \Vhen the
purpose of the mcetina is explicit, clients do not have to ,vort)• a.bout workers' hidden
agendas, and they a.re in a. more informed position to cake advantage of assistance. ln
the example below, a school counsellor is ma.Icing an excellent attempt to engage with
an 11-yenM>ld boy who has transferred to the school in the middle of the a.endemic yenr
and Sttms depressed and alone:
Coun.seltor: My name is ?l.·1r. S1nith. I'm here bec3usie your te::.cher thou$:ht I mi$:ht be
:1ble t'O help you with Sm»e of the problems you 're havinK :.t sehool. I know that ii ean
be tou~, to be the new kkL Sometimes it's just not mueh (un. Maybe we rouJd 1~t
:.nd see i( we ean O~-ure o ut 3 way to mW 1hi~ better. \Vh::u do )'Ou thin.kt
Past Experiences with Counselling Many clients have considerable experience
working with counsellors, and they have learned what works and what docs not ,vork.
CounscJlors can learn from chis and adapt their approach nccordinaly. A sample probe
illustrates as follows:
Coun.seltor: I'd like )'Our help. I know )'Ou\~ bet>n oomin& to this 3~ncy for 3 while,
:.nd you have a lot o( ~perienu as 3 user. h would help me i( )'Ou could tell me a bit
:1bou1 )'Our ~perience~1ke. wh3t did )'Ou f'lnd helpful and not help(ul? TI,en we ean
t3lk about how )'Ou and I t21n best v.-'Ork t~ther.
\Vhile diems ma.'>' have had satisfying and empowerina expe.rience~ the reality is
that many have fclt discmpowe.red by counsellors and other socia.J service providers.
Open discussion about this can provide valuable cues for structuring the current rel3,
tionship. Moreover, the process can help clients who have had a b3d expe.rience reach
some closure on unresolved fcclinas. Ac the same time, the process dearly communi•
cates chat chis relationship has the potentia.J to be diffe.rent.
Discussion of the Roles and Expectations of the Participants Counsellors
should know somethina about what clients want from chem. Do clients expect them to
provide 3dvice on how to manage che.ir problems! Do they want to be challenged with
new information and new perspectives? Are they looking for someone who is warm,
gentle, and supportive, or someone who will just listen? Similarly, counsellors need to
tdl clients a.bout an'>' exptttations they have. Role discussion may also address is.sues
such as how the participants might 3ddrcssconflict, and how they can provide feedback
to e3ch other.
Clients may be a.ware of the.ir pain and may rccogni!e and accept the need for
change and help, but they may have no idea what form this help might take. In such
situations, counsellors need to be able to hdp them unde.rstand the potential assistance
that counseJling can provide.
Somedients also have unrealistic expectations of their counsellors and the process.
They may believe that counsellors will tell chem what to do and solve all their problems.
Or they ma.'>' have no faith in the process whatsocwr. According to Wicks and Parsons
(I 984), when people enter counselling they often anticipate "either a. miracle or complete
failure" (p. 175). Contracting is a significant opportunity for demystifying the process
and for challenging unreasonable positive or negative expectations.
The followina example is taken from the midpoint of a. second inte.rview. le illustrates how the counsellor gen th• encoura,;es the client to re-examine some self-imposed
restrictions on the relationship:
Client: Let's l:ttp rny feeli1l{tS out o( thil. I simpl'>' want 10 look at ways to improve rny
relationship with my son. I( you could teieh rne some tt"<':hniques. I'd be rnosc Kr:l.teful.
Coun.sell.or: Of eourSe you're entitled t'O privacy on issues <>r (e,eli~ that )'Ou don't
want 10 share with me. At the ~rne time. I wonder i( )'Ou miiht be too hasty in rescrieth1K wh:lt v.--e t21n discuss.
Relationship: Tile Foundation lor Change
75
Client: I don't i et it. What do )'OU mean?
CounS(>IJOr. \Veil, you·ve bee!, throu$:h a lot. \\11th your son' s arrest 21nd his dis:1ppear,
antt (or over a month. I'd be surprised i( rou weren' t (ee1m~ stress.
CUent: \Vho ..vouk.ln·e
CounseUor. That' s exxtly my point. When I don't ~lk about (ee.lin{t:l th:u are bother,
ina me, I have to keep them inside or pretend they're not there. I've (ound that doesn' t
work. Sooner or bter. I h:i,'t, to (21ee my (eelin~s.
Client: I'm Just 21(r3id that i{ I start er)•i1l{t. I won't be :lbte l'O Sl'Op.
CounS(>IJOr. Th:it tells 1fie that the pain must be ,'t,r)' deep. (Slknte as tht- clitnt tc>ars up.)
CounS(>IJOr. I Yi·on't push )'Ou, but I hope our rel:u.Onship ean beco1fie a 5::11(e pl.:1ee for
you. 1t·sobrwith me i( )'Ou ery.
Many clients arc slow to develop trust, perhaps for good reason. They may have
lifelong experiences o( betrayal or abuse by people they trusted. \\:fhy should it be
any different with a counsellor? As a result, it is understandable that they approach
counselling with a degree o( mistrust. Wides and Parsons ( 1984) provide a compel.ling observation: "Though there may seem to be a great distance between counseJ,.
lors and their clients during the beginning phase o( counselling, they should not be
discourai;cd because at that point their clients ma)' be closer to them than anyone
dsc" (p. 168).
Client: I really don't see the point in be.in¥ hen:-. ?l.·f)• sit"uation ishopeless. J','t, ~n l'O
other oounsellorS and nothina worked. 1'1n onl)• here because mr wi(e insisted. She
thou~,t rou mi~u be 3b1e to help.
CounS(>IJOr (Choice I): You eer~inl)• do sound diseoul"3~-td. but I think you should
Kive eounsellu~ another chanee. Marbe b)' talli~ about )'Our problems, we c=n discover
some solutions you've O\~rlook.ed.
CounS(>IJOr (Choke 2): Given rour past experie:nees,. I ean see wh)· you' re pessi1nistie.
You're wise to be skeptical until )'Ou Ond out i( you can trust me. In the end, the results
will be the most important thi~
In this example, Choice I is well-meaning but ill.-timed and may lead to n powe.r
struggle i( the client fods compelled to defend his position. Choice 2 is not condcsccnd.ing, it avoids the power struggle trap, and it docs not promise success.
Anticipatory Contracts
antidpatoty contract: An ag,eement
between couns!lots and clieus tu'!
plans kif predictlble ew:nts. Antqii.;ory
contracts pnrme g_uidance ICJ coasElcn
•d ans•111.r tbe questioo. '"M.at shodd I
d) jf .. !"'
Anticipatory contracts enable counsellors and their clients to plan for predictable
events. Jf you know something has been problematic in the past, ask your client for heJp
on how )'OU might respond if the same situntion arises in the future. Some examples o(
what counsellors might say are as follows:
CounS(>IJOr (to .:1 client with a hl;;tory of \iolenc.e): "I need your help. I( I see that )'Ou
are :u,irY. what would be a ~-ood thlfl¥ (or me to do that rou would And useful? ..
CounS(>IJOr (to .:1 client iW.rtina a job search): "Suppose three or lour w~k.!l inl'O )'Our
job seareh )'Ou 21re ~ttina diseoul"3~-ed. Give 1fie some ::.dviee on wh::u I miaht do l'O help
you r«.3pture some o( the positive ene"iy you (eel todar. ·•
Homebuilders usuaJI)• prewire n~w homes so that future instaJlation of services
like cable television will be easy. In the same way, reJationships can be "prewired" to
mnke resolution o( communication difficulties easier. Conrracting smnegics, such as
discussing in advance how conflict will be addressed and working to develop and refine
open communication, are the tools for prewiring relationships. )( conflicts occur, a
76
Chap1er 3
mechanism is aJrendy in pince for resolvina them. Herc arc some examples that illustrate
the options:
Counsellor: Suppose th::u I h::r\'e some (eedbr:lck for you. How would
2pprooch )'Ou?
)'Ou
hk.e me
IO
Coun.seltor: let's talk about wh::u e::.ch o( us tan do i( there's 2 problem be1ween us.
l m~ne th::u I sar or do somethinK t~1 offends rou or you don' t like.
All o f us h.nve preferences about how we like to give and rece.ivc feedback. Some
o( us want it straight and to the point; some respond better to a "S3ndwich Sl)•le," combinina critical feedback with suppon and positive affirmation. Others need visual or
behavioural illustTiltions. Anticipatory contractina identifies these preferences.
SUCCESS TIP
TM onus is on the counsellOf to adjust his Or' het styte of giving feeelbaek to moot 100 style
of the client. Clearty, this fe<::iuites counsetlo, fkoobllily. Anticipatory eootrac1s tel the counsellOI" how to be flexit:,e.
Work Contracts
Whereas the relationship contract focuses on the respective roles and expecr:ntions of
the participants and how they will communicate, the work contract defines the focus for
the current session and the overall objective of the participants' ,vo rk toJ;cther. Sheafor
and Horcjsi (2008) identify the following basic components of the wo rk contract:
■
problems o r concerns to be addressed
■
goals and objectives of the intervention
■
activities Iactions) the client will undertake
■
tasks to be per formed by the worker
■
expected duration
■
schedule of rime and place for interviews
■
idemification of other persons, agencies, or o rg3nizations expected to participate
(p. 322)
WOltc contr-ac:t: An ag,eemea1 di.at
specifies the iMended to3ls• «r.OCdle ol
uunselling..
As well, ethical issue~ including the limitations of confidentiality, arc also pan of
the work contract.
Sessional Focus The scs.sional contTilct answers the question, "\Vhat are we hopina
to talk about a nd accomplish toda,.•!" Althouah the importance of defining sessional
focus seems seJf-evidcnt, it is surprising how often counsellors procttd without a clear
sense of direction or purpose. Or they assume that the.ir clients undersr:nnd and arc
working with the same purpose in mind. \\:'hen clients are involved in negotiating the
contract, they arc respected and empowered as active partners, not passive recipients
of service. W ith clarity and agreement reaard ina purpose, clients arc more likely to
support and participate in the work. Sometimes what counsellors sec as client resis•
tance is better understood as legitimate client defence against something (i.e., goals o r
processes) they experience as imposed.
Sessional contracts can direct anemion to one o r more of the three major domains:
behaviour, thinking, and feeling, SessionnJ contracts based on beh.nviour target objec•
tives such as skill d evelopment, problem solution (what to do or say), decision making,
Relationshi p: Tile Foundation lor Change
77
TABLE 3.1
Contract ing l eads
What are you hopi~ to acc:ompis.h as a (eslAt of our \\()rk IOday?
Whete do you feel most comtortable ssartl~
What brings you hefe?
What oo you need to get out of tOday?
What dO you need from me-?
Lei's talk abOut hO'N we can use ouf time here.
Flnis.h this sente~: When I leave he-re tOday, I hope tr.at .
Several limes you've hinted at . .. Perhaps it migt\t be important to focus on this a bit
( To art il'tYOlunta,y dienO You feel forced to come-. Neve-rtheless. you could have chosen
not to. So I wondet if we could talk aOOut hOw you couk1 make the beSI use ot the Ume we
have together.
The- e-xami:,es belOW are chOice options when you wish to intrOduce clients to the services
available at tne age-ncy, wtle-n c~nts a(e stuck, and when d ie-nts have limited understanding of the possibilities of counseling.
If you wis.h. we could ex.ptore . .
Here's an idea of wtlete we might go from here.
In my e-xpede-~. I have found that it is very helpful, sometimes crucial. to talk abOut feelings befOl'e \\()rkj~ on problem solutions. Ooos this make sense to you or not?
Let me tell you a bit abOut the prawams here. Then we can discuss which ones. if any,
you wish to use.
He-re are two choices: Eithef we could wol'k now oo fiOOi~ a SOiution. ot pe-rhaps it might
be be-tte-t to just spend time talking about how you fool.
I wonde-t if it makes sense 10 talk a bit abOut . . .
exploring options, 3nd goal setting. SessionaJ contracts ba~ on thinking arc concerned
with hcJping clients explore vnJue~ assumption~ beliefs(induding spiritunJ beliefs), and
scJf-csteem is.sues. \Vhen feeling is the focus of the comrnct, the work concentrates on
clients' emotions.
Counsellors 3re sometimes too quick to 3ssume that clients need to worlc on sofu,.
tions when the.ir primary need may be to "unwind" with a sympathetic listener. Through
sessionnJ contracting, counseJlors ensure that whal is done in the interview is explicit
and relevant.
Work Focus Jf there is no agreement on the purpose of counselling, the work is
apt to be direc:tionless. 'W ithout an agreed-upon purpose, counseJlors tend to make
assumptions 3bout the needs and wants of their clients-which arc frequently wrong.
Sec T3ble 3. 1 for examples of leads th3t c3n be used to initiate contracting.
Every counseJling a,;ency has a purpose chal defines and limits its service. Specialty
a,;encie~ such as employment counselling cenrres, m3y focus on c3reer testing and job
search skills, while a transition home may provide crisis counseJling and shelter. A
community centre might provide a broad ran,;e of counselling, education, 3nd group
suppon services. The multiple purposes of counselling can indude helping clients with
problem soh•ing, decision making, and managing feelings. It can also provide suppon,
give information, and foster skill acquisition.
Counsellors define and limit their role based on their position in the agency and
their training, An intake worker, for ex3mple, may be restricted to inirinJ screening and
assessment~ while a community outreach worker ma'>' spcci31i:e in reaching clients who
do not \'oluntarily seek service.
But clients may have specific wants and needs that do not mesh with the mandate
of the agency or its workers. Abrah3m Maslow's (1954) famous hierarchy of needs
(Figure 3.2) can be a useful wa'>' of understanding client priorities. Maslow suggested
that people normally seek to fulfill their basic survivnJ needs before pursuing higher
order needs. As one counsellor put it, "You can't counsel a client who hasn't eaten."
78
Chap1er 3
~
actualizailon
Safely
a.1cs...1va1
Figure 3.2
Maslow"s Hierarchy of Needs
Contracting needs to con.sider three variables: client need, ai;cncy mtmdau; and
counsellor expertise. Contracting ,vorks wd) when the client's needs matc.h the agency's
mandate and the counscJlor's competence, but when the service the client needs is
beyond the mandate of the agenq• or the competence of the counscJlor, rcfc.rral to
another counscllor or a,;cncy is appropriate. lntcrview 3.1 illustrates how contracting
is used to eng3gc and map out a plan with the parent of a teen who is abusing drugs.
})!} INTERVIEW 3.1
This interview is exc:e-pted from the IS-minute mark of the first session with a parent of a teen who is abusing drugs.
Counsellor: Let's take a few minutes to talk abOut hO'N we
mighl \\()rk togetnet. Then we·u bOth have a Shared sense
of direction.
Cllent: Great i:lea. I was \\()ndeMgwhere we go from here.
Counsellor: Pethaps you have some idoos on what you'd
like to achieve. I'd like to hoor lhem. Then. if you wish. I
can add some ot my own.
Client: As I tOld you. my big goal is to keep my son alive.
I don't want to (eceive a cau from the hOSpital saying he
has overdosed.
CounsellOr: Whether you( son uses drugs is n01 under you(
control. If you ,.;st,, we could talk abOt.C some of tne ways you
could deal 'Mth his behaviot.Jf, sl.d'I as how to handle it Vi'f'lef'I
he b<eakS curlew 01wt1a1 todowMO you think he's high.
Analysis: A simple. flot1-ja.rgo,,lstic statement initiates tfle contracting process. CCl'ltracting is presented as a col/at>txatlve
process.
Analysis: By seeking input, the counsellor communicates
respect for lhe client's needs at'ld signal$ that lhe counseNor is
t'10/ going 10 take control and make all the dedsJoos. Tfl;s helps
&:, empower the clknt and minimae any tet1de.ncy for the clknt
w become overly dependent.
Analysis: The counsel/Or gently attempts to contain tfle M'Of'k
within areas that the client can COf'lttOI, namely her behaviour..
Thedienrs reactictl COt'lf,rms ut'lderStat'ld1ngat'ld ptr,vides agree.
mer1t 00 000 latget fotM'Of'k.
Client: That would be g(eat.! Those are rwo of my biggest
problems.
Counsellor: Obviousty. this i:S a time of sttess for' you. One
of the ways I may be able to work with you is to help you
deal with your feelings. Sometimes you might feel OYe(·
wool med by evefythi~ that's happenmg, and I'd be happy
just to listen o, to help you sort out you- feeli~.
Client: You have no idea how tough this has been fOr' me
as a single parent. My fathe(was addicted to alCOhOI. and
my son brings back ail those memories..
Analysis: Counsellors can suggest addJYiona/ Ideas to hel(J diet'lts
make the be.SI use of the setVlces available. In this Slatement. t/'Je
counsellor attempts to lntrOduce feelings as Ofle of the areas on
which COUl'tSel/klg rnigftt focus.
Analysis: The client's willingness &:, begin to share SOfl1e of her
feelings signals to the counsellot ll'lat She has accepted ll'le offer
we,p/ofe feelings.
Relationship: Tile Foundation lor Change
79
>»
INTERVIEW 3 .1
Contracting (continue}
Counsellor: So, you're no str'an.ger to the pain lhat is
caused b-f addiction.
Analysis: Empathy Is the f)(eferred resp()(tS(J to srrong feelings.
(Five minutes /all!r.)
Anaty1l1: This work sets the sttJge fot feedback. It giWJs the
COU!tSellor a dear picture of the c/J'enrs p,efetred style. KnM11g
this, the counsellor ctJn tailot any feedback to fit the Client's
ex,:,ectat!Ctls.
Counsellor: Whal do you ooed and want from our
relationship?
Cl5ent: I want you to be honest with me.
Counsellor: What do you mean by Mbe honest?·
Cllent: Don't try to spare my feelings. If you ltlink I'm
wrong, say so. Don't sugarcoat the truth.
Counsellor: So, if I have some ideas abOut how you might
dO thi~ differentty or another way of looking at thi~.
I'll jusa tel you.
Client, Eliac:lly.
Counsellor: can I expect the same from you?
Anaty,ls: The cout'ISeJIOr avoids assumpUoos of meaning atld
asks tile cfietll to define tile word •hOf)(!St. • Wolds ctJn have ver'y
differer,t meatllngs to ifldividuai'S... Later. if the cout1sell0t wishes
to challenge tile ctier,t, he or she can use an ;ntroductOr'y statement such as I/le fo/l(}v;iflg to rem;nd the Clklnt of the C-Ot'ltract:
~Remember' whert we agreed that if I had some kieas that were
different from youtS I should be hotle.st?" Because there has
been f)(iot agreement, the cliertt Is l'l'l()re likely to support the
f)((>Ce'SS and to be open to feedback or challenges.
Client, (Hes/tall!~) Iguess so.
Coun.sellor: You seem unsure. Would it be tough to confront me if you thought I was wro~
ClitM: I'm the kind of perSOn who likes to keep those kinds
ot thi~ inside.
Counsellor: Sometimes it makeS sense to hold back, and
that's a s1rength. Uke with your son, you need to pick your
battles. Overall. it's beltet to have Choices. In OIX refa~
ship, I'd like to invite you to risk telti~ the truth to me.
(A
Anatys/1: &me clients have trouble de:Jllflg with persoos in
autflOtlty. Even tflOugfl the clietll agrees. it Is im,:,orttJnt to pick
up on the he.sitab'ot1. Others are simply Shy and have habitual
pattert'IS of taJd11g a passive apptOOCh to re/ab'ooship ptoblems.
The cout1sellit1g relat!Ctlshjp c.an be an opporrut'llty to e,q:,erlmertt
with new way$ ofrelating. WIie{) couttSe/lors create condltioos of
safety for rislc-lakJflg, c/J'er,ts Catt Jeam Skills that they can ttattSfer
to otflet relatiot1Sh;ps.. In 111;s excerpt, the cout1se/Jor also finds a
way to hOr'IOU( strengths.
few minutes later.)
Cl5ent: AbOut a yeat ago. I we-nt to a family counsenor for
help. That was a disaster.
Counsellor: You might be wOt'ried that ttlis will turn out the
samew.ry.
Client, Yes.
Counsellor: Now I'm worried too.
(Cout1sel/or and client laugh.) Tell me what went w(ong;
1r.en, we can talk aoout how we can avoid 100 same ptOb·
tems here. Just tell me what happened. but don't tell me
whO your counseltor was.
Cl5ent: Well, fOt' one lhiog. he never gave me any information. If I as.keel for a brOd'lure or something on heroin, he'd
a~Nays say sure, and then he'd forget.
Counsellor: I wonder if it migt\t be useful if we kept a few
notes.
Client, Okay.
<A few minutes later.)
Counsellor: Oo you have any questions?
Cl5ent: WhO gets to see my file?
Analysis: The purpose ofasking clients about experiences ;s tlOl
to engage the client ifl a gossip ses'Slctl abOut the mistakes ofcoJ.
leagues. Gandld dl'Scus'Slor'ls about what ~s effective at'ld ineffectlW! Pf(JVide Important lt1fO(matiot1 oo the cliet'lt'S e.xpectatiot'IS
attd feats lot the curroot re/atiooship. Th;s gives the COU!tSel/or
a chance to customize cout1selling to meet the needS attd ~nts
of the client.
A little shared humour adds watmlfl to the reliJt/Mship.
Rev;ewlng the client's counselling Mstory flel,:,s avo;d the
mistakes of the past. Of course. tflls dfscusslotl must be conducted in a professional maMet that does not invc/tle maflgning
COiieagues.
Analysis: o;scusslon regarding the limits of coofidentlality
attd any other ethictJI concem-s that the clioot has cart
addressed.
Reflections:
■
How does the counsenor in this interview promote collaboration?
■
How would you have answered the counsellor's que,stion, MWhat do you need and want from our relationShip"?
80
Chap1er 3
oow be
Relationships with Youth Establishing a relationship with youth involves all of the
same clements of success thnt are involved in relationship building with adults. \\:'Ith
youth, it is important to establish relationships with dear boundaries. It is desirable to
hnve warm and friendly cncountc.rs where the convc.rsation ftt.ls nntural and spontaneous; however, conditions diffo:rcm from friendship arc present. For one, the.re arc limits
to confidentiality and these should be discussed. Insofar as possible, the youth's right to
privacy can be respected, but lcgn] and a,;ency responsibilities need also be considered. ln
this sense, it is important not to compromise the role of other professionals by withhold~
ing information to whkh they are cntidcd, or by undermining thc.ir authority or competence throuWl collusion with youth. 1t is also essential for counsellors to avoid assuming
a parental role. Unsolicited advice or attempts to control will likely meet resistance.
Many youths who come to counselling have histories of abuse and neglect. Some
may still be living in abusive or dangerous situations where fear and caution arc constants. Counsellors can expect that these youths will bring these same feelings to the
counselling relationship. and initial attempts to connect with 't'Ouths may be difficult.
If they expect that the counseJlor cannot be trusted, then whatever defences they use to
cope with rejection will come into play. Thus, initiatives to establish counsellor trust,
rcliabilit)', and predictability arc crucial. A tr..mmn.-informed approach should be used,
which features the core conditions. r«ognition of the client's strengths, and collaboration as the foundation for relationship eng3gemcm and development.
Adolescence is a time when there arc enormous physical, emotional, and social
developmental challenges. During this period, anxiety, depression, moodiness, and indecision are common experiences. When the.re arc also issues involving substance abuse,
poverty, the criminal justice system, mental health, marginalization, abuse, and neglect,
the chaJlcngcs arc multiplied and new barriers cmcri;:c which ma,., bring youths to counselling. Jf a warm and trusting counselling relationship can be ncgotiat~. much-needed
stability and structure is inmxluc~ into their otherwise chaotic lives. Chapter S will
explore in more detail the skills and attirudcs n«essary for establishing this relationship.
Engaging with Seniors
Life Stories Counsellors who work with older adults should become familiar with
the values and issues that have defined thc.ir lives. Just as the rise of terrorism and
the events of 9/11 have left an indcJiblc imprint on current generations, seniors were
impacted b\• world events such as the Vietnam \Var and the cultural changes of the
1960s. As part of relationship building with seniors, counsellors should ask them to
share details of significant life events and influences. Some of these will be highly personal such as the birth of their children, death of their spouse, or significant travels.
Others will be intimatel't' conn«ted to significant experiences like war (e.g., World
War II, the Korean \\:far), the Cuban Missile Crisis. the Scarles, or the fall of the ~rlin
Wall. One senior related how air raid sirens used in Cannda in the 1950s as a drill for
nuclear war, left hc.r so tc.rrified that even today, sounds such as the siren from an ambulance rekindle her fc3.r. Hearing such stories will provide counseJlors with context for
a grcatc.r understanding and empathy for lives that have evolved very differently than
their °"'n. He.re arc some sample questions that might be used:
■
\Vhat were the most significant memories or moments from your life?
■
\Vhere have you lived (or travelled) during your lifd Hou.•did this clungc or affect you?
■
\Vhat were your happiest moments (or saddest)! \Vhat lasting ~ffcct did they have!
■
\Vhat changes in the world have affect~ you the most?
■
\Vhat arc the things about your life that arc important for me to understand?
Relationship: Tile Foundation lor Change
81
Age Differences Signific:mt differences in a,;c berwttn counsellors and their clients
is a factor th.nt can be discussed openly. Some seniors ma'>' be reluctant co share, fc~uing
that a youn,;cr counsellor will not be able to understand thc.ir problems. Others may
wckomc the idC3 of working with someone '>'oun,;cr as a chnnce to ,;ct fresh ideas and a
"youth" pe.rspective. A simple lead can be used to initiate the conversation. For exam,.
pie, "How do you think the fact th.nt I am much younge.r than you might help or hinder
our ,vork tog,ethcr"! Counscllor IC3ds can also honour the experience and wisdom of
their senior clients. Using a srrengths approach, a counsellor might say, "I'm betting that
'>'ou've learned a lot in )'Our life that you can use to deal with your current problems."
Relationship Dynamics Transference and countcrtransfercncc arc often at play.
Some seniors may adopt a pnrcntnJ and protective role toward the counsellor. For their
pan, counseJlors need to be aware of their own feelings (positive or negative) when
working with seniors. For example, interaction with an aging client facing declining
hC31th might trigger the counseJlor's own fears about death and dying. ln response, the
counsellor might withdraw or become overly prot«tive.
Counsellors need to be ready to examine their own assumptions regn.rding aging.
Seniors arc a very diverse group. and there are vast differences among them with respect
to health, cognitive ability, capacity for autonomy, lifestyles, and income. Counsellors
must be willing to re-.•isit any negative assumptions they might harbour such as the
notion that seniors arc rigid or not capable of making their own decisions due to cog•
nitivc decline. \Vhile many seniors have hC3ring los~ this should not be confused with
loss of mental ability.
SUSTAINING THE COUNSELLING
RELATIONSHIP
Immediacy
I mm ediacy is a tool for exploring, evaluating, and deepening counselling reJntionships
(Eg3n & &hrocde.r, 2009). All rdationship~ including counselling relationship~ are
subject to periodic conflict. This may arise from communiai.tion problems, strong emotion~ misconceptions, failed expectations, power struggle~ value conflict, and many
other re3sons. Such conflict has the potential to be destructive, but it also presents a
great opportunity for further development of the relationship.
The~al of immediacy is to strengthen the counscJling reJationship by evaluating the
gene.ml working di.mate of the counscllor- diem relationship. "The reJationship is cwlu,.
ated or reviewed, and relationship strengths and weaknesses are examined by exploring
the respective feelings, hopes, and frustrations of the parties involved" (She.bib, 1997,
p. 114). All relationship~ including the counselling relationship. arc occasionally tested
with minor or serious personn1it)• conflicts and communication breakdowns. Counscl.ling involves rislc..taking, whidi. can lead to stress and anxiety. This process of change
means that the reJationship is not always plC3sant. Handled wisch•, these conflicts have
the potentiaJ to deepen rather than impair reJntionships.
When problems arc identified, they can be resolved through discussion, compromise, conflict resolution, or renegotiation of the relationship. Jmmcdiacy can address
fttlings such as anger, rescntmem, or resistance that are adversel'>' affecting the reJntion.ship. Similarly, positive feelings of liking or attraction miaht also need to be addressed
if these feelings are clouding objectivity or progress. The example below illusrrntes how
a counsellor might initiate relationship immediacy:
immediacy: Atool f o r ~ .
evaluar.&. and deepening coun~
nlation~ s.
CounS(>IJOr. I want to put ,iskle what v.--e\'t, been ~!kin¥ about ,ind ~ke a look at wh::u's
h::appeninK betv.--een us. I think we have ,i ¥ R':at r::apport, and Yi't, both seem relaxed when
82
Chap1er 3
we're h'.)~ther, but I believe l\ee betome reluctant t'O be totallr hones«. ?l.fa)'be it's
because I don't want the rel3tionship to become unple:aS3.nt. I( I'm not mistaken. you
seem to hold back too.
Immediacy is a pO\\rc.rful tool for preventing communication brc~llcdowns and build~
ing rrust. By addressing relationship difficulties as they arise, problems that are more
serious are prevented from deveJoping because of the buildup of unresolved feelings.
This does not imply that every relationship issue must be explored. With immffliacy,
counsellors can address significant feelings and issues that affect the reJationship as they
occur. but it is important for counsellors to be sensitive to timing and pacing. Gene.ra.11)•,
immediacy should nor be introduced when a session is ending if there is insufficient
time to resolve issues. 1t may also be wise to delay immediacy discussions if clients are
unduly stressed with other is.sues. As well, avoid initiating immediacy discussion too
C3rly in the relationship before a base of trust is developed. Counscllors can ensure the
appropriateness of using immediacy by asking: Would immediacy be useful for the diend Does the client have the capacity (personal strength and resources) to profit from
immediacy at this time? Immediacy is a way to get closer to clients.
A dependent relationship arises when clients become overly reliant on their coon•
sellors for decision making. Common indic3tors that a dependent relationship exists
include excessive permission seeking, frequent phone calls or offKe visits for informa,
tion, and an inability to make simple decisions or take action without consulting the
counsellor. A dependent relationship undermines the principle of self-dne.rmination b\•
shifting power away from clients and preventing them from deveJoping independence.
A well-timed immediacy discussion can address dependency issues and lead to a new
contract that favours client autonomy.
(n the following example, the counsellor uses immediacy to identify a sharp change
in the mood of the interview:
dependent relationship: A
uunselling Rb1ion~ ii wbQ dients
tieoc. ow,t, teliant on lktr counsfflors
for decision maliing. lndicitors indDde
a:cesswt pe,mission seeting. frequent
ptic. calls « office visiis rorillcrmat•
and a11 inabiityto m..W simple de:isioa
« Lale
11ihout c.sulting .ith tile
uunsellor firsl
act•
Counsellor: You ~m to h:t,'t, become S<HnN·~t quiet. \\'hen I ~,sk:. question, you
i-1\'t, me one. ort\\'0-Yi'i>rd 2ns"eers. Usual!)' you're q uite expressive. Is somethifl¥ wroni!
Client: Now that you mention it, res. I'm just noc sure !'loo.\• 1m.ch I'm willina to trust
)'Ou. At first it was okay. but now you ~m intent on pushina me to deal with thin¥,$
I'd rather keep pd\'ate.
Couruellor : Perhaps l'1n movina too fast or brU,i.ina up issues v.--e h:l\'en't :!ir~d 10
talk about.
Client: Mostly )'Ou don't take no lor an an5\\-e-r. When I s::I)' I don't want to ~lk about
somethintt, I mean it.
CounseUo r: Like earlier today. when I kept oomlfl¥ back to how )'Ou (elt when )'Ou broke
up with )'Our wife.
Client: That ·s 2 perl'ttt ex2mpte.
Coun.se.ltor: I ttuess I was push)'. I knN• )'Ou would rather ::t\'Oid the topie. At the s::m~
t ime. I could see t~t there wu so much poin in\'olved ch:tt I thou{tlu it m~t be useful
to talk 2bout your (~hn~.
Client: You're probably ri$:ht. I should face it, but r,n :i(r2id.
\Vhen responding with immediacy, it is important to use I -statements to under•
score responsibility and ownership of feelings. (n genera], the emphasis should be on
statements such as "I'm uncomfortab le," not "You make me feel uncomfortable."
I-statements: Clear asserti>ns abo-JI
penonal feelings« reaaions that de not
blame or judge others.
Coun!l('Uo r: Let's stop (or:. 1no111ent. r,n feel1fl¥COn(us«I, and r,n oot sure where v.--e're
he~ed. What's happenina for you!
Client: We do seem to be K()lna in circles.. I'm lost too.
Coun.se.U.o r: All ri~u, let's talk 2bout how \ \'e can ~-et ix.cl. on track.
Relationship: Tile Foundation lor C hange
83
In Interview 3.2, the counsellor uses immediacy to address concerns that his client has
become dependent. Initially. the client is reluctant to discuss this issue, but the coun.sdlor's
persistence sets the stage for the client to emerge with some important feedback. Changes
in the relationship can then be negotiated. Morcovc.r, the process models communication
and relationship problem-solving skills that are transferable to other situations.
Transference and Countertransference
transferenc:e: The tfadffl(J al tlieals
toa,mmunicate ■idl, t!leir couns.elkn in
the sa• •.tr that theycommunicated to
signific,• people in the pisl
Transference is a concept that ,.,,.,..s first introduced by Freud to describe the tendency
of clients to communicate with their counsellors in the same Wtt)' that they communicat~ with significant people in the past. Transference can include reactions of both
attraction and aversion. \\:'hen transference is strong. clients have intense feelings and
reactions that arc unconnected to experiences with their counsellors. Transference is
))l} INTERVIEW 3.2
counsellor: Oo you remembet that when we fil'SI met, we
agreed that from time to time we'd stop to evaluate hOw
thi~ ate going? If it's okay with you, I'd like to talk abOut
out rel3tionshi~O'N we're communic.ating, as well as
what's wOr'kiog ar\CI what's not wOl'kiog.
Client: I lhink it's been great. You always seem to know
what to say. I don't know if I COlJCI cope if it we-ren't lot you.
counsellor: ThankS. To be hOOeSt, I have mix.ed reactions
to what you're saying. It's nice to be appreciated, but I'm
alSO concetned. I wondet if by telyin.gon me so mud'l, il's
bee:Omi~ harder fOI' you to do it on )'OU' own.
Client: I can'I do it on my own.
Counsellor: Okay, so you need help. 8Qt~ a~e to seek
and accept help is a sign of strength. My concern is that I
may be dcin.g things fOr' you that you need to do yourself.
Client: Now you sound like my father. He's always saying
that I ShOlJd stand on my own two feet more and not rely
on him so much, but every rime I try to be independent.
he intederes.
Analysis: The counse/10t signal$ an interest In l()()l(ing at the
relationship and P,OY!des a link to earlier relationship contracting. so the ,:,,ocess should not come as a surprise to the client.
Ana/y1/s: Many clients are uncomfortable with immediacy
discussions, perhaps because of past failures. The client's
praise of the counsellor may be justified, or it may be an
attempt to avoid any controve,sfal topics.
Analysis: The counsel/Or self-discloses feelings and concerns.
This alSo models fo, the clfent.
Ana/y1/s: Without attempting to argue with the client, the
counse/10t gently perSfsts In encouraging the client to look at
the issue..
Analysis: The client ;s able to k:Jentffy an important parallel to
her relationship with her father (transference).
counsellor: Does that happen between you ar\CI me?
Client: <Hesitates.> A rime.
counsellor: Can you efatx)rate?
Client: Don'I get me wro~. I really want you( help, but
sometimes it seems like you've already decided what I
Shouts do. I figufe that you probably kOOw what's best, so
I just go atong 'Mth )'OIX ~n.
counsellor: 11 sounds as though you have mixed feelings.
On lhe one hand, you value my help. but on the olhet I
alSO sense some retuctanice, maybe a bit of a~r at me. I
wonder if part of you knows it isn'I good fOI' you if you don'I
have 100 freedom to make youf oNn deeisions.
Client: That's right
84
Chap1er 3
Analysis: The counsellor uses a simple probe to make su,e that
he understands.
Analy:sls: An empathic response recognizes the client's ambivalence Of mixed feelfngs.
INTERVIEW 3 .2
~JI)
Immediacy {cMtinue)
Counsellor: can you think of a recent example? I want to
Analysis: Asking for an e.KAmp/e ensu,es that bOlh the coun-
make sure I undel'$tancl.
sellOt and client have the same understanding. As well, the
enmple adds necessary detail and clarity to the Issue.
Client: Earlier tOday when I mentioned lhat I wanted to go
back to schOOI, you were really supJX)ftive, and I appreciated that, bul it seemed like you were buldozing me to take
art. I like to paint, but it's a hObby. not somett'li"lg I want to
purs:ue as a career-.
Counsellor: That's a g()()j point Thar\kS f0t the feedback.
Let's talk abOut hO'N we can change ouf relationship to
avoid similar ptOblems in the future. fOr' my part, l'U try to
be m::>fe sensitive to interfering. What abOut you?
Analysis: The Immediacy d/scU$slon deepens the relationship
and enables the counse.llor and the client to negotiate necessary changes.
Client: I guess I should be mofe assertive.
Counsellor: Meaning?
Client: If I think you're pushi~. I wtl you tel you.
Counsellor: And. when I sound like youdather . . .
Client Watch ou~ (Both laUf/fl.)
ReHectJons:
■ What might be the outcome if this conversation never happens?
■
Suppose the client insists that ..all is well." Suggest options for the counsello,.
■
The success tip below sugge:sts that relationship patters and p,oblems for bOth clients and counsell0rs tend to be
duplicated in their relationship with each other. Expl0re how this might be hue in this relationship.
liket,., present when the.re arc strong feelings of liking or disliking another person based
on first impressions (Young, 1998). For example, a client might relate to the authority
of a counsellor with the same withdrawal and inner anger that charactcri.!ed an earlier
rcJationship with parents. In addition, as Egan and Schroeder (2009) note, "Some of the
difficulties clients hnvc in their da)'•to-dtt)' relationships are reOected in their relationships to helpers. For instance, when they are compliant with authority figures in the.ir
everyday lives, they may be compliant with their heJpcrs. Or they may move to the
opposite pole and become aggressive and angry" (pp. 20 5- 106).
SUCCESS TIP
Relationship pattems and problems that clients have .-i theil' everyday lives tend to be duplicated in thei( relationships Vitth counsetlOr'S. Similarfy, counselbs may bring relationship
patterns and ptOblems frotn their everyday lives to lhe counselling relationship.
Examples of transforence:
■
Kevin despe.rately w-ants to be liked. He gives his counscllor unsolicited praise and
gifts. Increasingly, he begins to act and talk in the same,.,,.,.,,., as his counsellor.
■
Claire suffered ab use from her father and both of her brothers. In the first session
with a male counseJlor, she immediately begins to cry, despite the fact that she felt
optimistic and self<onfidcnt before she entered his office.
■
Amar has n strong need for npproval. He withholds information that he thinks
might provoke the counsellor's disagreement.
Relationshi p: Tile Foundation lor C hange
85
countertran.sferenc:e: -ne positive •
•ptiw •fahes. f•tasies, and feelings
that acounsfflor •onsciom.ly dEts or
transfen to adent. steaail:g frca tis or
lier tni.nsoh,ed cooflicu"' (Cl~.
2011,p. 42).
))t) BRAIN
■
Jamie, a sb:•'>'C3r.-old who has been abused, behaves in a sexually provocative way.
■
Toby, age 18, has had a very strained relationship with his father. His coon•
sellor notes how easily he becomes angry during the interview at the slightest
provocation.
With transference, unresolved is.sues result in distortions in the way that others
are perce.ived. Consequemi)•, the successful examination and resolution of counsellordiem relationship difficulties heJps clients develop communiation and problem resolu•
tion skills that will be useful to them in their daily lives. Jt is important that counsellors
distinguish client reactions and feelings that arise in the currem relationship from those
that arise from transference. Counsellors should not be too quick to rationali:e clients'
feelings and behaviours as transference. Their clients' responses may be valid reactions
to what has transpired in the counselling session.
Transference happens to some degree in aJI relationships. but it is much more likely
to occur in relationships in which authority is present. Of signifiance is the fact that
to some extent all counselling reJationships involve J)O\\'er and authority. Counsellors
such as probation and parole officers ma'>' have formal roles of authority. Counsellors
may also have power because clients perceive them as having su~rior or expert knO\\•l.edge. Some counsellor~ such as those in weJfare setting~ have control over services and
benefits that diems are seeking. Clients also may react to other variables, such as a,;e,
socioeconomic status, position, gender, marital smrus., appearance, size, intelligence. and
social deme3nour.
Countcruansfcrencc is defined b\• Gladding (201 I) as "the positive or negative
wishes. fomasie~ and feelings that a counsellor unconsciousJy directs or transfers to a
client, stemming from his or her O\\'ll unresolved conflicts" (p. 42). The risks of coun.tertnmsforc.nce underscore the importance of counsellor self.awareness and the respon,.
sibilit)• of supervisors to pro\tide opportunities for them to " monitor the tendency to
be too helpful, and to deal with feeJings of sexual attraction as well as anger, fear, and
insecurity" (Young, 1998, p. 169).
Countertransfercnce is.sues are emotional reactions to diems whereby counsellors
come to see clients as project~ sexuaJ objects., friends., or even extensions of themselves
(Young., 1998). Below are some signs for counseJlors that countertransference is happen,.
ing or that a risk for countercransference is present:
■
h3:Ving intense feelings (e.g., irritation, an,;er, boredom, and sexuaJ attraction) for
clients '>'OU hardly know
■
feeling attraction or repulsion
■
being reluctant to confront or rending to avoid sensitive issues or feelings
BYTE
Neural networks, f0<med by loaming and experience, afe
ac1ivated by explicit Or' implicit memory. Explicit mem0<y
activates the frontal COftex. and the hippocampus to fecal
ex.petiences, in.formation, Or' ideas. Implicit memocy ir'WOl\'es
diffefenl parts of the brain, the basal ganglia, and the cer.
ebellum. It encompasses m::>tof memo,y skills suctl as how
to drive a car. as well as associative mecno,y, W'hid'I includes
defences. emotions, and behaviours lhat emerge from trig•
gers 01 associations. F'0c example, hearing a particular~
may evoke sadness that i:S connected to a past unpleasant
86
Chap1er 3
experien:e. This conoeclion ot association is nor available to
conscious awafeness. (Gabbatd, 2006). Transferen:e occurs
in counsem~ when implicit memories stimulate emotiooal
and behavioural responses associated with other felatioo•
ships such as wilh one's father. A clien.t who feared the harsh
discipline of his father and kept his feelings to himself may
do lhe same tt'ling with his counseltof, unawate that there
are aspects of his counsel.lOt's appeatance Of behaviour that
temind him of his father and have set off the same guatded
response.
Adults who wefe abused 0r ooglected as children may
develop bl'al'ls It.at are JXX)rty eciuipped to fOl'm healthy feta•
tionships.. TM amygdala, a part ot the brain that is fesponsible fOr' pfOCessing fear, can be damaged btf abuse. A person
may entet adulthOOd with ex.eessive feaf of raking risks, a
necessary part of reaming and k'lfunacy. In tess lhan one-half
a second and outside ot consdous awareness. a damaged
amygdala may triggef feaf and 100 ..flight 0c figru· fesponse
befOr'e the mofe tational pre-frontal cortex can ascertal'I that
a felationship is potentially safe. 1n lhis way, the amygdala
erects bar(aers and gener'ates negative emotions that ptevent the formal.ion of meani~ul and intimate relationships.
(Cozolino, 2010; CozOlioo & Santos, 2014). Abused children
may feel unworthy of love and Mremain in dySfuncrional patterns of behaviof, hOtd on to failed str'ategSes, and temain in
destructive felarionships• (Co2olino & Santos, 2014, p.163).
A unk:lue opportunity to altef these patterns i:S possible if a
strong and Irusting counsem~ relatiooslip can be negotiated using a ttauma-based approad'I. Cozolino and Santos
(2014) discuss the ne-1.Xoscience: "A positive emotional connection sthn ulates fewardi~ metabOlic pfoc:esses that aclivate neuroptasticily, and secure relationships pfotect against
sttess. wtlid'I inhibits pfotein synthesis and othet biotogjcal
processes necessary fOr' brain gfoNth.· This is furthef evidence of the centrality ot the eounsetling telations.hip as a
Pf81'8'Cluisite fOr' client groNth and d'lange.
■
continually running ove.rtime with certain clients and wishing that others would
not show up for scheduled appointments
■
adopting rescuing behaviour, such as wanting to lend money, adopt abu~ children,
or protect clients
■
thinking about client similarities to other p«>ple
- -' - ' CONVERSATION 3.3
STUDENT: I think thal many counselt)rs mi:sund81'Sland selfdiSCIOSufe. Some of my COiieagues make a point of telli~
theif clients about thes' past whereas others Share little Or'
nothing abOUt their private LiveS.
TEACHt:R: CounseUOr' self~isclOs.ufe can be an impoftant
para of effective counselling.. The problem is knowing W'hal to
Share, hON muctl to Share, and when to Shafe 1t.
STUDENT: I agree. I lhink some disclOSum conveys that the
counsellor is warm and human, and 1t helps clients OYet'COO".e
the common mistaken belief that they are the onl'j ones with
problems.
TEACHER: Self~iSC:l::>Su(e modets apptOptiate sharing of loolings and gives clients the courage to open uJ). Some clients
may feel reassufed knowing that theit counsellOts have faced
similar problems. but unless it's haOOled carefulty, clients
may see their counsellors as~.
STUDENT: Back to your earlier statement Whal do you share?
HON muctl? When?
TEACHER: The a~rs vary depencfi~ on the client and the
situation. 1.n gener'al, a moder'ate level of setf-disclOSufe is
appropriate (Sheafo, & Horejsi,
Howellel, some sUua1.bns maywa«anI a great deal ot self-disctosure and some oone
at au. Oependi~ on the siluatklo, too muct'I self-diSd::ISl.l'e may
be as bad as too little.
=>.
STUDENT: As I see ii. the most impoc&anl principle is that
self~iSC:IOSure shouk:I be an oprion, not a compulsion. CounsellOrs ooed to be able to self-disclose, but they al!.O should
be able to consttain lhemsetves from always disclOSing. If the
session is m::,ving smoothly withOut self-disclOSufe, then it's
ptObably unnecessary. Self~isdosure must stfengthen the
relationship or other'Wise contribute to lhe v.()rk. The primary
goal is to meet 100 client's needS.
TtACHER: Thal's ~ht fot me, the most important principle
is to avoid letting counsellOC' setf-disdosure Shift the focus of
the intel'View from clients to eounsenors. That leads to role
reversal, with clients counseui~ counselOrs. As I sai:1 eartief,
too much setf-diSdOSure leads clients to see counsellors as
incapable and lose confidence in the ptocess and the capacity of their counsellors to help. The counselling relationship is
not mutual, with each person taki~ rums Shari~ a problem.
What's often forgotten is the fad that setf-disct>sum inwlves
IT'IO(e than sharklg details of )'OU' past Or' youf per-sonal problems. Sharing your feelings wilh clients abOul the r'elationslip
or the "-«k i:S al!.O self-diSC:IOSu'e and a key eternent of the skill
of immediacy. Rogers (1961 and 19Sl), a centr'al figure in
counselling and too found81' of client~ntred <~ntred)
ther'apy, em,:tlasized the lf11portanice of bei~ tr'ansparenl and
real in the felationShip by Sharing m::,ment-to-momenI feelings that am relevant to the relationship. Aftef all. if we can't
be open abOut OUf fee6~. hON can we expect dients to be?
Relationship: Tile Foundation lor C hange
s·7
TABLE 3.2
Guidelines for Counsellor Self-Disclosure
Self-disclOSure should 001 Shift the focus from client to counsetlo,.
Self-disclOSure should be used only to meet the needs of the d ients.
Counsetlors need to be able to self~ isclOSe as wel as able to 001self-disclose.
Too much can be as rnapp(Ol)(aate as too Htle.
RevealW'lg current feelings, concerns, and ideas is usually more useflA than revealing past
~ IO<y.
If the work is prcxooeliog smooltlly without it. then it probabl'f is not necessary.
■
dealing with clients who have problems or personal histories similar to your own
■
employing unncccsS3ry o r excessive self-disclosure (see Table 3.2)
■
fccling rductant to end the cou nselling relationship
ENDING THE COUNSELLING RELATIONSHIP
Counselling relationships wry in length from a single interview o r a short e ncounter to many years. Some are super ficial, with minimal e motional investment by the
participants, wh ile others result in conside.rablc intimacy and emotional involvement.
Counsellors need to make intelligent decisions about when to terminate the reJation.ship. Term ination of counselling relationships may happen fo r a number of reasons:
I . T he reJationship may be ended when the ,;oats of co u nscJling have bee n rcnc.hcd .
Counselling relationships arc time-limited, so when clients have developed a
sufficient ai.pacity to work on their own, it is time to end the relationship.
2 . Counsello rs may end the relationship if they do not have the tim e o r competence
to fulfill their clients' n eeds. In su c.h cases, the ending will include refc.rraJ to other
co u nscJlors o r agencies.
3 . Counsellors ma y d etermine that they are u nable to work with sufficient objectivity.
Herc again, refc.rraJ is the preferred a1ternativc.
4 . Siruationa.J factors such as illness, mo\ting, o r the end o f a practicu m may necessitate
ter m ination o r refer ral
5 . If evidence shows that cou nselling has not worked and that the re is lin le potential
fo r success, it is tim e to term inate o r refe r.
SUCCESS TIP
Clients may decide to opt out of future service and fal to show up for scheduled appointments. However, lhis does oot necessarily mean that the work has been unsuccessflA
because "as many as twi>thU"dS of dropouts reJX1r1 considerable progress• (Fortune, 2002,
p. 459).
T he Canadian Cou nscJling and Psychotherapy Association's Code of Erhic.s (2007)
offers this guidance on term ination:
CounsellorS tertnin:lte «Junsellina rElauonships. with dien1 ~ree.me:n1 whenc,'er po,$$ible.
wtlt:I, it is reasonably dc.l.r th::n: the '--oc3ls o( rounsellirl{t h::t\'e b..>ei, met, thedient ii no Ion,
~er benef'ht irl{t from eounselhn$:, when clienu do not P3)' fees cha~ed. when p revious!)•
d1sclosed 3'~11('.)• or inst itution:11l lunits do not allow lor the provision o( fu rther eounsel,
lifl¥ serviees. HOYi'e\'t:r. counsellorS make re::tSonable e«ort.s to l::.ciJ1tate the eontinu:ltion
o( eounsellifl¥ sen •kes when sefVi~s are inter-rup ted b)• such (:k't<>rS as counsellor illnes:s,.
client or eounsellor rek1<'::ltion. client llna.nd:d d1((ku1ties. :md so forth . (p. 818)
88
Chap1er 3
The end of a counsetli~ relationship may t(.gge-r some of
100 same feeli~ as those ex.perienced in any relations.hip
breakup. The psyd'lotogjcal distress thal people feel can noN
be (partialy) explaiood by funcrional magnetic tesonance
unaging (fMRI) of Ille btain. Imaging shows Iha! parlS of Ille
btain 1hat typically ftte when people ex~ience physical pain
a~ fite when tr1ggered by cues associated with 100 ended
telationship. In addition, research also found tnal the tewatd
system of the brain e ~ i"I a waysi'nilar to the~ perSOns
with addiciions c1'3Vedrugs(Greenbefg. 2011). This research
suppocts the imJ)Orlance ot spending ritne addressing the loss
associ'.ated with the encl ot the counselling relationship.
Endings can evoke painful feeJings. All relationships, regardless of their length,
have the potential to be intimate. The counselling rdncionship is not designed to be
permanent, but owing to its intimacy the ending of the relationship may trigger powerful feelings nnd behaviours in both clients and counsellors. For some clients, intense
satisfaction and feelings of accomplishment punctuate their success, but ochers may
fed abandoned and dese.rced. The ending may remind chem of the pa.in and sadness of
other endings. so they may need help dealing with che.ir loss and grief (Brill & Levine,
2005; Shcbib, 1997, ond Shulmon, 2009).
The ending of a strong counsclling relationship brings anention to the fact that all
rc1ationships are temporary. Pending termination may generate a variety of emotions
and reactions including anxiety, anger, nnd denial of the ending. Counsellors need to be
sensitive to signals chat clients are having trouble with endings. Some clients who have
shown progress miaht regress to previous ways of coping, or they may present new and
complex concerns that seem to say, "I'm not read,., for this to end." Gladding (2011)
emphasizes the importance of mutual agreement to end the relationship, although for
a variety of reasons this may not always be possible.
Other clients might express their pa.in about the ending by expressing unfounded
anger nnd resentment (in dfect, avoiding the pa.in of the ending or denying the importance of the relationship). Still others fail to show up for the final meeting as another
way to avoid dealing with the pain of the ending.
Young (I 998) suggests that "a helper's feeJings of loss at termination may also be
due to a reliance on helping relationships to meet needs for intimacy (friendship) as well
as a conscious or unconscious sexual attraction" (p. 286). The termination may also
remind counsellors of other losses in their lives. When these losses remain unresolved,
the.re is a risk that counsellors may be unable to handle termination with the dient. They
ma't' feel guilty for leaving the dient, and they might dcla't' or avoid termination to dude
their own feelings of pa.in. Counscllors who have invested heavily in the reJationship
have to deal with the.ir own fedings about the ending. This may result in a variety of
denial renctions:
■
Denial of the ending b)• allowing or encouraging clients to remain in counselling
loni;er than necessary. The counseJling relationship is not designed to be lifelong,
and the counselling contrac.t should set an end point to the relationship. As wcll,
individunl interviews should be structured within n time frame. A defined time
frame helps to focus and contain the worlc. Excessively long interviews without time
controls can lead to fatigue, unnecessary repetition, and inattention.
■
Denial of the ending by making false or unrealistic concessions or promises (e.g.,
by promising to visit or correspond with clients)
■
Denial of feelings by behaving apathetic:.llly or avoiding discussion of feelings about
the ending
■
Denial of feelings b)• abruptly ending without warning
Relationship: Tile Foundation lor Change
89
SUCCESS TIP
C(edit the client for success ln counselh.ng. If, lot exami:,e, tM client says, "You am 1he
only one that listens to me,· you might say, ·"What have you been dc::ing differently lhat has
tnade it easy f0t me to listen?"
Dealing with Endings
The ending phase can also be a time of continuing growth for clients, so it is important
to involve clients in the process. As Brill and Levine (2005) suggest:
In termin::uion. as in the other step!? o( the probJem.-$0,JvinK proces!l. the d1e:nt's p.,r1ki,
p3tion ill o( maxilnum import:mtt. I( the helpin~ rel::uionship is at 311 si~nif"lC3.nt. the
way it ends will be import21nt for the d!ll'nt's sel(,im~e and C3p.1C'Jt)' for future rel.:uion,
ships,. The re:ason (or termination should be dear in the minds o( both client and work.er
and. whene,~r possible. (eeli1l{tS about it ~pressed and und.e.-scood. (pp. l~l~I)
doorknob commt.nieation: A
pkiloffl!IIOII descli:led tdlerein tli.-s
twing - ~ issues at the end al
the intervie,,,hebtimsll,f) 'lltlen then is
iitle or• time to addres.s lliem.
The ending ph3se, when h3ndlcd effective],.•, offers rich potenti31 for work. Surprisingly, many books on counselling do not e.x3mine the thera~utic possibilities of
the ending phase. With trust firmly established in the reJntionship and the urgency
of the end approaching, clients ma'>' b roach signific:.m t themes and topics in the ending phase (Shulman, 2009). Shulman (2009) describes the phenomenon of doorknob
communication, whereby clients bring up important issues 3t the end of the interview/
rcfotionship when the.re is linle or no time to 3ddrcss them. Clients are typicnJI,., amb ivalent about dealing with the is.sue~ but their need to address them finally overcomes
their need to 3void them.
Tc.rmination or transfer should not be 3brupt but 3nticipnted 3S 3n outcome during
all phases of counscJling, It should be "discussed during the planning and contracting
phase of the helping process and the client should be reminded from the beginning
that intervention is goal oriented 3nd time limited" (Shcnfor & Horcjsi, 2008, p. 479).
Generally. termination of the counselling relntionship should focus on the following:
■
review of the e>,,'tent to which worlc contract goals have been realized
■
procedures for further conroct or services from the agency, if needed
■
rderral to other services, if necessary
■
relationship closure, including discussion of feelings regarding the ending- for
e.x3mplc, unresolved feelings 3nd rcgrcts~ .dong with unfinished business
■
next steps
The ending might also include some culturally appropri3te ritu3l such as the offering of a sm3ll gift, but generally, there is no expectation of counsellor reciprocity. One
uception might be the end of a long rcl3tionship with a youth, in which case the worker
might present 3 token of remembrance.
It is appropriate for counsellors to express chc.ir feelings about the termination of
the relationship. This models 3ppropriatc sharing for diem~ and it stimulates them to
risk sh3ring their reactions and feelings. Of course, this discussion requires counsellors to be open to strong feelings that clients ma'>' express, such as s3dncss and anger.
Shulman (2009) underscores the importance of counsellors sharing their O\\•n feelings,
but he acknO\\•IOOgcs that this is a difficult skill to develop. In part, this difficulty arises
from the fact th3t counsellors may be struggling with their own sense of loss as they
prepare to cod the relntionship with a vaJucd client. Continued sclf-e.x3mination can
help counsellors develop self-awareness 3bout their own behaviours 3nd feelings regarding endings and separations.
90
Chap1er 3
lntervicw 3.3 illust:raccs how the ending process can be used to address focling:s. The
client is a young adolescent about to bc-dischari;ed from a residential rreacmem centre.
For the last six weeks, he and his counsellor have bttn actively planning for his rctum
home. The client has been looking forward to more freedom and release from the rules
and restrictions of the centre. As part of his pre-release planning, he has spent two
weekends with his famil)•.
))!}
INTERVIEW 3.3
In this interview, the client. i 16-ye.ar-old youth. is abOut to be released from a heatment centie endiog a six-month
relationship with the cOull$ellOI. During his time at the centie. the youth has g1own vey close to his counsenor.
Client: How long are we gotng to be hem? I have thi~ I
need to do.
CounsellOI: If I'm not mistaken. you IOOk a little glum tOday.
Client: can't you tl\let let anythi~ pass? Why don't you just
get off my back?
Counsellor: Tomon'ON you11be leaving the centfe to feturn
hOme. Maybe we could talk atx>ut that. I'm wondering hoN
you feel abOut it. I \\()lJCl.n1 be sufprised if you had mix.ed
feelings of betng happy to be leavi~ but atso sad to be
leavi~ youf friends hefe.
Client: It's no big deal. but why should you cafe?
Counsellor: I feel sad k.nowing you're leaving. We've
become very close, and l'I miss OU' time togethef.
Client: It's been all rigt\l. I guess you'fe Okay.
Counsellor: ThankS. and you·,e Okay with me too. ( Ten
seco(l(}S of silence.> How do you feel abOul us not seetng
each Other- anym::>m?
Client: I can handle it.
Analysis: The counsello,- risks empathy by picking up on
n<Jnverbal cues from the client. The counse/10t suspects that
the client's overt anger may be connected to the ending of
the relationship and the more Important feeling Is sadness.
not anger.
Analysis: TM client's first reaction is to deny his painful feelings about tM ending by expressing mote anger. The counsel!Ot
is careful not to get hooked. 1h(J counsel/Or o,:,ts to keep the
conversation active in the feeling domain.
Analysis: By sharing her own feelings. the counsel/Or communicates her willingness to deal wlth emotions. He,- disclosure
undersc0t&S that the relationship had meaning. This acts as
a model for the client. Of course, any feelings tM counselk:Jr
shares must be genuine.
Analysis: AlthOugh his anger softens. he Is still reluctant to
acknowledge his feelings. The counselk:Jr persists.
Counsellor: I know you can. You've featly ShOwn a rot of
courage dealt~ you( pfoblems.
Client: I wish it wasn't happentng. I don't k.now if I'm ,eady
togo.
Counsellor: It's very sca,y lhinking abOut ~~.
ClleM: I want to go home, but my mother and I always
seem to end up fighti~. You and I can talk and not fight.
Why can't it be that way with my m01oor?
Counsellor: Maybe you have more conuOI than you think.
What dO )'OU dO dlffetentlywith me than with )'OIX mother?
Analysis: Although tM client has trouble labelling his feelings.
M begins to open up. The counse.llor uses empathy to acknowledge the feelings suggested by the client's remark.
Analysis: The client risks talking about his feelings abOut going
hOme. 1h(J counse/10t tries to get tM client to accept credit f0t
success in the counselling relationship. She challenges him
to cons/de,- how he can transfer some of his behaviour from
the client--counsellOt relationship to Ms relationship wlth his
motMr.
Reflections:
■ What might happen if this client is not able to resolve his feelings regarding leaving the centie and the end of his
close relationship with the counsellor?
■
Explore the importance of cOull$ellOt self~isclosure in this encounter.
■
What impo,ctant p,inciples regarding endings are evident in this excerpt?
Relationship: Tile Foundation lor Change
91
SUMMARY
■
Developing and sustaining an effective counselling rcJntionship is widcJy accepted
as critical to success in counselling.
■
Throughout aJI ph3Scs, the core conditions of counscJlor warmth, empathy, and
genuineness arc csscntfal.
■
Counselling contracts arc important tools for defining roles, purpose. and for antici•
paring issues that might arise during the life of the counselling relationship.
■
Over the four phases of counsclling-prclimin:.uy, beginning, 3ction, and endingthe counselling relationship needs to be developed, sustained, and then ended.
Understanding the concepts of transference and countcrtransfercnce, the imcJligent
use of counsellor self-disclosure, and immediacy for dealing with relationship issues
is cruciaJ for maintaining the working dim:.ue of the rcfarion.ship.
■
The inC\•imblc ending of the counselling relationship may trigger J)O\\'erful fodings
in both clients and counsellors. The ending phase, when handled cffoctivdy, offers
rich potential for work.
EXERCISES
Self-Awareness
1. What were (or are) the auributes of your most positive
telationship with another person? The most negative?
How can you use this information to be a more effective
counsetlOt?
2. Pay attention to lhe people you see and meet over the nex.t
week. Who evOkes str~ emotbnal reactions? Who seems
most similar to your parents or other authority figures?
Now ex.amine your feelings and try to identify transference
reactions-feeli~ that you carry over from prior relationships and that ace not baSed on ot:;ective teacfions to the
current relationship.
3. Most of us tend to repeat established patterns when we
begin new mtationsrtips. Seek feedbaek from others W'ho
know you and ex.ptore Questions such as the folto'M~:
• What first impressions are you likely to leave with others?
• How do their perceptions compare with your intentions
or k'lner feelings?
Now consider the fonowiog ciuestions:
• What am your typical feelings, thoughts, and behaviours
as you begin teN relationships?
• How ace beginnings the same 0t different f0r you when
you are relating to differant inclM:lualS or groups (e.g.,
clients, colleagues, 0t supervisars)?
• What WOt'kS tor you?
5. This exercise is desigoed to expand your self-awareness
regardi~ issues that might affect your counsem~ relationShips. Complete each sentence Qlkkty, without attempti~
to edit your thoughts.
The one thing I have to have from other people is .
What's missing k'I my personal life is . ..
Somethi~ that people dO that bathers me i:S ..
The one type of person I'd hate to \\()rk wilh is .
Retatiooshil)s would be better if .
What I like most abOut people is ..
What I dislike most aOOUI people i:S .
6. Think abOut significant relations.hips in your life that have
ended beeause of separation, death, or Other reasons. How
did you res,:x,nd emotionally and behaWOU'all'j 10 lheSe endi~? In retrospect, are them thrlgs you wish you had said
or 001 said? What ramains unresol\ied in 1hese relations.hips?
(Suggestion: If thi:S ex.erdse evokes strong emotions, you
may find it useful to debrief 'Mth a friend 0t colleague.>
7. In your answer to the pmvious Question, vd'lat behatJioural
patterns am eviden1? What a,e lhe imi:lications of you,
insights for your WOrk as a counsenor?
8. Rate the extent to which you think it would be apprOl)riate
for you to disctose the infofmatioo listed belOw. Use the
fallowing scale:
S = a~N3yS appropriate
• What ooesn't?
4. b.amine your own needs with respect to keeping the counsem~ relationship warm and pleaSanL How far would you
go to ensure this as an outcome? Under what conditions
migt\t you ooecl to sac,iflce pteasantoess?
92
Chap1er 3
4 = usually appropriate
3 = sometimes appropriate
2 = usually n01 appropriate
1 = never approp(aate
Be ptepar'ed to defend your answet'S with examples.
___ Details of you( education and training
_ _ Your phlosophy of counselli~
___ Information abOut youf age. marital status, and
number of childmn
Your sexual orientation
___ ParUcutars abOut your life. such as pe-fsonal
ptot,ems lhat you have faced
___ Details abOut youf eve-ryday life, such as your
hobbies, reading pfeferences, and vac.ation plans
___ Intimate details abOut youf personal life, such as
marital problems and recovery from addictions
___ F'eelings soch as anger, bOredom, confusion, or
sexual attraction lhat afe influencing the interview
To what ex.tent wefe your answers influenced by your comforl level with each of the categories?
9 . Evaluate your general comfort with self~isdos.ure and intimacy. What areas ot your life are you feluctant or uowilti~
to talk aoout? To what extent wouk1 your friends and colleagues describe you as open or clOsed? O::> you tend to
be guarded aoout sharing in.formation, Or' do you generally
disct>se a great deal to Others? How does your comf0r1 with
disclosufe vary depending on wtlom you are talking with
(e.g., family, friencts, authority figures., clients, COiieagues,
and strangers)? What afe the imp6c:ations of your answers
for your work as a counsenor?
10. Imagine you afe a client with liffle knowtedge of counselling going for youf first intel'View. Assume you are seeld~
help managing deptession. What are some of the thi~ you
wouk1 want to know abOut the counselling pfocess and your
pending relationship with the counseltor1
Skill Practice
1. Interview friends and coueagues on the to,:iics of warm1h,
empathy, and genuineness. Ask them to describe how they
kOON vd'len someone exhitits lheSe iMer qualities.
2 . Talk to people wtlO are hapP'f in lheif wol'k. Ask them to
describe hoN lhey sustain lheil' energy and enthusiasm.
3. Otcoostrate an immediacy enicounter-. Conttaet with a colleague to spend one hOUf evatuati'lg and stre~ni~ your
relationship. use the fOllo-Ni~ ope-n-encled statements to
devetop lhemes f0( youf discussion, but be sure to explore
your ideas and resJX)nses:
Periodic.ally, Share hO'N you are feeling using a statement
such as MRight no-N I'm feeling . . .• You are free to add
other- significant lhemes in your retationShip that afe n01
sugg,asted in lhe at:x>ve list. When you are finished, discuss
what d'langes you would like to make in youf relationship.
4. On the baSis of your Obsel'Vations and insights from lhe
pfevious question, begJ'I the process of develo,:iing a range
of different Skills and s1tategjes for beginni~ relationships..
This will help you avoid beeomi~ locked into estabis.hed
patterns. Oeflne pet'SOOal goals fof development in relation
to hOw you handle begk'lnings. As par1 of thi.s, detail three
diffefent begj.nning styles you wish to add to your Skill rep.
eftoi,e. Desctibe when and how you will experiment with
these three appfoaches.. What prOble-ms do you anticipate
migr\t interfere Vdth actlkNement of lhese goats?
5. Simulate a retatbnship contracti~ session with a coueague
in the role of client. Choose youf own issue and setting,
6. Imagine you are interviewing a cl~t who believes Mcounselling is a waste of time.· Suggest several approaches.
Concepts
1. Under what conditions do you thrlk it WOlJd be wise for a
counsellor to avoid self~i:sctosure?
2. Evaluate the JX)tential appro,:iriateness of eactl of the lolbwing counsenor self+di:Sctosufes (the counseltof is speaking
to a client):
a. Youf situation fetniOds me of my own ptoblems. Maybe
we can poo OU( energies and find a SOiution that WOr'kS
fof bOth of US.
b. I'm SOtry to say that it's none ot youf business whethef
I have children.
c. When my huSband abuSed me fOr' lhe firSt time, I knew
the marriage was ovef and I left.
d.
(In an addict/Otis t,eatment ce.nt,e, meeting a client
lo, the fi,st time) Hi, I'm JOhn, and I'm a recovering
alcOhOlic. so I kt'IOw what you're going thl'ough.
e. I'm feeling confUSed. 1think we need to stop fOr' a minute
and decide where we'fe gci~.
f. YOU' i:toblems are realty getti'lg to me. They remin:S me so
much d my own struggles. They brklg back all my pain.
a:.
You have the most beautiful eyes.
b. I like what you're weari~ tOOay. It's really sexy.
I. Genierally, I like to lty to eslablish open communication
in my fetations.hips, so I push myself to be open with my
feelings even when it's difficult.
The thi~ I value mosa in this relationship is . .
The ooo thing that is mi:Ssi~ in our relationship is .
When I fr'SI met you, my feaction was .
J.
You are most like .
k. This has been a bad day lor me. The(e have been $0.IT'le
cutback.Sat the agency, and I'm "«ried abOut losi~ my
jOb, so if I seem a little ptOOCCupied today I hope you11
undel'Sland.
I. What a weekend! We partied all night. I could hafdly
make it to work tOday.
When I lhink aoout sharing foof~ with you . .
F'or us to oocome dOSef, 1WOUid have to .
What I want most from you is .
When I lhink of the future of OU' relationship. I .
Your attitude really makeS me want to juSI give up on you.
Rel ationship: The Foundation lor Change
93
3. Oescr'ibe hOw counseltor setf~isclosure might be appropriate in response to each of the fOllowk'lg client statements Or'
questions. Suggest a response.
a. Have you ever felt so angry that you wanted to kill
someone-?
b. My mother n.evet gives me the support I need.
c. I began using drugs when I was 11.
d. Are you gay?
e. I'm te«ified abOut gci~ back to SChOOI. I don't think I
can handle it It's been so many years since- I wrOle an
essay Or' read a bOOk.
4. What are the is.sues (pros and cons) involved in counselli~
friends?
5. What themes trigr\t emerge as important and unique when
devetoptng counselling relationships in different fields of
practice Or' settings, such as woddng 'lfith seniors, group
hOrnes fo, youth, fostet hOmes, addictions settings, immiwant clients, COr'rectional facifrties, rtXal settings, hOspitals
and hospice settings, work in the LGBTQ (lesbian, gay,
bisexual, transgender, ciue-stiooing) community?
6. Explore how a counseltof's age might be a factor wtlen
working 'Mth youth, such as counse-llot'S wM are-vety you~
and those whO are much older.
t My teenage son is d(rving me crazy.
r.. 1think lhis counseli~ session is a waste of time.
h. I realy Wke you.
I. 1dOO't think anyone hasevet been as depressed as I am.
WEBLINKS
An overview of the basics of Person-Centered Therapy .. The
Foundation of Pe-son-Centered Therap(' by Jerold O. Bozarth
This site contains an article explo,ing juvenile offenders'
perception of the counseHing relationship
www.pet"soncentered.com/theraplst.html
www.jtpcrim.org/August_2011/Juvenile-OffendersPercepbons-Joh n-Ryals.pdf
This site contains links to major personality theo,ists, including Carl Roge-s
www.Sh1p.edu/-cgboeree/pe,se:ontents.html
This Counselling Today article examines technology and the
c-aunselling relationship
http:J/ctcounseling.org/2011/10/finding-technolOgys..
role-in-the-counseling-relationShip
94
Chap1er 3
This site contains YouTube video links where clients discuss
their experiences with counselling
www.youtube.com/ - ~ rch for Experiences of Counselling
Part 2: Developing the Counselhng Relationship
iQ:)noep1'ShuttetS':ock
■
Define the components of listening for understanding.
■
Identify and describe strategics for overcoming listening barriers.
■
Ex-plain the importance of active listening.
■
Describe nonverbaJ communication.
■
List and explain the multiple meanings of silence in counseJling.
■
Define and demonstrate paraphrasing skills.
■
Define and demonstrate summari: ing skills.
LISTENING FOR UNDERSTANDING
When yoH ralk, you are only repenting what )'OH already
know, bur if you listen you ma)' learn something new
(Dafai Ulma)
Proficient counsellors are dynamic and responsive listeners. They arc persistent and
curious Je3rners committed to understanding. They strive to hear, not just the words of
the.ir clients, but also the nonvcrbaJ channel of inform3tion where variables such as voice
tone, posture, and gestures act to support, repe3t, enhance, or contradict vcrbaJ mesS3ges.
95
Effective listening, not only includes silence, but also involves the components
of hearing, observing, interpreting, 3nd responding through 3 complex process that
requires sensory, mental, and bch3vioural competence. As a mcntaJ proces~ listening
involves separating rdcwnc information from irrelevant information, 3ssigning meaning
to words 3nd experiences, and remembering and linking related data. High~levd listening
regards emotional unde.rst3nding 3S 3 prerequisite for fully comprehending the words
and content of wh3t the speaker has said. Put simply, listening is making sense of what
h3s been heard from the perspcctive of the other person.
Counsellors ma'>' use questions to obtain cl3rification, definition~ and ex3mples.
They use silence to reflect and communic3te respect for the risks that clients have taken
to share the.ir stories. Summarizing, paraphrasing, 3nd cmP3thy 3re, in pan, listening
c.heclcs to ensure the 3ccuracy of the.ir observations 3nd conclusions.
Effcctive listening as a counscllor requires man3gement of or diseng3gemem from
b3rricrs such as personal problems. boredom, lack of interest, or competing dem3nds
to folly focus-both psrchologic.ally 3nd physicallr~n the mess3gc. Counsellors need
to be self.aware 3nd constand'>' on the aJert to ensure that their own perspective docs not
detract from or contaminate their capacity to understand the words and fttlings of the.ir
clients. The listening process is oudined in Figure 4 .1. Since the challenge to effectively
listen is demanding and potentially cxh3usting, it is not surprising th3t failure to listen
dfcctivdy is a primary reason for relationship breakdO\\•n.
The Power of Listeni ng
Listening is a cornerstone of counselling 3nd is essential to understanding and reJation.ship development. Often clients come to counsclling with considerable experience of
not be.ing he-3rd. They may have turned to family and friends for help but found that
their concerns were discounted or were met with simplistic 3dvice by people who we.re
so 3ru:ious to heJp that they failed to listen with attention. In contrast, effective counseJlors 3nd interviewers h3VC' a cultivated ability to listen.
As a fundament3l building block for the counsclling relationship, listening com.munic.aces to clients chat their ideas and fodings 3re important. Our natural inclination
is to interpret meaning to words 3nd behaviour based on our own experiences. This c3n
easily lead to assumptions that 3re very different from those intended or experienced
by others. Listening educ3tes counsellors 3bout the uniqueness of their clients, thu~
minimizing 3ny tendency to make erroneous assumptions. Moreover, listening encour•
ai;cs clients to tell their stories and disc.lose che.ir feelings. In the proces~ they m3y gain
enormous therapeutic value from rdc-3sing pent-up emotions. Also, when counsellors
listen to clients, clients become better 3ble to listen to themsclves. In genera], S)'Stem3tic
Hearir,g and
Rememberir,g
Verbal and
Nomabal
M._..
Selecting and
Somog
lnfarmation,
Ideas. and
Feelings
Figure 4.1 The listening Process
96
Chap1er 4
Understanding
Meaning and
Emotions
listc:ning, punctuated with appropriate probes, clarifiai.tion rc:sponscs, and summaric:~
helps clic:nts ori;:ani!c: confusing and contradictory thoughts.
Listening is an act of accc:pt:mcc: and caring that says, "Your feelings arc: precious
and unique:. 1 ,von't insult you by assuming that I kno"' "'hat you're going to sa)' before:
you S3Y it. I w-on't judge or ridicule whnt you say. I ,von't try to change you to fit my
idc:a of "'hat )'OU should be." Listening is an active attempt to undc:rstand our clic:nts'
perceptions and fc:ding~ "'hid,. may be different from our own.
Ironically, "'hilc: listening rc:quires counsellors to be silc:nt, rc:maining silc:nt doc:s
not necc:ssarily mean that one is listc:ning. A silem person may hear the words and c:ven
be able: to rc:peat vc:rbatim what has bc:en said, but a tape rccordc:r or a dc:ver parrot
can do the: same thing. Good listening is an active procc:s.s that requires hearing the:
contc:nt. c:motional tone, and context of "'hat is bc.ing said while controlling listening
obstacles and using skills such as summari.!ing, paraphrasing, and empathy to confirm
understanding. 'W ithout attention and self-control, learning obscadc:s can contaminate:
mc:ssagc:s with unintended distortion, selective attention, and inte.rprctation. Thu~ good
bstc:ning requirc:s that we: opc:n ourscJves up to learning.
Listening is not a passive act---cffc:ctive listenc:rs arc busy "'ith the task of trying to
comprehend what is happc:ning for their diems. Somctimc:s counscJlors arc patiently
quiet as they respectfully yicJd the right to spc:ak to their clients. At othc:r times, they
are vocal, with questions and directives for more derail, example~ or darification. At all
time:~ they should ai.rcfully observe and try to understand nonverba.1 bdi.aviour. Active:
listening, a collection of skills discussed in this and subsequent chapters, is the way
that counsellors sho"' their dients that they are listening. This is possible because they
are, in fact, mc:ntaJly and ph)•sically committed to the msk of listening. \\:lith so much
at stake and so much to do, listening is hnrd work. 1t requires counsellors to focus all
their intc:llcctual and physical anc:ntion on clients so that clic:nts hnve the counsc:llors'
un"'avering commitment. Listening is the diem's re,.\--ard for talking.
SUCCESS TIP
To be heafd and deei;:iy underStOOCI by anothe-r pel'SOO rS a rare-and profoundly e-mpo.-.eri'lg
ex.pe-tie-oce-. Consequently, an lhe he-Ip that some- clients need is the opportundy to shafethe-if problems Viith a patient, non;udgmental listene-t who ooesn-'t butden them with advice-.
LISTENING BARRIERS
Communiai.tion is a process involving a sender and a r«eiver (for two-person communi,cation). In its purest form, the communication loop begins "'hen one-person frames and
sends a mes.sage using verbaJ or nonverbal channds (frequently both); the receiver must
hear and intc:rpret the: message, then pro,•ide fc:c:d bac.k that confirms undc:rstanding.
))l) BRAINBYTE
L,t,_1 1,;
Barth (2011) re-pofted on a study by Prioce-ton neufosci-
e-ntist tauten Silbe-rl who demoosttated that fMRI scans
of good listene-rs showed thell brain activity patalle-led that
of those to whom they wete listening. In addition. the
scans showed lhat key b<ain ate-as lit up befofe wofdS
wefe spoken. suggesting anticipation of what was abOut to
be- said. On the one haOO, this might suppotl lhe- listening
pfocess aoo add to a pe-rson's capacity to be- e-mpathic.
On the othet hand, inacc.urate anticipation has pitfalls and
can cle-arly le-ad to misunde-r'Slanding and communication
bfeakdown. To p,-e-ve-nt lhis miscommunication, counsel
lorS must temain ve-ry aue-ntive to ensufe that their clie-nts·
mess.ages are in sync with any mess.ages 0c feelings they
anticipated.
listening & Responding: The Basis t or Unders1andlng
4
97
TABLE 4.1
Common Listening Barriers
seooina Mes.sace:s
Receiving Mes.safH
• Not havi~ the wOl"ds to ex.press feelings
and ideas.
Lack of i.nsigt\t o( awa,eness
Contradictory vet'bal and nonverbal
messages
• Assumptions, bias, and judgment
• E«ors inte(preti~ messages
• Selective attention
• Heari~ words., but 001 emotions
• Em::>1.iooal reaction
• failure to attend to oonve-rbal channets
• Unwlling to heat content or feelings
• Distract.ions sud'I as fatigue, ooreoom,
and preoccupation with personal issues
• Ptanni~ wtlat to say instead of listening
• lnte«upring. rushi~. or finishing 100
speaket''s sentences
• Resista~
Bias
Un(esolved trust issues
Pet'specrive (eun.u,al/wortcMew)
Unwillingness to communicate
(self-ceOSO(S,,ip)
Information gapslincomi:,&te
communicatio.n
• Resislance
ln counsclling, this fttdb3ck, usually in the form of summaries, paraphrases, or emP3thic
responses., acts as a po\\'e.rful incentive for the client to continue. Questions(as discussed
in Chapte.r 5) are nJso an important tool in communication. They provide a W'll)' to get
missing information, example~ and definition.
Typically, the.re are a hui;e number of b3rrie.rs to listening (see Table 4. 1). Some
originate with the sender, others with the receiver. These can interfere with cffoctive
communication such that high-levcJ communication is often the exception, not the rule.
Closed-minded listeners respect onl)• those who agree with them. Since they nlready
have the "right" answ·ers, the.re is neither need to conside.r new thoughts and ideas, nor is
there any reason to seek additionaJ information. ln contrast, opcn.-minded listeners are willing to explore new ideas and arc secure enough to he3r difforcnt opinions without distortion..
Overcoming Listening Barriers
Be Patient To make themselves unde.rstood, people need to be able to frame their
ideas. Clients who lack the ability to express themseJve~ perhaps because they have a
limited vocabulary or capacity to articulate in precise terms, use words that are vague,
ambiguous, or conrradictory. Others ma)' not have sufficient awareness or insight to
describe their feelings. In such circumstances., counsellors can become impatient, and
this becomes an obstacle to listening. They ma,., try to hurry the process b\• finishing
sentences for clients who are struggling to express themselves. Or they can become lazy
and assign their own mC3nings to words and phrases.
Active listening heJps to minimi.!e the risks of misinterpretation. Summaries and
p3raphrascs hclp confirm understanding, and they provide a re.flective mirror for clients
to hear the.ir own ideas from a different but undistorted perspective. Targeted and sys..temaric questioning encourai;es exploration and specificity, and it helps clients orgnni:e
their thinking and engage in problem solving.
~I· Ai.1 '. ,.,
))}) BRAIN BYTE
Al,111·1
Ten times faster than a visual image or a lhought can be
processed. lhe auditOty cifcuits of the bfain respond to
sound. (Horowitz, 2012). Neufoscientist Seth Horowitz
(2012) depicts lhis auditory circuit as an alarm system
in a constant state of readiooss to respond 10 sounds that
signal danger or attraction. Most sounds a,e ignored as
98
Chap1er 4
S,,'.•
·1
irrelevant, while others, like a fingin,g phone, demand our
immediate attention. But Horowitz wams of lhe dangefs in
a new digital wOJkl, where effeclive listening beeomes difficult as ouf brains afe being seduced by constant noise.
As a safeguafd, counsellors ne&d to soundproof their
sessions.
Focus on Trust Client messages can be incomplete or missing inform3tion because
of trust issue~ particulnrly in the beginning phase of the counselling relationship when
the client ma'>' be reluctant to share. This is understandable since the counselling rela,
tionship has yet to be tested. Consequently, the client may hold back information or
feelings that a.re ultimate!)• vitaJ for understanding 3ocf instead present "safe'' issues to
test the relationship or only hint 3t conce.rns th3t are more important. ldeaJI,.,, as counselling: progresses, clients learn th3t they can depend on their counsellors to respond
with respect 3nd understanding. Unforrunaccly, in some cases, they m3y learn that the.ir
counsellor cannot be trusted with feelings.
Control Distractions and Stay Focused
Once mcss3ges 3rc sent, they must be
received and interpreted accurately- hence the importance of a counseJling environment that is free from distraction and inte.rruption. Counsellors should never discontinue an inte.rvicw to 3nswer the phone since th3t m3y brc3ch confidentiality, impede
relntionship rapport, and stop the flow of information. Similarly, pager~ fax machine~
cdl phone~ and even an unanswered ringing phone c3n destroy the ambience of a
meeting. Ideally, a.II such equipment should be turned off.
Good listening is difficult work that requires effort to stay focused. Since we can
think many times faster th3n others can talk, it's easy co allow our thoughts to wander.
The trick is to keep our minds busy with listening. Active involvement in listening,
through summarizing, p3raphrasing, 3nd 3slcing question~ helps counsellors stay 3Jert
3nd focused. Mental involvement helps counseJlors concentrate on and understand
what's being s3id. For example, as they listen, they can ask thcmsdvc~ "\Vhat does the
client mean by chat? Wh3t arc the key points in th3t explanation!" However, counsellors
should avoid trying to figure out what clients are going to say next since chis will only
dive.rt che.ir attention from listening.
lmcrn31 noise can 3Jso interfere with listening. Counsellors might be pr«>ccupied
with che.ir own needs or ideas. They could be looking fonvard to their vacation and
im3gining their break. They ma'>' be unde.r pe.rsonal stress. suffering: from fatigue or
thinking about other clients. A tired counscJlor might ddiberatdy neglect to explore or
define important idC3s.
Stop Assuming Jf counsellors believe that they a.lrc3d'>' know what others arc going
to SU)' and arc not open to new information, then listening is not possible. App3rent
patient 3ttention and silence could give the illusion of listening, but assumptions and
preconceptions quickly become obvious to asnue clients. Typical I'>', clients are guarded
3nd defensive with people who h3VC opinions different from their own. ln the following ex3mple, a high school student h3s just told her counsellor th3t she has been offered
3 scholarship at a prestigious university.
Student: h's one o( the flnest unh'i'"rsities in the 2rea. It is an honour l'O h:ave been
chosen from :ill the 2pplicants. Mr fad,e-r, who never h:ld a chance to ¥0 l'O univerSity,
isecstatk.
Coun.se.ltor (Choke I): Wow! TI,::u is ternfle. You must be so proud o( )'Oursel(. TI,is
is re:tll'>' an ouutandin¥ opportunity.
Coun.se.ltor (Choke 2): How do rou (eeJ about it!
The counsellor in Choice I in this example assumes feelings 3nd mc3ning. As a
result, further exploration is discouraged or cut off. Choice 2 is 3 listening: response that
encoura,;cs more information. It 3Jlows for the possibilit)• that the client might say, "I'm
depres~ 3bout it. I've been ,;oing to school for 12 years, 3nd I really wanted to t31cc a
year off." Choice 2 illustrates 3 basic principle of effective listening: Good listeners arc
open to learning.
listening & Responding: The BasfS t or Unders1andlng
99
Personal Re.actions \Vhnt clients sa'>' and how they say it may arouse a counscl.lor's tension and anxiety. Emotions in the client c:m trigger emotions in the counsellor,
which, if unchecked, can lessen the counsellor's capacity to listen. For example, an
angry diem might stimulate fear in a counsellor, who, preoccupied with fe3r or insecu.rity, then might act defonsivcJ'>'· A depressed client might have a contagious effect and
cause a counsellor to become similarly despondent. Certain words or messages might
act as emotional triggers for counseJlors and lead to faulty listening and understanding.
Many beginning counsellors react strongly to clients who have been abusive, and
they erect listening barriers. They ,;ct so trapped in their own neo:I to condemn the abhor•
rent behaviour that they have no room left to become aware of their clients' frames of
reference. Consequently. they fail to establish any base for understanding and any crcd.ib ilit)' to promote chan,;c. Entering into the private w-orid of clients whose behaviour and
artitudcs differ sharpl)• from one's own requires emotionaJ maturit)', skill, and, often,
abundant courage. Such apacitics distinguish and define competent counseJlors.
Sometimes counsellors become bored (e.g.., when dealing with clients who spC31c in
a monotone or clients who arc repetitious and long-winded), even to the point of falling
aslttp during the interview. To stay alert during an interview, counseJlors must arrive
alert. They should get enough sleep and exercise and avoid heavy lunches that might
lead to drowsiness. Short breaks to take a walk, stretch, or dear the mind are important
ways of sustaining energy.
When clients share difficult feelings and topic~ some counsellors handle their own
discomfort by becoming inappropriardy quiet or silent, becoming excessively talkative,
changing the subject, or offering premature advice or reassurance. Such responses may
communicate that the counsellor does not understand or is not listening or, in the case
of inappropriate silence, that the counsdlor does not care. Counsellors need to become
confident in their skills and abilities so that they can tolerate clients' feelings, rcoctions,
and even verbal assaults with a minimum of defensive reactions, which obscure listcn.ing and understanding.
Listening Does Not Me.an Agreeing A common misconception occurs when people
confuse listening with agrtting.. One new counseJlor remarked, "ff I listen to someone
who abuses children, am J not condoning it?" Another person remarks, "J told him what
I want. \\:rhy doesn't he listen to me!" In fact, the other pe.rson may have listened and
hC3rd, but has chosen not to comply. In this example, failure to comply is interpreted as
e\!idcnce that the other person isn't listening.. This is a common error in thinking..
Exemplary counsellors are vigilant when they are dC3ling with clients who test the.ir
values and beliefs. They discipline themselves by taking extra precautions tom.sure they arc
listening accunndy. They also try to become alert to any inte.rnal noise that might impair
their capocit)' to hcnr. They know they arc vulnerable, and they take preventive measures.
Self.Awareness Since everyone's frame of reference is different, we can never per•
focth• understand how other people arc experiencing their world. Our understanding
is aJwa)'S clouded to some e>..'tent by the mC3nings we as.sign to events and by our own
thoughts and feelings. Counsellors may have unrccogni!cd or unresolved prob lems
))t) BRAIN
BYTE
Reseatd'I has s00-1«'1 that when people feel ovetloaOOCI, they
Mat better' with theit right eat. Tris is beCauSe the rigl\t eat COO·
Mets to the lefU::irain hemispf'e'e which ~ a doninant tde
100
Chap1er 4
;,, prC>OOSSlng 1ar-euage. nti,e ywr head., allow mom SOI.Wld to
the rigtlt ear miNf impt(We: listeni~ an:S mamory frOO'l 8pereent
to as much as 40 percent in some individuals. (Starr, 2017)
parallel to those of their clients. Fo r example, o ne counsello r experienced unusual d isco mfort whe n trying to work with a client who was dealing with a n unw-nnted prcJ;nancy. Ten years before, the co u nsellor had placed her own ch ild up for adoption, but
she had never addressed the emotions she felt over the d ecision. \V henever her clie nt
focused o n her o ption~ the co u nsellor's o wn feelings made it tough for her to separate
he r feelings fro m those o f the client.
Table 4.2 summari!cs strategies for ove.rco ming co mmon liste ning p roblems. These
strategics are presented as ideas rather than as recipes for responding. E.nch intervie w
situation requires indiv id unli!ed and Crc3tive responses.
TABLE 4.2
Overcoming Listening Barriers
Ptoblem
COunsello.- Choices
The dient has prObtems with language
(e.g., nisleading WOrd chOice and
difficulty verbalizi~ ideas).
Ask questions to clarify meani~ .
Pay careful attention to noovet'bal
communication f0t dues to meaning,
Messages are incomplete, ambiguous. ot
undeat
Probe fOt detail and examples.
Relationship ptot,ems/b'ust issues ate
resulting in client cenSOr'St.p of feelings
and ideas.
Sho-N empathy.
Have a candid discussion abOUt the ttust Or
relations.hip issues.
Go at a sto.ver pace and reduce questions.
Communicate openness thraugh nondeteosive
Pataphtase to confllm underStandlng.
Ask for definition.
There is outside i'\terletence (e.g., noise
and laek ol p<ivacy).
There is intemal interference
(e.g., COU-IOt fatigue, difficulty
concentrating, bOtedom. and hearing
impairment).
'"'-·
HOid phone calts and move interviews to a
ptivate setting.
Start a personal wellness plan.
Improve rme management Skins.
Defer the interview.
Use self-discipline to increase concentration
(e.g.• mentally sum.mari?e key det.a'ils).
Summarize, paraphrase, and empathize.
The counseltor has a IOSs of ot;ectivity
when dealt~ with ideas that are contrary
to his Ol her values..
Use supel'\lision ot consultation to address
perSOnal issues that ctoud objectivity.
There are cuttutal barriers between
counsetot and client.
Etllist the client's help to understand cultutal
values and issues; lhen adaPI the interview style
to fit.
Discipline yourself to ext,IOte different ideas.
Use translators ot refer 100 client to a counsetlOt
of the same culture.
Oew!lop cuttufe-spe,cifllC kno-ldedg,e.
Content is o...el'Wtletming f0t the
counsetot (e.g., wtlen the client rambles
Ot is long-winded).
Summarize to identify themes and priorities.
Seleclivety intertuPI to contrOI the Oo-N ot the
interview.
The dient is inappropriatety silent.
Attempa to unders1anc1 the meaning of the
slence; then respond apptoptlatety.
The dient has speech prot,ems (e.g.•
mumtling, stuttering, and wtlisperlng).
Remembet lhat problems may decrease as
the counseltor becomes more familiat 'Mth the
client's style.
Ask the client to speak up.
list ening & Res ponding: The BasfS t or Under s1and lng
101
ACTIVE LISTENING
Understanding is alwa)'S tentative- hence the importance of aJlowing clients to confirm
or correct our understanding. Active listening describes a duster of skills used to incrc3se
the accuracy of meaning. Attending, being silent, summari!ing, paraphrasing, questioning,
and empnrhi!ing are the essential skills of active listening (sec Figure 4 .2). They b renthe
life into listening so rhnt it becomes a continuous process of paying attention, hearing,
exploring, and d~pcning. Active listening involves hC3ring what is said as well as what is
left unsaid. Counscllors need to use both their e\•cs and enrs to asce.rroin meaning. Careful
anenrion to sud,. cues as word choice, voice tone, posture, and verbal hesitations is nee~
sary to discover confirming or conflicting messages in the verbal and nonverbal mcssa,;cs.
Subtle changes in voice tone o r sudden shifts in the topic may signal important areas
for the counsellor to explore:. In one case, a 28-'>'C3r-old woman who w·as describing her
career goals happened to mention her sister. As she d id so. the counsellor noticed that she
avoided eye contact and her voice dipped slightly. He asked ho"' she felt about her sister.
The woman beaan cryina as she related how her sister had alwa'>'S been the favoured one
in the family and how she had felt rejected by her mother. Subsequently, this relationship
became a central issue during counscllina, and the client developed insiaht into how she
was using her career as a desperate: attempt to gain her mother's acceptance:.
Active listc:nina skills defuse c ritical incidents. The FBI, for example, has rccogni!ed
active listenina skills as essential competencies for resolving crises, including hosmi;ctn.king incidents, and it has replaced using force "'ith active listc:nina as the preferred
strategy (Van Hassclt et al., 2006; Royce, 2005). Research has shown that active listc:n.ing, particularly the skills of paraphrasina. empathizing, and open..ended q uestioning,
helps subjects (i.e., hoscage takers) release frustration, despair. anger, and other p,m,-erful
foelings, with the result that they rerurn to a more normal level of arousaJ a nd rational
thinking. One reason active listening is so effective: is because it docs n()( threaten people
with an overt attempt to change them. Active listenina builds rapport because it sho"'s
that the listener is nonjudgmemal and is interested in understanding. Individuals in
SIience
Att.ndlng
•
Asking
Quest,ons
Pa,iphraslng
Figure 42
102
Chap1er 4
The Skills of Active Listening
crisis may erect he3vy psychologicaJ defences, but "bec3use active listening poses no
threat to an individual's self-image, it can help a subject become less defensive" (Nocsner
& \Vcbster, 1997, p. 16). Active listening is a powerful tool for dcvcJoping a relationship,
which becomes a basis for negotiation.
Anending. nonverbal communication, using silence, P3rnphrnsing. and summarizing will be explored in the following sections. Subsequent chapters will address the skills
of questioning and empathy.
ATTENDING
Attendini is a term used to describe- the way that counsellors communicate to their
clients that they are rc3d)•, willing, and able to listen. When coupled with understanding and appropriate verbnJ response~ attending promotes exploration. As a basic active
listening sic ill, attending conveys physical and psychological commitment and openness
to the helping intcrviN•. Anending sa\'S to clients, "l'm here for you. You have my undivided attention. I'm not afraid of your feelings and what you have to say."
Certain core attending skills are univcrS3lly applicable, and counsellors can use them
with confidence. First, counsellors need to ensure that their ftt.lings, attitude~ and commitment to clients are genuine. Jf a counscllor has negative feelings about a p3rticular
client, then refc.rral to another counsellor may be warranted. On the other hand, if such
negative ftt.lings permeate a counsellor's attitude toward many client~ then additional
remedies may be necessary, such as personal counselling, assistance to deal with burnout, consultation and supervision to manage feelings, or a career chanJ;c. Sometimes a
counsellor's personal rc3Ctions can be a valuable clue regarding how a particular client
imP3cts other people. The key conside.rntion here is whether the counsellor's feelings
are unique to him or her, or whether they arc indicative of a client's general demeanor.
Second, pro\•iding a safe and private space is an incentive for clients to open up.
This includes efforts by counsellors to control distracting noise and curb the.ir own
imcrnnJ distractions. ScJf,<fiscipline to suspend hasty assumptions and judgments is
also essential. Counsellors need to avoid rc3cting with verbal or nonve.rb3l mes.sages
that express imp3tience, disagrttment, or judgment. As noted earlier in this chapter,
this may be difficult when clients present ideas that are offensive or conflict with the
counsellor's values and beliefs.
Third, counsellors can show that they are attending b)• being on time for the interview, remembering important detail~ and following through with agreed-on plans. A
ce.rmin ph)•sical and verbal presence conveys comminnent. Verbal and nonverbal behaviours such as hC3d nods and encouraging probes convey interest. Counsellors need to
bring warmth to the interview, which is communicated through appropriate smiling.
changes in voice tone, and expressions of caring and support. An unemployed client
who rcpons with glee to his counsellor that he has found work has a riWlt to expect
more than a monotone, "That's grc3t."
There may be cultural and individual differences that require adapting how )'OU
attend to clients. For example, some clients arc notcomformblc with sustained eye contact, and others may be suspicious of warmth and humour. This rc3lity underscores the
importance of continual work to devcJop cultural understanding and competence. As
alway~ it is important to remember thal individuals vary in the extent they subscribe
to the values of their culture of origin.
There is general agreement that the following behaviours convey appropriate
attending:
■
keeping an open posture (i.e., turning towards the diem, arms and legs uncrossed)
■
maintaining eye contact
listening & Responding: The Basis tor Unders1andlng
attending: Atera used to descriie
tile •ar that c•selkn communicate to
t!leir clients tu'! they an teady. 11illing.
and able to liMta. Vefba:1. ncaverbal.
and attitudinal CIIES are 1M es.seaceClf
effeaiw attending.
103
■
leaning fonvard
■
using responsive facial expressions like approprhne smiling
■
encouraging comments and head nods
■
speaking in a warm and pleasant voice
As with any counselling skill or procedure, attending must be applied intelligently
relative to diversity and cukuraJ variables. For example, among many Middle Eastcm.ers, six to tweJvc inches is a comfortable conversational distance; but an "arm's lcngrh"
is more comfortable for most \\:festerncrs (Hockney & Cormier, 2005). Counsellors
should also avoid rigid adherence to one style of attending. For example, the needs of
a client who is embarrassed may be best served by avcned or less.-intcnse eye contact
until more trust and comfort develops.
Careful attention to words, phrase~ and nonverbal communic3tion opens counsel.lors up to lc3ming. Counsellors need to hear what is said, as weJI as what is not said.
They need to rcffcct on how ideas arc communicated through cone of voice, posture,
and other due~ and listen careful!)• for confirming or conflicting messages. As well,
they need to sift through what ma,., be complex and sometimes confusing information
to identify P3ttcms, priorities, and areas of relevance. This work may involve the major
senses of hearing, sight. smell, and touch. Although counselling work gene.roJly centres
on hearing and sight, significant information can be gleaned from our other senses. For
example, alcohol and some other drug use may be detected by smell.
When counsellors are patient, they give clients space to confront painful emotions
and to gather their thoughts. \\:f'hen counsellors sit still, mainmin culturally appropriate eye
contact, and avoid nco:lless questions they do much to convey to the.ir clients their unwav.ering attention. These actions focus the attention of the interview completely on clients.
To accomplish thi~ counsellors must develop their ability to be comfortable with silence.
SUCCESS TIP
The pitfaus of listen.-ig include saying too much as weu as too liltle. SIience is important, bul
ultimatety k\suffdent b effective listening.
Selective Attention
selectiw perception (selective
attention): Atera 11Sed to desuibe
the natwal taidency to avoid being
OYM1helllied by illcrmat• by screaaing
out material t!I.M is irrtlev•.
Selective perception or selec,th•c attention is a term u~ to describe the natural tendency to screen out ir-relc\lant information to avoid being overwhelmed. Of necessity,
counsellors must ignore some parts of a client's communication and selectivdy attend
to othe.rs. It is not possible (nor desirable) to attend to everything a client says; however,
communication breakdown can easily occur if a counsellor ignores issues or feelings that
arc important to a client. This underscores the importance of the contTilcting process
(see Chal){er 3) as a tool for ensuring that counsellors and clients are on the S3me P3ge.
What a person pays attention to is likdy to be influenced by one's frame of refer..
ence, which is uniqueJ,., defined through influences such as past experiences, personal
value~ current mood, interests, concerns, fear~ prejudice~ health, culture, and context.
A tow truck driver looks very different depending on whether you have a flat tire on
SUCCESS TIP
Oients atso selectivety attend. FOr' example, lhOSe whO a(e O\ler1y anxious are more likely to
pay attention to anxiety-prO't'Oking stimuli, and those who ate suspicious WIii be more sensitive 10 cues that the eounselOt cannot be trusted.
104
Chap1er 4
TOO brain is una~ to pay attentbn to l\\() thi~ at the same
time. In Or'der to divert our attentkln to a different &ask, the t:tain
must Shut cbNn an:S shift its focus from tne fW'SI task (Medna,
20'.)8). Research also SOONS that shifts rn attention resul in a
greater risk of m$Si.ng important cues and no1 rememberi~
what clients have said (Taylar, 2011). This realily uooerscor·es
the importaoce ot counsetbrS atk!Oeling to their diants' corrwnuricatkln Viitrout beeoni~ ,:reoccupied Mh what to say next.
a dark and stormy night, or you are being to\\'ed for illega] parking. The word moiher
may caJI up images of love and support or memories of abuse and pain.
Recognizing and Managing the Pitfalls of Selective Attention
Mnnng;ng rhc
pitfalls begins with self-awareness about how our point of \tiew and life experiences
influence our perceptions and interpretations. Counsellors need to re.fleet on their O\\'n
listening habits to identify areas of vulnerability. Counsellors need to be alert to the
dangers of selective perception in their own thinking and responses. They must be
vigilant to make sure they understand how and when prior learning, va.Jucs, and current
expectations influence where they focus. They need to be careful that they don't impose
their own sense of what's important, which can easily lead to loss of objectivity as well
as missed information and opportunities. Viewing scssional recordings and seeking
feedback from informed observers is an important part of this process. Herc are some
typicaJ counsellor seJective perception errors to consider:
t. Egpcemricity. Hearing only messages that support established opinions and beliefs.
\Ve need to remember that whal \\'e know is subject to change.
2. Role bias. Counsellors will pa)' more attention to cues that arc consistent with the.ir
professional focus, training, and responsibility. An employment counsellor will be
interested in career and vocationaJ data, whereas a marriage counsellor will be more
alen to information on familial communication. This is necessary and appropriate;
however, attending to one issue runs the risk that other important areas for inquiry
are overlooked. For example, an employment counsellor who docs not recognize
the S)•mptoms of a mental disorder or substance abuse will have limited effectiveness when dealing with clients who have these issues.
3. Disengaging. \\:'hen this happens, counsellors have simply stopped listening and their
anention is focused elsewhere. This may occur for a variety of rc3sons, including
boredom, disinterest, fatigue, or preoccupation with their own issues. As well, counsellors might deliberately discni;pge when they arc uncomfortable with the topic.
4. Preoccuparicm tdrh problems. When counsellors arc too fixated on problems, they
miss the opportunity that comes from a strengrhs appro3c.h. Rec:ogniiing client
strengths heJps to buikl confidence and self-esteem, and it mobili:es resources for
problem solving.
It is also important to pay aucntion to the counseJling relationship. Over the
life of the counsellor-c.licnt relationship, various priorities will emerge related to
beginnings, conrracting, problem solving, and endings. The vitality of the relationship is a strong predictor of a successful outcome in counselling, so this important
wriable should never be ignored.
5. NOl. auending ro rhe emotional domain. By focusing on behaviour, counsellors ignore
the emotions of their clients, which are often more important to problem resolution than finding behavioural solutions. Emotions can sustain problems, interfere
with decision making, and crente stress that pre-vents problem solving. When clients
express emotions, active listening, particularly empathy, is crucial For example,
listening & Responding: The BasfS tor Unders1andlng
105
Miller, Forcehimcs, and Zwcben (2011) reported that "one of the strongest prcdic~
tors of a counseJlor's effectiveness in treating substance use disorders is cmpa,.
thy" (p. 49). CounseJlors should also monitor and deal with the emotions that they
bring to an inte.rvicw or that arise during an interview.
6. Nor co,uidering the nom't"'rbal channel. Listening to words without considering non.verbal communication ma'>' result in counsellors he~uing only a small pa.rt of what
their clients arc communicating.
7. Snap judgmenu. Good listeners are curious, patient, and cautious in the pursuit of
understanding. Medina (2008), a molec:ula.r biologist, n()(CS., "\Vhat we pay attcn~
tion to is often profoundly influenced by memory. ln eve.ryday life, we use pre..,i~
ous experience to predict whether we should pay attention" (p. 75). This suggests
a major pitfall that has profound implications for counsellors. \Vhen our clients
share stories., their stories may stir our own mcmorie~ and we may begin to "fill in
the blanks" based on our experience. This shoncut to understanding can result in
erroneous assumptions and mis~ information. \Vhile past cxpc.riencc with the
same issues as our clients may give us an empathic advantage, this is only true if we
remain viailant to ensure that we do not contaminate our clients stories with those
of our own. Perhaps we are safer when clients present unfamiliar issues and problems because our lack of lcnowledi;c makes it easier to explore for understanding.
8. Muhira.sking. Neuroscience has demonstrated that the human mind is incapable
of multirasking with respect to paying attention (Medina, 2008). Here's the most
common problem in counselling: While clients arc talking. counsellors are thinking
ahead, planning what to say. ln order to think ahead, their minds must disen,;pg,e
from listening. Active listening skills can hdp counsellors maintain focus on what
their clients arc communicating.
SUCCESS TIP
Too much time ex.plOring content comes at the expense of ptOblem solving and feeling
management. Whtie some detail is necessa,y for uooerstandi.ng. excessive attention to all
the de&aits rS neithet neoossa,y not ptOductive. NOr' rS it generally usehA to d1ted the wock
of counselling to ftnd the ·(oor causes ot prObrems.
Remember that listening is hard work, and you nttd to be physically and psycho.logically ready for the interview. One essential component of this readiness is to address
)'Our psychological nco:ls by dealing with your own is.sues that might make it difficult
to hear clients. If you have unresolved difficultic~ cspcciaJly if they mirror those of
'>'our client. it will be paniculnrly difficult to listen effectively. A second component is
to malcc sure you fully disengai;c from )'OUr last client before engaging with the next.
Finally, make sure you understand before you move on. Summarize, paraphrase, and
ask defining questions to enhance and confirm )'OUr understanding. As a rule, the more
)'OU occupy '>'ourself with the active demands of listening, the less you will be tempted
to let your thoughts ,\--under.
NONVERBAL COMMUNICATION
Most people are familiar with the physiological reactions that occur in moments of
great fcnr. Powered by increased adrenal secretion~ our bodies respond automatically
with eJcvared heart rate, rapid breathing, dry mouth, and ()(her symptoms. Many of
these reactions arc dearly ,risible to any observer, even before any verbal declaration
of fear. Nonverbal behaviour is usually outside our conscious control and is less likely
106
Chap1er 4
TABLE 4 .3
Nonverbal Behaviour: What to Observe
Eye contact movement, tears, dilated pupils
Eyes
Facial cues and expmssions Frowning, Shaking the Mad, smilWlg. clenched m::>uth, blushtng
Vocal
Tone, volume, use of silence, hesitation, pace, mood
Use of space
Appearance/Dress
Body language
Seati~ dislance. movement, bOdy position
Grooming. hygl,ene, dress, tattoos. t.'ancli~. scars
Posture, gestures, pacing behaviour, arm and hand m::,vements
Toudl
HandShake (e.g., Ump, aggressMl), hugging, hand on Shouldet
Distractions
Playing with a rtng 0t pen. touchi~ hair
Blunted, flat, inapptopriate, labile, mstricted (see gtossaJY)
Affecl
to be censored. Consequently, counseJlors can often trust nonverbal communication
as a more reliable indicator of feelings than ve.rbal communication. Sue and Sue (2008)
found that "studies support the conclusion that nonverbaJ cues operate primarily on an
unawareness level, that they tend to be more spontaneous and more difficult to censor
o r falsify, and that they arc more trusted than words" (p. 171). Table 4.3 includes some
of the key things to look for in your clients' nonverbal behaviour.
(n ,;cneral, research has shown that often 55 to 65 percent or more of the meaning
of a message is conveyed nonverbally (Shcafor & Horejsi, 2008). Sometimes aJI signifi•
cant communication comes from the nonverbal channel; for example, people's emotions
may be conveyed much more accurate!)• by their body posture and eye contact than b\•
their words. Counsellors who rely only on words will be limited and ineffective by 00(
integrating that part of the interaction that contains the meaning.
Knapp and Hall (2006) offer these condusions:
KonverbaJ eornmunie::uion should not be stud100 as an isolate-cl phenomenon bu1 :lS an
inseparable pore o( the total eommunbtion p ~ . . . Nom'e'rbal eonununie::uion is
import=nt beeluse o( its role in the t'Ot:il 001nmunk21tion system. the tremendous quant ity o( in(orm::uion:11I cues it ah,es in 20)' p3rtkubr situation. :ind its uSc in (und3mcntal
2re:lS o( our d3ily li(c. (p. H)
Meaning of Nonverbal Communication
CounscJlors can learn a great deal more about their clients' ideas and feelings if they
cardull't' observe and try to unde.rst:md the nonverbal channel GenemJly, nonverbal
communication serves one or more of four purposes:
■
Confirming OT repeating: Nonverbal mes.sages are consistent with messa,;cs that arc
spoken. Alternativcl't', nonverbaJ cues embellish the intensity of the client's ideas
or feelings. Example: thumbs up with a smile while saying yes.
CONVERSATION 4.1
STUDE:NT: I find that I'm so busy ltying to lhink of what to say
next that I miss what the client is sayi~.
TEACHER: Yes, 1t is tough. That is a eotnmon problem. even
for ext,erienced counsellors. TM brain canno1 ml.dtitask Its.
tening and planning. One tas.k must stop for the 01t1er to
occur. Of course, it is hard to stay focused on what is bei~
said witoout some thought of wtlat kl do next. but with ptaetice it can be done. One ttick is to lhink about \\flat is being
said before thinking about what to say. As you reflect on
'llf'lat is bei~ sakl, try to identify majoc themes and footings.
Often, )'OU' response will emerge naturally out of lhis effOr'l.
DeYelOp your comf0tt with silence. If you need a moment to
think, ask for it
listening & Responding: The BasfS t or Unders1andlng
107
■
Comradicring: Disp3rities between the verbal and nonverbal mesS3ges arc apparent.
Example: Cliem might say, "I'm «static," but in a sarcastic manner that conveys
the opposite. Another common example occurs when people say, "l'm interested
in what you have to say," but at the same rime, they continue with another activity,
betraying their lnck of interest.
■
Subsriuaing: Ideas and feelings arc communicated only in the nonverbal channel.
Examples: shaking or nodding the head to say no or yes; shrugging the shoulders,
expressing confusion or indecision. Nonve.rb3l communication such 3S vocal into.nation~ pauses, and hand gestures can aJso be used to regulate the flow of conversation (e.g., turn-taking). Yawning might unconsciousJy signal to your guests that
it is time to go home.
■
Expressing emorion: The client's emotions are suggested through nonverbal mc3ns.
For example, crying might signify sadness, fc3r, or jO\' ; a mi~ voice might suggest
anger or frustration.
Counsellors need to interpret nonverbal behaviour cautious!)•. NonvcrbnJ behaviour can have many mc3ning.s, C11C.h of which can vary according to culrurc, context,
and individual comfort level. For example, people from some cultures interact at very
dose personaJ distances, but others experience the same personal distance as intrusive
or even aggressive. Some people consider direct ere contact rude, while others view
avoidance of ere contact as cold or as e-.•idcncc that people are lying. Jn fact, in some
cultural groups averring one's eyes is a sign of respect and courtesy. Hays and Erford
(2010) offer this perspective on Native Americans:
To subd)' ,natch this Je...el o( ere eon12et is respectful and shovi·s an underst2ndinK of the
dient's way o( bein&, Tilt eyt:s 3re oor,skler«I to be the p.,tJ1w-3y to the spirit: therefore.
tooonsiscentl)' look someone in tl,e i')'e is to show 2 Level of e:ntitle.ment or 3iKl'dSM'>n.
It isi ood to Kl.:11l« 31 someone e\'erronce in a whi.le, but hstenh,K in tl,e tl"3d1tion.3I W2)'
is sornetl,ina tl,::u happens with tl,e e3rs and the heart. (p. 320)
kinesics: Tliestudyolbcd7l-,:ua,e.
such u p)sture. lacial expessioos.
pstu,es, and qe aotica
Body Language
Kinesics is the study of body language, including such variables
as posture, facial expression~ gestures, and eye motion. Sometimes body language is
easily interpret~. such as when ~pie use gestures that have dir«t verbal equivaJcms.
For example, people might point to indicate direction or use their fingers and hands
to signify size or numbers. At other rimes, body language is ambiguous and more difficult to interpret, particularly when people communic3tc contradictory mesS3ges. For
example, a person miWlt appear to be listening intently and making appropri3tc eye
concac:t, but if these actions are accompanied by fidgeting and rapid finger tapping,
then the rc3l mcs.s3ge is "l'm bor~."
Even a simple smile may have multiple meaning~ including warmth, amusement,
or ner\'ousness. Te,us ma)' convey sadness, amusement, embarrassment, or fear. Consequently, counsellors should look for multiple indicators of meaning rather than a single
explan3tion. Factors such as context, culrurc, relntionship, power dynamics, and gender
may be loosely or intimately connected to the me3ning of any nonvcrb3l mes.sage.
In some situations where ve.rb3l and nonverbal messages appC3r contradictory, the
client may be 3mbivalent and both messages may be corr«t. For example, a mother
might SO)' how proud and happy she is th3t her son is leaving home to attend college,
but at the same time be crying. In this example, it is dear she has mixed feeling~ and an
appropriate empathic counsellor response might be, "Even though )'OU'rc proud to see
)'Our son taking this important step, it still hurts btt3usc he will no longer be at home."
Voice VocnJ nonverbal cues include tone, \'olume, pitch, and rate of speech. These
variables can reveal if clients arc depressed, euphoric, angry, or sad. For example,
Kadushin (1990) concluded that anger tends to be expressed with sptte.h that is more
108
Chap1er 4
Ema'il aoo text messaging communication is often misintef.
p(eted beeause lhe(e is no access to lhe non-verbal channel
which signalS the subtle meanings. emotions aoo in1en1ions of the sender. To fully process meaning, Ou( bfains
need to access and intefpret bOth the vefbal and the nonverbal channel. Note thal IM nonverbal channel is often
more impoftant aoo reliable, parlicular1y when emotions
a(e invol\led. Generally, nonverbal communk:ation is p,-ocessed in IM rigt\l hemisphere of the b(ain. Damage to
the (ight side of the b(ain can lead to a vatiety of social
communication difficulties, including understanding nonvefbal cues and oar.er subtleties of communication such as
humour Of metaphors (Ame(ican Speech t.a~uage Hearing Association, 201 S).
rapid 3nd loud, whcrc..ls sadness is ch3rac:terizcd by more pauses and slowness of
speech. Silence is 3fso an important component of nonve.rb3l communication. Coun•
sellors need to be 3ble to rc..ld nonverbal cues to decide how, when, 3nd if they should
interrupt a silent moment.
Spatial Oistance/Proxemics Proxemics describes how people use space and dis•
tancc. Hall's modcl ( 1959) is still widely used to describe the four m3in distances (for
Weste.rn.-born C3nadians):
proxemics: Alelmusei:Jtod.scribe
how people sse space -6 diManoe in
social bala'lioia
t. lntim3tc distance is a :one of up to0.5 merrcs (l feet), rcse.rved for private exchanges
of intimate thoughts 3nd feelings.
2. Pcrso03l distance is 3 zone of about 0.5 to I mctre(l to 4 feet), used for less intense
uchanges with friends and family.
3. Social distance is 3 zone of approximately I to 3.5 metres (4 to 12 feet), used for
more impersonaJ meetings and social contact.
4. Public distance beyond 3.5 metres (J 2 feet) is used for casu3l cxch3ngcs, such as
giving a speech or lecture.
How an individu3J uses space is influenced by many wri3blcs, including gender, 3g,c",
culture, ph)•sic3J characteristics. smru~ various personality trait~ and the narure of the
rcfationship. Thus, counsellors should 3dapt their se3ting to mttt the nttds of individual
clients 3nd siruations 3nd remember th3t angry clients usuaJI)• need more space. Moreover, in such situation~ counsellors need more space for safety reasons. Counsellors
should 3fso be mindful of spatial shifts during the inte.rvicw. Often these changes arc
subtle, such 3S when a client shifts his or her chair back, 3S if to say, "I'm not comfort•
3ble with what we're taJking 3bout." Simil3rly, as clients le3n in and move toward them,
counsellors can conclude that imim3cy and trust 3re increasing. When clients physically
withdraw, counsellors might want to avoid confrontation or sensitive topics.
Counsellor Self~Aware-ness of Nonverbal Behaviour Counsellors neo:I to be
3w3re of the.ir own nonve.rb31 behaviour and the subtle ways it might influence the.ir
clients. Counsellors may inndve.rtcnrly communicate displeasure by frowning, rurning
3w3y from clients, or increasing the physic31 distance from clients. Altcrn3tively, they
communic3te interest by smiling, using a pleasant tone of voice, inc.reasing eye contact,
3nd lC3ning toward clients.
SUCCESS TIP
Clients can be very adepa at notic::i~ nonverbal cues lt'lal might betray thei( counsetlol"S'
judgmen1, bias, deception, disinte-rest, anxiety, o, lack of genuineness.
listening & Responding: The BasfS tor Unders1andlng
109
Some counsellors might laugh nervously when they are anxious or scared, thereby
confusing their clients. Counscllors can review videotapes of rcaJ or mock counselling
sessions to increase their sensitivity to appropriate and inappropriate nonverbal com,.
munication habits.
Culture and Nonverbal Communication All cultures have unique nonwrbal languages. In the deaf culture, for example, nonverbal communication is an e>..'tTemely
important adjunct to ASL (Ame.rican Sign Languag,e). Gestures and fucinJ expressions
may be emphasi:ed to define meaning. One Canadian study supported the conclusion
that the French speak more often with their hands and rypicnJI)• use more gestures in their
interactions (Adler, Towne, & Rolls, 2001). Spatial dismnce also differs among cultures.
Mid die Easterners stand and communicate much closer than most Westerne.rs ,vould be
comfortable doing, With respect to eye contact, Adle.r et al. (2001) make this observation:
Like-di.ruul«', potterns o( ere eont:w!t vary around the world. A d1reet ~a:e is eonsidc--red
3ppn>pri:ue (m- speakers in Lat in Arneriea.. the Arab world. :md southern Europe-. On
the other hand. Asfaf)$. Indians,. P2kist3nis,. and northern Europe:ms K"3:e at a listener
peripher.tll't' or noc 2t 2ll. In either ease, deviations from the norm are likelr to make 2
liste,~r u1lM-lnlortabLe. (p. 231)
Some nonverbnl communications such as smiling, laughing, and fro\\•ning have the
same meaning everywhere; hO\\•e-ve.r, some cultures put more emphasis on controlling
the expression of personal feelings., which sometimes makes it difficult to g:iuge the
intensity of the client's feelings. An example illustrates how a counsellor might use
cultural knowledge:
CounS(>IJOr. (S/Ji!aklng ,o a mi.ddlt,a,ged Ad.an u.OO!Mn.J How 3re rou (eelina!
C lient: (Ulitl, a ~rtght nn/Je.) I'm f'me. I'm doina okay.
CounS(>IJOr. On a ~le from I to 10. with JO bein& the best you ~,~ e"\>er (elt. wl~re
would rou put )'Ourseln
C lient: (H~taus.) ?l.·bybe 3 or a -t.
In the preceding example, the counsellor knew that the Asian woman might (as pan
of her culturaJ learning) hide and suppress her feeling~ perhaps not wanting to burden
he.r counscJlor with her pain. The scnling question provides a face~saving way for her
to reveal he.r emotions.
SUCCESS TIP
Client nonvetbal cues will tell )(lu when you have spoken too much, when the client wants
to 131.k, and when lhe moo:1 of the interview has shifted. TrUSI these cues mor'e lhan lhe
WOtdS you Mar.
Working with Nonverbal Communication
Nonve.rb3l communication needs to be considered as P3rt of the toml communication
process that includes verbal behaviour and context. Herc arc four ways to respond to
client nonve.rb3l communication:
I . Use it as a basis for under.standing. By paying attention to the nonverbal channcJ,
counscJlors can greatly increase. their knowledge of those are11.S that are important
or sensitive for the dient.
2. lgnO'fe. lnconsequential nonverbal behaviour (e.g., a small shift in body position or
scratching one's nose) docs not need to be addressed.
110
Chap1er 4
3. Defer. Sometimes nonverbal behaviour is potenti31l)• signif,canc, but a sufficient
levcl of rrust has not yet bttn established. PotentiaJly significant nonverbal messages may come at the end of the interview when there is no time to address their
meaning. In such circumstances, it ma)' be wise to defer, but a mental note can
remind the counsellor to deal with it later when there is more time.
4. Acknowledge in the t~bal channel. Use responses such a~ "Your tears really say how
much this means to you." Responding to nonverbal cues communicates a dttp
sensitivity to the client's experience and (in this example) a willingness to worlc in
the emotional domain.
M etacomm uni cation
Metacommunication is the message that is heard (inte.rpreted), which may differ
sharpl)• from the ,vords spoken or the intended message of the speake.r. Factors such
as nonverba.1 cues (especiaJly voice cone, volume, and inflection), context, history, relationship trust lcveJ (espcciaJl't' regarding unresolved conflict), mood, and many others
all influence how someone interprets a message. So, it is important that we stay ale.re
for signs that a different meaning has been ascribed. For example, the seeming),., simple
offer, "Can I heJp?" might be understood (heard) by different people as:
■
You don't trust me.
■
You don't thinlc I'm capable of doing it on my own.
■
You need heJp, and J'm the one who can solve your problem.
■
You want the credit for what I'm doing.
■
You think J am doing a lousy job.
■
You are willing to do it for me.
■
You are angry because I didn't ask
)'OU
metacommunkation: The messaie
t!l.i'! is Mard (illerp«:fd), lldli::h mar
diffef fromdie ..onls sp,k£ft or the
intended messaie of the speaker.
to hclp.
The following example illustrates what some clients might "hear:"
Coun.seltor I: Wh't' don't you tell hlln how you (eeJ!
Mronll"l8 of the mts:soge fe,, du• client: You Yi~re not smart enou,ah 10 think of th::u on
)'Our own.
Coun.se.U.o r 2: Do you aaree with wh::lt I S3kl!
MNmf1.8 of du• me~ for 11.t- clit'nl: Do not disaaree.
SILENCE
The Personal Meaning of Silence
Another major active listening skill is silence. One distinguishing quality of effective
counseJlors is their mastery of language to communicate ideas and promote change;
however, language fluency a.Jone is insufficient. Counsellors aJso need to understand the
importance of silence in communication. They need to balance their verbal agility with
an tttua11y strong capacity for silence. Sometimes the most effective and appropriate
counselling response is to say nothing.
Individuals and cultural groups sh<:M• considerable differences in their comfort with
silm.cc ln some cultures, silence is a sign of respect. For many counsellors, silence is unnatural and if pauses occur in the conversation they become anxious and fear that their clients
will Stt them as incompetent. They also often burden themselves with pressure to fill the
silent ,roid with words. A silent pause, even as short as a few second~ may lead to inner
panic. Almost on reflex, they act to fill silent moments with questions and interprrtations.
listening & Responding: The BasfS t or Unders1andlng
111
Some p«>ple judae silence hnrshly. They sec quieter people as unmotivated, unin.terested, aloof, rejecting. and ianoram. In n discussion with a group of srudents in a
counselling class, I asked members who rated themselves as "more verbal" to ta.Jk to
"less verbal" members nbout their typical reactions to silence. The verbal members
made statements such as "I feel judged," "I don't think you're very interested," "I'm
boring you," and"( wonder if you care about what we're doing?" Their comments
deart,., indicated that they felt threatened by silence or viewed it as evidence of judgment or lack of interest.
In contrast, the members who rated themselves as quieter noted that they often did
not have enough time to respond and revealed thnt they were fearful or felt inadequate.
Sample comments from this group we.re: "You don't give me enough time to speak,"
"I'm scared to ta.Jk," "I ,vorry about makina n fool of m)•sclf," and "By the rime, I think
of what to say, someone else has already said it."
Silence in Counselling
attended silence: Atleaded sil!llce
is tharacteriled t,, •ali-, eye «intact.
~ al and psycb:dogic-M locus c. the
dient.-.:J self-drsC.,line to • inimite
illemJl-.:J Memal disuauion.
))t) BRAIN
As noted above, counsellors can have the same anxieties about silence as other people
have. Silence mtt)' heighten their sense of inndcquacy as counsellors and lead to unccrtninty in the interview. As a result, counsellors may become impulsive and try to fill
silences too quickly.
However, disciplined counsellors who nJlow silence in their interviews may find that
their relnrionships mkc on nn cmireh• different tone, with thc.ir clients answering their
own questions nnd discovering their own solutions. A repe.rtoire of skills position counscJlors for dealing with silence in nn interview. CounseJlors should become comfortable
permitting silence as wcll as knowing when to interrupt silences appropriately. Knowing
when to speak nnd when not to requires some understanding of the vnrious meanings
of silence. A survey of the use of silence in counselling suggested that counsellors
use. silence "primnril't' to facilirote reflection, encoura,;e responsibility, focilitntc expression of feelings, not interrupt session flow, and convey empathy" (Hill, Thompson, &
Ladany, 2003, p. 513). Silence may be ill-advised, however, with clients who are ps\•choric
or with those who are likeJy to view the silence as punishment.
During silence, counsellors need to do more than just keep quiet; they also need
to attend to the silence. Attended silence is characteri!ed by e\•e contact, physical nnd
psychologicnJ focus on the client, and self-discipline to minimi!c internal nnd external
distraction. Silence is not golden if it communicates lade of interest or preoccupa.tion, or if it snys, "I'm not listening." This means refraining from fidgeting and other
digressions, such ns raking notes or nnswering the phone. At the snmc time, counsellors
should not sta.re or turn the silence into a contest to sec who breaks it first. Counsellors
should 00( nutomatically assume that silence means failure, nor should thq• think that n
few moments of silence means that the work of counselling has stopped. Passive clients
may be busy with thought, or they mny be seeking to gain control or understnnding of
p3inful and forgotten feelings.
S ·
BYTE
·1 ,_
Co20fino (2010) suggests that some clients find silence in
counselli~ difncult and they imagine that the eounseu0r
Mthinks they ate bOting, stupid. a waste of lime, ot a
bad client· (p. 88). He suggests that lheit teactions ate
activated by implicit memories (unconscious) lhat mitrOr
difficult telationShips with theit parents. It seems that
112
Chap1er 4
fot some, ·defences to escape negative feelings come
10 tequite constant action and distraclion to keep us
from becoming frightened ot overwhelmed• (p. 88). In
contrast, CozOfino identifies anothet group of clients who
ftnd silence supportive and a bl"eak ftom lhe ptessutes of
communication.
Every silent interlude: h3s a different meaning, and counsellors need to be 3stute
to discover the signific3ncc: of each quiet momem and the most appropriate response.
Understanding different types of silence: hclps counsellors look for cues 3nd consider
3ppropriate responses. Herc 3re the six common meanings of silence: in counselling:
t. The dient is thinkina.
Although all clients need time to process information 3nd frame their response:~
some need more time than others do. Some clients talk with only a momentary
p3use to catch their brc:3th, but others punctu3te their speech with periods of
re.flection. If counseJlors do not allow this time for contemplation, their clients
m3y fee] disc:mpowerc:d or inadcqu3te. Clients may be formulating their thoughts
or feelings. onh• to be prc:marurcJy cut off by counsellors whose own anxiety with
silence docs not permit them to wait.
When clients need time to reflect, counsellors c3n simply rcm3in anemive and
nonverbally show their interest 3nd involvement through eye contact, open posture,
and so on. Thc:yc3n 3lso verbally indicate their willingness to listen by using simple
phrases, such 3S "I sense )'OU nttd some time to think. That is oka't'· I'll wait" 3nd
"h's ok3y with me if you just need to think without speaking."
2. The dient is confused and un.,;ure o f what to say or do.
Sometimes questions arc undC3r, the focus of the interview is ambiguous, or clients
do not know what is expected of them. Cliems may sit in silence, shifting uncomfortably 3nd 3ttc:mpting to sort out what to do next.
When cliems become quiet because they 3re confused, 3llowing the silence to
continue sustains or increases the clients' anxiety. These circumstances w3rrant
intenupting the silence to cforify meaning, direction, or c:xpcct3tions. Rephrasing.
summari! ing, paraphrasing, 3nd even repetition can help in such situ3tions.
Coun.se.U.or: Perhaps )'Ou' re confused.
Client: V,..1ods.)
Counsello r (Choke 1): t think t mi~t h::n't' confused )'OU with tn)' !:1st q uestion. It didn't
make sense to rne either. Let me reword it.
Counsellor (Choice?): let's s.loo• down:. bit. Help me to underst.:1nd "-hat is unclear or
eonfusi1l{t.
In addition, clients may have diffteulty expressing their idea~ or language: problems ma,., be a barrier. Sometimes clients just need 3 littJe more time to find the
right word or phrase. At other times, counscJlors need to tentative!,., sugi;c:st idC3s
or help clients label feelings.
Clients 3re more likely to be silent during the beginning ph3sc: of counselling
and during first interviews. This is norm3J 3nd usually indicates that clients arc
unsure of what to say or do. Consequently, they depend on the counsellor to t31cc:
the IC3d to cl3rify role and direction.
3. The dient is encounce rins: painful feelinas.
lntc:rviewing 3nd counselling can stimulate powerful feelings 3nd memories. CounscJlors who can tolerate: silence give space to their clients so that they can o:perience and deal with pain or anxiety. (n some c3ses, clients may be ambivalent 3bout
facing thc.ir fceJings. They ma,., be afraid of their intensity, or they m3y be unwilling
to face thc.ir feeling~ at lc:3st at this time. Silence is 3 chance for clients to examine:
the merits of continuing further or rctrenting to safet)•. Usu3Jly, such moments arc
obvious because the discussion is intense immediatcJ't' before the silence.
When clients arc struagling with powerful feelings. counsellors m3y need to use
multiple responses. First. you C3n 3llow this type of silence to continue. Responding
listening & Responding: The BasfS t or Unders1andlng
113
with :.ntentivc silence can be very thcmpc:utic and supportive. 1t says, "I am here. J
understand. 1 have the courage to be with you as )'OU dc:aJ with your P3in."
S«ond, you can suppon silence with empathy when dc:aJing with powe.rful
client feelings. Othe.rwise, clients might fcc:l ignorc:d o r misunde.rstood. Empathy
confirms that fcc:lings have been hc:ard, and subsequent silence gives the client time
to p rocess. Empa thy might be u~ to let clients know chat they have been u nderstood. As well, empath)• tells clients that they have not been abandoned and that
their counsellors arc ready, willing. and able to be with them while they consider
their feelings. Once the co unsellor has expressed empa thy, silence may be appropri,.
ate. ln the following example, empathy frames nvo long, silent moments:
CounseUor. As I hsten to )'Ou. I am bei.innin¥ to sense your (eelinK o( resentment that
your mother cont inWIII)' t ries to run )'Our life.
( I 5 ~ d J of Ji.ftnte)
Client: (fMrs m NT eyes.) Resentment! That's only port of it. I don't think I could ever
li"e up to her expectations..
(CounklfOJ ,n.aintahu eye Mntat1. far:n dknt.)
(IO~dsof slftnte)
Client: But it's K'()ina to be okay. I reali:e that I h::t\'e m)' oo•n eicpectations to n~t. It's 1ne I
h::t\'e t'O face in tll(' 1nirror.
Counsellor: Sounds like )'Ou are be.:i.nnina to ::.ccept that your mother is not ¥Oifi¥ to than~-e
and. th::u onlr )'Ou ha"e oontrol over who you are and how you act.
4. The client is dealin~ with issues o( trust.
Before crust develops in the counselling relationship. clients may be hesit:mt to share
personal information, and they may communicate this reluctance through silence.
T h is is a normaJ and self-protective way for people to avoid rejection and maintain a sense of control over private matters. A different trust issu e may arise with
involu ntary clients who use sile nce as a W'll)' to control o r sabotai;c the interview o r
demonstrate hostility. The.ir silence says what the client may want to express: "I'm
here, but you can't make me talk." Silence becomes a way of retaining d ignity and
control in a siruacion in which thq• feel d isempowercd.
GencraJly, counsellors will want to move the interview genth• toward more
openness and intimacy. One way to proceed is to acknowledge the risk in sharing
a nd to d iscuss issues of trust. You can open the door with a comment like this:
" ( know it's not easy to share your feelings with a stranger. You don't know me
rec, and you can't be sure how 1 might respond." Another strategy is to move at
the client's pace and discuss less threatening content until rrust in the relationship
dcve]ops.
Sometimes it is preferable to put trust issues on the cable rather than try to proceo:I when the.re is ob-.•ious resistance. Consider using a lc:ad such as the following:
CounseUor. I'd hke to share a per«ption with )'Ou. 1',..e not iced that whenever I ask 2
question. you answer me quickly. :lnd then )'Ou beconl(' rathe-r silent. I'm v.-'Orried that
there mi$:ht be so1ne problems betw~n you and me th::u w~ should dis.cus!l. OT perhaps
you ~ it differently. In any case, I think it v.--ould help i( we could discuss it. I'm ce-r,
tainl't' w1ll1n& to ltSten to anr o( )'Our concerns or fttlin~s.
(Oknt luJknt.)
Coun!l(>IJOr. I'm not )'Ou, 2nd without )'Our help I c::rn't underStand how you (eel, but I Sus.
pen )'Ou 'd r.uher not be here. Th::rt ·s how I'd (eel in the same drtumstance.
ln the preceding example, the counsellor's invitations do not guarantee chat the
client will open up to d iscuss feelings about being forced to attend the interview;
114
Chap1er 4
however, such openness to discuss rhe issue frequently works. ln any c3sc, clients
will have heard the invitation, and it ma,., help to build trust.
5. Silence L-. the client's usual way.
Some clients arc quiet by nature. They arc unu~ to giving long or spontan«>us
response~ and they may be more comfortable keeping their ideas to themsdvcs.
Silence is not a sign of counsdling failure, so counsellors should avoid the tempt3•
tion to end it prcm3turcly. Sometimes counseJlors need to modify their own expectations and W'tl)'S of rcfoting to nJlow for the extended silences of some individuals.
As we will sec in the next chapter, there arc interview techniques th3t arc effective in drawing out quieter clients. For example, opcn..ended questions that cannot
easily be answered with a simple yes or no ma,., help overcome P3ttcrns of continued silence. Another technique is to discuss with clients how silence is affecting the
counselling work and then to explore ways for them to become more expressive.
Sometimes clients don't understand the expectations of theircounscllors, but once
they do they arc willing to cooperate. Professionals should re.fleet on the foc:t that
whereas they have had training in the skills and process of counselling, their clients
have not. Clients may be inaccurately seen as resistant when they are just unsure
of what to SU)'. This underscores the importance of counseJlors keeping clients
full,., informed by taking advantage of opportunities to explain their intent and
procedures. Simple stnteme.nts such as the following hcJp dcm)'Stify the counsel,.
ling process:
Cou n.se.U.o r: l 'rn sure there's tn<n-e th:u you ean tell me. It will help rne t'O understand better
i( you tell me more det,i1ls 3nd perhaps s:_l\'e me a few ex3mple~
Counsellors can also adapt the.ir methods by using strategics that require less
verbal inte.rnction. Children, for example, may respond better to play, art, music,
and drama. Adolescent males may be more motivnt~ to talk if the interview is
conduct~ in conjunction with an 3Ctivity, such as a walk in the park or a game of
pool. Counsellors arc wise to remember that while they tend to be most comfortable with verbal intcrnc:tion, their clients might favour other methods. For example,
some clients like to write in a journal, which gives them a chance to think inrrospcctivcJy without time pressures. With thesedicnt.s, counsellors might seek agreement
to use rdC\.nnt journal entries as reference for discussion. (n the following C3.SC. a
counsellor relates how poetry was used:
The dient was 3 20.rear-old Yi'Om3n who se,tn~. at f'irst. n>1uttant to ulk 3bout
her depre$$iOn. Her usl.dl responses wen> one•Yi'Ord or short ansv;-erS.. I remern,
bered th3t she h::.d mentioned th3t she liked poetry. so I asked her i( she would
be willina to brin¥ some o( it to our meecini, She was wi.llin¥ 3nd in (::.ei e~er to
sh3n> her ..vork. She brou¥Iu a short poem t'O the next session. wh.id, she re:3d to
me. TI,e poein m,e3Jed her deep depression 2nd her preottup3tion with death.
A(terw3rd. we talked about her tonnent at a Le\'t:I t~t ..vould not h2,'e bee!, other~
wise possible. fa,d, ..veek, she brou¥ht 3 new poem. 3nd these poems bec=in~ our
startina point. As she be¥aJ1 to (eel better 3bout herSeU. her po.:-rns be<-3tne more
buorant and optirnistk, 3nd. the,., beeame one n~sure o( her pqress..
6. The client has reached closure.
Silence happens when there is nothing more to say about a parriculnr topic or idea.
Silence is a way of saying, " l'm finished. Let's talk about something else."
When counselling topics reach natural and appropriate closure, counsellors
need to move on to a new subject. They ma)' break such silence by seeking confirmation that an end point has indeed been reached. One strategy for prevent•
ing premature closure is to nd:nO\\rledge the possibility of closure, as wd) as the
listening & Responding: The BasfS t or Unders1andlng
115
possibility that the client may need time to formulate more idC3s. A comment such
as the following acknowledges both aJtc.rnatives:
CounS(>JIOr: I'm think in¥ th::rt we miilu h:t\'e K(Jne as far :u we e,n with that ide:3. O r perh3ps
there is tn<n-e )'Ou would like to S3y.
Subsequently, a transition to a new topic is appropriatc.1t may also be valuable
to take a few moments to summari:e before moving to a new area of discussion.
Nonverbal Cues and Silence
Sometimes nonverbal cues can rcveaJ the meaning of silence. Presenting the open palms
o f one's hands ma'>' SU)', " \Vait. I neo:I time." Looking awa'>' and clenching a fist ma'>'
signal an angry silence. At other time~ the meaning of silence is unclear. Jn such situa.tion.s, counsellors may choose to let the silence continue for a while to sec if its meaning
becomes apparent, or they ma'>' wish to see.k help from their clients to understand it.
Following ::are some sample responses th3t counsellors can use:
■
You've (We've) become very quiet. I'm ,vond cring wh3t that means.
■
HcJp me understand the meaning of your silence.
■
Perhaps you arc hesitant to tcll me, or maybe )'OU just need some rime to think.
Although silence is often ambiguou~ and understanding its meaning is difficult,
some dues can help counsellors inter p ret silence. Tab le 4.4 presents some of the mes.sages of client silence. The table includes a range of nonverbal cues and idC3s about
how to respond to each; however, all nonverbnJ behaviour neo:ls to be inte.rpreted with
e>..'trcme caution. The same behaviour may have multiple meanings. C rossed arms may
SUfiest defensiveness but may also signal that the client is physically cold, or the client
may be both defensive and cold. You need to interpret all nonverbaJ behaviour by considering the individuaJ client and the overall context in which the behaviour occur~ and
then check with the client to confirm accur3cy.
Encouraging Silence
S ilence can serve a number of useful purposes in counselling. It provides rime to cxpc.rience fcclings and contemplate. lnsight may emerge from moments of uninterrupted
thought. Therefore, it makes sense for counsellors to promote periodic silence in their
interviews with clients. This may be panicularh• useful when working with clients who
CONVERSATION 4.2
ST\JOENT: How IOOg is a feasooable amount of time to allow
a silence to continue?
TUCH£R: Without knowi~ the context, I can'I answef )'Ouf
question. Somethn es aftet a few seconds of sdence, it's
appropriate 10 bfeak in and say scwnethi~. In othet cifeumstan:es. an extended silence of several mrtutes is okay. Ead'I
situation must be IOOked at indi\lidually.
STUDENT: I agree, but my pl'Oblem is that I get uncomfortable
after- a few seconds. I get so anxious that I usualty rUSl'I to say
something, eyen when I know I sholACI keep quiet.
116
Chap1er 4
TEACHER: Try paying anent.ion to 'llf'lat you're saying to your.
setf during silent ll"IOt'l'M?nts. Watd'I for depfedating se•-talk.
s.ud'I as Mlf I d0n1 say something, the client will think I'm
incompetent.· Counter- this by reminding yourself that sdence
has its place W'I counsetti~. If you inter-rupt too soon, you rob
clients of important opportunities to reflect. Remember that
comfort wtth sileoce can be learned, but as with au Slults.
leafl'liing feQLifes practice. It may help 10 have a gtass of water
so that you can take a long, SIOw sip to pfevent speaking
premahxety. Deep bmathing may atso help. finalty, do 001
over'Compensate. Some silences sholAd be inter-rupted.
TABLE 4 .4
Responding to Silence: Nonverbal Cues
Cllenl AttJons
Palm ol one hand ,.;,,a 90 d,wees,
S(juintiog. fur(owed tx-ow, eye m::wement,
and smiling (positive 0t pleasing thOUgt\U.
Intended Message
Shoulder Shruggi~. raised palms, and
r-apid eye movement.
"Help--fm confused and
don't ktlow what to do next:
Se-t the direction; clarify instructions.
Ignoring°' providi~ inapptopriately shor1
answe-rs, movi~ the chair baek.
"You can't make me talk: "I
don't want to be hete. •
Communicate that it's Okay 001 to talk..
Empathi:ze with resistance.
Describe your feelings wtlen forced to &alk.
Starling lo lalk, ab,upl!y Slopp;og, shaking head, and stutte(mg.
"I don't know Vtt'lether to &alt
or not.·
Empathi:ze with ambivalence.
Discuss the risks of Sha(mg and not Sha(.-ig.
Pf¥ieal withdr-awal. averted eye contact
carefully measured WOtdS, and whispering.
"I'm scared of what you might
thlnk of me.·
Reassure and convey a nonjudgmental attitude.
Tears, covering eyes, quivering lips.
flUShed face, loold~ at the ft()()(, and
trembling.
Low vdce tone, a pattern of short
answe-rs.
"I'm overwhelmed w'ilh these
feeUngs. •
Show empathy, use attended silence. and tneo
;,This is the way I am. I 000'1
say much:
Accept it as a cultur"al or lndividual norm.
Gentty encour-age w'ilh open-ended questions.
Leanrng baek, smiling. saying, .. That's it·
"I'm finished.•
Summarize.
Change the topic and move on.
"Please be patienl I need rime
to thlnk.:
Counsellor Respon-Se Choices
Verbalize willingness to wait.
Indicate attended s~oce v.;th eye contact and
Other nonver-bal expressions of support.
Rephrase the last response.
reveal further empathy.
ExJ:jain lhe importance of sharing.
are impulsive and diems who seem afraid of silence. The followina are examples of
counsellor leads:
■
I thin k it miaht be useful if weeoch rook a q uiet minute or two to think about this
idea.
■
Let's pause for 3 moment.
■
lt's oka,., with me if you wam to thinle 3bout it for a while.
■
\Vhcn you're ready, we can talk about it. In the meantime, I'm comfortable if we
don't say 3nythina.
■
Occasional silence is somcthina that m3y occur during our time together. Sometimes one or both of us will need time co thin k.
SUCCESS TIP
Avoid the imputse to respond irrwnediately to a client's question. Sometimes dients ask a
ciuestion bul after a pause go on to answe-r ,t lhemse-tves, ex.ptessiog their thoughts and
feelings in more depth. This rS another example of hOw silence can be a high-level counselling response.
PARAPHRASING
Paraphrasini means rest3ting the client's words and ideas in your own words, but
paraphrasina is not the same 3S r~pe3tina what the client says. Repetition confirms
mcmoriz3tion, but it docs not mean that the words and ideas h3VC been understood.
Paraphrasing is a way of stating thoughts from a d ifferent angle. The defining feature of
3n accurate p3raphrase is its interchangeability with the client's ideas.
listening & Responding: The BasfS t or Unders1andlng
pa,aphrasi,_ A IIOlljldgmeau l
1u1atement of the dient"s w.ords and
idei.s in the 00'.llselkw'SOIUl 'Mlf'ds.
117
Paraphrasing is an important active listening skill that sc.rves two purposes. First,
paraphrasing confirms that counsellors have been listening and have understood clients.
Second, paraphrasing gives clients an opportunity to correct inaccuracies. Jn the begin.ning phase of counseJling, paraphrasing is particularly important b«ausc the counseJ,.
lor is just starting to unde.rst:md how the client thinks and fceJs. Paraphrasing helps
the counseJlor "J;ct on board." Paraphrasing, summari!ing, and empathy arc reflective
skills that are crucial to dcveJoping the counselling relationship. As well, it helps clients
explore their problems in a way thal is less forceful and directive than direct question,.
ing techniques.
Paraphrasing concentrates on immediate client statements. It is presented without
judgment and without an attempt to solve problems. The important point to remem,.
ber is that paraphrasing does not add to or alter the meaning of a client's statement.
(nstend, it promotes more discussion and elaboration. (n the following example, notice
how the counsellor's paraphrased responses otpture the essence of what the diem
has said:
Client: Losin& 111y job was 1ust the start o( a bad )'i'3r. I h:a"e h:ld bia riurri.:1~-e probtems
too. ::and now 111)' d.:1uahter is on the scn:-et.
CounU"Uor. You have h::.d 3 nuinber of serious thin{tS i'°' wronK thii year.
Client: Ri,aht now, the most u~•ent thll,i is t'O Ond some W3)' t'O ~t 111y dauKhter b3cl.
home. I 1ll'('d to know she's s:a(e.
Counsellor: So the (()("us o( )'Our attention ii ~in& t~t )'Our d::al¢hter is out of d.:11~r.
Client: I'd lo"e t'O be able to le:t,'e mr husband ::and move to a new dty. but "-hat would
h::appen to mr d::au~ter! I e2n' t be seJOsh.
Counsellor: I( it were just you, you'd know wh::at
your priority.
t'O
do.. but )'Our d.:1u~1ter really is
Client: You're ::abso1utelr ri~t. On~ she's ok3r, then I'll uike c::an:- o( mrsel(.
It is always preforablc for counsellors to present paraphrases tentative.I)•. This provides the opportunity for clients to correct errors, confirm accuracy, or provide more
det::ail. A tentative paraphrase opens discussion for deeper o:plorntion. Statements such
as "Correct me if J'm wrong" and "Would it be foir to Sil)' . . . ?" suggest tem::ativencss.
Table 4.5 provides some other examples of p::araphrasing statements.
Sometimes counsellors move too quickly by doing two things at once. ln the foJ,.
lowing example, the counsellor offers a potcntinll)• useful paraphrase and then abruptly
switches to a question that will move the interview in a different direction:
CounseUor. As I~ it, )'Ou\'e re::.ched .:1 point in )'Our li(e where )·Ou're not ~-oinK t'O
take 2ny rnore abuse. \Vh::at do you see as )'Our opt.Ons!
In this o:amplc, a vocal pause or short silence should have been given to allow the
client the chance to confirm th::at the paraphrase was correct. Client confirmation may
come from both verbal and nonverbal channels.
TABLE 4.5
The l anguage of Paraphrasi ng
Put a different~. you seem to be sayi~ .
As I uOderstand ii .
Is lhis right? You're saying.
In Othet WOfdS • .
It seems as if .
It sounds a bit like .. .
As l heatit .
TM picture I get i:S •
118
Chap1er 4
Paraphrasing and Empathy
Paraphrasing differs from c.mp3thy because it concenmncs on the content of mcss3g~
information, facts, details, and descriptions-whereas empathy focuses on feelings.
Paraphrasing may be less threatening to clients who have trouble discussing feelings. Para,
phrasing can be u~ as a prelude to empathy, with cmP3thy being introduc~ as clients
become more trusting and willing to address their feelings.
(n general, paraphrasing arises from words that the client has actually said, whereas
empathy builds on verbal and nonvcrbnJ cues, responding to feelings that the client
may never have identified. Paraphrasing is more closely rclat~ to summarl!ing. Both
paraphrasing and summari! ing condense content, and both highlight key ideas in the
client's communication.
The following example shows the difference between paraphrasing and empathy:
Client : Noc h:wina a ,ob is~ttu-)¥ me dovm. I know it doesn'c help to sit in front o( the
TV 211 day hopin¥ s<.uneone will call with tn)' dreim job.
Cou nsellor p:l.r.l.phnlSe: You're aw;,ire th::u you have l'O become more :ietive in se::.rehina
(or:. job l'O stop the downward sltde.
CounselJor empath y: You' re ::rware that wishina for a job o((er is ma.kill¥ you depressed.
ln the paraphrase response, the counsellor paid anemion co the key message (content) in the client's statement and then restated it in different words. ln the empathy
response, the counsellor picked up on the emotion3l component. Counsellors often find
that simple paraphrases such as the prec~ing one have a powerful, positive effect. Paraphrasing helps clients reali:e that counsellors are listening and that they are interested.
Subsequent]}•, clients who fod heard and understood often release the.ir defensiveness
and fears about sharing. ln turn, the process o( sharing and exploring may generate
new understanding or insight for clients regarding their foeJings and problem situations.
SUMMARIZING
Summarizing is an active interviewing skill that can serve a number o( purposes. First,
summari! ing confirms understanding and checks assumptions. Since client mes.sages
may be complex and ambiguous, it is crucial that counsellors validate their inte.rpreca,
tions. \Vhen they summari: e content, counsellors present a snapshot o( their clients'
main ideas in condensed format for verification.
Cou nsellor: So far, )'OU se,ern to be s:ayin¥ th::u )'OU don't se,e 211)' point in lr)'ifl¥ the
same old scr21~ies. T2lkin¥ l'O he-r didn't see.in to work. ijp,onna her was e\'e:n v."'01"$('.
Kow )'Ou' re not sure wh::u elSie )'Ou t21n do. Does th::n seem like an :)C('ur2te surnm::ary!
CONVERSATION 4.3
STUDENT: If the client has just said something, what's the
pcint in testating it? I think that a d ient migt\t find pataphtaS-
iog very imtaling..
TEACHER: You're sayi~ why an.get your client by repeati~
\\tlat's obvious?
STUDENT, That"s nghl.
TEACHER: Notice that I just pataphtaSed what you said, and
you seemed Okay with it.
STUDENT, (Nods in agreement.)
TEACHER: AA effect ive paraphrase is m::,fe than just mechani:.al festatement Or' pa,rl'Oti~ ot the client's worcts.. Verbatim
restataments may imtate clients because lhey don'I add
anythi~ to the interview. A useful pataphrase considers client ideas ftom a diffefent perspective. Paraphrases ate most
potent when they invite ot stimulate further etabOration and
discussion. Nevertheless, I think it's best to avoid e.KCessive
use of pataphrasi~ 0t any othef Slull. use pataphrasing
vd'len you ~ to chock yout pefCeptions and when it sootnS
important to let a client know that you uodet'Sland.
listening & Responding: The BasfS t or Unders1andlng
119
Second, summari!ing is a Wtt)' of o rgani!ing complex data and content by tying
d isjointed but related ideas together. This ma,., help clients look at existing problems
d ifferc:ndy, thu~ permirting new insights. Such summaries can :.dso significant!)• reduce a
client's confu sion by o rde.ring ideas in a more coherent sequence. The following example
is excerpted from the midpoint of an hour-long counselling session. Prior to this point,
the d iem had been ta.Jking a.bout a variety o f ways to manage his d ep ression.
CounS(>IJOr. Let me Stt 1f I can su1n up what ..ve'"e been ~U:.inK ::ibout. Essenti.:11llr, 21s
you ~ it, rou need 10 Yi-Ork on lorl{t~t erm solutions. so-ine refated to improvin& )'Our
fl tncss,. others ta~til,K )'Our social life. As well. rou want t'O look at thin~s rou C21n do
iinmedi.:ue1y t'O reduce rour depression. indudinK s.eui~ a medical 21nd look.in& for
some fun thin,a:<i to do. ls th:u a fair way t'O o utline our discussion?
T he counsellor's summary helps the client systemati!c his o r her action plan. Sum,.
ma.ries such as this help clients and counseJlo rs identify priorities. By summarizing,
counsellors configure their clients' problems and issues in a way that gives precedence
to certain ideas.
T h ird , summari!ing can be helpful in working with clients who are verbose-who
introduce irrelevant mate.ri3I and wnnder from topic to topic. Summari.!ing separates
what is important from what is irrelevant b\•focusing the inter view on particular themes
and content.
CounS(>IJOr. From w~t )'Ou\-e ~n sayil,K, it Sttms th at your problems 21t Yi-Ork with
your supervisor 2re your top priority. Do you aaree.!
content St.nrna,y: As.marythat
lccum • content and is• • IIEdi'..d
conoe.sing of the client's •crds.
theme St.ftlmaty: As.taaarythat
edits-«Ss.wy detail .tatt~s to
ii.ntifyley pal.'lerns and areas« urgency.
Summarizing ma)' focus on a short time within an inter view or it may encompass
a broader pe.riod, induding the whole interview o r the entire helping relationship. Two
types of summaries arecontent(or simple) summaries and theme summaries. A content
summary focuses on conte nt and is an unedited condensing o f the client's word~!
ideas arc included. A theme summary ed its unnecessary detail and attempts to identify
key patterns and areas of urgency. The fol!O\\•ing example illustrates the two types of
summaries. The client, a 45-'t•cnr-o ld male, has been describing how unhapJ)\' he has
been as a welder.
Client: From the Ars:t d ayor1 tl,e ,ob. I k new th:n weld in¥ wasn'1 for me. E\'en as21 duld. I
alW'3)'S wanted to wo&. with people. As a wi'lder. I spend 11\0St o( rny time on my o vm. La.st
v.--eek was 21 aood example. Frorn ?1.fonday to Timrstl3y, I was in tl,e shop bo.sei1~1t. a.nd
tl,e only time I had :l.11)' h uman interact ion was when I v.--ent to lunch. It's not mud, better
::at home. My wi(e has aone back to 9Choo1. so she's b u sy with homN-ork e\'ery niaht. The
kkls a.re arown. ailCI we don't see them t~t often. AU I seem to do is work 21nd watcl, n.,:
\V1th tl,e junk on TY. th at's not mud, o( 2 li(e. TI,e only thi~ worth w:1td,i1l{t ii ct\.1'.
Content (or simple) s ummilf)·: Frorn the beQ:inninK, )'OU were aware th::lt your weld ins.
career didn '1 meet )'Our lona,s:t::indins. need to work with people. It seems th::lt your
work. with last week as a l't'Pk.:111 ex21mple, lea,-es )Ou on your OYi'n. With your wi(e
s tud yinQ: 21nd your children aone. TV olfer-s little com (Ort.
Them(> summ21f)·: You ·re (eel in¥ 001::ated. Keitl,er ,.·our job nor )'Our home life ah'\"S )'Ou
mud, opportunity 10 S3t isl't' )'Our L<n,~,standh,K need t'O work with people.
LIVE: An IICfOl'1ffl tu descrbs tile
loure~ial steps in s.aa.riz-,:
ista1. ii.ntify, Wfbaliie. m luate.
120
Content summar ies make linJe or no ju dgment about rclcwncc. The major ,;oaJ of
the content summary is to organi!e ideas and sum up d3 t3➔ Theme summaries a.re risky.
They require interviewer s to d etermine which information is rcle\.nnt and which is irreLevant. In the preceding example, d ifferent interviewers might focus on different theme~
depending on the.ir mandate. A researcher investig:iting u•.le-.•ision p rogramming would
hear this client's statemem d iffcrcml't' from a career co unsello r or a marriage counsello r.
Good summari!ing involves four csscntia.1 steps that you can remember with the
acronym LIVE: listen, identify, ve.rbali:e, evaluate.
Chap1er 4
Step 1: Listen
In this step. the ta.sic is to listen carefully to verbnJ 3ncJ nonvc.rbal
mes.sages that provide dues to content 3nd meaning. Counsellors must exercise a grc3t
deal of scJf,<Jisciplinc to 3\'0id contaminating clients' idC3.s with personal bi3.s and dcfi•
nition. Counsellors can aslc questions, request example~ and probe for definition as
ways to reduce any rislc of imposing their own biases and assumptions. At the s3mc
time, they need to control distractions, indudingoutside noise, daydreaming, attending
to other activities, or becoming preoccupied with what to say next. In genera], active
involvement in wh3t is being said divens counsellors from any temptation to become
distracted. Another technique to avoid distraction is to silently repeat or review client
mes.sages.
Listening mC3ns pn)•ing attention to the five W's -Who? \Vh.nd Where? \Vhcn?
Why!- plus How? Sample questions co consider arc: \Vhom arc clients t31king 3bout!
What are they S3)'ing? \Vhat arc they feeling! \\:lhat are they thinking? \Vhcn docs this
happen? \Vherc docs it occur! \\:lhy docs it happen! How are clients saying it?
Step 2: Identify and Interpret The prim3ry goal of this step is to make sense
of nJI that has been said and heard. This involves distinguishing import3m informa•
tion from irrelevant inform3tion, identifying underlying themes and P3ttcrn~ and
setting priorities. 1t also means hc3.ring what has been said in context and avoiding a
common pitfaJI in listening: not seeing the forest for the trtts. The counsellor's goal
is to arrive at as similar a meaning as possible to the meaning the diem intended. At
this step. counsellors need to remember th.at their ~rsp«tives 3rc biased. \Vhat they
deem significant 3nd what their clients view 3.S important m3y differ sh3rply. This
reality underscores the importance of discussing these differences openly within the
interview.
One technique that counsellors can use is to listen for keywords in cu.h of the
three domains: behaviour, thinking, and feeling. Some sample reflective questions for
counsellors include the following:
■
\Vhat is my client doing?
■
How docs he make sense of what is happening! What beliefs docs she have about
hc.r problem situ3tion!
■
How is he feeling?
Step 3: Verbalize Your Understanding The goal of this step is to vc.rbali!c ),'Our
understanding of what the dicnt has said in a summarization response, using words
3nd phrases that the client can understand. Undc.rst3nding is 31\\"ll)'S tentative, at least
until clients have 3n opportunity to confirm or ch31lengc counsellors' perceptions. So,
this step is crucial to test the accuracy of comprehension.
The move to a summarizing statement can be flagged by leads sud,, 3S the following:
■
To summ3rize what you've been saying .
■
lf I may offer 3 summary .
■
To be sure I understand .
■
Let's summari:e .
■
Summing up .
■
Let's pause for a moment to recap.
Step 4: Evaluate After summ3ri!ing for clients, the next step is to watch and listen
carefully for signs that the summary is correct. Accurate summaries ma'>' be signaled
nonverbally by the client's head nod~ smile~ and relaxed posture, and vcrbaJly with
short statements, such as "That's right" or "Exactly."
listening & Responding: The BasfS t or Unders1andlng
121
Oisagreemc:nt may be: dirc:c:t, with c:.xpressions lilcc: "No, that's not right," or it
may be nonvc:rba.J, with clients mO\'lng back, hc:sitatina. or looking away. Lulcc:warm
responses, such as "Kind of," are subtle: clues that your summary is incomplete or inac~
curate. In addition, para.Jinguistic cuc:s, such as spcec.h that is drawn out, may indicate:
a lukc:\\"8.rm response:, c:vc:n though the: words may appenr to confirm undc:rscanding.
\Vhc:n dc:aJing with lukewarm responses, counscllors need to use questions and state:~
mc:nts to invite: confirmation. This reinforces the: notion that the dienc's riaht co be
henrd accurateJy will be: respc:c.ted, and it empowers clic:nts to take: an active: role: in
evaluation. Lc:ads such as the following can be: used:
))l} INTERVIEW
■
Ooc:s my summary capture the: important points!
■
I'm wondering if you agree: with my summary.
■
Is that accurate?
■
How does that sound to you?
■
What have I missed?
4.1
The followii,g interview excerpt illustrates some important concepts from this ch.apter. This is the second interview with a
client who is seeking help with anger management The excerpt begins abOut frve minutes into the interview.
counsellor: Lei's feview what we talked aoout laSI week.
(Three seC011ds of silence. Client smlle.s and oods her
head.)
Analysis: This opening comment sets the stage for a summary
revittw of the last interview. This is important for re-ttslabllshing
the contract. It confirms that issues important in the last session still remain priorities.
Counsellor: I remembet two pcints. fll'st, you indicated
that you wanted to find out what youf tr1ggers af&-the
thi~ that lead you to bse contfel. Second, you wanted
to explOr'e some ideas fof staying in contrOI. What have I
missed?
Analysis: After offering a summary. it is important to confirm
its becuracy. In this case, the counsellor uses the brief silence
to allow for the client to respond. This theme summary foe.uses
on what the counsellor cons;ders to have been the priority of
the last session. Checking for client agreement is an imJ)Ortant
component of making su,e the p,ocess is cOl/abOrative.
Analysis: The client confirms partial accuracy and then adds a
point that the interviewer's summary has missed. This should
alert the interviewer to the client's priorities.
Analysis: A succinct paraphrase offers another pe,spective.
Perhaps the counsellor missed an opportunity to get mo,e clarity on the WOrd ..pushover."
Client: Yes, that abOut sums it up. But I don't want to
beCOme a pushover".
COunsellor: So, a•f manage~nt but not at lhe ex()Mse
ol gjviog up your rlghlS.
(Ten SSCC(lds of si-e.)
Counsellor: vou•ve beCOme very quiet. I'm suuggling to
under"Stand what that means.
(Ten secot'ldS of silence. C/J'ent /coks at Ille flcor, tears Ill
her eyes./
counsellor: Pethaps thi:S i:S painful for you to think aoout.
ClleM: In eitety relationshiJ) I've ever had. I end up being
the underdog. I do everything to please my partoet, but
nothing fOr' me. I a~ysgive in. Inside, ifs a diffetent sto,y.
I'm ful of rage and resentment.
122
Chap1er 4
Analysis: There is not enough information fo, the counsellor
to understand the meaning of the client's silenc.e. It might be
tempting to move on with further quest.ions, but the counsellor
suspec.ts that the silence is significant. A gentle statement
invites the client to give meaning to her silence. Nonverbal
cues (looking away and tea,s) suggest that the client Is
encountering strong feelings. The counsellor then focuses on
feelings.
Analysis: The client's comments suggest tha-t she is willing to
take a trust risk. This is a critical moment in the interview. The
cllent will be watching carefully for signs of ,ejection.
i>»
INTERVIEW 4 .1
Listening, Silence, and Summarizing Skills<contn.te)
COunullo,: Teti me mote.
(Leat'IS toward c/J'ent, maintaining eye COflttJct.J
Client That's 100 essence of the prOblem. I let things butld
up inside and 1hen I ex,:,IOde. Once, I was even f11ed when
I bleN UJ) at my bOSS.
COunullor: So, your anget is a bit like a time t:ornb, tickl~
away until you explode.
Cller,, El<aclly.
(Short silence..)
Client But, as I think abOut ii. it's not just my a~t.
guess what I'm realy afraid of tS nev« having things go
myway.
COunsello,: As I hear it, you seem to need to have more
controt <:Net you, life.
Client: No, lhat's no1 it H's not contfol so much as
validation.
Analysis: This directive encourages the client to go on with her
story. It confirms direction and Is short enough not to Interfere
with the momentum that the client has established. Attending
behaviour shows that the counsel/Or is Interested and o,:,en to
hearing the client's Ideas and feelings.
Analy:sls: The client continue.s to risk. This signals that trust is
growing, but the connection may sJill be very fragile. As we will
see in Chapter 6. It is now impo,tant fo, the counsellor to make
an empathic connection with the client's feellngs.
Analysis: Here the counsellor paraphrases, using a simile that
is consistent with the client's phrasing.
Analysis: This silence m~ be a simple pause that allows the
client to decide what to talk about next.
Analysls: The client does not accept the counsellOrs paraphrase as accurate. Secure counsellors need not fear such
mistakes 0r corrections. The client's willingne.ss to correct the
counsellor indicates that she has enough trust in the relationship to feel safe In challenging the counsellor. Ofcourse, some
clients may challenge because they have no trusJ.
Reflections:
■
■
■
If you were the counsellOc in this interview. what feelings might you have experienced during the extended silent
moments?
Early in the interview, the counsellor asks, MWhat have I missed?" Consider the advantages of this question compared
to an alternative. "Have I missed anything?"
Sugge:st le.ads that would enable the c-0unsell0c to follow up on the client's statement, • 1don't want to be a pushover."
SUMMARY
■
Listening is the basis for understanding and a prerequisite for relationship
development.
■
A wide range of problems, such as culturaJ and language barriers, difficulty in
framing idea~ outside noise. ambiguity, loss of objectivity, and spcec.h problem~
can inte.rfere with this listening process. Competent counsellors remain sensitive to
these problems and take steps to overcome them.
■
Active listening (silence, anending, summari! ing, paraphrasing, questioning, and
empathizing) is an essential tool for inc.rc3sing unde.rstanding, communicating interest, and letting clients know that they have been heard. Active listening involves
counseJlors in an ongoing process of pa)•ing attention, listening, exploring. and
deepening.
■
Significant information is communicated through the nonverbaJ channel.
listening & Responding: The Basis tor Unders1andlng
123
■
Silence may have multiple meanings. Effective counsellors are comfortable with
silence, but they :.dso have the wisdom to know how and when to interrupt it.
■
Attending is the way that counsellors communicate that they arc physically and
psychologically committed to the heJping relationship.
■
Paraphrasing is a way of restating someone's words and ideas in your O\\'n words.
Paraphrasing is important in counselling because it confirms to clients that counsel,.
!ors have heard and understood them.
■
Summarizing helps clients o rg:aini:e complex thoughts and is used to focus on rcl.evant themes and content.
EXERCISES
Self-Awareness
1. Describe an encountefyou have had where nOOW!tbal communication was more im(X)rlan.t than the content of lhe vet-
3. Conducl an. interview with a colleague on an.y topic of inte-rest. Practise pataphtaSi~. Watch fOr' vetbal and n.onvetbal
in.dic.at0rs that )'OU' par'aphr'ase- was cortecl.
4. Conduct a five- Of ten-minute in.tel'\liew with a coueague
bal messages.
2. list wOr'ds, phtases, an.d siluations that you think are youf
e-motiooal triggers that mighl make ii difficult for you to
listen.
3. Ovef the next week Of so, pay attention to the vocal pauses
and silences that you and otherS use in evet'yday and pt~
fessional communication.. What in.di::'.atOr'S sugg,asa comfort
wilh slence? Oiscomfor1?
4. Oellberately altef yolM' resJX)nse time in a con-..el'Sation. to
experiment with silence.
5. Ask a coneague to ObServe yout use of silence dur1~ an
intetview (e.g., attanded slence. apprOl)riate in.tet'fuptioos,
and leoglh).
6. Videotape an. inteNiew Or' ask a coueague to Observe you(
attendi~ behaviout.
7. Metacommun.ication.. Oesctibe the possible- meaning (fof
you) of each of the- fOIOwiog:
a. Youf te-ad'ler askS you to see hef rigr\t after class.
b. Youf pal"ttlet forgets yout birthday.
c. A Men.d asks if you are free ~ Sat1Xday mor'ning.
d. A client does n.ot soow up fOr' an apJX)intme-nt
e. Youf client ask.S, "How old afe you?·
Skill Practice
1. Outing interviews with some colleagues or clients, ftnd
o,:,por1une moments fOr' bde:f pe(a:xls of reflective- silence-;
1hen con.tin.ue lhe inteNiew. Discuss 'Mth your coueague-/
client what the impact of lhe silence was on the in.tel'\liew.
2. Work with a cotieague to ~ lore 100 effects of poot listening. As an &efcise. delibe,atefy (but subtly) violate lhe
prlnciptes of effective listening ar\CI atter\Cli~. FOr' example,
inte-rfupt inappcOl)(aatety, ask unrelated ciue-stions, switd'I
topics pmmatufety, and avoid eye con.tact and othet in.dicatOr"S of intemst. When. you are ftnished, discuss hoN it fee-ts
to not have othel"S listen to you.
124
Chap1er 4
on. any topic of in.tefe-st. As interview-er, you should ptactise summatlzing skill.$. Try to offet bOlh content ar\CI
theme summaries. Al the conclusion of the in.terwew, offet
a complete summary of the session. ASk you( partoet fOr'
feedback.
5. Conduct practice interviews with a colleague to experiment
with spatial diStance. Oeliberatety increase or decfe-ase the
distance be-tween. lhe r.w of you to learn abOut the e:ffed
of space-. Al what poin.t did yout space- become tJiotated?
How did physical distance affecl the quality of youf vetbal
exchange-?
6. Attempt to communicate with a COiieague using only nonverbal cues and gestures..
7. ObServe the n.onvetbal communication. patterns of diffetent
age woups. What similarities and differences am apparent?
8. F'orm a small woup of fouf to five cOlle-agues. Identify on.e
of you whO is wiling to discuss a eurfent pr•obfematic situation. Two or lhree people will ObServe the interview, and
r.w will act it out.
Counsellor 1: Conduct a 10-minute intel'\liew whtle payi~
cafeful attention to lhe detail of the prOblem. Deliber-ately
avoid addfessi~ feelings.
Counsellor 2: Conduct the in.tel'\liew while paying cateful attention to em::>tions. Oetibetately avoid expl0ting the
details of lhe prOble-m.
Counsellor 3: Oelibet'ately inctease lhe le~ of counsetlOr'
pauses (silence).
Debrief and compare the outcomes of lhe interviews.
Concepts
I. Explain how silence can. be- used effectively in counsetling.
2. Paraphrase e-ad'I of the follO-.-dng dient saatements:
At a party the Othef night I finalty met sorneon.e Mh whOm
I can cany on. an intelligent conversation. He- seemed
intefested too, but he di:fn.'t ask for my phone- n.umbet.
It's a dilem.rna. I dOn'I knON whether to ftni:sh lhe SChOOI
yeat or dtop out and get a handle on some of my debtS.
My super.to, wanlS 10 see me today. 1kt'Owstie~to talk
10 me beCauSe rvet:JeEo late fOr'v.O'k Oler' the lalSt ie-Nweeks.
If Sile wanted me toe.all het, wily didn't shesaysometiw,g?
Rrsa my cat~ OONr\ lhM the fri:2ge. NON it'stOO ,:It.Im~
,,g, 1shOuld """IY someone wro;,; ~ at fbong tt'ings.
I think lhat 'Mth AIDS and all the othet diseases you can
catch, we shoukl all take precautions. You nevet know
wl'oO migllt be infected.
Well, to pu1 it bluntly, I think my partoet haS a lovet. But
I could forgjve that. I jUSI want OU( (elations.hip to be the
way it was when we firSt met
I've tried everything. I have a great r~s~. I've caued
ever-yone I kOON. I IOOk fOr' WOrk five to six hOurS a day.
StiU, I can't fand a jOb.
Lately, I've been thinking that there has to be more to life
than wOr'k and play. I'm not even sure if I believe in GOd,
but I need to find some meaning fOr' my life.
• I just IOSt it. My anger- bul t up and I hit her. She got so
upset lhat she packed up and left with the kids. I've
never- 0000 anything like that in my wtlOle life. I realiZe
that I didn'1 SOive any1hing by losing my tempet. Now
I may have tuined my marriage ar\CI hxned my kids
against me.
• I guess I'm goi~ to have to find some way of dealing
with my dtink.i~ ptOblem. The othet day, I was so sick
from drinking lhat I couldn't even get out of bed. I jUSI
can'l let bOOZe continue to jeopatdize my WOtk and my
family.
3. ln.tef'Jiew people from different cultutes regarding theit use
of nonverbal behaviout (e.g., greetings, saying gOOClbye,
summoning a waiter, eye con.tact ph)'sic.al contact, and
use of space).
4. Ext,lain wtly counsellot'S might a\lOid paying attention to cettain topics because of their' own needs. Alter'natively, ex.plain
why counseuors might pay ex.ces.sive attention to cettain
topics beeause ot theit own needs..
WEBLINKS
Links on listening from the International listening Association:
The International Child and Youth Care Network (click on the
www.hsten.org
"Reading•· tab f0c ac-cess to practice hints. a reforence library,
and othier useful connections):
..Tips on Effective Liste:ning." by Larry Alan Nadig:
httpdkyt-net0<g
www.drnadig.com/listening.htm
listening & Responding: The Basis t or Unders1andlng
125
#-
' t•
r,;,
)'
~ . ;1
i~ { ~
.
I
'-~\·
~'1~" - ~J:
q('l'loep1 /l23RF
)!
,
LEARNING OBJECTIVES
■
Describe rhe importance of asking questions.
■
Explore esscntiaJ questions (dosed, open, and indir«t) and hO\\• they might be
used cffectivcJy.
■
Identify and describe common qucstionina pitfalls.
■
Explore strategics for interviewing youth and seniors.
■
Explain how to promote concreteness in counscJling.
■
R«ogni:e the five different types of interview transitions.
THE ART OF ASKING QUESTION S
Questions Support Counselling Goals
No single approach to quesrionina works with every client. Counsellors must consider
numerous fuctors., such as the goals for the session, the comc:x"t in which questions are asko:J,
and the individual needs of dicnts, and then adapt thc.ir questioning t«hniqucs accordingly.
\Vith a rcpcnoirc of techniques, slcillful intc.rviewers use questions to cngnge clients in
hiahtr-ordc:r thinking., kindle rhe.ir curiosity. and prompt them to consider new possibilities.
126
Asking questions is a cornerstone of active listening and counselling. Purpo~ful
3nd well-timed questioning considers variables such as the current interview ph3se,
sessional contract, level of trust, 3nd the c3pacity of the client to handle that level of
questioning. Used appropriate1y, questions support the J;03ls of counselling in a number
of ways:
■
Gmhering infonnmion. Answe.red questions provide counseJlors with detail~ definitions, 3nd examples. As an adjunct to empathy, questions help clients explore,
clarify, and define emotions. Counsellors who use questions to learn will be less
likdy to make erroneous 3ssumptions.
■
Prmriding /oms. Session3J contracting is used to define the purpose of the inte.rview.
Subsequently, questions control the topic and direction of the interview consistent
with this contract. Focused questions ensure that the interview remains on trade.
■
PromOling in.sighr. Thought-provoking questions stimufote clients to begin a reOective process that can promote insight. Asking the right questions can promote
aw-areness by leading clients to ex3.mine issue~ ide3s, and fcdings th3t they might
h3ve othe.rwise overlooked. Effective questioning can also help clients m3ke connections 3nd uncover patterns in their thinking 3nd prob lem solving. A ~ries of
questions C3n S)'Stematically lead clients through problem exploration, goal setting,
and prob lem solving.
■
CarMni.s. Stimulating questions in combin3tion with nonjudgmental responses fuel
the cath3rtic process by encouraging clients to tell their stories 3nd explore the.ir
feelings. Often the therapeutic va]ue of this is sufficient to provide the necesS3ry
strength 3nd motivation for clients to address the.ir problems on their own.
Types of Questions
When counsellors wry the W'n)' they ask questions, the interview takes on more vit3lity
3nd the use of time becomes more effective. Effective questioning technique depends
on 3 number of factor~ including timing. the nature of the refationship, the purpose
of the interview, and the mood of the participants. Moreover, questions that 3re
surprising!)• u~ful with one diem m3y generate hostility in another. There is an 3.rt to
3slcing questions th3t precludes 3ny attempt to structure questioning in the same way
for each client.
Closed Questions Closed questions can easily be 3nswered with a yes or a no, 3nd
they are u~ful for confirming facts and obt3ining specific information. Since closed
questions do n()( invite detailed responses, they can effectively bring closure to an
interview or slow the pace of clients who are overly verbose. On the other hand, dosed
questions should be avoided with clients who tend to be succinct. For example, clients
})l) BRAIN BYTE
dosed questions: Cluestic.s di.at can
easilybe aniv.eied rib a simple ,es• no
(e.g.•"!lid JOU g_o byyca-wlfM.
r,l,_1-1 ,1,
Questions can triggef recall of memories long lotgOtten. Questions evoke answerS 01 emotional teactions baSed on stoted
infotmation and expe(I(>~ from the past A simple ciuesrion such as Mwhete did you attand Sd'loolr may triggef a
stmng em::>tional fesponse from an Indigenous per'SOO W'ho
endufed the abuSeS of the canadian Residential SchOOI sys.
rem. Metnary ir'WOl\'es all five senses. The s.mel of cOOkies in
a bakery may prOduce a pleasant fecal ot one's t,andrnotl'wl-r.
A IOud noise may instantly take a C3nadian veteran back to
his expe-rienc&S in Afghanistan. ~uently, when asking
ciuestions, counsellors need to considef that their clients may
interpr'el tne question frOO'l an entirety diffetMI frame of te:fe-rence. Uoox.pected fesponses and nonvetbal communic.ation
are dues that this may be happenlOg.
Asking Questions: Tile Searcll lor Meaning
127
can ea.sit,., dismiss the question "Do )'OU have anything 't'OU want to taJk about today?"
with the answer "No." Typic:.dly, dosed questions begin with words such as can, did,
are, hal't', is, uiill, u,-otdd, and do, as in the following examples:
■
Can you tcll me whnt )'OU 'vc done about id
■
Did you hnvc an opportunity to call the schooH
■
Are you fodingdcprcsscd?
■
Is my understanding corr«d
■
Do you agree that the most important problem right now is . .. ?
In J;Cncral, when counsellors want a definite )'CS or no answer to an important
question, a dosed question is preferable. In the following example, the client hints that
suicide might be an is.sue. This possibility is too significant to be ignored, so the coun.seJlor uses a dosed question to sec if this is a risk.
Client: Lately. I ~,~been so down I wonder, wh::u·!l the point o( ~oi~on!
CounseUor. Have )'Ou been thinldfl¥ about killin& yourself'!
Sometimes oraanizations require an intake interview that requires a great deal of
inform:nion. A series of dosed questions is an dficiem way to gather data quickt,.,.
Unfonunatc1)•, too many dosed questions may irritate clients and leave them feeling
interrogated and restricted. To minimize these effects, counsellors should blend dosed
questions with various interview stratcgic~ in particular, other active listening skills.
SUCCESS TIP
At the beginning of an .-iterview, 1t is usually beltet to mioimi:ze questions and sim~ encout-
age clients to Mtell lheit sto,y.• By ooing so, counsellOrS may fand that they Obtain much of
the infotmation lhat they need without having to question clients.
open questions: Ouestilns tut
promo:eespansive ans-""1. These types
ol quesli>ns ta.at be aasMltd d a
simple yes orno (e.g., •i-ro. doyoa le.I
abclll her!").
Open Questions Open question.'> are distinct from dosed questions because they are
difficult to answer with a simple yes or no. For this reason, open questions arc usu.nil,., prefc.rnble to dosed questions. Thq• provide a great deal of freedom for clients to
ans,.n~r the questions in the way they choose, with 3S much or as little depth as they wish.
Open questions may be used to begin an ime.rview, for example, "\\:fhat brings you he.re
today?" They may also be used to explore thoughts, feelings, or behaviour: "\Vhnt were
you thinking?" "How did you feel?" "How did you respond!"
Open questions begin with urho, tt-h.ar, tt-h.ere, tt•hen, or tt"1.1(thc "five W questions")
or how.
■
Who knows about )'OUT situation besides )'OUT wife?
■
Whnt have )'OU been able to do to cope with this problem?
■
Where do you see this relationship going!
■
When did this begin?
■
Why do you think it has been difficult for 't'OU to copc?(As will be discussed later
in this chapter, wh1 questions should be used cautiousi)•. )
■
How do )'OU see id
■
At whnt point do you think you might be read,., to malcc a decision?
Keep in mind that with some clients both open and dosed questions yield the
same result. \Vith these diem~ the dosed question "Did you have any feelings about
what happened?" and the open alternative "How did you fecl?" will generate the same
128
Chap1er S
response. However, counsellors should avoid using the dosed n1te.rnntive with less verbal
clients. If co unseJlors want an expansive answer. they should avoid using clo~ question~ particularly when dealing with clients who tend to provide single-word or short
answers to q u estions. For example, instead of asking. "Did you come he.re for help with
your rCsumC?" a counsellor might ask a q uestion that conveys a greater expectation for
detail, such as " \\:'hat we.re your reasons for coming in today!"
Clo~ questions become leading q uestions when they su~est the "right" or expected
answer to the client. ln the following example, a single mother describes her .situation:
Client: I often think that 11\)' kids do not i-h'e me e:no~ respect. Just once. I'd like
them t'O ~,sk me how mr da)' went. When r,n tired, they rould help out more.
Coun.settor: Do you feej 3n~ry?
Client: Sure I do. \Vho wouldn't?
In this example, the client hints at strong b ut u ndefined feelings. Even though the
client affirms anger, this may not be her main fecJing. The client may indeo:f be angry,
but other fttl ings may be dominant. Yet many clients find it easier to go in the d irection
suggested by the counsellor's q u estion than to shift the answer. A less biased q uestion
miaht be "How do )'OU feel about this?"
Kadushin (1997) suggests that o pen questions can be intimidating for incxpe.ricnc~
clients who are unsure of their expected role: "For .such inte rviewees, open..endcd q uestions provide little structure, little guidance for what they are suppo~ to tn1k about and
how they arc .supposed to talk about it" (p. 24 I). As a rule, clients may remain confused,
resistant, o r threatened by q u estions until clarity is estab lished regard ing the goals and
process of counselling. This underscores the importance of relationship contracting
that establishes counseJling ro utines and expectations, which typically ICOOs to more
client control and colla boration a nd a reduction in client resistance.
SUCCESS TIP
Questions can lead to surprtsi.ng and unexpected client responses (for bOth clients and
cou~). These responses create options for aransitions to new areas ot ioqliry and for
renegotiated agreement on the direction of wOr'k (contracO. When clients respond to ciues1:ions with sttong emoti:)ns, empathy is a preferred response.
Indirect Questions Indirect questions, o r embedded question~ arc statements that
act as q uestions. Indirect questions are a .softer way of .sec.king information. They arc
less intimidating than open and dosed questions. Indirect questions are effective for
breaking up the monotony and threat o f constant questioning, particularly when they
are combined with other skills, espcc:in1ly empathy. The following are some examp les
of indirect questions:
■
I w-onder whether you believe that it's possible.
■
Perhaps )'Ou're feeling confused over her response.
■
I'm curious about your opinion.
■
Given what you've said, I wouldn't be surpri~ if you decided to accept the offer.
■
I have no idea what you might be thinking.
■
I w-ould not be surprised to find that you have strong feelings on the maner.
■
You may have already reach~ a conclusion.
■
Your views on this are very important to me.
indirect questions: State.nts that
impt, questicm (e.g.. ·rm curi>usabOIIII
hc,#)1)1.1 respodd">.
Table 5.1 summarizes the various types of question~ including their advantages
and disadvantages.
Asking Ques tions: Tile Searcll lor Meaning
129
TABLE 5. 1 Types of Questions
Type
Description
Advantages
Disadvantages
Examples
Closed quesUoos
Quest.i:)ns that can
be answered yes
no
•
Conftrm fadS.
• Restrict answers
• Wtll you be going to
the parents' group
•
Slow the pace of a
l'ambti~ intetview by
limiti~focus
Ate easy f0t clients to
(do, will can,
are, If)
°'
•
Open <i u&Stioos
(who, what.
where. when,
Questions that
promOle a mor'e
•
Statements that act
as questions
•
• When asked repeatedty, can leave clients
feeling intefrogated
tonight?
•
Did you say everything
that you wanted to
say?
answe(
Allow fOr' an
unrestrk'ted
expansive answe-r
why, oow)
Indirect questions
•
conclusions, or
aweements
l'a•
of
responses
Em po-.ver clients by
• May be more Ume-consuming process
• Are mor'e d'lalleogjng
for clients to answer
• What a(e you( plans
for this evening?
• How are you feeling?
g'Ning 100m incr-eased
control of answers
Ate less tt'lreateni~
1r.an traditional
questions
• May not elicit a
response from the
dieot
I am
interested in
kr10\\;~ if you have
thought aOOut what
todo.
ESSENTIAL QUESTIONS: SOME OPTIONS
struc:b.red Interview: An inteMl!'w
that fol!Gws a l)ffdet.rmiflfd sequeace d
-·
oostruc:tured hrtertiN: An illervi!w
that doeitot haw a preset plan that
mtricts dir!Cli:in, pace.« content
Some interviews arc highly strucrur~ with a series of q u estions to answer, such 3S a
survey o r 3 st3ndardi:~ assessment tool or p rotoco l. For example, 3 suicide risk assessment interview will include targeted questions designed tog,et inform3tion about knO\\rn
ris k factors. A psychi3tr ic interview gnthe.rs data to see whether a client's symptoms
m3tch the criteria for P3rticular mentaJ disorders. Although it is possible (and some~
times desirable) to conduct 3n interview without question~ the ab ility to fo rmul3te
targeted questions is 3n indispens3b le skill for every counsellor.
A structured interview follows 3 d efined sequ ence o f predetermined stand3rd
questions. E.x3mples include inter views th3t require counsellors to complete forms to
establish clients' cJigibilit)' or to m3ke assessments. (n structured inter views, there is
little o r no freedom of choice reg3rd ing the focus 3nd pace of the inter view.
An unstruc.tured interview gives interviewers and clients freedom to go in any
d irection without a predetermined set of q u estions. In this t)·pe o f interview, the tone
is more conversational, and the pace and style of questioning is less rigid. The conmtct
remains flex ible.
Typically, most interviews will h3ve the following process goals:
I . Establishing purpose (ses.sioMI contract)
2. Defining, strengrhening, or troub le shooting the counselling refotionship (reJntion~
ship contract)
3. Exploring and understanding the client's siruation and p roblems
4 . Problem solving
5. Evaluating the work
T he follO\\ring sections propose s3mp le questions for each of the preceding 3rens. It
is alw3ys p referable to have 3 variety of ideas (choices) for 3ccomplishing the S3me tnsk.
A reperto ire permits ffexibility 3nd contributes to keeping the interview interesting and
individuali:~ . To increase the chances for rnppon, counsellors nttd to modify ques..tions and word choice to meet the particular nttds, educational levcJ, 3nd culrure of
130
Chap1er S
C3ch client. Other active listening: skills such as summari! ing and, in particulnr, empathy
are essentiaJ to ensure that the interview does not become an interrogation.
Questions for Establishing Purpose
Contracting was introduced in Chapter 3 as a tool for ensuring that clients and counscl.lorsdearh• understand the intended purpose of the relationship. \Vhen clients come for
service, the basic question counsellors need answered is "\\:'hat brings you he.re toda,.•?"
Of course, this does 00( prevent counsellors from introducing: their own ideas, but this
question and its variations ensure that clients are consulted regarding their nttds and
expectations. This is particularly important when working with involuntary or reJuctant
clients. Here arc some sample questions:
■
How would
■
Do you have feelings and concerns from our last session that you want to address!
■
\Vhat would you like to talk about!
■
\Vhat do )'OU think would be a good starting point?
■
\Vhat would you like to accomplish today!
■
\Vhat is '>'our gonH
)'OU
like to spend our time together!
Questions to Define the Counselling Relationship
Clients may come to counselling: with denr ideas of what they wam from the.ir counsellors, or they may be aware only of their pain and be hopeful that some heJp will
be forthcoming:. In any case, it is important that both clients and counseJlors understand their resp«t:ivc roles in the process. Relationship contracting (see Chapter 3)gives
clients and counsellors an opportunity to define their relationship and how they will
work toj;cther. TypicnJ questions include the following:
■
\Vhat experiences have you had with counseJling? \Vhat did you find heJpful/n()(
helpful?
■
\Vhat are your expectations of me!
■
How do you prefer feedback (e.g., soft, direct, and "sandwic.hcd")l
■
\Vhen you imagined coming he.re today, what were you hoping would happen!
■
How will you know if our time together has been useful?
■
Anticipatory feedback helps to plan for things that might arise in the counselling
relationship. For example:
■ ff I notice that you arc getting discouraged, what should 1 do?
■ \Vhat would be a good way for me to approoc.h you if 1 think there were problems between us!
Questions for Exploring and Understanding
At the beginning: of an interview, or when a new topic is introduced, an open-ended
question such as "\Vhat do 1 need to know about your situation?" empowers clients
to identify areas of immediate concern or willingness to explore. This question communicates to clients that counsellors will respect their needs and wants without making
assumptions. It ~ms to say, "I nm willing to listen and lenrn. I will treat you as a person,
not as a number or a category." At least initially, clients may 00( put forward the.ir most
urgent need. They ma'>' start with a safo topic to test the waters for understanding and
acceptance. Once they fed more trust, they may present matters that are more serious.
Asking Questions: Tile Searell lor Meaning
131
Sample wrintions of this question arc "\Vhat arc the important things I need to
understand about you and your problem?" and "Can you tcJI me the key points we need
to explore!" Concreteness probes are used during all phases of the interview to ensure
clarity and secure examples. They move the interview from superficial understanding
to shared understanding.
Questions designed to learn about a client's situation genc.raJly target three important areas or domains:
I . How the diem {«ls about the problcm-affec,rivc domain
affective domain: HGwclients feet.
CO,gJ'litiw, dCWt'lain: Koll cliffl1s think
abclul tlleir situati>ns.
behavioural domain: 'Mai'! cli!als
andcini,
2. How the diem chinks about the problem-cognitive domain
3. Whnt the client is doing about the problem- h e.h avioural domain
Affective Domain (Feeling) Sometimes solutions to problems nrc obvious to
clients, and they do not need help with decision making or problem solving but still
lack the capacity to cope with their dilemmas. Often this is because their struggles to
deal with painful feelings detract from their power to solve the problem. So, in many
circumstance~ managemcm of emotions is a pre.requisite to problem solving.
Questions thnt explore the feeling or affective domain include the following:
■
How do )'OU fttH
■
Whnt emotions docs this rriggcrr
■
I'm interested in hearing more about your emotions.
■
Whnt feelings best describe your reaction!
■
Are you feeling .. . r
The question "How do you feeJ!" is one way to introduce feelings and co encourage
clients to explore the emotional components of thc.ir problems.
Cognitive Domain (Thinking)
setf-ta.lk: .Mental messages p8l$)1e give
to t!lems.elve (e.g., -rm no good1.
132
How people think about their difficulties is often
more important than the problem itself. An event thnt may be no big deal to one diem
may represent a life-threatening crisis to another. Self-talk, or inner dialogue, refers to
the mental messages we give oursclves. Ncg3tivc self-talk is associated with inaction and
poor self-image.
In contrast, positive self-talk builds conf,dence and is self-empowering, 1t moves
people away from a victim mcntnlit)• of feeling powc.rlcss. It also enables individuals to
deal with crises realistically, without self-imposed rigid and punishing demands.
By seeking to understand how clients think about problems, counsellors can get
valuable clues rcgnrding important issues, such as sclf-estccm, motivation, and irrational thinking. Subsequently, counsellors can directly chnllcnge clients' ncg3tivc self-talk.
Sometimes counsellors can achieve quick and dramatic counscJling interventions
by chnllcnging the rationality of the worrier. By offering factSi, challenging assumptions,
and inviting clients to consider the rc3l probabilities of dreaded events. counsellors
introduce much-needed critical thinking that may interrupt the worry cycle (She.bib,
1997. p. 81). This strategy is an esscntl31 clement of cognitive behnvioural counselling,
which will be cxplor~ in Chapter 7.
Herc arc sample questions thnt can prompt exploration of the cognitive area:
■
Whnt arc you thinking!
■
Whnt is the evidence for your belief?
■
How do )'OU know this to be true?
■
Whnt do you say to yourself about this problem?
■
Whnt does your "inner \'oice" say?
Chap1er S
■
\Vhat messai;cs do you give yourself th3t are self-defeating!
■
\Vhat arc you tcJling yourself!
Behavioural Domain Although it is important not to move too quid:J,., to work on
problem sohting. an important patt of ,votk in the beginning phase involves interviewing clients to le3rn what they arc doing and not doing about their problems. Such information is important for assessment. It tells counsellors whether their clients arc active
in seeking and working on solutions or whether they have become withdrawn and have
given up. Some questions for exploring the behavioural area include the following:
■
\Vhat have you done?
■
\Vho cJsc is affected by this problem!
■
Can 't'OU identify what triz:crcd 't'our relapse?
■
How did you respond!
■
\Vhat did you do or say?
■
\Vhcn is the problem worse or better!
■
Has the way )'OU have been h3ndling your problem changed!
SUCCESS TIP
Changes in any of the lh(ee domains-feeling, lhinking, or behaviou(- will stimula te
changes in the other two areas. For ex.ample, when a clien1 is able to alte( negative lhinklflg
patter~ positive changes are mote likely with respect to thei( feelings and lheir behaviou(.
(See Figure S. l).
Questions for Problem Solving
Questions can assist clients to think systematically about the sequenti31 steps involved
in finding remedies to their problems. Questions of this type arc more appropriate
when the problem h3s been fully explored. Some key template questions include the
following:
■
\Vhat do 't'OU see as possible strategics for overcoming this problem?
■
\Vhat arc the costs and benefits of this a1ternativd
■
How would
Figure 5.1
)'OU
feel if you took this step? How would you feel if you did 00( act?
The Three Domains
Asking Questions: Tile Searc ll lor Meaning
133
■
Wh.nt prevents 't'OU from caking action?
■
How can you overcome this barrier?
■
Wh.nt eJsc do you nttd to make it h3ppcn?
■
Wh.nt do you sec 3s 't'our first step toward ch3ngc?
■
How can you m3kc it (your go3J) happen!
■
Wh.nt strengths or resources will help you achieve 't'Our goal?
■
When will you start!
SUCCESS TIP
Avoid the eotrwnon tendency to move too ciuicidy to prOblem sotving. Make sure that the
prot:,em has been fl.Aly expl0ted firSt and that clients have been given an opportun.ty to
expmss and process their feelings.
Questions for Evaluating
Ongoing evaluation of counseJling outcomes and the counsclling rcl3tionship ensures
that the work rem3ins on track. EwJuation enables counsellors and clients to trouble~
shoot relationship problems before they become cam.strophic. Evaluation also informs
contract negotiation and revision. Some examples of questions th3t might initiate evaluation arc as follows:
■
How has our work met your expectations?
■
Looking back on our session, what were the things that you found helpful!
Unhelpful?
■
How woukl you like things to be the same or different next time we meed
■
Wh.nt remains to be done?
■
Wh.nt ch.nnges would 't'OU like to m3kc with respect to the way we communicate?
■
On 3 scale of 1- 10 how w-ould you rate our time together?
■
How would you evaluate our work!
At the end of 3n interview (or 3s a significant topic ends), the question "Wh.nt
have we missed?" often yields surprisingly rich information. This question provides
a last<hnncc oppommity for clients to t31k 3bout unexpressed issues and feelings. In
addition, when clients have been ambivaJent about sharing some det3il~ this question
m3y tip the scales in favour of sh.nring. 1t 3lso empowers clients by giving them control
over content, and a final chance to make sure their nttds are on the table for discussion.
Some variations of this question include the following:
■
Wh.nt eJsc do we nttd to discuss!
■
Wh.nt's left to explore!
■
H3vc we cove.r~ all that is important?
■
Wh.nt questions haven't 1 asked?
In the following example, the counsdlor prompts the diem to examine the session:
CounS(>IJOr. Our time is almost up. and I want to make sure I ha\'i":n '1 O\'fflool:.ed ~mp
thin¥ t~t is import:uu 10 you. \Vh::u have we 1nissed!
Client: ~e.lJ. v.--e h::n'i'n' t e"en be~-un to talk 3bout hoo• m't' di\'Ortt h:uth:u,~-00 my kids.
In m:u,y W'3't'll. the,., ~,,e be,en the re:al victims.
134
Chap1er S
> : •.
Ne-ufoptasticity means that ouf brains are constantty
irwOlved in f0tming new ne-ural pathways as well as pruning
ones that are no looge-r used. Effective intel"Viewing can help
10 form a Mnew brain.· FOr' e-.xample, questions that focus
on selling goats create neural pathways that strengthen the
focus on moving forwatd and change. Questions targeting client str'e-ngths activate areas of the br'ain that stimulate positive emotions, and increase the oouro1tans.mitter
serotonin, which is essential to a sense of well-being (Ivey,
""Y & Quuk, 2009>.
Coun.se.U.or: I :l¥ret with you. It's verr important th::u Yi't, don't overlook them. Does
it m::d.:e sense IO you 10 make th::u discussion pore o( our next meetin,a! I want to make-
sure tilt-re is eoou~, time.
Client: Yes. that makes Sense.
Coun.seltor: Then let'!? make- th::u number one on our list for next time.
Remember th.nt there are some risks to opening: up new nrca..s of discussion at the end
of an imc.rview, panicularly if the topic involves strong emotions for the client. ln the preceding example, the counscllor suspected that this was a complex topic, so she ~to:I
deferral to the next session. In such circumstances, thecounscllor might have been tempc:cd
to :.lSlc further questions or to empathize. but these responses miaht have prolonged the
interview bc\nnd the time 3wiJable. 1t is important to end the interview without Je3ving
the client in a state of disrrcss.
SUCCESS TIP
Six Key Questions
1. What beings )(lu here IOday?
2. What a(e you( expectations of me?
3. What do I need to kOON abOul your situation?
4. What do )(lu mean by . . . ?
5. What did we accomplish?
6. What did we miss?
QUESTIONING PITFALLS
Asking questions is a skill. Faulty questioning may b ias answers, antagonize clients, or
keep the interview at 3 superficial level Jn addition, insensitive questions that disregard
clients' feelings or culture can leii.ve them feeling judged or abandoned. Poorly timo:I
questions may rush the interview or frighten clients with demands for disclosure before
trust has been established.
Leading (Biased) Questions
A leadina question suggest the "correct" answer b)• conveying a strong due about the
3nswer the interviewer would prefor to hear. The following ex3mples illustrate this
pitfaU,
leading CJJtStions: Aquev.ic. t11a1
suigests a preferred a11SWH
(e.g.• ~ on't )1)tl think ourses.sia. W!ftl
realt, ~ II today?").
"Don't you beJieve it's time you toolc care of yourseJf inste3d of putting 't'Our
husband first!"
"You lilce school, don't 't'ou?"
Asking Questions: Tile Searcll lor Meaning
135
"Do )'OU really want to keep working for a man who trc3ts )'OU that way?"
"You're not thinking of killing yourself, arc you!"
C lients who have a h igh need to be liked, those who tend to be compliant, and those
with dependency n eeds arc especially vulnerable to lC3ding q uestions. These clients are
less likeJ,., to be assertive by disagreeing with their counsellors.
How a question is wo rded can also dramatically change the answer. Asking your
spir itual leader, "Is it a.JI right to smoke while praying?" may get a ver y d ifferent answer
from asking, "Is it a.JI right to pray while smoking?" (Sudman & Bradburn, 1983, p. I).
Counscllors may use lc3ding questions to camouOag:c their own ideas. For example,
the counsellor who a.sics, "Do you think you should be doing that?" is probably sa ying,
"I don't think you should be doing that." Leading q uestions tend to corner client~ as in
the following interview excerpt, in which a co u nseJlor talks to a man about his mother:
CounseUor. Gwi":n wh::u )'Ou\'t, been s:1yin~ it's t ime (or action. \Vouldn't )'OU ai.:re,e
th:u allowina your mo ther to ll\'t, alone 3t home is not in 3n)'One's best interest!
CUent: I su ppose you' re r!iht.
CounseUor. 'Would you prefer to put her in 3 sen.OrS' home!
CUent: I ~ll)•don't want
t'O
put her in a home. TI,::u v.-,oukln't be ri$:ht.
CounselJor: Don't )'Ou think this mi,aht be easier on )Our family th3n taldni.: on the
enormous probtems involved in movh)¥ her in with )'Ou!
CUent: (Hes&atd.) I suppose )'Ou·re n~ht . But . . .
Coun!l(>IJOr. (lntc·rrnpcm,g.) I h::n'e a list o( possible pl::.eeme:nt!l. Do )'OU w;,int to 1nak.e
some calls no"-!
It's C3SY to sec how the counsellor's agenda in the preceding encoume.r d iscounted
the views and needs of the diem. By selectively emphasizing one aJte.rnntive, the coun.seJlor allowed the client little fTttdom of choice. Consider how the outcome might have
been d ifferent had the counsellor used the following lead :
Coun!l(>IJOr. Gwi>:11 wh3t you h::1,'t, bee!, s:iyintt. it seems you\~ re::iehed a point wilt-re
it's t inlt' for action. What do )'Ou se,e as )'Our opt ions!
Such a lead would have a.Jlowed the d iem to identify alternatives, such as arrang~
ing for in.-home care for his mother or inviting her to live with him. The counsellor's
favoured aJte.r nntive docs not cont3minate the discussion. Counsello rs need to remind
themselves that the solution belongs to the client and there may be considerable ambiva,.
lcnce rcg3rd ing the alternatives. The counscllo r's role is to support the management of
this amb ivalence by paying 3ttention to feelings, exploring the problem, and weighing
alternatives.
Excessive Questioning
Although questions can be an important part of most inte.rvic:ws., excessive question,.
ing can quickly leave clients feeling inter rogated and bombarded and, as a result, some
clients fail to return for a sa:ond interview. Others become increasingly defensive and
terse with their response~ particularly if they arc unsure of the purpose of the quc:s.tions. Excessive questionin g can overwhelm clients., IC3ving them frustrated, confused,
and exhausted. Questions put co u nseJlors in control, and they remind the client who
has power in the rcJationship.
Some clients simp l)• do not respond well to questions. Counsellors may find that
r3the.r than gcning more information, they arc obtaining less. For example, involuntary
clients may c:xpc.ric:nce questions as an invasion of their privacy. As wcll, clients from
some cultures may TC3Ct unfavourably to questions. In such circumstances, reliance on
136
Chap1er S
CONVERSATION 5.1
STUDENT: Sometimes it leets as if an I do is ask Questions.
I can't help thinkil'lg that if I were the client, I'd be really
irritated. I don't want to le.ave clients fooling intefrogated, but
ciuestioos seem to be 100 only way to get 100 information I
need. Oo you agJee?
TEACHER: You're rigt\t to be coocemed. There is a real dange-r
that dients will beeome defensive if they feet cross-examined.
By paying attention to the needs, feelings. and responses of
individual dients, you wil be able to see if you are alienating 100m. Sometimes counselling works best if you avoid 0t
minim.ize questions. for ex.ample, clients who have not yet
developed trust in lheir counselJors may r&Sl)OOCI better in
interviews vd\en questions are minimi:zed.
Another drawback to aSki~ too many questions is that
too much respons,ibdity foe the d,recti::,n and content of the
interview can be left on your ShOuklers. This can be disempowering to, clients and can lead the-m to beCOtne overly
dependent.
STUDE:NT: But are there ways to ex.plOfe and get information
TEACHER: Yes, there are a number of skill alternatives to
Questions fOf' gathe-ri~ k'!foanation and makl~ asseS:StnMts.
In some cases, pte-rnterview questionnaires can be used to
gathe-r importanl information. Switching to a nonverbal mode
btf using tools such as fliJ) charts, J)ictures, J)lay (with d'lildren), Of music can also be effectNe ways to eon~t 'Mth
dients. Technk:lues such as ShOwing empathy, summariZing,
usi~ S1:lence. and self~i:sclOS~g may be more effective ways
of getting details, fac1s, and examptes.
Empathy, fof e.xample, is a powerful counseni.ng tool
that tells clients. that we undefs.tancl Of afe trying to aJ)J)reciate lheif feetrngs and perspectives. Empathic tesponses
and s.ummafaes create an essential base of tfust btf ShOwing
that counsellors are nonjudgmental and caJ)able of listening and understanding. In f&Sponse, clients often beeome
mofe courageous and motivated to Shafe and explore.
AJ)J)rOJ)ri.ate use of silence creates SJ)ace fof clients to
speak. QuestioM are important fof effective interviewing,
but you should try to add vaftely to your interviews by using
a range of siuns.
without asking questions?
questions will frustrate the gools of the interview. Counsellors should be 3le.rt to signs
th3t the.ir clients 3re reacting poorly to questions. For example, their clients' 3nswe.rs m3y
become briefer, a dear sign of the.ir intention to be less cooperative. Clients 3fso may com,
muniane their displC3surc nonve.rbally by shifting uncomfortably, grimacing, or 3\-erring
eye contact. Some clients m3y refuse to 3nswe.r by becoming silent, but others ma,., be
more outspoken with the.ir disapproval, saying, for instance, "I don't Stt the point of all
these questions." Jf counsellors continue with questions when it is cJe3.r th3t their clients
3rc rejecting this approndi., se.rious d3mage to the counselling relationship m3y result.
Con5tt1ucndy, it is important that counsellors 3re able to modify their approaches
to reduce or eliminate questions. Sometime~ for example, an empathic response c3n
3chieve the s3me purpose 3S a question:
Client: I just don't know what I'm ~-oinK to do. Slnce she le(t, l'\'e (eh lost 21nd unsure
of what I should do with my l1(e.
Coun.se.U.or (Choke I): \Vh:lt ::are some possib11itiesr
CounS(>JIOr (Choke 2): Sounds 21s 1( )'Ou (eel 31131onc ::and u1ltert21in o( what l'O do next.
Choice I seeks more inform3tion from the client about wh3t a.1te.rnatives he sees for
him.self. This question moves the int~rview away from feelings to problem solving 3nd
decision making. In Choice 2, the counscllor 3Clcnowledges the client's feelings as well
3S his indecision, and the response is much more likcJy to be perceived 3S supportive
3nd sensitive.
Sometimes counsellors have to ask man,., questions. such as in dete.rmining eligibility for se.rvice or completing an intake (first) interview. One way to lessen the imp3Ct of
excessive questions is to have periodic P3USCS to check how their clients 3re doing. For
example, they might S3\', "I'm asking a lot of questions. How arc )'OU doing? I know it
c3n be a bit overwhelming." Respectful comments such as these empower and involve
clients in the process.
Asking Questions: Tile Searcll lor Meaning
137
It is important for counscllors to remcmbe.r to balance questions with responses
that confirm u nderstanding (summa.ries) and empathic responses that affirm sensitivity to feelings. \\:lhen q u estions arc dearly linked to the ngreo:1-upon purpose of the
inte.rvicw (contract), clients are much more likdy to bc-coo~rativc, but if the questions
nppenr meaningless or intrusive to the diem, resistance is likely. Asking questions is
an appropriate way to g,et informa tion. Howeve.r, skilled cou nscllors have the ab ility to
switch ton non-questioning mode when the situation warrants. The foUO\\,ing example
shows some of the different options for exploring a client's an,;cr:
Open Quesdon: \V~t happens when )'Ou ~et 21nar)'!
Cl~
Q uESt.ion: When )'Ou 21re af)¥r)', do you become violent!
lndittet Q uestion: r,n curious about how you handle )'Our 2111~-er.
Self-dl$Clo11:ure: \Vhen l'rn a.ni r)', I :UW3yS wonder " -hat to do with it.
Empathy: Sounds as thou$:h. in 21ddit1on to your anier, )'Ou also~,~ a lot o( poin.
Silence: (Appropri21te si!e,~ 21vokls arousinK the d1ent's de(en«s. It Kives the client
time to e>:preS.$ his or her feeli.n~il.)
Contract: Perhaps we ea.n pause for a moment and dttide whether this is a iood tune
to explore )'Our feel1n,a:-i of af)¥er.
Directh~ : Tell rne rnore.
Sentence completion: Use 2111 ineomplete se:nte:nee (se:ntenee stern) that pauses with 2111
expec12tion that the client will f'l.niilh the Sentence. Usl.dlly the client will f'lll the pause
with his or her thou£;hts or (eelin~s.
Herc are some examples:
■
It seems rhar urhen you become angry, you tend LO •••
■
And you are feeling .
■
The mosi imporranr rhing f« you is ro .
■
If :,ott u-ere LO rell him tt-'har :,ott think, ,ou u,'Otdd .
T h is tool enables counscJlors to control the process by p rO\tiding clients with stimulating prompts while ensuring th:.n the content comes from clients.
Summ21ry: The theme i.n " -hat )'Ou a.re s:ayi1l{t seems l'O be a iltro1l{t (eelin¥ o( 21~r.
P21r.1.phr21se: l.n otherwon:ls. )'Ou're a pe-rson who wi.11deal with )'Our21~r in sorne " 'ay.
A ll of the preceding examples are potential counscllor responses, a nd C3ch has the
potential to achieve the process gonJ o f angc.r exploration. They illustrate the range of
choices that arc always available to skilled, versatile counsellors.
SUCCESS TIP
Consider switching to a no~questioning mode (1) to reduce lhe tone of inte(rogation
and avoid the power s t ~ trap, (2) when client responses are guarded and defensive,
(3) wtlen clients are not responchng to questions, (4) for el.Atural adaptation, and (5) to add
variety to your interviews.
Multiple Questions
Multiple questions nrc two or more questions asked at the same time. ff the questions
arc complementary, they are not problematic. A second q uestion ma)' be asked simul.tnnoously that embellishes o r clarifies the first:
Counsellor (Ex21mple I): How did you feel about it! How did )'Ou (eel when he rejected
you!
138
Chap1er S
ln Example I, the second question does not detract from or contradict the first.
Of course, the second question a1one would have sufficed. In contrast, the follo"'ing
example illustrates how multiple questions can be confusing:
Coun.~ellor (Ex::ample 2): How did )'Ou (e,el about it! Did
h::mdlina the !lit"u::ation!
)·OU
see any other war of
\Vith E.x3mple 2, both questions 3re potenti3lly useful, but n()( when they 3re 3sked
3t the same time. The client has to decide "'hich question to answer. Each "'ill take the
interview in a different dir«tion: the first focuses on feelings while the second moves
the discussion to the behavioural domain. At their worst, multiple questions can inundate 3nd assault clients with complex and conflicting: demands. Imagine if you were the
client in the following interview:
Coun.se.U.or: So. is there :l..11)1hifl¥ )'Ou ca.i, do! Do )·Ou think )'Ou mi,.i,t h:a"e mid heihow )'Ou (elt! Or 11\3)' be )'Ou see it di(ferentl)'. How lofl¥dO )'Ou think )'Ou ca.i, continue
to h::anion!
The counsellor ma)' be wen-meaning, but responses such 3s these complic3te matters 3nd m3y add to the client's confusion. As a rule, counseJlors need to curb any
impulse to 3slc more than one question 3t 3 time. When thq• aslc a question, they should
wait for the 3nswer before proceeding: to another question or topic.
Irrelevant and Poorly limed Questions
One way that counseJling inte.rvie"'s are distinguished from everyday conversations is
that interviews have a definite purpose or intem. \Vhcn counsellors know the purpose
of the interview, they are able to frame questions that suppon that purpose. Converse.I)•,
counsellors "'ho are unsure of the purpose 3re more likely to ask random questions.
Counsellors should have a purpose for questioning, and they should be prepared to
share this purpose with their clients. They might offer 3 brief explan3tion, for example,
"lt woukl heJp me to understand your situation better if I asked you some questions.
This "'ill give me an ide3 of ho"' )'OU see things.'' Prc3mbles such as this inform the client
of thecounseJlor's motives and procedures. When clients know what is happening, they
are less like1)• to be defensive and more lilccly to support the process.
Sometimes counsellors 3sk excellent questions but ask them at the wrong time,
which IC3ds to inappropriate topic changes. A common error of this type occurs "'hen
counsellors ask content questions after clients have expressed the.ir feelings:
Client: I wa!l luriou!l with her. I ne\'er im::aained that 11\)' best friend Yi'OuJd be havina an
:affair witl, my husband. 'We' ,..e been married for 10 )'elrS.. and I thou~t I could trust
him. I (eel like a complete loot
Counsellor: How d,d you llnd out the)' were se,ein& e:ich other!
ln the preceding example, the counsellor's question ma)' be valid, but it is timed
insensitively. Since the client has just risked expressing strong feelings, the counsellor
should consider empathy 3S the preforred response. The next chapter addresses the
critic31 skill of emP3thy.
A second common error occurs when counsellors shift the topic "'ithoutexploring:
beyond a superfici3l level This can happen for seve.ra1 re3sons. First, counsellors may
be unskilled 3t probing 3 topic. Second, they may be overly cautious about probing,
perhaps fearing that they will be invading their clients' privacy. Third, they may be fix3ted on problem solving, 3S in the following example:
Client: We A,.iit all the time.
Coun.se.U.or: How do you think )'Ou n,i~ht cut down on the O~hti.n~
Asking Questions: Tile Searcll lor Meaning
139
In this ex3mplc, the counsellor jumps to problem solving far too quickly. A better
choice would have been questions to find meaning 3nd empathy to connect with fcel.ing.s. For example, the counsellor needs to learn what the client meant by "fight." Do
they yd) and scream? Do they refuse to taJk to each other! Or is the.re physic.al conflict?
Perhaps the best response choice w-ould be a probe ta~ting feeling~ such 3S "How do
't'OU fed about the constam fighting!"
Why Questions
\Vhy questions should be used C3utiousJ,., since they tend to be more thrc-3tening for
clients if they arc perceived 3S 3slcing for justific3tion, or if the tone of the u1Jt,question
communicates judgment, disapproval, or embedded advice. The question "Why don't
you leave him?" may put a dient on the defensive with the implied mcs.saJ;c "You should
leave." \Vh1questions ask people to explain 3nd justify the.ir bch3viour. Frequently, this
requires a degree of insight th3t they simply do not have. In response, clients may make
up answers or feel exposed and stupid for being unable to answer the question.
Even when judgment is not intended, "when someone asks why you did something,
't'OU might fed she or he is judging you for not being 3ble to handle the situ3tion more
effectively" (Hill, 2004, p. 121). \Vhy questions may provoke defensive rc:.lcrions, including 3voidance 3nd attack because "m:.ln't' clients 3ssoci3te u1hy with a past experience of
be.ing grilled" (lvey, Jvey, & Zalaquctt, 2010, p. 103). The following excerpt illustrates:
Client: I e2n't rel.:ue to my father :10,.,rnore. He eannot see that I !"K'ed my independence.
CounS(>IJOr. \\'hy don't you just move out :tnd live on )'Our own!
C lient: Impossible. I h:ave h'i'<> n\On' 't'i':::lrS of rolJe~~. and I ean 't af(ord it.
CounS(>IJOr. \\'hy not just tell him i'lic:M• you (eel!
C lient: h'se:uy for 't'Ou t'O say. but you just don't unders:tand.
K3dushin (1997) suggests asking urhar instead of urh, questions. For c:x3mplc, "What
prevents 't'OU from sharing 't'OUr fttlings?" is more helpful th3n "Why don't you slurc your
feelings?" The first question (what) seems to accept that there arc expl3nations and rt':.lsons
for thedicnt's behaviour, whert'3s the second question (why) sccms to dcm3nd justification.
TAILORING THE INTERVIEW TO THE CLIENT
When Clients Do Not Answer Questions
Sometimes clients do not 3nswer questions, or their answers 3re supe.rficial. To decide
how to proceed in such cases, counsellors need to consider some of the reasons why
clients miaht be reluct:.lnt to respond.
Questions Are Not Understood Clients m3y not understand questions because
they have not heard them. For example, clients may be hard of he:.uing or deaf, or coun.seJlors may be speaking too softly, or b3ckground noise interferes. As wdl, clients may
not have been listening. In 3ddition, counscJlors may be using ,vord~ phrase~ meta.phors, 3nd expressions that 3re not part of the client's repertoire. Effective counsellors
arc able to 3dapt their idiom3tic language and voice volume to meet their clients' needs
and expectations. They 3\-oid technical terms and jargon, p3rticularh• when communi.cating with clients from different cultures. Furthermore, counscJlors are role models
for their clients, and one of the interesting :.lnd positive outcomes of counselling is
that clients may lc-3rn how to listen. \Vhen counsellors demonstrate effective listening
and responding skills. clients tend to imitate them. Alte.rnativdy, counsellors can tC3ch
clients to use listening tools. For example, to encourage clients to summari:e, leads such
140
Chap1er S
as this can be used: "Please tc11 me in your own words what your understanding of our
agreement is. 1 want to make sure we both have the same unde.rstanding."
The Purpose of Questioning Is Unclear Clients have a riaht to lcnow why questions arc be.ina asked, and they arc more apt to respond when the purpose is clear.
CounseJlors may simply sane the purpose in an explanatory sentence: "The reason I
am asking this question is . .. f' However. if counseJlors do not have a valid reason for
aslcina particular question~ they should not ask them. Questions arc crucial for accomplishing the goals of counsellina. but they must be used cautiously, either to obtain
important information or to direct the interview to relevant channels.
The Answers to Questions Are Unknown Some questions are difficult for clients
to answer. For example, the questions may call for insight and explanations that arc
beyond the clients' current lcvcJ of undcrstandina. Sometimes clients are unable to
articulate the.ir ideas and inner feelings. Learnina disabilities arc also a factor for some
clients. \\:'hen clients don't have answer~ "why" questions arc particularly frustratina.
Client Privacy Is an Issue Jf clients arc concerned about the.ir privacy. they may say
(verbally or nonvc.rbally), "That's not an issue 1 care to explore." They may change the
topic abruptly. or they may respond with silence. Some clients resist questions because
of prior expc.ricnccs of beina embarrassed, interrog:itcd, or put on the Spo(. Moreover,
the.ir cultural norms may disc:ourai;c questions of an't' type, or they may restrict the
areas in which questioning is appropriate. In some situations, clients withhold answers
because they fear that their answers will not be understood or that they will be judg~.
At other time~ they arc simpl)• 00( ready or able to address the issues the questions raise.
Unresolved Relationship Issues
It will be difficult to proceed with counscllina
if there is outstanding tension or conflict in the relationship. Good question~ insightful emP3thy, accurate summaric~ even warmth and ca.ring may be rejected because
they are filtered through the relationship discord. In such situations, it may be a bener
choice to shift the discussion to address the conflict.
Response Choices When Clients Don't Respond to Questions
First, counsellors should honour the rights of clients to control areas of discussion and levcJs of inti•
macy durina any phase of the rcJationship. Using the contractina proccs~ counseJlors
can respect clients' wishes not to explore the particular area and shift the discussion to
less threatening content. Neve.rchcJcs~ some anxiety is normal and po(entially productive when difficult topics arc being addressed, so counsellors should not automatically
shift the topic when anxiety arises.
Second, counsellors can evaluate whether they have given their clients enough time
to answer. Some clients arc slower to respond, and counsellors ma)' misinterpret the.ir
silence as reluctance to speak.
Third, counseJlors might tactfully ask clients what is preventing them from answcrina. Sometimes trust issues impede candor. Candid discussion of barriers usuaJly
increases trust, if counsellors are nondefcnsivc. Moreover, by remaining nondcfensive,
counsellors demonstrate their capacity to be open and nonjudgmental. They show their
ability to handle tough issues without retaliating. As well, when questions target sensitive or private information, counseJlors can express empath)• regarding how hard it
miaht be to share such personal material.
Fourth, counseJlors can simply stop askingqucstions. Jf they continue to ask questions even though clients refuse or dismiss them, unfortunate con5tt1uences will likely
result. Moreover, under pc.rsistcnt questioning clients may become increasing!)• frustrated, angry, and resistant, or they may feel inadequate because they have been unable
to meet their counsellors' expectations.
Table 5.2 summa.ri:es conditions for using questions appropriately.
Asking Questions: Tile Searcll lor Meaning
14 1
TABLE 5.2
Guideli nes for Questioning
00R't:
Do:
Bombard clients with questions.
Satance and add variety to lhe interview with
a range of Othe< Skills.
As.k more than one q uestion at a time.
Pause aftef ead'I question to gtve clients
time to answet.
Re~mbef' that summary and empathy
responses are important to confirm
understanding,
use leading questions to control clients and
theit answe<s.
use whyquestions, as they usuatty imply
blame or c,oovey j udgment.
As.k questions unleSS you have a feasoo to
need. 0t a right to have. lhe answet.
As.k a ~ se-ries of closed questions.
Ask dOsecl q uestbns when you need to
confirm spedfi::: facts 0t ideas.
Ask questions ooe at a time.
Respect eultutal no(ms and individual
style'S that may make certain Questions
k\approp(aate.
Ask questions for a specific pur(X)Se.
Ask open questions to gtve clients maximum
COOt(C,.
Managing the Rambl ing Interview
A challen,;e th3t all counsellors face is how to focu s and control ove.rly verbose clients,
who ramble from topic to topic with u nnecessary or ovenvhdming detail. Significant ly,
the thinking patterns th3t lead clients to verbose w3nde.ring in the interview may be the
s3me P3tte.r ns that prevent them from h3ndling their problem siru3tions nppropriatdy.
Consequ ently, it is importnnt that counsellors take some responsibility for m3nnging
the interview p rocess. In this w3y, clients lenrn 3bout sequencing and managing problem
exploration 3nd resolution. He.re are some strntegy choices:
■
Since open questions tend to elicit detailed responses, counsellors can use more
closed questions.
■
Identify the p roblem. For ex3mple, the co unseJlor might make a comment such as,
" You're giving me a lot of inform3tion , and ( ,.,,.,mt to m3ke sure I don't miss an\•~
thing. So, can J h3\-e your permission to focus on one point at a time?"
■
Aslc q u estions that chtdlenge clients to be b rief and focused, such 3S. "ff J asked )'OU
to summar i.!e your siruation inn sente.nce o r two, wh3t would )'OU S3y?"
■
Monitor the use of nonverbal cues that might enco urage wandering, such as an
3ttentive posrure, head nods, 3nd paralinguistic cues (e.g., "Go on," "Yes").
■
Be candid with the client by using a sc:ntement such 3S "Jt seems to me that whenever
we st3.rt to talk about a topic, we end up w3nde.ring off the subject. \\:fh3t do you
think might be hnppeningf'
■
When clients m3ke innppropri3te or premature shifts, immediately refocus on the
topic be.ing 3ddressed. Jt m3y be helpful to let the client know why )'OU 3re doing
this with a comment such as "I'm going to slow )'OU down a bit. I want to m3ke sure
we fully explore the issue of .. . before we move on. If we stay with one is.sue nt n
time, we are less likdy to miss important work."
■
Identify time constraints. Set time limits on the intentiew 3nd remind clients of the
interview time remaining.
Although it may be necess3ry to cut some clients off, it is important th3t this be
done in a way that the client does not feel dewJued o r overpowered. Counsello rs need
142
Chap1er S
to monitor and control their own negative fcclings, such 3S irritation and frustration that
may be e\'oked by their verbose clients. ff this is not done, it will be difficult for them
to communic3te 3 genuinely caring tone and empathic attitude.
SUCCESS TIP
I.n the beginning phase, clients often need an unintefrup(ed opportunity to tell theif stOr'y
and Shafe their feelings. ContfOlling and focusi.ng the intel'\liew too quickly may impede and
negate the cathartic beoofit to( a client that is made possible btf attentive listening.
Interviewing Youth
The period from puberty to young adulthood spans ~12 ye3rs 3nd is ch3racte.ri:ed
by enormous biological, psychologicnl, 3nd S<>cinl development, 3S well as significant
changes in cognitive devdopment and the brain. Even under the best of circumstances,
it is often a trying time with rapidly ftuctu3ting emotions, insecurities, and angst 3S
people confront the challenges of developing an adult identity. These ch3Jlenges 3re
compounded for 't'OUth in the social service system who could bede3ling with 3ddition3J
issues such 3S fnmil't' b reakdown, homelessness, poveny. drug abuse, physical and se>.."Ual
3buse, mental disorders, and conflict with the legal system.
Like nil groups, the.re is no one-size.fits-all script for working with youth. Although
they ma't' be dealing with common problems 3nd challenges, each young person is
unique and the counselling relationship must honour these individual differences. P3ying attention to the counselling relationship m31ces this possible.
The core conditions (uncondition3J positive regard, empathy, and genuineness)
discussed in Chapter 3 of this text are the foundation for this relationship. Youth may
come to counselling with considerable suspicion so counsellors need to be patient,
c3lm, and consistent during wh3t might be a lengthy beginning phase of trust building.
Past rcJntionships where trust has been \'lol3tcd ma,.• leave youth justifiably suspicious
3nd cautious of the motives of others, including wcll.-mcaning counsellors. Counsellor
consistency and predictability provides structure that increases 3 sense of safety for
the youth.
The contracting process C3n be used to explore 3nd understand the youths' neo:ls,
what thq• w3nt from you, 3s well as individual preferences. Open discussion to achieve
cl3rity on the role of the counsellor and the goals of counselling, 3S well ns the limits of
confidemiality, helps to reassure 't'outh th3t there are no hidden agend3s.
Youth may present with behaviours that don't make sense. Intense reactions to
seemingly innocuous triggers, resistance to simple rules, anger, acting-out behaviours,
3nd an in3b ility to make simple decisions in the.ir own best interests m3y signal 3 history of traum3. Youth who distrust the sincerity or commitment of the.ir counseJlors
))I) BRAIN
BYTE
The prefrontal cortex (behind the forehead) is a majof area
of the btain responsi~e f0r fegutatrng behaviour, making
good judgment chOices, and predicting the outcome of
behaviout It also ptays a paft in fegulating emotions and
sexual ufges. It is the last afea of the brain to f-.Aty develop,
with full maturation delay&d until earty adullhOOCI. As a
fesu1t, adolescents are more likely to ac1 imp-.Asivety and to
experiment with drugs and high ri.sk 0r sensation seeking
behaviouf <Ashwell, 2012). Compounding the problem is
the fact that dfugs such as aitOhol compcomise the pce-frontal cortex., fufthef limiti~ its ability to support effective
decision making.
Asking Questions: Tile Searcll lor Meaning
143
may test che.ir rcfotionships repetitively by questioning motive~ eng3ging in provocn,.
tive behaviour, and exhibiting outright expressions of hostility tow-ard their workers.
This requires chat workers be exceptionnJly patient and resilient and not cake their
clients' actions personally. A trauma.-informed approach to youth recognizes that these
behaviours and reactions serve a self-protective purpose, and counseJlors need to cake
time to cry to understand these clients in the context of their trauma. This underscores
the importance of giving )'OUth time to "teJI che.ir stories" and the criticaJ importance
of counsellors letting them know chal their stories have been heard. Active listening
skills, in particular empathy, are crucial in this process. On the othe.r hand, excessive
questioning can fed intrusive, and it ma)' unde.rmine the intended collaborative gonJ of
the reJationship. Table 5.3 offers additionaJ tips for interviewing youth.
Indigenous youth may be deaJing with significant issues of marginali!ation,
including a system involving workers who arc typically Caucasian. An anti-racist
approach such as the one described by Hick (2010) demands that workers "change
their own awareness and procedures, and social reJations and systems that operate,
both ove.rtly and covenly, to perpetuate racism" (p. 267). As pan of chis, counseJlors
should activcl't' explore how they can support the use of Indigenous spiritual and
healing practices.
Youth can be an incredibly satisfying population to ,vork with, as there is great
potential for shifts and chani;cs in their lifestyle that could result in major positive
movement. A strcngth~bascd approach shifts the focus from dcfteits, problem~ and
idemifying what is wrong to collaborative relationship where the emphasis is on helping clients take control by utili!ing pc.rsonaJ, community, and family strengths. \Vayne
Hammond (2015), President of Resiliency Initiatives Canada, emphasizes that children
can be resilient and grow, even thrive, when faced with adve.rsity and that our approach
should cmphasi: e hope, solutions, and possibilities. He Sll)'S that "those who embrace a
strength-based perspective hold the bcJief that children, youth, and the.ir families have
strengths, resources, and the ability to recover from adversity (as opposed to emphash.ing problem~ vulnerabilities, and deficits)."
TABLE 5.3
Success Tips for Interviewi ng Youth
Don't get drawn into powet str'uggleS.
Maintain self-.awar'eness and a nol'lfudgmental attitude rega,di~ is.sues such as dr'&SS,
hair, and txxly piercings.
Avoid pmssuriog youth to make d'langes they are not ready fOI", as lhis is Wkety to evoke
r'esistance.
Pay close attention to d'langes in baseline (established pattems of behaviour) as lhey may
sigoal increased stress Or' suicide risk.
Seek youth input in goal setting and decision making to rnc,ease the likelihood 1r.at they
will engage in and susiai"I cha~.
Be friendly and wa,m. but ramember you are oot their' perSOoal Mend.
Avoid ltyi"lg to be "with ir b-f adopting 100 language, maMerisms, and dr'ess of lhis group.
It's 001 expected; it may 001 be respected.
Remember that what may seem to be "no big deai- to )'Ou may be a majot c,isis to 100
youth. What is important is how they see and define the problem.
Don't assume heterosexuality.
Support and eoltabOtate with Other prolessionalS whO may be invclved with you( d ient.
Social media is a big part ot most teens· lives. lOOk for op(X)rtunilies to discuss safety
issues (e.g., the dangets ot ·sextiog·). Etlcoutage clients to utilize apptopriate online
r'&SOur'ces to assist them to undersaand is.sues rn 1t1eir lives.
144
Chap1er S
Interviewing and Counselling Seniors
Canadn's 6 million seniors are a very diverse population. lntc.rvicwing and counselling
with this group requires consideration of a large number of variables. In addition to the
usuaJ cultural and personality difforcnccs that define any group. counsellors will w-nnt
to consider factors that are significant for seniors, including ph)•sicaJ health, cognitive
ability, economic status, famih•, and community supports.
?l.•fason and Paul 3n' lifeJonK friends in their early se,'i":lnies.. ?l.•fason is physically ::.etl\'t,
2nd enjo)'!I spend!~ time with his wife 2nd six $tr3.ndchildren. Paul uses 2 walk«. lwd
in a l<,r1~,term c:ire facilit)·, 2nd is dependent on medk2tion for a vuiet)' o( llt::31th
i$$UCS indudinads:tbetes,. Parkinson' sdi:sease, and depress.On. P2ul in"~ed wiselr and
is AMneidilly independent wtule ?l.•fason continues to \\'Ork pc:ut,tin~ in orde-r t'O ,~t
his basic needs.
Ch:.dlenges and problems fucOO b)• seniors can be discmpowcring. As with any grout;
the gooJ of counseJling is to assist them to restore or sustain elements essential to an
empowered life including independence, freedom of choice, and an opportunity to pursue ,;oaJs and dreams.
All of the principle~ values, and counsclling strategies discussed in this book arc
still appropriate when working with seniors. As always., flexibility in the choice of skills
is cs.sentiaJ in order to accommodate individuaJ difference.
Counsellors who work with seniors need to be exceptionally empathic. They need
to invest considerable effort to understand life issues that they have not 't'et faced. For
example, the neo:I for a senior to move to assisted living ma)', in the face of diminishOO
capacity and failing health, seem seJf-evident and necessary, yet it is met with considerable resistance. This resistance must be understood from the perspective of the client's
emotions which have been aroused by the implications of the multiple losses associate
with the prospect of mO\'lng. Empathy and patience provide an opportunity for the
client to express and process these emotions. Table 5.4 provides further success tips for
interviewing and counseJling seniors.
Senior Abuse
When interviewing seniors, counseJlors should be alert to the possibility of abuse.
Senior (dder) abuse includes a wide range of problematic issues induding: physical
assault, sexual abuse, over/under medication, neglect, denial of personal rights such
as the right to practice one's religion, threats., emotionaJ abuse, and harassment. It may
come from stran,;crs who target seniors, caregiver~ or in any setting providing service,
but it is most likdy to come from someone known to the senior, usuaJly a family member. Neglect in care facilities may occur as a result of inadequate staffing or training. ln
recent years, onlinc predators have targeted seniors and have successfully duped many
of them out of their life SU\tings.
Counsellors need to be fully familiar with the.ir legaJ and professional responsibilities with respect to elder abuse. Sometimes the abuse is a criminal offence (e.g., assault,
theft, and uttering threats) and protection and invcstig3tion arc subjcct to the jurisdiction
of the criminal code. The Canadian CMrrer of Righu and Freedoms offers protection
ag3inst discrimination. There is no spccifte legisJation in Canada that deaJs \\'lth the rights
of seniors but each province has enacted its own laws regarding issues such as guard~
ianship (sec Canadian Centre for Elder Law, 2017) for details on provinciaJ legislation.
Counsellors should look for dues that suggest abuse such as:
■
Signs of neglect: shaggy appearance, malnourishment, lack of personal hygiene,
and be.ing left unbath~
■
Injury: unexplained or untreated W'Ouods, blade eye~ or bruises
Asking Questions: Tile Searcll lor Meaning
145
TABLE 5.4
Success Tips for Interviewing and Counselli ng Seniors
• Adapt fot hearing problems. Minimize noise, and if you need to talk IOudet, take ex.tta precautions to insure confidentiality.
• MOdify the k'lte-rview as necessary to accotM1odate vision and m::>bility ptoblems.. for' e.xample, ptovicle any written material in
a larger font. Ens.ufe that off.ce fumitufe is n01 a ba«iet or an obsiacle to the client.
• Be careful with physical contact FOr' example, a firm hands.hake may injure someone with fragile bOOes.
• If your client has cognitive impairment, keep ii simple, speak slO/dy, summarize, use repetition, and simple and focused
questioos.
• Altow time f0t the client to reflect and ptocess. Pictures can be used as memo,y cues.
• Focus on empowennent. Adopt counsem~ strategies that gtve clients conuOI and cOllabOr'ative in\(ll\letnent in decision
maki~.
• Adopt a strengttrs-based approad'l lhat assumes capacity, not incapacity. A client may have vision impairment, but this does
not mean that he Or' She is unable to make independent decisions.
• Ext,l0te and understand the events and life experiences lhat have shaped lhe values and WOtld view of dients.
• Adapt counsem~ strategies to tne cultural n0tms, values, and beliefs of 100 client
Facilitate life revie~ that help seniors make sense of their lives.
Be open to discussioos tr.at invcive spirituality.
Use Mr.: Miss.; or ·Mrs.: unle'Ss you are k'lvited to use first names.
Be sensitive to gender-r'elatect issues..
Eliminate age inapprop(aate jargon or unfamiliar acronyms.
• When \\()rking 'Mth fanilies. talk directly to the Older person, 001 tlvough other faintly membe-rs. Similarly, wtlen using a
translatOr', maintain eye contact with 100 client and speak to lhem, 001 about lhem.
• Remember, some seniors may be meeting social/emotional needs llvough their retationShip with a counsetot. This factOr' may
add tnOr'e ti.me to the interwew. However, oldet dients may have le'Ss energy, so avoid lengthy sessions that cause fatigue.
Use empathy to convey unclerStanding, but be careflA that empathy does 001 invade the clients' need fOr' privacy as they may
not be comfortable 'Mth excessive intm3cy with a stranget.
Be sensitive to clues (e.g., bruising or unexplained injury, changes in baseline behaviolX in mood Or' social involvement. lack
of hygj,ene) that 100 client may be a 'Jictim of negtecl, Or' physical, emotional, sexual, and financial abuse.
Be alert to 100 facl that depression, soci'.al a~ty. and multiple IOSSes may trigger thoughts of suicide. Ooo'I be afraid to ask
the •intent question· (see Chaptet 9).
Listen. There i:S much to learn frOO'l the acquired wisdOO'l of seniors.
8
8
See Chapter 11 f0t strategies for WOrki~ with seniors who have dementia.
■
Behavioural changes: withdrawal, depressio n, defensiveness. and pcrsonaJity changes
■
FinanciaJ changes: altering a will o r power of attorney, large cash withd rawal~ and
exploitation by unscrupulous business
■
Unsafe living conditions
Seniors, even when asked, may be very reluctant or unable to disc.lose that they are
vie.rims o f abuse. This ma'>' occur because of shame, o r fear of the consequences, o r a
desire to protect family members from legal con.sequences. ln the following example, a
social worker notices that her client, age 8 I , has a blade eye.
Socbl \Vorker. I ean ~ th::u yo ur eye is sv.'OIJen.
Client: It' s no thin&Socbl Worker. Ho w d,d it happen!
Client: I must h:3,ee bumped into a door o r sornethi1l{t. I re:311)' don' t reme.mbe-r.
Soci31 \Vorker. \Vas your h usband with )'Ou when it h::lppened!
Client: Like I 53,.,J, it's nothinK co v.'Orr)' about.
Soci31 \Vorker. I'm wo nderina i( )'Ou (eel s:.(e when )'Ou 2re 2lone with him.
Client: The l2sc ft'\\•yeu s h::t\'e no t bee., easr for him . He really is a 1t(JO(I nun. But. since
his stroke. tilt-re are times when . . . . (Long prawe.)
Soci31 \Vorker: You care for your h usband, and it sounds like )'Ou do n't w:mt l'O cause
hitn an'>' trouble.
146
Chap1er S
Client: I don't know wh:u I'd do without him.
Soda] \Vorker: Sure, but it's also important that )Our nt<tds are rnet. You need to be
2ble to (eel sa(e in ourov,m home. Marbe, "~•re 211 a point where both o( )Ou could use
some extr:i support.
(n the example, the social worker proceeds with considerable p3tience and tact while
gently maintaining the trust that will set the stage for a referral to appropriate follow-up
and support se.rviccs. Each province and city will have its own resources chat can be
accessed by seniors for support and protection including police, social se.rvice a,;cncies,
hea.Jth authorities, shelters, community care facilities, and other ori:anizations chat offer
spccia.1i!cd se.rviccs for seniors.
Cross-Cultural Interviewing
CounscJlors nttd to be careful chat their counseJling and questioning methods arc 00(
cukura.11)• biased. For example, cukura.J groups diffe.r profoundly in the way they react
to questions. When attempting to relate effective!)• to members of other culture~ coun,se.llors need to avoid stereotyping and ovcri;:cnerali!ing. 'W ithin a culture, an individual
may subscribe to all, some, or none of the cultural norms. Following are some points
to consider:
■
Clients with histories of oppression may tend to be overly compliant during the
interview. Consequemly, closed questions such as "Do )'OU understand!" may
be answe.red "yes," when in fact the client docs not understand. Open questions
arc preferable.
■
Use sea.ff or interpreters who spc3lc the immigrant client's language. \Vhen using an
inte.rprcccr, look at the client when the inte.rprcccr is translating.
■
\Vhcn langua,;c skills are limited, pay careful anemion co nonverbal cues.
■
Some cultures may react neg3tivcly to question~ or they miW't find some questions
on parciculnr topics intrusive.
■
Speak slowly, repeat or summari!e often, and allow frttauem pauses. Sometimes
\•isua.J or written cues will assist communication. Use simple langua,;c and minimi!e
jargon and idioms. Spc3king louder will not hcJp.
BEYOND THE SURFACE: INTERVIEWING FOR
CONCRETENESS
The Need for Concreteness
Concreteness is a te.rm used to me3sure the clarity and spccifteity of communication.
le is "a way to ensure chat general and common experiences and feelings such as depression, anxiety, an,;cr, and so on arc defined idiosyncratically for each diem" (Cormier
& Cormier, 1985, p. 48). \Vhen communic3tion is concrete, aJI participants share an
Ivey, Ivey, 2.alaqueu. and Quirk (2009) teported lhat neutoscientists have found that 100 stmss of poverly, oppression, sexism, and racism can create unhealthy and damaging
lew!IS ot COr'lisd in the brain, which negal.M!ly impac1 netXal
developtnent in areas of the brain associ".ated with language
concreteness: Atermused to
musuf! the clarity ud spetifdy
d communflli>n.
and memory. This unde-rscofes the im(X)rtance of counse~
IOr's sup(X)rting social action initiatives to combat oppression.
Counselling can atso assist clients to explOr'e ways that they
can mitigate 100 tc»6c darnarge from mafginalization. including
ways to de.al with oppressive systams.
Asking Questions: Tile Searell lor Meaning
147
understanding of words, phrase~ idC3s, feelings. and behaviours. 'W ith sclecto:I probing
skills. counsdlors assist clients to provide necessary definition and detail. Counsellors
also need to model concreteness b)• ensuring that their ex-pres~ ideas and feelings are
dear and specific. (n addition, they need to remain aJert to signs (verbal and nonverbaJ)
that their clients may be assigning different meanings from tho.sc intended. When client
communication lacks concretenes~ counsellors can use interviewing skills to raise it to
the desired level Figure 5.2 outlines various strategies counsellors can use to achieve
concreteness..
Probing for concreteness is necessary for the following reasons:
■
People see and experience et-enu differemt,. \\:'hen someone describes a problem or
shares a feeling, there is a natural tendency to make assumptions based on our own
prior learning and experience. \Vhcn a client asks a counsellor if he knows how
she feels, the counsellor may automatically answer "yes" without funhcr inquiry or
clarification. Even though personal experience can hdp them appreciate the problems and feelings of client~ counsellors risk communication breakdowns if they
neglect to explore their assumptions for accuracy. Active listening enables them to
understand the experiences of others with less risk of contamination.
■
The meaning of urords and ideas is •~Y much influenced 17:, factors such as culture or
history. Although people may have links and similarities in their experiences and
common human need~ everyone is unique. All people have different frames of
rdercnce based on their learning and experience. Consider the images that a word
such as anger miWlt evoke for various people. One person might vividly rccaJI an
abusive childhood, in which anger always led to someone getting hun. Another
might visuali:e screaming and hurtful words, while someone dse thinks of withdrawing and saying nothing. To a 12.-year-old, 30 might seem like old age, but to a
man in his late 80~ 70 is young, Similarly, a joke may be pe.rccivcd as humorous by
some p«>ple but provocative, insulting. or sexist by others.
Clitnt
Statement/
Respanse
•
c-
Quesljc)ns
•
-
Explore
......
Figure 52
148
Chap1er S
Strategies for Achieving Concreteness
■
ma,
Jargon and idiom
cc,nfu.se dienu. Questions must be dC3.r and understandable
to the diem. Like many other profcssionaJs, counsellors 3nd their work settings
h3ve their jargon, consisting of abbrcvi3tions, distinctive ,vord~ and phrases th3t
arc commonly understood by the people who work in the ficld. This jargon allows
for a quick shorthand flow of communication and helps to define activities and
routines precisely. Unfortunately, jargon is often used inappropri3tc1y with clients
who do not undc.rstand it, 3S in the following example:
Coun.seltor: I'm assuminK th::u this ii the flrst time th::u you\'t, K(Jne throuah the intake
process. A(ter we eomple1e your app, I ean refer you to an appropri::ue oonununily
resource.
A new client may h3vc no ide3 wh3t is mC3nt by the terms inrake process and co~
muniry re.source or the 3bbrc-.•iation app. Too cmb3.rrasscd to 3sk, such a diem m3y
be left feeling demoralized, stupid, and incaP3blc. Non.assertive clients frequently
respond to jargon by acquiescing or pretending that they undcrst3nd when they
h3ve no idC3 what h3s been S3id.
■
Messages are ofr.en unclear, incomplete, or ambiguous. Important information ma)' be
mis.sing. Sh3.rcd understanding between two people is possible onh• when c3ch
p3rticipant understands a message in the w3y th3t the sender intended.
■
People may lack ,he tocabulary 10 express ,heir ideas preci.sefy. \\:fhen langu3ge abilities
arc limited, it is difficult to communicate idC11.S 3nd feelings.
■
People may be unatmre of ,heir feelings. Questions c3n stimulnte thinking 3nd bring
clients' 3ttcntion to areas and feeJings that they m3y not h3ve considered.
■
Communication may be .superficial. \Vhen counscJlors move too quickly without
exploration of key ideas and feelings, the interview is likely to remain on a surface
level, and it m3y quickly run out of ste3m. He.re's 3n example:
Client: I lee.I stron{tly about ii.
Coun.~ellor: I'm not Surprised. From wh::u
that W:l.)'?
)OU
h::t,'t, be<en ~yin&. who wouldn't (eel
The counseJlor is supportive but docs not explore further to find out how the
client is feeling. This client hints at feeJings but gives no information about their
precise narurc. Unless the counsellor probes further, assumptions 3nd misunderstanding arc the likely outcomes.
Probes for concreteness propel the interview from 3 superftei31 level of discussion to 30 intimate lcvcl that requires a deeper investment from eve.ryone involved
in the inte.rview. Chapte.r 2 defined the illusion of work concept as a kind of implicit
p3rmership between counsellors and clients. In this 3.rrangemcnt, counscllors permit clients to avoid the P3in and struggle that 3rc often associated with growth,
while counsellors 3Void the risk that purposeful challenge cnt3ils:
\Ve h3VC all developed thec3pac:it)• to engage in convcrs3tions which arc empty 3nd
which h3vc no mc3ning ... \\:lorkers h3\-e reported helping relationships with clients that have SP3nncd months, even years, in which the worker 3fways knew, dttp
inside, th3t it was all illusion. (Shulman 2009, p. 154)
■
Content alone does nor full1 communica,e meaning. A counscJlor can casil't' miss important information by failing to notice the underlying emotional or personal content
in the words.
Counsellor Reluctance to Probe One distinguishing characteristic of cxcmpl3ry
profcssion31 interviewers 3nd counselJors is their c3pac:it)• to be comfortable with any
topic. Effective interviewers and counscJlors arc learners, 3nd they recognize that the
best te3chcrs 3rc their clients. This means having the courage 3nd assertiveness to ask
Asking Questions: Tile Searell lor Meaning
149
diff,cult questions about private matters. If counsellors have personnJ needs to avoid
certain topics o r if they are fearful that the discussion miWlt unleash strong diem
emotion~ they miaht hold bade to meet the.ir own neo:ls to keep the interview pleas.ant. At the same time, co unseJlors need to lcnow when to back off and respect their
clients' right to declare some topics off limits. Probing too deeply o r movina too fast
may result in clients revealing a grc3t dC31, but having done so. they may react adversely.
They might foci violated and not return to future session~ or they miWlt put up barriers
to protect against further unwanted inquiries. To be ethical, counsellors must question
wisely, explorina onh• those maners that are rcJevant to the work and fit their competence and rrnining, Thu~ asking clients for more concreteness requires that counsellors
arc willina to invest time and energy to listen.
Client Reluctance Some thoughts may be private, and lack of relationship rrust
may preclude full disclosure. For example, people fearing judgment or ridicule may tcll
others what they thinle thq• want to hear, or what they believe will result in accept:mce.
lndividunJs may also distort or exngi;erate messai;es because of experiences. Emb3rrass..mem, fear, uncertainty, taboos about taking help, and simple mistrust of the interview
process, including suspicion about the motives of the interviewer, present natural b3rriers to shnrina information. For some people, talcina hcJp from someone else suggests
dependency and we3Jcnes.s, which may result in feelings of inadequacy. None of this
means that the interview relationship is dysfunctional. In relationships, everyone must
decide how much, when, and with whom they are willina to reve3J persona] thouahts
and feeJings. Everyone differs in the degree to whidi. they are comfortable with disdos..ing intimate thouahts and feelings. Restraint and self-censorship of some ideas and
feelings are normal and necessary. Some people prefer to remain private, sharina linle
o r nothing. Others open up very slowly and only with people whom they deepl)• trust.
C ulrural norms may aJso influence what individuals arc willing to share. Clients often
view co unseJlors and intervie,.nrs as authority figures, and they tend to relate to them
b3scd on their prior experiences and imaaes of people in power. Even though thecoun.seJlor may have very little real authority, what is important is the perception o f the
client that the counsellor has power. Probes for concreteness arc invitations to clients
to trust their counsellors by revealing thoughts that they miaht prefer to keep hidden.
Shulman (2009) suggests that the same sodct:.d taboos that inhibit open discussion
o f sensitive topics also affect helpina relationships. Among the taboos that Shulman
identifies is reluctance to tn1k about sex, money, dependency, loss., and authority. To
Shulman's list of common tabooscould be added discussions about spiritual issues and
hC31th, as wcll as others that vary between people and between c ultures.
SUCCESS TIP
Compete-nt intervievdng requires cu(iOSity and a willingness to learn. This beeomes even
more important when counsellors have personal and prolessional experience with the issue
on the table. Unless c o u ~ monitOr' and control their assumptions, they are vurter-at:,e
to assuming they kOOw thei( client's situation without needl"lg to be told.
Strategies for Ach ievi ng Concreteness
Let Clients Know the Purpose Counsellors should probe for understanding only
in those arc3s that support the purpose o f the counselling relationship (contract).
\Vithout a dear contTilCt, the counsdlina interview is more likely to be haphazard
and random. However, in the beginning, it ma)' be necessary to give clients some time
to tell their story. When counsellors have a nttd for information o r if they wish to
150
Chap1er S
explore a particulnr area, they should consider sharing their objective, as in the following example:
Counsellor: You h:t,'t, not 13lk00 much about )'Our (eelu~ l 'rn wonderin¥ i( it rni"1u be
uselul lor us to spend a little bit o( time ~orll1¥ thii important 2rea. TI,::rt mi$;11t help us
undersc2nd S<H»e o( the pressure you \'t, ~n under 2nd how l'Ough it is l'O tnO\'t, lorw2rd.
Wh:lt do you thll,k?
\Vhcn clients understand and support the purpose, they arc much more likely to
respond positively to probes for concreteness.
Respect Timing
Herc are some brood ,;cneral guidelines:
■
During the beginning phase of n relationship. probe more cautiously until trust is
developed, or you gee a sense of the client's capacity for more in-depth exploration.
■
\Vhcn there arc relationship conflict issue~ consider the wisdom of dealing with
this reality first.
■
Probes for concreteness may stir up ftt.l ings that clients nttd time to process; therefore, during the ending phase of an interview probe more selective!)•.
Use Simple Encouragers and Directives
The simplest way to probe for more
information is to use short phrases and ,;csturcs thnt cncoura,;c clients to continue
with their stories. Nonverbal gestures, such as head nods, sustained eye contact, and
:mended silence, convey such support and interest.
Directives arc short statements chat provide direction to clients. Using directives
is nnothcr way o f gathering informntion. They can also be used to control the pace and
flow of an interview, and in cognitive behavioural counselling (discussed in Chapter 7),
they are used to nssign homework to clients. Directives such as "Describe- your feelings,"
"List your main reasons,'' "Give me an example," "Tell me what 't'OU did," "Share your
thoughts," "Tell me more," "Expand on that," "Don't move too q uickly," "Describe
your feelings," and "Put it in your own words" nJI help nc.hicvc concreteness.
S ince overuse of directives may leave clients feeling controlled, they should be used
sparingl)•. A softer tone and open body lnngua,;c can lessen the command nspect of the
directive. Short statements and directives, such ns "Tell me more," "Yes, ,;o on," "\\:fhat
else?" "Please expand on that," and simple encourage.rs such as "Uh-huh, hmm," c.nn
be used to sustain client sharing without interrupting the flow of the interview. A short
example will illustrate-:
directives: Sllot'I stateaents that
promi!' directi>n to tlieals • s .
infor1Ution, and pace (e.g., "Tell me
°'
_,.I
Client: I ¥m'SS rm prett't' an{tr)·.
Coun.seltor: Meanil,K!
Client: O ur refationship is on the rot.ks.
Coun.seltor: Tell me more.
Client: M)· brother always puts me dov,m . It's '--ot to the point where I don't want to
be a.round hitn.
Coun.seltor: (Nods: aurnt/t\' sifentrJ
Client: We used to be so dose. \Ve were insepa~ble, but in the fast year. it's bero1ne
so eompetitive.
Questions
Questions nrc the primary tool for seeking information. lnteJligcnt questioning can be used to get example~ define te.rms, o r probe for detail. The following
interview excerpt demonstrates chis process:
CounseUor: I want to nuke s ure I unders12nd. \Vh::u do you me:2n when you ~y
eOfn/~ltlu~!
Client: It's somethh-)¥ ualy. Not just wantll,i to wll, but al,so needina to win. h's as i(
ever,.•thil1¥ rides on winnll1i,
Asking Questions: Tile Searcll lor Meaning
151
CounseUor. Is th::u true for both o( )Ou!
C lien t: At first, it wu Just him. Kow I'm JUSt :u but.
Coun!l(>IJOr. \\'h::u's:. typie:d ex::ample!
Counsellors can use ~rics of questions to explore vague statements beyond a supe.r~
ficinJ level. The following excerpt illustrates:
Clien t: I know there are m3n)' times wben I let my (ee.li1'{tS ~ the better o( me.
Coun!l(>IJOr. \\'h::at kinds o( (eelin,iS,!
C lien t: Son~unes I let my an~-er build to the point where I'm read)'
l'O explode.
Coun!l(>IJOr. "Ready to eicplode"-wh::at does that mean!
C lien t: I would never become ph)•Sie:U and hurt someone. I'm JUSt a(r3id o( ~-ettin¥
re:Ul)' mean ::and s::arh,i hurt(ul thi~
Coun!l(>IJOr. H:u t~t happened!
C lien t: Yes. (Heslt.ata) A lot.
Coun!l(>IJOr. C::an you think o( a ~ ex:imple!
C lien t: ?l.·ty mother. She's alwars tryin¥ to eontrol m)' li(e. Most o( the tune. I just Ir)'
to iifi()re he.reonstant n:ij$in~ but l::atelr it seems th:u e\'e-rr s«ond. d3)' she pho!"K's with
::.dv iee. I don't w::ant it. and I don't !"K'ed it. Ye.sterd::ar I blew up 31 her.
Coun!l(>IJOr. \\'h::at did you do or say?
C lien t: I told her in no uneert:.in tenns to buu out o( my life. She started toer,·. Then
I felt ~-uiJty.
Empathy Although it is n()( usunJI,• thought of as a probing tool, empathy in foct
Cre3tcs a powerful incentive for clients to open up. Although the.re arc exceptions, successful empathy builds trust and safety for clients to reveal and explore their feelings.
\Vithout empathy, clients are more likcl,• to kttp their feelings private.
Follow Cl ues Often clients hint at a concern, which provides counsellors with a
natural opportunity to probe for more detail nnd to open the discussion to a gre3ter
levcl of intimacy.
C lien t: (Aoorldmg eye oontact.) h's not e3S)' to open up to 3 stra.n~-er.
Coun!l(>IJOr. It is tou~,. You mi~ht wonder hoo• I ::am it()in& to re::iet or whether I w1II
hold wh::at you S3)' ::t:it'3inst you.
C lien t: It' s just so emba.rl"'3ssina.
Coun!l(>IJOr. One wa,· tOO\~reome tJ131 is to t::t:ke a eh::aniee on me I'm open to a.nythin~
you have to s::ar. I flnd that when I avoid talki~ :.bout 3 tou~, area. it becomes e,.•en
more dirAeult to de:U with later.
C lien t: L2tel,·, l cannot sJe.ep :it nidlt bec::ause I'm wonderi~ i( I midlt be ipy.
SUCCESS TIP
"To helJ) a client. discuss &abOO feelings and concerns, the worke-r has to create a unique
'culture' in lhe helJ)ing interview. In this cultu(e, 1t is acceptable to discuss feelings and
concerns 1ha1 the client may ex.pe-rience as tabOO elsewhere'" (Shulman, 2009, J). 156). To
create lhis culture, IOOk fo( clues that tabOO-r'elated btOCks are present, b(.-ig discussion of
the blOek 10 the open, and 1hen renegolr.ate a new aweement that allows fo( opan d.rscussion
of lhe labOO area (Shulman, 2009).
Making Choices
A theme throughout this book is that effective counseJlors have a broad range o(
alternatives for responding. When they have choices, counsellors are not locked into
152
Chap1er S
repetitive panern~ nnd interviews are more interesting and \tibram for both clients and
counsellors. The follo"'ing example demonstrates some of the many "'ays that a counsellor might respond to a client:
Client: I suppose I should ha\'e ~peeled it. Mr Kirlfriend said she needed time to
think to "re-ev.llu::ue our rel:1tionship, .. 3S she put it. It was tol¢h, but I s.a ...e her some
t ime alone.
Counsellor (Choice I): How d,d )'Ou feel :lbout what W'3S happenin~ (an open question
that focuses the di$CuSS.ion on the dient·s feelinKS]
Coun.seltor (Choice?): What was )'Our plan! la.n open question coneentr:ltina on the
client's behaviour a.nd thol¢htsl
Coun.se.U.or (Choke 3): Tell me wh:lt )·Ou pbnned t'O do. fd1rtttive]
CounselJor (Ch.o k.e 4): Sounds M:.e th.is wu a painful lime for you. [empathic response
dirttted t'O the client's (~li~I
Coun:1;eUor (Choice 5): I'd be interested in knoo•ins. how you h:1ndled it. lindireet
question]
Coun:1;eUor (Choice 6): (Sifen«.) fsdenee used to {th'i' the d1e:nt 3n opportunity to
continue sharil,K]
Counsello r (Choice 7): It was hard. but )'Ou v.--ere able t'O Kh'i' her time to reaS!le$$ )'OUr
relat1onsh.ip. (poraphr3seJ
SUCCESS TIP
Choices fot ptomoring etabOtation (concteteness) ioclude combining each of lhe six.
bas.ic open ciuestion stems (who. what, when, whete, why, and how) wdh ead'I of the thfoo
baSic domains (behaviout, feeling, and thinking). Simple encotXagers: such as ·Teu me
more· and F'0t ex.ample ... • p(omote fwthe( depth and ctarity.
8
INTERVIEW TRANSITIONS
An interview transition occurs when the topic of conve.rsnrion shifts from one subject
to anothe.r. Such shifts ma.)' occur spontaneously in the course of the interview, or they
may be orchestrated to further the objectives of the interview. The need for a. transition
a.rises in the following situations:
interview tran$ition: bhifl in the
topicolthe interviea
t. Discussion of n pn.rticular issue is finished, and it is time to move on.
2. Discussion triage.rs ideas in another area or links to earlier areas of discussion.
3. The topic is too threatening or painful, and a topic change is needed to reduce
tension.
4. The subject has limited relevance or hns lost its relevance to the goals of the
inte.rview.
5. A change from one phase of the interview to anothe.r is necessary (Shebib, 1997,
p. I 56).
There are five types of transitions: narural, strategic, control, phase, and connect
or linking (Shebib, 1997, p. 156).
Natural Transitions
Natural transitions a.rise as the discussion Bows seamlessly from one topic co another,
with dear links between the two topics. The most common natural transition occurs
Asking Questions: Tile Searcll lor Meaning
153
when clients mention new themes as part of the interview, and counseJlors use this
information to jump to the new topic.
Client: All I ~lk about my di~tisfaction with 11\)' job. I rdh:e that the s::m~ could also
be sakl about mr marri~e.
CounseUor. Pert\:tpS we could addrtSS th:u new.•. Tell me wb:u·s h::appenb-w in )'Our tn.:trrb~
Clients arc unlikdy to resist natural transitions since the interview moves clC3rly
in the direction they have SUstRCStcd. The topic chanae is not abrupt, and transition
responses indiate that counsellors have heard what their clients have just stated.
Strategic Transit ions
Strategic transitions arise when counsellors make choices among topic :.dternatives.
Imagine that a client makes a statement such as the following:
Client: This h:as been the: worSt year on record for me. Mr f'lnanees were: a d1saster
an)•w:ay. 2nd now that J\,e lost my job I think I'll KO under. Ke,edless 10 ~)', this hasn' t
been i ood for 11\)' marria~ I can se:,e how h:anl it is on mr kkls. ?l.·1y eldest dau~ter
see.ms to avoid 1ne entirely. 2nd I'm sure mr son ii on dru~. h :all becomes too mueh.
How should a counscJlor respond to this revelation? Should he or she select finances
as a priority for follow-up? Or go with one of the other problems: marriaae, rcJation.ships with children, drug abuse, or unemployment! Should the counsellor focus on
problems or fccJing.s or both? How a counsellor responds is a strategic decision that
affects the direction of the interview, at least for the moment. As much as possible,
clients should be involved in decisions to make a strategic transition.
Control Transitions
Because counsellors have to orchestrate the flow of the interview, they sometimes use
control transitions to manaJ;e the interview's direction. Redirecting the flow of an interview is warranted when the discussion topic is irrelevant or when it prevents diaJogue
on more important is.sues. Preventing pre.mature subject changes is crucial for ensuring
concreteness or full exploration of content and feelings. Moving too quickly from topic
to topic results in a rambling and superficial interview where many things are discussed,
but few are unde.rstood.
Control transitions are used not to dominate clients, but rather to exercise profes..sionaJ duty to ensure that the interview rime is productive. (n practice, counsdlors and
their clients should share control, with counscJlors giving clients as much po\\'e.r as possible to set the course of counselling based on their needs. For the.ir pan, counsellors
hdp by monitoring the process and pace of the interview to ensure that discussions have
sufficient intimacy and stimulation. Skilled counsellors are sensitive to the following
elements of the interview that arc open to control:
I . Specific topics that are the subject of focus
2. The e>..'tent that the interview focuses on each of the three domains: feelings (indud.ing control on lcvcJ of emotionality), behaviour, and thinking
3. Sequences in which topics are discussed, including decisions to move the interview
from one ph3se to another
4 . Use of time, induding depth of discussion as wcll as interview start and end times
5. The following example illustrates a control transition:
Counsellor. I think we m"-'u be mo..,ina 100 quickly here. ~e havm ' t h3tl 21 th:utee to talk a.bout
yo ur (e,eibl{t.t. I wonder 1( )-OU'd ~ree that v.--e should do th:n before v.--e mO\'i' on to a di Ire-rent
topk. It miaht help us both to understand wb)• it's been sod1(t".e-uJt (or )'Ou to tn.:tke:2 decision.
154
Chap1er S
(n this o:3mplc, the counscJlor gives a brief rc3son for slowing down the interview
3nd focusing on feelings. Clients who understand what is happening: are much more
likcl)• to support the process.
But clients thcmscJvcs may suddenly change the subject of the interview for a vari•
cty of rc3sons. For o:amplc, perhaps they were rC'\•caling too much, or the materinJ was
too painful or persona] to discuss. Because of issues of client rrust and rcadines~ coon•
sellors need to use control transitions wiscJy and be mindful of the underlying feelings
that client-initiated shifts signal One way for counsellors to deal with a topic shift is to
openly acknowledge the shift, then gently explore its meaning.
Coun.se.U.or: Arn I n~n in think in¥ th:u you seemed un«unfort2ble talkina about ,.·our
relationship with your father!
Client: It'll not somethin~ I want to s.e1 into ri¥ht now.
Coun.se.Uor: Th:u's okay. I w1II not force )'Ou. On the othe-r h:md. )'Ou mi,aht deeide later
that )OU ~ue ready.
Counsellors can use summaries as a way to introduce control transitions. As the
following example illustrate~ summari!ing makes the topic switch seem less abrupt.
This is important because abrupt transitions ma,., appear harsh to clients and accentuate
their feelings of being cros.s-ex:.lmined.
Coun.~ellor. So. as I understand it, dru¥ abuse h:u h:ld a SiiJ1i0can1 imp::.et on )'Our
work. Your boss h:ls re:.1ehed a point where he w1II support )'Ou. but only i( )'Ou e:nte-r
rehab. Let' s sluft our forus for a minute and talk 2bou1 problems with )'Our family.
Phase Transitions
CounscJlors also use topic changes to help move the counscJling process into the next
phase. For example, in the beginning phase relationship building and problem explora•
tion arc paramount. However, at some point, it becomes dear that sufficient time has
been spent on problem exploration, and it is time to move on to the chaJlenges of the
action phase, where the activity shifts to problem solving: and scssionaJ contTact work on
feeling:~ thinking, or behaviour. Thus, phase transitions are needed to bridge the work
of one phase to another, as illustnncd by the following: o:amplc:
Counsellor: I wonder if v.--e have reached a point where it makes sense to ~ n talldna
2bou1 the ehan~ you W'3nt to make. ~e could b¢in to discus!? some o( )'Our ¥°"Ill and
then think about how to ::.chie..-e the-m.
(n the following o:ample, the counsellor uses a phase transition to end the int~rvicw
and to establish a linlc to the next session:
Counsellor: I'm impressed with )'Our ins¢1sabout how )'Ou tend l'O put )'Ourself down.
It ~m!l to me th::u the next lo$:.ieaJ step 1ni,ah1 be to explore hoo• 10 combat this tendency. I( )'Ou 2~~. we can start "'1th th::u nb:t t ime.
Pacing Generally. inte.rviewcrs should proc~ at a pace that their clients can manage.
This docs not mean that clients must aJways be 100 percent comfortable with the intensity
of the interview. lndccd, the work of interviewing and counselling can be demanding, and
exploring difficult topks can be exhausting. He.re are some genemJ guidelines for pacing:
■
Move more slowl)• in new relationships and first encounters.
■
Expect diffc.renccs among clients.
■
Don't expect to maintain the same intensity or an ever-increasing intensity throughout the interview. Periodic "rest" periods with nonthreatening or less demanding
topics c3n energize clients.
■
End interviews with less demanding: questions and responses.
Asking Questions: Tile Searcll lor Meaning
155
CONVERSATION 5.2
ST\JOENT: What are your looughts on takl~ nOles duri~ an
interview?
TUCH£R: You fl'SI.
ST\JDE:NT: 1have mix.eel footings. On the one hand, I don't
want to forget anythi~. On the other hand, it seems so COid
and dinical to be writing wtlen die-nts are talking, It seems to
lake .r14y from the intimacy ot the relationship.
TEACHER: Suppose you were IM client. and I were takltlg
nOles.
ST\JOENT: I'd wonder about what you wete W(itiogabOut me.
I'd be really scared that someone else might see the notes.
I'd probably be really careflJ abOut what I said.
TUCH£R: What if I tOld you that you could see the nOles?
TEACHER: AU clients have a right to that information. They
may n01 ask but, as a rule-, you Should tell them. You rarSed
a gOOCI point earlier abOut how nOle--takiog can dettaet from
rapport in 100 inteiview. I agree. I think it's partkular1y important to put 100 pen oown when clients are 1aUd~ abOut leeliogs 0t Olher private matters. On the other hand, most clients
ex.pec:t that you'll write oown informatbn such as phone numbers and add fesses.
STUDENT: I'd preiet not to take notes at au during the interview and just Wl'ite up a summary aftef the client leaves.
TEACHER: That v.()uld be ideal. Of courstt that's 001 atways
possible. There may be fofms ot computetlzed questionnaires to complete that can'I be delayed until afte-r the interview. Or you may have other clients warli~. so there may be
no time after the interview.
ST\J0ENT: That would help. Then I'd be able to COtr'ed any
mistakes. 1-'d re-ally want to know wM would have access to
100 file.
Mortt>ver, counseJlors need to m3na,;e interview transitions between one topic and
another. As well, they should avoid r igid agendas such as might be followed in a formal
meeting and instC3d allow some freedom of movement bcrnf'C(.'n topics. Counsellors also
need to be careful not to sprint from one topic to 3nother without adequate exploration
o r completion.
Connect {Linki ng) Transitions
Connect or linking transitions arc used to join or blend ideas from recurrent themes.
For e.x3mplc, a client m3y m31cc continuaJ subtle rcfc.renccs to 3 need to have everything
just right. The counsellor might use a connect transition to bring this theme to the
foreground:
Counsellor: ln~ll )'Ourex::unples, )'Ou t:llk about how you make- Sure' th::u you pay 3UC'n•
1.0n t'O C'\eery little deuul. Then )'Ou sec-m t'O ber:ue your:W'I( i( e,eer)•thin¥ isn't pc-rfttt.
))l} INTERVIEW
5. 1
The followiog excerpt illustrates selected interview skills. This is the first int~iew with the client, a single mother on
welfare. The counsellor w01ks in a C-Ommunity service centre that offers a variety of programs.
(During the first five minutes of the interview, the cout1sel/cr at1d the client engage ;,, small talk.)
counsellor: Per'haps you can tetl me what bt'ings you here
tOday. You did not tell me much on the phone, but I had
the impression that you fett some ufgency.
ClleM: I've been on wetfare f0t year'S, and I just can't make
ends meet.
156
Chap1er S
Analysis: lt1lervkw c,pet1fngs t!Stabllsh first lmpressJOfls. A few
minutes spet1t on small talk helps clients relax. and it should
t1ot be considered time wasted.
Analysis: A simple phase trat1sition begins the process of establishing the purpose of the Interview. By making a llt1k to the
ifltake phone call, the counselk:Jr demOflstrates that thectkt1t's
sense of emergency was heard. This Jets the client know that
the counsel/Or Is a good listener at1d sensitive to feelings.
i>»
INTERVIEW 5 .1
Interviewing Skills (continue)
Counsellor: Sounds (OUgtl. Tefl me more.
Client: Ifs not just 100 money-ifs what il's dci~ to my
kids.
Counsellor: What do you mean?
Client: My oldest is 18. He doeso'I seem to have any motivation. He says he can ha(dtywait until he is 19 so he can
go on wetfare too.
Counsellor: I wondet if it seems to you that being on welfare somehOw conne<:ts with yout son's attilude.
Analysis: A supportive and sympathetic reaction communicates warmth and concern. The counsellor uses a directive
to seek more detail and concreteness. As well, it creates an
apportunlty for the client to tell her story.
Analysis: It would be easy to assume what the client is talking
abOut. Instead. the counsellor probes for definition. An open
question gives the client full freedom to speak freely.
Analysis: This Indirect question offe,s an interesting ,eframe
for the client to consider.
Client: Good i:dnt. I hadn't thought of lhat, but it makeS
sense. It's all we've ktlown fo( the last five years.
(A ftrN minutes later.)
Counsellor: I need )'OIX help to undet'SlaOCI what you we(e
hoping would happen when you came here today.
Client: I need to gel into some sort of mtrainiog, My skillS
are way out of date.
Client: I'm willi~ toWOr"k anywhete, but eventually, I want
to frnd something that frts.
Counsellor: Fils?
Client: I'd mally like to WOrk with people. I'd like )'Ou( job.
(Ba/h laugh.)
Counsellor: I noticed eatlie( lhat as you described you(
voluntee( wOt'k with ldds. you seemed happy.
Client: 1-'d IOYe to do it full time, but the(e's no way.
Counsellor: What prevents you?
Analysis: Here the counsel/or- might have asked an open
question to initiate the working contract. However, an
Indirect question ;s substituted. This adds some v.vlety to the
interviewers style and helps to /WOid leaving the client feeling
Interrogated.
Analysis: The counsellor's response accents a key word using
a questioning tone. This is yet another way to seek info,mation
that ls more concrete. The counsello,-'s Interest stimulates the
client to say mare. Humour lightens the tone, but provides an
apportunity to probe further.
Analysis: A linking transition connects two parts of the
lntel"llew. Good counsel!Ots try to remember a blt of Information
that might be relevant o,- useful later-a kind of '"mem0ry
Post-It note. N
Analysis: An open question to identify barriers.
Client: I need to earn a li'o'I~. Veiunteet'Saren'I pai:S. To get
hired ful lime, I'd need to get a diploma.
Counsellor: But .. . ?
Client: But .. . That takes money, and I ha\18: no idea hO'N
I'd pay for it. Plus, 1-'venever been a g()()j student sogotng
back at my ag,e may be a recipe fOt' disaste(.
Analysis: Here, a simple unfinished res,:,onse is a useful
prompt for the client to identify ba"lers.
Counsellor: Sounds as if you've al(eady looked into it.
Although you sound like you'd lave todo it, you'(e wOt'ried
abOUt au the ObStades.
Client: Yes. As I said ear1iet, I'm detefmined to gel out of
lhis rut. I suppose I sholJCI do somethtng abOUt it.
Reflections:
■ What is the lmpo,ctance of the client telling her story?
■
How d,oe,s the counsell0r in this interview communicate empathy?
■
Suggest what the counsellor migJ,t say or do next.
Asking Questions: Tile Searcll lor Mea ning
157
SUMMARY
■
Questions are an important interviewing tool for g3thering information, pro\tiding
focus to rhc interview, promoting client insight, and supporting catharsis. Good
questioning can systematically lead clients through problem solving and can heJp
clients examine arc3s th.nt they might otherwise ovcrlook. Jt is important to balance
questions with responses that confirm understanding (summaries and paraphrases)
and empathic responses that confirm sensitivity to fccJings. So experienced counscJlors use a broad rc~rtoire of skills all the time.
■
Questions can be either dosed or open. C losed questions can be c3sily answered
yes or no. Open questions are difficult to answer with a simple 't'CS or no. The vast
majority of open questions will be "five~, ., questions (who, what, where, when,
why, and how). Another effective questioning tool is the use of indirect questions,
which are statements that function as questions.
■
Faulty, insensitive, and poorly timed questioning may bias clients' answer~ antagoni:e them, or keep the interview at a superficial level. Common errors include lead ing question~ excessive questioning, multiple question~ irrelevant or poorly timed
question~ and urhy questions. A lternative options to questions arc always available
for use by skilled counsellors.
■
Interviewing youth and seniors involves paying attention to individual differences
as well as cognitive ability.
■
Concreteness concerns the extent to which the discussion conveys dear and specific
meaning. When communication is concrete, all participants share understanding of
langungc, ideas. and feelings. Strategics for promoting concreteness include using
simple encouragc:rs, probing for detail with questions and dirtttivcs.
■
Interview transitions occur when the topic of the interview shifts from one subject
to another. Such shifts may occur spontaneously in the course of the interview, or
counsdlors ma)' orchestrate them to further the objectives of the interview. There
are five different rypcs of transitions: natural, strategic, control, phase, and connect
(or linking).
EXERCISES
Self-Awareness
1. Pick an issue that you have wry stt~ footings abOut (e.g.,
abOrtion, capital punishment. Or' canadian politics). Conduct a 5- to 10-minute inter'view with a colleague to ex.plOm
his Or' her' viehS oo the same 10pic. Howevttt", do not reveal
any of you, feellngs or th~ts on the topic. Afte, the intetview is ovet, discuss the experience. To what ex.tent we,e
you able to keep you, oNn views separate?
2. Think abOUt an expe(aence where you had a sliong reaction
to being questioned. What were you, thOu.ghts and leeli~
durk'lg the enicountet? How did you react?
3. Ask a friend 0t COiieague to monitor your interactions over
lhe nex.t week 01 so regarding your use of questions. Seek
feedbaek.
158
Chap1er S
4. Conclucl an i'\ter'viewwith a coneague. Use questions k'la~
ptopriately (e.g., ask irrelevant questions, change the topic
freciuantty, bOmbard with questions, and ask leading ques.
tbns). After the inter'view is completed, discuss how it fett
to be k'I tx>th the rnter'vie.ver and the client ,·ote. What did
you learn atx>ut yourself from this ex.perieoce?
5. Reflect on the variables that might make it difficlAt lor you to
se•~isclose 10 a counsell01. What issues rn your lile would
)<Ill be A!luc&art 01 uf'Mili(€ to discuss? How dO )<Ill think )<Ill
migt\t react if a counsellor pursued these topics?
6. Think abOut some of your pel'Sonal and WO(k relation.
Ships. Ate you mofe likely to be the one asking questions 01
the one answering questions? In what w:¥yS does this impact
the powet dynamics of the relatbnship?
7. On a scale of 1- 10 (1 =easy; 10 =tougtt), rate hO'Ndiff!CIJt
it might be for you 10 conduct a d ient interview Ydth the 101IOwing themes or topics:
Oealll
c. It's been a long time.
d. I knO'N e-xactty what she me-ans.
e. You have no idea hOw I fool.
f. I'm realty angry with you.
Spiritual issues
a:. The-re are some significant thi~ happening in my lile
Sex and intimacy
right
Mental heallh issues
now.
b. I'm 001 sure I can handle this pfoblem. I need he-Ip.
1-tyijeoe
4. Each of lhe fonowi~ client slate-men.ts has ooo or m0te
Aging
YOIS relationstlip with him/her
What can you learn aoout )'OU'self from your answerS?
Skill Practice
I . Coo:foct a 10-mW'lt.lte locused interview with a Cdleaigue. YOU'
task is to explore one topic in as much depth as JX)Ssible.
However', in this interview, you are n.ot allowed to ask ciuestbns. Use a range of Skits other than quesl.bnir'lg,. (Note to
the client: Keep yots answers very brief. Try n01 to be overl'j
cooperative.) After the i'\teM8W is O'iet, discuss the exparience. See 00W many diffefenl strategies you can identify fOI'
getti~ ir'D'matioo c.-. addil.ioo toOl)(!l'I and ct)Sed questions).
2. As a conditioning &efcise fOI' interviewi~ ciuiel clients,
conduct an in.tef'Jiewwith a COIie-ague-. Set up the in.te-rview
so that your colleague- does not resJX)nd verball'y. use a
variety of ted'lni::lues Other than questions.
3 . Videotape an extended intel'View with a celleague. Classify
each response that the counse-tlOr' makeS in tem'ls of ly~
open ciue-stion, closed Question, summary, and so on. Identify patterns. Ate the-re Skills that are overused 01' underused?
Concepts
I . ClaSsify each of the foltowing questions as open, closed,
Of indirect.
problems with concreteness. F'ust, identify lhe concre-t&ooss problem. Second, suggest a possible counselloc
response to promote concfe-te-ne-ss.
a.
1stitJ have lee-Ii~ fOI' he-r.
b. IW
ftlen tt a lot of lhOugl\l.
c. I hardly sleep at nigr\l.
d. I've tried to control my kids, but nothrlg seems to WOrk.
e. She's an elder1y person.
I. I f... bad.
5. Each of lhe- fallowing counsellor statements contains
phrases or jargon that may be unfamiliaf to d ie-nts. Reword
each using everyday language.
a.
It seems as 1h0u.gh youf
son has a 101 of inte-rpe:ISOl\3I
difficllty, and ii is gene-rating acring~ behaWOuf.
b. Cognilive-ly, he see-ms we-II within the- mean.
c. It appears 10 me that you are feeli~ ambivalent.
d. After intake it seems appropriate to make a refe«al to
one of our community resources.
e. Youf aflect is euthymk::.
6. Work in a small group to brains.tofm jargon that is used
in a setting that you knON. Next, reoor'd these tefms and
phrases so that lhey are easity unde-rsaaodable.
7. Watd'I a talk Sl'IOw. See if you can identify the interviewing
Skills that are ~d. LOOk for e-viden.ice of improper interviewing techni(lue.
a. How do you feel aoout your brOthe-t?
b. I'm pUZlled aoout yotX mact.ioo.
c. Do you have time to see me oex.t week?
d. I'd like to kn.ow somethi~ aoout your sttategy.
2. Rew0r'd the fOflowing clOSed questions as (a) open ci~
I.ions and (b) i"ldirecl ciuestioos..
a. Are you enrolled in the seo-etarial PfO!Jam?
b. Did the principal refef you?
c. Are you feeling sad?
d. Do you want 10 talk abOUt your feelings?
e. Did you tell hef hOw you lel?
3. lmagk'le that you am responch~ to the lolto.-dng d ient statements. Suggest fOflow-up responses that are- open ciuestions, closed ciue-stions, indirect ciuestions, and d1fe-ctives.
a. I have mixed feelings.
b. The~ step is to Sdve the blOOdy prOblem.
8. Identify six or mo(@ different chOices for obtaining lhe
folk)\\;~:
• The- p(~ of a oottte of socsa
• l.nfOl'matbn abOUt your client's feelings
• Youf client's reason fOI' se-eki~ help
9. Imagine that you are a counse-uor preplaMing an interview
with each of the follo-lMg d ients. What in.formation do you
think you might need? Identify Questions and directives that
you migttt use.
• A patient who has been physically fe-strained in a hOspi.
tal e~rgency wafd aftef a dfug OYefdose.
• AA elder1y woman vd'I0 is going blind.
• A man whO seeks he-Ip tor ang« management.
• A pafe-nt of a child who has been taken into cus.to:Jy.
Asking Questions: The Searc tl lor Mea ning
159
IO. Interview Aerobics
11. Prepare l'las.h caros \\1th the names of various Skills oo each
cafd (e.g., open question, ck>Sed question, paraphrase-.
summary, empathy, iOClirecl question, direclive, silence-.
wild card (any Skill), self-di!.clOSufe. and contractl"lg). Then
use them in an inter'View with a COiieague.
Note: The foUo-Ni~ exercises are desigr\ed to help you
develOp a range of SkillS. The mofe comfortable you are
wilh a 'hide afr'ily of responses.. the mor'e you wUI be able to
respond based on the oeedS of the client and the situation.
Uerdse 1: Shuffie the cafds. The counsellOf istens carefull'f to what the client says aOCI then setects the fil'SI card in
lhe stack and fol tows the dk"ections on that card. For example-. if lhe next cacd reads "closed question,· the counsenor
must ask a clOSed question, even if that migr\t 001 be the
beSt response. (Note: Do n01 IOOk at the card until lhe client
has finished speaking,)
Exercise 2: WOr"k in a group of three (counsellor, client,
and coach). Dufing the interview, lhe coach coooses an
appropriate ski\J cafd fOr' lhe counsetor to use.
Exercise 3: Conduct an interview using the cans in any
ordef that you choose. Continue interviewing until all of the
cafdS are used. ca,ds may be used more than one time.
Exercise 4: Conduct an interview using the ca,cts in any
ordef that you wish. Howevef, you can use each card only
once.
Exercise 5: OeV1!IOp your o-.m strategy for using lhe cards.
(Adapted ftom Sneb;b, 1997, p. 161)
WEBLINKS
Article on investigative intervi~ing of childieo.
"Guidelines on lnyestig~to,y Interviewing of Children: Wh.at
Is the Consensus in the Scientific Community?.. by Hollida
Wakefield (2006). American Jourt1al of Fo,e11sic PsychO!Ogy,
24 (3), 57- 74.
www.i pt.forensics..com/hbr.ary/.ajfp 1.him
160
Chap1er S
Basie: counseling skills for wo,king with teens (Center f0t
AdOlescent Studies)
https:l/centerforadolesce:ntstud1es.coml3-b.asic<0unselingski Ils-working-teens/
=C-
'"""'
-'
~
~~
.....
.;~
.
~~
- ,:;;-~
-.....
■
Explain the impormncc of emotions in counselling.
■
Define what is meant by empathy.
■
Identify the types of empathic responses, including when and how to use them.
■
Explore lccy principles (g:cncrali:ations) for using empathy.
"" ,
SimikOIIShutterstock
THE EMOTIONAL DOMAIN
At any moment in a counselling interview, counscJlors can choose to focus on one of
three brood areas: behaviour, thought. or fcdings (emotions). All thrtt are potentially
important and necessary for problem mtmai;cmcnt and change. Of significance is that
change in any one domain will have impact upon and trigger change in the others.
\Vhcn the emphasis is on behaviour, counscJlor questions and responses tarj;ct what
the client is doing or S3ying. Responses such as, "\\:' hat did 't'OU say?" "How did you
handle the situation!" and "\Vh.nt do you Stt as the next logical step!" 3re dominant.
If the focus shifts to the thinlcina (coanitive domain), responses such a~ "How did you
make sense of what happened!" and "\Vh3t were )'OU thinkina?'' 3re evident. Work
in the feeling or affective dom3in will involve counsellors in responses and questions
th3t explore emotions. Questions such 3S. "How do you fecH" 3S weJI as empathy will
161
dominate the ,vork. The bruancc of this chapter will explore concepts and strategics for
working in the important emotionaJ domain. Chapter 7 will explore how counsellors
can work in the behaviouroJ and cognitive domains.
Emotions define and shape the course of our lives. They remind us that we are
alive, but sometimes they make us long for death. Some cmotions--such as joy at the
birth of a child-demand to be expressed. Some that are too frightening to acknowledge
are destined to remain forever hidden, perhaps e,.,cn from ourselves. Carl W Buechner
underscored the importance of emotional connections: "they may forget what you said,
but they will never forget how you made them foci" (public domain). Shared emotions
are the cornerstone of intimacy. One's emotionaJ reaction, while not always mtionaJ,
dear, or understandable, often controls the finaJ judgment on communicative meaning.
EmotionaJ responses trifler unique physiologicaJ responses in our bodies such as
nausea or headadie~ and they can have a profound impact on our health and well-being
(Seligman & Reichenberg. 20 I0). In fact, "Emotions experienced as positive can activate
the inner pharmacopeia, those chemicals that reJax, help fight infection, and restore"
(Solccl,y, 2009, p. 17).
Historically, emotional responses have helped humans respond to important
situations:
■
Anger: The hands swell with blood, making it easier to use weapons or strike back;
increased heart rate and adrcnaJin serve to increase energy and power.
■
Fear: Blood Bow to the legs increases, making it easier to escape; the body may freeze
for a moment, giving time to gauge whether hiding is a better response.
■
Happiness: Brain activity inhibits negative thoughts and fosters increased energy.
■
L01.-e: General bodil't' responses promote well-being and a ,;cneral state of calm and
contentment.
■
Surprise: Raising the eyebrows cxP3nds the field of vision, thu~ making it easier to
figure out what is going on and to plan the best course of action.
■
Sadness: A general drop in energy and enthusiasm creates an opportunity to mourn.
(Golcmon, 2005)
Jones (2006) makes this interesting observation: "Emotions are clever design solu.tions to the problem of making fast decisions in response to significant practical problems posed by the natural and sociaJ worlds: we percejvc a danger and fear immediately
primes us to take protective action" (p. 3). But she aJso comments on the way that emotions can cause us to act inappropriate!)•: "They prepare us to embrace motivationally
actions we should shun and leave us in physical turmoil when we would be better served
by calm" (p. 8). Murdock (2009) identifies how problems miaht arise from emotional
reasoning: "Because of the emotional investment in an idea, it is seen as true, reg3rdless
of discrcP3m information" (p. 329).
))t) BRAIN
BYTE
Emotional reactions are also linked to our emotional memi>
rtes. TM human brain compcues current expe:ftence with
past events f0t similarities. and it may command us to •feact
to the present in ways that wefe impcinted IOog ago, with
thoughts, emotions, teactions reamed in msponse to events
perhaps only dimly similar· (Goleman, 2005, p. 21). This
may tesult in what Goleman (2005) desctibes as Mout-of~ate
162
Chap1er 6
neural alarms· that cause us to feact with outdated ot iooffective fesponses. Mofeovet, emotions can be partkul3r1y
baffling beeause Mthey often date from a time earty in OUf
lives when things were bewildeting and we did no1 have
w0tds foe compfe-hending events. We may have the d'laotic
feeli~. but not lhe WOfdS fot the memories that fonned
lhem" (p. 22).
Because the human expe.rience is so closely connected with emotions (feelings), we
c3n upect co unselling work to frequ ently focus on heJping clients identify, explo re,
man3g,e, o r accept their emotions. CounseJlors engng:c with clients' emotions in a n umber of ways. The co unselling relationship provides safety for clients to explore and
understand their feelings. Friends and family may be well-meaning but poorly equipped
to deal with complex emotions. T hey ma,., be prone to simplistic advice giving, o r they
may try to chani;c the subject when painful feelings are revealed. CounseJlors, on the
other hand, are able to deal with feelings. They do not tell clients how they should feel,
nor do they insult or frustrate clients with quick.-fix solutions. Instead, they allow clients to express emotions without nco:ling to censor what they reve3J. Nonju dgmental
responses and pe.rmissive encouragement from counsellors can be enormousl't' therapeutic for those clients who have struggled on the.ir own to cope with their emotions.
The pursuit of empathic understanding opens up an avenue for communication and
insight that is seldom accessible in everyday communication.
Golema n (2005) sus:i;csts that the ability to rccogni!e feelings as they happen is the
cornerstone of emotional intdligc ncc, and that people who are more in touch with
their feelings arc better able to navigate the.ir lives a nd are more competent decision
makers. G ladding and Newsome (20 10) suggest that "people who are unaware of the.ir
emotions o ften exper ience problems in relationships" (p. 154). Prcsbury, Echte rling.
and McKee (2008) conceptualized emotional intelligence in two C3teg<>ries: skills related
to understanding the seJf and skills related to understanding others. Self-skills include
ab ilities such as recogni!ing., monitoring, managing, and remaining open to our own
emotions; being congruent in what we feel and how we behave; and u sing emotions
as part o f problem management and creativity. Emotional intelligence when relating
to othe.rs requires empathic ab ility, including the capacity to unde.rstand, manage, and
navigate emotions in others that may be complex and ambivaJem. As well, we need to
be ab le to rccogni.!c incongruence; that i~ inconsiste ncies between what people feel and
what they sa y o r do. Seligman and Reichenberg (2010) give an ex:.lmplc:
A pe-rsoi, ~press.in¥ words o( lo"e w1II spe-.l.k $0(dy. 111::aintain K()od ere cont~ , ::and
h::1:,,e 211 open ::and ..vtJrominKposture. HOYi'e\'tr, i( that person ,>erbr:1111:es 101:e but has
poore)>e contact. an :l.11$tr)' tone o( voice, or 2 ten,sie 2nd dosed poscure. conflict in¥ ::and
con(usii,K emotions are co1nn1unk::rted. The receiver ,nay not know "-h:u t'O belu.'•,,e. only
IX''t' 2tten1.0n to part o( the mess~e. m isinterpret the mess~e. or discredi1 the n~~-e
because o( its delivery. (p. JJ2)
Howeve.r, communication d ifficulties and problems ofte n occur, since there arc
wide variations in the extent to which individuals value and express emotions. Many
factors impact this, including ::age, cultural norms, i;cnder, setting, mental disorders,
and soc:ialimtion. For example, people from Asian cultures value emotional restraint,
whereas \Vesterncrs tend to be more boisterous in expressing feelings. (ndividuaJs may
openly ~xpress emotions when they are with peers o r friend~ but be guarded or mute
with pe.rsons in positions of authority (induding counsellors).
Counsellors need to be alert to the impact of these variables, and they must also
monitor their own emotional reactions and mood to m::ake sure that the.ir feelings do not
))I) BRAIN
BYTE
Recent ne-ufdOgic:31discoveries may help explain the foots of
e-mpathy as well as the (ISkS ot ,.;cafious ttauma foe those- in
the hefpi~ pfofessions. When we listen to 0t obServe others,
•mifl'Of neufons• in our btains tend to fire in the same way
as tr'IOse of OU( clients. Put simi;::iy, when we heaf abOut 0r
witness an event OUf bralfls respond in the same way as if we
expe-rienced the event directly. As a res.ult.. OU( fee-tings tend
to mimic our clients' feelings.
Empathic Connec tions
163
ncgntivdy impact the work. Grancllo and Young (2012) cmphasi:e that "clients in counseling must be nJlowcd to work through their own issues without regard to the changing
emotional state of the counselor" (p. 119).
Counsellors can hcJp clients consider how their emotions might be intcrfe.ring with
decision making or eve.ryday life. Decision making, for example, may be difficult when
clients' emotions pull them in different directions; however, many unhappy feelings.
such as sadness, anger, grief, and disappointment, are part of everyone's life. (n fact,
feelings like grief are healing responses., and they arc not usuaJly pathologicnJ or in need
of treatment.
The Language of Emotions
Our language has wisely sensed the tivo sides of being alone. It has
created the ulOrd "loneliness" ro express the pain of being alone. And
it has creared the u:ord "solitude" ro express the glory of being alone.
- Paul Tillldi (TM Etn-naJ Nou,. 1952)
Much of counselling involves gening in touch with the subjective experience of cli.ents, particularly in the emotional domain. CounscJlors are constantly chnllcngcd to
understand and respond to the range of subtle feelings that clients express in language
that they can unde.rstand and accept. Despite the fact that there are hundreds of words
for emotions in the English language, words alone often fail to communicate precise
information about client fee.lings. A client who says, "I'd kill for a chocolate ice cream,"
is dca.rly exaggerating. Another might minimi!e a problem, saying, "It doesn't bother
me," but context and other cues might reveal evidence of profound pain.
Table 6.1 presents a feeling inventory of the most common families of emotions. lt is self-e-.•ident that cmotionaJ intensity varies among people depending on
the circumstances. Sometimes., word modifiers (e.g., t'ff)', exr.remely, .somewhat, mosdy,
and lirrle) serve to limit, quantify, and add further precision to the levcJ and type of
emotion expressed. For example, we can expect some difference in emotional levcJ
between people who describe themselves as somewhat happy and others who say they
arc incredibly happy.
Metaphors
Metaphors describe a state by using a symbol in a direct comparison.
For example, a diem who says he is "going around in circles" is using a metaphor to
describe his fedings of confusion.
Herc arc some metaphors with the possible fccJing that cnc.h one su~ests:
■
tied up in knots. in a pres.sure cooker (stressed)
■
about to blow up, bent out of shape (furious and angry)
■
on a sinking ship, down in the dumps (hopeless)
■
tearing my hair out (s\\--ampcd)
■
in a sticky situation (vulnerable)
■
between a rock and a hard pince (helpless., confused, and ambivalent)
■
butterflies in m't' stomach (fear and excitement)
■
on top of the ,vorld, on cloud nine (happy and ecstatic)
■
taken for granted (dcva.Jucd and put down)
■
going around in circles, feding pulled apart (confused and ambivalent)
■
Cfi on face. lilcc cw'O cents (embarrassed and shamed)
In addition, sometimes people use metaphoric phrases to describe ways of dealing
with emotions, such as "rising above it."
164
Chap1er 6
TABLE 6.1
Feeling Inventory
Intensity
tateao,y ot Emodon
Ana,e,
fur
tow Level
annoyed. il'filated, miffed,
olfencled, resenthA, ptOVOked.
disi:,eased. aggravated. put off,
licked, upset and disturbed
Medltn levet
Hieb level
angry, mad, hOstile. hatefu l,
disgusted, inflamed, in a tiff,
fed up. sore. agttated, and seettlS'lg
outtaged, fu(ioUS, ve~hA,
repulsed, bOili~. in a fage-.
irate, and infufiated
alarmed, net'VO!Js, anxious,
teased, uneasy, timid,
bOthered. apprehensive.
frightaned. scared. WOr'ried,
distressed. fearful, jumpy, and
ShOC:ked. hottified, pa.ntked,
uptlgl\t
and c()lj sweat
confodent, capai:.e, adepL healthy,
quaHfied, whole. ene~oo.
dynamic, tough, suong, brave,
detefmined, and secufe
irwulnetable, in conttol. OOld,
potent. couragoous. and
unbeatable
weak, vulnerable, falling apart. burnt
defenseless, impotent,
worthless. no good, po-Net'less,
ex.r.austed. lifetes.s. useless,
and petnfM!d
terl'ifted, mortified, terrorized,
intimidated, and butte-rflies
Ellll)Owerment
adequate, up to the d'lalleoge.
able to cope, and stable
Vulnerability
OO!k.ate, insecufe, Umk:1, Shy,
small. ftagne, tifed. weary,
emba(tassed, Sl)O()ked.
Joy~leasure
Saidness
appfe-heosive, and concemed
sick, i.ncompetent, i.nadequate, and
unptotected, frail
saUsfM!d, i,ad, good, pleaSed,
and eotnfortable
happy, contented. joy!IA, loY<d,
excited. optimistic, and cheerful
disappcinted. hurt, trout:,oo,
unhappy, glum. sad. depressed.
melanchOly, blue, lonely, dismal,
and pessimistic:
cSowncast, upset and bOlhefed
focus
distracted. muddled, u~rtain,
OOUbtful, hesitant, mixed up,
unsure, and indeeisive
Shame
out, eowafdty, helpless. usetess,
embartassed, humbled, and
regretful
Surprise
startled. and puzzled
love
atttaeted, and friendly
confused. baffled, per~oo.
puzzled, ambivalent. stumped.
jumbled, disjointed. and frustrated
belittled, diSCfedited. guilty, Shamed,
femorseful, and ashamed
surprised, stuMed, and shocked
ctose, intimate, wa(m, tendet,
Cherished. smitten v.;th,
anddoti~on
euphOric, jubilant, ecstatic:,
thrilled, delighted. passionate-.
elated, mal'W!IOuS., fu!I ot life,
terrifoe, and o,e,joy,!d
agonized, dejected,
de<pairi~. de<pandent.
hopetess, and miserable
(_.. a state oO pandemonium
O( chaos, mystified, and
swamped
disgraced, scanda~.
huniliated, and mortified
astonished, astounded,
flabbergasted, amazed,
overwhelmed. anct in a-.ve
IOvecl, adOl'ed, entaptured,
craiy abOut, wild aoout, flip
over, idOliZe. and worship
Nonverbal Communication of Emotions One key to successful communication
is monitoring a nd understanding the nonverbal channcJ of communication. Body langun,;e (especially facial expression): voe.al c ues such as tone, intensity, rate of spe«h;
and affect are essenti3l components of emotions that confirm, embellish, or commdiet verbal statements. All cues should be interpreted cautiousJy, including these common ones: tears, forced smiles, grimaces, covering clenched fist. shaking, becoming
silent, smiling, shaking he1ld, pacing. looking at the floor, turning away, and 't·elling.
For example, lack of eye contact may be culturally appropriate in some Indigenous
groups in Canada, and so non-Indigenous helpers should 00( inte.rp ret it as a sign of
disrespect. Counsellors need to remember that their O\\'n nonverbal communication is
not always under che.ir control, and it may be outside their lcvcJ of awareness. As Sue
and Sue (2008) note, a counsellor "who has not adequatel't' dealt with his o r her O\\'n
biases and racist attitudes may unwitting),., communicate them to a culturally diffe.rent
client" (p. 171). Despite their words and seated intentions, their nonverbal communications express an uncensored meaning.
Empathic Connections
165
Individual Differences and Cultural Context
All feelings can be c:xpcricnc~ as positive or negative 3t wrying lcvcls of intensity, but
this subjective determination is individunJt,., defined. For some ~pie, anxiety c:m be
debilitating, serious!'>' affecting: the quality of thc.ir lives; however, for an athlete the same
emotion may arouse a competitive spirit and the individu:.d might thrive on its physi.ologicaJ consequences. CounscJlors need to remember that their clients ma'>' respond
with emotional reactions very different from their own- with similar fccJings, sharply
different feeling:~ without significant cmotionaJ reactions, or with markedly increased
or decreased intensity; therefore, counscllors should a,-oid using: thc.ir own mC3suring:
criteria to interpret the emotions of others. For example, if they expect rhal people in
crisis will be verb3J 3nd ded3re their pain, then they might miss the fact th3t the quiet
child is much ncedie.r th3n the one who is 3cting out.
But circumstances and context 3re not 31\\"ll)'S good predictors of feelings. One person miaht be anxious about public spC31cing but find the experience exhilarating, while
another pe.rson is terrified by the prospect. One individu3l might enjoy parties 3nd be
stimulnted by the ch3nee to meet new people, but a second person looks for any excuse
to avoid the p3nic brought on by c.rowdcd social events. Consequently, when the mean,.
ing is notobviou~ counsellors should aslc clients to explain the.ir emotional experiences.
In the following example, the counsellor m31ces erroneous assumptions 3nd then,
sensitive to the client's nonverbal mess3gc, ,vorks to correct the error. This models
openness to the diem 3nd serves to reinforce the rea1it)• that counsellors arc not pc.rfcct.
Client: Mr mother isrominato visit me ,~t wttk.
CounS(>IJOr. Oh, th::u'!i nice. h'!i alwa)'!i $trt:::II when you h::n,e:. chance to see ,.·our (olh.
Client: (H~tatmg.) I ttuess so.
CounseUor. (Pk ldng up on tht- clit'flt'f htutadan.) Perh::aps I was mo h:lSt't' in assu mh)¥
you Yi'Ould be happ)' th:u she was cornini, I should h::a"e waited un1i.1 you told me how
you (elt. How do ,.·ou foe.I :iliout her \ti.Sit!
Client: I dre::.d it. ?l.·1y mother :dw3)'S w::ants to tell rne hoo• to run my li(e.
lndh•iduals arc also often governed by cultural norms, and there 3re wide vari.ances in the e>..'tent and manner to which they express emotions. Some cultures value
emotionnJ expression, whereas others favour emotional restraint. CulrurnJ empathy
(Connie.r & H3c.kncy, 2008) requires counsellors to pay 3ttention to both cukurnJ 3S
well as contextunJ considerations. Note th3t emp3thic responses should be culturally
appropriate with consideration of issues of pride and shame. For some dientSi, empathic
responses m3y le3d to embarrassment and "loss of (acc." Thu Si, diem receptivity to
empathic responses should be conside.red.
Ambivalence
Clients interpret their own problems and expc.riences and find them frequendy compli.catcd by multiple and seemingl,.•contradictory feelinas from two or more emotional famj,.
lies(sce Table 6.2). A great deal of stress and confusion can 3risc from the pushes and pulls
of competing fcdings that, if unm3naged, C3n disrupt a client's life. The tenns ambi1~lence
and of tu'O minds are often used. Ambivalence is normal, and although it can kttp people
stuck, identifteation, exploration, and resolution of ambivalence can be a wlunble P3rt
of decision making, Four key questions can be used to systematicaJly ewlu3te options:
I . What 3re the 3dvant3ges o( m3intaining the status quo!
2. What 3re the 3dvant3ges o( changing!
3. What 3re the diS3dvantages of the status quo?
4 . What 3re the diS3dvantages of ch3nging?
166
Chap1er 6
TABLE 6.2
Common Mixed Feelings
Happy and
scared
Happy and sad
Depressed and
fed up
This olten arises in coojul'd.ion with a lifestyle change (e.g., getti~ ma«ied,
retumtng to Sd'IOOI, starting a MN job. sending child(en to daycare, and
experienctng the "emp1:y nesr when children le.ave hOme).
Some transilional life events, such as leava"lg one job lot anotner or seeing
a chik:I off to COilege (or kinde(garten, etc.), elicit these leeli~. A sense o(
IOSs as well as gain is olten present.
These feelings suggest that the person has "bOttOO'led out.· Significantly,
100 feeling of be.-ig led up may be used as a st(ong morivatOr' for change
(e.g., deckli~ to change a self~estrucrive drug habit).
An&ry and
afraid
fear i:S often the n'IOr'e significant emorioo, but anger is m::>re c0tM1ooly
expressed (e.g.., a pa(ent fad~ a teenage!' wM is 1wo hours late fOr' curlew).
Hopeful and
despairing
Many clients fluctuate between believing tr.at cha~ is possit:,e with the
potential for lite to get bette( and that nothi~ Viill knprove and further effort
i:S futje. Oe\ltllOping and susiaintng motivation is crucial in such situations
(e.g., a pe(son cop.-ig with a life-threatening i!Joess).
Many people who am consideri~ changes in thei( lives experience tnese
footi~. Part of them wants thi~ to be diffetent, and part wants the
security of thei( p(esent situation. however, distressflA (e.g.• a perSOn
contemplating leav.-ig an abusive (elatioos.hip).
Attracted
and repelled
<•Pt>roaclll
avoid)
Love and hate
This usually arises in the face of conttadictory evidence (e.g., a friend
whOSe behaviour i:S ooatic-sometimes IOvi~. sometimes abuSive).
This method adcnowlcdgcs thnt there arc costs nnd benefits to each co urse of
action. lt aJso presents a nonjudgmental way to honour the fact that clients ma,., resist
chnnae for good reason, even when they P3Y a henvy price for doing so. For example, a
client may continue to abuse su bstances despite enormous persona] and financial costs
because it provides relief from h is severe d ep ression.
SUCCESS TIP
Counsetors need to remember that dients are lhe ex.pe(ts on theif own lives and tr.al they
have made the best chc::ice frOO'l what they consider to be thei( available options. Counselling empowers dients by hell)lng them identify add1t.ional ctu::ices and by helpi.ng them to
address or remove barrie-rs to options that were not seen as viable.
Motivational Jnterviewing (Miller & Rollnick, 2013) was developed as a collnbo rativc communication style specifically for assisting clients co resolve ambivalence.
Empathy, a ccncraJ feature of Motivational lnterviewing "normalizes ambivaJence
and demonsmttes that the counsellor unconditionally accepts the client" (Capu:i.zi &
Stauffor, 20 16, p. I 53). This popular, evidence~bascd approach will be~xplored in derail
in Chnpter 7. Example:
A wonun dest:ribes the j~• she felt when her son ielt home l'O b¢in trainiO¥ as a counsel~
lor. but as she c~lb, her ~-es well u p with tears. C learly. she is expe-riendn&:. scrona sense
o( los!l. despite the fact t~t words speak to her prkle and happiness.. More accur.nely.
both (eelin~ exist sl1nultaneo usly.
SUCCESS TIP
When responding to clients who express mixed foolt.ngs, say and instead of but. This rS less
confrontational and fully honours the presence of bOth feelings.
Empathic Connec tions
167
People also have feelings about the emotions they experience. Sometimes they are
very aware of these mixed fccJings. sometimes not. Try this simple experiment. C lose
't'our eyes and r«all a r« cnt strong emotion, such as anger o r joy. Take a moment to
get in touch with 't'OUr feelings. Now try to complete this sentence, "l feel about feeling
(your recent strong emotion)." Many readers will find that this simple exercise leads
to a deeper unde.rst:.mding of the.ir emotions. Some may find guilt behind their joy;
others fear.
Mixed fttlings arc often associated with anxiety and stress, especially when the
fttlings require opposing responses. Jf a person is both attracted to and repelled by
a particular choice. anxiety is likely to continue until he o r she resolves the dilemma.
Affect
affect: A tera t!lat counS!lors uS! to
desuibe hlw~ tiprm emo:ioa.
blunted: Eaotiouespressi>n is less
than one aight eapa:t.
flat: Ttie,e is an absellce« ne.- abS!IICe
ol any s.ps of emational expessica
inappropriate: TIie perso.'s manner
• d mood cootr,dict what one might
espe«. For
a clieal migflt laugll
,...ile describing die deatl of • is MIiier.
w_.,
labile: Tliere is abncmal variability ii
affect. wiih rti)eated, rapid, and atwupt
shifts in affective e,:pressica
restricted or constricted: Tllereis a
aild reduuion in die range • d intensiy
ol emoti>nal tipression.
affective disorders: Distarbaaces in
aood. indllding d~ss• • d mania.
mood disorders: See also affective
d;SIXders.
dysthym.ia: Achronic tonditi>n 11ith
S)fflptom similar to depfessi>n bell duit
an less sMre.
Affect is a term co u nsellors use to describe how people express emotions like sadness,
excitement, and anger. C ulrurc and context help to define what is considered within the
"normal range" of affect. Moreover, affect is communicated through voice tone and
quality, posture. facial expressions. a nd other nonverbal cues. These terms arc o fte n
used to describe affect:
•
•
•
•
•
Blunte& EmotionaJ expression is less than one might expect.
Flat: There is an absence o r near absence of any signs of emotional expression.
Inappropriate·: The per son's manner and mood contradict what one might expect.
For example. a dicnt might laugh while describing the d eath of his mother.
Labile: There is abnormal variability in affect, with repeated, rapid, and abrupt
shifts in affective expression.
Restric.ted or constric.ted: There is a mild reduction in the range a nd intensity of
emotionaJ expression. (For more information, sec Amer ican Psychiatric Associa.tion, Diagnostic and StmisticaJ Manual of McntaJ Disorders., 4th ed., 2000.)
Psychologists and other mental health professionals use the terms affective
disorders o r mood dic;;orders to describe a variety of disturbances in mood. T he most
common mood disorders are major depression, d't•sthymia, a nd bipolar disorder. Cfi,.
ents with major depression arc likely to experience many of the following symptoms:
depressed mood; inab ility to experience p leasure: loss o f energy and interest in life
and wo rk; changes in appetite; sleep d istur bances (especially insomnia)~ decrease in
sexual energy; feelings of ,vo rthlcssncss, helplessness., guilt, anxiety, or pessimism; and
thoughts of d eath o r suicide. Oysthymia is a chronic condition with symptoms similar
to d ep ression but that arc less intense. 'W ith b ipo lar d isorder, clients have alternating
depressive and manic episodes. Manic episodes inclu de these symptoms: abnormally
elc..,ated mood, irritability, hostility, grandiosity, ovcractivit)', flight of ideas., decreased
need for sleep. a nd buying sprees or other indicators of poor judgment (Da..,is, 2006;
American Psychiatric Association, 2000). In these situations, refc.rral to a physician
should be considered as an adjunct to counselling (see Chapter 9 for 3 more in-depth
d iscussion).
EMPATHY
It is the mind which create-s the world about us, and euen though
u:e srand side b:>· side in the same meadou\ nt)' eyes will never see
whar is beheld by )'Ours, ID)' heart will never stir to the e-morions
with which yours is rouched.
~or~-t Gissina (1857- 19.13)
168
Chap1er 6
Empathy Defined
In cveryda'>' terms, emparh1 means seeing the world through someone clsc's eyes. For
the purposes of counselling. though, cmp3thy is defined as "the process of accuratdy
understanding the emotional pc.rspcctivc of 3nother ~rson and the communication
of this understanding" (Shcbib, 1997, p. 177). The primary objective of empathy is
to understand and respond to feeling~ but there is 3Jso a cognitive component. Reiter
(2008) defines cognitive cmP3thy as "an understanding of the values, worldvicw, and
intentions of the client" (p. I09). Cognitive empnthy is an cs.sc:nti3l component of appreciating how emotions arc experienced and understood from the client's perspective.
But as Baron.-Cohcn (2003) note~ "empathi!ing does not entail just the cold caku13rion of what someone else thinks and feels. . . . EmP3thi!ing occurs when we fee] an
appropriate emotionnJ reoccion, nn emotion trigge.red by the other person's emotion,
and it is done in order to unde.rstand another person, to predict their behavior, and to
conn«t or resonate with them emotionally" (p. 2). To be dfective, empathi!ing needs
to come from n position of compassion and caring. Rogers ( 1980) outlined what he
considered to be the essential clements of empathy:
■
Entering the private perceptual w-orld of the other and becoming thoroughl)• at
home in it.
■
Being sensitive, moment to moment, to the changing felt meanings that flow in chis
other person.
■
Temporarily living in his or her life, moving about in it deJic:ately without making
judgments.
■
Sensing meanings of which he or she is scarcet,., aware.
■
Not crying to uncover feelings of which the person is totally unaware, since this
would be coo threatening. (p. 142)
SUCCESS TIP
Empathy needs to be expfessed to be effective. The empathic process rS not complete until
clients have an opportun.ty to confirm, correct. or embelli:sh lheit feell.ngs, and they know
that U'leit feelings am understOOCI and appreci'.ated.
The Importance of Empathy
Carl Rogers (1902- 1987), one of the most influential psychologists of the twentieth
century, wrote and lectured extensively on the importance of empathy in counselling. He conceptunli!ed empathy as one of the core conditions of helping (along with
unconditionaJ positive regard and congruence) that determine the outcome of counselling. In fact, Rogers argued that the core conditions we.re not onh• necessary but also
suff1eient co effect change. Near the end of his life, he offered this comment on the
importance of empathy: "To my mind, empathy is in itseJf a healing agent. 1t is one of
the most potent aspects of therapy, b«ause it releases, it confirm~ it brings even the
most frightened client into the human race. If a person can be understood, he or she
b.-loTIJ:S"(l981, p. 181).
Empathy is a fundamental building block for the helping relationship nnd is clearly
connected to positive outcomes in counselling(Table 6.3 outlines some of the ways that
emP3thy hclps clients). le is widet,., nmlced as among the highest qualities that a counsellor can possess (Cla.rk, 2007, 201 0; Egan & Shroeder, 2009; Reiter, 2008; Roge.r~ 1980;
Empathic Connections
169
TABLE 6.3
How Empathy Helps
Encoufages ex.pressioo of emotions. which is cathartic
Normalizes and validates feelings, reduces isolation, and contributes to 100 develOpme-nt
of the counselling relationship
ll'k:l"eases awareness ot emotions, including ambivalent feelings
Stimulates furthe( explOr'ation of clients' sut,ective ex.pe-riences
Helps clients (ecogrwle the impact of emotions oo themselves and others
Assists d ieots to uooerstand how emotions influence decision maid~ Of hOw they can
impede action
Provides a starting JX)int b managi~ and expressing emotions in constr'ucrive ways (e.g.,
r'e cogoiZi~ triggers)
and Shulman, 2009). Emp3thy is a powerful hdping tool nnd a core condition for nJI
hcJping rcJationships, reg3rdlcss of the counselling or therapeutic model adopted.
Among clients who abuse substance~ research shows that empathy is one of the
strongest predictors of success in reducing relapse (Miller, Forccchime~ & Zwcbcn,
201 I). Appropriate empathy communicates understanding, builds trust, and assists in
establishing the counsellor's credibility. Miller and Rollnid: (2002) conclude that the
degree of empathy expressed by counsellors is a signifteant determinant of the success
of clients in addictions treatment, whereas confrontationaJ counseJling leads to high
dropout rates and poor outcomes. P«>plc tend to protect thcmsdvcs from judgment
and rejection through defensive reactions or by e\lading disclosure; howeve.r, as Clark
(2007) obse.rves, empathic responses reduce ps,.·chologicaJ threat. Effective empathy is
nonjudgmental and it is non prescriptive (i.e., it docs not suggest that the client's feelings
need to be changed or "treated"). The counsellor's manner and cone convey acceptance,
comfort, and capacity co listen.
When counsellors arc empathic, they arc less likely to oversimplify complex problems. Because they understand more, they are aJso less prone to insult their clients with
wcll~mcnning but unusab le and premature advice. A common counselling error is to
move too quiclcl)• to problem solving when, for many clients, their difficulty is primaril)•
emotional. They may al'l"COOy have ready solutions to their problems, but emotional tur•
moil or ambivalence is a barrier preventing action. As a result, they arc unab le to engage
in taking action until the.ir emotionaJ needs are unde.rstood and managed. By assisting
clients to understand and manai;c feeling~ energy is freed up for problem solving and
clients ma)' be able to move ahead without further counsellor involvement.
Counsellors who accept the feelings of their clients help them accept themselves and
their feelings. Effective empathy honours the fact that clients have real and rational rt':lsons
for feeling as they do. Roi;crs (1980) note~ "True empathy is always free of any evaluative
or diagnrucic qualit)t The recipient perceives this with some surprise: 'If I am not being
juds;cd, pc.rhnps I am nm so evil or abnormal as I Juve thought. Perhaps I don't have to Jud~
myself so harshly.' Thus, the possibilit)• of sclf..acccptance is graduaJly increased" (p. 154).
Rogers further suggests that empathy is more than just a skill- it is a Wtt)' of
be.ing with another pe.rson. As he succinctly put it, "The ideal therapist is, first of aJI,
empathic" (1980, p. 146). As important as empathy is, it should not prcdude efforts
to understand other parts of clients' experience~ such as their thoughts, experiences,
behaviour, and the context in which they live the.ir lives.
Empathy aJso assists clients in identifying and labelling feelings, which allows them
to deal with thrue feelings. Moreover, with strong and supportive counsellor~ clients
can find the courage to den] with feelings that may have been too painful or overwhelm,.
ing to address on the.ir own. In this sense, empathy conrributcs to therapeutic chan,;c.
170
Chap1er 6
))I) BRAIN
BYTE
Recent f&Seatch at the Mount Sinai Medical Center (2012)
has found lhat an ate-a of the brain known as the antef10t
insular cortex is wtle-re empathy is p(ocesSed. This frnding
has huge futute implications foe conditions suctl as autis.m,
dementia. and some perSOnality disol"derS whete a laek of
empathy is a centtal feature.
Furthermore, clients often adopt the communication patterns of their counsellors.
Thus, counscllors who use empathic communication nnd other active listening skills
arc modelling skills that clients can use to improve their rcJationships with others.
CounscJlor empathy modcls a healthy and effective way of communiating.
To cmpathi.!e cffectivel't', counsellors need to be able to demonstrate comfon with
a wide range of feelings. For instance, they need to be able to talk openly about painful
feelings such as grief. Just as doctors and nurses need to be able to dea.1 with catastrophic
injury without losing control or running away, counscllors must develop their capacity
to w-ork with intense feelings without neo:ling to change the subject, intcllccruali!e, or
offer quid: fixes. Sometimes counsellors misinterpret this capacity as meaning that they
nttd to be emotionaJly detached nnd coldly indifferent. ln fact, empathic counseJlors
are deeply involved with the.ir clients. They put aside or suspend the.ir own reactions to
their clients' fccJings and adopt an accepting and nonjudgmental attitude.
Rogers (1961) emphasi!cs the neo:I to "sense the client's private world ns if it were
your own, but without ever losing the 'as if' qua1it)• . .. To sense the client's anger, fear,
or confusion as if it were your own, yet without your own anger, fear, or confusion
getting bound up in it" (p. 284). Rogers aJso provides this important observation about
emP3thy:
You 13)' aside your own "iews and "alueii in order t'O enter aiu>the-r'ii ",orld without
preJudiee. In some se~, it means that you lay aside )·Our self: thiii can only be done
by persons who are secure eoou~, in themselves that ther k°""• they will noc iet loiit
in what tlU)' tum out to be the !ltr.ln,ii' or bi:arre \\'Oddo( the other. ai,d th::u ther can
comfortablr return t'O their OYi'n world when ther wi.iih. (1980. p. 143)
An empathic connection does not mean that we endorse our clients' \'lews or
behaviour. As Miller nnd Rollnick (2002) note, "It is possible to accept and understand
a person's perspective while not agreeing with or endorsing it. Neither does an attitude
of acceptance prohibit the counselor from differing with the client's views nnd expressing that dive.ri;cncc" (p. 37). In extreme cases, clients may present with attirudcs and
behaviour that we find abhorrent- a man who has ab used his partner, for example.
Understanding this client's inner world in such a case may even be vitaJ, as it establishes
the counscllor's credibility for understanding and, subsequent!)•, as a potential influence
to help the client move toward non-violent responses. ln such situation~ empathic
efforts often help counsellors to become less reactive with their O\\•n feelings after they
learn about the complexities of their clients' lives.
> : •.
Gwen Oewaf (2015) reviewed fecent research on empathy
and the bt'ain and re(X)rted a numbef ot significant findings.
She found that ex(X)Sure to medta violanee can blunt ou,
ability to be empathic to other'S. She also reported that the
fesearch suggests that we afe less sensitive to lhe pain and
em::>tions of others when they are str-angers, members ot a
differ'ent race or subgroup, Or' individuals who am subject to
social stigma.
Empathic Connections
171
Client Reactions to Empathy
ClicnL,;; may respond to empathy differently. Posit ive reactions include:
■
ROOuction of pain through the rclensc of feelings (catharsis):
■
Increased insight as feelings arc rccogniz~, 13bellcd, and managed; and
Increased trust and rapport with the counscJlor.
Nc,zath·e reac.rions include:
■
Anger at the counsellor for crenting rhc conditions that led co their feelings being
exposed;
■
Embarrassment arising from fear of being judg,ed as wcalc;
■
A sense of intrusion if empathy violates pcrsonnJ, familial, or cukuroJ vaJucs that
preclude sharing feelings with others; and
■
Fear of continuing the counselling work if empathy pushes the client to deal with
feelings before they arc rc3dy.
Consequent!)•, in sessions where powerful feelings are reve3Jcd, counsellors should
leave time to process thedicms' rcoctions. This might uncover any feelings or concerns
that should be addressed before moving on, or it may prevent clients from dropping
out of counselling. Example-:
CounseUor. \Vhen you 1.-0 home toni~u and retlect about wh:u you shared rn,b)•. "-hat
do )'Ou think you m~t say to )'OurSelf!
Client: I think I'll beembr:lfr.l:;$$('d that I eriied. You must think I'm really w~k and (r.11i:Ut.
CounseUor. \VouJd )'Ou like to know how I (eel!
Client: Sure!
CounseUor. I'll tell you, but first I W'3nt to know i( )'Ou will belie,'t, rne.
Client: You\'t, always been up front with me. I'll believe )'Ou.
CounseUor. I think it took 2 lot o( ooura~ for )'Ou to be open with )'Our (eelin~s. and
I respect )'OU for takina th:u step. For me. it was 2 sian o( stren,tth.
In some e,ses, the di31o~ue mi$:ht take a different route sucl-i 2s the (olJowina:
Coun!l(>IJOr. I'll tell you, but first I W'3nt to know i( )'Ou will belie,'t, me.
Client: You·n probably just
5::1)'
somethi11K to m.:11ke me (~I better.
CounseUor. So. let's talk about what needs t'O h:tppen before you ea.n trust me.
Sometimes clients who have shar~ dee-ply come to the next session dcte.rmined to
exercise more control over their emotions. They may appc3r defensive or withdrawn.
A lead such as, "\Vhat are )'OUr thoughts and feelings about the last rime we met?"
can be used to debrief the Inst meeting. On the other hand, it may be healthy to avoid
confronting this apparent resistance; instead, see it as a healthy W'n)' for the client to feel
safe and g:iin composure.
Angus and Greenberg (2011) su~cst that some clients have developed problematic
emotional responses that often originate from trauma. For example, if a client learned as
a child that closeness and kindness was followed by sexual abuse, then, as an adult, she
may respond to empathy and requests for intimacy as an impending violation. As a result,
counsellor empathy may be- met with anger and rejection, particularly in the early developmental scages of the relationship. On the other hand, sensitive and weJl-timcd (measured)
empathy can provide an opponunity for he.r to begin to address how prior learning, while
protective at one time, now prevents her from dcvcJoping deep and meaningful relation.ships. Exploring emotions associated with the trauma can help her become unstuck from
automatic emotionaJ reocrions and ncrions that arc no longc.r useful or appropriate.
172
Chap1er 6
_ CONVERSATION 6.1
STUDE:NT: I WOtAd realty like 10 incfe-ase my empathy Slults.
but my \'OCabulary is so limited. I seem to k.nO'N only a few
fooling v.()fdS, such as happy, sad, scafed, and angry. How
can I increase my feeling WOtd d'loice?
TEACH£R: It's not necessary to have an eocyctopedic \'OCabula,y, but you should have eoough WOr'd ctu:ice to capture a
tx"oad range ot feelings. Study Table 6.1 (which appeared
earlier in thi:S chapter) for new feeling v.«ds: 100n take advantage ot every opportunity to practice empathy and use U'lese
v.()rdS. The lnte-r~t has many s,tes 1001 feature leeli~ word
inventOl'ies and these can be usehA, but remember that feel-
ings are often mixed. Try reading books and watching TV
with a special ear for discemiog how people are feeling. One
of the t>est ways is to use invtlational empathy to as.k others
hoN they feel. then to listen carefully to their WOtds. This wil
help se-nsitize you to their unique \'OCabulary. By adopting an
attitude ot inte-test and curiosity and focus~ on feelf'lgs, you
can dramaticaly k'letease your vocabulary. AnOlher suategy
'llf'len listening to clients is to lty to recall footings that you
migt.l have had in similar d r'Cumstances. This might give you
some ten1ati\ie: ideas abOul what yolM' dien1 could be fooling.
STUDE:NT: What abOut the danger ot imposing my feeli~
on them?
TEACHER: Yes, lhat is atways a tisk. Hence the need to be
tentative, remembering that people may respond to IM
same situation in widety different ways. NevertheleSs, there
are often SCll'M comrn:::,n aoo predic1able emotions fot most
people in a given situation. It's also important to w0tk on
beeoming aware of yout own lee6~.
TYPES OF EMPATHY
The three types of empnrhy arc invitational cmp3thy, basic cmP3thy, 3nd inferred cmpa,
thy. \\:'Ith invirotionaJ empnthy, a counsellor uses strategies to encourage clients to rolk
about thc.ir fcclings. With basic empath)•, a counsellor mirrors what the client has explicitly said. And with inferr~ empathy, a counsellor reaches empathic undc.rst:mding b)•
interpreting subtle dues. At 30)' point in an interview, counsellors can use empnthy to
explore a client's bdi.aviour, thinking, or feelings. \\:'hen counscllors focus on behaviour,
they explore what clients arc doing or saying or they shift anemion to problem solving.
When they pursue thinking, they are interested in their clients' bcliefs and assumption~
including their inner dialogue and self-esteem. Empnthy enables counsellors to pay primary anention to the third area-feelings (Figure 6.1). Frequently, counsellors are too
anxious to solve prob lems, and they move the interview focus prematurely to prob lem
Thinking
Feelings
Figure 6.1
Empathy Focuses the Work of Counselling on the Feeling Domain
Empathic Connections
173
solving, ignoring, or discounting whnt may be more important thnn solution~ their
clients' feelings.
invitational empathy: Ato:il a
counsel!« uses to ..,ur;aie clieali to
esi,:lore eaotioa.
Invitational Empathy
I m •itational empathy encouragesdients to explore emotions. It signals intent (or an invi,.
tntion) to move the interview 3'\-,t)' from one of the other domains (behaviour/problem
solving or thinking) to a focus on emotions. lnvitationaJ empathy is initiated with a simple
question such a~ "How do you feel?" Another choice is to say something like, "It might
be helpful if we put solving this problem aside for a moment to explore how you feel."
lf appropriate, counsellors can make further process comments about the importance of
addressing feelings as an integral part of problem management. lnvirotional empathy SO)'S
to the diem that the counsellor is re3dy and able to ta1k about difficult feelings.
Todo this, counsellors can draw on their knowledge of human growth and devclopmcm, such as ways thnt people tend to deal with particular life evcms and crises. Some
clients are reluctant to share their feelings for fear of judgment, or they ma,., believe
that they shouldn't feel a particular way. Others may think they arc the "only one" or
that they are "crazy," "evil," or "abnormal." For example, it is common to feel some
relief, even happiness (as well as grief) when a loved one who has been struggling with a
painful illness dies, but a diem may feel guilty for feeling this''",.)'· Invitational empathy
normalizes the expc.ricncc, making it easier for the client to talk about it and accept it:
"h's normal at a time like this to struggle with mixed foeli~rief, pain, comfort, and
perhaps joy that her suffering is at an end."
By encouraging clients to talk about feelings and then responding nonjudgmentally,
the counsellor is saying, "It's olcny to fee] this way." In the following example, the coun.scJlor uses invitational empathy to "give permission" to a client who might othenvise
suppress or ignore his pain to experience and verbali.!c his emotions:
Client: I ttuess it's no biide3L So. wh:lt i( the)' know the scoop on my m::arit::il problems.!
CounS(>IJOr. A lot o( people in the S3me situation 1ni~t (eel emb::ar~ a.nd perhaps
di~ppointed or :l..11ir)' that a (rie:nd oouJd be so indiscreet about son~hi1'{t ~id in
eonf",denee.
In the following example, the counsellor uses nonverbal cues as a basis for invirn,.
tionnl empathy to encourage the client to explore a difficult topic:
CounS(>IJOr. \VouJd )'Ou mind i( I shared 2n obser\'ation with rou! I ,nay be wron~. so
I'd like your opin.On.
Client: Sure. 1.-0 ahead. 53,., it.
CounS(>IJOr. I notiee that wbene,'er mention o( )'Our l2ther eomes up. you seem keen
10 ehan~ the topie.
(Lon,g s1lmce; dknt starts a, tht- jloorJ
CounseUor. Some memories are p.,infol- maybe e"en too painful to talk 2bout.
Client: (So/d,. tears ln hiseyd..) h's just th3t his death wu so unexptteed. ~e h:ld 2 fl$:ht
th:11 mornilli, 2nd I didn't e"en i.~t a eh:1..1,ee to sar ~b)'e.
Invitational empathy begins with questions and responses tnrgctcd at encouraging
clients to express feelings. The choice o( strategy is influenced by the usual variables,
including the amount of trust in the relationship. time constraint~ culture, and the
counsellor's role. Timing is one o( the most important variables. Since the exploration
o( feelings can be time.consuming, it is important for counsellors to make sure that
they have enough time to complete the process. Intelligent use of silence is another
important variable. Clients may need thc.ir counsellors to patiendy listen and restrain
themselves from filling evc.ry silent moment with words.
174
Chap1er 6
One w3y to brid,;c the inte.rvicw into 3 discussion of feelings is to use invitational
statements, such 3S "I don't know how you fed, but if you're feeling pain or lonelines~
I'm f'COOy to listen." Comments such as "I need 't'our hdp in understanding: your feelings" c3n also move the interview into the 3ffcctive-or feding--area.
Frequently, clients pro\•ide n3tural opportunities when thq• give hints about how
they are feeling:. Then the counsellor can use questions to encourage further sharing.
Open questions promote clients to sh3re feelings: "How 3re you feeling?" "\Vhat feelings best describe how 't'OU reacted!" Closed questions t3Jl:Ct spccifte information 3bout
feelings: "Did you fed angry?" "ls this something: you feel strongly 3bout!"
Helping clients understand the importance of 3ddressing feelings is 3n important
step th3t keeps clients involved in decision m3king (contracting). \Vhcn counsellors
inform cliems and solicit their support for the proces~ clients' motivation is higher.
He.re are some sample lc3ds:
■
I think it might hdp if we shift our focus and talk 3 bit about how you feel. This
might hclp us both to understand why your decision is so difficult.
■
\Ve haven't yet talked about your feelings. In my experience, feelings often present
one of the biggest b3rricrs.
■
Umil feelings arc unde.rstood 3nd 3Ccepted, they can distort our thinking: 3nd even
reduce the 3mount of control we have ove.r our behaviour. So 't'OU might find it
useful if we spend some time exploring how you feel
In addition, directives c3n be used to move the interview into the feeJing are3: "Tell
me how you feel." "let's switch our focus and talk about your feelings.'' Directives arc
one w3y to man3g,e the flow and focus of the interview.
Moreover, with some clients, counsellor sclf-disdosure is 3 Pffi\'Crful tool if used
sparingl,.•: "I don't know how it is for you, but I know that for m3ny months 3ftcr my
marri3g,eended, I was in a state of shock."
Another tool for exploring fcding.s is the sentence completion statement. Sentence
completion statements give counsellors a way to focus feelings on a particular arc3, and
they give freedom to clients to control the 3nswer.
■
\Y./hen I think about 31) my problems., I feel . ..
■
If I could use one feeling to describe my situ3tion, it ,vould be .
■
\Y./hen I first came for counselling., 1 fclt .
■
The feelings th3t 1 most nttd to deal with arc . .
But invit3tion3l cmp3thy should 3fways respect the clients' rights to privacy. Many
variables., especially trust, imp3Ct the e>..'tent that any client is willing to open up and
discuss fceJings. In addition, vari3bles such as gender, past experience, socializ3tion,
mood, 3nd power issues can also influence how much individuals 3re willing to share.
Basic Empathy
'With basic empathy, counsellors perceive 3nd respond to feeJings that 3rc explicitly
communic3ted. Basic cmP3th't' ma't' involve labelling feelings or summ3ri! ing expressed
feelings. Frequently, clients W3nt to talk about feelings. particular!,.• those closely rclated
to their problem situations. \Vhcn they take the initiative to introduce feeJing.s, it is
relatively easy and nonthreatening for counsellors to respond with b3sic empathy. &sic
e.mP3thy simply Sll't'S. ") have heard how you foe], 3nd 1 accept your feeJings without
judgment." \Vith b3sic cmp3thy, no anempt is made to interpret, judge. or promote
greater 3Warcness or insight beyond that which the client h3s alre3d't' 3rticulatcd.
Despite its apparent simplicity, basic empathy c3n be a powerful heJping tool. \Y./hcn
people express feelings in evcl)•tfoy communication, they may be blocked or discouraged
Empathic Connections
basic empathy: AtounS!lor's
actnCMtedg_•nt d adienrs cleafty
a,mmunicated feelings.
175
when others react by judging. ignoring, or giving advice. For example, one common but
o:trc.mel,., unhelpful response is "You shouldn't ftt.l that way." ln contrast, basic c.mpGthy
crc3tcs a clim:.nc in which clients do not have to defend or hide the.ir feelings. For m3ny
people, basic e.mP3th)• responses arc an unusual and satisfying cxpe.ricnce. As one client
described it, "For the first time, I felt safe. Someone had finally listen~ and heard me."
Furthermore, counsellors who puncruatc their work with frequent empathy are
more likely to build rapport and evoke further information from clients. Simple logic
suggests that when people bclicve that they are accepted and understood, they are more
likely to feel secure and less likcly to raise defences. As a result, clients are more inclined
to share and o:plore at a deeper level of intimacy than they would under more threatening conditions. The following example illustrates basic empathy:
Clien t: I wu ready to ki.11 her. How eouJd she embarr"3SS me in front of all those people!
CounseUor. So )'Ou' n:- a.n¥rY th:n she d,dn't h::r\'e e:nouah sense to ke"('p quiet.
Clien t: Anary. but ~lso hurt. After all. she w;,is supposed to be
eould !ihe double<ro!i!i me!
In)'
be!it friend . How
CounseUor. Sounds as if )'Ou fe"('I betr.tyed.
But empathic responses also need to be presented with an air of tentativeness to
give clients an opportunity to offe.r corrections. A simple pause or a question such as
"Have I j;O( it right?" can be used to this end.
SUCCESS TIP
To make simple, yet effective, empathic r e s ~ use lhis format:
~vou fool . .. (add tee1,n g wotd) because .. . (add contMtT
Inferred Empathy
inferred empathy: IN ificatia.ol a
clients"feEfings based • IOIIYttbal 00.S
•d indited cca.aicatica
I nferred empathy, sometimes called ad,~nced empathy (Egan & Schroeder, 2009),
involves identifying clients' feelings b3scd on nonverbal cue~ theme~ and hints. Coun,sellors should also pay careful attention to what their clients do 00( say, including topics
they ::rvoid and sudden shifts in focus. lnforr~ empathy is a pO\\•erful counselling tool
that enables clients to dC3l with feelings at a level deeper than expressed emotions.
Some clients find that their trust level incrc3scs when counsellors identify their hid.den feelings: "M 't' counsellor seemed to know how I felt without my saying so. Finally,
I felt understood. In fact, I began to understand myself better." Moreover, inferred
empathy may be P3rticulnrly useful with clients who lack feeling vocnbula.ry or arc unaccustomed to expressing feelings. lnfe.rred empath)• s«ms to say, "I have thecouraae and
the ability to hC3.r your feelings."
Clien t: It was a tou~, !iitu::ttion. Here I
W3$
in front o( ~ll those people with 11\)' prh'3te
life hl1id lxtre.
CounseUor. From the tea.rS in )'Our eyes. I suspect this w;,is a painful ::tnd emb::trraS.Sll1i
moment for )'Ou.
In the pr«eding o:ample, the client sec.ms willing co explore her experience, yet she
stops short of wrbally identifying her feelings. The counsellor takes a mild empathic risk
and considers context and nonverbal cues to infer empathy. lnfcrr~ empathy should
always be present~ tentatively to allow room for correction and further exploration.
With inferred empathy, some speculation based on the evidence of feelings is necessary. Consequently, there is more risk involved than with basic empathy. There are
two significant risks. First. because the information b3sc for infc.rrcd cmp3thy is more
ambiauou~ more errors arc likcl)t Hence, counsellors should be especially tentative with
176
Chap1er 6
inferred empathy. As wcll, counseJlors should nvoid becoming overly speculative to the
point where they arc simpl)• guessing at their clients' feelings. Second, inferred emp3thy
may be met with resistance from clients who are unwilling or unable to acknowlcd,;e
their feeJings. Inferred empathy notices subtle cues, and clients ma)' be surprised to
henr that their ftt.lings h.nve been communicated. They may renc:t with anger and resentment that their feelings have been uncovered. In addition, some clients are afraid of the
intensity of the.ir feelings, whereas others have strong needs for privacy. Thu~ inferred
emP3thy must be timed appropriately. The counselling rcJntionship should have a rea,
son.able level of trust, and the counselling session should h.nve sufficient time left to
process any renctions. Otherwise, it is best to defer inferred empathic responses till later.
Since inferred empnthy involves "reading" the client, counsellors need to de,.'Clop
skills in this aren. First, clients provide clues to their feelings in a number of ways. They
might be emb3rrassed about shnring their feelings or reluctant to ask for help, so they
talk about a "friend who has n problem." Second, as stressed earlier, understanding
nonverbal behaviour is crucial. Astute counsellors learn a great deal about the.ir clients'
feelings b\• carefully observing: changes in voice tone, sudden shifts in posture, nervous
behaviour, ten.rs, grimace~ clenched fist~ finger tapping, and smiling. As \\'CII, certain
behaviours can suggest feeJings. For example, a boy who runs away from a group home
just before a visit from his mother may be saying something about his fe3r or anger. A
client who arrives late, refuses to take his co3t off, and sits with arms folded across his
chest might be saying, "I don't want to be here."
SUCCESS TIP
Yv'hen lhefe afe time pfess.ures, counsellOrS tend to locus more on task at the expense of
felationship. Appfopriate and pfoportional empathy, even when time is limited, helps che-nts
to manage beltet than if the interview Of encountef addressed only task.
People often express emotions using analogies. For example, a client who comp3res
his life to a speeding train may be expressing his fears of be.ing out of control. Some
clients hint at the.ir feelings by asking questions, such as "Do )'OU worry about your kids
when they arc out late at night?" ln addition, clients who minimize problem~ as in "I
h.nve a bit of a problem. Do you have a minute?" or "This is probably not impormnt,"
may be signaling: that they have sianificant issues and feelings that they need to discuss.
Preparatory Empathy
Tuning: in, or preparatory empathy (Shulman, 2009), is another useful way to prcpnre
for inferred empathy. Prep3ratory empathy is n prcJiminary phase skill that involves
trying to anticip3te the feelings and concerns that clients might bring up in the interview. Since clients often do not directly revenJ their feelings, tuning in helps counseJlors
anticiP3te how clients might communicate feelings indirectly. Shulman (2CX>9) illustrates
tuning in with a common exnmple involving an e.ncounter between a ll•ye3r-old counsclling novice and a 38-year-old mother of seven children. The mother asked the worker,
"Do you have any children!" The worker responded defonsivdy by talking nbout her
training: in child psychology. Shulman sugi;ests th.nt the worker missed the implicit feelings expressed by the mother- the fear that the worker will not understand her. Had
she used the tuning-in skill, the worker might have been able to consider in advance the
range of feelings that a mother of seven kids miWlt have when meeting with a young
counsellor who has nochildrcn. With such advance prcpnration, the worker might have
been more sensitive to the mother's real question, perhaps responding, "No, J don't have
any children. \\:rhy do 't'OU ask? Are you wondering if J'm going to be able to understand
what it's like for you having to raise so many? J'm concerned about that as well. If I'm
Empathic Connections
preparato,y empathy: Atounsfflor's
11netJf1 to a.sider (in advafltf al the
interviewJ the feelings and CCIC'fflS t!l.i'!
tile client may commllicate ida::tly.
177
to help you, J'm goina to have to understand, and you are going to have to hdp me to
understand" (Shulman, 2009, p. 57). This response is an excdlent illustration of genu.inenes~ which in this case provides an opportunity for a discussion of the mother's
feelings about w-orkcrs and gives the ,vorker a chance to share her own feelings. Similar
counsellor strategies might be appropriate for diem question~ such as, "Have 't'OU ever
been to jail!" "Do you know what it's like to live on the srreed" and "How old are you?"
Table 6.4 summarizes the three types of empathy.
TABLE 6.4
Type
Invitational
Types of Empathy
OescrfptJon
E~agtng dients to
&alk. abOul feelings
Maj<M" Use
Comments
To stimulate discussion of
emotions
To oonnalile feelings
Invitational empathy undet'scores the ll11portance
of emotions. It counter'S any tendency to m::we too
quickly to problem solving without fully considering
the role that emotions ~y.
Basic empathy contributes to the 00Vt>lopmen1 ot
trust It signats to clients that counsellors are wifli~
and able to deal with feedngs.
Basie
ResJX)ndl"lg to clearly
aflkulated feelings
To encoufage continued
expmssioo of feelings
To connrm capacity to hear
feelings
Inferred
ResJX)ndl"lg to
oonve-rbal cues and
other indicators of
To move feelW'lgs into
the verbal chanool ot
communi::ation
lnte«ed empathy may genel'ate tnOr'e anxiety in some
clients if feelings that they avoided, suppressed, Or'
wanted to keep hidden are made visible.
lnte«ed empathy may ptOO'lote dien1 insight.
feeti~
))) CONVERSATION 6.2
SllJDENT: I don, think empathy is always such a good thing.
1watd'led one taped interview of car1 Rogers and two olhe:f
lherapists interviewing the same client, GIOria. If I had been
Roger'S's client, I wolld have been irtitated. He seemed to
continualy regtXgitate what the dient had just said.
TEACHIR: You've l'aised a good point. Too much empathy,
particl.Aar1y wtlen you get stuek at a basic level. migt\t leave
you and )'OIX client going in circtes.. It's alSO true that If you
move too fast With empathy, your dients can lee! lhr-eataned
and put up lhell defences. This is particularly tfue with clients W'ho have stfong needs for privacy. They may view your
empathic statements as an unwanted intrusion into their
feelings. Empathy invites greater relationslip intimacy, and
some clients are 001 ready lor the (isks that this entaits. As
Clark (2007) noted, Msome fand the emotional closeooss
of 100 therapeutic retationShip threatening and invasrve·
(p. 37). Some clients open up to empathic responses only to
tater regret having revealed too much. They may ·ciam up·
in future sessions, nevef return to counselli~. or they may
(esent their counsellors f0t allov.i~ that to happen.
But~ trough you migt\t have been irritated. it's s'lteresti~ to
note that, years late(, Rogers's client Gtoria described OOH he(
Sim time Vfilh Rogers was lite~hangj~ for het. This reo'lindS
us that cliants respond diffet'antly to the same techl'lique. Be
cam/'-' lhal )W' P<!(Cei:,ion of !he Rcgers tape doesn1 dO!e( )<lU
from using empathy. It may be e""'-1Jy wt,at )<lU' cloot . - s.
178
Chap1er 6
Other clients W'ho may 001 be ready lor empathy are lhOse
who are so caught up in their own talking lhat they do 001
even hear empathic statements. As Shea (1998) suggests,
attemprs to empathi:ze with this woup may adualy be counterproductive because empathy interferes with what lhey
want most-an audience to listen.
STUDENT: I lhink one way to handle that is to test y()U( client's
capacity fOr' empathy with a few bask empathic Slaternents.
If lhey a(e not well received, you can baek off by switching to
less demancfi~ content or more basic empathy.
TEACHER: t ag,-ee, back off, but not fore.....! As kust - p s ,
the dient may welcome that same empathic response Iha!
he Or' she at fir'Sl rejected. To continue 100 lisl of times 'llf'len
empathy may not be a good idea, I'd add the lollOwi~:
•
YOIX clients reject empathy.
• It's dear1y time to move on to ptoblem Sdving Or' another
activity.
• Empathy is continuousty misinterpteted by the client
(e.g., as conttolling or intrusive).
We Should always remember that counselling techniques
will not work the same way wtth al clients. Cultul'al norms,
tlUSI IM!I, mOOd, and personal resiliency are au vartableS that
influence how empathy is received.
FOUR GENERALIZATIONS ABOUT EMPATHY
Generalization One \'(Ihm dienu share feelings, empathy is (more often th.an nO() che
preferred response. A positive reinforcer "prescmcd immediately following n bch.nviour
C3uscs the bch3viour to increase in frttiuency" (M3rtin & Pear, 201 I). Clients talcc
an intcrpc.rsonaJ risk when they share their fccJings. EmP3thy acknowledges this risk
by conveying recognition and acccpcancc of the client's fccJings. Empathic responses
are a reward for sharing that conveys the mem-messaj;c: "This is a safe place to bring
your feelings." ln this way, it rc.inforccs the wisdom of the risk and motivates clients to
continue sharing feelings. On the other hand, when clients share feelings and they arc
not rc\\'tlrded (or reinforced) with cmpnrhy, rhc:n they tend to keep their feelings more
private. Non-empathic responses to expressed feelings carry the mct3•message, "Your
feelings 3rc not important." or " I'm not comfortable miking about wh3t you're feel.
ing." This underscores the importance of ex-pressing cmp3thy C3rly in the rcl3tionship.
When dealing with reluctant or mandated client~ empathy provides a w3y to acknowl•
edge and validate their strong emotions. Subsequently, as these clients feel understood
3nd listened to, their reluctance will often lessen.
Generalization Two Risk expre.ssing emparh1 eart, in rhe relarioru.hip. Norms, once
esmblishcd, arc difficult to alter. E3rly cmp3thy helps form the norm th3t the counselling relationship is 3 safe place to express feelings. To become comfort3ble with empa•
thy, counsellors need to overcome their own fenrs about bringing emotions into the
foreground. Many counsellors fear that by encouraging clients to express emotions,
they might trigger extreme reactions, p3rticularly suicide, but this fear is not substami•
3tcd by research. ln fact, it takes energy to suppress emotions; therefore, by helping
clients express 3nd get in touch with their feelings, counsellors can help them decrc3sc
the ncg:itivc effects of these feelings.
(nvimtional empathy is useful for working with clients who arc reluctant or unable
to articulnte feelings. Counsellor timing is criticnl, and counsellors should present invi•
tational cmp3thy in a gentle and tentative m3nne.r.
Early in the counsclling relntionship, counsellors should give priority to acquiring,
maintaining, 3nd deepening empathic undcrst3nding by rcm3ining alert to emp3thic
opponunitics. One obvious opponunity arises whenever clients vcrbali:e feelings. ln
such moments, counsellors can use basic empathy to confirm understanding. Some•
times clients rcve3J feelings nonvcrb31Jy, and counsellors c3n use inferred empathy.
When clients h3\'C not sh3red their feelings, counsellors c3n 3dopt invitation3f empathy
to encourage them to share their emotions.
Generalization Three Netff as.Rime rhar U't' ain know anorher penon's emorions in rite
way char rhcyknoui them. People often try to be understanding 3nd comp3ssionatc by say-
ing, "I know just how 't'OU feel." \\:fhilc this response h3s the potential to be supportive,
it is more likely that it will sabotage further opportunity for exploration and IC3rning. h
docs not honour the fact that each of us emotion:.dly processes experiences in our O\\•n
way. The fact that we h3ve h3d a similar experience does not give us C3SY access to instant
understanding. Our own cxpc.ricnce, with 311 of its assocfatcd memories, emotions, 3nd
outcomes, m3y 3ctu3Jly be a b3rricr to empathizing. Empathy requires th3t we ,vork to
see the world from the client's perspective. This means th3t we must carefully gu3rd
3g3inst bi3~hc n3tural tendency to 3ssumc that how we feel or have felt under like cir•
cumsta.nccs is how the client is feeling. High-le\'CI sclf-awarencss, he3lthy curiosity, 3nd
humility about our limited capacity to appreciate the client's emotions arc prerequisites.
Active listening. P3rticularly empathy, will help us to get closer to this go3I.
"I know just how 't'OU feel" also discourages people from the C3tharric benefit of
telling their storr~nc of the most therapeutic outcomes of active listening. Jc hij3cks
Empathic Connections
179
any opporrunity for the counscJlor to learn. Since we aJrc:ady "lcnow" what the person
foe.ls, what point is the.re in discus.sing it?
Counsellors should express empathy tentatively. Thu~ it is important to chc:c:k
with clients to confirm empathic understanding. Counsellors need to refrain from
using empathy as a wc:apon by insisting that their clients must feel a particular way.
Counsellors should also look for indicators that clients have accepted their empathy
and that it is accurate:. Clients provide confirmation through head nods, smiles, mani.festing rcduc~ anxiety, and verbal confirmation (e.g., "That's right" or "You seem to
know exactly how I'm feeling even before I tcll you"). Clients also implicitly confirm
willingness to accept empathy when they continue: to sh.arc feelings at a deeper level.
Conversely, clients may verbally signal that empathy has missed the mark (e.g., by saying
"No" or "That's not right")or with subtler nonverbal and paraverbaJ messages. Some
clients who are reluctant to challenge: may agree with empathy that is off the mark, so
it is important to remain aJcrt for contradictory nonverbaJ messages such as tentative
voice tone (e.g., "I guess so") or hesitation in their responses.
Sometime~ empathy misses the target and clients offer corrections. This is good
news and should be view~ as an important and positive: outcome: of empathic rislc.
Empathy is a devcJopmc:ntal process rttiuiring counsellors to remain open to adjusting
and refining their understanding until they reach a point of shared meaning with their
clients. Moreover, when clients correct their counsellors, counsellors know that they
can trust them 00( to capitulate.
Generalization Four Empachy requires flexibility in its use. induding che abilicy to refrain
from using ic. Empathy is an important and powerful skill, but counsellors need to use it
intcJligc:ndy. \\:fhcn clients arc willing to address feeling~ empathic responses are dfcc,.
tivc (sec Table 6.5 for sugi;c:stions). \Vith some client~ empathic statements result in
the opposite of what was intended. lnstead of deepening trust and encouraging clients
to open up. empathy arouses defences. This may happen when empathy targets feelings
that clients would prefer to hide, or when clients experience empathy as invading their
personal space. When clients resist empathy by withdrawing or becoming defensive,
counsellors should discontinue: using it for a while.
SUCCESS TIP
If clients exl)f&SSfeeling. respond wrth empathy. Risk ex.pressing empathy early in lhe relationshiJ). Be tentative-we can nevef fully ktlO'N how othet'S fool. Oew!loJ) ftexibifily (hO'N,
when, and when n01 to use empathy).
Moreover, situationaJ difforc:ncc:s influence how the work of empathy unfolds.
Some clients arc verba.1 and open with their feelings. They arc likely to respond posi.tivcJy to empathy. Others need gentle encouragement to tallc about feelings. and they
open up discussion of feelings gradually and in a very controlled manner. Counsellors
will gc:nc.raJJ,., find that they encounter less resistance: when they match their clients' pace.
TABLE 6.5
The Empathic Communication Process
Decide if it is an app,q:iriate tme to exi;:b'e emciions (coosider' cootext,. limi.-.i aoo 1e-..e1 of trusa).
Use invitat.iooal empathy to initiate discussion of feelings.
Pay attentbn to vefbal and nonvetbal inclkators of emotion.
ExplOl'e feelings fOr' detail, deflnition, and ex:amJ)le.
Forml.Jate a tentative empathic msponse.
Wait b Or' encour"3ge the d ienl to con.firm Or' COtr'ect your' empathic: perception.
COl'r'OCt 01' offer a doope:f empathic r'es:i:x:>nse baSed on the clien1's r'&S,:)Onse.
180
Chap1er 6
Empathic Response Leads
Using 3 range of different responses adds interest and variety to the interview. Using the
same words and phrases too often can irritate clients and reduce the interview's energy
3nd vitality. Having 3 ran,;c of leads for empathic response prevents the interview from
sounding artificial or robotic. The following list sugi;csts some variations.
I m •itational Empathy
■
How/\Vh.nt do you fed? (open question)
■
Do you want to tallc about your feelings! (do.scd question)
■
I'm wondering how you are feeling. (indirect question)
■
Tell me how you feel (directive)
■
Any thoughts on how thnt made you foci! (dosed question)
Basic Empathy
■
You foel .
■
My sense is that 't'OU might be feeling ...
■
From your point of view .
■
As you sec it . .
■
I w-ondcr if what you' re S3ying/fcding is .
■
You appcar to be feeling .
I nferred Empathy
■
Your tears suggest chat you might be feeling .
■
You've become very quiet. Perhaps )'OU are feeling .. .
■
One the.me th3t keeps coming up in what )'OU are saying is . .
■
\Vhen you taJk about .. . 1 sense you feel .
■
\Vhat 1 understand from wh3t you have said is .
SUCCESS TIP
A tMtative tone and a pause fof further dient input or correction is an important part of any
empathic tesponse.
Why Achieving Empathic Understanding Is So Difficult
Empathic errors are ,;enernJly unlikely when counsellors are simil3r to their clients
(in a,;e, gender, race, etc.) 3nd when they have had simil3r problems 3nd experiences;
however, even in these situations., empathic errors C3n happen if counsellors do 00(
separate their own experiences from those of their clients. CounseJlors need to reme.mber to nJlow for individu3l differences by remembering th3t, however, simifor their O\\' n
experiences might be. they c3n never fully understand how their clients feel. Through
emP3thy, they can ,;et 3 sense of their clients' feelings 3nd rise 3bove imposing the.ir own
interprct3tions., feeling~ and judgment~ but this understanding will never be perfect.
Empath)• is perhaps the most difficult counselling skill to master. Empathy demands
a lot of mentaJ energy from counsellors. First. they must man3g,e their own emotioMI
and judgmemal reactions. Then they h3ve to find meaning and discover feelings from
their clients' verbal and nonve.rbal communication. This can be exceptionally demand•
ing since clients m3y keep fccJings hidden or suppressed, or l3ck underst3nding and
Empathic Connections
181
nwarcncss of their emotions. Relationship issues, including lade of trust, cmb3rrassmcm, and fear of being judged, can inhibit clients from disclosing. For example, there
may be societal, cultural, or personaJ norms thnt prohibit sharing of feelings. Or clients
may not have the ability (language) to communicate their emotions.
Further complicating theempnthic process is the fact that counsellors must respond
right away. Jn nn interview, there is no time to use a thesaurus or a dictionary and no
opportunity to consult others, rehearse the.ir empathy, or ponder the feeling state of
their clients. Empathic risk means daring to share percejvcd understanding with clients
using concrete words and phrases that are accessible in the siruation.
Poor Substitutes for Empathy
\Vhen counseJlors express empathy, they adcnowlcdgc the feelings that cliems have
expressed (verbally and/or nonverbally). They might include a brief "because" clnuse
that summari!es content. ln most siruation~ they will stop there. This gives clients a
chance to process what they have hc3rd, to offer correction~ or possibly to share at n
deeper level. At this point, counsellors should avoid cutoff responses, subject changes,
empty responses, sympathy, or any other response thnt divens attention nwn't' from
empathy.
Cutoffs Cutoffs are phrases thnt inhibit the further expression of feeling. Counsdlors who make statements such n~ "Don't fed ... " and "You should feel ... " aredem.onstrating a low level of understanding nnd acceptance of how their clients feel. Such
statements are not supportive. They force clients to defend their feelings. Similnrly,
when counseJlors nsk clients questions such as "Why do you feel like that!" n judgmcn,ta1 tone is present that can leave clients feeling defensive (sec Chapter S).
Another response that may inhibit clients is silence. \Vhcn clients risk sharing
feelings, empnthy is bener than silence. \Vhcn counseJlors fnil to aclcnowledi;c feelings,
they mn't' be saying, "This is 00( important" or "I'm 00( capnblc of dealing with your
emotions.'' ln response, clients might fee] abnndoned, embarrassed, or judg,ed.
CounseJlors can also make the mistake of cutting clients off by changing the subject
or offering advice. A subject change gives the mem,-messagc "Let's not talk about that."
C lient: Sometimes when he speaks t'O me that way. I Just want to '--o hide in 2 corner.
CounS(>JIOr I (appropriate empath)'): It sounds like m.:1ybe you're (~lu~ emb,urassed.
Counsellor 2 (in2pproprb1te empathr ~ubject jhift): It sounds like ma)·be ,..ou're
t'O talk about ways o( O\~roomlfl¥ it?
(eel in¥ embarrassed. Would you hk.e
Empty Responses Empty responses arc de-void of content. Phrases such as "I hear
what )'OU'rc S3ying" and "I understand what )'OU mean" convey no confirmation that
the counsellor has understood. Another empty response is P3rroting, or repeating
what the client has said. Egan and Schroeder (2009) describe p3rroting as "a parody
of emP3thy" (p. 145). ln contrast, empnthy communicates the counseJlor's cffon to go
beyond merely he~uing the words to understanding the client's feelings and perspectives. Using empathy, the counseJlor rephrases the client's statements and nssigns labels
to feelings that the client has expressed but not named.
Be aware that diches and platitudes, such as "Everybody has to have a little pain
in their life," pntroni!e and reject clients' feelings. As Egan and Schroeder (2009) put
it, dic.hcd responses say, "You don't really have a problem at all, at least not a serious
one" (p. 145).
Sympathy Sympnthy and empnthy are frcqucnth• confused, and many people view
them as idcnticaJ; however, there arc important and signif,cant differences between the
nvo concepts. Sympathy refers to concern for other people's problems and emotions
182
Chap1er 6
))!}
INTERVIEW
6.1
The following excerpt illustrates some of the itMpProprldte responses that counseuors som~imes use instead of empathy.
lgno,ing feelings and offeting empty resPonses, simplistic advice, and sympathy are inadequate substitutes fOI empathy.
Client: (Softly, with tears fr, he( eyes.) I just haven't been
lhe same since he left. I Sltl look out lhe dOOr' and ex.peel
him to come hOme.
Counsellor: How old was he when he ran away?
Analysl$: /napproprfate to,:,lc shift: TM client Is clearly experiencing ,:,aln, perhaps grief, and she trusts the counselk:Jt enough
to share these feellngs. Generally. when clients share feelings,
particu/.vty feelings that are strong. empathy is the prefe"ed
resp(J('ISe. The counsel/Ors response shifts the foe.us away from
feelings to content. This may subtly signal to the client that the
counse.llor is uncomfortable with feelings. Continual shifts such
as this will ..,,afn" the client not to share feelings.
Client: He was just 16. I still tt'IOu~tof him asmy OOby. NON
I go to Sleep at nighl wondering v.tiethet he's dead or alive.
Counsellor: You thOught of him as you( baby. Now you go
to sloop at ~ t wonderi~ wtlethet he's dead O( alive.
Silence.
Counsellor: I unde-rstand hoN you feel.
Cllent (Buries her face itt her hands.) Sometimes I just
don'I ktlow vd'lether I can go on livi~. If something ooe-sn't
happen soon. then .. . (Counsel/Or intertuf)ls...)
Counsellor: You have to lhink of you( hUSband and you(
other- chilclreo.
ClleM: Yes, I ktlO'N, but dO you have any ide-a wtlat I'm
going th(ough? How tough it is just to get out of bed in
100 momiog?
Counsellor: My guess is that you feel vety a~ry at lhe
wor1d, maybe- e-ve-n some guilt that you are,esponsible fot you( son's running away.
someho-N
Client: No! I don't feet guilty. I was atNays a goo:J mothe(.
I think if my son we(e here, he'd say that too. When he
became addicted to drugs, it was more than eithe( of us
ktle-w hOw to handle-.
Counsellor: I heat vd\31 you're saying.
Client: So, what am I sup(X)Se-(1 to do? I fee-I so empty and
Analysis: Parroting. Repetition at this Point sl!M!'S no purpose.
Some.times key wo,ds o, phrases can be emphasized as a w.,y to
focus attention. but this type of parroting ;s inappropriate here.
Analysis: Superficial response. The counsellor tries to be supJ)Ol'live, but the response is empty. Until the counsellor rls.k.s
empathy with specific feeling words and phrases. the client
cannot know whether she has. in fact, been heard.
Analysis: Misguided rescue attempt. Ignoring feelings. It seems
Obvious that th;s courrselkJr ls unable to deal with the Powerful
feelings that the client presents. After an ill-timed interruption,
the counsellor offers a misguided and simplistic solutkm, while
Ignoring the emotions the client ex.pressed.
Analysis: Inaccurate empathy. The counsellor-attempts infe"ed
empathy. Unforlunately, there Is insufficient evidenc.e to sup.
Port the counsellOrs conclusion that the client feels angry
o, guilty. The counsellor may be right, but as suggested it Is
merely a guess, a JJOOf subs.titute (Or empathy. M0reover, the
counsellor- is not attending to the feelings that the clfent has
already ex.pressed.
Analysis: Superficial rt!SPonse. This res,:,orrse has the same
problems as her earlier OM, " I understand how )(lu feel."
useless.
Counsellor: H's a ve-ry bad feeling
(Brief silence.)
Counsellor: You shouldn't lee-I tnat way. One day your son
mighl walk rn the door. You have to go on living.
Client: I sup(X)Se you'(e righl ThankS for istentng. It felt
gOOd to get It off my chest.
Counsellor: I'm glad I was able to he-Ip.
Analysis: Inaccurate empathy, Jack of specificity. The counsellor attempts empathy but m;sses the intensity of the client's
feellngs. Then, the counsellor- quickly shifts the foe.us without
giving the client time to ,espond.
Analysis: The counsellOt''s rt!Sponse violatt!S the im,:,ortant
requirement to ac.cept clients' feelings without judgment and
withOut trying to tell them how they should feel.
Analysis: Someti mes clients bl!n'1fit from the Tntervl~
when the counselkJt's res{XJ(tSl!s are as ,:,,oor as thOse t1ep;r;ted in
th;s encounter. Sim,:,ly telling one's story and verbalizing feelings
can help people deal with pain or problems; however. it ;s much
more likely that this client ;s ready to dismiss the counsellor.
The coun.sello, may be just as ,ellewd that the interview Is over.
ReHectJons:
■
Suggest alternate approp,i.ate resPonses that the counsello, might h.ave used.
■
What might counsellors do when they r~gnize that their resPonse was inaccu1ate or inappropriate.
Empathic Connections
183
and is related to our own emotional and behavioural reactions. SymP3thy is the coun.seJlor's personal reaction, and though it is intimatd't' connected to the d iem's foe],.
ing.s, it is not the S3me as empathy. Sympathetic responses arc self-disclosu res., whereas
empathy is a process o f seeking to unde.rstand anothe.r's feelings; however, counsellors
arc human, and it is normaJ for them to have emotionaJ responses when listening to
their clients. In fact, their reactions are the basis for compassion, an indispcnS3ble com,.
ponent of a caring counselling rcJationship. T he.re arc moments when it is appropriate
for co unsellors to express symP3thy by letting clients lcnow that they support them
and that they are moved by their P3in. At the same time, it is cssemial for counsellors
to d evelop the ab ility to separate their emotional reactions (sympathy and comP3ssion)
from those of their clients. Counsellors also need to ensure that their s,.•mpathy docs
not detract from the client's feelings by interfering with their need to express feelings,
tell their stories, and face the reality of their problems.
C lient: l 'rn re:Ul't' v.-'Orried about tellinK my d:.d th:u l'\'e dropped o ut o( oo.Jleiti'. Even
when I was a little 1.::irl. tn)' (:uher kept s:ayi1l{t. "You\•e p to ~'t't an education or ,.·ou'II
ne\'er iti't anr,\-here in li(e.•·
CounS(>JIOr(Ch.o ice l ~·mp:uhetk re3ction): I don't think it wu ,-er)' fair (or him t'O
h::n-e l3kl sueh a he:h')' burden on )'Ou. It alwap1 makes me somewhat a~r)' when I he::ir
about parents push in¥ their kids..
Counsellor(Choice 2---empathk reactlon): So )'<lu (e2r th:u you \-e Let your father down!.
In the preceding example, Choice I is a misguided anempt to offer support. Judg~
memal in tone, it shifts the focus from the client's feelings to those of the counsellor.
Choice 2 expresses basic emP3thy, setting the smge for further explorntion.
C lark (2007) cautions thu ''A counsellor is subject to being ps,.•chologicall't' drawn
into the experiences of a d iem, and the interaction can lead to a distortion of perspcc.tivcs" (p. 14). For example, an overt,., sympathetic counsellor might curb discussion of
painful emotions o r might change the topic or avoid funher d iscussion of the area to
"protect" the client from the distress of facing the issue. Too much sympathy might
also cut off an opportunit)• for the client to explore foeling:s and options for action. The
following example illustrates this:
C lient: A(ter 15 )'ears of \\'Orkin¥ for the cornp:mr, they tell me th::u e\'en thou~, 1\-e
done a ¥ ff:at ,ob. I h:a\'e t'O take a par rut and a new job because the)· can' t afford to ha,-e
two supervisors.
CounseUor. That' s so un(air. What do they expect? You desen -e better.
It's eaS)' to speculate how in the p receding example the counsellor's response might
c urtail a more balanced airing of feelings and later exploration of the merits of a pay
c ut as one of the options. He.re is a more appropriate empathic response-:
CounS(>IJOr. Perhaps )'Ou (eel used, bel1evh11i:: that their pr:aise was just empty words..
SUCCESS TIP
Clients a(e often successful in making us feel as lhey do. Use lhis as a baSis for empathy
and as a ~ to monitor, undetsrand, and conuOI yout own emotions.
Tough Empathy
It is easy to feel caring and compassion for most people in pain, such as the aging d iem
who loses his job, the young mother who has had a second miscarriage, and the single
parent who is trying to raise children on a limited income; howcve.r, some clients may
challenge a co unsellor's tolerance. Even the most accepting counsello rs occasionally find
184
Chap1er 6
CONVERSATION 6.3
STUDE:NT: I haven't had a lot ot life e-xperlenice, and I'm worried that I
won't be able to uOOefSland what IM c lient is
feeling.
TEACHER: Somethnes counseUOrs do lheit beSI WOr'k when
they ad inst they don'I unders tand, then take the time to listen.
We ate constantly challenged to wor'k 'Mth clients who are
very different from us, so we ~ to be willi~ to le.am and
wdti~ to let d ie-nts "teach· us abOut their extieriences and
feelings. While we may not have had the same experience, we
can df3W on events in out own lives that have evoked sin-.lar
feeli~ such as pain 0t IOSS. If we have been thete oursetves,
we ha\18 some ad\tan~ but only if we are cautious to avdd
assuming that OU' feelings, perspective, and solutions will be
the same fOr' OIX clients. The best w.ry to do this rS listening
to out clients' stories, even if we think we know wtlat they ate
going to say.
ST\JOENT: Maybe there's an advantage to n01 having had the
satne ex.perience in that I'll be m0te ready to listen, leam,
and be curious.
it difficult to ta,., aside pc.rson:.d reaction, suspend judgment, and respond with cmp3thy
to clients such as the following:
■
Bob, an 3ngry 20-,.•e3r--old who savagely artackcd an cider!,.• woman
■
Perncll, a father who argues for the morality of sex with girls ove.r IS
■
Eileen, an HIV~positive prostitute who ignores the dangers of having unprot«to:I
sex with her customers
■
Ruby, 3 W'Oman who rejects 3nd attacks efforts to help
Counsellors working with clients such 3S these often experience strong emotion31
rcu:tions, and they m3y find it difficult to put aside their personal feelings to feel and
express empathy.
Some criminal psychopaths live with cruel disrcgnrd for the rights and feelings of
others. displaying a complete absence of ability to feel empathy or caring. ln fact, "the
blotting out of emp3thy as these people inflict damage on victims is almost always part
of an emotioMI cycle that precipitates the.ir cruel acts" (Goleman, 2005p. 106). Commenting on the research, Goleman offers evidence th3t suggests a biologic.al basis for a
13d: of empathy in psychopaths.
\Vhy then should counsellors respond with empathy to such people? First, empathy
is 3 way for counsellors to understand how their clients think and feel. Second, as noted
C3rlier, empathy is instrumental in forming the helping rel3tionship, the pre.requisite
condition for the contract between client 3nd counsellor➔ One outcome of emp3thy is
that clients come to feel valued and understood. Because of the empathic rcfationship,
cliems begin to rcve3J more, make discoveries 3bout themsclve~ and alter the.ir pcrsp«.tives about themselves and others. With clients who lack emp3thy for other~ counsellor
use of empathy obliges them to face their feelings 3nd those of their victims.
(n situations in which it is difficult to respond with empathy, counsellors ma't' need
to work on their own issues. For example, they c.nn ask themselves. "\Vhat is it 3bout
this particular diem that makes it difficult for me to be empathic?" "Does this client
remind me of someone else (e.g., parent and forme.r partner)?" "To what extent do I
have unresolved fttling.s and is.sues th3t this client triggers?"
Another strategy for counsellors is to spend time getting to know the client. Usu3lJy, familiarity increases emp3thy, as in the following example:
Carl. an emplo,.•ment counsellor, c3re(ull't' re::.d Anmnio's Ate. Antonio was a 19-,.~r-old
unemplored tn.3!e. From all indk::mons. Antonio W'3S not ve:r't' interested in f'mdil'l.¥ 3 job.
His n\Othercompl.:1ined that he usu.:111)' sle-pc until noon and th3t he rare!,., o?\'i":n read the
Empathic Connections
185
nN·spcaper want ads. Antonio arrived (or his appointment 20 minutes fate and a;h'i' out a
dear rness~~ that he d,dn't want t'O be there. ''How Joni will thisuike?" he asked bluntly.
Carl's n::uu~I reaction was an~r and di~ust at Antonio's 21titude. He v.'Ondered to
hitnsel( why he should spe1,d time with this die:nt, who w-as clearly u1ml0t1vated. PuttmK
his personal (e,elinKS askle. Carl dttided to reSpo1,d witl, empatl,y. and he ~-e:i,tlr replied.
"~•1y hunch is that )Ou don't se,e much point in beina here. Marbe )'Ou'reeven a little
anar)' at beina forced to come." Antonio. a bit surprised at C3rl's. percep11,·e:ness. told
him how mud, he resented everyone tryil,K to run his h(e.
Gr.klu3lly. Antonio be~an to Let do-Nn his de(e:ncesa,,d a ve:q• di((erent picture emer~-00.
Antonio talked about the rejection he (elt from countless. emplO)~rS who turned him
::rway. Soon it wu de3r to Carl t~t Antonio was deeply depressed. He slept l3te because
he could not sleep 3t ni~ht. He had stopped lookina for work bec3use it was his best
choice (or deal in¥ with the pain o( rejection.
Sometimes counsellors fo3r expressing empathy because they mistakenly believe
that empathy endorses their diems' beliefs or lifostylc~ but keep in mind that being
emp3thic docs not mean agreeing with the client's fodings or perspectives. Empathy
simply attempts to Sil)', "I understand how )'OU foci and how you see things." ln fact,
clients must fee] understood before they will respond to any efforts to promote change.
Empathy is one of the wars that counsellors csmblish credibility nnd win the trust o(
their clients. \Vhen a trusting relationship exist~ clients may be willing to consider other
pe.rspcctives and look nt the consequences of their choices.
})!} INTERVIEW
6.2
Client: F'o, as loog as I can remember, I've been drinking
~
ly basis. It's no big deal.
counsellor: (Sc/tty, whi.le ma;nttJirlirlg eye COtltact.J Drinking has bee-n part ot yout life, and you don't see a prOblem
with it.
(Client nod~)
Counsellor: You mentioned lhat your family gives you a
hard time abOul drinking. How do you feel abOut that?
Analysis: The counsello,- trittS to proceed cautiously with b.tt.ic
paraphrasing. Mirroring the client's t1,oughts conveys that he
has been heard. Suspending verbal and nonverbal judgment
helps to dtNe/op trust.
Analysis: An open question encourages the client to talk about
his feelings. Such st.atements atso say to the client that the
counsellor is willing to listen.
Client: Yeah. I work hatd all day. If I want to have a dtink.
no one has a rigt\t to tel me to stOI'). Otinking helps me
relax.
counsellor: Sounds as though you resent it wtlen otherS
interfe,e with somethi~ that gives you pleasuce.
Anaty1l1: Inferred empathy. Although the client doe.s not
diteclly label his fee.lings. based on the wordS. context. and
nonverbal messages. the counselk:Jr speculates that resentment
might be the predominant feeling.
Client: (Loudly.) They should baek off and mind their own
business. I don't tell them how to live.
Analysis: The client ·s response suggests that he is ,espansive
to the counsellor's empathy. He signals this by continuing to
share at a deeper level. Th;s is a significant event in the interview, which should give the counsellor confidence to COtltinue
to ,;sk empathy.
counsellor: It's tnOr'e than j ust resentment Pethaps you're
angry that they oon·1 respect your tigt\t to Hve your life as
Analysis: Anger is inferred from the client's n<Jnverbal e.rpression (volume). By labelling the anger, the counsellor gives the
client "permission" to dlscuss h;s anger.
you see fit.
186
Chap1er 6
~JO INTERVIEW 6.2
Effective Use of Empathy<conHn,e>
Cllent: 1guess I shouldn'1 be so ticked off. After au, my
father was an atcohdic, and I know fltst-hand what it's like
to live v.ith a drunk.
Counsellor: To some extent, your feeli~ am mixed. You
feel anger beeause you think they sholJCI mind theit own
busiooss, and you atso see where lhey're coming from.
You are sympathetic to lheit fearS.
Analysl$: Since the counse.1/or accepts h;s anger, the client may
feel less that he has to defend it.
Analysis: The counse.llor picks up on and ldftntifles the client's
mixed feelings. Mixed feelings can often be a source of anxiety
for clients. particularly if they pull their emotions in different
directions.
Client: Well. to be perfectly honest, it's not just their fear.
I dOn't want to drink tnyself 10 death like my father did.
Counsellor: You've oone some thinking aoout hOw you'd
like yout life to be different When yolM' wife confronts you,
it realty touches a nerve, and you're mminded of fear'S
you'd rather n01 have.
Client: No way I'm gci~ to let that happen to me.
Counsellor: You're determined to control your drinking.
Client: I'm n01 going to be like my father.
Counsellor: Co«ect me if I'm off base, bul as you 1alk, I
wonder if a part of you is afraid that youf drinld~ could
get Dul of hand.
Analysis: Inferred empathy. This client was initially guarded
and de.tensive, quick to de.fend his right to drink. As he flnds
acceptance from the counsellor, he begins to let his guard
down. In some interviews, such as this one, trust can develop
quickly. but more often, the counsello,- requires extended
patience.
Analysis: This bask empathic response gives the clfent some
breathing room. Counse/lOtS shOuld avoid constant pressure on
clients to move to a higher level of intimacy. The counselk:Jr
needs to move deeper, but caution is eritical to avoid moving
too quickly.
Analysis: The counsellor uses both confrontation and infe"ed
empathy in this statement. Presenting the ide.as in a tentative
manner softens the confrontation.
Reflections:
■ What might have happened if this cOun$tllOr had used a m0re confrontational approach?
■
If you were the counsell0r. what would you want to do in the nex.t half-hour with this client?
SUMMARY
■
Because of the centm1 role that emotions play in our lives, counsellors must give
priority to exploring :md understanding clients' feelings. Emotions are characteri:ed
by physiologicnJ as weJI as psychological and behavioural reactions. Mixed feeling~
including contradictory emotion~ arc common. A great dC3l of client stress and
confusion can arise from the pushl":S and pulls of competing feeling~ which, if
unmanaged, can control a client's life.
■
Empathy is a core skill for all helping reJationships. Empath)• helps build the helping
relationship, assists clients in identifying and labelling feelings, modcls a healthy W'a)'
of reJating to other~ and helps clients accept their own feelings. Although counsellors can neve.r know exact])• how their clients feel, empathy enabll":S them to move
closer to understanding.
■
The three types of empathy are invitational, basic, and inferred. Jnvitational empa,
thy involves strategies to encourage clients to talk about their feelings. Basic empa,
thy mirrors what the diem has explicitly said, while inferred emp:nhy attempts to
reach empathic unde.rstanding from less obvious clues. A variety of strategies can
Empatlllc Connections
187
be used to encourage clients to express feelings. includina invitational statements,
questions targeted at feelings, explan:.uions of rhe importance of addressing fedina~
directives., self-disclosure~ and sentence completion statements.
■
There are four key gcne.ro1i!ations about empath\•: (1) When clients share feelings,
empathy is often the preferred response. (2) Counsellors should risk expressing
empathy early in the relationship. (3) C ounseJlors should express empathy ten.tativdy. (4) Empathy requires flexibility in its use, including the ab ility to refrain
from using it.
EXERCISES
Self-Awareness
1. Begin a bg to track your footings. Al periodic intervals (e.g.,
every hour), rec0td WOr'ds and phrases lhat best deSCribe
hOw you are footi~ at lhat moment. Try to be as precise as
possible-. usi~ terms thal captLXe the essence and in.tensity
of hOw you feel. Maintain your IOg lot at least one week.
a. What patterns or cycleS are apparent? Are there limes
of the day Or' week when you are more likel'j to feel par.
ticular emotions?
b. How could you have altered your emotions (e.g., to
inc,ease pleasurable feeli~ and decrease negative
feeHngs)?
life that involves emorion.s. In response, other members
attempt to identify the predominant feelings exptes.sed.
2. Practice ln.ter'vie'N: Work in. pairs: wilh one pel'SOn acti'lg as a
dient Shari~ lhe details of something curten.t that in'VOl\ies
emotions, and the other person acti~ in the counseuor
role. AIIO-N abOUt 15 minutes for the interview. As counsellOr', use lhe three types of empathic responses to keep the
in.terwew focused on. footings. When the interview is over,
review the experience with each Other' using the foltoM~
questions as a glJcle:
()ient: What was easy and difftellt abOUt s.hating your
footings? What responses from your partner were help.
ful? UnhelJ)flA?
c. What have you learn.eel abOut yourself from this ex.ercise
that 'liill assisl you in yolM' WOrk as a coun.setor?
2. Recall the 10 families of emorion.s: anger, fear, strength,
weakness, joy, sadness, con.fusion, Shame, surpri.se. and
love. Rate your ability to Show or ex.ptess each one on. a
scale of 1 to 5 (5 = suong. 1 = unable to express).
a. What are the emotions that you have m0te difficulty
expressing? Ate 1here feelings you would never- express?
b. How dO your ability and wiUiogoes.s to Share emotions
vary depending on. the person you are with?
3. Would you flOO it easier' to tel your friandS (your parents, fam.
tty, etc.) that you tove them Or' that )(Ill are angry with them?
4. What d«1 )(Ill learn. abOut expr~ emotions when you were
gro~ up? bt,lom l'ON this migt\t help Or' hinder- your v.<lrk
_.. your field d practice. F'Or'examJ:je, if you wewupin a famly
Or' culture wtlere em::,tions were seldom extiressed, consider
hOw Ui s haiS impacted your curtent 'lfili~ to sOOW your
leeliogs or to encourage Otf'lerS to share their emotions.
5. Describe in. detail how you feel, think, and act when you
experience specific emotions. For example, you migt\t write,
·When I feel seated, I want to escape. My breathing is shal•
low. I tend to IOOk away. I become quiet. I think I might
vomit.· (Hint: use yolM' imagination to visualiZe situations
where you might experience the specific emotion.)
CounseUOt: What aspects of responding with empathy
d;d you fond most challengµ,g?
3. The purpose of lhis exercise is to dewlap your ability to
"ttaek· the flow of an. interview. including identifying the
use of particular interviewing and counsetting skill$. Wot'k
with Sluden.t coneagues. One student wll be the counsellor,
another the client 'Mth the others as obSer'vets.. Videotape a
15-minute segment of a counseli~ interview. Classify each
counsellor response (e.g., open. question, closed question,
silence, empathy, self-di:sctosure, Or' mixed msponse). Use
the tonowing table to compile interview statistics. Ptace a
d'leck each time a partkl.Aar skill i:S uSed. Notice that the
table is organiled to divide the _..terview into time segments.
0-S millUles
Open ques1ion
Closed ques1ion
Indirect question
Sience
Empathy
Selk:lisct>sure
Directive
&.mma,y
Leaming Group
Paraphrase
1. Work in a smatl group of tour Or' five students. Take turns
mak_..g a brief saatement abOut something current in your
188
Chap1er 6
Other (spedfy)
~1 0 • i.Us
11- 15 mines
Aftef the inter'view, discuss these questions:
d. Mtf I started ctyi~. 1oon·t think I coukS eve( stop:
a. Did the counsetklr' use a vafiely of diffetent fesponses?
e. (An ex-offender to his or her pa.role offlcer.) · Have you
b. To what ex.tent did lhe counsellof vaty his ot her
appfoach as the session ptogressecl?
c.
What interview uansitions were appafent? Were lhey
appfoptiate? Considet, fOr' example.• whethef the ltans~
tion occuffed prematufely, befote concr-ete undel'Slaoelk'lg or ex.ptoration was com pteted.
ev« been to jair?·
f. (A 16-year-okl bOy.)Ml'd rathef live on the sareet thangp
to another fostef home. Five foster homes an five years..
IW had enougl>!"
a.
(A gay man.) "I dkl.n'l expec1 to live to see 40.•
d. What Skills were ovefused or underused?
b. MWhy do you want me to go to see a psyd'li:altist? Ooyou
think I'm ctaiy? You're the one who's crazy.•
e.
Which fesponses were productive? Which responses
were counterpr·oductive?
I. (Patient speaking to a paramedic.) · Leave me alO.ne. I
4 . Interview calleagues Or' friends from diverse ethnic groups to
ex.ptore how different individuals: ex.ptess emotions..
7. ln.tetwew people from different cultufes. If JX)SSible.. intef-
5.
In a smal group, predict and describe the possible emotions that difletent individualS in the following scenarios
might experience. What nOOWl'bal cues might you ObServe
in each case?
a.
Man whose wife ot 60 year'S haS just died
Middle-aged man fired from his job
d. 20-yeat-old man told by his doctor that he has
SChiZOphtenia
e.
view first-geootation immigrants wtlo have been in lhi:S
country fof onl'j a shor1 time. Ex,:,l0te their views on emotional expression, fof e.Kample, the ex.tent that theif personal. familial, and clJh.-al roots value Wring emotions.
Remembet that peoples' viewpoints do not niecessarity represent that of theit culture of or~n.
Concepts
b. Young teenager on a firSt date
c.
jusa want to die.·
Mothef discove-ring her teenage daughtef is usi~ drugs
f. A young \\()man subjected to online hatassment
1. Assume that lhe fOllowtng clients a,e speaking to you
aoel that an empathic response is appropriate. Suggest a
response to each statement
a. (Y'outh speaking to a youth }U$t/Ce worker.) "You doo'I
care abOut me. All you guys are the same. You tel me
that you want what's best lot me. You' fe just tn this job
fOf the mo.ney.•
g. PerSon wt10 lost his "e savings in the stock market
It. Prisooef abOUt to be sentenced
I. An3Y dient
j. Oient seeing a counsetklr' fO( the fll'St (or last) time
k. Patient in hOspital waiting fO( maj:)f surge,y
I. Child en.te-ring a foster home
b. (Client, smiling.) · Fof the flrst time. lhings am really
saafti~ to come togethet lot me. My kids afe an ooing
well in schOOI, my marital ptoblems are o.n the upswing.
and I finally put some money aside fOI' a rainy day:
c. (Parent to a teacher.) Mf don't know what to do. I know
you said I s.houkS try to help my son with his homeNOrk
m. Man who has just abused his wife
and ShOw some tnteresa in his \\()rk_ but he comes home
n. Couple on lhe day of theit ma«iage
from school and goes straight to his room. When I ask
o.
abOut his h0mew0tk, he a~NayS says that lhere wasn'I
any. When I offer to help. he makes it cteaf he'd rathef
do it on his own:
Immigrant whO has left his wife and children at home
vd'lile he settles in C3n3Cla
p. Setial killer
q. Compulsive gamble( afte-r a big win and aftet losing his
paycheque
r. ll-year-<lld girl wro haSbOOn sexually abuSed byhe< father
s. 75-yeat-(jj woman remanying thfee yearS after too death
of he( hUSband. (She was happily maffied for 45 years.>
d. (Teenage.r, crying.) ·i-m ptegnant. This will kill my dad,
but first he'll lull
me:
e.
MEvetyo.ne atways says hOw togeth« I am, but I dOo't
feel together. Sometimes I get so wound up that I think
I'm gci~ to bur'Sl.•
each of the fonowing clients may be feeling:
f. (Man. age 57, talking abOut his family problems.) " I
have to make every decision. I can nevef count on my
wife Or' kids fOr' hell:):
a.
a.
6. Identify teeli~ words and phtases that beSI describe hOw
MEveryone in my life keeps putting me down. Even my
childten constantly criticiZe
01m
me:
b. (Shakil'lg.) "fifteen hafd year'S with lhe same company
and what do lhey do? They dump me with three weeks'
notice.·
c.
(A six-year.c,td boy. crying while speaking torecrMtion
sJaff.J •Noooo wants to play'lfith me. No one llk.eS me:
(Parent to a teacher.) ·My so.n does not have ADHO.
I 000·1 cafe what you say. I'm not going to put him o.n
drugs.:
b. (Client shouting.) Mf am calm!•
I. (Mt)man, age 50-plus, talking to a 23-yea,-old worker.)
..You're pfetly young to be working hefe.•
j. (Patient In an ambulance.) MOo.n'l let me die:
Empatlllc Connections
189
2. Each ot the fOIOwing client statements expfesses mor'e than
one feeling. Identify feeling \\()fds and phrases that beSt
describe the mixed foof~. Next, fOr'mulate an empathic
response.
b. ·I'm not ashamed to admit it. Once in a wtltte, 1hl my
wife. It's no big dea1.·
a. "Thank.S fOr' seeing me tOday. It really felt good to get
thi~ otf my chest. No one has evef listened to me the
d. · 1want to die. I've lhOught abOut it fOr' months, and I just
way you did. I hope you dOO'I think l'm crazyOr'Stupid."
b. (Eyes we/litJg up with tea,s,J-1t'stM'll. I don't care to be
with him anymOr'e.•
c. Ml was bro~t up to believe you should handle your
problems oo yotX own. LOOk at me now-sitti~ he-re
JX)uring my guts out to a counsetlOr'.•
d. "lo tel you lhe truth, I'd like to just mard'I rlgN in, 100k
him in the eye. and tell hlm exactl'j whefe to go. I don't
know wtiat to dO...
e. "F'lnding out that my fotmef g'i"lfriend had my bab-f was
totally shocki"lg. After we bfOke up, She didn't even tell
me She was pregnant I'd love to be a fathet, but I don't
want a relationship with her. Maybe it wouk:I be beSt if I
just forget thewhOle lhiog. but I want to dowtlat's rigN.•
t MLM~ on your 01m is the pits. Now I doo'1 even knON
where my next meal is c:omi~ from. I used to IOve betng
martied. I felt as if life really had meantng. At least, I
don't have towony abOut being beat up b-f my hUSband
every time he gets drunk. It's just so diffteult. Maybe I
s.houk:I gj\iQ him anothet chance.·
r..
(Woman, 79 years old, crying.) "My daughtef keeps
saying lhat she is coming for a visit. but it has boon
weeks sinice I have seen hef. (Wipes away the tea/$.)lt's
not that important. I realty do not want to bea bOlhef. I'm
just feeing SOtry fof myself this mor'ntng.•
h. (A clvll engineer from Syria who Immigrated to
CatJada.) " I was so ex.cited to begin my new life in
caoada when I came three years ago. Bui all my dreams
have disappeared. The onty wOr'k I've been able to find
is drM~ a cab.·
I. {12-year.oJd girl.) ·1 flashed my breasts on the Internet
whle I was in an onlioe chat room. Now my life is ruined.
Everyone at school calS me a Slut. I have no one."
f. ·n,e 2015 te«orisl klllings in Pans realty messed me up.
1haven't been able to steep, and I constantly think abOut
my kids. I don't travel or even gp to movies anymCl(e. It
could happen hefe:
3. This exetcise albwS you to apply tough empathy. The foi.
lowing statements may evoke stfong per'SOOal feactions.
Assume that the petSOO is speaking to you and that you afe
responding with empathy, even though empathy may n01
be the ptefetted response.
a. MCanada was much beltef when it was white and
Chfisti:an. With such high unemployment, don't you
think it's time to stop letting every damn lfflmigrant into
the country? No wonder I can't get a job:
190
Chap1er 6
c.
· 1 don't cate what you s:¥f. I won't give up on you untH
you eonvett and save you( solJ.•
d00'1 want to live anymore.•
e. ·What's lhe big deal if I have to steal a bit from Safeway to make sure my kids afe feel? It's oot like it hurts
anyone.·
f. (Student to teacher.) · 1 suppose this course is gci~ to
be like au the Olhers:. LOts of feadlng. a bunch of papers:.
I only hope lhere's some relevance to it al ."
g. (Client, 35 years old.) Ml had oo idea she was only 15.
She was the ooo vd\owanted to have sex. Ftom the look
in her eyes, I colJCI tel She was begging fOr' it. It's featly
unfait that I'm now charged with rape. Besides, 15 is
Old enougtl fof someone to make up theit own mtnd."
II. ·This counsetling isn't very helpful."
I. · 1 reatlydOn'twonytoomuchabOutAIOS. What can I do
abOut it? If I'm meant to get it then 111get it. So what?
We all have to die sometime...
j . ·I'm 001 stupij. I know that he sholJCl.n't hit me. Bui I
guess I desetved ii, lhe way I put him dOl«'I. I sholJCI
learn to keep my mouth Shut. When I see him, I'll
apolOgJze.•
k. (Client. with angry tone.) ·No one is willi~ to 1alk to
me abOut the fact that I migtlt be dying. I can accept
it, but every time I ask lhe big question, people change
lhe topic."
I. ·There's no way I'm going to pay for her stupidity. If she
didn't want to get ptegnant, She sholJCI have taken the
pil . Now she ex.peels: me to sup(X)rl the baby until he's
18. I 000·1 care if I am the fathet. NOi a chancer
What do you think are the advantages ot resJX)ndtng with
empathy to the pteceding clients?
4. Each of the follOwing client statements might be a routine tnqliry for in.formation 0t could be an tndirect way of
ex.ptesstng feelings. Assume that the client is ex.ptesstng
feelings and lormulate an empathic response.
a. How old afe you?
b. Have you ev« been uoemplOyed?
c. Have you ever lived in a fostet home?
d. Oid you use dcugs when you wefe my ag,e?
e. Have you ev« taken psychiatric medications?
5. Record a television pr·awam. Watch l Vfith lhe sound lutned
off. Pay attention to the nonvetbal communic.ation of the
aetars. Now watch it with the sound lutned on. How sucoossflJ wefe you in correctly reading the nonverbal cues?
6. The fOlloMng is the tr'anscript of a por1ion of a counsellOr"s interwew. The wOr'ker is an emptoyment counsetlOr' at
a Vancouvet social service agency. Ctiticalty evaluate the
counsetlOr"s tesponses (e.g.• approprt.ateness of questions,
use of empathy, etc.). What attitude do you think lhe counsetot conveys to his dient? Suggest alternative resJX)nses
baSed on empathy.
Counsellor: Hey! Are you Leah? I'm Mr. Short. Won't you
come in to my office? (Brief small talk 111 office.)
Counsello1: So wtlat i:S yout ptoblem? How can I help you?
Client: Well, I don't really know wtlere to begin. Ri~t
now. my life i:S a mess. I've gotten ato~ well so far, but
latety . .. well. I'm just not coping very well. (Client pauses.
wipes tears with a tissue.)
Counsellor: Okay, cam oown. Try not to er,. Have you been
to thi:S agency before? By lhe way, hOw old are you?
Client No, lhis is the fll'SI lime. I wondet if anyone will evet
give me a d'laoce. So~es I lhink, why not g;,.,e up? I feel
so sw:.ared al the time. Oon'l get me wro~I really want
to w0tk, to be independent. to buy my kids all the lhiogs
I haven't been able to afford. 1just don't koow if I can do
it. I haven't wOt'ked in 10 years. Plus, there's the problem
of daycare ... the things you read . .. it's hard to koow
wtlo to trust. Things just seemed so much easier when my
husband was alive.
Counsello1: You say you haven't w0tked in 10 years. What
was lhe last jOb you hek1? What dkl you do? What ate yout
Clie-nt: Mostly, I've WOrked as a secretary in Toronto. It was
okay, but I don't want to dO that anymore. I realtydon1 have
a Clue what I'd like.
Counsellor: So you know you want to get out of cletical
wot'k, but you'te uns1Xe what etse you might dO ot like.
Cliem: Yes, exactty.
Counsellor: Have you considered social services? There are
lots of gOOCI programs that you couk:I complete in a short
time.
Cli&nt: No. I don't lhink I'd like that.
Coun-Sellor: How can you be sure until you give it a try?
Sometimes votunteet wot'k is a really go:xt way to ftnd out
if you like il
Cli&nt: Wei .. . I guess so.
Counsellor: Actually, I was in the same bOat as you. Then
I vOlunteetecl. Nex.t thing I knew I was baek in Sd'IOO. Now
1·m wot1d~futl time and loving it. I have a friendwhoWOrkS
at the votunteet bureau. Why don't I gjve het a Call and set
up an ap!X)intment fOr' you?
Cll&nt: Okay ... thanks.
Counsellor: No ptoblem. I was glad to be of help. 111phone
her, and then l'l gjve you a call. It'll probabty be next week
OtSO.
job skills?
WEBLINKS
Roots of Empathy, a p,ogram with Canadian o,igins, to teach
empathy skills to child1en
Website offering comp,ehensive tOOls and WOrksheets on emotions and a variety of other relevant topics
www.rootsofempathy.org
http://www.therapistaid.com/
The Compass OeRose Guide to Emotion Words: A c-0mprehensive list of emotions and fe,eling words as well as some links
to other resources and articles on the topic
Emotional Intelligence Network
http://www.6seconds.org,'
www.derose.neVsteve/resou1ces/emotionwords/ewords.html
The Association f0c the Development of the Person Centered
At,proach (includes links and articles based oo the teachings
of Carl Rogers)
www.adpca.org
Empatlllc Connections
191
Jacek Oudzinsk.Vl23RF
Empowerment: TIie prooess o f ~
dients discowr personal stiengths-6
capacities so tu'! ...,ate~ to1alle
contrdowr t!leirhes: the elJIE!(ted
outa,me of succtssful counselling.
192
■
Identify the clements of empowering clients.
■
Explore the srrengths approach.
■
Appreciate the complex and diverse chaJlenges of ,vorking with seniors.
■
Understand the goaJs and skills of crisis intervention.
■
Describe the principles and strntegies of motivational interviewing.
■
Identify and describe the stages of change model.
■
Explore the principles and strategies of cognitive behavioural counselling.
■
Understand the process of problem solving.
■
Understand the principles and techniques of brief counselling.
EMPOWERMENT: MOBILIZING STRENGTHS
FOR CHANGE
Empowerment that results in clients discovering strengths and taking control of their
lives is the expected outcome of successful counselling. There are many clements
of empowerment that impact all three domains: feelings, thinking. and behaviour
.ll
Figure 7.1
The Elements of Empowerment
(sec Figure 7.1). Empowered clients have high self-esteem 3nd confidence, enabling them
to cake appropriate risks without undue anxiety. Able to enjoy success without guilt,
they arc fully aware of their needs and values. They behave assertively, aware of thc.ir
right~ yet respectful of the rights of others. \Vith access to knowledge and resource~
they make their own decisions by using a r:mgc of skills and strategies. Although
empowered clients have the ability to act indcpc:ndc:ndy, they arc also able to draw on
social and community supports. Empowerment is the antidote to oppressive S)' Stcms
that deny people access and opportunity to particiP3tc in decisions that affect their lives.
Empowerment requires self-determination as well 3S the mca.ns. opportunity,
resource~ and freo:lom to exercise choice. Fully exercised, empowerment ensures foll
particip3tion in decisions nffecting clients' lives. Responsible empowerment is founded
on the principle of reciprocity nnd respect for rclntionships and the rights of others. It
is 3ssertive for personal rights 3nd freedoms. but not 3t the expense of the rights 3nd
freedoms of others. In relationship~ responsibleempmnrment commits people, insofur
3S possible, to negotiating, coll3borating:, consensus sec-Icing, and rem3ining occountable.
Responsible empowe.rment is nssertivc, neither passive nor aggressive.
How Counselling Promotes Empowerment
Counsellors do not empower clients; rather they promote the conditions where
empowerment can flourish. Counsellors support diem empowerment with the foundntion3J belief that clients 3rc capable of change and h3ve a right co mnnngc their own
lives. An empowerment 3ttitude focuses on the cap3citics nnd strengths of clients
while forgoing: nny need to control clients by t31cing on an "expert" role that m3kes
them dependent. When empowerment is the priority, clients become the expert~
3nd there is "coll3borntion and sh3rcd decision mnking within the profession3J reJntionship" (Sheafor & Horejsi, 2008, p. 79). CounseJlors dem,.•stify the counselling
process through open and non-jargonistic discussion with clients of their methods
3nd nssumptions.
Sdf..detcrmination, 3n important component of client empowerment, is promoted
by helping clients recogni!e choices nnd by encouraging them to make independent decisions. Counsellors shouJd not do for clients whnt clients can 3nd should do foe themselves.
Supporting Empowerment and Change
193
SUCCESS TIP
PerSOr\3I identity, that sense of kOowm"lg whO you are and how you connec1with Olhel'S, is
an essential part of empowe<ment. CounsellOt'S can help d ients inctease pel'SOl"lal identity
(and se•~oom) b'f helping them ex.ptore and appreciate U'leit roots, in particl.Jat positive
aspects of g(oup hisl0cy, lncluding accompfish~nts, cl.Ahxal and (eligious pr'actices, and
language.
Anti-Oppressive Practice
anti-oppressi'lt practice: 'Mien
couns.elkn 'llllfk ICJ str~ural dl..-ges
il«ganizatioos. pcicy, -.:Iii promoting
equity in lie disttibutioo of m ouroes,
opportunities. and po--.
Often clients come from diS3dvantag~ and marginali:~ groups where they "have been
'beaten down' by oppression, poverty, abuse, and othc.r harmful life experiences. They
want better lives for themsdvcs and their familic~ but they feel powerless to make the
necessary changes. Some clients have a pervasive sense of failure and foci different from
and rejected by other ~pie" (Sheafor & Horejsi, 2008, p. 422).
Sometimes pO\\•erlessncss 3rises from neg3tivc self-evaluation 3nd lo"' sdf-cstcem
or from lade of confidence in one's ability to 3lter one's life, but sometimes the systems
that 3re set up to 3ssist clients are themselves oppressive and contribute to powerless..ness. Anti-oppressive practice involves counsellors working for structural changes in
organizations or policy, 3nd in promoting equity in the distribution of rcsourcc5i. opporrunitie5i. and power (Drolet, Clarie, & Allen, 2012). P3ul Moore (200 I) suggests that 3n
anti-oppressive framework ch3Jlenges workers to examine and challenge the lenses that
may colour our vie"'points on what is "right and acceptable:" racism, sexism, heterose.xism, 3bleism, ageism, and cl3ss oppression. Feminist theory 3ddresses the power
differential th3t allows men to enjoy privilege at the expense of women.
Ben Carniol (2010), 3 C3nadian social work ~uator and 3d\'OC3tc, re.minds heJpcrs
that since racism and other prejudices may deny clients access to jobs and resources
such as 3dcquatc housing, helpers have a responsibility to advocate for a progressive
system 3nd social policy changes.
Since client self-determination is enh3nccd when clients h3\'t". more choices, counscl.lors should 3lso be involved in broader 3Ctivitics such 3S working to identify and re.move
gaps and barriers to service and encouraging more hum3nc and accessible policies and
services. The counsdling process itself offers empowerment to clients. The beginning:
phase offers many clients a unique opportunity to explore their situ3tion and their feel.ing.s. Active listening skills hdp clients bring: long-forgotten or misunderstood fcdings
to the surface. Ventilation of ftt.lings c3n energize clients, 3nd it can lead co spontan«>us
insight into ne"' "'3YS of h3ndling: problems th3t seemed insurmountable. For some
clients, the work of counselling: is finished 3t this phase.
THE STRENGTHS APPROACH
streng_ths approach.: A counselilc
perspe«iw that asS>Jmes tile inherent
capacity of people. lldimaals and
communities are seen to haw assets
•d iesouttes that can be mctiililed I•
probleascf\ing.
learned helplessness: Astate al
aind tu'! oa:urs llflen indi\ifualsUle
learrlfd throug) lailure that their effcru
¥ill not result i• change.
194
The strcnjtth s approach is 3 perspective that shifts the focus from diem problems
and deficits to possibilitie~ c3pacities, and resources th3t can be mobiliz~ in the pursuit of goals and change. Many clients come to counselling "'ith lo"' self-esteem and
confidence. Sdigm3n's (1975) concept of learned helplessness suggests th3t individu.als can become demoralized through foilure to the point that they give up trying to
alter their circumstances, e,-en in situations in which change is possible. Persons "'ith
learn~ helplessness c3n be difficult 3nd frustrating to work "'ith bec3use these clients
do not believe the.ir efforts "'ill make a difference. \\:fhen they 3rc successful, they 3re
likdy to attribute it to luck, rather than their efforts or c3pacity. As long: as they hold
these beliefs, they arc unlilcdy to engage in risk.-t31cing to solve problems and achieve
Chap1er 7
empowerment. Signif,candy, individuals may in foct be quite capable, but believe they
are not. For others, anxiety about rislc-tnking or failure deters them from action. ln
addition, if clients nre locked into a view of themselves ns victim~ they nre likeJy to
resist change, or they may enter into dependency relationships in whidi they relinquish
power and control to others, including their counsellors. The key is to help them set
small goofs and implement a successful action plan, then accept the conntttion between
their actions and success. Cognitive behavioural techniques are also vaJuable in helping
clients change the way they think about themsdves.
SUCCESS TIP
Counseilol'S need 10 manage lheil' own unmet needs then mighl impede lheit capac,ty to be
helpful. F'o, example, if lhey have a higri r')OOd for' control, they can potentially take power'
from clients, who lot their part may freely g;,.,e it away.
Here are some basic strategies for maintaining a strengths approach:
t. Negoti3te coll3borative relationships with clients where they share responsibility for
identifying priorities, goals, and preferred wnys of proceeding. Accept that they are
the "experts" on the.ir own lives and that with encouragement they can make decisions on what will and will not w-ork. Counsdlors need to be Oexible and accept that
every intervention plnn will be individuali:ed to the unique needs and attributes of
each client. What works with one client may be counterproductive with another.
2. Trust that clients have the capacity to change, and that they can learn to cope with
the.ir problems and challenges. Every experienced counsellor can relate ama!ing
stories of people who have recovered from adversity and overwhelming odds.
3. Stay interested in strengths. Acknowledge clients' skills, resourcefulness, motiva,
tion, and virtues. \Vhen workers value their clients' strengths, clients learn to vnJue
themselves. Discovering overlooked abilities, lcnowledgc, and experience can also
ene.rgi:e counsellors nnd clients.
4. Ask questions or make statements thnt uncover strengths, such ns "Thinle of a time
when )'OU were able to handle problems such as this. \\:fhat skills and resources
enabled you to cope?" Other approaches include these: "\\:'hen you were nble to
manage, what were 't'OU doing that helped )'OU succeed?" "\Vhat are the things in
't'our life thnt you fed good about?" "What's ,vorking well for you!" "\Vhat ,vould
't'our friends say arc your best quaJities?"
5. Help the client identify strengths that come from adve.rsit)' with questions such ns
"In whnt ways have the problems you've faced in 't'OUr lifemnde )'OU stronger!" To a
client who has struggled for six months to find work and get off welfare, you might
say, "I'm impressed with )'Our ability to hang in the.re. Mnny people would have
given up." look for strengths in the way clients have handled adversity with comments and questions such ns "You've been through a 10( in your life. but somehow
't'ou've managed to survive. How have )'OU been able to do this!" Or you might Sil)',
"In what ways have your problems made you stronger?"
6. U se cognitive behavioural techniques to help clients challenge and mann,;e selfdeprecating remarks that reinforce low sclf-esteem.
7. Avoid diagnostic labels ns a way of describing clients. Labels tend to ignore strengths
by focusing on pathology nnd deficits.
8. Focus on problem soh•ing and goal setting rather than on discussions of blame
or on finding the root causes of current behaviour or problems. There may be
Supporting Empowerment and Change
195
cathartic benefit to discus.sing history, but once this purpose is achieved, the focus
of the ,vork should shift to present and future events. Goal setting energizes clients
to action and mobilizes their resources and motivation for change.
9. Use the info rmal resources of fam ilies, neighbourhoods, and communities that
are potentiaJ sources of help and srrength for clients. Use community d irectories
to pinpoint agencies, services, and self-help groups that coukl be supportive. ChaJ,.
lenge clients to ide ntify and discover these resources: "Who do )'OU rrust?" " Who
suppor ts )'OU when you neo:I help!"
Strengths-based counselling shifts the focus from deficits and problems to a process
in which clients' strengths, capacities, and resources are recognized. Strengths are the
resources that e nable clients to overcome prob lems. ln this sense, client as.sessmem
moves beyond identifying obstacles and prob lems to discussion of personal and envi..
ronmental resources.
Helping clients renke their strengths empowers them with the belief that thq• are
capab le of change. For example, helping clients re frame how thq• think about p roblems
can enable them to see their problems as opportunities. SaJCffly (2009), a major proponent of the strengrhs approach, offers these perspectives:
It is a collaborative process .. .. It is an 3ppt"Oach honorh-)¥ the inn.2te wisdom of the
hutiun spirit. the inhe-rent eapad ty for translonnation of even the roost humbted and
::abused .. . . Rally clients· interests,. eapadties. motwations,. resources. and emotions in
the v.'Ork of re::1ehinK their hopes ::and dre::1ms. help them llnd pathways to those "°"ls.
::and the p.,yoff ,nay be ::an enh::ul«d quality of d::ul't' life for them. (p. I)
SUCCESS TIP
"Practicing from a strengths perSpec1ive reqlires lhal we Shift lhe way we lhink abOul.
approach, aoo relate to our dients.. Rather lhan loc:using exclusively or dotninantly on problems, )'Our eye rums towards pos$,lbiily. In lhe thicket ot trauma, pain, and trouble, you see
blOOms of hope and transfotmatioo.· (Saleeby, 2009, p. 1)
T he strengths approach rW uces some of the power differentiaJ that occurs when
client vulnerabilities and d eficits are given priority over their strengths. G licken (2004)
offers this reminder: "There is usually more a bout clients that is positive and functionaJ
than is neg::ative or d't•sJu nctional" (p. 4). W ith the strengths perspective, the client is
the exper t and the primary author of the change p rocess. "Thus, the worker's ro le is to
listen, help the client process., and facilitate by focusing on positive behaviors that might
be useful to clients for coping with the.ir current life situations" (Glicke n, 2004, p. 6).
Our minds and bOdies react wilh mmarkable speed to deal
with C(isis and stress. To divert ils resources 10 fighling
the crisis, the brain Shuts dOwn nonessential actMly such
as digestion. Our hearts pump taste( and our b<ealhing
inc,eases to maximize oxygen to the bOdy. Adrenaline, the
stress hOrmone cortisol. and dozens of 01her hOrmones a(e
released. The bf3in signats the liver to release mo(e sugar
C(eating a burst of eootgy. While cortisol, ad(enaline, and
01her hOrmones help us cope in the short run, with chronic
196
Chap1er 7
(prolonged) stress. depression may inc,ease, lhe prOduction of oow brain neurons i:S reduced, and the(e is damage
to the Hippocampus, a part of lhe btain associated with
memory and learning. Maladaptive attempts to deal with
srress using d(ugs, overeating, and s.mOking compound lhe
problem by iner-easing lhe (iSk of suoke, heart anack. liver
disease. and a myriad of olhe( health problems (Ashwell,
2012; The Franklin Institute, 2015; and University of
Maryland, 2015).
EMPOWERMENT AND SENIORS
On July 1, 2017, there were almost 5.8 million people in Canad3 over 65 't'C3rs of age
representing about 16 percent of the population, and for the first time, the number of
seniors over 65 years of 3ge in Canad3 is grc3tc.r than the number of children under 15
(Srotistics Canad3, 2017).
The first of the baby boomc.rs arc now in their 70s. Thc.ir lives have evolved very diffcrendy than past generation~ and they are rewriting the book on 3ging. \Vith improved
life expectancy, thq• can expect to live 15 to 20 years or more and their cxpcctntions
for 3n 3ctivc and productive retirement are high. As a group. they arc healthier, more
educated, and more financinJI'>' secure than previous generations.
Today's seniors 3rc very adept 3t self-advocating for their rights and needs. Generally, they have led lives where they we.re active pnrricip,mts in decision making, so there
is linle doubt that they will have an enormous imP3ct on services for this age group.
They will want to be very involved in defining and developing programs and services
that will meet their needs. Since the foundation for empowerment is choice and control, counseJlors will welcome this proactive stance as one that is very consistent with
strengths and empowerment counseJling philosophy and routines.
Aging offers many opportunities. 1t is a rime when people can have more time to
pursue hobbies, spend rime with family, assist with raising grandchildren, travel and
realize dreams that were not possible in the.ir young,er •fears. Increased attention to
fitness and nutrition along with bener healthcare results in more seniors living longer,
healthier, and independent lives. Financial need, better health, and a ,;eneral desire to
remain active in the labour force has resulted in many seniors ,vorking wdl past the
traditional retirement a,;e of 65.
Aging can also pre.sent with man,., unanticipated challen,;es that lead seniors to seek
counselling (see Table 7. I) For example,. health issues may have imP3cto:J the ability of many
seniors to w-orlc or pnnicipnte in octiviries that have defined their lives. Some, bo::ause of
mobility or hrokh issues. including loss of ~-csight, have become dependent on others for the
6rst rime in their lives. \Vomen live longer than men, so they are more likd)•to face the prospect of living alone without their spouse, sometimes with very limited income or suppon.
Retirement or unanticipated job loss can result in dramatic changes in role and
stnrus that have de.fined a person's life. \Vithout the demands and time commitments
of employment, retirement requires people to find new ways to structure their time
and find meaning in their lives. Otherwise, depression, loneJiness, and despair may
take over. Consequently, helping seniors achieve or maintain a sense of purpose is an
essential empowerment ,;oaJ.
CRISIS INTERVENTION AND EMPOWERMENT
A crisis can take many forms. NarurnJ disasters, terrorist attacks, and w-nr create crises that
impact all members of a country or community. Personal experiences such ns rape, denth,
divorce, loss of income, or incarce.mrion dearJ,., affect individunJs and their families.
Many factors influence how an individual copes with a crisis, including past experiences, overall physical and psychological health, the presence or absence of social
and community supports, substance use, personality factors such as impulse control,
and genetics. Catastrophic disasters, assaults, war, and other traumas can disempower
even the strongest individual~ and people may experience devastating and debilitating
life change~ such as post-traumatic stress disorder. For some, a crisis ma)' stir up pnst
memories of other traumas and the impact may be cumulative, leaving them more vulnerable. As a result, the.re is further psychological injury leading to depression, ph)•sical
illnes~ anxiety, hopelessness, suicide, or withdm,.,,.-nl.
Supporting Empowerment and C hange
197
TABLE 7 . 1 Empowering Seniors
Component
MedicavPsychiatric
Potential Issues
• Complex health, f0t example. loss of eyesigt\l,
heari~. and physical mot,li1y
• Oep(ession
• Oemtmtia includi~ Alzheimer's Disease
Flnancial
• Po,,el'ly (especially women)
• Unexpected job IOSS
• Costs of hOusi~ in IO~tefm ca,e
• financial abuSe
• Oisc(ntination (ageism)
• Managing time, use of leisure.• and copi~ with
retirement
• Emotbnal and phyS:ical neglecl and abuse
• ISOiation and fear of abandonment
• Housing
• Couples who beeome separ-ated in diffefent
care facilities beeause one of them oeects tnOr'e
complex cafe
PsychOI. .I
• LOss of control, indepe-ndence, and identity and the
•
•
•
•
•
need to find pur(X)se in life
Oeali~ with death and dyi~
LOss of control, identity, and independe~
ISOiation and fear of abandonment
Grief exacerbated b-f multiple IOSSeS (friends,
family, and spouse)
Sex.uaity
Suppon Choices
• famity sup(X)rt and education
• Lifestyle counse1Hng-t1ut(rtion and exefcise
• Appropriate use of medication and the
heafth system
• Respite care
• cafe« and job counselling fot those
remaini~ in the wor1dofce
• Community fesouroos f0t financial and
housi~ support
• Legal ramedies
• Wellness counsem~
• Expt>r-ation of meaninghA social and
recreational opportunities
• use of advocate groups and 0tganiz.atioos
• Empt>yrnent of vOlunteers
• Police inteiwntion
• LObbyi~ fof systemic: change
• Pets
• Arrangement of traosportat.ioo (famil'j, vOI~
unteers, and seniors' services)
•
•
•
•
Stfengtns-based counselling
Grief counselling
MaximiZing in'V()l\lement rn decision maka"lg
Utili:zation ot adlAt day care and droP.,.n
progr-ams for seniors
Neve.rtheles~ many people adapt and may even thrive during a crisis. T hey dis.cover their resilience and untapped strengths, including previously unknown resources.
OptimisticaJI)•, the resolution of a crisis is an opportunity fo r growth. Presbury, Ech.terling, and McKee (2008) suggest that post-traumatic g rowth (PTG) happens when
people "come away from traum:nic events having gained a new perspective on life and
having achieved important understandings" (p. 212). Supportive crisis intervention by
counsellors and others can increase the probability of post-traumatic growth (lames &
Gilliland, 2013).
A crisis can overwhelm individuaJs and disrupt their ability to cope and function
normally. Persona] crises that may arise from depression, loss of job, or rape mil)' evoke
emotions so intense that action or rational thinking is impossible. Sometime~ as in the
case of a disaster like a flood or tsunami, people are c ut off from the.ir basic physical
needs. Whatever the nature of the c ris is, the p riority goal for counselling is to heJp
clients obtain power and control b\• re-establishing safety and stability. One centra.1 step
is to help and encourage connections with supportive family, friends, and community
resources to restore equilibrium and to reduce psychological trauma➔
SUCCESS TIP
In the immediate aftermath ot a crisis, counsellOts n'lay wish to minimize (but no1 prevent)
expfession of footings rn favouf of l!litiatives that locus on safely aoo coMection with sup.
portive family and community resources.
198
Chap1er 7
The ultimate goal of crisis inte.rvention is diem empowerment, so that wherever
possible counsdlors should collaborate with clients; however, bcc3usc of physicaJ inca,
pacitation or emotional in3bility, there ma)' be times when counsellors need to assume
power and be more dirtttive. For example, if 3 dicnt is suicidal and not responding to
counselling initiatives, the counsellor ma,., need to caJI for emergency se.rviccs and hospita1iz3tion. ff 3 dicnt is emotionally unable to make rational decisions, the counsellor
may be required to take chari;:c. Table 7.2 summa.ri:::cs counsellor skills and strategies
for selected crisis intervention goals.
ln the remainder of this chapter, strategics for motivating clients and helping
them develop and sustain change will be explored. MotivationaJ Interviewing (Miller
& Rollnick, 2002, 2013) is a tool to hdp clients deal with the ambivalence that inhibits them from making necessary changes. The stages o f ch ans:e model (Prochaska
& Norcross, 2001) is based on the notion that people go through different motivational stages, C3ch of which requires different counsellor skill choices for success.
Frequently, the stages of change model is reflected in Motivational Jnterviewing. Cognitive behavioural counscJling is a collaborative (counsellor and diem) approach to
helping clients make changes in the three major psychological domains: thinking.
behaviour, and emotions.
stages of chance, model: A IMOry of
mo:rt~ion tut recopil2s liw changes ol
piecontemplat • contemplat •
st•
preparation. auion. and main~.--e:.
MOTIVATIONAL INTERVIEWING (Ml)
Motiv-arionaJ lnterviewina (Ml ) (Mille.r & Rollniclc, 2002, 2013) is an empirically
validated strategy for helping people ove.rcome ambivaJcnce to change. Motivational
interviewing requires a collaborative, nonconfrontational relationship. lt assumes that
motivation and capacity for change arc within the client. Consequently, it honours the
client's right to seJf-dcte.rmination regarding whether change is to take place, as well
as the ultimate gooJs of any change process. "MI allows clients, both mandated and
voluntary, to discove.r their own reasons for making change. Ml aJlows the impetus to
change to emerge from within a client, thus honoring the client's unique circumstances
and worldvicw" (Caponi & Stauffer, 2008, p. 145).
TABLE 7.2
motirational interviewi~ (Ml): A
nocCllfruuati>nal coaseHing approach
t!l31 promotes behavml change by
assisting tlieals to recognize: and iescbe
ambi~
Crisis Intervent ion
Intervention Goal
Pt,ys;cai safety
Counullot Skill and Strategy CholcH
Link to fesouroos f0t fOOCI, sheftef, and medical assislance.
Help d ient move to a physical psychologically safe setting.
Access emergency secvtes (e.g., police and ambulance).
°'
P~hOIOgjcal safety
Etlcoutage client to ink with personal supports (famlfy, friends,
and religious leader).
ShoN empathy Catlow clients to ex.press feelings).
Normalize feelings.
Empowefment
Provkle information.
EtlcotXage decision making.
Promote and reinforce small goals with reaistk time frames.
carry out 1tauma counsetling.
Mobilize Or' help client coMect wilh sup(X)rt groups.
Restore balance
Offer reassurance.
Provi::le sel'Vioos (informat.ion, support, and refenal) to
significant family.
Communicate hope and optimism.
Etlcoutage resumption of normal routines..
Plan f0t follow-up.
Supporting Empowerment and Change
199
Miller 3nd Rollnick's (2013) conception of Ml highlights the following features:
■
The "spirit of motivational interviewing" is more important th3n technique. "The
spirit of motivational interviewing" as conccptuali:~ by Miller and Rollnick (2013)
is primaril)• conce.rned with the 3ttitudc of the counsellor and the counseJling refo,.
tionship. It derives from Roger's person-centered 3pprooch with 3 high cmph3sis on
client sclf-determin3tion and faith in the ability and cap3city of people to change.
They identify " four key interrcl3t~ cJements of the spirit of Ml: p3rtnership.
acceptance, compassion, and evocation" (p. 15). Partnership emphasizes colfoborativc conversations to assist people to strengthen their motivation for change.
Acc:cpt3ncc involves the esscntiaJ core conditions described by Rogers (1961) of
unconditional positive regard, empathy, and genuineness (Stt Chnptcr 3 of this
book). Compassion, as defined by Miller 3nd Rollnick, involves a conscious focus
on promoting the best interests of clients by giving their needs priority (p. 20). Evocation focuses on the inherent strengths of clients as opposed to detecting problems
and deficits. As discussed earlie.r in this chapte.r, the strengths approoch assumes that
clients arc experts on the.ir O\\•n lives, and they h3ve within them the experience, wi~
dom, and resources that need to be the focal point for decision making and change.
■
Avoidance of the "righting reflex.-thc desire to fix what seems wrong with people"
(p. 6). This desire to fix might involve confrontation (which tends to promote rcsi~
tance), 3nd advice giving on the best course of 3Ction. It often involves trying to persuade clients to change. The righting reflex tends to put clients on the defensive whe.re
they take positions that hnve hisroric3lJy been defin~ 3S resistant. In MI, counsellors
are encouraged to consider how their bdi.aviours and responses might be evoking
resistance. (Sec Chapter 8 for a further discussion of this important perspective.)
■
A belief thnt the resolution of 3mbivalencc is a criticaJ step in supporting change.
Ambivalence Miller & Rollnic.k note that most people who need to change are
ambivalent: they hnvc reasons to change as well as reasons to maintain the status quo,
however, dsyfuntionaJ that might be (2013). Anxiety and indecision can leave people
stuck. Ambivalence is a normal part of the chnngc process. For clients who are not interested in changing, the emergence of ambivalence would signal movement t0\\'3rd change.
When people are 3mbiwlent, they are drawn in opposite directions at the same
time. People may be ambivalent for a number of reasons, including the following:
I . The aJte.rnatives are cquaJly appealing (Approach/Approach).
2. Neither course of action is appealing (between a "rock and a hard place").
3. Both altcrn3tivcs have features that are both 3ppealing and unappealing.
4 . Conflicted fccling~knowing what is right, but finding one's emotions taking one
in the opposite dir«tion (Hcan/intcllect).
5. Desire to move in one direction, but fear of loss if that direction is chosen.
6. Simply not knowing what is right.
"Change Talk" and "Sustain Talk17
One way counsellors can address ambivalence
is by listening for "change talk"- dient statements favouring change and "sustain
talk "- dient statements favouring the smrus quo (Mille.r 3nd Rollnick, 2013, p. 7).
Here are some examples of diem statements that signal change tallc:
change talk Clieal statanents
laYOJring dt.an,e.
sustain talk: Client Mat.ement.s
laYOJring 1M mtus quo.
200
■
I wish my life was different.
■
I w3nt to quit drinking.
■
I could ask my family for help.
■
I miaht be able to work pan.-time.
Chap1er 7
■
I probably should go back to school.
■
I need to find a W'll)' out of this mess.
■
I will look into it.
■
My intention is to fight this problem.
■
I tried to stop using heroin.
SUCCESS TIP
The fact lhat a che-nt firmly defends a lifestyle that he knows is unwOr'kable is prool that he
is in need of great assistance and suJ)port.. (WickS & Pal'SOOs, 1984)
\Vhcn counsellors hear change talk, cardully targeted responses can increase the
level of change talk and motivation for change.
Client: "I know th:u smokin¥ is Nd and. I !"K'ed to q uit (chan,e talk). but I'm 2(rakl. that
i( I q uit I'll ¥:l.in \\re~t (tlillam talk)."
Coun.seltor (Ml choice~):
■
I( )'OU rn:lde 2 dedsion l'O q uit. how would )'Ou do it!
■
\Vh::lt are )·Our re:asons for wanth1¥ to quit!
■
Hoo• important is it for
)'Ou
m s:.ive up smokiOi!
A decisional balance sheet lists the benefits and costs of different choices. By
addressing barriers to change, counsellors may help diem to "tip the baJancc" in favour
of change. ln the above example, exploration of the ways one can control weight g3in
ma,., help this client overcome resistance to change.
Empathy
EmP3thy and other active listening skills are now universally recognized as important
to any counsdling relationship. regardless of the choorctical approach of the counsellor.
Ml is no exception and empathy is a central feature of this approach. "\Vithin the Spirit
of Ml," it creates an interview climate where clients are free to explore their value~
perception~ goal~ and the implications of their current situation without judgment.
Conversely, "confrontationaJ counscJling has been associated with a high dropout rate
and rdativet,., poor outcomes" (Miller & Rollnick, 2002, p. 7). Active listening, especinJly with the use of empathy, increases intrinsic motivation for change.
Developing Discrepancy
The ove.rnJI gonJ of motivational interviewing is to help people get unstuck. The method
is to initiate "change talk" by caking advantage of naturally occurring opportunities in
the interview to embellish diem statements chal suggest differences between the way
their life is and the way they would like their lives to be. Simply focusing on a client's
goals and aspirations can often help people appreciate how the.ir current lifestyle is
inhibiting che.ir ideals. Motivational interviewing uses a number of strategics to evoke
change talk, such as the following:
■
Asking evocative questions about disadvantages of the status quo, advantages of
change. optimism 3bout change, and intention to change.
■
Using scaling questions- for example, "On a sc3Je of
t~rms of satisfaction with )'OUr life?"
to 10, whe.rc are you in
Supporting Empowerment and Change
201
■
Exploring the positive and negative consequences of the status quo.
■
Using eJaboration skills (e.g., asking for darifiC3tion, examples, description, and
further infor-m:.nion) to clicit furthe.r change caJk.
■
Querying extremes, such as "Suppose you don't make any changes. \\:lhat do 't'OU
think might be the consequences of this in the worst-case scenario?"
■
Looking back to help clients remember how things were before compared with the
current situation.
■
Looking forward by asking clients to describe their hopes and goals for the future.
■
Exploring goals and vaJucs to target discrepancies between important goals and
current behaviour (Miller & Rollnick, 2002).
■
Helping clients understand their ambiva]cnce to change using the metaphor of
a secsaw- ,vhen the costs of continuing present behaviour and the benc6ts of change
outweigh the costs of change and benefits of continuing present behaviour,
change will occur.
" Roll ing with Res istance"
\\:fhcn counscllorsconfrontdients with arguments for change, they can e3sily find themselves in power struggles where they are pressing for change and diems are resisting.
ln Ml, client resistance is seen as a message that the counsellor nttds to do something
different. Power struggles arc likely when counsellors do the following:
■
Offer unsolicited advice from the cxpe.rc role.
■
TeJI clients how they should feel.
■
Aslc excessive questions.
■
Order, direct, w-am, or threaten.
■
Preach, moralize, or shame.
■
Argue for change.
■
Blame, judge, or critici!e.
SUCCESS TIP
"As long as )(lu( clients are goi.ng to (esiSI you, you might as 'm!II encourage it• (Milton
Erickson., sou(ce uokoown).
radical acceptance: A strateg:,
that ifl\'OIWS ..agini espressi:in al
statemeais t!latyo, tend to disagree wit!I
or philos-icalJ oppose.
Radical acceptance is a strategy that involves encouraging expression of state~
mems that you tend to disagree with or philosophically oppose, for example:
C lient: I don't see the point. The onlr reason I C3tne rn,b)• is the fact that 1( I didn't
show up. I'd be cut off wel(:ue.
CounS(>IJOr. I' in Ve?")' $:lad )'Ou bro~t this up. Man)' people s.h3re views soch as )'Ours
but ..von't speak up. so I appred::ue )·Our willin{tness t'O be honest.
ampl.ified reflection: Atethniqll!
that exauerm wtuit a cliea1 has said
Mt!I the llope tu 1M clieal 11ill ,-seat
the ether siJe of aabivalenoe.
202
Amplified reflection is a t«hnique that exaggerates what a dicnt has said with the
hope that the diem will present the other side of ambivalence. However, as Mille.r and
Rollnick (2002) stress, " (t )his must be done empathically, because any sarcastic tone
or too extreme an overstatement may itself elicit a hostile or otherwise resistant rcac~
tion" (p. IOI).
Chap1er 7
Client: I don't se,e what the problem is. \X'h::u 's the harm in havin¥ 2 (e,., drinks a(ter a
h::ard d::ar's v.-·o rk!
Counse.Uo r: So, you're s::ari.n~ th2t drinldn&
211)' reason (o-r ooncern.
h::.sn't c::aused 30)' problems or aiven rou
Client: Well. I wouldn' t ao th3t far.
Support Self-Efficacy
To begin and sustain change, clients must bclicve in their np::acity for change. For their
part, counsellors can have an enormous impact on outcome if they believe in their
diem's ability to chanae and when they take steps to enhance diem confidence. One
choice is to heJp clients identify past success. Another is encouraging clients to m:.llce
an inventory of their strengths and resources. \\:forking on small achievable goals often
starts a chanae process that gathers momentum. CounseJlors can also look for opportunities to affirm their clients' effons. strengths, and successes.
STAGES OF CHANGE
Risk Taking
Change involves risk, and risk creates anxiety. Even when motivation to change is high,
emotions such as fear make it difficult to replace established behaviour with new W'n)'S
of behaving. As a result, there is often tremendous (seJf-imposed) pressure on clients
to maintain the status quo, however, ineffective it might be. Sometimes change involves
a "sdlina" job, but the results are bette.r when clients, not counseJlors, do the selling.
Clients need to convince themseJves that the benefits of chanae outweigh the risks, and
they neo:I to dcvclop positive attitudes and beliefs about their capacity for change. Counsellors with a strengths perspective believe in the capacity of their clients to change, and
this beJief in them can be a powerful motivating factor.
Johnson, McClelland, and Austin (2000) identify three factors important for motivation: "the push of discomfort, the pull of hope that something can be done to relie,.'<'
the problem or accomplish a task. and internaJ pressures and drives coward reaching a
goal" (p. 133). Thus, not on!)• must clients want to change, but they must also believe in
their capacity for change.
The concept of secondary iain is a useful way of understanding why some people
resist change despite the obvious pain or losses involved in maintaining their current
situation. Secondary gain refers co the benefits that people derive from their problems,
such as increased attention from others, having an a\--nilable rationale for not changing
or participating, financial advantage, or escape from W'Ork or other tasks.
Secondary gain: Auseful•arof
undefs!and-,.,.,. some people m ist
dl.-ge des.pie the «Nioas pail or lossei
inrolwd in aailllainilc their curreat
si1ualion.
CONVERSATION 7. l
ST\JOEHT: The clients Ihave the most trouble with a(e the laZy
ones--the ones whO won'I even get out of bed in the mOO'ling
to go IOOk for a job 01 100 clients whO nENer fonow through on
commit~nts.
TEACHER: Sure, these clients can be exceptionally diffadt
and frusuati~ to \\()fk wtth. Sometimes it's hard to do, but
we ShOtJCI discipline oursetves to be nonj udgmental regardi~
motivation. AJ!hough it might be tempt~ 10 label SOt'ne cl.ants
as laly, we ShOtJd remember that they may have given up for
good reason. They may not have IN resCIU'cesor supp:,rt they
need tor change or they may have given uJ) k'I Order to protect
themsetves from the furthe( damage to lheir self~eem that
would come from repeated failure. In this way, their behaviour may be soon as adaptive. It's normal f0r counselbrs to
lose patience with lhem and give up, but it's important to
remember that precisely what they did to lhemsef\ie~
up. That's one of the reasons they need counseling,
Supporting Empowerment and Change
203
transtheoretical model of
change: A aodel tu identifies fiw
stages ol dt.ange---piecontemplatio..
contemplatioo, pnq:iaratio.. actio.. . t
aa:intenance. 0-Sellof re$p)IIS! choices
an difiefat depeaiing • the dierrt's
stage of chang_e.
The stages of change model, nlso known as the transtheorerical model of chans:e
(Prochaska & Norcross, 2001), has rcce.ivcd a great deal of attention in the literature
since its inception in the 1980s. In this modcl, five stages of change arc rccogni!ed: pre~
contemplation, contemplation, prc-P3ration, action, and maintenance. As wdl, change
is viewed as progressive development in this modd, with success at any phase depcn,.
dent on the success of previous phases. Figure 7.2 illustrates the five stages of change.
Although this figure implies an orderly progression from one phase to another, in reaJ~
icy, clients may progress through stages and then drop back to an earlier scag:c (relapse)
before starting a.gain.
An essential assumption is that counselling interventions need to be selected to
meet the needs and motivation of the particular stage clients are in. Thus, for example,
it makes no sense to talk to a client who is not ready to change (precontcmplativc) about
change strategies, but this tallc ,vould be wholl)• appropriate for a diem who is preparing
for change.
A client may be at different stages of change for different problems. For example,
a client may be precomemplative (not interested in changing) rei;prding his drinking:,
but ready to cake action with respect to his foiling marriage. Accordingly, discussing
strategies for cuttingdO\\•n his drinking is likeJy to meet with failure; hO\\revcr, exploring:
strategics to improve his marriage is likely to elicit a positive response.
P'recontemplative Stage: " I Don't Have a Problem." Clients at this stage have
no intention of changing. These clients do not pe.rccivc themselves as having a problem, despite the fact chat their behaviour is problematic for themsc.lvcs or others in
their lives. These clients are not thinking about change, and they may rationnli.!e their
problems. minimi.!e the consequences of their action~ or blame others.
For these clients, empathic and sensitive listening chat encourages them to examine their situation and its consequences can be very heJpful. Counsellors can provide
information, offer feedback, or encourage reflection with questions such as "ls what
you're doing now working to mttt your needs!" Obviously, for clients to change, they
Contemplati\le
Fl
•
Actian
Figure 7 2
204
Chap1er 7
The Stages of Change
must move beyond the pr«ontcmplative stage. Unforrunatdy, many people, including
some counsellors, believe that confrontation is the remWy for denia.L Denial is a defence
mechanism that enables people to cope, perhaps by protecting themsclves from the risks
of change. As a result, confrontation threatens this protection and it often rri~ers further
and deeper resistance. OiClemcnte and Vclasquez (2002) observe that "Sometimes the
reluctant dient will progress rapidly once he or she ve.rbnJi.!es the reluctance, fttls listened
to, and begins to feel the tension between the reluctance to chani;e and the possibility
of a different future" (p. 205). DiClemente and VaJasque! (2002) offer this perspective:
Clinki::uu o(ten belie-\'e th::u rnore edueat.On. n\Ore intense treatment. or more confron.t:ltion will ne«~nl)' produce more chan~'C'. Nowhere is this less true th::m with precontempl:1t·orS. More inteiuit)' will o(ten produce fewer resu!u with this Stroup. (p. 2C6)
Contemplative Stage: "Maybe I Should Do Something About It."
A, the contemplative stage, dients know they have a problem and are thinking about change, but
they have not developed a plan or made a commitment to take action. Contemplative
clients may be ambivalent and may vacillate between wanting to alter their lives and
resisting any shifts in their behaviour or lifost)•le. At this sroi;e, clients ma)' be open to
new information as they self-assess their problems and the advanmi;es and disadvantages of change.
Ex:1rnp1e: A~nes has been in an 2busive rel:1tionship for )~rS. She wishes th:u she could
!e::n,e 2nd s12rt O\'er. In f::.et, she h:u !e(1 her husband twice in the past, but C.l.ch time she
h:u returned " '1th in:. (ew wttks.
Contemplative sroi;e clients like Agnes are "burnt out" from previous unsuccessful
attempts at change. They are often in a state of crisis with considerable associated stress.
Although they desire change, they doubt it will happen, and they believe that if change
is to occur, it will be beyond their control. They aJso lack self-esteem and believe that
they do not have the skill, capacity, or energy to change.
Ex:1mp1e: Peter (.S5) ~s ~n 1.memplO)~ lor alu\OSt t'Yi'O )'e:lrS. but he h:lS nOI looked
(or 2 ,ob in months. He 52yS. "l1lt-re·s no work out there. Besides. who is it0111K 10 hire
2 nun o( rny a~?"
Seligman's (1975) concept of learned helplessness is a useful perspective for understanding these clients. Ptt>ple with learned hcJplessncss come to believe that their actions
do not mane.r; as a result, they are unlikely to extend any effort to change since they
believe that thq• have no control over their lives and that what happens to them is a
result of chance. They believe in a "luck ethic" rathe.r than a "work ethic." Their beliefs
are reflected in srotements such as the following:
■
"You have to be in the right place at the riWlt time to succeed."
■
"ff I'm successful, it's because the task ,.,,.,..s C3sy."
■
"It doesn't maner if I work hard."
■
"There's nothing I can do about it."
The key to working with people with learned helplessness-indeed, with most
clients at the contemplation stage-is to assist them "in thinking through the risks of
the behaviour and potentia1 benefits of change and to instill hope that change is possible" (DiClemente & Velasquez, 2002, p. 209). Many people with low self-esteem and
lcarned helplessness are in fact quite capable; it is the way they think and feel about
themselves that is problematic. Consequently, it is important that counscllors look for
ways to counter the client's self-deprecating remarks (e.g., encourai;e clients to sec the.ir
past failures as deficits in the plan, not deficits in them). As well, counsellors can encourage clients to sec clements of success in previous efforts (e.g., P3rtiaJ gooJ achievement,
Supporting Empowerment and Change
205
lessening of problem severity, and short-term achievement). Cognitive behavioural techniques, discussed later in this chapter, have also proven to be effective.
Confrontation should be used cautiously. As a rule, confrontation is most effective
when it is invited in the context of a collaborative relationship-in other words, when
it is invited. Then, it may be useful as a way to help clients understand incongruities
between what they believe and the way they act, and rccogni:e self-defeating ways of
thinking and behaving, behaviour that is harmful to sclf or other~ blind spots, blam.ing behaviours, and communication prob lems. As wcJI, confrontation can aJso target
unrecognized or discounted strengths.
Preparation Stage: " I'm Going to Do It Next Week."
\Vhen clients rcuh this third
phase, they have made a decision to chani;c and motivating them is no loni;cr the principal task; however, counsellors neo:I to sustain the energy for chani;c through support,
encouragement, and empathic caring. The principaJ msk for the counsellor is to assist
the client to dcvcJop concrete goals and action plan strategics. \Vithout concrete, system.atic plans, change efforts can be quickly frustrated and abandoned like soon-fo~ncn
New Year's resolutions. The essence of good planning consists of Setting concrete goals,
identifying and evaluating alternative W'tl)'S of reaching goals, selecting an action plan,
and anticipating potential o bstacles. For clients with learned helplessness, Setting smaJI,
achievable goals is crucial for establishing and maintaining a climate of success and hope.
Example: Iris. a 't·OUni siniJe parent. is excited about the po$$ibilit)' o( returnin& t'O
school. She sees a sc.hool counsellor for assistance with enrollment in the hiah schoors
speeial proal"3m for teen 1noms,. but she has not 't~ considered issues like d:t)'C:!Fe.
Using a strengths approoch, counsellors can assist preparation stage clients to draw
from their past experiences (proven success strategics and lessons learned). As well,
clients can learn about strategies that h.nve ,vorked for others. FinaJly, it is very important to conch these clients to anticipate potentiaJ obstacles and to plan strategics for
addressing them, including the emotional stress of the ch.nnge process.
Action Stage: " I'm Changing." At this stage, clients are ac.tiveJ,., involved in the
change process. They arc working on the goals and implementing the plans developed
in the prcP3ration stage. DiClemente and Velasquc! (2002) offer this perspective on
counsellor srrategies for this scagc:
Cl1ent'S in action ,nay still h::n,e some oonfhctinK (eelin~s about the tha.n~-e. They ma,.,
1niss their old l1festyLe in s<.une w:iys 21nd be struj$1ina t'O llt int'O this new behaviour.
Ca.re(ul listeniO¥ 21nd 21mrmina clients t~1 they 21re doiO¥ the
thin¥ are important in
this sta~-e. It is also important to c.hec.k with tilt c.lient to see if he or she has d1SCO\~red
p::aru of the tha.n~-e plan th3t need revision. (p. 212)
""'t
When clients encounter anticipated obstacles, counsellors can re.mind them of previously developed contingency plans. If there are unanticiP3ted obstacles, counsellors
can assist with interventions to support clients as they deal with these potential setbacks.
Maintenance Stage: l'l've Done It. I Need to Keep Doing It."
ln the final
stage, the challeni;c for the client is to maintain the changes that have been made and to
deaJ with reJapses, which may occur for a number of reasons (e.g., unexpected tempta.tion, personal stres~ triggers, letting down one's guard, and sabotage by others who are
threatened by the chang,c).
Counsellors can heJp clients accept that relapses, while undesired, are pan of the
change proces~ and they can hclp them to reframc the relapse as an opportunity for better success ne>..'t time. For example, they can heJp them develop new or rc,.•ised strategies
for dealing with stress points or triggers.
Table 7.3 oudines the stages of change.
206
Chap1er 7
TABLE 7 .3
The Stages of Change
Staao/C4al
PfecMemptatfwe Slage
Clients with no desire or intent.ion of d'langi~
• Counselling goal: JllCfease awarell6$$ of
neoo for change.
contemplative Stage
Clients who afe lhinkiog abOut d'lange
• Counselling goal: Resolve ambivateoce w
engage in the change f)(OCess.
Strateo Choices
• Emptoy empathy and Olhet active listaning skits.
• Provide information and feedbaek (if invited).
• E~age dients to seek S'lklrmation and feedbaek frOO'l others.
• Help clie-nts beCOme aware of attractive alternatives.
• use lhOught-proYOking questions.
• Avdd dllective and confrontational techniciues.
• use films, brochures, bOOkS. and self-assessment questior\nakes as tOCiS to
increase client insight.
• With irwOluntary clients, extilore feeli~ and concems openly,
self<tisctose your own feelW'lgs aoout being bOOCI, give clients choices,
involve them in decision makl~, and encourage client-initiated goats.
• Support "change talk:
• Discuss risks and beoofits of change. but avoid argui~ in favou( ot change.
• Help clie-nts uOderStand and manage self-deprecating remarks (e.g.,
reframe past failutes as learni~ ex.pel'ieoces).
• Identify elements of success in p(evious d'lange efforts..
• Uptore pmvious relapses emphasizing failure ot ~ns. not failure of dients.
• use support groups.
• Convey hope and belief in the dient's capacity for success.
Preparation State
• Setgpats.
Clients who am committed to change
• Counselling goal: Develop C011ctete strategies lot action.
• Plan systematic action.
• Assemble/mobilize tesoutces to support d'lange.
• Make contingency plans (anUdpate obsiacies).
Action Stage
Active change effort
• Counselling goats: Implement change at'ld
• Reward (p,aise, sup(X)rl, and ackno-ldedg,e) change efforts.
• Assist client to antidpate and manage JX)tent.ial obStades.
sustain momentum.
Maintenance Stage
Sustain cha~
• Counselling goal: Sustain change.
• Assist client to deal with periodic ObStades or (elapses.
COGNITIVE BEHAVIOURAL COUNSELLING
"l know rhar you believe )'OU understand what )'OU think 1 said, bw
l 1m nor sure ,·ou realit;e that whar you heard is nm what l meant."
- Robert McClosk~
Thouahts nre the birthplnce of emotions, sclf-cstttm, nnd behaviour. Positive (helpful)
thinlcina creates an "I can do it" attitude, which IC3ds to a arenter willinancss to embrace
new chaJlengcs and to rake appropriate rislc.s. Neg3tive o r unhelpful thinlcina panern~
on the other hand, Cre3te distress and interfere with one's ove.rnJI sense of weJL-being.
Cognitive behavioural tedmiqucs focus on increasina helpful thinking and on changina
problemntic behavioural patterns.
Cognitive behavioural coun....elling (therapy), or CBT, hns been empirically tested
in hundreds of studies. T he results have demonstrated its usefulness for a wide range of
sociaJ, emotionaJ, and mental health p roblems such ns mood disorders (depression and
bipolar disorder), anxiety disorders (obsessivc<ompulsive disorder and post.-traumatic
stress disorder), substance use problem~ enting disorders. g:imbling problem~ anger,
personality disorders, srres~ unresolved afief, 3S weJI as medical problems such ns hypertension and low b3Clc pain (Buder, Chapman, Fauman, & Bcc:lc, 2006; Chambless &
Ollcndkk, 2001; ond Beck & Beck, 2011).
Supporting Empowerment and Change
c:ogniti¥t beha-tioura.l c:ounselli,_
(therap7'): Acoonsellint appiod
t!l31 assists dients to ii.ntify-.:J
mdfy unhelpW t!linling and pdlt!m.a~it
bebtiour.
207
Figure 7.3 ABC Model
Amc.ric:.m psychiatrist Aaron T. Beck (192 1- ) is considered the founder o f CBT.
\Vills (2008) identifies the ccm:raJ assumptions behind Beck's npproach: ''At rhc heart
o f the CBT paradigm the.re is a very simp le yet effective working modcJ: the way people
think a bout their situations influences the W'll)' they foci and behave" (p. 5). CBT docs
not focu s on finding the root causes of problems; rather, it emphasizes problem solving
to hcJp clients find new W'll)'S o f thinking a nd responding.
Counsellors can q uickly teach clients the basic ideas behind CBT and, in the pro-ccs.s, hcJp chem lenm a bout how unhelpful thinking impacts behaviour and emotions,
and how behaviour and thinking that is lenmcd can be unlearned.
The k~• to changing problematic behaviour o r emotions is to explore and modify
d istorted thinking:, and then to learn and p ractis e new responses. CBT focuses on understanding current thinking(thc prescnt)and problem solving todcvdop new behavio urs.
Marie and Aiesh:3 3re pa$$(":i1~-t-rS on the same airline fh.i1t. t-.-b ne ii consumed by her
le::tr th3t the pfane will eras.I,. thin.kin¥. "This is 3 d3n~rous situ3tion. \\1h3t if the
en&ines fam A nd 2ir turbulenee will surely te3r the pl:me :lp3rt." Aiesh3 boards the
pfa.ne 2nd qukkl)' immerses herself in a book with no intrusiv~ thou$:hts o( <lrin~
Ellis (2004) developed the famous ABC model (Fiaurc 7.3) as a tool for u nderstanding why Marie and A icsha experience the flight so differently. ln the model:
■
A represents an activatina cvem (in this case, the airplane flight).
■
B refers to the beliefs that are triggered by the activating event, A .
■
C is the consequent emotion or behavioural reaction.
C lear!)•, Marie's beliefs about fl)•ing arc markedly different from Aicsha's. Cogni.tive behavioural counselling would concentrate on how Marie can modify her thinking
about flying, which is based on erroneous and distorted beliefs about its d angers. Moreover, the skills Marie learns will help her adapt to future problems she may encounter
in other areas o f her life.
SUCCESS TIP
If ooe's thinking changes, behaviour and emotions a~ d'lange. If one's behaviou( changes,
thinking and emotions also change. If one's emol:ioos change, thiMing and behavi::lut also
d'lange. See f igu(e 7.4.
Cognitive behavioural counselling uses a combination of methods to help clients
learn more effective copina strateaics. indud ina
208
■
hclpina diems recogni:e thinking patterns, in particular those chat are unhelpful;
■
hclpina d iems modify thinking patterns; and
■
assistina clients to develop action plans and strategics (modifyina behavio ur).
Chap1er 7
Figure 7.4 Interd ependence of Feelings, Behaviour, and Thinking
Helping Clients Recognize Thinking Patterns
"\Whether )'OU rhink you can or think )'OU can 1c- Jou 1re right."
- Henr)' Ford (pubi,c dom3in)
Frttauend)•, behaviour persists because clients are locked into unhelpful wnys of thinking
about their problems or solutions. Thinking pnne.rns that drive fee.lings and beh.nviours
are frequently outside a client's awareness. and theyemerJ;e from schema or core bdiefs.
Schema are the "basic beliefs individuals use toorgnni:e the.ir view of the self, the world,
and the future" (Sperry, 2006, p. 22). Significantly, a person's thinking ma)' be driven
by schema, assumptions and errors in thinking that are not fact based. (ndividuals who
are potentially very capable may act as if they were incapable because of faulty beliefs.
Automatic thous;:ht.'i occur spontaneously and are often outside of one's awareness.
Usually, they repeat weJL-establishcd themes such as. "J ,von't succeed," and this repeti•
tion strengthens J)O\\'er of the belief. Such unheJpful or maladaptive thoughts can lead
to distress., innction, low self-esteem, depression, and reluctance to engage in healthy
risk-taking, such as initiating social relationships. Cognitive beh.nviouraJ counselling
helps clients recogni!e automatic thoughts, identify "errors in thinking," and explore
how thouRJus hinder them from re3ching gon.Js. Table 7.4 outlines some common heJpful and unhelpful core beliefs clients might have. Once clients become aware that an
automatic thought is about to h.nppen, they can practise replacing that thought with an
alternative. This interrupts the repetitive cycle of problematic behaviour. On a broader
level, clients IC3rn to understand and modify schemas that drive dysfunctional bchav•
iour and painful emotions.
TABLE 7.4
automatic thoughts: T~
s t!l31
CICtW spoo1a118lUst, and areob outSd'
«• 's Nareness
Helpful and Unhelpful Core Beliefs
Unbtlpful
Helpf\11
• I am unlovable.
• I am a pe-rson wOr'thy of IOve and r ~cl.
• I can ask for and offe-r assista~.
• I am resJX)nsible f0t my own haJ)piness .
• To seek helJ) is a sign of weakt'less.
• Without a (elationShiJ) partnier, I am OOlhiog,
• I wi• fail. I am helptess.
• I have to be IOved by everyooe.
• I must be J)erlect in ever-ythiog that I dO. I musa be soon by
otners as the best
• I am special; I can lake advantage of J)OOJ)le.
• I will do my best, savour my success, and le-aro from my
mistakes.
• I accepr that not everyone wi\J IOYe me.
• I accepr my limitations: they dO not diminish me.
• My rights as well as the rights ot Others need to be (espected.
Supporting Empowerment and Change
209
Example: A new social setting t,iggers Troy' s automatic thoug,,ts: "'I don't belong.
I won't fit in ... These thoughts originate from hisc0re belief, " I am unlovable." Hi$
automatic thougtits and his core beliefs aeate anx.iety and fear. His strategy is to
use drugs to curb his anxiety, which in tum lead to the new belief that he won' t
be able to cope unless he uses drugs.
Unhelpful Thinking Patterns
It is the mark of an educated mind robe able ro enrerrain a thought
wirhour accepting it.
- Aristotle (publie domain)
Most of the rime, our thoughts are outside of our awareness. Cognitive behavioural
counselling is designed to help clients develop conscious awareness of the.ir thinking
p3ttern~ then criticall,.•examine the.ir validity 3nd usefulness. Subsequently, clients Je3rn
strategies for interrupting unhelpful thinking, while increasing helpful thinking and
behaviour.
Thinking errors can easily lead to faulty ime.rpretations and maladaptive behaviour.
Other thinking patterns. while they ma)' be 3ccurate, 3re simply not helpful. In 3 cfossic
early work, Beck (1976) proposed the notion of "Cognitive Triad" (alc3 Beck's Triad)
consisting of views about seJf, the wo rld, and the future to explain depression:
Self: "I am worthless. .. (or ui,worth)·, useLess,. and de:f"tdent)
\Vor)d; "The world ii unsa(e.•· (failure is imminent)
Futun:-: "TI,e future is arim.·• (problems will per-Sise inde:l"mitel)•)
.-thelpful tt,,intd,_ patterns: Fatty
m:so11i11g caused bydist«tic., ifltOfflplete
• at,sis. ~
ity. ripfty, and
self-defeating tllougllt.
The assumption is th3t the negative tri3d sustains the client's depression; therefore,
CBT focuses on helping clients to ch3ni;e their maladaptive and unhelpful inter-prcta..
tions of self, the world , and the future.
It is important to understand the major unhelpful chinking patterns, such as e.mo.tional decision m3king. distortion, selective 3ftention, worry, m3gnif,c3tion/minimiz3,.
tion, mind reading, ~rfcctionism, and self-defeating thought.
Emotional Decision Making
In a Mr. Spock (Swr Trek) world , nil decisions would
be b3sed on totaJI)• objective, ration31 nn3lysis of the facts, 3nd emotions would pin)' no
p3rt. In eve.ryday life, it's not so simple. Emotions can 3nd often should pin)• a p3rt in
most decisions. Emotional decision m3king is problematic when it results in negative
o utcomes. Or, emotions might strongly support one conclusion despite evidence to the
contrary. For ex3.mple, peo ple might feel inadequate and unlovable while igno ring the
fact that they have nc:hieved succes~ and they h3ve many friends.
Distortion
Disto rtion results from misinterpretations, faulty assumptions, o r c u),.
tural biases. An extreme form of this is delusio03l thinking, which involves holding
beliefs th3t have no b3sis in reality. Here are some common examples:
))}) BRAIN BYTE
I
■
Misre3ding 3nother person's silence as lack of interest (mind reading).
■
Assuming th3t othe.rs should know wh3t we want, neo:J, or feel without be.ing told.
Tl' '::
I
,[1, I ~1
",1: I
Recent brain research (Naqvi. Shiv. & Bechara, 2006) is
mapping hO'N different parts of the brain (some rational
and some emolional) are ac1ivat&e1 during decision making. In some circumstances. the Memoriooal btain" hijacks
210
Chap1er 7
rationality and people make (and sometimes repeat)
decisions and actions that are not in lheir best interest.
Moreover, this can continue despite full awareness of lhe
continuing er-r0c.
■
lnter-preting lade of eye contact as a sign of disrespect or lying when, in fact, the
other ~rson is from 3 culture where dir«t e)•e contact is discouraged.
■
Arriving 3t false conclusions such as bclie-.•ing (after hurting a friend's feelings) th:.n
"( 3m a horrible ~rson', and she'll never spe3k to me 3gnin."
Selective Attention Selective 3ttention errors arise from a failure to look 3t all
3Spects of 3 problem or siruation. For e.x3mple, people with low self-esteem m3y owrlook evidence of their successes and strengths by looking only at their failures or limitations. Or, people ma)' be egocentric and not consider other people's fecJings or ideas.
As a result, they may be seen by others as insensitive. Selective 3ttention ma)' involve
3ny of the following:
■
Listening onl)• to information and facts that support )'OUr point of view.
■
Having 3 selective memory th3t overlooks or distorts important information.
■
Losing focus on wh3t a person is S3)'ing (beatuse of factors such as boredom, pr«>ecupntion with personal issues, or setting distractions).
■
Focusing only on the present without considering the long-term impliai.tions.
■
Oispl3ying egocentric thinking that does not consider other points of view or the
impact of one's behaviour on others.
Worry or Rumination
Excessive worry interferes with problem solving, 3nd it m3y
lead to feelings of an.xiet)•, depression, helplessness, and pessimism. Unhelpful worrying might involve dwelling on P3St events or failures, or it m3y focus on events th:.n
clients fc3r might h3ppcn in the future.
Magnification/Minimization These types of thinking p3nerns distort faces b)•
extreme and exaggerated thinking. Here are some examples:
■
Splitting (all or nothina}-the tendency co interpret people, thing5i, 3nd experiences
as either totn11y good or totally b3d, with no sh3des of grey.
■
Overi;:eneralirntion-drawing conclusions from a single fact or event. For example,
after be.ing rurncd down for a job, 3 man concludes th3t he is wonhless and no one
will e-.'e.r hire him.
■
Discounting-rejecting compliments by refusing to believe that the other person
is telling the truth.
■
"Catastrophizing"- mngnifying small mistakes into disaste.rs or tot3l failures.
Mind Reading This common error 3rises when people assume they know how others
3re thinking or feeling. Mind reading frequently arises from personal insecurities. For
example, low self-esteem m3y result in interpreting the actions of others as rejection.
Perfectionism
HC3lthy individuals set re3Jistic, challenging, and achievable goals. They 3re motivated
to do their best, 3nd they maintain high standards for themselves. Conve.rseJy, people
who 3re perfectionists set unrealistic standards of 3chie-.•ement with 3n expectation of
constant success. Perfectionist individuals are under constant srress ai.used by the 3n-Xiet)'
to perform, or the renli:z:3tion that they have failed to reach or sustain the.ir unrealistic
expectations of seJf. lrration.nJ beliefs that arise. from perfectionism include the following:
■
I can't make a mistake.
■
I nm 3 failure if ( 3m less than perfect.
■
I have no value unless ( 3chieve the very best.
Supporting Empowerment and Change
211
setf-ctekating thoughts: lnne,
liilog• al critic-M MSs.JteS.
MOANS: Matf'C¥1orthe'Mlfdi
must. ought. alwa,s. neve,, and
should, Mflich .
I irrati>nal or
self-defeating ~gilt.
■
If I can't be perfect, then J might as wcJI give up.
■
I have to be the best. To win is the only option.
■
I'm probably going to fail anyway, so wh't' try?
The personal cost of perfectionism can include chronic pessimism, lo"' self-esteem,
lack of confidence, depression, anxiety, and obsessive concern with order and routine. Pc.rfectionists frequently use the words must, only, always, nevc.r, and should (the
MOANS acronym introduced in Chapter .S).
Self-defeating thoug.hts are irrational (unhelpful) idC3s about one's own weaknesses.
Albe.rt Ellis (1962, t984,t993a,1993b, and 2004) has wrinen a grc3t deal about "'hat he
defined as irrational thinking and its impact on emotions and behaviour. Ellis argues that
people's belief S)'Stcms influence how they respond to and understand problems and
events. \\:fhm the.ir beliefs are irrational and characterized by an unrealistic shor.dd, they are
lilcet,., to experience emotional anxiety or disturbance. This thinking is often accomi:mnied
by sdf-dcprccating internal dialogue: "I'm no good," "Everyone must think I'm an idi()(,"
and "No one likes me." Ellis believed that irrational beliefs come from sdf-imposed rigid
dc.mands or shotdds, such as") have to be perfect" and "Everyone has to love me."
Golden and Lesh (1997) use the acronym MOANS for five ,vords that often signal
ncgntive self-talk: muu, ot1gJu, alwa:,s, netff, and should.
■
I musr succeed or 1 am worthless.
■
I oughr to be able to do it.
■
I afuu,s sere"' up.
■
I "'ill net'l:'r be able to get a job.
■
I sho1dd feel different!,.,.
■
Everything mua be perfect.
SUCCESS TIP
Chen.ts will profit from considering what triggel'S self~efeating thoughts. Fof U'IOse with
addiction problems, triggerS afe a pfelude to subStance abuse. By suceesshJly eounte-ring
cogndive triggerS such as Mlt'le only way I can telax is to use drugs,· subSlaoce abuse and
relapse can be preve-ntoo.
Helping Clients Increase Helpful Thinking
\Vhcn people learn to P3't' attention to their thoughts, they can begin to identify those
thoughts and pancrns that are unhelpful and then take nction to change their thinking.
Thinking patterns arc often well established and firmly anchored by core beliefs, so
considerable practice mn't' be necessary to ~ffect change.
An important first step is to hdp clients become a,.,,.-nrc of their automatic thoughts.
Counsellors can ask questions such as:
■
What were (arc) you thinking!
■
How strong was this thought!
■
How much (1- J0)do )'OU bdievc it to be true?
■
How does this thought/imngc link to fcdings and behaviour?
■
HcJpfuH Not HclpfuH
If clients have trouble identifying thought5i, counseJlorscan ask them to visualize and
"replay" the problem situation. Or clients can do homework to monitor their thoughts
2 12
Chap1er 7
and rc3ctions. (The.re arc numerous online sites that offer thought monitoring form~
example: https:.//www.psychologytools.com 3nd search for the heading "CBT tools.")
SUCCESS TIP
Yv'hen clients de-scribe ptoblem situations or em::,t.ions, lhe quest.ion "What we-re you lhink•
ing?" may help lhem to discover- unhelpful thinking pattei-ns that have contributed to the
problem Of 1he outcome.
Thought-Stopping/Diversion
Negative self-mlk can easily b«ome 3n 3utomatic
response. Thought-stoppini is 3 technique for interrupting repetitive unhelpful thinking that impedes action and confide nce with positive, empowering substirutions. After
identifying negative self-talk, clients nttd to develop positive st3tc.ments to replace
intrusive negative thoughts. Herc 3re some examples:
Unhelpful Thou~ht: "I'm so stressed about aoing for the job intc.rview, I'm aoing
to p3nic 3nd make a complete fool of myself."
thought-stopping: A tedriaique I•
brea._, tile pattern of «¢itne
self-defeating llioug)I patter-ts.
khniquesilclude tkluglll replacement.
yea.g •stop• il)'Cllr mind un~il die
undesiied t._.t disappears. wpping
an ebstic b.t on the wrist toshil
t!lilling. and acthily diwrsion.
Thought Substitution: "I'm qualified for the job. I can control my 3nxiety through
deep breathing."
Unhelpful Thouiht: "(f I don't do everything well, then I am a failure."
Thought Substitution: "I don't have to be perfect. I'm hum3n and sometimes I'll
miss the mark."
(see Ba:k & Beck, 201 I, p. 213 for more examples)
Clients might find it useful to think the word STOP to intc.rrupt unhelpful thinking,
then immediatcl)• use thought substitution to introduce helpful thinking. A lternatively,
other cues can be used as a thought.-stopper. One d iem carried a p icrurc of hc.r son
as a baby. This helped hc.r interrupt negative thinking 3bout him that w3s trigi;er~ b)•
his current drug abuse. Anothc.r im3gincd 3n 3.XC as 3 cue to substitute a new helpful
thought. Figure 7.5 illustrates the sequence.
Thoughr.-stopping works, but it requires practice. Negative self-talk P3ttc.r ns may
represent years of learning th3t must be "unlearned," and the best wa't' to do this is
to IC3rn new ways o f thinking. Intrusive thoughts c3n 3Jso be countered by diverting
attention with activity, music, physicaJ activ ity, or mcdit3tion.
Mindfulness ln recent years, many cognitive bdi.avioural counsellors h3ve intc•
grat~ mindfulness techniques in their ,vo rk. Mindfulness is simpl)• defined 3S "3warcness of present expc.rience with accept3nce" (Siegel, 2010, p. 27). W ith mindfulncs~
mindfulness: FOQlsing on momeaM~
mcaent ~noes wilhlul judgment
Unbelpful Thoui,-t
Thought-Stopper
New helpful Thought
Figure 7.5
Thought-Slopping Sequence
Supporting Empowerment and Change
2 13
"the intention is for parricip3ms not only to bring their 3w3reness to prcscnt•momcm
expe.ricnce but aJso to become 3w3re of the tendency of the mind to w3nde.r 3W3\' from
the moment and to IC3rn to gcndy guide it b3c.k without judgment" (Bowen, Chawla, &
M3rlatt, 2011, p. 34). 1t helps people to disengage from worry about past, current, and
future problems that m3y not occur.
Mindfulness is not difficult, but practice is essential. Mindfulness has shown to
be an effective adjunct to cognitive beh3viouraJ therapy in the treatment of a range of
disorders, including depression, obsessive-compulsive disorder, posvtraum3tic stress
disorder, and others (Firouzabadi & Sh3reh, 2009; Godfrin & van Heeringen, 2010;
and Vujanovic, Niles, Pietrefesa, Sc.hmenz, & Potter, 201 I).
SUCCESS TIP
"MiOO lhe Gap·- TM time gap between lhinking and action provides an opportunity to
make new chc::ices. In the abSence of effort and attention, lhe same unhelpful patterns of
thinking aoo behaviour 'liill be (epeated aoo strengthened. Mindfulness slows dOwn experiences and giving people an opportun.ty to identify thinking patterns. SubSeq~ntJy, they
can practise helpful ways of thinking and responding, Practice then c,eates and sarengthens
new netXal pathways.
Evidence Finding Beliefs ma'>' arise from foulty assumptions 3ncJ ocher errors in
thinking, or they m3y be based on emotions, not foct. UnchnJlenged beliefs can limit
new learning, 3nd they may lcccp clients locked in old, ineffective W'a)'S of acting or
thinking. Evidence finding is 3 CBT technique th3t teu.hcs clients to be their own "de,.•.
il's 3d\'OC3tc" through the use of disputing questions to test the validity of their bclicfs.
As well, counsdlors c3n also encourage clients to seek out information 3nd data by
suggesting they talk to others to expand their perspective. Counscllors can 3Jso directly
challenge beliefs with facts., examples, or they can use brainstorming t«hniques to generate alternate idC3s. Guided discovery (Neenan & Dryden, 2006) involves asking qucs..tions to help clients consider perspectives that are currcnth• outside their 3w3reness.
Herc are some counsellor responses that will stimulnte evidence finding:
■
How much of what you believe is based on how you foci 3nd how much is based
on fact?
■
How do )'OU know chis to be true? Do you have facts or 3re )'OU assuming?
■
Let's try to explore evidence that this may not be true. Play devil's advocate.
■
What 3rc some other w3ys of thinking about '>'our situation?
■
If 3 friend thought this w3y about his situation, whnt would you SU)' to him?
be-
SUCCESS TIP
Oo,,1
retr-am.ing: Atechnique ror lllelping
dients look at things dittetealty by
suggev.ing altematite inteqntatic.s,
perspe«iws.• new ~ s . Re.tr.es
should Pl!S:ftl loffeal Hd p)Siti...e
alle.m,a.;iw..-ays ot llin-,_
2 14
e,,~hing you lhink (Thomas l<ida, 2006).
Reframing
Reframin,: is 3 counselling skill thnt hclps clients shift or modify their thinIcing by suggesting altt~rnative interpretations or new mC3ning.s. It empowers clients by focusing on
solutions and redefining negatives 3S opportunities or challenges. Client stubbornness
might be r~framed as independence or greediness as ambition.
Chap1er 7
> : •.
Neuroplasticity refers to the brain's ability to wow and teat-
ra* neut'al pathways based on MN ex.perien::::es 0c leacning.
Cor'Wersely, ne1Xal pattrways that are not used will be pruned.
NetXal groMh can be JX)Sitive Or' negative, bul in the at>sence
of awareness, effort. 0r new ext,erience the br'ain tenets to ad
on autopilot, repeating and reinforcing established patterns.
MiOClfulness creates awareooss of lhOughts and feelings as
well as the ability to change mental focus with the goal of
influencing bt'3in wowth in a positive way.
Although niOOfutness can stimulate re-la.xation, that is
n01 its goal. MindhAness involves a 'Mlde range of strategies
lhat might invOlve al five senses. It helps people develop
self-awareness and acceptance of their moment-tCHnOment
lhOughts and leeli~ b-f paying attention to one ex.pe-rience
at a time. Mindfulness can focus on sounds, thou~ts. smets,
taste, visual hnages, and bOClily sensation uslng techniques
such as the foUOwing;
• Mindfully attending to a sensary ex.perience. such as eati~ a banana.
• focusing on breathing; paying attention to the Row of
Ulougl\t<.
• Simply paying attention to any daily activity such as washi~ the dishes..
• Perl0tmi~ 100 "bOdy scan,· which helps people beCOme
aware of physical sensations that often precede 0r accompany habitual msponses. The ptocess invclveS systamatically locus1ngattention on ead'I part of 100 bOdy, including
breathmg. (See Bowen, Chawla, & Matlall, 201 I, p. 42, 0<
Siegel, 2010, p. 72 f0< detailed k\stJuction<).
Ex3mp1e: Out 3~ 11, is pfarina b::a:Seball b)• himsel(. He throws the bdill inm the 2ir 3nd
exclaims. "I'm the are3test b3uer in the Yi'Orld.'' He swin{tS 2nd misses. Once ~in. he
tosses the ball into the 3ir and 53.ys. "I'm the are3test OOuer in the world." He SYi•in,a:<i
2nd misses. A third tune he thrOYi'S the ball into the air prodaimin,a ernphatblly. "l'tn
the are::atest pitd,er m the world."
(See Table 7.5 for 3dditional ex3mplcs.)
Before presenting rcframcd ide3s, counsellors should use active listening skills to
fully understand the client's current pe.rspectivc. As well, emP3thy is crucial~he.rwise,
clients may conclude that their feelings are being discounted or trivi31i!cd.
SUCCESS TIP
flve ways to refr'ame:
• Tum p(Oblem statements into gOalS.
• Help c~nts accepa thei( emotions and reactions as ·n0tmal.•
• LOok at pe(ceived weaktlesses as strengths.
• See ;,trtggers· as an opportunity to ac1 differently.
• Exi:,or-e the posdive outcomes of advet'Sity.
Rcframing should not be confused with p latitudes, such 3S "It's 3hvays darkest
just before dawn," which arc typically not very supportive or helpful. An ex3mple of a
welL-meaning but misguided re.frame thnt people give in times of grief over the loss of
3 child is "You're )'OUnJr-)'OU C3n hnve more children." A response such 3S this ignores
Exi:,oring the past may help clients develOp some insight
into theif behaviour and emotions. However. it may feinbce
neural pathways tr.at have sustained unhelpful think.I~ and
actions. Consequently, it is rn'lportant to use technklues such
as lhOu.ght-stopping, behaviour-al rehearsal, and the Mmiracle question,· beeause these actions ""ill create new neural
connections that will support goats and changes that clients
largel
Supporting Empowerment and Change
215
TABLE 7.5
Reframi ng
°'
Client's Petspeethre Statement
This counseling is a waste of lime.
Reframlna l ead
Sounds as if you've done some tt'lrtking abOut how out work coukS be m0te
relevant to you.
I 000·1 fit in. I come from a differ'en1 cult...-e
Of eour'se. Some people have not had ex.pel'ience with your culture, and they
may be frighte-ned. Per'haps you couk1 IOOk at tt'lis in a different w.ry. Your
experiences migt\t alSO be fascinats"lg lot people wt'lo have not lived outsi:1e
lhe country. They nigl\l wetcome your fresh <leas.
and my ideas and values must seem strange.
I'm very Shy. When I first join a group, I
usually don1 say anythi~.
F'Ot tne firSt time in 20 years, I'm 'liitnout a job.
Wheneve-r I am late fot curlew, my mother
waits up fot me and immediately starts
scre.ami~ at me.
My life is a mess. rve lived on the street lot
the last six m::>nths.
You llk.e to be patient until you have a sense of wf'lat's happens"lg. People
who are implJSive are WOr"Jd~ to develOp this skill. You also soom to want to
devt'ICII') altemative-s, such as being tnOr'e expressive in 100 beginning,
Obviously, thi:S is devastating, At the same time, I wonder if this migt\t also be
an op(X)rlunity fOr' you to try something different
I'm curious aOOUt why she might do this. Per'haps She haS ttouble telling you
hOw scared She is that something may have happened to you. It might seem
strange, but hef anger could be het w.ry of saying hOw much She IOves you.
Sounds like you've had kl sut'Vive under conditions that might have defeated
m:>St people. How did you do that?
the person's grief by offering well-meaning but simplistic and ineffective advice. Rcfram,.
ing should not trivialize complex proble ms with pat answers; rathe r, it should offer a
reasonable and usab le altcrnntivc frame of reference that challcng,es clients to brc~llc out
o f unhelpful Wa)'S of thinking about their problems.
Tim ing is important. Even though it may be obvious that a client's thin king is
d istorted, it may be wise to hold back on rcframing until the client's problem is fully
explored. Moreover, as p reviously SUficsted, it is important chat the client's feelings be
acknowlcdg,ed through empathy. Exploration and empathy ensure chat the cou nscJlo r
unde rstands the client's feelings and situ ation, a nd they pro\tidc a basis for the client to
consider reframcd ideas ns rc3sonable o r wo rthy of consideration. If counsellors push
clie nts too q u ickly, clients ma y feel d cvnJucd and misu nde.rstood, and in response they
ma y resist new idcns. Empathy helps counsellors to establish and maintain credibility
with their clients.
In addition, counsellors ca n use rcframing to invite clients to cake control over
feelings and bcha\tiour:
■
C lient might S3Y, " I can't get ori;:anizcd ." Herc, a counsellor can chaJlenge the d iem
by proposing that the diem rcframe this state me nt with " I won't let m)•self get
organi:ed."
■
C liem m ight sa y, "She makes me feel hopeless.." In response, the co u nsello r can
propose that the client rephrase the stateme nt by SU)•ing, "l have decided to feel
hopeless." The latter response underscores the client's control over personal fccJ.ings. As part of this wo rk , counsellors can empower their clients by explaining
that clients have ownership over their feel ings and that no one can make the m feel
a cenain wa)•.
Refrnming can ene.rgi:e clients. \\:fhen clients arc locked into one wa)' o f thinking
about their problems, their solutions a re lim ited. But when they consider new perspcc~
tivcs., problems that seemed insurmountable can yield new solu tions. Moreover, rcfram,.
ing can serve to red irect client anxiety away from self-blam e and onto ocher rational
explanations that a re less self-punishing, ln these W'U)'S. effective refrnming e mpowers
clie nts to action, problem resolution, and management of debilitating feelings.
2 16
Chap1er 7
))I) BRAIN
BYTE
canae1ian neuropsychotogi.st Donald Hebb (public domain;
1949) made the now famous saatetnent, ..neUl'"ons lhat fife
together' wire togethef: The meani~ i:s tr.at repetitive actions
0r tnoughts strangthen
neural pathways and links. F0r exam-
ple, if one experiences anxiety in a social situation. repeated
expe(~nces may cause the per'SOO to beCOme stuck in a pattern of social anxiety fueled by unhelpful self-talk. With CBT
clients learn to bmak lhis pattern and, in the process, new
neural pathways are created and sare~ened.
Thete i:S ex~iinental evi::leoce tr.at CBT alte-rs the btain.
f0r example, a study by Kumari et al. (20 11) found that
lhere are meas.ureat:,e d'langes k'I the brain as an outcome
of CST. In particular. the positive symptoms of psychosis,
espedatty delusions reduced in severity. As well, afte-r tr'eatment, clients had decreased fear and anger responses. A
,eport ~ Mayat (2004) noted 1r,a1while anUoop,essanl moo;.
cation attacks depression by alteri~ the neurotransmitters,
cogrilive behatJioural therapy atso cha~ tne brain, but in
a diffetent way by d'langing activity io tne ptefront.al cortex.,
~ppocampal and dorsal cingulate areas of Iha brain. Anotherstudy by de La~ et al. (2008) using patients with Chfonic
fatigue syndrome (CF'S) demonstrated that brain shrink.age
(eefebral atrophy) associated with CF'S might be partially
mversed ~ CBT.
})!} INTERVIEW 7.1
The fOIIOwing interview excerpt illustrates some of the essential strategies of cognitive behaviou1al c-ounselliog. The client, a
40-~-old first-ye.ar university psyt,hology student, has sought help to deal with the fact th.at she has been " overwhelmed
and depressed" since returning to school.
Counsellor: feelings, thinking. and behaviou( afe all connected. Change one and the other rwo alSO change. In particular', it's critical to explOr'e hoN yout thinking affects yotX
feelings and youf behaviou(.
Client: I'm at Iha pcint whete. if I don't do something fast.
I'm going to lose Iha whde term. I might as well drop out.
Analysis: Cognitive behavjoural counsellillg requires a co/Jabotative relaticnSh;p. All jm()Orlanl compofle(lt of this js edUCtJtjng the clier'll oo hOw the process vi'Oflt"S. This
also h(!!p
1/'Je client to make her own intervenb'ons when she recogr,Jzes
proble.maUc thillking.
wm
Counsellor: You're leefi~ desperate.
AnaJysls: Wirh aR courrsellitlg apptOaeheS, empathyisan im{)Oftant response. Mote than any other skill. it tel/s clknts that they
have been heard at'ld that their feelings have been ut1derstootJ.
Counsellor: can you remember a time in the last few days
when tl'W'.!$8 feeli~ were particular1y strong? What was goi~
AnaJysls: Ellcitiflg and exp/oriflg examples such as this ,:xovides
a database for helping this clknt understat'ld hOw her thoughts
contribute to her feelings. Signif,cantlY, probe.s to discover
lh;nklng ,:,atterttS may reveal "lnner dia.lOfP,Je" (se/1-defeatiflg
l/'JOught pattems) ot lmages.
lhrough yotX mind at the time just before class?
Client: YestQ'day, I was scheduled to make my fll'Sl-ctass pre-
""'"'tion. I was llwlki~1ha1 I was gong IDma1<e a loo ci myself
in front of tt'l8 woote CbSS.. Ever,-one etse seems so confident
when lhey lalk, bul I - 1 bOOn ;n SCOOOI fat 20years.
Counsellor: And that made you feet . . .
Client: Stupid and te«ified. I finalty phoned in sick.
Counsellor: So, hem we ha\18 an e,ram~ of hOtY vd'lat you W(f'@
lhinki~Ml'm gci~ to make a foot of myselr - influeoe:ed
hOw you were feefi~and vd\at you did. Does 1his make sense
to you? Let's use the ABCm:xlef to illustrate it. (The COUttSellor
uses a /Tip chart, A /acti,ati!lg situationHh,;,,king of mal<iflg
the /J(ese,itatio,,, 8 /beJil!f/-·rm !!Pi!'€ to /ool( /il<8 a foci"; and
C /conseq""'11 emotionJ-fear. feeling °"""""/med.
Counsellor: If you agree. I'd like to ask you to make notes
during the next week when you fl"ld yourself feeli~ warse.
When this happens, I want you to pay attention to what's
gci~ thfough your mind.
Analysis: [a,t;er the couttSellot atld the client discuss«/ the
essential elements of cognitive behavbutal COUt'ISelliflg. N(YN
lfle clknt's example can be used to re;nforce the princl,:,le.s..
Using a flip chart ot dra";ng is very helpful for mar1y clients.,
particularly lot those who are le.ss comfortable in the verbal
moda.lity.
Analysis: Homework Is essential to effective cogr,it.lve behavloutal cout'ISelliflg. Here, the homewotk creates an opportut'llty
lot the cl'iertt to become mo,e famillar with haw her feelings and
behaviour are lnb'mately COt1rJeeted to her lhit'IJdflg.
Supporting Empowerment and C hange
2 17
>» INTERVIEW 7 .1
Cognitive Behavioural Techniques <conHn"')
In the next session (ex.eefpted late(). the counsellor uses
re:framiog and lhOught-stoppi~ as tOOIS to help the client
Cha~ he< thinking,
Counsellor: YotX jo11na1 is great. You've identified rots of
great e.Kamples. Let's try somethi~ different f0t a minute.
What if it "-ere possible to look at your leafs differentty? (Ctient nods approval.)
counsellor: I think it's natur"al wtle-n we ha\18 a problem to
C!Well on au its unpleasant aspects.. 1ktlow lhat I tend to do
that uniess I discipline myself n01 to. For example, when you
think of how oorvaus you ant you lhink of au tne oogatives,
Analysis: The counsellor jntrOduces Ille ,:,ossfb;lfty of ,etrarmng.
Analysis: The couflSe/lO('s ShO,t self-disclOSute commuroc.ates
Ullderstaridlng at'ld a n()('Jjudgmemal attitude.
sud'I as you migtit make a fool of youfself. Or' your mind
might go blank vd'lile you're talking.
Client: (Laughs.) Ot that I might lhrow up in front of
ever)(lne.
counsellor: Okay, those are real fears. But b-f considering
only your fear'S. you beCOme !bated on the negatives, and
you may be overlookl~ some im(X)rtant JX)sitives.. If you can
IOOk at it diffe-rently, you might discove( a woole new way of
dealing with youf class presentation.
Analysis: One teoot of cognitive behavioural couflSe/Jing is
that people tend to pay too much attentkJn to the r,egatlve
aspects of the;r situations while Ignoring posiUw,s or other
explanations.
Counsellor: Want to try it? (The c/ief)[ nods.) Okay. lty to
identify some positi\ie aspects ot your fear.
Analysis: As a rule, 1rs more empowering for clients togerwate
their own suggestioos before couttSe/kJrs Introduce their Ideas
and suggestiotls. In this way, diems become self-conftootlng
and are more likely k> cane up Milfl Ideas that lfley Mill accept
as ctedible.
Analysis: In this example. the client Is able to getterate a
reftame, which lfle couttSellor embe/JisheS. Ill other situatlMs.
counsellors might 111tt0duce reframes of their O"M).
Client: Wefl. I guess I'm not the onty ooo W'ho is scared of
public speaki~ .
COunsell01: So. )'OU koow tnat ther·e wil be Other peoJ:le in 100
class who understand ancl will be ChOO'i~ for you to succeed.
ClleM: I never thought of that befofe-. He-re•s another- ijea:
Because I'm so nel"VOUs. I'm going to make sure th.at I'm
mally ptepa(e-d.
Counsellor: Great! Do you think it mi.gr.I be possible to
look at yo1S fears diffe-rentJy? Consider that it's normal to
be ner\'ous. Or go a step further and look at it JX)Sitive-ly.
Maybe- there's a part of it that's exciting-kind of like going
to a SIC.3ry movie.
Analysis: The cout1seltot offers the ct'ient a teframed way of
IOOJdng at ttef\,'()U'Sf'leSS.
ClleM: I did come baek to school bec.ause I hated my bOring
Analysis: The client's response suggests that this notion is
jOb. One thing is for SU(e, I'm 001 OOfed.
possible.
counsellor: So, the more you scare yourSelf, the mom you
ge-t your money's worth. (Tfle counseJkJt and the clie.nt
laugh.)
counsellor: Her-e's an ide-a th.at WOrkS. If you agree, I'd like
you to try it o,,,r tne next -k. Eve,y lime you notice yourself
starting to get overwhelmed or feeling distressed, in'lagi.ne a
stop sign i"I )'OU' mind and immecfiatelysubstitute a healthier
though!.
218
Chap1er 7
Analysis: SponttJneous humcur helps tfle client see her protr
lemS ltt a lighter way (yet aflOlflet reframe).
Analy,is, Anolhe( ,xamp/e ofcounse/6ng l>OrOOwOrk. The CO<Jr>sellor ifltroduces tflOught-stopping-a 1echmQue to help clients
COtltrol self-defeating thiflidng (DattlNo &Freeman. 2010). The
basic assumption is that ;f self-defe:Jtlng lflOugflts are interrupted, tfley will eventually be replaced by more em()OK-ering,
Jmitoo perspect1,es.
~JO INTERVIEW 7 .1
Cognitive Behavioural Techniques (con,;nue)
Reflections:
■ How mig,,t you intrOdue:e cognitive behavioural c-aunselling to a 10-year-Old child?
■
Suppose the client returns f0c the next session and reports that "thought-stopping did not wo,k." Suggest
counsell0c choices f0c dealing with this outcome.
■
Identify this client's neural pathways.
At this point. the cout1se/10t could also help the client develop diffeI11t1t chok:e strategies for dealirtg with dysfut1ctional
thinking. such as an activity dlverslot1 to shift attention. use of a prepared cue C/Jfd with a positive thought ,ec0rded,
imagining success.
0r su~tituting a different Image.
CONVERSATION 7.2
STUDE:NT: can we use CST to deal wtth OU( C)N(I (eac;tions?
CIT Counsellor: AbSOlutely! Clients can Mpush out buttons:
test our patience, and leave us OOUbti.ng OUf ability to wOr'k
effectively. Sometimes. negative feet.i~ such as a•(· frus..
tratioo, 0t lea( can e:toud OU( objectivity and impalt OU( ability.
Feelings ot atttaction p(otectiveness can be just as p(oblematic. When we begin to take client behaviout personall'j,
\\tlen we become disconnected from essential skills and altitudes such as being nonjudgmental and empathic, it's time
to do some wOt'k on self. That's wtlere CBT strategies can be
very hel plul.
°'
STUDE:NT: How?
CIT COunsellor, The CBT approach ;m<)I,.,. payu,g attenuon
to the connectbn amoog hOw we Irtink, feel, and behave.~3'Na(eness (egat'ding dienl behaviour~ wrich trigger unhelpful
thir'iung ghies us an opp:)rtunity to criticaly exarna"le thei' valklily, then Challenge umelpful lhOughlS I>, usir,g · ~ · ~ SUCfl
as 1hougN-stopping. Iat-Nays IY'ld it telpful toconsi:Jet that my
dent's behavioU" may be theit usual way, so if, fOt' ex:ami::,e,
they a(e rude to me. I can understand that this is part of their
pe~ty. and I am much leSS •kely to take it pe,sonall'f.
Student: People in (ecovery from substance misuse leam to
recogni:ze triggers that could lead to relapse. Counsenors can
do the same thing by identifyi~ client situations behavburs, which trigger problematic feelings.
°'
HELPING CLIENTS MAKE
BEHAVIOURAL CHANGES
Goal Setting
Obstacles are those frightful rhings you see when )'OIi take your eyes
off your goals.
- Henr)• Fon:!, public: dom::ain
Goal scttini is a counselling process th::at helps clients define in p recise, measurable terms
what they hope to ach ieve from the work of counselling. Goals c3n be classified as p rocess or outcome goals (Shebib, 1997; N)•srul, 2011). An outcome ioal relates to what
the client hopes to achieve from counselling. These goals have to do with changes in the
client's life, such as getting a job, improving communication with a spouse, de:.lling with
painful feeling~ o r managing self-defeating thoughts. A process ioal conce.rns the procedures of counsclling. including such variables as the frtttuency of mttrings and the nnture
of the counselling relationship. Process ,;oals are strategies for reaching outcome gooJs.
There is wide suppon in the counselling literarure fo r the importance of setting
goals (Nystul, 20 11 ; Marrin & Pear, 20 11) Goal setting serves many important purposes,
including giv ing direction, d efining roles, motivating, and measuring progress.
Supporting Empowerment and Change
goal setting: Acomefling prooen
t!l.i'! hefps tlieals de.fine ii precise.
musurablf' lefms what they h04)e to
adliew fiomtile r.ort ot CCJUns6g.
outcome goal: Atoal rtla;edto
what the dient llopes to achieve from
uunselling,
process goat: The •~sand
pnndures tut -.ill be used iacaselling
to assist cli!•ts in ieaclil:g tileir to3ls.
219
Giving Direction GooJs help to give direction, purpose, and structure to the work
of counselling, thus, helping counsellors and clients decide whic.h topics and activities
arc rcJcvant. When clients and counseJlors arc dear about their goaJs, they can begin to
structure their thinking and action toward their artainmcnt. Setting g,c,als hcJps clients
make reasoned choices about what they want to do with their lives. Goal setting helps
clients prioriti:e these choices.
Defining Roles Goals provide a basis for defining roles. When g,c,als are dear, coun.seJlors know which skills and techniques are appropriate, and clients know whnt is
expected of them. Moreover, when counsellors lcnow the g,c,al of the work they can
make intelligent decisions regarding whether they have the skills., capacity, and rime to
work with the client. Jf not, they may make a referral.
Motivating Cools motivate clients. Setting and reaching g,c,als is also therapeutic. 1t
energi:es clients and helps them dcvcJop optimism and self-confidence about change.
Cool achievement confirms personal capacity and further promotes action. \Vriting
dO'l.\rn goals ma'>' add an extra measure of motivation.
Measuring Progress Goals help pro\tidc benchmarks of progress., including de.fin.ing when the counselling relationship should cnd--that is, when the gools have been
reached or their pursuit is no longe.r \•iable.
Developing Effective Goal Statements
Sometimes clients arc able to dear!'>' articulate whnt they hope to achieve as a result of
counseJling. At other rimes, they have difficulty identif)ting their pi.ls; however, through
systematic interviewing counsellors can help these clients define and target their goals.
ThewidcJy used acronymS.M.A.R.T. (Bovcnd'Ee.rdt, Botcll, & \Vadc, 2009; Harms &
Pierce, 2011) defines the c.haracte.ristics of effective g,c,als: Specific, Mcasureable, Ac.hicv..
able, Realistic, and Timely.
Effective Goals Are Specific
One defining feature of a counselling relationship is
its goal-dir«ted nature. But some clients begin counselling with vague and undefined
gools:
■
"I want to feel better."
■
"My husband and I nttd to get along better."
■
"I need to make something of my life."
These g,c,als arc starting points, but they are useless until they arc described as dear
and concrete targets. Beginning phase work that explores problems and feelings should
lead to the dcvclopment of goals that define and structure subsequent worlc. Then in
the action phase, clients can devcJop these goals as specific and measurable targets. This
step is a prerequisite for action planning-the development of strategics and programs
to achieve gools. Vague g,c,als result in vague and ill-defined action plans, wlu~rcas explicit
gools lead to precise action plans.
In Chapter 5, concreteness was introduced as the remedy for vagueness. Concreteness can add pr«ision to unclear and ambiguous g,c,als. For example, when clients are
describing the.ir goaJs, counsellors can use simple encourage.rs., such as "TeJI me more"
and "Yes, g<> on" to g,tt a general overview of what clients hope to achieve. This is the
first step in shaping workable goals.
The next step is to use questions to define terms, probe for detail, and develop
examples. This step hcJps to cast the emerging g,c,als in precise language and move from
220
Chap1er 7
good intentions and broad aims to sp«ifac goals (Egan & Schroeder, 2009). He.re arc
some sample probes:
■
■
\Vhat is )'OUr goaH
\Vhcn you say you'd like to feel better, what exactly do )'OU mean!
■
Describe how )'OUr life ,vould be different if you were able to reach your goaL Try
to be as detailed as possible.
■
■
If )'OUr problem were to be solved, what would need to be different in your life?
\Vhat do you think would be the best resolution to your problem?
■
\Vhat arc some examples of what you would like to achieve?
■
As a result of counselling, whnt feelings do you want to increase or decrc3sc?
■
\Vhat do )'OU want to be able to do thnt )'OU can't do now?
■
If I could watch you being successful, what would I sec!
Some clients are reluctant or unable to identify gools, and they may respond with
a dead-end statement like "I don't know" when they are asked for their goals. To break
this impasse, counsellors can use some of these responses:
■
"Guess."
■
"\Vhat might 't'OUr best friend (mother, father, teacher, etc.) SUfiCst as your gool!"
"\Vhat W'Ould you like to achieve but don't think is possible?"
■
A good gencroJ technique is to encourage clients to visunli.!c themselves reaching
their gools.
\Vhcn clients say, "I don't know," their responses may indicate friction in the coun.selling relationship. and this answer is a way of sabotaging the work. In such cases,
goo! setting might be pre.mature, and the focus of the interview ma)• nttd to shift to
relationship problem solving (immediacy). Moreover, when clients say, "I don't know"
they might also be saying, "I can't do it" or "I'm afraid." Here, counsellors can suggest
setting a very small goal as a starting point (e.g., "If you could make just one tiny change
in )'OUr life, what W'Ould it be?").
SUCCESS TIP
Yv'hen clients say, ·1don't know: oon•t rush in too quickly with anolhe( quest.ion 0t comment Often, aftet a short s,lencQ, clit:?nts wil generatQ ne-w ideas, fQelings, or thoughts.
Effedive Goals Can Be Me.asured \\:fhcn goals arc measurable, clients arc able to
evaluate progress, and they know precisely when they have reached their goals. More•
over, dear goals sustain client enthusiasm and motivation. Vague and unmeasurable
gools, on the other hand, can result in aP3th)• and vague action plans.
Baseline A baseline is a measure of what is hnppcning now. 1t becomes the reference
point for measuring future change. For example, a baseline miaht be how often during
any I .S-minutc interval a child is off task in a classroom. Baselines might be taken over
one or many selected rime frames to obtain an average. Mcasurc3blc pl]s identify how
much change in the basclinc is targeted. ln this example, suppose the baseline shows that
the child is off task an average of 8 minutes during any I .S...minutc interval. The goo! might
be to increase the frequency of on-task behnviour to 12 minutes during any I.S...minutc
interval in the next three weeks (i.e., reduce off-task behaviour to maximum 3 minutes).
Thus, goals need to be defined in terms of changes (increases or decreases) in baseline behaviours, thoughts, or feelings. Gools should also hnvc a realistic schedule (a target
Supporting Empowerment and Change
22 1
date to start working on them and a rorget date to reach chem). Counsellors can help
clients frame goals in quantifiable language with questions such as. "how often?" "how
many times?" and "how much!" The question "When will 't'OU start!" is a simple but
pO\\•erful way to ensure client commitment co the change.
Example (sk ill): "My goaJ is to upress my opinion or aslc a question once per
class."
Example (thoughts): "My goal is to manaae self-depr«acing chouaht patterns by
substitutina positive affirmations each time 1 say to myself that I can't do it."
Example (fee.lings): "My goa.1 is to reduce anxiety when I speak in public from a
subjective level of 8/10 to 3/10 within the next six months."
Other measurable goals would include, "Tari;:et \\-eiaht reduction of 9 lcilograms in
10 weeks" or "Make five calls per day to potential employers."
Effective Goals Are Achievable and Re.alistic A goaJ has to be somethina thac
clients can reasonably expect to achieve, even though it may rttauirc effort and commit.mem. So counsellors need to consider variables such as interest in achieving the goals,
skills and abilicic~ and resources (induding the counsellor) available to help in rcuhing
the goals. In addition, the goals need to be significant enough to contribute to managing
or changing the core problem situation.
Bue some clients may be reluctant co set chaJlengina goals or even to set goals at aJI.
This situation can occur for a number of reasons:
■
Poor sclf-estcem
■
Fear of failure
■
Lad: of awareness of capacity for change
■
Fear of change and rclucronce to give up established patterns
■
Lad: of resources to support pursuit of the goal (Shcbib, 1997, p. 210)
Addrcssina these reluctance issues is a prc.rttauisitc for goal setting. \\:1hen problems
arc complex and the client's capacity or self-esteem is low, settina short.-term goals or
subgoa.Js is particularly useful. Short-term goals represent small, anainable steps to,.,,.-ard
long-term goa]s, and they help clients build confidence that long-term goal achievement
is possible.
Clients need to sec goals as relevant to their needs and consistent with their values.
Thus, when clients arc involved in the process of deciding what their goa.Js arc, they are
more likcJy to be motivated to worlc coward achieving them. Counsellors can suagcst
goals, as in the follO\\•ing:
Ex3mple: Evelrn w:lS referred to the oounsellor for help in copin& with Trevor. her
IS.,.~r-<>1d stepson. who wu in\'Olved in petty crime. E"elyn·s itnmedi:ue ~-041I w3s t'O
enrou~e Trevor to move out of the house. and she hoped that the counsellor tni~t
help her do thi$.. Durina the interview. it btt21n~ apparent to the counsellor that Evel,.,n
needed help ck...elopina parentina ski.Us for dealu~ with Trevor 3nd her tv.'O other teen,
3~ step$ons.. Without di:smissinK E,-ely-n 's objec1h-e. the counsellor su~.sted th3t this
be p3rt o( their 3~•end3.
When clients are forced co come to counsdlina by a third party, they may not feel
committed to any of the aoa.Js of counselling. Thus. the chances of success arc dimin.ished greatly unless some mutually acceptable working agreement can be reached.
Understanding a client's values is an important part of goaJ settina. Some clients
arc motivated by spirituaJ va.Jucs, some b\• mate.rial gain, and others by family values.
Other diems focus on immediate gratification, while still others have objectives th3t
arc long term.
222
Chap1er 7
?l.·1 ina Le(t his &nuly in Ch.in:1 to ron\e to North A n ~. He has see.1 his wi(e ooly once in
the last lh'i' )'i'arS. wben he rc-1.u med to C hin.2 (or a sho rt visit. He main12ins ~ ularcont:k't
with her 2nd their s~'i'3.r,okl son. He sends mueh o( hli monthly tor home to support hli
wi(e and extended futruly. Ah.hoUW, he hopes th:3t one d ay hii &nuly will be 2bte t'O joi.n him,
he has at«pt.ed th:. his purpMe is to position futun- ~ner.ttionsol his furruly (or a belt.er lie
Sometimes clients set go3fs that require others to change, such as " I want my husband to stop rreating me so badly." Counsello rs nttd to encourage clients to form gooJs
based on what is unde.r the.ir control, name.I)• their own fccling:si, behaviour, and thoughts.
C lient complaints and problem statemems c3n usually be rd ramcd as positively
worded goa.1 statements. Herc arc some examples:
Ex.:unple I
Client : E\'e-r)One 2lwa)'S takes ad" a.1112~-t of me.
Cou nseU.o r: Sounds as tho~ you 'd like to Je3n, to sttnd up for yoursel(.
Exmnple?
Client : I'm tired o( not worldn,a,
Cou nsello r: Put simply. your ~-Ml is to
~t a
job.
Ex.:unple 3
Client : M)• li(e is a mess.
Cou nsellor: You would like to
Ond a way to ~t your li(e in order.
The above responses change the focus of the interview from problems to gooJs. Of
course, the co unseJlor and client will have to worlc togcthe.r to shape these vague goaJs
into more explicit te.rms.
Effective Goals Are Timely Setting go3Js in a rime frame, that is, identifying a target for gool achievement, is important for planning the work. The rime frame should
also be realistic-not too quick and not too slow. \Vhcncvcr possib le, goal statements
should include "b)• when" the goaJ will be achieved. For example-:
■
To improve my grade-point average from C
■
To make prayer a daily part of my life.
■
To develop skills at organi!ing my rime and setting priorities. I need
schedule so 1 can plan at least a month in advance.
))!}
INTERVIEW
to
B b)• the end of the semester.
to set
up a
7.2
The fOllowing interview e:xc:e-pt illustrates goal-settii,g techniques. Prior to this d ialogue, ex.plo,ation and active li$lening
enabled the counsell0r to develop a solid base of understanding. With this work apparently finished, it seems timely to
move on to goal settii,g.
Counsellor: I'd like your optnion. Am you (eady to move on
to makl~ a change? If so, the nex.t steps would be set a
goal. then exi:,ore hO'N you can ad'lieve ii.
Analysis: The counsellor uses a phaSe trat1sib'ot1 to suggest moving f,om problem exploration to making a change. This wf/1 also
Change the eot1tract. The c/J'enrs response signals that he is
Client: Yeah, I'm not getting any younger. It's now or nevef.
ready to move from the C011templa.tlw! stage to the prepatatlotl
CounselIOI: Help me understand what )(llld like to change.
c,i.,.., 1need IOrelocus my IKeoo the ir.-es 1na1a,esrc,o,1an1.
Counsellor: What do you mean?
Client: I've been so busy with \\()rk that I (eally haven't had
too much time f0t family. That has to d'lange.
for change phase.
Analysis: At this point. the counsel/Or will have the criteria for
effectMJ goals (i.e.. specific. measureable. ach;evable, te:Jllstic,
aM b'mely) as a teferer,ce point. Subsequent questioos Mill be
deslf!l1e<J to help ffame the goal atowld these ctiteria.
Supporting Empowerment and Change
223
>» INTERVIEW 7.2
Goal Setting<conHn,e>
counsellor: JUSI so we can be dear, can you try to be more
specific? Suppose you're successful. What Will be diffetent
from the way thi~ are noN?
Client: Less work, more famity time. NON, work takes so
much of my rime and energy I don't ha\18 anything 18ft for
family.
counsellor: Okay, you'd like to be able to give tnOr'e time
and commitment to family. To do that you'd have to cut
baek on work. What's the situation now?
Analysis: The counseJIOr' e.Slablishes the baseline at'ld encourages goal setting k, behavjoural terms that are clear and measuteable. Goals should specjfy what clie.nts v.i/1 be oo;,1g, oot ;,,
temrs of what they want to stO() dOing. A Clear measurable target
for change emetgeS.
Client: I'm locky if I can have dinner- with my family onice
a week, and I can't remembe-r the last time my wife and I
had a night out.
counsellor: So, in a typical week, wtlat do you see as the
balance between WOrk and famtly?
Client: If possible, weekends-strictty famil'j. One night a
week rese-rved as ·<Sate ni~t· with my wile.
counsellor: You smile and seem excited as you talk abOut
this.
Client: I lhink it's what I 008d to do to be happ,j.
Analysis: Empathy is still an lm()Oftant compooont of the worl<
even though the eortvetSat!M has become more focused on the
behavloural domain. The c/J'e,,l's res()()(lse conlitms tl'lat the
empathic statemoot is accurate. II gives this c/J'ent an opportUJlity
to be mere deftnmve abOut his em<Jljooal needs
counsellor: You said ..if possiblEt when you talked abOut
cutti~ baek on wOt'k. What problems do you anticipate?
Analysis: CounseJIOrS have a tesportSibility to help clients CMskier the implicatiCt'ls (positive and negative) of tflt!ir goalS and
Client: 1-'d like tot,y for a manageme-nt position at the company. but evetyone's so competitive. I've got to pu1 i"I the
hours if I'm going to keep my sates abOve the others. And
~ S3leS is the flrst thing lhey IOOk f0t when It's time f0t
promotion.
action p/ar>s.
counsellor: vou·,e torn. To compete-. you\ie got to put in
the hour'S. Bui if you dO that, it 1akeS away from you, time
Analysis: The courtSe/lOr acJu'lowiedges the ctient's ambivalettee-a factor that often ;mpeoes decis.kx'I mak;11g and acb'oo.
Jdenb'freati<Jn of ambivaleoce helps the client gel Clarity Oil the
and energy 'Mth the famlly. That's a lot of st,ess.
Client: Now that you JX)int it out, it seems obvious. I've
been under stress fo, so IOog. I don't even think abOut it
anymore. It's ctea, to me now that the p(ace ot success is
just too much.
chokes.
counsellor: Meaning that if you have 10 sactifice time with
youf famtly to get aMad. you're not interested.
(Client nod~)
counsellor: Sounds as if you've made a decision, but let
me play devil's advoc.ate. Suppose you cut back on your
job and IOst a promotion. How would you feel abOut that?
Client: It would be hard on me, but I think not near1y
so hard as what's happening n<YN. At heart, I'm really a
family man. I'm certain of it. Famity has to be number
one. My career is impoftant to me, but it's my second
p(aotity.
224
Chap1er 7
Analysis: By exploring the imp/icatkx'Js of the client's goal, the
courtSellor helps w ,:,tevent the client f(()((J acting ;mpuisive.ty.
Goals atld actiotl plat1s are much more likely to be pursued jf
l/'Je costs and bet1efits a,e clearly uMerstOOd atld antld,:,ated.
~JO INTERVIEW 7.2
Goal Setting<conHn,e>
CounsellOf: Lei's go back to you( goat What Olher problemS
do you anticipate?
(20 seconds of s;1ence.J
Cllent He-re's one. My family is so used to geniog along
without me, they've developed lives of theit ONn. I guess I
can't ex,:,ec1 them to dro,:, everythlflg f0t me.
Analysis: The counsellor cot1b'nues the ptOCeSS ofexf)IO(ing risks
at'ld problems. By dOing so. ptOblemS may be anUcipated at'ld
srrateg;es to overcome them devekJped. Often goalS and actiotl
plans fail or are abatl<JOiled because of u,ianb'c/pated obStacles.
The cout1sell0r is free to be an acJive participant in kJentify;ng
riSks. but, as a tule. dNMts shOuld have the fitst Of)()Orlut1Uy.
Counsellor: So hO'N can you daal with that reality?
Cllent: That's easy. 1guess 1·11 just have to negotiate with
100 family on how much time we'll spend together-.
Counsellor: One thought oe:curS to me. How Yrul youf bOSS
teact if you suddenly start spendi~ less time on 100 job?
Oo you think 1tiat's somethi~ to considet?
ReHectJons
■ What indicators suggest it is appropriate to move on from problem exploration to goal setting and action planning?
THE PROBLEM-SOLVING PROCESS
Counselling is a dcvclopmcmal process. Jn the beginning phase, the process go3J is
the development of a strong dicm...counsdlor working relationship and contract th:.n
describes the worlc to be done and the respective roles of both the counsellor and the
client. 1f clients arc motivated to make chan,;c~ then problems c:m be identified and
explored, which provides the foundation for goaJ ~tting and action planning. Clear
goa.Js and a systematic action plan hcJp to prevent failure that often comes from impulsive or premature action.
Problem Exploration
Problem Solving
Problem solving has four steps: (1) identify a1tcrnatives for action, (2) choose an
3Ction strategy, (3) develop and implement plan~ and (4) evaluate outcomes.
Step 1: Identify Alternatives
The first task in selecting a plan is to list alternative ideas for nchieving the goals. This
step holds clients bade from impulsive action based on the first alternative awil3ble,
which may simply be a repe3t of previous unsuccessful anempts nt change. When there
is choice, clients can make more rational decisions. Brainstorming is one way to quickly
generate a list of possibilities. To encourage clients to generate ideas, counsellors can
use leads such as these: "Let 't'our imagination run wild and see how many different
ideas you can come up with that will help you achieve 't'OUr goa]s," "Don't worry for
now about whether it's a good idea or n bad one." Sometimes counseJlors can prompt
clients to be creative by aenerating a few "wild" ideas of their own.
Step 2: Choose an Action Strategy
Once a creative list of alternative action strategies is identified, the next task is to assist
clients in evaluating aJte.rnntives nnd making choices. This involves helping clients intd·
ligently consider each aJte.rnntive by exploring questions such as:
Supporting Empowerment and Change
225
■
Is it sufficient to make n difference to the problem!
■
Is it within the capncity (resources and ability) of the client!
■
Is it consistent with the client's values!
■
What are the costs?
Cost miWlt be me3sured by time, money, and energy expended in finding resources
to execute the alternative. As well, n1te.rnntives might result in other losses for the client.
For example, suppose a client wishes to end a P3ttern of alcohol abuse, but the pe.rson's
friends are drinking buddies. If quitting drinking involves developing new activitie~
the potenti31 loss of friends and social structure must be considered as a negative con.sequence that will have an impact on the client. Unde.rstanding and exploring this loss
is important, for unless clients are awnre of nnd prepnred for these contingencies, they
may be unable to sust3in an)' efforts at changing.
SUCCESS TIP
HelJ) dients conduct autopsies (atso known as post-mortems) on past experiences as a tool
to helJ) them identify er(ors tn thinking,. triggerS, J)roblemat.ic (espooses, and successes.
HelJ) them answe( the ciuestions -What wen1 wrong?" "What couk1 I have done differen.Uy'r
and "What worked weir?·
Step 3 : Develop and Implement Plans
conti,_enc,- plans: Prewntiw plans
that anti:ipate possillle barriers tu
dients miglll NOO'.llter as lley carry cm
actioo,e.s.
Developing and implementing plans involves four substeps: (I) sequencing plans,
(2) devcJoping contingency plans, (3) putting plans into action, and (4) CV3luating plans.
Effective plans are maps that detail the sequence of events leading to the finaJ gonJ.
Counsellors should avoid t3ilor-made plans in favour of customized strategies that are
desianed in collnbomtion with individuaJ clients. Some of the import3nt questions that
need to be answered include the following:
■
What specific strategies will be used?
■
In what orde.r will the strategies be used!
■
What resources or support will be needed at each step?
■
What are the risks and potential obstacles?
Contingency Planning Effective plnns nnticip:ne the potential obsrades thnt clients
might encounter along the wa)t Once clients know and accept the possible barriers that
could inte.rforc with their plnns, they cnn develop contingency plans to deal with these bnrri,ers. This preventive work hdps lcttp clients from giving up when things don't go smoothly.
A variety of different strategy choices can be used to suppon- contingency planning::
■
AnticiP3tory questions such as "What will )'OU do if .. . (detail possible obstacles)?"
■
Role pln)•ing (including counsellor modelling) to explore and practise strategies.
■
Use of contracting-before problems occur, counsdlors can ask clients for advice
on how they can respond when the time comes. For example (to a client who has
just begun a job se3.rc.h): "\\:'hat would you want me to do if a few weeks from now
I notice thnt you're becoming frustrated with your job senrchf'
With flight simulators, airline pilots learn to tly aircraft in eme.rgencies. Should n
re3l-Jife emergency happen, they are able to respond with confidence knowing that their
training has preP3rcd them. Simila.rly, contingency plnnning helps clients prepare for
pe.rsonal challenges and sustain the.ir goals. It hdps to prevent rclapse to previous but
ineffective ways of thinking and reacting.
226
Chap1er 7
Other Selected CBT Techniques
A wide range of behavioural change techniques
can be used and customi.!ed to address the needs of clients (Maclaren & Frttman,
2007; Neenan & Dl)tden, 2006; Vonk & Early, 2009). These include the following:
■
"Auropsie.s'' hcJp clients evaluate and learn from past experiences. As we have discussed, clients often rcpc11.t and reinforce the same thoughts and actions., sometimes
with full knowledge that they arc not w-orking. A counselling autopsy involves systematic review of past actions to identify "triggers," unhelpful thinking and thc.ir
link to behaviour and feelings. Of course, there is also considerable wJuc in reviewing what worked. This enables clients to identify and build on proven strategics.
■
Relaxation rraini'ng helps clients manage anxiety and tension.
■
Assertion rmining, where clients learn to express feelings or thoughts and achieve
their rights while respecting the rights of others.
■
Relationship problem solving, where clients can learn communic3tion skills and conflict management strategics.
■
Homeu.ffl enables clients to implement and practise change strategics discussed during CST, such as activities that provide pleasure. Home,.vork may also include charting and monitoring: emotions or bdi.aviour through the use of diaries and checklists
to measure baselines and progress to goals. Homework enables clients to see tangible
and positive results from counseJling, which builds confidence for further change.
(f clients encounter implemcnrotion barriers., these can be addressed quickly.
■
Expo.n,re provides gradual desensitization to anxiety-prO\-olcing events. Real or imagined exposure ma)' be combined with relaxation training to inhibit anxiety.
SUCCESS TIP
HALT (hungry, angry, IOnely, and tired) is an acronym fof common feelings that can triggef
(elapses. Help d ients explore what they tend to dO, and what they migt\t dO differently, when
they are hungry, anwv. lonely, or tired.
HALT: An acronymfer hungry. angry.
ic.ly, and tired. HALI is a quick w.y to
~ clients as.sess trigvrs and plan
alteruti...e ,esponses.
Counsellors need to support and encourage clients as they deal with the stress
of change. One way they can help is to remind clients that anxiety, awkwardness, and
periodic slumps are normal when change is occurring. Meanwhile, counsellors can loolc
for ways to re.frame failure or setbacks as learning opportunities. Empathy should be
used to support clients dea.Jing with feelings that accompany chanacor setbacks. During
implementation, counsellors should also encourage clients to use fnmih•, friends, and
support groups to assist them.
Step 4: Evaluate Outcomes
Effective plans include continua] evaluation during the implementation phase. Evaluation recognizes and confirms success and is a powerful motivator; however, cva.Juation
may also uncover problems that need to be addressed. For example, it may become
apparent that the goals arc too unrealistic. (f they arc too challenging and unreachable,
counsellors can hcJp clients define smaller goals. Similarly, if goaJs prove to be too
easy, they can be modified to provide more chaJlengc. Thus, regular review of progress
ensures that goals and action strategics remain relevant and realistic.
\Vhcn evaluation rcvcaJs that the plan is unlikely to be successful, efforts can
be redirected toward redesigning the plan or scJecting a different strategy for action.
In some cases, the client may need help that is beyond the capacity of the counscllor; in
this case, referral to another counsellor or service is appropriate.
Supporting Empowerment and Change
227
CONVERSATION 7.3
STUDENT: I get stuck when a client sa~ Mf've tried 4M),ything
and nothing seems to wor'k.•
TtACHER: You feel stuck, \\tlich is ,:recisefy how the client feels.
,....,gs
Clionis cllen t,mg out in coun,..,., the same
!hat they
are experien::::ing. This reality can be a useful tool f0t empathy.
Wl>!n clienlS say lhey'"' trkld ev~-,g. ;r, important not IO
ge1 into a )'es, but. game, vd'lereby counsellors generate ideaS
and clients diStl'iss them with a "yes, blA. response.
ST\JOENT: So what are my cooices?
TUCH£R: I'd be interested in ex.plOfing wtlat the client did.
Oid he or She try loog enough? At the rigf\t time? In 100 right
way? Satnetimas problems gel worse before they get better,
and clients may gj\18: up too soon. A mother migt\t lty igoor~
her' child wtlen he has a &antrum and then tell you ignoring
doesn't WOrk, but She may have abandOned this tactic after a
few minutes wtle-n 1t appeared that the intensity of her chikS's
tantrum was incteasing. In thi:S situation., you could help her
anticipate thi:S obSlacle so lhat she would n01 be demota!ized
if it recurred. Or maybe she has been giving her cr.ik1 lots of
OOl'Wet'bal attention, not realizing hO'N this has been reinfOr'c-
iog the tantrum.
STUDENT: I can think of anothe-r example. One of the members of my work group was havi~ uouble with her supervisor'.
She tOld us that lhere was no point k'I &al.Id~ to him because
he didn'1 listen af'r'f'N<¥Y. But from lhe w.ry She desctibed hOw
she 1a1ked to him, I wouldn't listen either. She was vicious
and cruel.
TEACHER: So, if She we-re )'()IS c~nt, she WOIAd need SOtne
help devetopi~ awareness about hO'N she affects Olhers.
BRIEF COUNSELLING
t..ief counselling: A.uippioadlito
counselling characteriled bJ a foClls
OR r~
s and solutic.s rather than
pobl.-s.
Since the I980~ the 3ssumption th3t counselling nttded to be lengthy to be effective h3s
been successfully challenged. In many settings. counsclling relationships are brief, sometimes limited to a few sessions, a sing.le session, or e\-en a brief encounter. Brief coun.wllin~
approaches., with the.ir emphasis on strenarhs, resources, problem solving. solutions, and
coll3bora.tion with clients, are now accepted as effecti\-e for m3n't' clients (&ttino, 2007;
Cameron, 2006; Carpctto, 2008; Hoyt, 2009~ and Presbury, Echterling:, & McKtt, 2008).
Steve de Sha:er (1985), one of the early pioneers of brief counscJling, argues that
it is n()( necessary to spend time searching for the root causes of a problem, nor is it
necessary to have elaborate knowledge about the problem. In brief counselling, the gonJ
is to help clients do something different to improve their situ3tion rather than repent
the same ineffectual solutions. Small changes (e.g., insight, reduction of painful feelings,
and new skills) can h3ve a dramatic long-term impact by moving clients from a point
of despair to one of optimism and motivation to work on changes in other areas of
their lives. Bec3use of its emphasis on action and change, brief counselling hdps clients
become "unstuck" from ineffectual ways of thinking, foding, and acting. Clients can be
encouraged to rdrame by focusing their 3ttention on wh3t's working. thu~ interrupting
their preoccupation with problems 3nd foilure. This focus may gene.rate or renew the
clients' optimism that change is possible. In addition, brief counselling., even a single
session, can be therapeutic for clients if they are able to unload pent-up feelings. A car~
ing and empathic counsellor can encourage such ventilation and reassure clients that
their reactions and fodings are normal. This can significantly reduce feelings of isol3tion
by disputing the belief that many clients hold: "I'm the only one who feels this way."
Selected Brief Counselling Techniques
P'recounselling Change Momentum for change is often established at the momem
clients seek counselling. Carpetto (2008) notes that studies have shown that chanaes
frequenth• occur in the interval between the rime clients make an 3ppointment to see a
counsellor and the first meeting. Thus, counsellors can make use of the foct that some
clients realize progress while w3iting for their first scheduled appointment.
228
Chap1er 7
SUCCESS TIP
capitalize on the possibttty of p(ec:ounselling change by asking questions suctl as MSince
making )'Ou( appcintment, have )'Ou noticed lhat lhings have i.mproved in arry way, hOw·
M!I' sma1r?· If lhe response is pos,tive, suss.a~ thi:S change (l'l()vement by helping the client
identify lhe feelmgs, thougNs, and behaviout associated with ii.
The Miracle Question A cypicaJ miracle question might be formulated as follows:
"Suppose that tonight while you're s1ttping a miracle happens and )'OUr problem is
solved. \\:fhen you w-nke up. what will be different 3bout your life?" Variations of this
question ma'>' need co be dcvdopcd to accommodate different dic:nts. For example,
some clients may object to the religious overtones in the question and a more neutral
term, such as something remarkable, could be used. The following example illustrates
the process:
m.irade question: Used ia twiel or
si• •s.ssi:in coun~
asa Wk/ to
~ dients who It.ave difficulty coaing up
•ill definei:I goals. ne miract!' questica
dlJlenges clieaa to imagine how their
lives 'M)Uld be different ii a mftde sct,e:J
their pobl.-s.
CourueUor: Suppose when you v.'OkC' up tomorrow son~hin& rem::u-kab1e has h3p,
pened and your problem i.s ~one. How would )'Ou know t~t )'Our proble1n is soh~!
Client: Well. for one thin¥, I'd be worryin¥ leu.
Coun.se.ltor: What mi~,i )'Our fanuly ~ as d1((erent!
Client: I'd be n\Ol'i' w1llu)¥ l'O ~l involved in fanuly activities.
Coun.se.ltor: Actwities!
Client: Thinv like SportS. family outin~rnovies 2nd so forth.
Coun.se.U.or: \Vh::u else would ther Ond di((erent? !Note: 1t is imporbnt (or the cow,~
sellor l'O use probes sueh as this to elicit detail. I( a chan~e can be inu¥ined, the more
possible it "'111 ~m 2nd the 11\0re the behaviou~I e~n~-e.s 10 1nake it possible will
berome 2ppore:nt.l
Client: I think that we'd be h3ppier. Koc just because we' re <loin¥ fun thi~ tOiether,
but we'd be 2f¥uh1¥ less about money 3nd our other problems..
Coun.se.ltor: How much o( this is already happenina!
The above excerpt shows how quickly the counsellor c:m move the interview to
focus on change and solution possibilities, which heJps clients become more hopeful
about their situation. As Carpeno (2008) concludes, "they nre aJready on their way to
findina solutions to their problems" (p. 181). Since the client has imagined nnd described
some o( what nttds to h3ppen to solve the problem, the counsellor's next task is to
get the client mO\tina in the direction o( the "miracle" with questions such as "\\:'hat
would you need to do now to beain co move tO\\>ard the miracle?" or "\\:'hat would it
t3ke to make the first step?"
SUCCESS TIP
It is important lhat lhe client, 001 the counsellor, articulates the answet 10 the miracle
ciuestion, and it is the client whO must describe what changes or SOiutions need to happen
fot the miracle to occut. The counseUOt's role is to manage lhe explOration and solutionfinding ptocess.
Helping Clients Get on Track Counsellors don't need to stay with clients until all
the.ir problems are solved and the.ir lives are in order. With brief counsdlina, the relation•
ship may end when the client has a plan in mind, nnd they are headed in the right direc•
tion. Once clients st3rt the process, counsellors should consider ,;errina out o( their way.
Suppo rting Empowerment and Change
229
Looking for Exceptions
Clients often st3\' fix3ted on their problems 3nd on
whnt doesn't work, and they continue to repeat or cxnggerntc "solutions" that have
alread't' proved unwork3blc. By doing so, they fail to notice times when they are
successfully managing their problems. Looking for exceptions ch3Jlcngcs clients
to focus on those momc.nts, hO\\•cver r3rc, when they arc coping successfully. The
assumption is that there 3rc times when clients arc successfully m3naging their problem, 3nd they do many positive things th3t they 3rc not aware of (\Vchr, 2010). There
are moments when anxious persons foe] calm, 3Cting-out children listen to their par.ents, and 3ngry people arc peacdul. By dr3wing clients' attention to these moments,
they c3n remember and discover potentially successful answers to chronic problems.
Challenging clients in this way stimulntcs them to think about more exceptions in
their live~ thu~ increasing sclf.-confidcncc and their 3Wareness of proven success
experiences.
When clients are 3skcd, "\Xlhnt is different 3bout those occasions when )'Our
child obeys you or 3t least responds more receptively to your requests?" or "What is
different about those rimes th3l you're not 3ngry or only minim31Jy up~d" the coun.scllor is requesting that clients report on experiences to which they h3\'e paid 3lmost
no nncntion.
Working with exceptions provides a quick 3nd powerful wa't' to motivate and
encrgi!e clients to think about solutions rather than problems. The process is as
follows:
I . Identify exceptions to those times when the client is hnving difficulty.
2. Help the client explore what was different about those times; including what
(specifically) the client w3s doing differemi)•.
3. Identify elements (e.g., behaviour, setting, and timing) thnt contributed to n
successful solution.
4 . Hclp the client plan to do more of what was successful.
In the follO\\•ing brief excerpt, the counsellor uses the technique to 3Ssist a diem
who is having trouble dC3ling with her tttn3ge son:
CounS(>IJOr. From "-hat )'Ou\,e been sarifl$:. it's a r.are moment when )'Ou 2nd your son
ean sit t0$;ed~r and 1:ilk e:dmlr.
C lient: M3)'be on« or 1wi«' in the bsc year.
CounS(>IJOr. Let' s look 21 those two times. I'm rdil)' curious :.bout wh::u w:lS d1ffe-rent
about them th::u en:!lbled )'Ou to talk without A~tin¥, Pd one lime that worked best.
C lient: Th::u's e:.sy. ?l.·1)• $011 was excited be<-3use he w:lS ~h,¥ 10 a n'.K':l. concert, and he
was in a re31l)• K()od mood. I (e.lt more refaxed too. He just seemed more approach:3ble
th:u day.
CounS(>IJOr. H::n,e )'Ou cons.dertd that port of your success m,d\t h3,,e t'O do with )'Our
mood! Perh:3ps your $011 was more appro:lt.h:3ble because )'Ou Yi'eri' more refaxed.
C lient: Interest in¥ point.
CounS(>IJOr. Let' s explore- tJ13t 2 bit furtheT. Btt2use )'Ou w~re inore relaxed. what else
w:lS dif(ert:nt 2bout tJ,e wa)' you handled this encounter!
C lient: I d,dn't (eel stressed,
$0
I think I w:lS more open to listenif1¥ t'O him.
CounS(>IJOr. \V~t v.>ere )'Ou doin&di((ere:ntl)·!
C lient: I let him talk witJ,out jutnpina into aJ'iue.
Finding Strengths in Adversity
Hardships 3nd difficulties often have positive
spin-offs in th3t people develop skills to deal with their misfortunes or discover cap3ci.tics that they did not know they had. Following arc some S3mplc probes:
230
Chap1er 7
■
How hnve you mnnag~ to keep going in conditions that would h.nve defC3tcd n IQ(
of people!
■
You h.nve dealt with this problem for a long time. Man)' people would not have sur\•ivcd. How did you man.a.gem keep going? \Vh.ntstrcngthswe.reyou3bletodrnwon!
■
\Vhat h3\-e you le3rncd from life's trin.Js and tests?
■
Have hardships heJped to shnpe your values 3nd ch3racter in positive wnys!
■
People often develop t3lents or discover strengths from facing challenges. How has
this been true for you!
Using Solution Talk To gee clients to notice their skills and C3P3cities, counseJlors
c3n use smcemems nnd questions such as, "\Vhen )'OU've successfully coped, how did
you do it!"
(n 3ddition, counsellors need to be 3lert for opportunities to reinforce clients'
strenw:hs. Personal qualitie~ actions th.nt underscore their determination, nnitudes,
positive decisions, nccomplishments, effort t0\\"11.rd ch3nJ;c. and courage in the face of
3dversity can 3JI be used to bolster clients' sense of c3pncity and self-esteem.
Clients mny nlread't' h3ve 3 rich undersmnding of their problems 3nd the W"n)'S in
which they might be solved. Counsellors need to tnp their clients' expertise about possible nnswers to their problems:
■
\Vhat solutions h3\-e you already rried?
■
\Vhat would your best friend 3dvisc you to do!
■
To soh-e )'Our problem, wh.nt will you have to do?
■
Lee's cry to identify something different for 't'OU to do to solve 't'our problem.
■
Lee's brainstorm solution ideas. The wilder the idea, the better.
SUCCESS TIP
Use a ciuestion such as ·What do you want to d'lange abOut yourself today?· as a quick way
to set a goal-ditected sessional contract.
The Change Continuum Often clients 3re overwhelmed with the number and depth
of their problems. Their despair C3n C3sily infect counsellors. The continuum is a tool
to assist clients to become motiwted in the direction of positive chnnge (sec Figure 7.5).
When clients c3n gain some control over their situation through smn.11 successes, this
promotes further optimism nnd chnn,;c. Counsellors do not have to be involved for the
whole change process.. Sometimes helping clients hC3d in the right direction is the extent
of their involvement. Here's3nexampleof the use of the continuum with Figure 7.6a toe
illustrating how it might be present~ to the diem: Kim, n young woman of 19 who is
heavily involved in drugs, seeks counselling for help "to get her life in order."
Couruellor. (U~:s a mp <:har t to draw the continuum depkted fate:r.) Khn. think
about :m are::t of ,.·our life where )'Ou v.--oukl hk.e t'O nuke a chan~-e. The eontinuum represents thi~ ai bad :lS ther eould be if thi~ K()t v.-'Orse 21 one end, and )'Our ultimate
iOaJ at the other end.
Kim: I ,~d to c~,~ my whole h(e.
As Bad a:s I Coold 8e
{Nea;ative>
My Ultim.ate Go.al
(P-ositiTe)
Figure 7.6a
Supporting Empowerment and Change
231
Counse.Uor: Okay. let 's work on the bi& picture. Let's ::.cld desi!ripl'OrS that represent
each end o( the continuum.
Kim: (Rei/x>nse depfcaed later.)
My Ultiaate Goat
(PositiTe)
As Bad a:s tt Cookl Be
(Neptive}
- Using hard narcotics
- Job
- Prosaitution
- Drug-free
- HIV-positive
- Money in the bank
- Criminal activi ty
- Friends who are "clean•
Figure 7.6b
CounseUor. \Vhere 3re )'Ou on the continuum!
Kim: (Dr.I.wit 3 cl.rcle.) I'm 3bout here. prett)• lle3r the bottom.
Figure 7.6c
Coun!l(>IJOr. \V~t direction 2re you headina!
Kim: (Dr.l.wit3n urow.) "?l.·ty li(e is a n ~ 2nd it's~ttin& worse."
Figure 7.6d
CounseUor. M2)•be you'd :1.¥re<e that the direct ion )'Ou' re he::.clin¥ in is ultimately more
llnport3nt that where you 2re on the continuum.
Kim: Absolutely, I can see th3t.
Coumellor: So wh3t 's one thll,i th::n v.'Oukl need l'O happen for )'Ou to cl12flie directions!
Kim: Th3t'se::asy. I need a pl~ o( m)•Own. a.nd I need to~~ out o( this3re3.
CounseUor. let's st~ut there 2nd mW th::n the locus o( our work.
Figure 7.6e
Comments: T he continuum hns a number o( usdul fe3ntres. lt is visual, whic.h
makes it easier for some clients to understand. It is a quick way to prioritize complex
problems and aools. This helps clients aenerate a sense o( control and d irection. Once
completed, it provides shortha nd communication for counsellors and clients. The two
basic questions o( the continuum can be used at the beginnina o( subsequent interviews
to nssess proaress and to identify emeraem issues: "\Xfhe.re are you on the continuum!"
and " \Vhat dir«tion are you headed!"
232
Chap1er 7
SUMMARY
■
Empowerment counselling rests on the foundariona.1 belief that clients are capable
and that they have the right to manage their own lives.
■
Canada's senior population, now almost 6 million, represents a growing diverse
group with 3 wide range of differing needs and cxp«tarions.
■
C risis intervention aims to empower clients by helping them regain physical and
psychologicaJ safety, control, and b aJancc.
■
Morivurional imcrviC\\•ing is a practice 3pproac.h that uses rhc scages of change model
to hcJp clients overcome ambivalence to changes. Its central fenturcs include active
listening, especial I)• empathy, developing discrepancies, and rolling with resistance.
■
The stages of change modcJ {prccontcmplarivc, contemplative, preparation, action,
and maintenance) provide a useful framework for understanding where clients are in
the process of chanae and for making intdli~ent decisions regarding the usefulness
of particular counselling skills.
■
C ognitive behavioural counsclling hdps clients understand how unhelpful thinIcing
can lead to prob lematic behavioural and emotional responses. Cognitive behavioural counselling hdps clients brc:.llc out of established (but ineffective) patterns
of thinking and behaviour.
■
Brief counselling recogni.!es that short encounters have the potential to be helpful
for clients. Brief counselling techniques include the use of skills such as the miracle
question, looking for exceptions, finding strengths in adversity, using solution talk,
and the chan~e continuum.
EXERCISES
Sett-Awareness
I. RetlectMareasW'l you life~echat'@e:isp:)SSitje, is MC~
sa,y, cx has already occurred. Classiy your Sla!l<! ol Chare, ~ilh
ead'I issue baSed on the stages ot d'la(€e model: pmcontem-
plative, conlM'li:tative. i:reparal.bn, action, and maintenance.
What could potential~ ·mo,,e• yQtJ from ooe stage to aoo,het?
2. Start a log that chronic&es your automatic lhtnking, for
example, wtlen you meet someone new, before ask.i~ a
question in class., when you want to ask fOr' help, etc.
3. Think of a crisis thal you have faced. Try to recal your reactbns in each of the three majOr' domains:. feetil~. thtnki'lg.
an:S behaviou'. What h ~ you cope with and rec:ovet balance lollOwi~ the crisis? What factors acted 33:linst recovery?
4. Use the concepts fromi this chapter to practise goal setti~
and action planntng fOr' yourself. Pick ooo or more 1arge1
areas (behaviour, feeli~. thoughts, skirts., Or' relationship).
DevelOp a baseline.
5. Practise mindfulness:
a. Go lot a watk. focus on COOtdinating your breath with
your steps.
b. Eat a banana or other fruit. Pay careful attention
(sequentially) to lhe sttuclure, cotour, and feel of the
fruit. Next, slowly chew it while foousing on the taste and
feel ot the fn:it in your mouth.
c. Bteath meditation. Find a quiet place 'lff'lere you can be
comfor&able. Obser\18 your breathtng by attendtng to the
flow of air through your nose and into your lungs. Watch
yQIJ' lhaugl\ts, and when a judgment arises, silently label
;1 "iudli)ng." (Adapted from Siegel. 2010, p. 83)
6. Interview seniot'S. Discuss their current oeedSand expectations. Meet with coueagues to Share your fandtngs and to
exi:,ore implications fOr' counselli~ this group.
Skill Practice
1. Working with a COiieague. take turns exptoring a time in
your life when you were unmotivated. What feelings were
associated with lhis periOd? What helped you get unstuck?
2. Worktng ~th a part~r. use setected brief counsetltng techniques from lhis chapter to help him or her deal with a
prOblem area.
3. Conduct a practice interview with a coueague lhat focuses
oo goal setting,
4. Conduct an interview with a colleague (as client) usmg the
principles of cognitive behavioural counselling.. Expl0te a
Supporting Empowerment and Change
233
problem area that the client ideotiOes as real and cu«ent
where they wish to make a cha• . Tty 10 help you( dient:
4. Suggest refr'amed responses f0t ead'I of the folto.vi~ client
ssatements:
a. identify automatic thoughts.
a. 1can, dO it
b. evaluate automatic thougt\ts.
b. (A studetlt counsellor.) I feel so unnahxal and phony
expressi~ empathy au the lime.
c. develop strategies for controlling and modifyi~ automatic thoughts that are not heli)flA.
d. set a goal fo, action (home.-ork).
5. Rec0td an interwew with a coneague (as dienl) wt'lere you
explOre a ptoblem 0t situation where they are ambivalent.
Review the recording ar\d i::lentify statements lhat "suslai.n
1alk· and "change &alk. •
Concepts
1. Suggest quesltons you mi~t ask dients to assess their
slage of cha~.
2. Identify wtlid'I saage of d'lange beSI describes each of the
fOUOwing clients:
a. "I hardty knON anyone who smokes anymore. I'll get
the<e too one day."
b. MWhat's the i:ont of IOOking f0t WOrk? Since the big stock
market Cr'ash there a(en't any jobs: out u-iere ariyway:
c. "It's been almOSI six. m::,nths since my lasl drink. I don't
even crave it like I used to:
d. Ml wish I could fr'ld a way 10 get off drugs:
c. I really want my kidS to avoid maki~ lhe same mistakes
I did. I dOO'I know wtly they don't listen to me.
d. If he realy IOved me, he'd send
me flowers.
e. M'ylife isa mess.
f. I'm tired of being depressed al the time.
5. Name at least 10 different ways to motivate clients.
6. £valuate haw the folloliing ssate~nts meet the ciileria f0t
effective goals:
a. To be a better perSOn.
b. To get my bOSS to stop haSSling me.
c. To drink tess.
d. To be able to disagree with someooe without dis.missi~
lhem or their' ideas.
e. To improve my fitness by next year to the potnt whel'e I
can run 1 ldlo.ineue in eight minutes..
7. Practise brainstO<ming techniques. Identify 5- 7 diffe(ent
action Sltategjes for a client wt'lo wishes 10 qllt drinking,
3. ~lore how each of the dient sa.atemeots might impact their
bahaviwr at'd em::>tioos. What errors .-. th~g am api;:ar'ent?
a.
" 111oev« get a job:
b. "She didn't even sayhettowhen She saw me at the st0re.
I guess She doesn't like me."
c. Ml have to be number one.·
WEBLINKS
Links and resources on the toplc of motivation.al interviewing
www.motiv.ationalinterviewing.org
Sh0rt a1ticle on anti-oppressive p,actke from a child and
youth care perspective
http://Cyt•net.org/cyc-on Ii netcycol- 1203-moore.htm I
Links to .articles and resources on goal setting
Mindfulness Exercises
www.selfgrowth.com/goal .html
www.sh1lm1nd.eom.au/m1ndfulnessandrelax.ation.htm
Beck Institute fOt Cognitive Behavior Therapy
A practical guide to elder .abuse and the law
www.becki nstitute.org
http://www.bcl1.o,gk.1tes/def.ault/f1les/Practic.a1_Guide_
EogHsh. Rev_JULY. 20 11_0.pdf
Online tools for CBT
https://www.psychologytools.tom .and search far the heading
··cer tools"
Substance Abuse Mental Health Service Administration (SAMHSA> publication: '"Brief Interventions and 8,ief Therapies for
Substance Abuse··
www.ncbi.nlm.nih.gov/books/N8K64947
234
Chap1er 7
■
Understand the nature of client resistance.
■
Describe techniques for dealing with resistance.
■
Explain the use of confrontation.
■
Identify key wriablcs for violence risk assessment.
■
Identify and describe strategics for preventing violence.
■
Describe strategics for intervening at c3ch phase of violence.
■
Understand the importance of debriefing critical incidents.
■
Describe counselling interventions for deaJing with angry and potentinJly violent
situations.
RESISTANCE
Resistance, a term first introduced by Freud, refers to a normal defensive re:.lction chat
comes from the natural d rive to preserve the scarus quo. Changing one's patterns of
thinking and behaving. even when desired, creates anxiety. le requires people to alter
existing and familiar P3ttc.rns of communic:.lting o r coping which, however painful o r
resistance: Adefensiw reaction br
dients that iMerf«ts ■idl, « debys the
pnnss of a.selling.
235
unhelpful, are at least familiar, and so the prospect of ch:.mJ;c represents some risk 3S
well 3S potentiaJ gain. Thus, resistance protects clients from the stress and threat of
ch3ngc.
Thus, resistance may be the dient's re3ction to being pushed (by the counsellor) to
do or accept something the client does not ,.,,.,mt. ln fact, the psychological need to stay
connected to the fumili3r may c3usc dients to resist the very ch3nges they 3re sedcing. For
example, 3 client may verbalize a strona desire to curb drinking, but foil to engaJ;c with
aarced.-upon goaJs or 3ction plans to work t0\\'3rd th3t pl]. Clients may be ambivalent
about ch3nge and the risks 3nd fears of chanJ;c may cancel any momentum tO\\>ard 3ction.
Active listcnina. particularly empathy, reduces or prevents resistance. Other
counse.llor responses may increase it. These include the follo"'ina:
■
Arauing for change
■
Assuming the expert role
■
Critic.i!ina. shaming, or blaming
■
L3belling
■
Being in a hurry
■
Claiming pre-eminence ("I know what is best for you") (Miller & Rollnic.k, 2002,
p. 50)
By pa)ting attention to diem resist3nce, counsellors can e.x3mine how the.ir o"'n
responses miaht contaminate the intervic"', and what they might do differently to
prevent, ncutrali!e, or reduce resistance.
SUCCESS TIP
Newton's third law of motion states that for eiJety action lhem is an ec:::iua1 and opposite reaction. Resistance is lhe equal and opposite madion thal happens when clients feel pressumd
or coerced. CounsellOrS need to monitor and reduce the.' tespon~ thal are aceeler-ating
resistance while incmasing responses that reduce 11.
Signs of Resistance
Resistance may reveal itse1f in a variety of ways, rangina from oven hostility to passivity that impedes the work. Herc are some client beha\tiours and signs that m3y suagest
rcsist3ncc(Cormicr & H3ckney, 2008; Gl3ddina& Alderson, 2012; Miller & Rollnick,
2002, 2013; and Shulman, 2009).
I . Failure to comply with the basic procedures of counselling, including keeping
3ppointment~ being on time, 3nd pa)•ing fees.
2. Hostile or argumentative st3tcments (c.a., "This is a \\'3Ste of time," "You can't make
me cooperate," "That's none of 't'OUr business.," and "I don't "'3nt to be here").
3. Passivity (e.g., silence, withholding information, persistent short responses such as
"I don't know," extreme self-censorship of ideas and feelinas)--such passivity may
indicate th3t the client does not want to be there, or it m3y mean that the feelings,
content, and ch3Jlenges of the interview are more than the client is willina or 3ble
to face.
4. Diversion as a \\"ll't' of avoidina difficult, rhreatcnina, or incrimiMring content
(e.g., chanaina the subject, using excessive humour, making sm3lJ t3lk, inrroducina irrelevant m3teri3I, being overly talk3tivc, intellcctua1i!ina. and restrictina the
conversation to parricul3r topics).
236
Chap1er 8
5. Uncoopc.rativc behaviour (e.g., failure to follow through with plans or homei.vork,
foJsc promises).
6. Subtle unde.rminina (e.g., acting seductivcJy, nnemptina to redefine the counsdlina
relationship as a friendship. uccssive praisina. being sarcastic).
7. Creating the illusion of ,vork, described by Shulman (2009) as cngnging in convcrsa,
tions that appear important but that in reality are empty and hnvc no real meanina
bcc:.mse they do not cmpO\\•er cliems to change.
8. Nonve.rbal cues suagcsting a passive-aggressive response, such as not making e\'C
contact, foldina arms. sitting on the edge of the SC11.t, using an nngry tone of \'oice,
clenching fists, raising eyebrows, fl"O\\•ning, and sighing.
9. Blaming, malcina excuses, and expressing unwillingness to chnnae.
Understanding and Responding to Resistance
Some Resistance ls Normal and Desirable Counsellors do not have to view all
resistance as problematic. Skilled counsellors rccoanizc resistance, but they are fl()(
threatened b\• it. They see resistance as a sianaJ that clients' defences are cngngcd, and
this insiaht opens a pathway to greater unde.rstandina of their clients. For example,
in the beginning phase of counscllina, before trust and a working contract are ncgoti•
atcd, mnny clients tend to hold bade. At this stage, their counsellors arc srrangers, and
it would be unwise for clients to open up too quickly without lcnowina how precious
personaJ information might be treated.
Shenfor nnd Horejsi (2008) note that it is common for clients to be somewhat defensive, particularly in the bcginnina phase when a person's naruraJ resistance to change
can be trigi;crcd by fear of what lies ahead: "Even a smnJI amount of change can create
a discomfort or fca.r for clients, cspccinJI)• if they hold riaid beliefs. are inflexible in their
thouaht processes and behaviors, or arc fearful about risking change in the.ir relationships
with others" (p. 205). Some clients resist because they do not understand the expectations
or the process of counselling, so they wisely remain cautious and guarded. Until relation•
ship contracting estab lishes the gonJs and purpose of the work, clients may hold back
from fully pan-icipating. CounseJlors also need to be explicit regarding their expectations.
They should not assume that what is obvious to them will nJso be obvious to the.ir clients.
SUCCESS TIP
Help clients unclefSland how anxiety and ambivalence abOut change may c,eate more
anxiety wtlid'I sabOtag,es action plans, then use anticipatory conttaeting to sttategjle hO'N
this can be addtessed.
Resistance and the Stages of Change The '""ll< of change modcl (ProdUlska &
Norcros~ 2001) was introduced in Chapter 7 as a modcl foe unde.rstanding the developmental nature of change. Different skills and strategies nre used to cn~c clients durina
diffe.rcnt srog:cs. For example, clients who arc at the precomemplativc stage of change do
not accept that they ha\'e a problem and arc noc thinking about making c.han~ e\'en
though their behaviour is problematic for them and others. At this srog:e, stratejpes such as
confrontation ro push a client tml"-ard change arc likely to be met with resistance, bur other
stratejpes (ca., open questions and empathy) will help to ncutrali.!c the resistance. Some
clients who arc precontemplarivc hold ro their current mode of thinking, feeling. and actina
because thq• lack the cne.rg)• necessary for change, or because they nre pessimistic about the
possibility of change. Whate\'er the reason, these clients resist counselling because it is
casie.r and safc.r than cmbracina change. Counsellors might deal with this resistance b\•
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clients
237
communicating optimism and by helping clients set small but achi,ei,-nblc: g,ools. By supporting and rc:.inforcing smaJI successes, counsellors contribute to the emp<:M·c:m'litm of the.ir
dim.ts. Hcmrevcr, during this proc~ counsc:llors should express empathy rcgnrding the
cha.Jleng:es and fears associated with any chani;c:. Oients nttd to unde.rscand that they will
00( be humiliated or ovc:rwhdmed b\• the demands of counsclling. Counselling can be
presented as a way for them to find d"K" resources, suppon-, and motivation for change
At the contemplative srog:e, dim.ts arc ambivalent about the change process and may
simultaneously desire and resist efforts and opportunities for change, "even when such
action is counterproductive and dysfunctional" (Gladding & Alderson, 2012, p. 141). The
messai;c:s from clients seem to say, "I want to change, but I don't want to change." This
ambivalence: can frce!c: clients in a state of indecision; and the resolution of ambiwlc:ncc: is
the key to change (Mille.r & RoUnidc, 2013). Even for those clients who arc highly m()(ivatcd
to change, the prospect of changing involves risk; risk creates anxiety, and the simplest
way to reduce anxiety is avoidance. From this perspective, resistance: is viewed as selfproto:ti,e. To rc:solvc ambivalc:nct in favour of change. the benefits of change must ourn't'iJC'l
the risks and anxiety associated with change, or anxiety regarding chani;c: must bt reduco:J.
SUCCESS TIP
Openly extifessed resisiance from a client can be a weat opportunity fof felationship building and goal setting If it leads to frank discussion of (~
expectations, barriers, and fears.
Relationship Issues Somc:timesdic:nts become increasingly resistant as counselling
psychological reac:tance: TIie
teadeaq for peopleto iflttiSe problea
behavicu if t!ley bEIM thei fie«tim
is threatened. Dis lkory can help us
•d.f~and -.fly uiging by COIICfflled
triffids and family mayh.Ma
pa.radcaical effec.1.
progresses. This mn't' signa] that the process is moving too quickly or that there is unrc~
solved conflict in the counsellor- client relationship. Clients ma,., be resistant because
of transference renc:tions or simply because they do 00( feel a good connection with
their counsellors.
Resistance may emerge when counseJlors chaJlenge long•c:stablished behaviours or
attempt to encourage: discussion or goal setting in areas that clients would like to avoid.
Miller and Rollnick (2002)dc:vc1opc:d the theory of psyc.holos:ical rcac.tance to describe
how painful consequences (e.g., personal suffering from drug addiction, nagging from
concerned family members) may actually increase the undesired behaviour. This thtory
predicts "an increase in the rate and attractiveness of a 'problem' behaviour if a person
pe.rcc:ivc:s that his or her personal freedom is being infringed or changed'' (p. 18).
Some clients have dealt with the social service system for many years and sometimes
their whole lives. They ha\'t' had many o:peric:nces with socinJ worke.r~ ps)•chiatrists,
foster homes, counsellors, and the criminal justice system, which have shaped their
expectations. Frequently, they have had bad c:xpe.ric:ncc:s with helping professionals or
other persons in authority, and they fear the same outcome again. For example, if they
expe.ric:nced othe.r counsellors as rude or unrrustworthy, they may be guarded with new
workers. This defense protects them from furthe.r rudc:nes~ inconsistency, or breach of
trust. Armed against the counsellor before they even meet, these clients may view caring as manipulative and empnthy as intrusive. Asking nbout prior o:peric:nces hclps to
bring feelings and issues into the open, including any preconceptions or fears about the
current relationship. \\:lhen counsellors do this, they shoukl provide: a brief explanation
to let the.ir clients know they arc not prying for gossip:
CounS(>IJOr. H::1:"e )'Ou had 311)' other e-xpedences with eounsie1!1~ in the p.,n!
C lient: Yes, 11\)' h uslxlnd and I went for marital rounsellin¥ about 1wo yearS :lK().
CounS(>IJOr. \V~t dkl )'Ou like and dislike ::ibout that e,:pedenee} 1'1n 2ski~ beeau.u I
think it will help me to un.derStand 2 bit about your eicpeetatiorn1. I'd like to learn what
v;·orked for )'OU 2nd wh::1:t d,dn't.
238
Chap1er 8
Resistance may also dcvdop because of conflict in the current rcJntionship. Counselling rcfation.ships, like all rcfotionships, a.re subject to periodic stress and conflict.
Counsellors cnn make mistakes and say the wrong thing, and they can offend their
clients. Vulnerable clients may be ovcrh• sensitive, or they might misinterpret mes.sages
and fed ang,crcd. This is an inevitable reality of the chemistry of human encounters.
h's a.I.so rruc that resistance may have origins that beg3n long before the current
relationship. Man)' clients have had negative cxpc.riences that leave them suspicious and
doubtful about the wluc of yet another encounter with someone representing the system.
\Vhac sets effective counsellors a.part is chc.ir ability to be sensitive to clues such as
verbal and nonvc.rbal shifts in the tone of the interview that signal that there is friction
in the relationship. Effective counsellors arc further distinguished by their willingness
and capnc:it)• to address these issues with nondefen.sive caring, By doing so, they not only
prevent furthc.r resistance but they also build trust and understanding with their clients.
Immediacy was introduced in Chapter 3 of this book as a process for exploring.
dttpcning, and evaluating counselling rcfotion.ships. \Vhen resistance blocks the work
of counselling, immediacy provides a way to deal directly with diem concerns rcgnrding
the counselling process or the rcJntionship itscJf. As a rule, if resistance is increasing.
it is wise to deal dirccth• with it; ochc.rwise, the client ma)' never return. The following
questions and statements illustrate the potential variety of responses that can be used
to move the interview to,\--a.rd a discussion of resistance:
■
How do you fed about be.ing here!
■
I'm wondering what's happening between us. Arc you feeling angry toward me!
■
Let's Stt if we cnn agree on what we want to accomplish.
■
lf J'm not mistaken, every time I mention your father you change the subject.
\Vould 't'OU rather avoid that topid
■
How committed arc you to making changes?
■
Do you believe it is possible for 't'OU to chan,;c?
■
\Vhat does it mean to you to be scc.ing a counsellor!
■
Arc you worried chat 1 will cry to force )'OU todo something you don't want todo!
\Vhcn nonverbal cues sug,;cst resistance (e.g., lack of eye contact, single word
an.swc.r~ crossed arms, and abrupt tone), counsellors miaht try "breaking the ice" with
statements such a~ "ff I fdt forced to come to counselling, I think I'd fed quite resentful."
Shulman (2009) comments on the fact that communication is frequently indirect
in that feelings and concerns are expressed in ways that might not be immediately clear.
Such indirect communication challenges counsellors to understand what clients might
be trying to SU)' behind the words expressed. For example, a client who asks whether a
worker has children may be communicating her fcnr that a childless worker might not
understand her struggles. By picking up on the question behind the question, workers
create an opportunity to explore these fears. Similar indirect communication might be
embedded in clients' questions such as these:
■
Have you e-.-cr been in jail!
■
Do you know what it is like to be on welfare?
■
Have you used street drugsl
Table 8.1 presents alternative ways of responding to personal questions such as
those mentioned earlier.
Resistance and Fear of Change For most people, it is difficult to change from
established routines and ''"-a.ys of coping. They communicate fears regarding the imagined
consequences of change through resistance. Some clients have trouble with intifl'IOC)•, and
OiHlcull Situations: Engaging wltll Hard-10- Reacll Clients
239
TABLE 8.1
Five Choices for Respondi ng to Personal Questions
Client! 00 )'OU "3ivt Child11n?
1. Answer 100 ciuestion: Mt dO not have any ch'iklren.•
2. Uptore 100 meaning of 100 ciuestion: Ml'm cu(k)US abOut your reasons for ask.-ig.•
3. Uptore 100 implication ot different answe-rs: ·what would it mean 10 you if you heard that
I don't have any d'ltldreo?" or
if you heard that I have d'lldreo?"
4. Empathy: "Are you pemaps wonted lhat I might not underStand what it's like f0t you. a
single mom with rwo kids?·
5. Silence: Provides an opportunity foe the client to elaborate and perhaps share concerns
and feelings associated Viith the ciuestion.
M
•
•
•
counselling may be seen as an unwanted intrusion that thre3tens their need to maintain
persona] distance and privac.,, A variety of counsellor responses might be considered:
■
Candid discussion with clients about the.ir fears and the reaJ risks of change.
■
Target small but achievable goals.
■
Empathi:e with the clients' fears.
■
Reassure clients that they will n()( be pushed beyond their capacity and that they
are in control of the pace of change.
■
Limited counsellor self-disclosure to nonnali:e fcars about change.
Resistance and Personal Beliefs Some clients are resistant because they believe
that taking help is a sign of weakness. They may belie,rc that counselling will undermine
their persona] autonomy. For others, culturnJ or familinJ values promote privacy about
one's pe.rson:.d struggles and the belief that they should 00( be shared with stranJ;ers.
One Wtt)' for counsellors to address this resistance is to look for appropriate opportuni..
ties to reframe counseJling as a sign of strength rather than feebleness. CounseJlors can
also deal with fcars about loss of independence by making sure that clients are active
and informed partners in the wo rk of counselling.
Involuntary Clients and Resistance Sometimes resistance stems from clients'
resentment at being forced to come for counselling and an inab ility to see a need for
change. These clients may see themselves as fighting "the system," and the counsellor
who represents it. Jnvoluntary clients typically receive services from large bure:mcraric
organi.!ations, but the structure and procedures of these agencies can make it d iff,cult
for counsellors to suppon the.ir clients. Systems designed to help clients may overwhelm them with rules and regulations. and counsellors often have to make troubling
decisions on how to use their SOl.«:e resources and time. It is important that counsellors
understand how clients ma,., percei,rc them.
Johnson and Yanka (2004) remind us that clients may overestimate the extent of a
worker's power. \\:'hen clients assume counscUors have more power than they acrually ha,rc,
they might withhold information, avoid mcetin~ or otherwise resist counselling: therefore,
frank discussion of roles. responsibilities. and dlC' limits of p,0\\tC.r may assist in clients' fears.
With imoluntary clients, it is important to restore their sense of control and right
to self-determination. These clients need to be able to answer the question "What
can counselling do for me!" They need to see go3Js and outcomes that they desire as
opposed to those imposed on them. Counsellors need to be patient with unwilling di,.
ents by rem3ining nonjudgmental and ca.ring. Moreover, they can decrease resistance by
demonstrating their ability to talk calmly with their clients about their re3sons for not
wanting to be there. Counsellors should be especially diligent about informing unwilling
clients about their rights, includ ing the limits of confidentiality. Cfe3r, succinct statements about these issues will help to reduce the.ir suspicions.
240
Chap1er 8
The brain is wired to keep us safe. Ne-ut'31 patl'wtays over timetesult rn Mhacd wited" ways of thinki~ 0r dci~. Em::>tiooal
teactions to risk tald~, changi~ behaviout, Or feeling presSlXed by others may be ex.perienced as threats to tne comfOrt
of the siatus quo. This c,eates anxiety aoout change. even
when lhe d'langes are soon by clients as gOOd and oosirable.
The brain reduces this anxiety by avoiding the change or
creati~ pressure to reverl to famtliat patterns, thus, sabOtaging the change. Significantty, some of this anxiely may be
dis~ ced as resistance or ange-r towatd counset.lOl'S, eve-n
when clients are wilting parttlers in the Objective to change.
CounsellOr'S can help by assisting clie-nts to anticipate and
plan for the natural an.x.ie-ty associated with modifying
established patterns.
Sometimes cou nsello rs C3n modify expectations throuWl re.framing. The follo"'ing
interview excerpt provides a b rief illustration:
Cou nselto r: What do )-Ou hope to :te.hie-.,e!
Client: Kothin i,
Cou nsello r: What' s behind th:u answer!
Client: I Ju st think th at eounsellin K is 2 waste o( t ime. W h::u iood does it do to talk
2bout problems 2n)•way!
Cou nsello r: You :Uso seern to be s:ayina th::u i( eounsellina could in some W'3)' help )'OU
with your p roblems,. rou would be tn<Ke s::ttisf",ed.
Client: I iueti so.
(n Cha pte r 7, " rolling "'ith resistance" "'as introduced as a way to avoid an)' direct
ch nJlengcs that might p r«ipitate a power struggle. This strategy ide ntifies bu t accepts
the resistance. This approach is illu strated as fo llows:
Client: I Ju st think th at eounsellh,i is 2 waste o( t ime. W h::u iood does it do to talk
2bout problems 2n)•way!
Counse!Jor. Gn'en your pessimism . it seems t'O 1ne t~t you 're wi.se to be eau oous 3bout
w~t we mi$:ht aeromphsh here.
The following story pro\•idcs anoth er example:
A hol)• man and an athe.ist met o ne dar. The 2theisc ehal!ena«( the ho!y rnan to deb.1te,
exd:1ilnll1i, "I don't beUe-,,e in God!" TI,e holr nun replied. " Tell me about the God you
don't belie\~ in... TI,e atheist talked :lt l ~ h about the2bsu n:I W'3rSth ::u h::.d been (ou~h t
in the name o( God. H e m :M':ked the "hypoerites" who espoused their reliaious values
2nd belie(s but beha..,ed in q uite the opposite fashion. TI,e holy man hstened p.,tiendy
until th e atheist h::.d sakl his pieee. Onl)• then d,d he respon d: "You and I h ave 2 lot in
eomrnon. I don't beUe-,,e in that God either...
Figure 8 .1 o udincs some counsello r responses that both incrc3se resistance and
d«rc3se resistance.
Resistance and Counsellor Self-Awareness
Cou nseJlors should monitor a nd manage their own emotional rcoctions to resistance.
C lient resistance can be u nsettling and demoralizing, and it can test almost any counsellor's ability to be- nonjudgmental. Common co u nseJlo r rc3ctions include fo3.r, anxiety,
avoidance, defensiveness, anger, pessimism, and a sense of r~jection. Counsellors ma y
tu rn against their client~ b lame them fo r their problems. and look for "'ays to rder
them to another counsellor.
(n response, clients ma y v iew their counsellors' defensive reactions as proof thnt the
situation is hopeless. Thu~ it is important that cou nsello rs find wa)'S to d eper sonalize
OiHlcull Situations: Engaging wltll Hard-lo- Reac h Clients
24 1
Rnponses Tllat lncttase Resistance
-Unsolicited advice
- Pushing for change
- Pre.aching. moralizi~ and b lamWt.g
- Argui ~ and warning
- Powe, struggles and defensive res,ponses
- Judging
11.!sponses Tllat Decrease 11.!sistance
- Empathy
- Nondefensive responses/open mind
- Genuineness and respect
- Rolling with resistance (see glossary}
- Reflective res,ponses
- Strengths approach
-Radical acceptance (see glossaty}
Figure 8.1 Resistance
CONVERSATION 8.1
COUNSEllOR: You Ya(lr'k, With stroot-ir'WOtved youth. What have
you leamed about working with invduntary clients.?
YOUTH COUNSULOR: I learned the ha(d way dOeSn'I work.
r oom's no point in lecluring, mol'aliziog. Or' p(eachi~ abOut
lhe dange-rs of dfugs. What seems to work bes.I is to focus on
lhe mtationship.
COUNSELLOR, How dO you dO that?
YOUTlt COUNS£LLOR: Somelmes it's just little thk,gs. lil<e bring-
a
ing a cup coffee to a sex.-trade "M.er, Or' cheeklr'lg to see If
they are all '1@1\t 0t 0000 anyth;~ I t,y., be ready b- the "teacfl-
able moment· That can hai:.:,en anytime, such as after' a #bad
date" 0t "1len they'm Wng oo.n. Ti>!n, empathy and list,n;~
stulls are best, espedaly empath-,. Spend;~ lime voth Clients
vothout r,aw,gan "agooda" goes a bng waylOward eslabHsli ~
trust When the time is ~t. you'll be the "Ill> to" person.
COUNSELLOR, That's ,lghl As you know, involuntary clients
can be (ebeUious, and bei~ fotced into counseni~ arouses
lhei( defences. F'Ot example, I fecentty me1 with one- W'ho
was refe(red by his emplOye( beeause- he could not get along
with his CO-\\()rkets. He ctaiined that others i.n his wOl'k team
simpty had diff!CIAty ooaH.ng with his assertive- man~ and his
~ standards. He came
in to see me-. but ii was evident that
his main motivation was to preser\'e- his job. With him I found
that 1t worked best to encourage him to express his angerabout being told vd\at to dO. This diffused his resi:slance to
the point whe(e- he- no longer- saw me as the eoomy.
YOUTH COUNSEUOR: It's like that With OIS clients as weU.
With youth on probation, I like to look fOr' w.rys to gNe- them
powe-r and i.nvOlve lhem i.n decision maktng. Here- again,
empathic listening can he-Ip lhem arrive at a plan that suits
them, one that doesn't fool imposed.
COUNSlliOR: So invduntary clients are n01 necessarily precontemptative. Many ar-e well awa(e- of their prOblems and the
need to change. They just don't like bei~ t(:j(I what to dO,
and that's the key to "«ki'lg succe-ssft.Jly with them. When I
"«keel in corrections, I found that many of my clients wem initiall'f resistant and overtly hostie to authority. Oients wilh such
anti..authOritarian values are not goi~ to respond to directhie,
rtgi:j attempts toconuot them. St.d'I strategies will onlySeM to
ircrease resislar.:e. Asalways, payi~ attention to the relatiooShip is. crucial. F'OI' example, 'lfith dients comi~ out of prison,
retationShip eted1biity can be devet)pe-d btf OOlpi~ them 'lfith
baSic needs_ SUCf'I as hOuSiog. d:)thes, lood, and a job.
the situation. Otherwise, they run the risk of further worsening the situation by rcject.ing the client or reta1iating in subtle W'tl)'S..
CounseJlors need to be ab le to objectively evaluate their own conduct and take the.ir
foir share of responsibility for resistance. \Vhen counsellors have high scJf-awarencss
o f their action~ they are able to monitor themselves and change their behaviour to be
242
Chap1er 8
})!}
INTERVIEW 8.1
The followi og inte,view excerpt shows some ways avoid and reduce resistance when dealing with an angry client. The client
is a young male, age 19, who has been referred to an addiction c-ounsellor as a condition of his probation. It is clear from
the client's nonverbal Mhaviour th.at he dOesn't want to be there (e.g.• he has not removed his coat, he gives single-wo,d
or shOrt answerS to questions. and his voice tone is hOstile).
Client (with angry tooe): Me we going to be hete IOOg.. I
got things to do.
Counsellor: I know that you wefe fofced to come here by
you( probation office(. I'm wondering hON you feel abOut
1h31.
Client: I' m teally not in the mood to be cros.s~mioed.
Counsellor: Of coul'Se-. you a(e free to leave at any ,:dnt.
But be:fofe you do, why 000·1 we take a moment to talk
Slr'aighl.
Client (sal'C'Astk:'al,),'): I think lhis is al crap. It makes no
sense. What's lhe JX)inl?
Counsellor: I appreciate youf honesty.
Client: I'm here, so let's get lhis done.
Counsellor: It sounds like you've been through lhis befO(e,
and it didn't wOl'k out.
Client: Yep! More Ihan once.
Counsellor: If you want, I'd be hapP'f 10 listen 10 what went
wro~.
Client: I'm lited of people tryi~ to control my life.
Counsellor: Fait enough. We agree. You don't want to be
cross-examined. and I cSon't intend to try. You don't have to
tel me abOut anything you d0n'I want to Ialk aoout.
Client: Let's get one thing clear. I do 001 nOOCI you(
permission to do anything.
Counsellor: Ag(eed. But since you have decided to stay,
let's talk. If you'te feeling angry because yotX prObation
officet ltlinkS you ooed counselling, I can undel'Sland. I
s...-e do not like it when I'm forced to do something against
my v.ill.
Cllent: It's noI you. I just don't see the point. There's
n01hing wro~ with me. I don't undel'Slancl why I have 10
come here.
Counsellor: Souncts as if you reatly want to star\CI up and
say, "Thisi:smy life. 8uttou1.·
Client: Yeah. What gives tnem the right to say I'm ctazy?
Counsellor: Aocl now that you're hem, you might be wottied that l'lldo the same thing, That I will try to get into you(
Mad. tell you what to do.
Analysis: The client's oPening comment clearly communlcbtes
his ,es/stance in a way that should not be Ignored.
Analysis: At th;s Point, the counselk:Jt needs to conuot her own
emotional response to ensure that she does not become defensive, a response that would almost certainty Increase resistance.
lnsJe.ad, the counse/10t encourages the client to say more about
his feellngs. The counsel/Or reminds the client that he does
have a coo;ce about whether to stay or go, which ls designed to
give him back some of the power he feels he has lost.
Analysis: Use of "rad;ca1 acceptance" (see Chapter 7). The
counsellor II/es to find a point of agreement, but her respanse
ls greeted by m0te anger. At this point, it ls Important that
the counsel/Or not give up. Even though the client's respanse
Is less than Ideal. he has heard what the counsellor said. The
counsellor needs to remain calm, patient. and empathic. This
will give the client an Of)p()ttunity to sp/11 out some of his anger,
which often helps to soften it.
Analysis: The client's earlier statement that he ..doesn't want to
be cross-e.umlned" Is a good ind/c.ation that it might be w;se,
at least at this paint. to avoid directly questioning the client.
Questions would be inapp,o,:,,iate In this interview.
The counsellor proc.eeds, while trying to honour the client's
need for autonomy and control.
Analysis: The counsellor contlnue.s to honour the client's right
to self-determination and autonomy.
Analysis: The counsellor continues to ..roll with ,es/stance. "
The counsellor tries to ally herself with the client by using setfd;sc1osure to encourage him to talk about h;s res;stance. She
emphbSizes that the client has made choices.
Analysis: The counsellor's persistence wo,-ks, as the client
begins to open up. At this paint, it Is Important for the counsellor to avoid becoming defensive. If she starts to "sell" her
client on the merits of counselling, she may lose him.
Analysis: An inferred empathic response .acknowledges the
client's feelings.
Analysis: Cautiously. the client begins to share his feelings,
Including his reservations about what will happen In the
relationship.
Analysis: The counsel/or uses immediacy to verbalize the
client's central concern, which the client has expressed
lmf)l/c.itly.
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clients
243
>» INTERVIEW 8.1
Dealing with Resistance <cont;nue)
ClleM: Of coufse. Isn't that how it wor'ks? 1have been to
counseling before. (Laughs.) You guys a,en'I hap~ unleSs
you're mucidng someone up.
Analysis: Despite his initial resolve to 1<1tep his distance from
the counsellor, the client Is beginning to connect. He Is seeing
the counsellor as less of a thieat.
counsellor: (Laugt'ISJ Well. we have to Shrink our ciuota
of heads.
ClieM: (Laughs.) My Mad is staying just where it is..
,:,o,t while
Analysis: A little humour from the counsellor helps build rapshOwlng empathy with the clfent 's feelings. The
counsellor's humour affirms he,- ability to talk about the issues
without becoming defensi've. However. when using humour timing is cdtlcat. What WOrlts very v'le/1 in one situation might
result in disaster in another.
counsellor: I am impressed that you're able to say what
you want
ClleM: I do not believe in playing games.
Analysis: The counsellor does not attempt to break down her
client's defences, which are helping this client cope with a
threatening situation. Instead, she reframtfS his stance as a
strength.
counsellor: Me neitnet. So. let's talk abOut Vtt\at you'd like
to see happen here. I wdl need some help from you. And
if it's okay with you, 111share some of my ideas.
ClleM: I guess so. It is not like I have a chOice. I've seen
dozens of social wor'kerS in my lite. They alt talked a good
game, but it didn't hell:) me one bit! How tS this going to
be any difte(en1?
Analysis: There is much wo,k to be done to establlsh a solid
working relationship with this client. The counsellor's responstfS
allow the process to move forward, but her manner gives the
client some much-needed cont.rot and power. Asking far the
client's help about process and direction is very empowering.
An imp0rtant beginning has been established.
Reflections:
■
How ml&Jlt tllls lnttrvlew have evolved diffttentfy It tbe counsellor bad used questlonin1 as her main tool for
Inquiry?
■ What are SOftle ot tbe personal feelings you ml&Jlt need to control if you were tbe counsellor In Uds scenario?
■ How can you approach clients wt,o have bad muldpte " bad,. experiences with counstllOrs or others In the soclal se-rvice
■
system?
How would you respond to tile cllent's last question...How b tllls goin1 to be any different?
more effective. Hill (2004) echoes sentiments from mtmy sources with the simple yet
profound 3dvice to counsellors to "respond to client 3n,;cr as they would to 3ny other
emotion" (p. 417).
Counsellors can use colleagues and supervisors for support when dc3Jing with
highly resistant clients, who can tax the patience of even the most do:lic3ted counsel..
lor. CollcginJ support c3n help counsellors unwind from tough sessions. They c3n help
counsellors to be more objective, or they can be 3 source of fresh ideas for rc3ching
difftc:ult clients.
CONFRONTATION: PROCEED WITH CAUTION
M3ny people associate confrontation with conflict and hostility, an association arising
from the fact th3t confront3tion often comes from frustration or anger. For counsellor~
dfective confrontation is not 3 hostile 3ct. Confrontation is simply a way of directing
clients' attention to 3spects of their personality or behaviour that they might othcnvise
overlook. 1t is a tool to move clients to a higher level of understanding of themselves
and others. Moreover, caring confrontation can d«pcn the level of trust in the counselling relationship. It is nJso a m3jor skill for helping clients dcvclop fresh pe.rspcctives on
244
Chap1er 8
CONVERSATION 8.2
STUDE:NT: What are someways tos:¥y Mno• toc~nts? I feally
hate 1t wtlen I have 10 deny them what they want o r ~.
TEACHER: That is my reacti::)n too. None of us in lhe hefpi~
professions wants to be seen as harsh or uncaring. Saying
Mno• may evoke feelr'lgs of gull in us. as well as stro~ negative re.actions from our clients.. We realy ooed to be able to
address our own emotions as well as those ot the clW!nt.
STUDE:NT: I suppose it's a realtly of the business. Sometimes
we have to make tough decisions, suctl as who gets the training money and who qualifles for assistanice. In the tesiclential
part of the protJam wtlete I wOl'k, we often have to say no
when the klds want exceptbns to then.des. No pto~m when
you're able to give them what they want. But vd\at about wtlen
you have to turn oown reciuests?
TEACHER: Even when you're sayi~ Mno: it's important lhat
clients kOON you cam. You ooed to istan and be available to
respond with empathy and compassion. fk'ld a way to ShOw
you understand. even if you are no1 able to give yout clients
what they want. Or see If there rS a way to compromise to help
yout dient save face. What do you think?
STUDE:NT: I have teamed a couple of thi~. Be ditecl, deat,
and brief. Don't waffle, hrll, Or' a\'Oid 1he ·oottom line.· With
lddS, I've found that, even wtlen they test lhe limits, they
may need limits and even welcOl"OO them when imposed. It
increases lheit se~ of safety and control when they learn
the bOundaries of acceptable behaviout.
TUCHER: I agree. I think it is important that you dOn't make a
hasty tetreat. Expect that anger, defensiveness, and countetattaek ate the ways that some clients tespond to frustratbn.
In extr'etne situations., you need to protecl youtself. Anticipate
potentially violent situations and take defensive action. Also,
be s....-e to debfaef with a colleague or superviSOr' after difflellt encount-el"S. And if ~ssary, take a tl'eak 10 e~ute
that yout teacrions do not contaminate yout abdity to deal
with your next client objectively. Flnall'j, remind yourself that
no mattet how yout client teac1s, you must stay in a professional role.
ST\JOENT: woon someone says ·no· to me, I find it a IOt easier 10 accepr it if I koow why. So, I try to explain my tationale
or the policy. Then I invite questio~ while remaining clear
'llf'len the policy is nonnegotiable.
TEACH£R: If you can, help your clients identify othet ways to
meet theit needs.
themselves and the.ir behaviour. Neverthcless., it is a skill that should be used sparingly
and with caution. As a ,;eneral rule, confrontation has the greatest chance of success
when clients accept it as part of the counseJling contract.
Types of Confrontation
The rw-o main types of confrontation arc feedback confrontation and confrontation of
incongruities. Feedback c.onfronrarion provides new information to clients about who
they are, including how thq• are pe.rcci\'ed b)• others and the effects of their behaviour
on others. Feedback confrontation can be used to hcJp clients become aware of the
consequences of their decisions and actions. It is not reserved for ncg:itivc or c.ritical
feedback; it can also be used to identify strengths.
ln some case~ clients do not rccogni!e the hnrmful effects of their behaviour on
themselves and others. They continue to behave in ways that are hurtful, yet they lack
insight into how they arc affecting others. Because they are unaware and fail to sec the.ir
behaviour as problematic, they have no motivation to chan,;c. Feedback confrontation
can hcJp these clients examine the consequences of their actions. The following arc
examples of client blind spots:
■
feedback confrMtalion: Used to
prom!~ informatiln to tli!alsabol!II
who they are. iflduding ha# they al!
peaiwd by octiiers ud the effects d tileir
bebl'iour 011 others.
Jerry thinks of himself as humorou~ but he is unaware that his jokes are offensive
and sexist.
■
Nathan has b3d breath and body odour.
■
Parvindcr is unaware of how his aagrcs.sive behaviour pushes others away.
■
Estelle has bttn in a series of rclntionship.s in which she has been batter~. She does
not understand how this has affected her children.
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clien ts
245
Despite its potential power 3S 3 helping tool, focdb3clc confrontation is often mis.used. Some counsellors 3Void it, perh3ps because they foar that they might alien3te
their clients or arouse their ange.r. Other counsellors feel the need to keep the hcJping
rd3tionship pleasant, so they distort or lie to clients to sustain their 3pproval; howeve.r,
effective counsellors need to be willing 3nd able to confront clients when ncces.s3ry.
Thus, counsellors must re.main aw-arc of their beliefs, fears, and expectations regarding
confrontation to use this skill 3ppropriatdy.
Sometimes beginning counsellors (and some experienced ones too) arc reluctant
to confront. They ma)' hold beliefs such as the following, which potenti3lly limit their
effectiveness:
confrontation of ir1COf'CRJities:
US!d to point «11 incoosiM•iesiu
client's wfbal and nofl\'elbal aessaies.
wlues « beliefs. and behlriour.
■
"I was brought up to believe th3t if you don't have something good
don't s3y anything 3t all."
■
"If I confront, 1 might damai;e the relationship. I don't want to upset mydient.s."
■
"I don't want to hurt my clients."
■
"My clients might retaliate."
to SU)',
then
Yet most of the preceding beliefs 3rise from an erroneous unde.rstanding of confrontation as 3 "no holds ba.rrcd" assault on clients. As.saufo-typc confrontation strate~
gies should, of course, be avoided. At the othe.r extreme, refraining from confronting
clients under any circumstance is 3n evasion of responsibility that cuts clients off from
the potential benefits of new information and focdbaclc. Competent counsellors should
not withhold potentially useful feedback.
The second type of confront3tion, confrontation of inconiruities 0vey, Jvey, &
z3foquctt, 2010), is directed at inconsistencies 3nd mixed mes.sages:
■
Discrepancy between a client's verbal 3nd nonverbal messai;es.
Client: (Crying.) It'll really nothifl$:.. I'm not bothered.
■
Discrepancy between a client's values or beliefs 3nd bch3viour.
Client: There' s nothi~ more important IO me than my 1:...-.ls. I know I h:wen't spent
much tin-.e with them. It' s just $0 h3rd to !lay no to my buddus when tlltyuk me 10 help.
■
Discrepancy between wh3t a diem s3ys 3nd what he or she docs.
C lient: I'm ronunitted to l0<>kh)¥ (or v.-'Ork. Yesterd3)' sornethil)¥ eaine up before I could
~-et to the emplorrnent omee.
In confronting discr~pancies, counsellors need to re.main calm 3nd nonjudgmental
while presenting clients with facts. Ivey, Ivey, 3nd 231:.lquett (2010) look at confront3•
tion as 3 way to support clients in a gentle and respectful manner rather th3n 3 h3rsh
c.h3lleni;e. Its purpose is to 3id clients to h3\-e a more complete understanding by offering additional inform3tion or perspective. 1t opens up new possibilities for changes in
thinking and behaving.
The Misuse of Confrontation
Although confrontation has potential for motivating clients to change and can assist
clients in dcvcJoping insight, misuse of confrontation can be destructive. As a rule,
counsellors should use it sparingly 3nd should be prepared to offer support and c3ring
to ensure that confront3tion does not overwhelm or dcvast3te their clients.
There are risks to confrontation, 3nd some diems do react poorly. They ma,.,
respond with hostility 3nd 3ttempt to question the integrity or credibility of the counsellor. Such a hostile renction m3y be 3 type of denial, indicating that the diem is
simply not read)• to 3clcnowlcdi;e the va.lidit)' of the confront3tion. Hostile renctions
arc more lilcdy to occur when foedb3clc or confront3tion is unsolicited, but they may
246
Chap1er 8
occur even whc:n dic:nts nppc:3r to be seeking informntion or feedb3clc. Counsellors aJso
nttd to consider that harsh dic:nt rc:3ctions may arise for legitimate re3sons. Somc:times
fc:edb3ck is confusina or the manner and cone: of the: counsellor are abrupt. Secure:
counsellors have: to be opc:n to the possibility that they may have erred.
Confrontation is not an oudct for n counsellor's anger or frustration. \\:fhen counsellors are not in control of their own fceJings, dic:nts are more lilcc:ly to view them as
agg:rc:ssivc: and to fc:el che.ir confrontation is unsupportive. The: counselling reJntionship
is formed to mttt the: needs of clients., and responsible counsellors forgo thc:ir own
needs to this c:nd. In addition, counsellors should be: se.lf-aware enough to know che.ir
reasons for wanting to confront.
Ovc:rly confrontational stylc:s have bc:c:n found to rc:sult in a hiah diem dropout
rate and poor outcomes. "Counsel in a directive, confrontational mannc:r and client
resistance aoes up. Counsc:l in a reflective:, supportive manner, and rc:sistancc: goc:s down
while: change tallc incre3sc:s" (Miller & Rollnic.k, 2002, p. 9). Ultimatc:ly, "the: manner in
which we prc:sent confrontations affects the way thc:y are hC3rd and accepted or rejected
by the client" (Spc:rry, Carlson, & Kjos, 2003, p. 120).
SUCCESS TIP
"Oo n01 confront another- perSOrl if you do not wish to inc:rease your tnvolvemi:mt wdh that
indh,iduar (Hamaellek, 1982, p. 230).
Principles for Effective Confrontation
Principle Number 1
Unsolicitc:d confrontation cc:nds to result in resistance:, hostiLity, and dc:fc:nsivcnc:ss, but solicited (invited) feedback is more: likeJ,., to be: accept~.
The skill of anticipatory contractina can be used to engaae clic:nts in acceptina
fttdback,
CounselJor. One of the wa)'!I I rni~t be abte to help is br s.h3rin& sorne of tn)' impressions :.bout wh::u )'Ou 3re <loin¥, or e"en about our rt.l3tionship. \\1 h3t do )'Ou think!
Client: Sure. I would 2pprtti.:ue that.
CounselJor. \Veil, let's look ahead. Suppose I wanted t'O t hee )'Ou sorne feedback about
son~hifl¥ I thou~,t you v.--ere <loin¥ wron¥ th::u )'OU were noc aware of. \Vh:n would be
the best way {or me t'O 2pprooch rou!
Client: I do 1101 like to be O\"erwheln~. And I like th e ~ mixed with the bad.
This example shows how contracting can be: used to hclp the counsellor "custom,i:e" feedb3ck to mttt the needs and expectations of the client. Some: clients like blunt
fttdback; othc:rs prefc:r it "sandwiched" bc:twcen positive statc:ments. AnticiP3tory contracting empowc:rs dic:nts and communicatc:s respect for their rights to malcc: choices.
\\:fhen confrontation is invit~, it is much less lilcc:ly to mttt with resistance.
Principle Number 2
Confrontation should be: used sP3ringly and in combination
with ocher skills, particularly sensitivity and empathic listc:ning.
Confrontation may involve: fc:c:db3c.k thal is unsenling for clic:nts, and emp3thy
reminds counsellors to remain sensitive to the impact of confrontation. In addition,
counsc:llors should not confront dic:nts without assisting them to dc:vc:lop new altc:rnn,.
tivcs. Confrontation should also be: measured to avoid ovc:nvhdming clients with more:
informntion than they can handle:. Jde31Jy, confrontation should not unde.rminc: the: sc:lfc:steem of clients. At first, dic:nts may rc:spond defc:nsivc:ly to feedb3ck, but after re.flc:c.tion, thc:y ma,., be more accepting. Altc:rnativc:ly, they may nppC3r to be: accepting but
latc:r become resc:ntful. Thus, it is important to chc:clc with dic:nts how chc:y fttl about
0iHlcull Situations: Engaging wltll Hard-10- Reacll Clients
247
the fttdba.ck or confrontation. Counsellors should monitor immediate rc3ctions. As
well, checking back with the client during the next session is a u~ful tool for identifying
delayed reactions and for noticing any feelings that might impair the relationship. The
foUO\\,ing example illustrntes the process:
CounseUor. rm wondedni how )Ou (elt 2bout our last rneetinK. Remember, I sh3rtd
with you some o( my opinions about the thin,iS )Ou 2re doll,i th:u seem to d1stan«
you from )Our family.
Client:! 2lmost did not eome tod2y. (S1leoce.)
CounseUor. Beeause!
Client: I W2S emb3rr.lSS('d by what
)'Ou
thol¢ht o( me.
Coun!l(>IJOr. You thou~t th3t I 1nleht think less o( )OU!
C lient: Yes..
Coun!l(>IJOr. \VouJd )'Ou like to Ond out for sure w~t I think!
C lient: Oh1y.
This counsellor's strategy ~ts the staJ;c to help the client correct any distortions,
and it is cruci3l for dealing with the aftcrm:.nh of confrontation. It :.dso reinforces the
understanding thu any feeJings about what happens in the counselling relationship can
be dealt with openly.
Principle Number 3
Confront3tion should serve the goals of counselling by leading
the diem to improved ways of behaving, thinking, and feeling.
Relevant confront3tion alw'n)'S meets the needs of the client. Thus, it is in3ppropri.atc for a counsellor to use confrontation as a means to vent frustration, anger, or to
punish clients.
Counsellors can best deal with feelings related to the relationship or the work b\• using
1-st3tcments ruhe.r than trying to mask their feelings as helpful feo:lback. I-statements
are assertions about personal feelings or rc3ctions that do not b lame or judge othe.rs.
Instead of saying "You don't care," an ].-message would be "J feel confused when )'OU
don't answer my questions." I-statements arc much less likely to cause resistance.
Principle Number 4 Confrontation must be timed appropriately at a point when
clients 3re ready and willing totalcc ad\.-antageof fecdb3clc and when there is a reasonab le
possib ility thu feo:lbock can motivate them to change.
Counsellors need to pay attention to timing and ensure thu there is a well-developed
counselling relationship to support confrontation. As a rule, it is preferable to avoid
strong confrontation in the beginning phase of coun~lling. Cliems are more receptive
and likely to 3ccept fttdbaclc as credible when there is a relationship and di.mate of
trust, when they do 00( feel insulted and misunderstood. Otherwise, they may neve.r
return.
Confrontation should be done as dose as possible to the relevant behaviour, events,
or circumstances chat ::are being addres~. In some case~ such as when strong emotions arc clouding communication, it may be best to wait. A client's ab ility to handle
confrontation is a cruci3l va.ri3b le. ff clients arc aJrcady ovcrwhclmed with feelings., con,frontation may add to their stress b ut contribute little to their ability to cope Moreover,
clients who are hiahly defensive and guarded may respond poor!)• to confrontation. In
such siruation~ counsellors may find it wi~ to deJay or avoid confrontation entirely.
Effective confrontation is an investment in the relationship. After confronting,
counsellors neo:I to be able and willing to invest ti.me to hclp their clients understand
any feedb3clc. As well, counsellors must be 3Wilable to heJp clients deal with any feeJ.ings chal ma)' result from the confront3tion. Conscqucnth•, the end of a counselling
inte.rvicw is J;Cnerally a poor time to confront.
248
Chap1er 8
Principle Number 5 Effective confrontation needs to be specific without 3ttadcing
the personality of the client.
Coun.seltor (Choice 1--inefTecth"(' confront:ulOn): You don't ~m 3t 211 interested in
w~t's h3ppeninSt he-re. I( you're too la:y t'O eare 3bout our v.-,ork. why don't )'Ou just
quie (Coirnsdlor U a1tackmg and ji.dging the dknt w&hmd of/nm.a any concrde ffflloock.)
Coun.se.U.or (Choice 2-more e:tTe:ct.h-e confront3t.ion): When )Ou don't show up lor
2ppointments. I wonder whether you're 2s committed to your ~"()c.11$ 3S )'Ou say )'OU are.
(CoirnselJor'J ro:mmenu me linked to ipttlflc dlfflt bmadou,.)
CoumeUor (Choke 3-most e:tTe<:.th·e confront:uion): I think )Our best work h::1s
h::1ppened on those d3)'S when )Ou C3tne on time and when you mok the e(lort to (ocus.
?l.·ty sense is that i( )'Ou eould nuke e\'err 3ppointrnent, )'Ou·d ~'t't a lot rnore out o( our
time tottether. (Counsdlor {oruseJ on u,engtM and u.fam the clfrnt can Jo tl,m u,·ill bt mtm
elftttlt,e-flf!O/,/_eare motfrau-J more fry posklt" f....dbad.: 1han n~th~ /«dbad.:.)
AGGRESSION AND VIOLENCE
CounseJlors, social worke.rs, child care counsellors, and othe.r social service profession3fs, especi3lly those who work in residential c3re, arc increasingly vulnerable to \'lolence
(Macdonnld & Sirotich, 2005, 2001; Newhill, 1995, 2003). For ex3mplc, 3 counseJlor's
denial of a client's request for fin3nciaJ assistance may e-.•oke rcta1iation. Hospitals,
especially emergency rooms, can be a particularly d3nj;erous pl3cc. A survey of over
9000 rcgiste.red nurses in Canad3 revenled rhat 3Jmost 40 percent had experienced some
form of workplace \•iolcnce and 3bout 20 percent had been ph)•sic3lly ass3ulted (spit
on, bitten, hit. or pushcd)(Canadian lnstitute for Health (nformation, 2012). A study at
one private psyc.hi3tric hospit31 found that the frequency of violence by m3Jc patients
was SO percent higher than a dec3de before, and that violence by fom3Je patients was
ISO percent higher than a decade before (fardiff, Marzuk, Leon, Portera, & \\:leiner,
1997). One srudy (Alink, Lenneke, Euser, &ke.rmans.-Kmnenbury, & Van (J:endoorn.
2014) of worke.rs in residential care rcvca1ed th3t 81 percent experienced some type of
victimization (verbal, physical, and sexual harassment) and 37 percent were subject to
physical \•iolence.
Situations th3t may increase counsellors' risk for violence include:
■
Dealing with people who arc using street drugs.
■
Dealing with menta11y ill people who 3re not tnlcing their mcdic3tion or mixing
prescribed medication with street drugs.
■
lnvestig3ting situations of child abuse 3nd neglect.
■
(nstitutional w-ork in prisons, group homes, and hospita1s.
■
\Vork th3t includes some clements of social control (e.g., prob3tion, involuntary
clients, 3nd establishing eligibility for income assistance).
■
Assisting police intervention in domestic abuse.
■
Hospital emergency work.
Canadian studies by MacDon3ld & Sirotich (2001, 2005), de LCSClcuc (2004), and
Rytm (2016) found the following:
■
Almost 90 percent of soci3J workers have experienced verbaJ harassment.
■
90 percent of C3nadian front.-line residential care ,vorkers experienced physic31
\•iolence from residents (or the.ir rcfatives).
■
About 65 percent have been threatened with physic3l harm.
■
About 30 percent have been sexually h3ras.scd.
OiHlcull Situations: Engaging wltll Hard-10- Reacll Clients
249
intimidating behaviour: Beha'AOUrs
such u aa.e calling: using obsce. •
st1uall1 harassing lang_u.aie and g_~ures:
sho~ •d tlrm1ening tkough
lisplays al po-• soch as fist shaking.
iMdilc personal ~ . stalking, and
issuing wfbal 1-Ws. Ttles.e behlriours
should be testrMled to l)fMllt escalatioo
to~o!Nce.
violent behaviour: ~ . pu-,:.
biiing. slawing. lid.ing. th10t1ing obje::ts.
•d usilc weapons such as ,.ns. lniws.
or s,ringes.
■
Close to 8 percent have been physically ass3ultcd 3nd injured.
■
One-third of 31) workplace \•iolence incidems took place in soci3I service or health
cnre setting~ with about 71 percent involving physicn.1 assault.
■
About SO percem of incidents were linked to substance 3busc.
■
Males were nccused in 93 percent of the 3ssnults, and 54 percent of them were
under 35 years of 3gc.
Sometimes clients c3usc fc3r bcc3usc their behaviour is thrc3tening, or they h3\'e a
history of violem behaviour. At other times, counsellors' fears arc b3scd on intuition or
hunches, the inte.rnnJ response to subtle signals thnt not all is well. Jn fact, some clients
provide 3bundant reasons for fear, because of either intimidating behaviour or overtly
violent acts.
Intimidating behaviour includes name c3Jling, obscene or sexually hnras.sing
language 3nd gestures, shouting, threatening displays of power such 3S fist sh3king,
invasion of person3J sp3ce, stalking. and verbal threats. Clients also beh3ve in an
intimidating m3nner when they will not take no for 30 answer or when they refuse
to leave the office. As weJI, clients ma'>' attadc workers with personal insults, or they
ma'>' intimid3te them with threats to call the newspaper or ch•il rights groups. Jn gen.era], intimidnting bchnviour should be controlled or manngcd to prevent escal3tion
to violence. The following case ex3mplcs of threatening behaviour arc aJI b3scd on
re3J incidents:
■
New client in a welfare office s3y~ "If I don't get some help. )'OU'll be sorry."
■
Man, in his lnte twenties st3.res obstinately at an inmke ,vorker.
■
Angry parent tells child protection w-orkers that if his child is not returned, the
worker will know what it's like to lose someone you love.
■
Tccnai;er in a group home refuses to com pl)• with house rules. He tells his child c3re
counscJlor. "I've had enough. Things arc going to change nround here."
■
Parole officer meets 3 new parolee for the first time. He is pleaS3nt 3nd cooperative,
but the parole officer knows the man h3s a short fuse and a long history of ass3ult
chnrges.
■
Mental health counsellor dC3Js with her client, a young m3fe with a history of self.
destructive behaviour. 1t is obvious that he is not caking his medication, and he
seems unusunJly agitated.
■
Ten.-year-old child who witnessed 3busc at home grabs a pair of scissors 3nd lunges
tO\\>ard the counsellor.
V io lent behaviour means hitting, pushing, biting, slapping. kicking, throwing
object~ and using weapons such 3S guns, knives, or syringes. 1t 3fso refers to kidn3pping and st3lking..
■
SociaJ worker in a hospital emergency ward is threatened with a syringe by 30 3ngry
HIV-positive patient.
■
Angry client picks up 3 chair nnd hurls it 3t the counscllor.
■
Client, disgruntled with the counsellor's rcfus3l to provide him with money, spits
in the counseJlor's face.
Nonetheless., it is important thnt counsellors do not become hypc.rvigil3m 3nd con.duct their w-ork in constant fear. Such 3 Sta.nee m31ces it difficult for them to seP3rnte
nctu3l h3!ards from siruations thnt present no rcnJ risk. Moreover, unw3rramed fear of
clients leads to uninformed responses. Though very real dangers exist in the workplace,
250
Chap1er 8
by and large it is a pince of safety. The challenge is to be able to answer some basic
questions:
■
\Vhich clients are likdy to become violent! \Vhat arc the indicators of potential
\•iolence!
■
Under what conditions should a client's anger be cause for concern?
■
\Vhat are the skills and behaviours that can be used to de-escalate dangerous
situations!
SUCCESS TIP
Anget, when ex,:itessed assertively, rS a n0tmal and potentlalt, useful part of retationShip
communication. Assertive anger' respects the tigt\ts, obligations, and feeh.ngs of setf and
others. /1€gressive anget k\volves intimidation, misuse of po-Her, and disr'especl fOr' Olhel'$.
Risk Assessment for Violence
Violence arises from a complex array of psychological, sociaJ, biologicaJ, and physiological foctors. Although certain wri3blcs are more lilcely risk factors. risk assessment
is difficult and violence ca.nnot be predicted with precision (Miller, 2000). There is
simply no foolproof way co predict with certainty who is likcly to become violent.
Violence may be pe.rccived as a desperate act by an angry client to regain control and
power. Multiple srressor~ such as poverty, the loss or absence of supportive relationships, and substance abuse, may magnify a client's vulne.rability and stress to the breaking point. Moreover, counsellors ma'>' be in positions of authority with the right to deny
clients access to goods or services. Clients ma'>' perceive such denials as further threats
to their fragile power and sclf-estce.m, and the risk of violence may escalate. Attacking
others works as a psychological defense against feelings of shame and humiliation.
Based on his review of the academic literature, Ross ( 1995) identifies five primary causes of violent crime in Canada: "interpersonal conflict situation (over smru~
resources, power, control, and reputation), presence of WC11.pon~ influence of drugs
and/or akohol, media facilitation, and cultural or subcultural reinforcement" (p. 348).
The key variables that have been found to have some validity for predicting \'lolencc
include: (I) past and current behaviour, (2) substance abuse, (3) ai;c and gender, and
(4) personality (sec Fiaure 8.2). The more risk factors present, the greater the risk, but
the presence of a risk factor docs not mean that a given person will become violent in
a given situation.
Past and Current Behaviour The best predictor of future violence is a history
of violence (Miller, 2000), and the more r«ent and severe the violent behaviour, the
greater the risk. Kclleher's (1997) conclusion that a history of violent behaviour should
always be given serious consideration is «hoo:I consistently in the research on violence: ''Although the argument can be made that historical c-.•idencc of violence is not
a guarantor future violent behavior, an understanding of any form of violent criminal
activity clearly supports the contention that a history of violence is often a pr~ictor
of future violence" (p. 13).
Counsellors should be particular!'>' interest~ in noting how a client has handled
difficulties and frusrrations in the past. Some clients who were victims of abuse as children have grown up without a capacity for warmth and empathy for others, which can
make them oblivious to the suffering of othe.rs (Miller, 2000). ln extreme cases, violence
ma'>' even bring these clients pleasure or sexual gratif,cation. Counsellors should also be
interested in the level of remorse that clients show for past acts of violence, P3rticularly
OiHlcull Situations: Engaging wltll Hard-10- Reae ll Clients
251
Histay
.-o1c-"',
c::=:::
Puor Conflict Resolution Skil s
Command Halucinalions
Figure 82
Risk Factors for Violence
for those who show no regret. On the other hand, clients who have IC3rncd other ways
of man3ging thc.ir anger now have more choices and 3re less likely to 3ct out physically.
(n this respect, it might be rcve3Jing for counsellors to explore how their clients arc managing stress outside the counscllina relationship. For cx3mple, do they show evidence
of a lack of concern for the s3fcty of others! Are the.re indic3tors of inappropriate or
uncontrolled anger? Arc they typicnJly c.xtremet,., defensive, irritable, or self-centred!
To what extent arc they prone to impulsive behaviour! Impulsive clients might assure
counsellors that they have no intent to harm 3nyone and then artack another client in
the w3iting room 10 minutes later.
Furche.rmore, clients who have 3 specifK pfon of \tiolent action and the means to
carry it out rcpresem 3n immediate risk of violent behaviour. Counsellors need to con.sider their professional obliaations 3nd lcgnJ requirements to w3rn 3ny intended victim
by examining their codes of ethics 3S wcll 3s relevant legislation or lea31 precedent.
Substance Abuse
Viole.nee from substance abuse is associated with
■
the effect of drugs.
■
violence to act drugs, and
■
violence in the drug culture.
Common sense 3nd cmpiric3J rcsc3.rch sugaest that intoxic3ted 3nd agitated clients
should be appro3ched C3utiousi)•. Substance abuse, particularly in combination with
other risk factor~ compounds the risk of violence (Miller, 2000). Rcvicwina the role
of druas in violence, Roth (1987, pp. 13-14) concludes the followina:
■
H3Jlucinogens such as LSD 3nd PCP, glue sniffing,, amphetamine~ 3nd barbiturates
have been 3SSOCi3tcd with agaressivc and homicidal beha\tiour.
■
N3rcotics tend co suppress violence, but individu3ls miaht become violent in order
to g,et these druas.
■
Alcohol reduces inhibitions. and it is implicated 3S the most frequent drua linked
to violence.
Furche.rmore, many studies link substance misuse to violent behaviour (Sw-anson
et al., 1997; Tardiff ct 3J., 1997). Newhill (1992) reviewed the available research
and recorded that certain druas subdue aggression, whereas others escalate it:
252
Chap1er 8
''Anticholincrgics. antipsychotics., antidepressants. sedative hypnotics. and analacsics
tend to suppress aagrcssion. Amphetamines and withdrawal from drugs such as morphine or nkohol induce aggression" (p. 70). Moreover, people who abuse drugs are at
an increa~ risk of victimization. The link between drua abuse and violent behaviour
may arise, at least in pan, from the fact that alcohol nnd other drugs are more likely to
be abused in a dan,;crous pince.
Age and Gender The vast majority of people who arc \•iolent and who have bttn
arrested for violent behaviour are male. The highest risk for violence is found in people
from 15 to 39 't'cars of age. The rate of violent nets for this age group is three times chat
of the general population (Newhill, 2003). Violence declines with age, but dementia
and other cognitive problems cnn result in an increase in violence by those over 65.
Personality Some clients deal with their sense of persona] fragility by lashing out at
others, and they arc hypcrvigilant about protectina themselves from perce.ived threats
from others. Miller (2000) notes:
Tendendes IOW3rd low frustration 1oler.u1ee, impulsive beh:wior, ,-ulne~bi.lit't' m criti~
dsm. {eelini hmnil1:ued and powe-rless. superlkial rel.:uionships, l.:iek o( emp3thy. a
p.1ttern o( exte-rnali:inK problems. and failinK 10 aceep.t responsibilit't' for one's own
:1etions 2re 311 assoeiated with more-violent beh:wior. (p. JOO)
De Becker (1997) nutions that some people assume the worst possible motives
and character and thnt they write che.ir own scripts: "The Scriptwriter is the t)'J)C of
person who asks you a question, answers it himself, then walks aW'll't' angry at what you
said . .. The things that go wrona arc the work of others who will try to blame him.
People are out to get him, period" (pp. 148- 149). These clients beJicve that you arc
uncaring and bent on harming them. \Vhatevcr counsellors do and however caring che.ir
actions. these clients will react based on their expectations. They may try to control the
rcJationship through manipulation and imimiduion; however, this behaviour should be
interpreted as a warning signal only. These clients may not escalate co violence.
Violence and Mental 11 lness
The question whcche.r people with mental illnesses nrc more dangerous than the aeneral
public continues to be the subject of research, debue, and controve.rsy. Not surprisinaly.
many people believe that there is a strong link between mental illness and violence. But
advocacy aroups argue that the media, through selective and exnagerated reporting,
have stimulated the deveJopment of false assumptions 3bout the dan,;crs posed b\•
people with mental illnesses. Sens:ation3Jizcd headlines such as "Schizophrenic Man
Kills \Vife, Then Turns Gun on HimseJf" and "Voices Told Mc to Kill My Child" create the impression thnt mcntaJ illness is associated with violence; however, objective
research evidence supports different conclusions.
SUCCESS TIP
Viole-nee that Ot'igj.nate-s from psychOSeS and olhef ne-ufdOgjc:al pfoblems can fOr' the most
par1 be prevented lh(OUgh r'nedication and suppor1 sel'Vic:es. This unde-rscore-s lhe imJ)Or'tance of wortung with dients to enhance- medication compliance, as well as providing teady
access counse-lling fot ettSis management, pee(support, and basic ne-eds soch as hOuSing.
One comprehensive Canadian stud,., of the literature on the link between mental
illness and violence concluded that there is no scientific evidence that mental illness
causes violence (Arboleda~Florez, Holley, & Crisanti, 1996). Echoing many other
research finding~ they aJso implicated substance abuse as the most significant risk
OiHlcull Situations: Engaging wltll Hard-lo- Reac h Clients
253
))I) BRAIN
11 : j T : I
BYTE
I' I : ,1 I
j ,
Otganic brain disease and head ttauma may reduce clients'
rn'lpulse contrOI and le-ad to an iocrease in aggre-ssion and
viotenice, as wet.I as changes in memory and ability to teason.
'
I '
A Sludy of prisoners linkS a hist.Or)' of brain trauma with an
increased likellhOOO lot viOlence (McCOOk, 2011).
factor, noting that studies suggest that "individuals are 3t grc3tc.r risk of being assaulted
by someone who abuses substances rather than someone who is suffering from major
mental illness such as affective disorder, anxiety disorder, or schi:ophrcni3." Another
study (Sw-nnson ct aL, 1997) confirms the link between violent behaviour and substance
abuse, particular!)• when there has bttn absence of recent contact with mc:ntaJ hC31th
service providers. A different stud,., concluded that predictions of violence based on
a history of violence were more accurate than clinical predictions based on diagnosis
(Gardner, Lich, Mulvey, & Shaw, 1996). Overall, persons with mental illness arc over
2.5 times more likcJy to be \•ictims rather than perpetrators of violence, particularly
when other factors such as poverty and substance abuse arc present (Canadian Mental
Health Association, 2005). The vast majority of violence comes from people who are
not mentally ill, yet the widespread belief that persons with mental illness pose a threat
contributes to the stigmatization of this group (University of 'W ashington, School of
Social Worlc, 2015).
Although "major mental disorder and psychiatric disturbance arc poor prcdic~
tors of violence" (Harris & Rice, 1997), Miller (2000) found that certain mental
disorders, such as schizophrenia with paranoia and command haJlucination~ mania,
substance use disorders, antisocial personality disorders, and borderline personaJity
disorders, arc more lilccly to be associated with violence. Moreover, in recent dcadcs,
deinstitutionalization of psychiatric patients has resulted in unprecedented numbers
of people with mental illnesses in the community. Clients with a history of severe
mental illness and violence who stop taking their medications can be very dangcrou~ particular!)• if they have command hallucinations (voices and images directing
them to be violent).
A comprehensive follow-up study of patients discharged from psychiatric hospitals
concluded that former patients who do not abuse drugs arc no more violent than a
random population sample (Bower, 1998). Pastor (1995) concluded that unrealistic and
dcJusionnJ thinking tends to increase the likelihood that violence will result. He aJso
noted, "Manic symptom~such as irritability, increased energy or activity, ps,.·chomotor
agitation and grandiosity, also increase the rislc of violent behavior. A belief that 'others' arc responsible for the person's misfonune increases the lilcclihood of srriking out
against those persons" (p. 117 3).
Violence Risk Assessment: Key Questions
Although long-term prediction of violence is difficult, counsellors should be able to
make reasonable short-term forecasts based on consideration and assessment of the
follO\\•ing questions and issues:
I . Docs the client have a history of violent behaviour or an arrest record for \•iolcm
crime? The counseJlor should review agency file records and other anecdotal
evidence for information.
2. To what extent does the client appear dangerous, as evidenced by marked or escn,lnting agitation or threatening behaviour! The counsellor shoukl consider verbal
threats as weJI as nonverbal expressions of aggression.
254
Chap1er 8
3. (f the diem is threatening violence, are the thrents concrete nnd specific? Docs the
client have a plan? Docs the diem have the means to carry out the stated plan! Docs
the diem have a weapon or access to one, especially a gun?
4. Is the client under stress (e.g., recent death, poverty, unemployment, or loss of
social support)? Has there been a r«ent event that represents the last straw for the
cliend Noticeable changes in baseline behaviour (the client's usual pe.rsonalicy and
manner) should be noted, such as the folJO\\,ing examples:
■
■
Haydon, usually quite demanding and argumentative, becomes quiet.
Jeff, a 16-yenr-old group home resident, who is typicaJly ve.ry social, withdraws
to his room.
5. \Vhat systemic factors might be exacerbating the situation (e.g., missed or delayed
appointments and denial of benefits)?
6. \Vhat counsellor variables might be heightening the client's anger! Is the counsellor
acting in ways that the diem might see as provocative! For example, is the counsellor defensive or judgmental coward the client!
7. \Vhat high-risk symptoms arc present! For example, is the client experiencing com.mand hallucinations! Is the client impulsive? ls the client near panid Js the client
narcissistic or sdf<entred and prone to blaming others for his or her misfortune!
Is the client hypersensitive to any criticism or hint of rejection?
8. Is the.re e-.•idence of substance abuse!
9. Has the client failed to talce ps)•chintric mediations! Has the client cut off or failed
to lceep scheduled contact with a psychiatric caregive.r!
10. Docs the diem believe that he or she is able to control his or her behaviour! Is the
client socially isolated?
I I. Is the.re a history of brain injury or organic brain disease?
These questions are references for the purpose of assessment only. The presence of
any of the factors docs not menn that the client will necessarily become violent. However, when there are numerous strong dues that suggest violence, counsellors should
procttd cautiousl)• and look for ways to reduce risk factors to establish safety.
Managing Angry and Potentially Violent Behaviour
Preventing Violence Effective intervention begins with prevention. Org3ni:::ations
nttd to be open to the fact that there may be clements of their se.rvice system that act
as trigi;ers for clients who are stressed or have short fuses. Additionally, W'Orkers need
high self-awareness to r«ogni:e their own triggers, as well as how their responses and
behaviour miaht escalate frustrated and angry clients to \'lolent responses.
Systemic Factors Many clients come to counselling inn state of crisis, with low tol•
e.rnnce for added stress. Consequently, it is important that ai;ency policies and routines
Soctely f0r Neutoscience (2007) tepotted findings on
IM neutobiology of aggression. II found evidence of brain
damage in neutal cifcuits telated to motal decision maki~ in viOlent individuals. Damage to the pte:frontal cortex,
and the angular' gyrus can al:SO increase violent behaviout.
Hyperactive tesponses in the amygdata (r'esJX)nsible foe managing thteats and fear) and decreased activity in lhe frontal
IObe are also imi:,icated. As well. bw fe\iel:S of the neurotransmitter serOlonin may help predict violence.
OiHlcull Situations: Engaging wltll Hard-10- Reaell Clients
255
do not compound the risk by exacerbating: client frustration. Parada, Sarnoff, Morron,
and Homan (2011) comment on this Canadian rea1ity:
Conununity member!? who use ~bl services o(ten h::1:"e to wait too Ion¥ for an 2ppoint,
n~u, wait too loi,i to be seen on the day o( the If 2ppointment, and ha"e t·o o little tune
with )Ou or othe-r pro(ession.3ls when ther are f'ln.31ly seen. The (ornu they must rom,
plete are o(ten le:i,Kthy and con(usinK. Some a~-t:i1C)' sta(( can be insensiti"e, unhelp(u1.
or dow·n rlj~ht rude. Then t·o~-tther. these prae,e«s reinfor« the idea that community
member!? who have to use these service!l 2re unworth)' and fad:. di1;nit)' (p. 6)
Organizations need to understand that for many diem~ systemic change is what
is needed. Part of this ought to include review of the structure and service delivery
systems of the agencies whose mandate is to help.
Agency Safety Precautions In settings where there is significam risk for violence,
procedures should be developed for dcnJing with potentially \tiolent clients. In foct,
employers usuaJI)• have a leg3J responsibility to provide a safe working environment.
Minimum S3(cty precautions might indude the following:
Policy Agencies should develop and regularly review policies and procedures for
dealing with potentially violent situations. Policies should address issues such as the
procedures for visiting homes, giving clients home phone number~ using last names,
and interviewing after hours. Gene.rally. counsellors should not make home visits alone
if there is a possibility for violence. Many counsellors who work with potentin11)• dan.gerous clients use unlisted phone numbers as a way to ensure privacy and safety. In
e>..'"treme situations, such as dange.rous child abuse investigation~ counsellors may need
to be protected by police. GenernJI)•, counsellors should avoid making unescorted visits
to high-crime areas. And onl)• those counscJlors with leg3l authority should investigate
allegations of child abuse or neglect.
Staff Training Training: should address tactics for dealing: with difficult clients,
including those who arc involuntary, angry, or acting out. Front office and reception
staff should also be rrnincd so that they can relate to clients in W'n)'S that do not escalnte
the clients' frustration or anger. Periodic team simulations will ensure that everyone
is familiar with their roles and responsibilities. This prevents members of the team
from becoming confused during: a critical incident. Simulations also help staff build
confidence in themselves and trust in the.ir colle3gues as backups.
Interviewing Procedures and Office Design Counsellors who arc interviewing:
diffteult or dangc.rous clients should work in offices where access to immediate help can
be provided. A silent system for alerting othe.rs that a dangerous situation is developing:
should be implemented (e.g., panic button and encrypted phone message). Leaving the
When counsellOr'S 0r clW!nts feel fear 0r threat from the other-,
the classic "flight or fighr response may result f0r eithe-r 0t
bOth. Stofed me-m0tie-s of sinilar threatening events have an
eOOr'mous influence on hO'N individuals fe-spood. five majOt
afeas of the brain, amygdala, hippocampus. hypothalamus,
thalamus. and se-nSO<y c0tte-x all play a part in the deci.
sion to fun (fligt\t) Of fight, (although some may respond btf
freezing). When the lhreat is pefCeived as real, h0<mones
such as epioophrioo (adrenaline) and norepinephrine
256
Chap1er 8
(OOr'adfenalioo) are released which cause an incfe-ase in
heaft rate and blOOCI pmssure. MuscleS tense-, breathing rate
iner-eases, digestion SIOw Of stops and blOOCI glucose levets
iner-ease-. Because attention is fuly directed at the lhreateni~ situation, individuals may be- unawafe of 01he-r things
such as hO'N lheir responses are affecting Olhe-rs (Layton,
2015; Shetr'3r'd. 2015). Thus, some angry and aggfessive
clients may be quite unaware how Mghte-nlflg the-.' behatJiouf
i:s to Other' peo,:,e.
door open durina the inte.rview can aJlow other staff to monitor any incrc3sing danger,
but this practice may violate the client's conf.denti3lity.
SUCCESS TIP
AA ideal office seating artangemen1 gives bOth the eounsello t and lhe client a clear,
unobStructed path to the dOOr'Way.
Files on clients with a history of violence should clearly document details of any
pa.st violent behaviour or thrc3ts. For clients with a high propensity t0\\"11.rd violence,
a te3m approach may be desirable, with nvo or more persons being present during the
interview. In such cases, it is usually preferable if onh• one person does the interviewing. This can lessen any feelings the client might have of be.ing ganged up on. Too many
people may heighten the client's anxiety. Backup help can be stationed out of sight, but
on quick standby for dangerous situations.
Off1Ce furnishings should be carefully c.hrucn to minimize risk. For example, shatterproof glass can be u~, and items that a.re potential weapons, such as scissors, should
be removed. Also, soft lighting and calming colours ma)' have some modest effect on
mood. In addition, the agency itself should have good external lighting. Finally, during
high-risk hours. such as late at night or earl,., in the morning, access doors should be
locked, and worke.rs should not have to w11.lk alone into dark parking lots.
Table 8. 2 on the next page provides some tips on how to prevent and manage anger
and \'lolent behaviour. The table is ori;pnized according to the phases of violence, which
are discus~ in the next section.
SUCCESS TIP
A writtM script for staff call$ to police 0t emergency baekup intervention ensures lhat relevant tnfotmation is presented quickly and Cle.arty. In a panic situation, people may forget
bas.ic information, such as emetge:ncy phone numbel's.
The Phases of Violence
The Na.tionaJ Crisis Prevention Institute (2012) has developed a modcl for nonviolent
c.risis inte.rvemion that is widdy used in Canada. It is based on four phases of violence:
(I) anxiety, (2) defensiveness., (3) acting out, and (4) tension reduction (see Figure 8.3).
Each phase is characterized by particular indicators and demands specific responses.
phases of violence: The lour-phase
med.I (a:IW!.1J', de-fenSM!leSs.. aclillg Gil
and tensioo fedo::tiol) duit desc!Us tic,,.
u is.es escabte to ~olelce:.
Phase 1: Anxiety In the anxiety phase, there are often enrly warnings that a.re
marked changes in the client's behaviour. The client's agitation and anxiety may include
verbal cha.Henges, such as the refusal to follow directions or questioning of authority.
Statements such as "You can't tdl me what to do" accompanied by finger pointing
may suggest escalating anger. Signs of escalation, such as pacing, intense staring, and
refusing to sit down, should be noted (Shea, 1998). Other indicators may include excessive euphoria., angry facial expressions, increased voice volume, and prolonged scaring. Counsellors should watch for changes in diem baseline behaviour or personality
panerns.
During the anxiety phase, the diem may respond to gentle directives and invita.,tion~ such as "Let's mlk and see if we can work things out" and "I'm willina co listen."
This phase offers counsellors the best opportunity to intervene earl)• to prevent anger
from intensifying into acting-out behaviour.
OiHlcull Situatio ns: Engaging wltll Hard-lo- Reac h Clients
2 57
TABLE 8.2
Preventing and Managing Anger and Violent Behaviour
Preventive Phase
• Recogrilze (tSk factors.
• Identify and minimize systemic factors lhat might be triggers fOr' clients.
• Structu,e the agency to reduce client s1ress and danger to personnel.
• Set up emergency (esponse protocols.
• Ptaetise crisis f&SJX)nses \\1th simlAatioos.
• Take steps to ptotecl identified intended victims..
• Self-awareness.
Earty Wamill& P11ase (Anxiety)
• Pay attentbn to changes in clienl behaviour such as increased anxiety.
• Attempa to identify and mctify client ~trtggerS. •
• P,omote client inVOlvement in dedsi:)n making to g'Ne 100m a sense of emJ)Owerment and
contrOI.
• Take Mgut instincts· and 1hmats se-riouSly.
• Use empathy and feassuraoce to acktlowledge and atteoo to client needs.
Lall Wamlnc Phase (Defensive)
• Pay attentbn to changes in clienl behaviour such as increased defensiveness, challenges,
aoo vefbal threats..
• Set dear, reasooat,e. aoo enforceable limits.
• Respect client need for increased space.
• Remain calm and avoid sudden movements.
• Avoid using an authoritarian tone; fesJ)Ond assertively.
• Use basic: counselling Skills.
• SeafCh lot compfomises and -win-win· solutions.
Uncontrolled Anger and Violence (Acting 0111)
the police (do not try to disarm clients who have weapons and do n01 risk personal
safety untess una\lOidable).
Try to ensure the safety of eve-ryone, including bySlanclers, Other Slaff, and the client.
Use a team apptoach, induding. if necessary and appropriate, physical festr'aint, but
ex.treme caution is reciuired as untrained persons can inflict inj...y or death.
• Refef or artang,e to transpor'l dients to hOspital fof assessment or medication.
• Try to re-eslablish verbal eotrwnunication.
Tension Reduction
• Support lhe client's feturn to a state of calm.
• Re-e:ssablish communication.
• £licit availat,e family support.
Post-Event follow Up
lr'WOtve clients in loog-term counselling.
Help clients le.am nonviolent ~lutions to prot,ems.
Implement consequences, if any.
Conduct i'ldividual and team debriefing.
• When clients have plans to harm a specific victim. wam the victim and notify the police.
• Review ptOCedures fof handling distupaive clients.
ca1
Usually. clie nts enter the anxiety phase bcc:3usc of stress., which can come from muLtip le sources, including jobs, rcfotionships, health, 3nd fin3nces. Clicms define stressful
events; thu s, counsellors cann ot measure stress just by k nowing the facts about a situ3.tio n . What one d iem might sec as an o pportu nity, ano ther m ight ex perience as a threat.
Kcllchc.r ( 1997) d escribes the triggering event as 3n incident that pushes the poten tially
258
Chap1er 8
Figure 8.3
The Phases of VIOience
violent person toward violence-: "ft is the provc.rbi3l 'stmw that broke the camel's bade,'
and , like the straw, may often be perceived by others with far less significance than it's
perceived by the perpetrator" (p. I I). ~fore clients sec counscllors, they may nJrc:ady
be feeling helpless and abandoned. Any counsellor o r agency behaviour th:.n the client
views as provocative or rcjcctina ma'>' further propel the client tou•ard violence. Cou nsellors may have to d eny assistance, and clients ma'>' believe that they are denying them
3ccess to goods or services. These clients may perceive- themselves as "losers" and look
for ''""n't'S to save focc, indudina resistance, with statements such as "I don't have to put
up with this rreatment."
(ndividuals who arc predisposed to violence respond to stress with incrc3sing anger
and anxiety. A person's cmotionnJ reaction can also in6ucnce whether he or she might
become violent. La.big (1995) suggests that people who are p rone to anger, hatred, and
those who tend to blnme others arc at h igher risk or becoming violent, while those who
are more cmP3thic are less likdy.
Oe.aling with Threats CounseJlors need to take action when clients exhibit changes
in their norm:.d behaviour. T his action co uld include referral for psychia tric assessment and re-cvnJuation or medication. Jmmcdiatc crisis intervention might result in
moving the diem o ut or the environment where others might be injured, for examp le,
a crowded waitin g room. As wcll, long-te.rm co u nseJling might focus on anger management or relaxation train ing. The immediate goaJ is c risis management, but the long-term
goaJ is crisis prevention. T h is interesting conclusion reached by Quinscy, Harri~ Rick,
and Cormie.r ( 1998) cha.Jlcnges one common misbdief: "encouraging angry individunJs
to relieve anger through catharsis (e.g., boxing, using a punching bag) is concraindicatro
because it ma'>' lead to increased hostility and aggression" (p. 204).
SUCCESS TIP
"When arry type of th(eat (fr0tn a client) includes indirecl or veiled ,efe(ences to lhings lhey
might do, such as 'You'I be SOfr/ Or' 'Don't mess wilh me; ii is best to ask directly, What
do you mean by that?' ASk e.xaclty what lhe person is threatening to dO. HtS elabOt'ation w,II
almost always be weaket than hi:S implied threat If, on lhe Olhet hand, his ex~nation of
the comment is actualy an explicit lh(eat, bettet to ieam ii now than to be uncertain latet·
(de Becker, 1997, p. 117).
Cou nsellors need to be attuned to their own fears and anxieties. Appropriate
anxiety is a due that the situation is escalating and that remroiaJ action is necessary.
De Becker (1997) argues that people have a basic intuition that teJls them when aJI is
not well, bur that they often disregard the red flags or danger. It is only in rhc aftermath
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clients
259
that they re.fleet and renli!e that they had suff,ciem informntion to make bener choices
but that they ignored it.
Phase 2: Defensive This is a late warning phase with dear indicators that the person is about to lose control. The client may become more challenging and beJligercm
by making direct threats and pro\'Ocations. The client has become irrational and dear
warning indicators may be present, including clenching or raising of fists, rapid breath.ing, grasping objects to use as weapons, and showing signs of movement to,.,,.-nrd nttack
(e.g., grasping the arms of the chair and denoting that the client is about to rise and
advance) (Shea, 1998; Shea for & Horejsi, 2008).
At this point, it is crucial that counseJlors refrain from reciprocating with the same
ngg,-essive behaviour that the client is using. This requires some self-discipline, as the
counsellor's narural reaction might be to respond in kind, which onh• serves to escalate
or precipitnte \•iolence. Decreased eye contact might be nppropriate with some clients.
As well, counsellors arc wise to increase the physical distance between themseJves and
their clients since potentially violent persons ma't' have an increased need for space. Note
that physicaJ contact, hO\\rever wdl intentioned, should be nvoided. Sometimcscounsel.lors try to calm clients by touching the.ir shoulder~ but this is ill-advised as clients may
interpret it as aggression.
During this phase, counseJlors need to be .self-disciplined and to modeJ calmness.
\Vhen counsellors stay calm, clients arc more likely to emulate their composure. This
calmness should be rcftecto:I in their voice and manner with slow, non.-jargonistic language Counsellors who speak caJmly and avoid any loud or authoritarian tone have a
greater chance of caJming their anxious clients. On the other hand, counsellors who
match their clients' defensiveness and anger exacerbate the situation and increase the
possibility of \tiolent retaliation. Rigid and authoritarian counsellor reactions may leave
clients feeling pressured or trappo:I.
It is essential that counsellors mnintain their own equilibrium and remain in con.trol. They need to develop the.ir capacity to monitor their own feelings and behaviour,
including the.ir ability to ask for hclp or to withdraw when they arc not in control. Coun.seJlors also need to resist any tendency to be baited by clients inro angry confrontation
or retaliation, which only escalates the crisis. Jf clients ~rce.ive that their counsellors
arc anxious and not in control, they may become more irrational.
Labig (1995) re.minds us of the importance of emotional tone. He notes that a loud
or aggressive \'Oice can quickh• precipitate retaliation, while a voice tone that is calm
and supportive inhibits violence. Simply put, a threatening environment increases the
risk of violence.
&sic communication and counselling sJcjlJs are excellent tools both for preventing violence and for dealing with clients who nre on the verge of losing control. In particular, active
listening skills communicate that counsellors nre willing to listen to and learn about clients'
wants and nttds. Counsellors should try to speak calmly and avoid any mannerisms that
clients might inte.rprct as threatening (e.g., touching a client, making a sudden movement, or
invading a client's persona.1 spoce). Encourage the client to sit and to be comfortable. Listen,
e.mpathi.!c, paraphrase, and sum.mari:e. while avoiding defensiveness. As a rule, respond
to clients in the anxiety and defensive phases with supportive and empathic. smte.n'litm:s.
However, some clients mn't' misinterpret empathy as an um\--nnted intrusion on personal privacy and react defensiveJ,.,. Counsellors should be alert to clients' reactions to
certain topics or questions. This will help counseJlors make intelligent decisions about
when it is appropriate to chaJlenge or confront, and when they should back off because
the subject is agitating the client to a dangerous level.
The Power of Compromise
Violent clients often fee] disempo\\'ered and disadvan.ta.g:ed. \Vhe.n counsellors promote compromise, they restore some balance of power
260
Chap1er 8
in the rclntionship and show their willingness to reach n solution. Conve.rscJy, when
counsellors argue with, threaten, or ignore the needs of their client~ the clients may
become incrcasingl,., belligerent.
Compromise helps clients find a way to save face and retain the.ir dignity. While
counsellors have the responsibility to set appropriate limit~ they must not argue with,
ridicule, challenge. threaten, or unfairt,., critici:e clients. The lanauage used b\• the counsellor can help establish an atmosphere of compromise and mutual problem solving-.
for example, "Let's work together to find a solution we can both live with" and "I really
do want to find a solution."
Client: (Ydling loudJ:y.) I 3m sk.k a.nd tired of ~ttin& the run3round.
Counse.Uor. (Calmf:,.) Your ::u-~er nukes it dear to me how stronaly rou feel 2bout thil. l
can see that this is a.n import:mt issue fm- )'Ou. but I wi.11 be able to work better with ,..ou
i( you St2)' calm a.nd don't threaten me. let's~ i( there·s 2nothe-r w-3y to appro-Y.h it.
Client: (Padng and ,dling.) Are rou '--oi~ l'O help me or not!
CounseU.o r: (Calmf:,.) I'm willina to work with )'Ou on the problem.
Client: (Siu and stmes lnttndJ.)
Counsello r: I understand th::u )'Ou think that thii is the best solut ion. I al.so appredate
)'Our reasonilli, but there ::are two of us here. We !"K'ed to Ond 2 solution that both of
us ea.n ln't' with.
Client: (l.At.1dl,-. but not 1dlms.) I a.in tq•i~ l'O be reason::tble!
Counsello r: Oka)', I'm liste:nina. I'd like to hea.r your ide:as.
Hocker and Wilmot (1995) identify five principles for establishing effective collaboration: (I) join with the other, (2) control the proccs~ 00( the people, (3) use productive communication, (4) be firm in your goal~ flexible in your means, nnd (S) remain
optimistic about finding solutions to your conflict (p. 212). They suggest a variety of
means for ope.rntionn1i! ina the principle~ such as usina "we" language to affirm common interests, activcJy listening even when you disaarec, and persuadina rather than
coercina. As well, they emphn.si!e the importnnce of separatina the issues from the
rcJarionship and dealing: with the important items one at a time. Such a collaborative
approach requires that counseJlors remain positive, creative, and constructive. The gene.ml goal must be "\Ve, working together, can solve this problem that is confronting:
us" (Hocke.r & Wilmot, 1995, p. 205). Dubovsky and \\:lcissbera (1986) underscore the
importance of promotingcollnborntion. They contend thnt the diem "protects himself
from feeling powerless, inadequate and frightened by attempting to demonstrate how
powerful and frightening he can be. His threatening: behavior increases if he feels he is
not be.ina taken seriously" (p. 262).
SUCCESS TIP
If aggressive behaviout is escalating. the safety of otherS must be a p(aorily. This might
include evacuating the waiting room, removing ot;ec1s lhat ~ t be used as weapons, and
seeking baekup from othet avatlable staff.
Setting Limits Setting and enforcina reasonable limits makes it possible for
counsellors and clients to continue ,vorking: together. Failure to set limits reinforces
actin,;-out behaviour, which if unchecked could lead to more violent and destructive
consequences. In the defensive phase, clients may still respond to appropriate limits.
Limits let clients know what will and will not be tole.rnu,.d, but counsellors need to
apply ce.rcain principles in setting limits. Counsellors should be specific and tell di•
ents which behaviour is inappropriate since they ma)' not be aw3re what is acceptable.
OiHlcull Situations: Engaging wltll Hard-10- Reae ll Clients
261
Moreover, they may 00( know how their behaviour is affecting others. Limits should
include enforceable consequences, and counsellors should state the consequences of
noncompliance.
SUCCESS TIP
um,t setting is m:::,(e effective when it is s1atoo rn a poSrtive tone Viith a payoff f0t compliance, as tn lhis ex.ample: •If you stop yet.ling at me, then I wiU sat wdh you to see if we can
find a Sdution.•
Phase 3: Acting Out
At this stage, the diem has lost control and has become assaul.tive. Protection of seJf and others is the primary goal. Jde~dly, a,;ency procOOures are
operative, 3nd counseJlors who are dealina with such situ3tions will receive immediate
assistance from the st3ff team. Police intervention 3nd restraint of the acting-out diem
may aJso be rttauircd. \\:lhen deaJing with acting-out client~ a team approach with a weJl.ori:ani!ed and trainOO staff is the preforr~ way to address the crisis. A team approach
provides increased safety for everyone, including the client. A wcll.-train~ team may
subdue violent clients before they injure themsclvcs or othe.rs, but staff should be
train~ in techniques for physical restraint and control. The team members provide
support and can act as witnesses if litigation should arise because of the incident.
Police Intervention Counsellors should not hesimce to call the police if a client
becomes too threatening or 3garessive. No counsellor is expected to risk his or her lifo
or endure physical assault as part of the job. Moreover, sometimes clients are unwilling
or unable to constrain che.ir hostility, 3nd police or psyc.hi3tric restraint is esscntial for
managina the crisis. Police intervention is particularly crucinJ when deaJing with clients
who have weapons. In addition, counsellors should not cry to prevent 3 client who
is determined to leave by blocking the exit. In genera], counseJlors who are assaulted
by clients should consider laying criminal charges. This establishes the importance of
clients' takina responsibility for their 3ctions.
SUCCESS TIP
Neve( t:,ock angry chents from leaving yout offa; allow a deat path f0t them 10 exit. Never
run aftet clients wtlo storm out
Never interview when )'OU arc alone in the office. Never enter a client's home when
you know the client is talking about hurting someone.
Phase 4: Tension Reduction The tension r~uction phase is characterized by a
gradual reduction in aggressive behaviour and 3 return to more rational behaviour.
The client may still be driven by adrenalin, so it is important that counsellors proceed
cautiousl't' to avoid reoctivatina aagres.sive acting out.
Follow•up Counselling Interventions Clients can be counselled to b«ome nJert to
their own warning sign~ such as "tenseness, sweating pa]ms, a ciahtening of the stom,.
adi, pressure in the chest and a surge to the head" (Morrissey, 1998, p. 6). Once clients
3re aware of che.ir own trigge.rs, they can be counselled on appropri3te diversion3ry tac.tics, such as employing rclax3tion techniques, talcina time out, and using assertiveness
3nd other bchaviouraJ response. alcern3tives. Morrissey ( 1998) describes a technique
that a counsellor used with a client who was on the verge of violence. The counsel,.
!or reassured the client "that he was there to help him and commended the client for
262
Chap1er 8
coming to sec him rather than acting on his feelings of rage. He also asked the client
what was keeping him in control thus far and used that as proof to reinforce the fact
that he could indeo:I control himself" (p. 6).
At the end of the tension reduction phase and after the diem has returned to normal, the client ma,., be mcntaJly and ph)•sicaJly exhausted and show signs of remorse
and shame. Con5tt1uently, counseJling can be direct~ toward helping the client use the
experience as a learningopportunit)•- forexamplc, todcvclop alternative responses for
future similar stresses. Interview 8.2 provides an example.
Counsellors arc wdl prepared to tcnc.h theirdients techniques for resolving conflict
and crises nonviolcmi)•. The skills of counselling arc also, to some extent, the skills of
effective everyday communication. Communication skill training equips clients with
more choices for asserting the.ir rights and respecting others. Assertiveness training cnn
hclp clients express feelings in a nonaggressive manner. When clients arc able to respond
assertively, they establish an atmosphere of cooperation and conflict cnn be peacefully
resolved. Often conflict is difficult for clients to settle because they arc unable to sec
the perspectives or foclings of others in the conflict. Clients who learn empathy and
other active listening skills are better able to compromise because they arc less likely to
judge their own behaviour as absolute!)• right and that of others as absolutely wrong.
Sometimes, long before \•iolence erupts, counsellors intuitively focl chat the situation is worsening. This foding ma,., be based on unconscious reactions to subde cues
and indicators. Counsellors and clients might find it useful to rry to concretely identify
these dues. Doing so will assist clients in becoming sensitive to those initial psychological responses that signaJ the imminent onset of the anxiety phase. Clients who become
adept at rccogni!ing early warning indicators arc in a much better position to cake
early warning action, such as withdrawing from an explosive situation or switching to
healthie.r problem-solving strategies.
Critical Incident Debriefing
An organi!ation needs to have a mechanism in place for debriefing after a \'lolent or
hostile act. This enables the counseJlor to restore a sense of equilibrium. It is important
to remember that a critical or violent incident may also affect and traumatize staff who
were not direcdy involved, including clerical, janitorial, and kitchen personnel; therefore, they should be involved in the debriefing.
Counsellors who have been assaulted or threaten~ with assault ma)' be traumati!cd. They ma,., experience symptoms such as recurrent images or thoughts of the
event, distressing dream~ flashbacks, and intense srrcss when returning to the scene
of the incident. There may be a marked decline in their ability to handle routine work
tasks. and they may fee] detached and isolated from colleagues. They may dcvdop sJeep
difficulties and have difficulty concentrating. Frttauently, they return to work in a state
of hypervigilancc, constandyexpecting funhcr trauma. Often, they describe themselves
as "numb" and unable to enjoy activities that usually give them pleasure. Macdonald
and Sirotich (2005) review~ studies and reported that victims of client violence might
experience the following:
■
Troubled relationships (with colleagues and famil't•)
■
Reduced ability to function in the ,vorkplace
■
More absenteeism
■
Higher levels of burnout, depression, anxiety, and general irritability stemming
from threats or abuse
\Vhen symptoms such as these arc present, counsellors should consider obtaining
mcdicnl assessment or professional counselling.
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clients
263
)}) INTERVIEW 8.2
In the following e:x.ample, the counsellor, a g,oup hOme worker, is revi~ing an incident with her client. The incident
o«uned two hours ago and was predpi~ted when the C-Ounsellor denied the client, a 16-ye:ar-old male, permission to
meet with some of his friends later that nigtit The client threw his chair ac,os.s the room and stormed out of the office
while saeaming obscenities.
Counsellor: I'm wondering if ltlis is a good lime to talk
abOut vd\at happened eartiet tOOay.
Client: It won't happen again.
Analysis: Whenever ,:,oss/ble. it's im,:,ortant that clfents be
Invited to review prior incidents.
can we just forget it evet
happe-ned?
counsellor: You're ~t. We need to move on. HoNevet, I
think it's im(X)rtant we bOth rake a IOOk at it to make some
~ns so it doesn't oc:cuf again. Okay?
ClleM: I guess I gol a bit carried away.
counsellor: 1was scared.
ClleM: I'm sony. I won't let ft happen again.
counsellor: 1accept youf apol:)gy.
counsellor: It mighl be helpful fof bOth of us to go ove-r
what happe-ned to see hON it migt\t ha\18 been prevented.
Client: I was stil upset from see-ing my mOlhef. When you
said no, it was just too much.
Counsellor: H' s never bee-n easy to, you to Ialk to your
mom. You always seem to come back realty wound up.
Clitnt: Yeah, lhOSe are- the days lhal people Should Slay
out of my face.
Counsellor: Good point. Sounds like you know lhal you
need some time alone when you're stfe-ssed.
Analysis : Often. violent or acting-out clients are so preoccu•
pied with their own needS and fears that they don't realize
the impact they have on others. By telling the client how she
fell, the counsello, hopes to inc,ease his capacity for empa.
thy. Acceptance of her client's aPology does not condone his
behaviour. as would a statement such as "lt'sok.ay. Don't worry
about it. No real harm was done."
Analysis: One goa.l of counsel/Ing is to help clients recognize
their own early warning indlcatOrS that they are in danger of
losing control.
Analysis: Empathy confirms that feelings have been heard and
understood.
Analysis: The client rationalizes his behaviour, putting the
respons/bj//ty on others. Without directly challenging the
raUonalizatlon. the counsellor shifts the focus baek to a client
strength.
Client: You got it
Counsellor: As we talk. I'm wondeting what p(evented
you from &aking that time. If you' d taken lhe time- to coal
off befOfe approachi"lg me-. tt'li"lgs would have been a IOt
diffefe-nt
Analysis: Feedback confrontation challenges the client
to consider so~ new alternatives. The counsellor takes
advantage of an opportunity to reframe the client's problem
statement Into a goal.
Client: Sure, I koow I have to le.am to control my tempe-t,
bul once- I gel gotng I just can't seem to stOI) myself.
counsellor: Put anott'le-t w.ry. yotX hope is to find a way
to deal with your feelings so that you don't get angry and
huft someone.
Client: I don't know if tnal's possible-.
counsellor: You've already shown me that you have some
Sklll at doing this. You threw the chair and you said some
awflA lhiogs, bul afte.-ward you left lhe (OOm withOut doing
any mOl'e damage. This tell$ me lhat you have the- ability
to bring thi~ under contrOI.
Analysis: Acknowledgment of the client's restraint. hov,-eve,
late. ,:,rovl~s a base for further development. This recognizes
the client's strengths by /JCknowledging and reinforcing nonag.
gressive behavioural altematfves.
Reflections:
■
■
How would you assess that the time is right to initiate a follow-up interview?
Suggest hOw anticipatory cont,acting migJ,t be used as a next step.
264
Chap1er 8
CONVERSATION 8.3
Youtti Worker: What Should a eounsetlOr' dO if assallted btf
a client?
counsellor:
The(e are many lypes of assaults fa~iog from
verbal lhfeats to ph)'Sical anackS causing i.njuiy. All of them
afe frigt\teni~ and potentialty traumatic.
Youtb Worker: We Should not f0<get that any assault on a
counsel!Or also impacts other wor'k.ers in the agency, even
those who wefe not pfesent during the altercation. Their psychOIOgjcal needs sholJd not be ignored Or' minimized. AA
assault on one v.()rker is a fetninclef to othets that they are
also vl.dnerable. In some cases, the assaulted worker- (or tnell
colleagues) ate 1taumatized. Thi:S can have serious tepe-rcussions fOr' lheit pe-rsonal and profe-ssional wol'k.
COuMellor: lndividualS may ex.perienice a myriad of ern::,t.ions.
including fear, anger-, Shame, denial, contempt f0t dients, Or'
even guilt. All of lhem are normal; au of lhem ~d to be
processed. Poople whO wol'k in the eounselli~ field already
know 100 be-neflt of the counselling ptocess. and they ShOuld
not hesitate to use counselling to deal with their own em~
t.ions. To do so is a sign ot strength, 001 weakness. Oetr'iefiog with a trusted cOlleague 0t supervisof 0t using emptoyee
assistance services afe possible options.
Youtti Wor\et: A team detr'ief whefe indi\lk:lua~ are enicouraged to Shafe their feelings about the incident is an important
way to regroup. The team deb(aef ShOuld include all personnel in the setting, no1 just the prolessional counsem.ng staff.
It may be helpful to have an outside facilitator conduct the
team deb(tef.
STUDE:NT: What Should happen dufing the deb(t0f?
Youtb Worker: The basic goal of any counselling or team
debtief is to f&-eStablish a sense of contrOI and saiety. The
deb(t0f is an opportunity to Share lee6~ and concerns. By
doing so, indjyijua~ typicaly diSCover that Olhers are affected
in similar ways and 100 powef ot group support is mobilized.
Counsellor: In addition, fMJCamining the clfcumsaances of
the assaul is important. A numbef of key questions shoud be
addfesSed, including: Wefe there indicators ot an esw:.alati.ng
risk of violence that were misSed? Were thefe aspects of the
seuing's sttuctu(e Of policy that contributed to the assault?
Was thefe ade(luate sharing of inf0tmation within 100 agency
(e.g,, history of viOlence, substance misuse, and non~pliance With psychiatri:: medications)? What ctia~am necessary to pfevent further k'lck:lents? Uptoring these questions
can help the team to develop bette-r procedufes and confidence f0t handling futu(e incidents..
Youth Worker: Since an assault increases peoples' feeli~ of
vulnerability, 1t is important to monitot how it migtit affed
relationships with othef dients. For example, individuals, Or'
even the entife setting. may ovefestimate the risks posed by
the entire client population. This might resl.dt in excessive
procechxal rutes or struch.-al changes that impair the agency's overau effectiveness. Counsellors must aaso be wary of
tta!WerrW'lg uncesolved feelings to other clients.
Counsellor: GOOCI point. I know o~ worker who, after an
assallt at the agency, deck:led to leave his office dOOr halfopened during intel"Views which compromised confidentiality.
He alSO became very reluc&ant to addfess pote-ntiallysensilive
issues fearing lhat it m.igt\t arouse client anger 0t defensiveness. As a fesUt. many of his counsetling interviews femained
superficial With opportunities for meaningful WOr'k passed
over. foftunately, an alert supervisof intervened with supportive supervision and feferfed the WOl'kef to an emptoyee
assistance counsem~ service.
Even whc:n counsc:llors are not injured, the thre3t of \•iolence can be just 3s traumatic. Typic3J rc:sponses may include hclplessnc:s.s 3nd thoughts of lc:aving the: profession. Thc:se fc:c:lings may devc:lop immo:li3tdy or emerge: after 3 dd3y of monrhsor c:ven
years. Consc:quc:nth•, it is important to debric:f critical incidents to lc:s.sen shock, reduce:
isolation, and restore personal control. Tc:3m debriefing should take place: as soon 3S
possible: after the: incident. Debriefing should be conducted by 3n objective third part)'
in a s3fc: setting. lt should be: hcld as soon 3S possible 3ftc:r the: critical incident, usually
within 24 to 72 hours, to minimize: the effects of any traum3 that victims or witnesses
may be e.xpc:riencing. This is important in promoting a rc:curn to the norm3J routine of
the agency. A t)tpic3l debriefing sc:s.sion is like 3 counsc:lling inte.rvic:w. The debriefing
should reinforce team inte.rdepc:ndence. Sometimc:s counsc:llors 3.rc: re1uct3nt to ask
collC3guc:s for 3ssist3ncc:, bc:lieving th3t 3slcing for heJp is a sign of incompetence. One:
goa.1 of a debriefing is to develop a staff culture in whidi. asking for heJp is understood
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clients
265
critical incident debriefing: A
tummeeling held to deius.e the ~ I
ol a rio!NI or tra.atic Mal sudlas
• assault on a staff meiaber. Oelwiefing
assists 'Mlfkers to nonn• and deal 11ith
t h e ~ that my be amsed because
ol the Mal. As wel. <1£,,lmfing is used
to ieriM and rt'nse prewa(iw, ud crisis
illefYNlica, pnndures.
as a sign of strength rather than a weakness. A critical incident debriefini generally
has the following elements:
I . All team members are invit~ to share feelings and reactions about the curre.nt or
prior incidents. Active listening can be used to promote this process. This hcJps
indh•iduals who were threatened or assaulted to "normaJizc" their own rcac~
tions. Counsellors should rttiuirc little persuasion about the benefits of talking
about their feelings. They might be reminded that sharing foeJings is something
they routinely ask of their clients. Helping team members manage feelings is the
major objective of the debriefing. At this time, it is important to identify the
potential ph)•sical and emotionaJ reactions that staff may experience. As well,
information regarding service~ such as employee assistance programs (EAPs)
that arc available to staff who need additionaJ help to manage their emotions.
should be detailed.
2. The team conducts a post~moncm on the violent event. A thorough analysis of
what transpir~ is used to re,.•iew and reinforce procedures for dealing with \•iolem
clients. An important question for the team to consider is "\Vhat, if anything,
could we have done to prevent this incident!" For example, the team can explore
whether an)' early warning indicators of pending violence were overlooked. They
can investigate whether there were things that individuals or the agency did or did
not do that contributed to the client's behaviour.
3. The tcam debriefing is an important "tcnc.hablc moment" when staff are highly
motivated to develop their skills. Jt is a chance to explore alternative responses that
might have bttn used at all stages of the critical incident. Role-play and simulations
can be used to practise alternative responses. This step helps empo\\'er individuals,
and the tcam by moving them away from any tendency to foci hcJplcss.
COUNSELLING ANGRY AND VIOLENT CLIENTS
The obvious counselling goal is to assist these clients to develop skills and responses that
do not harm others. Safety is the top priority. \Vhile there is no single best strategy, the
follO\\•ing intervention choices c3n be tailor~ to meet the needs of individuaJ clients.
Prevention
Sometimes, long before violence erupt~ counsellors intuitively foci th:.n the situation
is worsening. This feeling may be based on unconscious reactions to subtle cues and
indicators. Counsellors and clients might find it useful to try to concretely identify these
dues. Doing so will assist clients in becoming sensitive to those initial psychologicnJ
responses that signaJ the imminent onset of the anxiery phase. Clients who become
adept at recognizing early warning indicators arc in a much better position to take
early warnina action, such as withdrawing from an explosive situation or switching to
hcaJthicr problem-solving strategics.
Assertiveness Training
Assertiwmess: AssertiYEflm inYC!hes
eiertisilc personal rights, including
the ability to EqftSS ~ and ii!as
Mthout "'1 or~
aaiiety. witb>ut
den,ing the ripls ol cthen
266
Assertiveness involves exercising persona] rights, induding the ability to express focJ~
ings and ideas without guilt or undue anxiety, without dcnyina the riahts of others
(Shcbib, 1997). 1t rttiuircs respect and empathy for oth~r people. Assertiveness training helps clients express feelings in a nonaggrcssivc manner. \Vhcn clients are 3blc to
respond assertively, th~y establish an atmosphere of cooperation where con6ict can be
pcac~fully resolved. lt is dcnrly distinguished from aggression, which involves the use
of po\\'er, domination, and intimidation to achieve one's goa.Js, and p3ssivity, which
Chap1er 8
foregoes personal rights and needs. CounseJlors can he.Ip clients develop assertive communication skills such as active listening, especially empathy. Some clients know how to
respond asscnivcJy, but low seJf-estccm or fe3r inhibits them from making appropriate
assc.rtive choices. Cognitive bchaviouraJ counselling can be used to address these issues.
StTategics such as rcJa.xation training, deep breathing. and mindfulness can be used to
assist clients to deal with anxiety.
The skills of counseJling arc also, to some extent, the skills of effective cveryda'>' communication. This puts counsellors in a good position to tC3ch their clients
techniques for resolving conflict and crises nonviolently. Communication skill tTaining
equips clients with more choices for asserting their rights and respecting others. Often
conflict is difficult for clients to settle be.cause they arc unable to sec the perspectives
or feelings of othc.rs in the conflict. Clients who learn empathy and othc.r active listening skills arc bettc.r able to compromise because they arc less likely to judge thc.ir O\\•n
behaviour as absolutcl)• riaht and that of others as absolutely wrong.
Cognitive Behavioural Counselling (Therapy)
As discussed in Chaptc.r 7, Cognitive BchaviouraJ Therapy (CBT) hcJps clients to identify and manage unhelpful thinking patterns such as catastrophizing or blaming others.
CST can also focus on hcJping clients learn alternate behavioural choices which, when
practised, will lessen any tendency to default to the anger mode.
Anger Management
Anger is a normal emotion and the appropriate expression of ange.r can dttpen relationships. Out of control anger can destroy relationships. Anger management skills include
recognizing and managing: trijlR:e.rs (e.g., avoiding problematic situations). CounseJlors
can use role playing and modeling as a Wtt)' to help clients develop alternate responses.
They can aJso teach breathing and relaxation techniques.
Substance Misuse Interventions
The use of illicit substances is strongly linked to increased \•iolencc, so intc.rvention
tari;:cting this important area is crucial. A wide range of choices include 12-step programs, residential treatment, CBT, harm reduction, rreatmem of co-occurring mental
disorders, traditional hC3ling practices, exercise, nutrition, spiritua1ity, and many other
strategics have proven effective.
Psychiatric Intervention
Psychiatric assessment can determine whether medication is wnr-rantcd. Antidepressant
or antiaru:iety medication may be useful as an adjunct to counselling. Medication alone
is not recommended.
Reduction of Stressors
Resolution of issues rcJatcd to unemployment, poveny, relationship d,•sfunction, and
housing arc important targets for intervention.
Counselling Victims
CounseJlors may be caJled upon to deal with domestic \'lolcncc where the majority of
victims arc women. A 2015 survey by the Canadian \\:1omen's Foundation provides
startling statistics that unde.rscorc the c:xtem of the problem for women in Canada~
OiHlcull Situations: Engaging wltll Hard-lo- Reach Clients
267
■
Fifty percent of women over 16 report h.nving expc.ricnccd :.n IC3st one incident of
physical or sexual violence since the a,;c of 16.
■
Every six da)'S a woman in Canada is killed by hc.r intim3tc partnu
■
On 3ny given day in Canad3, more dun 3.300 W'Omcn (along with thc.ir 3,000 children)
3re fore~ to sleep in 3n emc:ri:ency shelter to esc3pc domestic violence.
■
Each year, over 40,()()() arrests result from domestic violence-that's about
12 pc.rccnt of 3JI violent c.rime in C3nada. Since onl'>' 22 percent of 31) incidents
3rc report~ to the police, the rcaJ numbc.r is much higher.
■
As of 2010, there were 582 known cases of missing or murdered Aboriginal women
in C3nada.
■
In a 2009 Can3di3n national survey, women reported 460,000 incidents of sexual
3ssault in just one )'C3.r, but only about JO percent of all scxua.1 assaults arc reported
to police.
■
More than one in ten Can3dian ,vomen SO)' they h.nvc been stalked.
When counsellors are ,vorking with ,•ictims of violence, the number one concc.rn
is to help them take steps to ensure their s3foty. Clients should be made aware of their
rights 3nd options, including use of police (phone 911), restraining orders, and tr.msi.tion homes. When dC31ing with pc.rprtrators of victims of spouS31 violence, counseJ,.
lors may face the ch3llcn,;c of dealing with cultural or religious ideologies that favour
p3triarch3l domin3nce 3nd control. Further, cultural norms may preclude disclosure and
the victim, fearful of judgment and shame, may suffc.r the 3buse in private. Counsellors
might explore whether there 3re culture-specific resources such as support groups or
community lea.de.rs th.nt might be of assist3ncc.
For m3ny and varied reason~ women ma'>' choose to stay in abusive relationships.
Counsellors nttd to rem3in c.mp3thic 3nd suspend any tendency to impose judgment
or to push women to leave. While counseJlors can help women understand the inherent
risks of remaining in the home, they need to support the decision to Sta)' or leave as
belonging to the W'Oman, even where this choice sec.ms to defy logic.
SUCCESS TIP
A comtn00, repeat~g pattem (cycle), often emerges in abusive (elationships. This cycle of
abuSe ot violence develOps lhrough lou(slages: (1) build-up of tension, (2) abusive incident
(Wf'bal. emotiOtlal, physical, and sexual), (3) abuse( rem0fSe, and (4) hOOeymoon pe-riOd
(when al is calm).
))}) BRAIN BYTE
I Cl
'.I' I
: 1,:
;,,,1,
The br"ains of children who are abused (Or witness abuse) can
be profoundly affected and lead 10 a wide range of p(oblems,
including emotional (egulatbn (damage 10 tne amygdala, and
cha~ in brain chenistty affecting neurottansmitterS such
as epinephrine, dOpami"le, serotonin, and tne stress hOtrnooe
268
Chap1er 8
cortisol), rearni~ deficits such as difficulty concenttating/
focusing, language acquisition, orga'-ling. loss of interest
(damage to the cortex and hippoc.ampus), sleep distu(bances, retationShip issues, and low self-esteem (American
Psychological AssoclaUon. 2015; Kendall. 2002).
SUMMARY
■
Resistance is a common defensive reaction thnt interferes with or delays the process
of counselling. It may be evident in a variety of ways, such as failure to cooperate
with the basic routine of counselling, subtle or direct nnacks., passivity, and nonvc rbaJ cu cs.
■
lt is important for counsellors to evaluate their own feelings and behaviour as well
as aspects of the a~cncy that might be triggering resistance.
■
Effective confrontation heJps clients come
behaving, or feeling.
■
Clients ma,., become violent or rhrc:.nening for 3 number of reasons. Although it
is difficult to predict with certainty which clients will become violent, some risk
factors can be isolated. The best pnxlictor of violent behaviour is a history of violence; substance abuse is also a common variable. Other factors that counsellors
should consider when assessing risk are age, gender, and pcrsonaJity characteristics.
■
Effective management of potentially violent situations includes prevention and
appropriate responses to the four phases of violence: anxiety, defensiveness, acting
our, and tension reduction. It is important to debrief critical incidents to lessen
shock, reduce isolation, and restore personaJ control. Team debriefing should take
place as soon after the incident as possible. lt should provide an opporrunity for
people ro ta1k about their feelings and to review what went wrong.
■
Counselling interventions include a focus on safety, assertiveness training. anger
mana~ement, cognitive behavioural counseJling, harm reduction, psychiatric assessment and treatment, and support for victims of spousaJ abuse.
to
a different level of understanding,
EXERCISES
Sett-Awareness
I. Self-evaluate your pe-rsonal comfo,1 wtlen confronting
others.
a. What people woukl you have difficulty confronti~?
b. Do you avoid confronti~
c. Think of times wtle-n it was feasonable 10 confront but
you dkl.n't What prevented you from confronting?
d. Flnish the fOUOwing sentenice: Whe-n I confront, I foot • .
a. Youth whO has ~ne problems
b. COiieague who has, in youf opinion, behaved in an
unprofessional maMer
c. Client whO coosiste-ntly arrives late for appointments
2. Evaluate the effectiveness of each of the confrontations that
foltow; suggest impfovements:
a. Try to dO bettef oex.t lime.
b. You'fe an idiot.
c. You'fe saying that you'fe Okay, yet you're ctyk'lg.
d. Grow up and ac1 yout age.
2. Review )'OU' extie-riences deali~ 'Mth inclMdualS wtlo are
a~. fe-sistant, or pote-ntialy vident. What i:S youf natural
reaction whe-n someone's ange-r starts to e-scarate? Oo you
te-nd to fight baek? Of do you withdr'aw? What aspects of
yout experience wiU help you deal effectively 'Mth difficllt
situations? What aspects will impede your ability?
e. As IOOg as you continue to act llk.e a doofmat, you'te
3. Reflect on your thoughts, feelings, and behaviour wtle-n you
wer-e fOfced ot pfessured to do somethi~ against your will.
3. Interview counse-llOfS from diffetent settings tegafding
their experiences with tJiolent Of JX)tentiall'j vident clients.
Discuss suategies that they have found effective.
How might your feactioos help you to undel'Sland and wOr'k
with clients whO are "involuntary·?
Skill Practice
1. Wot'k with a colleague to role-play an appropriate counsellOt
confrontation in each of the fOUOwing situations:
gotng to get abused. If you'te setious at>out protecting
y0Ul'Self, le.ave hint
4. Work in a small group.Assume thatyouaremembel'sof an
innet-city needle exchange centte. Devetop detailed JX>liciies and pfocedures fOr' deaW~ with violent and JX)tenlialty
violent clients.
OiHlcull Situations: Engaging wltl'I Hard-to- Reael'I Clients
269
5. Suppose you review lhe fde on your oox.t dienl, a l&yeaf.
Old male, and discovef thal he was IOUCI and abusive with
his previous counsetlOr'. What are some JX)SSible ex~nalions tot this client's behaviour? Suggest some strategies fof
wOr'king with this clienl
6. Work in a smatl group to exi:,ore the potential beneflls and
riskS ot each of the fOllowing:
a. Having an unlisted phone num bet
c. He's stil a~ry.
8. Wot'k with one Or' two COiieagues to practise asse-rtiver'W!lSs:
a. &pressing angerb. Saying Moo• to a requesa
c. Sharing positive feelings such as IOve Of affeclion
d. Accepti~ a compliment
b. Making home visits alOOe
e. &pressing disagreement
c. Making home visits onty when accompanied
by a
coueague
d. Conducti~ joa"lt interviews for potentiall'y hostile clients
e. Using only youf fll'St name with clients
t Knowing that a dient has a history of viole~
r..
b. He doNtlplays the serious nature of the incident.
Interviewing a client with a police office( present
h. Refusing to see a client with a history of tJiolence
I. Striking a dient to defend yourself
J. ca1;og the police
k. Warn.i~ an intended victim
I. Seeing a client whO has been dra"lking
7. The setting is a residential centm foe youth. Youf laSI lntet..;ew with Petet was partkl.Jarl'j distressi~. It ended wilh his
throwing lhe Chait against the wall, swearing loudly at you,
and then stormi~ out of yout office, Slamming the dOOf in
the pfocess and breaki~ one of the hinges. This in.ddent
seems to have been pfecipitated by his frusttation at not
being anowed to smoke in the centre. OevelOp a ~n for
dealing with Petet during the next lnteMew and in the coming months. Suggest specific leads you can use in the oox.t
lnteMew. Considef Itvee possible scenarios:
a. He di.splays remorse over- wtlat happened.
(Suggestion: Role play aggressive and passive responses fOr'
each of the pfeceding scenarios, then discuss hON assertiveness dlfet'S).
9. Conduct an ex.tended role play baSed on the fOUOwing situation: You have just begun a new job as a youth wOr'ket in
a residential woup hOme. Yout client i:S a 14-yeat-dd bOy
wM has been in care since he was six years old. Ouri~ that
time, he has lived in ovef 17 foster ho.ines. After mooting
you, he says, '"Why ShOtAd I tfust you? You guys are all allk.e.
You make all sorts ot promises, but nothi~ ever happens.
This is just a jOb fof you, but it's my life. Next month, there
wil probabl'f be anOthet new wOr'kef.•
Concepts
I. Research legal and ethtcal codes to ex.plore your
responsibility to notify intended victims of vidence. Talk to
counseltors and agencies fOr' their opinions.
2. Write a ShOrt concept paper lhat deSO'ibes what you believe
are lhe elements ot effective confrontation.
3. Hamachek (1982) says, "Oo not confront anothef person
if you do not wish to rnc,ease yolM' invdvement with that
individuar (p. 230). DIM!lop a tationale that supports lhis
statement.
4. How can assertively ex.pressed anget deepen relations.hips?
WEBLINKS
The Crisis Prevention Institute provides information abOut training programs and resou1ces fo, nonviolent crisis inf0tmation
A comp,ehensive Canadian study on mental illness and
violence
https://www.er1sisprevenbon.com/Spec1a1ties1Nonvio1entCnsis-l ntervention
www.phac-aspc.gc.calmh-sm/pubslmenta1_111ness/indexeng.php
Canadian Centre f01 Occupational Health and Safety provides
information about violence and violence p,evention
Canadian Centre fo, Threat Assessment and Trauma Re:spoose
offers information and training for responding to th,eats and
potentially violent situations
www.ccohS.caloshanswers/pS)'t'hosociaVviolence.html
http://www.cctatt.c-am
Th is ttbsite provides acc-ess and links to a wide rang_e of
health and emotional issues (use the sea1ch feature to find
material on violence).
www.mayocl1nic.com
270
Chap1er 8
sleep
hygiene
healthca
sports
nutrition
physical
activity
C.anbedone/Shutterstock
■
Understand the nature and bf'COOth of mental illness in Canada.
■
Ex-plain the structure, use, and limitations of the Diagnosiic and Suuisrical Manual
of Menral Disarders (DSM).
■
Describe rhc characteristics of and rrearmcm for major mental disorders.,
including sc.hi:ophrenia, mood disorders. :mxicry disorders, eating disorders,
and personality disorders.
■
Explore the mcntaJ health issues of children and youth.
■
Describe rhc nnrure and impact of substance abuse.
■
Identify best-practice approaches for w-orking with clients with substance use
problems, including those with co-occurring disorders.
■
Identify suicide warning signs and strategics for dc3ling with clients who arc
suicidal.
MENTAL HEALTH IN CANADA
Attempts to treat mental illness date back thousands of years, but they were typically
inhumane and crud when judg,ed by tocfay's standnrds. Historically, trc3tmcm of poople
with mcntaJ disorders was barbaric and ineffective with practices such as exorcising,
burning "witches/' bloodletting, whipping, starving, imprisoning, or housing in overcrowded "snake pits'' or insane asylums. During the twentieth and twenty-first centuries,
especially in the last 50 years, mental disorders have gradually been recogni:ed as health
problems. and more humanitarian practices have been dcvdopcd co rcplncc procedures
based on superstition, fear, and ignorance.
Over the past 70 years in Canada, there has bttn a major and continuous shift in
the delivery of mental health services from lonj;•tcrm treatment in hospitals to tT'C1lt.mcm of patients in the community, a process known as dcinstitutionalization. Today,
the population of mcntaJ hospitals in Canada is only a smaJI fraction of what it was
40 years ago (Scaly & 'W hitehead, 2004) and some, such as Riverview HospitaJ in
Coquidam, British Columbia, which once hou~ thousands of patients, are virrually
dosed. However, there arc some proposals to reopen abandoned facilities based on
modeJs of treatmem different from the traditional "wnrchousing" methods of the past.
The development nnd refinement of a ran,;c of psychotropic drugs has been the driving
force behind deinstirutionali!ation because these drugs enable patients to control hnJ,.
lucinations and behaviour that might otherwise preclude their living in the community.
However, this move toward community treatment has often been poorly funded, nnd
new problems for those with mental disorders have resulted, particularly homelessness
(Davis, 2006). Dcinstitutionalization in Canada left many people with mental illness in
communities with in:.ldcquate tre3tmcnt. suppon, and outreach. \\:rhile no one would
argue for a return to the ''\\--nrchouscs" of the nineteenth and earl)• twentieth centuries,
it is clear that many people dischar,;cd from rhc mental hospitals are now living in dire
conditions, often in poverty-stricken inner cities such ns the Downtown Eastside in
Vancouver. Table 9. 1 outlines some facts about mental health in Canadn. The Mental
Health Commission of Canada (2012) proposed an overhaul of the mental health system
that called for broad changes, including the promotion of mental health throughout life,
suicide prevention, support of recovery through use of optimum integrated services,
removal of S)'Stemic barriers to worlc and education, and the strengthening of services
to Northerners. First Nations, and Jnuit peoples.
Mental Health Assessment
The purpose of psychiatric diagnosis is 00( to label clients but to match dingnosis to
treatment decisions based on the best scientific evidence regarding which rreanncnts are
likely to be most effective with each disorder (Corcoran & \\:lnlsh, 2009). Psychiatric
assessment and dingnosis involves (idea.Hy) an in-depth interview, including a thorough
history of the person's situation. Physical examinntions, including brain scans, electroencephalograms (EEGs), and lab tests, mny be u~ to rule our O'l'J:anic illness, which can
cause psychiatric symptoms. Psychological tests mny be u~ to nsscss thinking, person.aliry, and other variables. ln nddition, families and friends are an important source of
information, particularly when clients arc denying the presence of psychiarric symptoms.
Psrchintric diagnosis is influenced by cultural and societal values. For example, at
various times in history, homosexuality has been considered both an aberration and a
gift. Jt is no longe.r considered a mental disorder.
There may be vast differences among individunls with the same mental disorder.
Psychological, social, and b iological variables in8uencc how illness manifests in each
272
Chap1er 9
TABLE 9.1
Mental Health, Canadi an Fac ts
• One in frve C3nadians ot au educatbnal backgroundS, income tievets. and cultures will
experience a menial illness or subsiance mis.use problem duri~ their lifetime-.
• Most mental itlnesses begin in adOlescence and young adulthood.
• Mental itlness arises from a complex k\tetaetioo of biologk.31. genetic, persooaffly, and
e-nvitonmental factors.
• Social ar\CI wOl'kptace pressures, poverty, subsiance abuse, and learned behaviow'al and
lhinking patterns can inftuence 100 onset and outcome of mental illness.
• Studies have Shawn that at least 23 percent and as many as 67 percent ot homeless
people have a mental l lness..
• During any ooo-yeat period:
• Over 8 pefcent ot the canae1ian population expedence a mooo diwdet
• 0.3 percent ex.pe-rience sct.zophrenia
•
•
•
•
•
•
•
•
•
•
•
• 12 percent experience an anxiety diSOr'det
• AltOOSt 2.5 percent expe(aeoce an eating disotder
• One in ten people ex.petience some disability from a diagnosable mental disorder.
In canae1a duri~ 2001- 2002, tnere were almost 200, 000 psychiatric hOspital admissions
with an average stay of 43 days--over 8 mtlion patient days.
MOr'e hospital beds in canada (8 percen0 are tl\Jed with persoos with schiZoph(enia than
with any Olher condition.
Mental itlness costs the healthcare system as much as $7 biltbn, while the annual total
impacl of mental heafth (healttk::a(e, lost prOductMty) exceeds $51 billion.
As many as one--thir'd of the homeless have a mental disorder.
App(oxlI1'13tety 1 percent of canae1ians wi\J ex.pel'ience bipolar disotde(.
At least 2 percent of au deattrs are from suidde.
Personality di:sol"ders affect between 6 percent and 9 percent (estimated) of the C3nadian
population.
Suicide accounts for 24 pe(cent of au deaths among tnose 1S to 24 years of age and
16 percent among 1oose aged 25 to 44 years.
Psychiatric ptoblems are the second leading cause of hospital admissions among 1oose
20 to 44 years (j(I.
Most mental itlness can be 1reated.
Best-practice intervention favours t(eatment in the community using a variety of
counselling inter-ve-ntions, occupational therapy, and medication.
Sources.- British CotufT't>ia Schizophrenia Society. 2008: Centre Jot Addiction and Mental Health. 2017:
Corcoran & Walsh. 2009: [>a,.,is. 2006: Go.<emment oi Canada. 2017a: Heatth Canada. 2002a: NIMH.
2012: Public Heatth Pf,,ett:y oi Canada. 2002: Regen( & Glancy. 2010: and Siatistics Canada. 2005.
person . In addition, people with mentaJ d isorders ma)' have con cur rent p roble ms, such
as poverty, su bstance ab u se, a nd social or reJationship d iffic ulties. A co-occ urring
diso rder is p resent when a person has both a substance abuse problem o r addictio n and
a psyc.hiarric d iso rder.
Psychiatric d iagnosis is made by a physician, prcfcrab l)• a psych iatrist, o r a psrcholo gist who is train~ in clinical assessm ent. Some jurisdictions aJlow social ,vo rke rs who
have co mp le ted considerab le training and supervised experience to make a diagnosis.
Everyone who wo rks in the field should be aJert to sians and S)'mpto ms that warrant
a referral fo r medical and psychiatric assessment. Significant warning signs include:
hallucinations, delusions., identity confu sion , m em ory loss, parano ia, inapp ropr iate
anxiety, eupho ria or sadness, mood swings, eating a nd bod,., image problems. o bses.sions and co mpulsion s., self~harm (e.g., c utting), and substance misu se.
Menial Disorders and Substance Misuse
2·73
SUCCESS TIP
Unless you have specific training, avcid lhe temptation to diagnose me-nt.al iUness. Le.am
to (ecognize the ge-ne<al symptoms and signs of me-ntal disorde-rs such as psychOstS
(hatluclflations and delusions), uncootrOllable- emotions (anxiety aoo depression), and
disturbances in thinking. Then make appropraate ,eterrals, support treatment, aoo promote
tnedication cotnplian::::e.
The Diagnostic and Statistical Manual
of Mental Disorders (DSM)
Diagnostic and Statistical Manual
of Mental Oisorders: Publisiled by
the American Pi)(.hiatric As.sociat._i
is uv.d ps,t.hct>gists. Pi)(.hiatrists,
•d Oiher psyddllerapiUi todassify and
"°
lia:gnose aEGtal disorden.
The DiagnoSLic and Statistical Manual of Mental Di$0Tders (DSM), published by the
American Psychiatric As.soci3tion, is used by ps,.·chologists, psychiatrists, 3nd other
psychotherapists throughout the United States, Cannda, and many other countries to
classify and diagnose mcnta.1 disorders. DSM docs not include guidance or information
on treatment. In Europe and some other countries, the International Classification of
Oiscascs-10 (IC0- 10) is used. The first edition, known as DSM-1, was published in
1952, and it was lar,;ely based on psycho3na.l'tttic principles. DSM-I listed 106 diagnoses
and with cnch subsequent revision, the number increased to the current number of
almost 300.
With the publication of the third edition in 1980, psychoannhttic theory was aban.doncd in favour of a system b3scd on diagnostic criteria. The criteria were rcsc3rched
and developed to help increase rdiabilit)•- the prob3bility that different clinicians
would assess a client with the same diagnostic result or conclusion regarding a person's
mental disorder.
DSM-Ill and DSM-IV used a multiaxinJ S\'Stcm (five axes) to facilitate a more
comprehensive assessment.
■
■
Axis I and II: to classify clinicaJ disorders, with Axis JI reserved for pcrsonn1ity
disorders and mental retardation
Axis lll: to rcpon relc..,ant medic:.ll conditions such as hypothyroidism (which can
cause depression) that affect a mental disorder
■
Axis IV: to report significant strcs.sors such as job and housing problems that miRht
be concributina to the mcntaJ disorder
■
Axis V: Cjlobal Assessment of Functioning Srnle (GAF): used to score on a scale
of 0-100 an individunJ's highest level of functionina in three major are3s: socinJ
functionina, occup3tional functioning:, and psychological functionina. Predictably,
people who have a higher level of functioning before their illness ,;cnemllydo better
than those with a lower level (Saddoclc & Saddock, 2004).
DSM-5 DSM-5, the latest edition, was published in late sprina, 2014. lt contains a
number of sianificant changes including: the followina:
I. The traditionnJ Roman numeral has been dropped and subsequent revisions will be
identified as DSM-5. 1, DSM-5.2, and so on.
2. The multiaxial S)'Stcm introduced in DSM-HI has been eliminated, and all disorders
arc now classified in a single section with 22 chapters.
3. Chapters are ori:ani!cd with a lifosp3n approach, beginning with disorders that are
most likdy diagnosed in childhood.
4. Aspcrae.r's S)rndromc has been eliminated.
274
Chap1er 9
5. Revised model for classifying substance use disorders. which also includes the
addition o f g3mbling disorder
6. New disorders: hoarding and disruptive mood dysregulation
7. The archaic term "mental retardation" has been rep laced by inteJlecrual disability
and intcllecrual developmental d isorder
Appropriate Uses of the DSM The over view in this chapter is a b rief introduction
to the basic structure of the manual. Counsellors should use the DSM classification
S)'Stcm as a diagnostic tool onh• if they have appropriate specialized clinical training. Typically, ind ividmds who use the DSM in the.ir cou nselling p ractice are licensed
psychiatrists or those with grnduate degrees in counselling or psychology. Unrrained
practitioners should not attcmJX to make ps,.·chiatric diagnoses.
Ho\\'ever, all counsellors should have a thorough knO\\•ledge of mental disorders
and the.ir effect on individuals and fam ilies. At the ver y least, they should be able to
recogni!c behavioural, cmotionaJ, and cognitive difficulties that suggest the need for
further assessment (sec Figure 9. 1). The DSM contains valuable information rcg3rd ing
variations in culture, age, and ,;ender with respect to particular mental disorders. The
manual also provides counsellors with refcre.nce materiaJ on the prevalence of mental
disorder~ including lifetime ris k, the typical patterns o f disorders, and data on the
frequency of specified d isorders among biological famil y members.
Warning
Signs
Figure 9.1
-
Signs of a Potential Mental Disorder
CAUTION: The presence of one 0t f1'IOfe oi these warni "1 signs does not mean lhe i ndividual has a
men1a1 disorder: however. 1hey may signal the need for a professional assessment to assess medical or
psychiatric illness.
Menial Disorders and Substance Misuse
2·75
Definition of a Mental Disorder
DSM-5 de.fines a mental disorder 3s follows:
A mental dison:le-r is a S)'ndrome eh3r:v!ted:ed by dmic::alJy si¥ni0eant disturb.In« in
::an individu::al's COitJ1it.On. emotion r~ufatk>n. or behavior th::n refleets. 2 dys.(unetion
in the psyeho1otie3I, bio1otie3I, or de"eloprnent2I process.es underl)' int ment21
(unetionh-)¥. MentaJ disorders. ::are us.uaJI)' assoc:i::ated with si~nil"tet.nt dist ress in sociaJ.
occupational. o r other import::ant 2ctivities. An expec12ble or euhur:1111)' ::approved
response 10 a oommon strdSOror loss. such 3S the de:ith o( 2 IO\wl one. ii not 2 mentaJ
disorder. Soefallr ckvi2nt behavior (e.~. politkal. reli&iOu!l. o r seicwil) and conflicts. that
::are prim::ml)' beh'i~n the individuaJ 2nd soeti'l)' 2rt not ment::al dison:lers unless the
deviance or conflict results (ron, 2 dys-fo~1on in the individuaJ. 2s. described 2bcn-e
(Amerk::an Ps.yehi::atrie Assod::at ion, 2013. p.20).
Unlike medic:)) disorders. sueh 2s.di::abete!l. there2re oode:ar fab1ests th3t helpdinki:ms
10 di2~nose 111ent11I disorders. Consequentlr, 111en121 health dinK"fans. must rely on
DSM~5 criteria 2nd their jud~rnent 1odeterrnine i( the DSM threshold for 2 mental disorder has been re::.ched-"siil)if'leant distress. in soei.31, oee-upahon31. or other important
::.etwities.. (Amerlean PsrehiatrK" Assodat.On. 2013, p.20).
T he.re can be significnnt diffe.rcnces among individu:.ds with the s:.un,e diagnosis. One
person with schizophrenia may suffer debilitating effects 3nd his o r her bch3viour may
present as bizarre. but 3nother m3y respond to medic3tion to the point where he o r she
functions "norma.11)•, " with no one suspectina that this per son h3s a mentaJ disorder. In
addition to the severity o( the disorder, other foctors. such 3S age of onset. presence o(
social support~ 3Vail3bility of treatment, 3nd willingness to follow rreatmem regimes,
affect how weJI people cope.
SUCCESS TIP
Everyone can have intense emot.ions and lhOughts when dealing with stress. These reactions
sholld not be confused with a mental disor'der. A diagt'losis of a mental diSOr'det can only
be justified when lheSe reacti:)ns happe-n over an extended pe(tOCI, and there is significant
impairment ot a perSOO's ability to function in daily life.
Critique of the DSM~S Even before it w3s published, OSM-5 3ttractcd a high level
o ( criticism. Among the most voC3l was Dr. Allen France~ author o ( Sm.,ing Normal:
An Insider's Relolr Agai1m Our..-of-Comrol Psychiatric Diagnosis, DSM-5. Big Pharma. and
rhe Medicalizarion of Ordinary Life. Frances, ch3ir of the task force that compiled DSM
IV argued th3t the new DSM-5 will "IC3d to massive overdiaanosis and harmful ovcrmcdic3tion" with n ew or sharply revised mental d isorders such 3S disruptive mood
dysregulation disorder, medicali!ing normal arid, minor neurocognitive disord er. and
m3ny others.
T he DSM, however, usdul as 3 tool for intcllcctu311)• understanding mental disorde.rs, is based on the medical model of diaanosis with an emph3sis on symptoms and
p3thology. Cou nscllina is p rimarily concerned with individua.Js in a soci3l conre.xt, with
an emphasis on hcJping them to deal with re lationship problems, crisis events, difficul.ties rcJatcd to in3dequate resource~ and problems dealing with ori:ani!ations such 3S
schools or government wclforeoffaces. Effective co u nsellors 3dopt a strenarhs 3pprooch
to problem solving that 3ssumcs the powero( individua.Js to overcome adve.rsit)'. With a
strengths perspective, they emphasi:e "human resilience-the skills. abilities, knowledge,
and insight that people accumul3teover time as they srruggle to sur mount 3dversity and
mttt lifo ch3Jlenges" (Corco r3n & Walsh, 2009, p. 10). They endeavour to find and
respect the successes, 3ssets, and resources o ( people, indudina those resources avail.able within their culture such 3s swe3t lodges and other hcaJina ritua.Js. \\:fhiJe Compton
276
Chap1er 9
and Galaway (2004) rccogni!e the advantages of the DSM in terms of its wide use and
common language for professionals, they also uri;e caution, re.minding us that:
■
Many phenomena included as mentaJ disorders are more usefully explained in
social, economic, or environmental terms.
■
Psychiatric labels often IC1ld co lifetime stigmnti.!ation.
■
Diagnostic reliability re.mains suspect (p. 196).
Lloyd SOOe.rer, medical dir«cor of the New York State Office of MentaJ Hea1th
offers this succinct comment on the value of the controversia.J DSM:
A di.:1KJ10stie m.:m~I of men1:il disordeTS eannot be eluded. Clink':ians need spec1(k· ways
of dedarin¥ what the)' obse-n'i' co be one oondit1on or~mother so che)'C2n spe::ak t'O eaeh
other 2nd t'O p3tients and fanulies. Rese::trehers need reliable db¥ooses co stud)' whether
t re::ttments work, and the course- and proauosi.s of diseases (Sederer. 2012.)
SUCCESS TIP
Most practitioners as well as people wrth mental diSOfderS and theif families wfl find mud'I
more useful and use-r-friendly infotmation on psychiatrk:: illness thtough organizations sud'I
as the C3nadi:an Mental Health Association (d'lma.ca) 0t lhe canae1aan Cen1re f0t Addiction
and Mental Health (carm.ca) than lhey Viill from the DSM. Both sites pfovide compfehen.
SNe information and ad\lice on specific iUness, medications, tfeatment and supPQC'I fof
fecovery, not jusa tfeatment of symptoms.
Structure of the DSM DSM-5 organi:es mental disorders under 20 major chapters
with each diagnostic class funher subdivided into specific disorders (APA, 2013). The
chnpters arc organized based on a developmental lifespan, starting with disorders first
diagnosed in childhood, then progressing to adult disorders. Table 9 .2 provides an
overview of the structure.
Major Mental Disorders
This section provides only a very brief synopsis of some of the most common mental
disorders that counsellors are like1)• to e.ncounte.r, including sc.hizophrcnin, mood
disorders. anxiety disorders, eating disorders, and personality disorders.
Schizophrenia According to the Schizophrenia Society of Canada (2009),
schitophrenia is a chronic (continuing) mental disorder affecting about I pe.rcent of the
population. ln rare case~ children can develop schi:ophrenia, but it usuaJly sta.rts in the
late teens or early Ntenties for men, and in d"K" twenties and Cl.rl)• thirties for women.
Although the exact cause remains unknown, it is bdievcd that the disease is a biochemical
brain disorder involving suspect neurotransmine.rs sud,, as dopamine and serotonin. The
children of a pGrent who has schi:ophrenia are IO times more likcly to dcvdop the disorde.r compared to children of a parent who does not have it (NationaJ Institute of Mental
Health [NIMH), 2012). Schi.!ophrenia is a chronic, lifdong illness with no cure: 00\,·evcr, it
can be treated, and most people are able to rccovc.r and continue with their lives. Nevenhcless, an estimated one of every ten people with the illness dies by suicide (NIMH, 2012).
Contrary to popular opinion, people with sc.hi:ophrenia do not have split personaJj,.
tics, like Dr. Jekyll and Mr. Hyde. Furthermore, although some once accepted it as truth,
parents do not cause sc.hi:ophrcnia➔ The current perspective on the disorder is that it
is caused by an imbalance of the complex, inte.rrcJat~ chemical systems of the brain
(NIMH, 2012), but the.re may be no single cause. The symptoms of schizophrenia wry
among individual~ sometimes dramaticaJI)•. The s~mptoms arc commonly classified as
Menial Disorders and Substance Misuse
schizophrenia: Athronic Mft1al
disorder i11rot-..., s,'llft.aas std as
hallucilations.. delusioa, discwdefed
t!lillling. and social isciblion.
2·77
TABLE 9.2 DSM-5 Structure
M•JO< c.te&OIJ
Specific DJsorde.-s Under Thb Cateaory
Neu(Odevelopmental disotderS
• lntetlectual; communication; autism spec1rum; attantion deflcil/hyperacrivily; learning;
SchizOl')htenia spectrum and other
psychork:: disorders
• SchiZotypal per'SOOatity, delusional; bl'ief psychotk; subStanc&-incluOOCI psychotic;
Bipola( and related disorde-rs
• Bipolar I; bipolar II; cyctothymic; subslance induced bipolar
Depressive disorders:
• Disruptive mood CfySregulation disol"dEr; major' depressive disorder; persistent
depressive diSOr'det (dysthymic) pramenstrual dySphoric diSOr'det; subslance/
meclkation◄nduced depressive diSOr'der
Anxiety disorders:
• Separation anxiety; selective mutis.m; specific phobia; social anxiety; panic;
ago,aphobia; generali?ed anxiety; subStance induced
Obsessive-compulsive and (elated
disorders
• ObsessmKompulsi\18; txxly dySmorphic; hoarding; hair putling (trichotillomania);
excoriatiOl'Vs.Jdn picking. subslaoce induced
Ttauma and stresw-related
disorders
• Reactive atiachment: disinhibitecl social e~etnent; post-traumatic stress.; acute
stress disorder; adjustment
Dissociative diwde<s
Somatic symptom diwders
• Dissociative identity; dissociative amnesia deper'SOOali:zation/dereali?.ation
F'eeding and eating disorderS
• Pie.a; rumination; avoidant restrictive fOOO intake; anorexia oorvosa; bulimia oervosa;
binge eating
motor
catatonic; schizophreniform; schizoaffeclive
• Somatic symptom; illness anxiety; corwersion: psychOlogical factors affecti~ medical
conditions; factitious
Elimtnation di!.orde-rs
• Enuresis. eOCOl')resis
Sleep.-wake disorders:
• Insomnia; hyper'SOtnnolence; narcOlepsy; sleep apnea; central steep apnea; Sleep.
related hyi::x,ventilation; circadian rhythm sleep wake; diSOr'det of arousal; nightmare;
rapid eye movement sleep behaviour; restiess leg; subStance induced
Sexual dySfunctions
• Delayed ejaculation; erectile; female orgasmic: female sexual intetest/arousal disorder;
genil~petvic pain penetration disotder; male hypoactive sex.ual desire; premature
ejaculation; substance induced
Gender dysphoria
Disruptive, impulse controt, and
• Gencl« dySph0tia in children; gendet dysphOr"aa in acldescents or adults
• Oppositional defiant; inte<mittent ex.ptosive: conduct; antisocial perSOnality disorder:
conduc1 disorders:
Subs1aoce use and addktive
disorders
• Akxlhol: caffeine; cannabis; hallucinogen; k'lhalant: opioid; Sedative hypnotic;
stimulant: tobacco; unk.no-,m subStance; gambling
P}'l'omania; kleptomania
Neurocognilive di:sol"ders
• Oefirium; mild & ma;or neurocogoitive (e.g., Alzheimer"s, vascular oeurocognilive,
traumatic brain injury, due to HIV infection)
PerSOOality disorders:
• Paranoid; schi:zoid: Sd'li:zotypal; antisodaf; bOr'dertine; histtionic: narcissistic; avoidant;
dependent; o~ompursi\18
Paraphilk disorders:
• Voye-uristic; exhibitioni:stic; frotte-uristi::::; sexual masochism; sexual sadism; pedaphillk;
fetishistic
Condit.ions kit furthet Sludy
• Attenuated psychosis syndrome; depmssive episodes with short~uration hy(X)mania;
perSistent complex bereavement; caffeine use disotder; Internet gambti~ disorde1;
OOIXObehavioural disorder associated with prenatal ale:OhOI ex(X)sure; non-suicidal selfinjury; suicidal behaviour
(further research encouraged with
poss.ibil~y of i~lusion in future
editions ol DSM)
Soorce: Based on Diagnostic and Statisaic-al Manual of Mental Oiscrdets (OSM-S-), American Psychiatric AssociatKIO
positiw, symptoms: S>,9rptoms ol
ps,t.hosis that incWe hal!l:inatioa,
delusioa, biiarre bdt,lriout, agitati>n,
thought disorder, dis«ganind sp«th
•d bebtiour, and cata;oai:: behariour.
(See also nega!Ne sy,tt¢Mt1J
278
positive o r negative. Positive symptoms may include hallucinntions, delusions., bizarre
behaviour, agitation, thought disorder, disorpni:ed speech and behaviour, and catatonic
behaviour. Ncaative symptoms include blunted or flattened affect, poverty of speech,
emotional and social withdrawal, lack of plC3sure (anhedonia), passivity, difficulty in
abstract thinking, and lad, of ,;oaJ.-dirccted behaviour (Ralph, 2003). Antipsyc.hotic
medications (neuroleptics) are the most effoctive way of tre3ting the positive symptoms
of sc.hi:ophrenia➔
Chap1er 9
There arc a wide variety of early warning sians of schizophrenia, indudina
noticeable sociaJ withdraw-a.I, deteriorating persona] hygiene, irrational behaviour, s1ttp
disturbancc5i. extreme rcaction5i. inappropriate laughter, cuttina or strange use of words.,
and many others (for a more complete list, sec British Columbia Schi:ophrcnia Society,
2008, p. 6).
negative symptoms: s.,np,oas
d ps,chosis tu include blunted c:r
Hattened afP.Ct. pc,.,e,tyof speech,
emotilnal ud social 'lliihdn111al, lack of
plei.suf! (anhedonia). passivity. drlficu.,
in abstract Hilling. -.:I Del ol g_oal•
direaEd bebl'iour. l'See also positive
S]1Q,Ot(IIIS.)
SUCCESS TIP
Psychotropi::: medication, wtlete warranted, is only the firSt step in treatment Aftet medication, counsetlOt'S play a key role tn assist~g clients to manage the negative symptoms
of Sd'li:zophrenia and othet mental disotderS. This is crucial since negative syrnptOO'ls can
be far more dt$1'uptive for people with mental diSOtderS and lheir families than positive
symproms.. Counsenors can also educate families abOut oogative symptoms, which Viill help
them 10 reali:ze lhat these ate symptoms of the disotder, not the resun of lack ot wYlpower.
(Velllgan & Pips, 2008).
Hallucinations There arc wide variations in the symptoms of persons with schi:o phrcnia➔ Most sufferers, however, experience hallucinations, usually auditory but
sometimes visuaJ or olfactory (related to smcJI). These hallucinations ma'>' be \'oices
that tell clients what to do (command hallucinations), or they may be \'lsions of things
that do not exist. Persons with command hallucinations telling them to harm themselves or others are dangerous risks for suicide, homicide, or other violent behaviour
(Soddock & Soddock. 2004).
Hallucinations can affect any of a person's senses, causing them to hear, see, taste,
touch, or smell what others do not. Auditory hallucinations arc the most frequent type
of haJlucination and arc most common for people with schi!ophrenia (60-90%) (Clark,
2015; Fauman, 2002). VisuaJ hallucinations arc much less common, and they are more
likely to occur as a result of acute infectious disease. Olfactory haJlucinations may
occur because of schi:ophrcnia and oraanic lesions in the brain. Tactile hallucinations
(touch) ma'>' occur as a reaction to drugs. Kinesthetic hallucinations may occur after the
loss of a limb ("phantom limb") and O\\•ing to schi zophrenia➔ 'Withdrawal from drugs
may cause vivid hallucination5i. such as the sensation that insects are crawling under the
skin (delirium tremens, common with alcohol withdrawnJ; Saddodc & Saddodc, 2004).
In fact, the symptoms of alcohol withdrawaJ may be clinically indistinguishable from
schi:ophrcnia (NIMH, 2012). \\:lith disordc.rs such as schi.!ophrenia, people may have
auditory hallucinations with voices that arc complimentary, but more often the \'oices
are hostile (Shea, 1998). These \'oices may be so re3f that clients bcJievc that they have
had broadcasting devices planted in their bodies. For example, one client was convinced
that her demist had secretly implanted "radio receivers" in hc.r dcntaJ fillings. Jc w·as so
rca1 to her that she could not dismiss it as imagination.
lt is important to know that many things can cause hallucinations, including
psrchosi~ high fever, mind-a1tering drugs (marijuana, psilocybin, LSD, and opium),
medication5i. withdrawal from depressant drugs such as akohol, brain disease and injury,
epilepsy, sensory deprivation or sensory ovc.rlo3d, oxrgcn deprivation, hyperventila,
tion, hypoglrcc.mia. extreme pain, e>..'tended fasting, dehydration, and social isolation
(Bcrerstein, 1998: Regehr & Glancy, 201 O; S3ddock & Saddodc. 2004). Hallucinations
can also occur in persons who have impaired vision but no mental disorder.
Delusions Delusions are false beliefs that "cannot be influenced or corrected by rea,
son or contradictory evidence (Fauman, 2002, p. 149). Persons with sc.hi:ophrcnia may
experience delusions or distorted beliefs involving birnrre thought patterns. OcJusions
of persecution, t)tpical in paranoid sc.hi:ophrenia, may lead people to believe they are
Menial Disorders and Substance Misuse
hallucination: Afals.e • distor;ed
senso,y pattplion std as Ilea,.,_
~ tasi.i, to~
or s.lling_
what otks do not
c:onvnand hallucination: Adistor;ed
peaptioo of voi::es-.:J iaa,es dir..ct-,
aae to perfcm some a«ion (e.g., attack or
ijtsa.eone).
delusion: Oist«tEdbeiefsort~
pat.'lerns t!l.it c..nct be thallengEd by
«hen • sint ruson • "'idelltf.
2·79
thought broadcasting: The
delusiod baie-f that aae's thinking caa
be heard t,, cthen.
thought insertion: ne delusi:inal
belief that thoughts are being inS!fted
il:o• 's brain t,,othffs.
be.ina chC3ted, controlled, o r poisoned. Other common deJusions indude reliaious
delusions (bclief th3t one is a m3nifost3tion of God), deJusions of grandeur (bizarre
beliefs about one's 3b ilities), deJusions of being controlled (e.a., belief that one is being:
d irected b\• radio mcs.s3gcs), thought broadcasting (belief that one's thinking: can be
hC3rd b\• others), 3nd thouJ:ht in....ertion (beJief th3t thoughts are being inserted into
one's brain by others). Not all deJusions arc bizarre. Ex3mplcs of non-bizarre delusions
are the client's belief that he or she is being watched or that 3 famou s person loves the
client (erotom3ni3) (F3um3n, 2002; Saddock & Saddodc, 2004).
Disordered Thinking Another common feature of sc.hi:ophrenia is disordered think.ing. Jndividuals may be unable to think logically, o r they may jump from one idea to
another without any apparent logic3l connection. Thinking ma'>' be so disorganized and
fraamented that it is tota.11'>' confusina to others.
Social Isolation Persons with schi:ophrenia arc often socially isolated and withdrawn.
They may be emotionally numb, have poor communication skills, 3nd show decreased
motivation 3nd 3b ility for self-care.
Treatment of Schizophrenia Hospitali!3tion may be 3 ncccss3ry first step in the effcc..
tive treatment of 3Cute psychotic symptoms, p3rticularh• if there is a risk of violence
(R3lph, 2003). Antipsyc.hotic medications such 3S clozapine and risperidone are used
to decrease the positive symptoms of the disorder- h3llucinations, aaitation, confusion, distortions, and delusions. There is no cure for schizophrenia, but long-term d rug
m3intcnance now en3bles most people with the disC3sc: to live outside 3 psychiatric
institution.
Counselling is an import3nt adjunct to antipsychotic medication. Counsdlors rypi.cally target their 3ctivitics at helping clients d eal with the socinJ aspects of the disease.
As well, counsdlo rs c3n be instrumental in encouraging clients to sedc psychiatric attention when necessary, and they c.nn suppon psychiatric initiatives by cncouragina clients
to continue with any prescribed medic3tion. This is crucinJ since about 50 percent of
people with schizophrcnfa are noncompliant in mkina their mediation 3nd for those wirh
co-occurrina disorders., medic3tion noncompliance is more common than not (Substance
Abuse 3nd Mental Health Services Administration, 2008). l ong-actina (one to six weeks)
antipsychotic medication is an option for those who have difficult)' (R31ph, 2003).
One client, a young university stu dent, jpvcs us a sense o f what the world of a
person with schizophrenia is like:
I want t'O sue 11\)' dent ist. O\'er the pr3st year. he has been installu)¥ r:1d10 t ransrniuers in
ll1Ji1l{tS. Now he uses them to rontrol me. A t Ar-St, he was nke. and then her.aped me
wlule he ..vork.ed on 11\)' tee-th. Sometimes he makes me sl~p with eomplete str.1.ns;er!l.
I( I don' t ~-et them remo"~ soon. I misht be forced t'O do son~hin~ awful. There are
others. I talked to a woman on the phone the otllt-rday. Her dentist d,d the s::une thin&\Ve ne«I to~-<> undef¥round where Yi't, ea.n be sa(e from the e:nemr.
11\)'
depr-ession: P«v1.Siw de-fbtica in
aood dufatteriz!d by S)mptoms std as
sadness. hope-lmness. dec1uS!d enera,
• d diffiOlty CC1Ceatr~
• d ma-,: Meisi>ns.
nmeatering,
bipolar disorder: A aooi disorder
characteriied by alternatilc pericds al
depressi>n and a.tmally hEigltt.enEd
aood. sometimes to tbe pciill of
i,andi>siy. , , . Mith bipctar diticwder
auy t>euve irrati)nallyte.g..!(ini on
.aintdled bu,-i sprees. committing
seiual indisueioa, and talilg part in
foolish businen iMstmeats).
280
Mood Disorders The two most severe mood disorders (3Jso known as 3ffcctive
d isorder s) arc major depression 3nd bipolar disorder, o r manic-depressive illness.
Depression About 8 percent o f Canadians will deaJ with depression 3t some point in
their lives; however, it is diagnosed twice as often 3mong women, who m3y be more
vulnerable to it or they m3y be more likeJ,., to seek treatment (Davis, 2006). Although
ever yone has bad day~ the depressed foding:s usually pass q uickly. A clinic.nl d i3gnosis
o f depression is made when a person's depressed mood becomes pcn'3sive over time
and interferes with the person's ability to cope with or enjoy life. In this way, depression is differcntinted from the normal mood swings th3t ever yone experiences. Dep ression is almost certainly more widespread th3n statistics suggest since it often goes
Chap1er 9
_ CONVERSATION 9.1
STUDE:NT: What is pafanoia?
MENTAL HEALTH WORKER: Paranoia is a very common type
of delusion that involves faase Of lflc!ltional beliefs 1riat others
afe intant on caus~g one harm. A certain level of suspicion
is normal and desirable as it ptotects us fratn venturi~ into
dangetous situations and from othets taking advantage ot us.
Ho-NENet, i.ndividualS with pamnoia jl«Sist in lhell mistrust of
olhefS, even when evidence to the conttary is ptesented.
They are hypervigilant, and they ate obsessed abOut the
hidden motives of others. Typically, lheit interactions With
people, inch.Jdiog counsellOrS and othet ptofessionals, ate
filtered thr'OUgh theit paranoid lens..
STUDE:NT: How can you tel if it's a delusion or n01?
MENTAL HUlTH WORKER: Sometimes. delusions are bizarre
aoo easdy identified such as the patient who believes that
someone has put trans.rnittets in Mr teeth in Otder to send
her messages and control her behaviou". Other times. 1t may
be difficult to detet'mioo if it is a delusion or if 100 client's
fears are justified. It's important to keep an open mind. One
woman, who had schizophfenia and a number of bi:zarfe
delusions, had trouble convincing people she had been sexually abused by her doctor. They assumed that because ot he-r
illness. her accusation was yet another delusion. In fact, 1t
later- proved to be true.
STUDE:NT: My gfandmothef, who had detnentia, thOUgt\t lhat
her ldds were steali~ ftom her. She aaso believed that they
~Med to kill het in ordef to get he-r money. In fad, it was
hef faili~ memory. She was misplaci~ hef possessions,
then she would conclude she was a vi::::tim of lheft.
MENTAL HEALTH WORKER: YOU( gmndmothef'S situation is
not uncommon wilh detnentia. HowtM!I', we need to be open
to the possibility ot elder- abuSe. Seniors with dementia afe
a vlJoorable g(oup, and there are certainly Sduations v.t'lere
famly membets take ad\<antage of them btf controlli~ and
using their money for personal gain.
STUDE:NT: So, what's the t'OOt cause ot paranoij delusions?
MENTAL HEALTH WORKER: The cause rS stdl unknown, but
the consensus is lhat there is no s~ gJ,e cause. Envir0nment,
genetics. stress. laek ot sleep, hi~ fevef, side effedS of medication, street drugs. and medical conditions such as st(Okes
can all conttibute to paranoia. Paranoia rS also a common
symptom in many mental diSO<ders includi~ dementia,
schiZOl)hfenia, par'anoid personality drSO<der, and moOCI
disorders such as depression and tipolar disorder.
ST\JOENT: How do you treat it?
M£NTAL HEALnt WORKER: Medications and counselling can
be effective, but often people afe unwd\i~ to seek treatment
beeause they do not believe they have a problem. M0teovef,
they are highly suspicious of lheir doctors and counsellors.
Antidepressant, antianxiety, and antipsychOtic medications
are often used. Counse!IOl's can help btf working with thei(
dients to ens.xe medication complt.ance. When symptoms
get noliceabty wOl'se, it rS often a sign lhat they am off theif
medication.
ST\JOENT: What are some counselling stmtegjes?
Mt NTAL HEALTH WORK.ER: Counsellors and others Should
avoid being drawn into ar'guments regardi~ the delusion.
Most often, such an approad'I wdl be met with fesistance and
the client wiU only furthef question lhe moti\ies of lhe hefpef.
As atways. relationship is the key to workil'lg effectively
with someone who rS paranoid, but this will fe(fuire patience,
as 1t is common that the client with paranoid delusions w'III be
highty diStrusrhA of counsetlors, particularty if they challenge
the validtly of strongfy held beliefs. Generalfy, you·• want to
empathize with the client's feeli~ without supporting the
delusion. Ho-.vevet, with SOtne clients. empathy may be experienced oogativel'j as an "attempt to get inside lhei( heads_·
so the counsellor may need to Shift to a less. threatening topic.
Sometimes, the beSI course of action is to distract the
diient by changing the subjed Of actMty. Clients who are
motivated to overcome paranoia can use anxiely manage.
ment techl'liques and cogriitive behaviour'3I strategies 10
addfess unhelpful thinking. Innovative approad'les am atso
avatlable. One uses custom.ized avatafS to represent a pe(.
son's paranoia, lhen the person lea(ns to confront and control
the pamnoia (avata() through role plays and simulations.
untrc3tcd. Jn fact, it is sometimes rderred to as the "common cold o f menta1 illness."
The signs of depression, sometimes described as clinical depression o r major depression to separate it from ordinary sadnes~ can be organi!cd into four major categories
with specific S)rmptoms:
t. Mood disturbances
■
constant sad, anxious, or empty mood
feelings of hopelessness or pessimism
■ feelings of guilt, worthlessness, o r helplessness
■
Menial Disorders and Substance Misuse
281
CM:r SO bilioo neu-ons i"I the bfain al"d b:)jy communicate with
each other- by sendi'lg li1y chemical$ called neurotransmitters
from one neuron to another-. A neufon may have actNe neural
pathway connections to 10,<XX> or more neu-ons. Dysfunction
in 100 neurotransmitter- may be one conlributing factor in a
number of mental and physical diSOrdets. A com pl& a«ay
of factorS iocludi~ he-redity, social factors, environment life
sttess, and othe-r unknown fact0ts make it unlike-ly that a
single cause fer mental inness is pre-sent
GABA: anxiety and fear (def.cit)
Se101onln: depression, mOOCI, sleep. appe-tite, impulSe controt, and aggression
Dopamine: Parkinson's disease, schizophrenia. altention
deficit hype-ractMly diSOtder, motivation. and depression,
moveme-n1
Gllltamale: obSeSSiw<0mpul:Sive disorder (OCD), Sd'li:zophrenia, depression, and autis.m
Aeelylchollne: deptes.sion (excess) and deficit (dementia)
Horeplnephrfne: depression (deficil) and schizophrenia
(excess)
Sources: NIMH, 2015; Hefner, 2015: Mohler, 2013: and Beish.am,
2001.
2. Ch3ng:es in behaviour
■ diminished inte.rest or pleasure in d3ily activitie~ including sex
■ decre3scd energy and fotiguc
■ withdraw·nl from others
3. Alterations in thinlcina
■
difficulty thinking, concentrating, and remembering
inability to malce decisions
■ recurrent thoughts of dC3th or suicide
■
4 . Physical complaints
■ restlessness or irritability
■ fatiaue or loss of enc.ray
■ sleep disturbances, indudina insomnia
■ loss or gain of appetite and weight
■ chronic P3in or other pe.rsistent bodil't' symptoms that are not caused by ph,.•sical
disC3.sc
■ suicide 3ttempts (American MedicnJ Association, 1998; American Psychiatric
Association, 2013; NIMH, 2012).
Scott Simmie, a Canadian journ3Jist, describes how his depression included
obsession with thoughts of suicide:
I spent wttks in bed, un:tble to f'lnd a rea.son t'O ~t up. S1eep wu 11\)' drut- dlt only.
albeit te1nporary. Ml)' to esc:,pe what had befallen 1ne. \\1hen ::rwake I brooded. almost
obsessiv~I)·, on death. Pietured 11\)'stl( dttinK pulleys $0 I oouJd h::ma 11\)'Sel( in the
eondo. .. . Mose mominKS, tilt llrSt thol¢ht that entered my he:3d was to put 2 i[un t'O
it. lbna. Problem solved. (Simrnie & Nunes,. 200 I. p. 27)
In a repon on diaanosis trends by Intercontinental Medical Statistics Inc. (IMS,
2001), which compiles statistical information for the Can3dian hC3lthcare community,
researchers noted th3t visits to 3 doctor for depression have shown the largest increase
among C3n3d3's leadina diagnoses. Ourina the period of 1995 to 2000, JMS statistics
rcve3lcd that visits to doctors in C3n3da for depression inctc11.Scd 36 percent, with
7.8 million consult3tions with doctors for depressive disorders. Put another way, almost
3 percent of nJI physici3n visits we.re for depression. \Vomcn represented 66 percent of
those diagnosed with depression. About 47 percent of individuals (m3lc and fom3Jc)
di3gnoscd with depression were in the 3ge group 40 to 59, 3nd 31 percent were from
the next largest group. m3de up of individu3ls aged 20 to 39. Significantly, depression
282
Chap1er 9
CONVERSATION 9.2
STUDENT: What ShOI..ICI I do when clients begin halllJC~tiog?
TEACHER: The first cotUm ShOulcl be the safely of lhe cli-
ent and others. including yourself. Pay particular attention
to die-nts whO desctibe voices Otdering them to hurt lhembe a
psychiatric emer-gency, particularl'j if lhete is evidence that
the clW!nt haS little at.:lity to resist the commandS.. Police intervention may be necessary to bri~ the person to the hOspital.
Let's talk abOut vd'lat not to oo. Counsenors need to tesist
the tamptation to argue with clients abOut the reatdy of their
setves or others (command hattucinations). This might
halh.,cinations. Altnough some clients are aware of wtle-n they
are hallucinating and have leamed to li\ie 'Mth 1t, others are
convinced of their hallucination's authenticity and dis.miss
argi.unents to 100 contrary. Their' ex.pe-rience is very real and
has to be accepted as such. Thi.s is alSO ltue when dients
are delusional; however-, imptobable 0t bizarre the delusion,
it is real to lhem.
Re~mbe-r that many thi~ can cause haUucinations.
When someooo is hallucinating beeause lhey have 1aken
a s1ree1 drug such as LSD, the beSt appfoach is to @Mure
safely and wait until the effects of the drug dear. I..n some
circumsta~ such as 'llf'len the dient has schizophrenia,
hallucinations afe g,ener-ally tteated wtth anti psychotic medications. Consec:iuently, feferr-al to a ph)'Sician Or' psyd'liatrist
is essential to make sufe that cliants have been assessed
fof an appropriate medication to control their hallucinations.
Subse(luently, it is important to ensure that clents are taJd~
theif medkation and that their dosage is appropriate.
Haih.,cinations can be frigt\teni~, so it is important that
counselbrs remain cam a..nd offet reass...-ance to clients that
they are safe. The canae1ian Mental Health Association (2015
onU..ne) emphasizes 100 impor1ance ot fespecting a client's
personal space and not touching them without invitation.
They suggest minimiMg distr-actions and noise, femaini~
calm, and anowiog dients more lime 10 process and fespond
are important when dealing with dients ~ are haltuc~ti~.
Counsellors sOOUld avoid patronizi'lg 0t huinouri~ clients
abOut lheif hallucinations, as lhis behaviour may pfomote
further halluc~ atrlg. One way that counsellors can fespond
'Mthout arguing is to simply state lhat they do not sense what
theif clients afe ser\S.ing. They can ex.press empathy that
ack~dges the lee6~ that clents may be ex.periencing
beeause of theif hallucinations. CounsellOrs atso can help
dients deal wsth any stressors that may be inc,easi~ the
frequeocy of hallucinations. F'Ot example, if being in large
crowds or rl"is.u'lg Sleep br"i~ on halludnations., clients can
take steps to minimi:ze these pfecursors. It may be helpful to
work With clients to help toom learn ski!IS for contfCIU..ng theif
hallucinations.. F'Ot ex.ample, they can discipline 1oomselves to
dir'ect lheir thoughts and activtties el:Sewhere. One researthet
found that silence, isolation, and attention to oneself tend to
promote hatlucinalions, but distr-action, explOt'atary activity,
movement, and extemal stimulation tend to impede hallucinations <S.lva & Lopez de Sitva, 1976). So simpty diverting
dient attention can be a useful strategy.
ST\JOENT: I learned something from one of my dients that I
found helpflJ and profound. I remembef him saying to me,
Ml have a mental di:sor'd,e,, but don't forget I ha\18 the same
needs and fears as ENe,Yone else.· I was reminded that he
and I were m::,fe a•ke than unlike each other.
TEACHER: MOfOOVef, hallucinatior\S and delusions, which
often define illnesses such as Sd'li:zophfenia, are common k'I
nOf'mal "e. Clar'k (2015) reported that -nanu::::inations, despite
common mi:sconceprions, are a part ot normal healthy life:
F'o, ex.ample, we might hear a noise and lt'link someone
has called our name. Or, in the periOd between waking and
sleeping, we nigt\t temporarily rose contacl with reaHy.
now ranks second behind essential hypertension as the leading reason for visiting a
physician. Moreover, the report su~est~ that almost 3 million Canadians have serious
depression, but less than a third of them seek help.
SUCCESS TIP
Premorbid functioning is a n'l8asufe of how wel an individual coped bef0te the onset of
mental disofdet or the nisuse of subStances. Ma tlJe, lhOSe who have a histo,y of success
in broad areas of life such as car'eer, relationships, and management of emorions Ml have a
more positive prognosis lot success. Asking clients to describe rimes in lheir IN8s when they
dkl not ha\18 a prOblem (e.g., when they wete not misusing drugs) is an effective way of identifying strengths as well as reasonable success goalS (i.e., retum to premorbid functioning).
Depression is beJieved to be caused by a complex combination of three primary
variables-biologicnJ, genetic (inherited), and emotional or environmental (American
MedicnJ Association, 1998). BiologicaJ o rigins are associated with brain chemistry and
Menial Disorders and Substance Misuse
283
hormon3l activity. RcsC3rch has demonstrated that some families are more likely to
have members who suffc.r from depression. Although no specific gene has been linked
to depression, the.re appears to be ample evidence that heredity lends to an increased
vulnerability to depression. EmotionaJ and environmental causes might include stress.ors such as the death of a loved one, a job loss, or the brc3kup of a relationship. As
well, depression might be the result of sleep disturbances. illness, or drug reaction.
Depression that originates from physicaJ illness usually abates once the physical illness
is trcnt~. Depression is symptomatic of a medical condition in about 10 pc.rccnt to
IS percent of all cases. Known physical causes of depression include thyroid disease,
adrenal gland disorders., hyperparathyroidism, diabetes, stroke, infectious diseases such
as \•iral hepatitis, autoimmune disorders, vitamin and minc.raJ deficiencies, and cancer
(American Medical Association, 1998). Thu~ clients who are den.ling with depression
should be referred for a medicaJ chcclc,up as an adjunct to counselling.
Counsellors can assist people who are depressed in a numbc.r of ways:
■
HcJp them recognize and identify the symptoms of depression.
■
Rdcr them for appropriate medical examination and treatment, whic.h might
include medication or hospitalization.
■
HcJp them to develop coping strategics for dcaJing with stress.
■
Counsel them for loss or grief.
■
Assess and manaac suicide risk.
■
HcJp them develop cognitive/behavioural strategies for overcoming low seJf-estccm
and other self-defeating thought patterns t.hat often accompany depression.
■
Support and understand emotions.
■
Provide family counselling to intc.rrupt communication patterns that contribute to
or escalate depression.
Bipolar Disorder With bipolar disorder, depression a1tcrnates with manic episodes.
During manic periods, people typically experience heightened energy, a euphoric mood,
and a grearJ,., incrca~ sense of confidence, sometimes to the point of grandiosity.
They may have sharpened and unusuaJl,.•creative thinking, aJong with a much-decreased
need for sJeep. Or they ma,., experience a flight of idC3s (thoughts without logicaJ con.ncction). Alt.hough they may engage in increased aoaJ-directed activities at work or
school, they often engage in them without rcg:ird to the consequences, thus, IC3ding
to irrational behaviour such as uncontrolled bu)•ing sprees, scxuaJ indiscretion, and
foolish business investments (Amc.rican Psychiatric Association, 2013; NIMH, 2012).
Scon Simmie's recollection of his mindset when he was in the midst of the manic
phase illustrates the irrationality of this state:
Despite e"\>erythinK rd been throu~,. I w:lS still oonvineed that I w:lS in pe-rfe<"t health.
t~t the real probLe1n wu the (~1lure o( other!? to ~ i : e that somethinK extraordi,
nar't' and wonderful h::.d h::,ppentd to 1ne. That I had been spintuall)• re.born. TI,::u 11\)'
limitless potential had Onall't' been (reed. (Slnunie &. Kunes. 2001. p. 25)
))}) BRAIN BYTE
I
C,_:,r ,, ,r
Current thinking suggests that it tS a combination of fac:tOrS
that results in deptession. For example, if people with a pre,.
disposition to depression ex.pe-rieoce stressful life crises. tney
may devetop depression. SubSe<!uently, lheif first deptessive
epiSOde may stimulate d'langes in brain chemistry 1h31 leave
284
Chap1er 9
tnem more vulnerable to further episodes, when even small
stressful events can tr1gger depression (American Medical
Association. 1998). Thyroid prOblems (overactive 0r uncleractNe) and hOfmooal imbalances (e.g.• after' chikibirth) can also
pray a rde in depcession CTartakovsky, 2015).
Thus, it is very difficult, though not impossible, to persuade people to accept
treannent. including hospitalization, during the manic phase of the illness. Supportive
counsellors, famil't', and friends may convince them to seek trentmcnt. but in some cases.,
particularly where behaviour has become self-destructive or dangerou~ involuntary
hospitalization may be necesS3ry.
Bipolar disorder usually begins in adolescence or early adulthood and continues
throughout life. It is often not recognized as an illnes~ and people who have it may suffer
neo:llcssl)• for yenrs or even decades. There is evidence that b ipolar disorder is inherited
(NIMH, 2012). Persons with untreated bipolar disorder ma)' experience devastating
complications, including marital breakup. job loss, financiaJ ruin, substance abuse, and
suicide. However, almost everyone with bipolar disorder can be helped through the use
of medications such as lithium, whic.h has demonstrated effectiveness in controlling
both depression and mania. Bipolar disorder ca.nnot be cured, but for most people,
treatment can keep the disease under control.
Anxiety Disorders A nxiet)' disorders arc characterized b\• higher than normal levels
of fear, worry, tension, or anxiet)' about daily events. High anxiety may be present without apparent reason. Four serious anxiety disorders arc obsessive-compulsive disorder
(OCD), phobia~ panic disorder, and post-traumatic srress disorder (PTSD).
anxiety disorders: "'>ce than nonnll
1Mb al fear. 'Mlff)', v.sion.« afllie1y
abOCII daily ewnts.
Obsessive-Compulsive Disorder (OCD} An obsessive-compulsive disorder (OCD)
involves recurrent, unwanted thoughts and conscious, ritualized, seemingly purposeless acts, such as counting the number of tiles on the ceiling or needing to wash one's
hands repetitively. Behavioural techniques and medication have proved effective in
treating this disorder.
•asllone'i'-'is repetiiwfy.
Phobia A phobia is an irrational fear about particular events or objects. Phobias
phobia: An irr.atic.al fear atoll
result in overwhelming anxiety in response to situations of little or no danger. Most
people have phob ias of one sort or a.nother, such as fear of flying, height~ public speaking, or snakes. For the most part, people dcaJ with their phobias through avoidance,
which decreases the anxiety associated with the fear. Unfortunately, avoidance increases
the fcar of the particular object or situation. Treatment of phobias is necessary when
they interfere with a person's capacity to lead a normaJ life. For example, agoraphobia
(fear of open or public spaces) prevents people from leaving the S3fety of their homes.
Trcatmcnt in such cases is essential to help clients escape what ,vould otherwise be
seve.ret,., restricted lives.
\Vith systematic desensitization, individuals with a phobia arc first taught how to
manage anxiety through relaxation. \\:'ith the help of the counsellor, they construct a
hierarchy of anxiety-provoking events associated with the phobia. Finally, they lcarn
how to control their anxiety with progressive.I,., more difficult exposures to the anxietyproducing object or event. ln addition, other specialized bdi.aviouraJ techniques, such
as flooding (immersing a person in the situation causing fcar or anxiety), relaxation
training. and pharmacologic (drug) trcatment, may be necessary to relieve anxiety
disorders.
particdar events or obje::ts that mula
in t'l!hflelming anriety ii iesp)llse
to siiuatioos ■heie tilef! is little or no
danga.
Panic Disorder A panic disorder involves sudden attacks of terror and irrationaJ fear accompanied by an overwhelming sense of impending doom. During a panic
attack. a person may cxpe.ricncc symptoms such as an acccle.rated heart rate, sweating.,
shaking, shortness of breath, chest pain, and nausea. as well as a fcar of dying or losing
control (American Psychiatric Association, 2000). Medication and psychotherapy have
proven effective in trcating this disorder.
Post.Traumatic Stress Disorder ( PTSD} Post~trau matic str ess d isorder (PTSD)
S)•mptoms devcJop following traumatic events such as rape, assault, natural diS3stcrs
(ennhquakcs, floods, etc.), war, torture, or an automob ile accident. Symptoms may
Menial Disorders and Substance Mi suse
obsesSM-Compu.lshe disorder
(OCO}: RecurNI, unw•ed thoughts
and conscious.. ritualilell s ~
purp)seles.s acts, such as u untii-, the
numbs of tiles on tile ttiling oc aeeding to
panic disorder: Sudden atlaclsClf
tero and irr.atic111I fear~ i . d
by an c,,endllelming SMSe Clf impeading
doom. 0uri-, a panie attack. a persoo
mlJ eq>Hiellce S)'lllp,-s std as an
aroeli!rated he.aft ra~ SM:--,_ shaking,
shortness o! bieath. dlieSI pail. . .sea.
and fear Clf dying or 1os;.g aintd.
posHraumatic stress disorder
(PTSO): Disabling symptOms such as
emotilnal n..t.ess.. sleep dm.bance
(11. -mares. difficulty sleeping).•
ieli--, tbe Mal fdbaing a tt-atic
e.811 sedl as r•. ass.tttt. n.a.111ra1
disaster (earthquakes, foods.. et£:.). •ar.
tortuf!, or aa w.omobie accident
285
occur immo:linccly after the event or ma,., be dcla,.·ed by months or 't'C3rs. R«ollec~
tions of the event result in disabling symptoms, such as emotional numbness; sleep
disturbance (nightmares, difficulty sleeping): reliving the event; intense anxiety at exposure to cues that remind the person of the trauma: avoidance of activities. people. or
conversations that arouse r«all of the trauma; hypervigilance; and outbursts of ange.r
(American Psychiatric Association, 2013). PTSD symptoms often dissipate within six
month~ but for some people the symptoms may last 't'ears. Relaxation training and
counselling are effective tools for treating this disorder.
Eating Disorders The two most common eating disorders. anorexia ne.r~a and
bulimia, are most likel)• to affect adolescent and 't'oung adult ,vomen, with about 90
percent of all those afflicted coming from this group (NIMH, 2012). Approximately I
percent of adolescent girls dcveJop anorexia ner~a and as many as 10 percent develop
bulimic disorder (NIMH, 2012). Eventually, half of those with anorexia will develop
bulimia (NIMH, 2012). Eating disorders are difficult to rreat because many people
refuse to admit that they have a problem and resist treatment. Counsellors and family
need to persuade those affected to see.k rreatment, but this can be hard because people
with these disorders may argue that their only problem is the "nagging" people in their
lives. Because of the life~threatening nature of eating disorder~ involuntary rreatment
or forced hospitalization ma,., be necessary, particularly when there has been excessive
and rapid we.ight los~ serious metabolic disturbances. and serious depression with a
rislc of suicide.
The National Eating Disorder (nformation Centre (NEDJC), a Toronto-based non.profit orpni!ation, offers this explanation of the cause of eating disorders:
E2tinK d1sordeTS 21re C3used b't' 3 combiMtion o( soc:iet2!. indMdu2I, and l211nily l2ctors.
They 2re 21 maiufest3tion o( rompLex underf)•ina str~!es with ;dentity 21nd self~oncept.
and of problems t~t often stem from tr.-um2tic experiences and patterns o( soc:ialb,,
t.On. E3tina d1sorderS are oopifl¥ behaviourS that provide the indMduaJ with ai, outlet
for d1spbcement o( (ee.linv <>r with 21 (false) sense o( be.in¥ in oontrol. Common t'O a.JI
ea.till¥ disorders is a per\'asive underi)'ifl¥ sense of pcM•erlessness.. (2005)
Social and Cultural Variables For most of recorded history, plumpness in women was
deemed desirable and fashionable. But during the last 60 years, particularly in Western
cultures, women have been bombarded with media messai;es t