The following topics and chapters will be covered in Quiz #3:
Ch4:
 Carl Rogers’s view(s) on what therapist qualities and alliance does for client.
The therapeutic alliance provides a safe and supportive environment for the client to
explore their thoughts and feelings, work through their issues, and ultimately promote
personal growth and self-acceptance.
 Therapeutic silence use(s).
Therapeutic silence facilitates client talk, respects the client's emotional space, or
provides clients with an opportunity to find their own voice regarding their insights,
emotions, or direction. Silence also allows clients to reflect on what they just said.
Silence after a strong emotional outpouring can be therapeutic and restful. In a
practical sense, silence also allows therapists time to intentionally select a response
rather than rush into one.
 What is a clarification response used for?
to make clear for yourself and the client precisely what was said
 Summarization
Demonstrates accurate listening, enhances client and therapist recall of major themes,
helps clients focus on important issues, and extracts or refines the meaning behind
client messages
 Therapeutic use of interactive summaries
Allows you to hear your client's view before offering your own. You can always add
what you thought was important later. Using a collaborative approach can feel
empowering to clients.
Ch7:
 Carl Rogers’s core conditions
congruence, unconditional positive regard, and accurate empathy
 Carl Rogers’s definition of empathy
the therapist's sensitive ability and willingness to understand the client's thoughts,
feelings, and struggles from the client's point of view. [It is] this ability to see
completely through the client's eyes, to adopt his frame of reference [p. 85]… It
means entering the private perceptual world of the other… being sensitive,
moment by moment, to the changing felt meanings which flow in this other
person… It means sensing meanings of which he or she is scarcely aware.
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 A Deeper Look at Empathy
Emotional stimulation: This happens when one person experientially mirrors
another's emotions
Perspective taking: This happens when you try to “see” the world from another
person's perspective.
Emotion regulation: Therapists must cope with and process their own emotions
and then provide an empathic response
 Countertransference/transference
Freud (1949) defined transference as a process that occurs when “the patient sees
in his analyst the return—the reincarnation—of some important figure out of his
childhood or past, and consequently transfers on to him feelings and reactions that
undoubtedly applied to this model”
Countertransference: Client transference triggers analysts' unresolved childhood
conflicts. This triggering results in analysts' acting out in ways consistent with the
unresolved conflicts. This CT is negative and should be “overcome.”
 Working alliance
Goal consensus or agreement
Collaborative engagement in mutual tasks
Development of a relational bond
 Relationship ruptures
tensions or breakdowns in the clinician-client collaborative relationship
Ch10:
 Law requirement on assessing suicidality
All states have explicit expectations of a duty to protect that requires clinical
recognition of the severity of clients' emotional and behavioral problems when these
struggles pose an imminent danger to self. If you determine that a client is actively
suicidal, you become legally responsible to initiate safety planning
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Risk factors
Mental Disorders and Psychiatric Treatment
Social Isolation/Loneliness
Previous Attempts
Self-Harm
Physical Illness
Unemployment
Military personnel
Sexual orientation
Firearms availability
Suicide Contagion
Abuse and bullying
Demographics
 Protective factors
 Reasons for living (children, loved ones)
 Higher global functioning (higher overall life functioning = lower suicide rate)
 Social Support
 Life evaluations (viewing life as meaningful)
 Frequent religious service attendance
 Suicide-related beliefs (believing that suicide is unacceptable)
 Connectedness to parents
 Neighborhood safety
 Academic achievement
 Supportive school environment
 Coming out (LGBT)
 Beyond the Medical Model
Contemporary practitioners began integrating a constructive (narrative and solutionfocused) perspective into suicide prevention work in the 1990s. This perspective
holds that, at least to some extent, individuals construct their own personal meaning
and reality. Constructive theorists posit that whatever we consciously focus on, be it
relaxation or anxiety or depression or happiness, shapes our individual reality. What
this means for suicide assessment and treatment going forward is that clinicians
should move away from illness-based weaknesses, deficits, and limitations and
instead adopt a stronger emphasis on clients' strengths, resources, and potentials.
Ch11:
 Factors affecting accurate diagnosis.
 Client deceit or misinformation
 Interviewer countertransference
 Diagnostic comorbidity
 Differential diagnosis
 Confounding cultural and situational factors
 Central focus of diagnostic interviews
gathering reliable and valid data to support accurate mental disorder diagnoses.
 Areas to assess for current functioning
 Typical day
 Social support
 Coping Skills
 Physical Exam
 Client Strengths
 Techniques to use with resistant clients
 De-emphasizing therapist authority and guidance
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Using tasks that “bolster patient control and self-direction”
Not using “rigid homework assignments”
Presenting homework assignments as experiments
Listening more and talking less
Providing fewer instructions
Emphasizing “self-directed work and reading”
Ch12:
 Therapeutic resistance
 From Clients: beliefs, attitudes, ambivalence, or opposition to therapy.
 From Therapists: overuse of confrontation or interpretation, rather than
focusing on clients' positive potential for change, can stimulate client
resistance
 As a function of the situation: a product of a difficult and uncomfortable
situation, a situation that naturally triggers reactance (i.e., negative
expectations and defensiveness
 Basic interviewing responses
 Motivational interviewing is a directive, client-centered counseling style
for eliciting behavior change by helping clients to explore and resolve
ambivalence
 Open Questions, Opening Questions, Goal-Setting Strategies
 Reflection, Amplified Reflection, Undershooting
 Amplified reflection
intentionally overstating of the client's main message
 Radical Validation
consciously accepting and actively welcoming all client comments—even odd,
disturbing, or blatantly provocative comments
 Reflection
When therapists accurately reflect their clients' efforts, frustration, hostility, and
discouragement, the need for clients to defend their positions is reduced.
 Cultural humility
Allow yourself to embrace an other-orientation, rather than focusing on your own
values; hold high your respect for diverse cultural values and ways of being; and
let go of any ideas you may have related to your own superiority.
Ch13:
 Types of countertransference
1. Classical. This is Freud’s view. Client transference triggers analysts’ unresolved
childhood conflicts. This triggering results in analysts’ acting out in ways consistent with
the unresolved conflicts. This CT is negative and should be “overcome.”
2. Totalistic. This CT refers to all reactions the therapist has toward the client. These
reactions are meaningful and should be studied, understood, and used to enhance
therapy process and outcome.
3. Complementary. This CT emanates from specific client interaction patterns that “pull”
therapists to respond in ways that others (outside therapy) respond to the client. Good
therapists inhibit their reactive impulses, seek to understand the nature of the
transaction, and use this knowledge to frame interventions to modify the client’s
maladaptive relational style.
4. Relational. This CT is constructed from the combination or integration of the unmet
needs and conflicts of both client and therapist.
 Parental involvement in child individual therapy
 Letting caregivers know that you'll be summarizing and sharing information
with the child will help set a meaningful semipermeable boundary
 Children's guardians have many legal rights, but if you're doing individual
therapy with children, the children should know that your primary allegiance
is to them
 articulating your policies and guidelines early clears up potential confusion
and allows you to develop a working alliance with the child
 It's helpful to try connecting with young clients first.
 Direct interaction and attention to parent concerns is crucial to getting the full
picture and to treatment compliance. If parents don't think you're addressing
their concerns, they won't support therapy.
 During joint meetings with parents and children, actively work to limit the
number of negative comments parents make about their children
 How to facilitate toy play therapy
Depends on goals
Give child permission to play
Allow you to observe what child chooses and how they play
 Nuances of mandated reporting
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Explaining confidentiality to teenagers and parents is especially delicate. To
do so well, you'll need to address several issues: (a) basic confidentiality
limits, (b) how parents hold a legal right to access their teenager's records, (c)
how you hope parents will give you and their teen freedom to talk openly
without fearing their intrusion, and (d) whether and how much you'll disclose
to parents when teen clients tell you about behaviors their parents wouldn't
approve (see Case Example 13.2).
 Termination or end of therapy with children vs adults.
 Especially during the closing, provide reassuring, supportive feedback.
 At the end be sure to allow time for questions and for reflecting on having
spent time together
 Children can be more overt and extreme in their termination behaviors. Adults
may wish to hug you but refrain, whereas children will jump into your arms.
Adults may fantasize about telling you to “f—off” toward the end of the
interview, but adolescents will just say it. Adults might feel sad; children will
burst into tears. Adults may express disappointment; children will complain
loudly that their time is up or rush out early. You need to stay in your role of
observer, empathizer, and gentle limit-setter. Sometimes, children feel things,
reflect things, and enact things acutely and dramatically.
Countertransference with children: Overidentification/Withdraw
 Projective Art/Play Therapy
 Can be excellent strategies for obtaining information and building rapport and
their utility in helping young clients open up and express themselves is high.
 Projective drawings are best for stimulating conversation, generating
hypotheses, and building rapport
 Projective drawings also may prompt conversations about cultural issues.
 Play is the means through which they work out pain, achieve mastery, explore
new terrain, and take risks. It's also a means through which they can distance
themselves from things too difficult to deal with directly.
Ch14:
 Gottman’s four horsemen that predict divorce
Criticism, defensiveness, contempt, and stonewalling.
 Genograms
Couple and family clinicians often use genograms as tools for understanding
multigenerational family dynamics. Family constellations used to explore family
history, legacies, birth order, and other family-of-origin dynamics that may
influence the current couple or family relationship