Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society 7th Edition Allen E. Ivey University of Massachusetts Mary Bradford Ivey Microtraining Associates Carlos P. Zalaquett University of South Florida Copyright © 2009 Chapter 12 Influencing Skills: Five Strategies for Change Blessed is the influence of one true, loving human soul on another. George Eliot Chapter goals ▲ Introduce five influencing skills: 1. 2. 3. 4. 5. self-disclosure feedback logical consequences information/psychoeducation directives ▲ These skills have specific strategies to facilitate restorying, generalization, and action. Competency objectives ▲ Master five influencing skills to: Share your story, thoughts, or experiences briefly with clients (self-disclosure) Provide accurate data so that clients can learn how their actions are seen by others and/or the interviewer (feedback) Help clients look at the possible results of alternative actions. (logical consequences) Present new information and ideas to clients in a timely and appropriate fashion—for example, career information, teaching about sexuality, and results of test scores (information/psychoeducation) Provide clients with specifics for action (directives) The Case of Alisia The client, Alisia, comes in with the complaint that she can’t express herself. Feels helpless and believes that everybody “runs all over” her. She feels powerless and wants to talk about her difficulties to get people’s attention. She says that she has tried to communicate with her partner, her employer, and many others but they don’t seem to care. She is frustrated and angry. The Case of Alisia Reflection Questions ▲ What do you think about Alisia’s situation? ▲ How might you help Alisia? (hint, remember the five stages of the interview!!) INTRODUCTION: THE RELATIONSHIP OF LISTENING AND INFLUENCING SKILLS ▲ Influencing is part of all interviewing and counseling. ▲ Confrontation, focusing, reflection of meaning, and interpretation/reframing are skills of interpersonal influence. ▲ This additional five skills introduce here work to directly change the way clients think or act. Interpersonal Influence: Listening Skills, and Influencing Strategies You cannot not influence what happens in the interview Interpersonal Influence: Listening Skills, and Influencing Strategies ▲ Mastery of the: Microcounseling skills and strategies Five-stage interview plan Relationship--story and strengths—goals—restory—action model ▲ Enables you to connect with theory and broaden your possibilities for culturally intentional counseling and interviewing. INFLUENCING SKILLS ▲ Listening skills are integral to effective influencing skills. ▲ Listening skills set the stage for the use of influencing skills. ▲ Influencing skills seek to promote change. ▲ Structure the interview and disclose the process to the client. INFLUENCING SKILLS ▲ Ethical practice demands respect for the client and awareness of the power relationship inherent in the interview. ▲ As you move to direct action with the influencing skills, do not forget the foundation of listening and empathic understanding. ▲ Remember that counseling and interviewing are for the client, not for you. ▲ Use influencing skills with full client participation. Disclosure ▲ Disclosure of what is going to happen in the session is an important part of maintaining a relationship and working alliance. ▲ Disclosure builds comfort and trust. ▲ The general rule is to avoid surprises. Using influencing skills: Listen, then act ▲The 1 - 2 - 3 Strategic Model 1 Listen and Assess 2 Select a Relevant Strategy 3 Observe and Respond 1. Listen ▲ Determine clients view through attending, observing and listening ▲ Find how the client see, hears, and feels the world with “I” statements ▲ Identify: Content with paraphrasing Feelings with reflection of feeling Meaning with encouragers and reflection 2. Assess and Influence ▲ Use influence AFTER you understand the client’s view. ▲ Influencing skills provide a new frame of reference from which the client may act. 3. Check Out and Observe ▲ Check out and observe AFTER use of an influencing skill. ▲ Observation becomes critical during influencing. ▲ Examine the impact of your intervention using the fivelevel of the CIS. ▲ Return to listening if you sense or observe: Verbal or nonverbal discrepancies Increasing distance from the client Five Influencing Skills 1. 2. 3. 4. Self-disclosure Feedback Logical consequences Information/psychoeducation/opinion/ instructions/suggestions 5. Directives Client Change Scale (CCS) The Creation of the New Denial 1 Full Examination Decides to Live With But No Partial Incongruity Change Examination 2 Denies or Discusses fails to hear part, but not incongruity. all of incongruity. 3 Discusses incongruity completely, but will not change. 4 Discusses and is fully aware of decision impact. Decides to Change From Incongruity 5 Discusses and alters choices when faced with incongruity. Low The Moderate Triad Moderate Confrontation Directive Logical consequences Interpretation / reframe Feedback Self-Disclosure Information / psychoeducaqtion. Focusing Closed questions Open questions Reflection of meaning Reflection of feelings Paraphrasing Encouraging / restating The Interpersonal Influence Continuum High Example Interview: The Case of Alisia--How listening skills can influence clients Reflection Questions ▲ What was Alisia’s main complaint(s)? ▲ What do you think the counselor did well? ▲ Which skills were used more frequently? ▲ Was Alisia helped? ▲ Did the counselor spent time on Alisia’s strengths and wellness assets? ▲ What would you have done differently? ▲ How can you use the CCS to rate Alisia’s progress. INSTRUCTIONAL READING 1 AND EXERCISES: SELF-DISCLOSURE If you use self-disclosure skills as described below, you can predict how clients respond. Self-Disclosure: As the interviewer, share your own related past personal life experience, here and now observations or feelings toward the client, or opinions about the future. Selfdisclosure often starts with an “I” statement. Here and now feelings toward the client can be powerful and should be used carefully. Predicted result: The client is encouraged to selfdisclose in more depth and may develop a more egalitarian interviewing relationship with the interviewer. The client may feel more comfortable in the relationship and find a new solution relating to the counselor’s self-disclosure. Self-Disclosure Should you share your own personal observations, experiences, and ideas with the client? ▲ Controversial topics need care. ▲ Many theorists argue against it and suggest a more distant persona. ▲ Humanistic and feminist counselors value appropriate self-disclosure. ▲ Multicultural theory supports self-disclosure early in the interview to build trust with clients from a different background. ▲ Research reveals that clients of counselors who selfdisclose report lower levels of symptom distress and like counselor more (Barrett & Berman, 2001). Self-Disclosure ▲ What about situations in which you have NOT experienced the client’s issues. ▲ Clients often feel that no one can really understand if you have not experienced their issues. ▲ Open discussion, some self-disclosure on your part, and exploration of differences may be essential. ▲ Self-disclosure of who you really are can be helpful in those situations in which you have not “been there.” Self-Disclosure Strategies of Interpersonal Influence ▲ Encourages client talk. ▲ Creates trust between counselor and client. ▲ Establish a more equal relationship. ▲ Counselor shares thoughts, feelings, and experiences with clients, Genuinely In a timely manner With appropriate tense Being careful not to monopolize client’s time. Self-Disclosure Effective self-disclosure 1. 2. 3. 4. Listen – use the 1-2-3 strategic model. Use “I” statements and self-reference. Briefly share or describe your thoughts, feelings, or behaviors. Use appropriate immediacy and tense, making selfdisclosure relevant. Genuineness Making Self-Disclosure Relevant ▲In relation to self - counselor must truly and honestly have had the experience or idea. “I had a similar issue. This is what it meant to me . . .” BE BRIEF. ▲In relation to client - experience must be in synchrony with client feelings and experience and they are ready. “My experience at this moment is that I almost feel your hurt myself right here in my heart.” Tense Making Self-Disclosure Relevant ▲ Present tense here and now is often the most powerful self-disclosure. ▲ Tense variations can also strengthen or soften the power of self-disclosure. Be careful when clients say, “What would if you do if you were in my place?” ▲ Self-disclosure is not necessarily the first tool for use in this situation. ▲ Help the client make her or his own decision. ▲ The right solution for you may not be the right solution for the client. ▲ Involving yourself too early may foster dependency. “Well, I’m not you, but it does seem to me that you are close to deciding to move to the new job. I’d be torn myself just as you are.” Later very carefully, if appropriate-- “Nonetheless, if I were you, I think I’d be tempted to take this opportunity.” Timeliness Making Self-Disclosure Relevant ▲ If a client seems to want to talk about a topic but is having trouble, a slight, leading self-disclosure by the counselor may be helpful. ▲ Too deep and involved a self-disclosure may frighten or distance the client, or may monopolize the session. Individual Practice in Self-Disclosure ▲ Structure of self-disclosure consists of “I” statements with 3 dimensions: 1. the personal pronoun I in some form; 2. a verb such as feel, think, have experienced; 3. a sentence objectively describing what you think or what happened. Individual Practice in Self-Disclosure Exercise: Writing Self-Disclosure Statements 1. How would you self-disclose to Alisia after hearing her story? 2. For each situation, below, write one effective and one ineffective self-disclosure. 3. “My family is totally dysfunctional. You’ve heard my story. What do you think?” “I find myself afraid and insecure in large groups. It just doesn’t feel right. What should I do?” Share one of your own stories briefly, provide a selfdisclosure and a check-out. INSTRUCTIONAL READING 2 AND EXERCISES: FEEDBACK If you use feedback as structured below, you can predict how clients respond. Feedback: Present the client with clear information on how the interviewer believes the client is thinking, feeling, or behaving and how significant others may view them or their performance. Predicted result: The client may improve or change their thoughts, feelings, and behaviors based on the interviewers feedback. FEEDBACK Knowing how others see us is a powerful and impactful dimension in human change. To see ourselves as others see us, To hear how others hear us, And to be touched as we touch others . . . These are the goals of effective feedback. Feedback is most helpful when solicited. Feedback Guidelines 1. The client receiving feedback should be in charge. 2. Feedback should focus on strengths and/or something the client can do something about. 3. Feedback should be concrete and specific. 4. Feedback should be relatively nonjudgmental and interactive. 5. Feedback should be lean and precise. 6. Check-out how your feedback was received. Positive Feedback ▲ “The Breakfast of Champions” ▲ Helps the client restory his or her concerns. ▲ Look for “right” things about the client. ▲ Help clients discover their wellness strengths, positive assets, and useful resources. Corrective Feedback ▲ Delicate balance between negative feedback and positive suggestions for the future. ▲ Focus on behaviors that may be hurting the client or hindering growth. ▲ Stick to the feedback guidelines. ▲ Praise and supportive statements convey your positive thoughts. Feedback and the client who avoids certain topics. ▲ Some clients switch topics, gives brief vague responses, or avoid sensitive issues. ▲ If issue needs to be faced, meet the client and use confrontation skills as part of the feedback. ▲ Examples: On one hand, I hear you wanting to resolve this issue, but on the other hand, you avoid expressing what you feel about it and what you want. On one hand, you really do seem to want to become more assertive, but then when we start to talk seriously about how you might actually change, you change topics. Just now, I saw it again. We were starting to deal with your concern but you switched to another issue. What’s going on? Individual Practice With Feedback Exercise 1: Your Experience with Feedback We have all experienced positive or negative feedback on our performance. ▲ Recall a positive and a negative experience with feedback. ▲ What do you notice about effective and ineffective feedback? Individual Practice With Feedback Exercise 2: Writing Feedback Statements Imagine that Alisia has just said, “I’m totally lost right now. I thought I had made progress on this issue, but this last week, I totally blew it again. I’m so discouraged with myself.” ▲ Write a positive feedback statement. ▲ Write a negative feedback statement. ▲ Write a corrective feedback in a positive way to Alisia. Individual Practice With Feedback Exercise 2: Writing Feedback Statements “My partner is simply impossible. So much is demanded of me. I just feel myself disappearing in the relationship. I need space.” “What do you think of me? I’ve done as much as I can with working through issues around my sexuality, yet others keep looking at me and talking behind my back.” “I have real difficulty with exams, no matter how hard I study. In the last test I worked really hard, read all the assignments, and thought I knew the material cold. But I still ended up with a weak C.” Individual Practice With Feedback ▲ Write feedback for: “My partner is simply impossible. So much is demanded of me. I just feel myself disappearing in the relationship. I need space.” “What do you think of me? I’ve done as much as I can with working through issues around my sexuality, yet others keep looking at me and talking behind my back.” “I have real difficulty with exams, no matter how hard I study. In the last test I worked really hard, read all the assignments, and thought I knew the material cold. But I still ended up with a weak C.” Individual Practice With Feedback Exercise 3: Writing Feedback Statements ▲ Review your feedback statements using the guidelines provided before. ▲ How many did you meet in each of your feedbacks? INSTRUCTIONAL READING 3 AND EXERCISES: LOGICAL CONSEQUENCES If you use logical consequences as suggested below, you can predict how clients respond. Logical Consequences: Explore specific alternatives and the logical positive and negative concrete consequence of each possibility with the client. “If you do this . . . , then . . . .” Predicted result: Clients may change thoughts, feelings, and behaviors through better anticipation of the consequences of their actions. Through exploring the positives and negatives of each possibility, the client is more involved in the process of decision-making. Logical Consequences ▲ Presents the probable negative or positive results of other’s action. ▲ Warning or anticipation of punishment predicts negative results from action. ▲ Encouragement or anticipation of rewards predicts positive results from action. ▲ Help clients sort through issues more completely. ▲ Used to rank alternatives when a complex decision must be made. Logical Consequences Steps Actions Listen Be sure you understand how your client sees the situation. Question Help client think about positive and negative impacts from actions. Disclose Provide data, or likely positive or negative results of proposed actions. Summarize Provide both positive and negative consequences in a nonjudgmental manner. Counseling Encourage client decision making where possible. Logical Consequences ▲ “If…then” language helps clarify key decisions. ▲ Use “+” or “-” values to rate alternatives. ▲ Even negative consequences create learning opportunities. The Decisional Balance Sheet ▲ With clients who have important decisions with several possibilities, it helps to write down the alternatives and the pluses and minuses of each. ▲ For example in choosing a college or a job change, the several possibilities can be listed and what the client likes and dislikes about each one can be seen visually. ▲ If there is one especially important issue, mark it with two “+” or “-“signs (Mann, 2001). The Decisional Balance Sheet A 68 year old female client deciding to use a cane: P L U S M I N U S ++Increase mobility. ++Feel more secure. Socialize more. ++Visit family. ++Play with grandchildren. - -My husband will tease me. - -Look old. Seem vulnerable. Cost of canes. Individual Practice in Logical Consequences Exercise 4: Writing Logical Consequences Statements ▲ Briefly indicate to Alisia, what the logical consequences will be for her if she continues with her lack of assertiveness. ▲ Summarize Alisia’s problem in your own words using “if . . . , then . . .” terms. ▲ Ask Alisia specific questions about the positive and negative consequences of continuing her behavior. ▲ Provide Alisia with feedback on the probable consequences of continuing her behavior. Use “if . . . , then . . .” language. ▲ Summarize the differences between the feedback just given and Alisia’s view when she says she doesn’t want to change (this implies the use of confrontation). ▲ Encourage Alisia to make her own decision. Develop an imaginary balance sheet as she might fill it out. Individual Practice in Logical Consequences Exercise 5. Logical Consequences Using Listening Skills For each client and situation, write logical consequences statements that help the client understand the situation more fully. Include questioning skills. ▲ A student who is contemplating taking drugs for the first time. ▲ A young woman contemplating an abortion. ▲ A student considering taking out a loan for college. ▲ An executive in danger of being fired because of poor interpersonal relationships. ▲ A client who is consistently late in meeting you and who is often uncooperative. INSTRUCTIONAL READING 4 AND EXERCISES: INFORMATION AND PSYCHOEDUCATION ▲ Giving clients information, offering psychoeducation, or making suggestions can be an important part of interviewing and counseling. ▲ Unless the advice is actively sought, it is very difficult to be heard. INSTRUCTIONAL READING 4 AND EXERCISES: INFORMATION AND PSYCHOEDUCATION If you use information and psychoeducation as shown below, you can predict how clients respond. Information and Psychoeducation: Share specific information with the client—e.g., career information, choice of major, where to go for community assistance and services. Offer advice or opinions on how to resolve issues and provide useful suggestions for personal change. Teach the client specifics that may be useful—helping them develop a wellness plan, teaching them how to use microskills in interpersonal relationships, educating them on multicultural issues and discrimination. Predicted result: If given sparingly and effectively, the client will use information and ideas to act in new, more positive ways. Psychoeducation that is provided in a timely way and involves the client in the process can be a powerful motivator for change. INSTRUCTIONAL READING 4 AND EXERCISES: INFORMATION AND PSYCHOEDUCATION ▲ Presents information, advice, instruction, opinions, and/or suggestions to the other person. ▲ Beware: excessive emphasis in this area may lead you to forget listening. INSTRUCTIONAL READING 4 AND EXERCISES: INFORMATION AND PSYCHOEDUCATION ▲ Attend and be sure the client is ready to hear your information / advice, etc. ▲ Be clear, specific, concrete, and timely in your instructional procedures. ▲ Check with the client to see if your ideas have been understood. Psychoeducation ▲ Psychoeducation is a more formal and systematic set of strategies. ▲ Strategies include meditation, relaxation training, assertiveness training, dating skills, multicultural awareness, etc. ▲ Often taught in groups but equally effective if taught to clients during the session. ▲ Social skills training—e.g., teaching the microskills to clients—is a major part of most counseling and therapy. Individual Practice in Information and Psychoeducation Exercise 6: Your Experience with Information and Advice What is your own experience with information or advice given to you before you were ready? ▲ How do you personally respond when someone gives you advice or tells you what to do? ▲ Summarize both negative and positive thoughts you have about this area. Individual Practice in Information and Psychoeducation Exercise 7: Your Experience with Psychoeducation ▲ You have been in a variety of workshops. Learning microskills themselves is a type of psychoeducation. Individual counseling may have focused on teaching you some skills. ▲ What has been your experience with psychoeducation and what part might it play in your practice? Individual Practice in Information and Psychoeducation Exercise 2: Writing Statements ▲ Imagine that Alisia has just said, “I’m totally lost right now. I thought I had made progress on this issue, but this last week I totally blew it again. I’m so discouraged with myself.” ▲ Write how you might use information or use psychoeducation to involve Alisia fully in the process so that you do not foster dependency? Individual Practice in Information and Psychoeducation Exercise 2: Writing Statements (cont.) ▲ Write statements and plans for educating these clients. “My partner is simply impossible. So much is demanded of me. I just feel myself disappearing in the relationship. I need space.” “What do you think of me? I’ve done as much as I can with working through issues around my sexuality, yet others keep looking at me and talking behind my back.” “I feel so stressed. What can I do about it?” Individual Practice in Information and Psychoeducation Exercise 2: Writing Statements “I have real difficulty with exams, no matter how hard I study. In the last test I worked really hard, read all the assignments, and thought I knew the material cold. But I still ended up with a weak C.” “I don’t know how to speak up in class. I just sit there and part of the grade is dependent on class participation.” “How would you go about establishing an exercise plan?” INSTRUCTIONAL READING 5 AND EXERCISES: DIRECTIVES ▲ Directives are especially effective in the restory and action part of the interview. ▲ Help client move to behavioral action. ▲ Outline specific behaviors and actions. INSTRUCTIONAL READING 5 AND EXERCISES: DIRECTIVES If you use directive skills as structured below, you can predict how clients respond. Directives: Direct clients to follow specific actions. Directives are important in broader strategies such as assertiveness or social skills training or specific exercises such imagery, thought stopping, journaling, or relaxation training. They are often important when assigning homework for the client. Predicted result: The client will make positive progress when they listen to and follow the directives and engage in new, more positive thinking, feeling, or behaving. DIRECTIVES ▲ Provide a sequence of events designed to produce a likely result. ▲ Directives are critical in training. ▲ Homework produces results. ▲ Directive strategies drawn from various counseling theories. Expanded 1-2-3 Pattern 1. Involve your client as co-participant in the directive strategy. Be sure you have heard the story and inform client what you are going to do. 2. Check out whether your directive was heard and understood. Just because you think you are clear doesn’t mean the client understood what you said. Check to make sure your directive was understood, specially when complex directives has been given. The Client Change Scale can be used to determine whether the client actually changed as a result of your directive. Expanded 1-2-3 Pattern 3. Be clear and concrete in your verbal expression and time the directive to meet client needs. Directives need to be authoritative and clear, and in tune with the needs of the client. 4. Be clear and concrete in your verbal expression and time the directive to meet client needs. Directives need to be authoritative and clear, and in tune with the needs of the client. Example Directive Strategies Specific suggestions/instructions for action ▲ “I suggest you try…” ▲ May be too elementary for some clients. ▲ Most effective with client’s who don’t have skills and need firm guidance. Homework ▲ Homework: generalizing goals and action beyond the session. ▲ Homework is concerned with action— generalizing thoughts, feelings, and behaviors to the “real world.” ▲ Work with client to do something different or new after the session. ▲ Homework assignments include: Thought stopping, using positive imaging or meditation daily, playing basketball with friends, starting a program of walking or running, or keeping a diary of foods eaten, or act .assertively. ▲ Keep a record. Now considered an important and basic part of helping the client take learning from the interview home. The Relaxation Response Relaxation ▲ Goal: to equip the client with an immediately accessible response (relaxation) when they encounter tense situations. When we face serious challenges, our heart rates go up, we breathe faster, our bodies tense, adrenaline and cortisol flow in, and we become “ready” to deal with whatever we face. This immediate tense reaction can become habitual and damage your body and brain. ▲ The relaxation response enable clients to deal more effectively and healthfully with life challenges. Relaxation ▲ Demonstration. Tighten your forearm, very tight, now let it go.” ▲ Usually start with feet and move upward in full teaching of relaxation. ▲ Relaxation response can be as simple as “think of a positive image when you feel tense.” Available instantly to the client in stressful situations. ▲ Can be taught as a sensorimotor environmentalstructuring intervention. ▲ Relaxation and control of the body helps the client to better cope with daily stresses. Relaxation training Relaxation training ▲ Forms the basis for the response. ▲ Edmund Jacobson (1934) pioneered the scientific study of relaxation with his book You Must Relax. He used a sophisticated approach, oriented to treatment of both regular tension and severe psychological distress. He considered relaxation training a necessary part of any therapeutic situation. ▲ Herbert Benson who popularized the use of relaxation techniques in medicine (Benson & Klipper, 2000). His mind-body research focuses on the role of relaxation in reducing stress responses and improving health. Mindfulness Meditation and Mindfulness ▲ Jon Kabat-Zinn (2005) mindfulness meditation is derived primarily from Buddhist thought and practice. There is no “goal” except perhaps to live as much as possible in the immediate here and now. BE HERE NOW! ▲ Kabat-Zinn (1990) has worked closely with the Dali Lama and has participated in basic research showing that the brain does change with the positive open approach of mindfulness. ▲ Training CD’s available (key Kabat-Zinn). Basic method is to focus on breathing in the here and now. Becoming the most popular form of meditation. Positive Imagery ▲ Often the most powerful directive and must be used with care. ▲ Most effective in helping clients experience the sensorimotor orientation. ▲ Children and young people like the freedom and creativity allowed in this type of directive. Guided imagery focusing on a relaxing scene ▲ Often the most powerful directive. ▲ Helps clients relax and reduce tension. ▲ Positive images represent positive strengths. ▲ Children and young people like the freedom and creativity from this strategy. Example Imagery ▲ “Close your eyes.” ▲ “Allow a picture of your most favorite place, an ideal day, or a future partner to come to your mind.” ▲ What are you seeing? Hearing? Feeling? Be sure you pace the client and are fully in touch with where they are through careful observation. Positive images of strength ▲ Give courage to meet difficult issues. ▲ Community genogram is a good source of people who represent positive strengths and resources. ▲ Provide model for present and future action. ▲ Connect with physical sensation. ▲ Focus on positive images. Encourage physical exercise and nutrition ▲ Encourage physical exercise and nutrition. ▲ Sound body, sound mind. ▲ Exercise improves blood pressure and reduce stress and depression. ▲ Proper eating habits, stretching, and meditation improve life. ▲ Teach clients how to nourish their bodies. Thought-stopping ▲ Almost everybody engages in negative self-talk. ▲ Thought-stopping: ending negative self-talk. ▲ Effective intervention, increases self-esteem and personal effectiveness. ▲ Applicable to a wide range of difficulties. E.g., perfectionism, excessive culture-based guilt or shame, shyness, mild depression. Thought-stopping ▲ “I’d like to explore some of your negative thinking and self-talk.” ▲ Sometimes internal self-talk becomes negative judgments. ▲ Suggest methods to interrupt negative self-talk. ▲ At times, start by giving homework where client actually counts and lists the negative self-talk during the week. Thought-stopping How to learn and use thought stopping? ▲ Step 1. Learn the basic process. Relax, close your eyes and imagine a situation where you make the negative self-statement. Take time and let the situation evolve. When the thought comes, observe what happens and how you feel. Then tell yourself silently “STOP.” If you are alone, say it loudly and firmly. Thought-stopping How to learn and use thought stopping? ▲ Step 2. Transfer thought stopping to your daily life. Place a rubber band around your wrist and every time during the day that you find yourself thinking negatively, snap the rubber band and say “STOP!” Thought-stopping How to learn and use thought stopping? ▲ Step 3. Add positive imaging. Once you have developed some understanding of how often you use negative thinking, after you say “STOP,” substitute a more positive statement. You may use positive imagery or think about an example where you had a positive experience or a brief, broader statement emphasizing general strengths. “I can do lots of things right.” “I am loveable and capable.” “I sometimes mess up—no one’s perfect.” “I did the best I could.” RUBBER BAND SEEN BY SOME AS NEGATIVE, BUT IT DOES DRAW ATTENTION MORE FULLY IN THE HERE AND NOW WHEN YOU BEGIN! Thought-stopping How to learn and use thought stopping? ▲ Step 4. Make positive images and thoughts a habit. Remove the rubber band and use positive images and positive self-talk as a basis for building permanent self-esteem. Consider positive internal self-talk about other people who disturb or “bug” you. It can help. Helpful to combine this with relaxation response! Role-Play Enactment ▲ “Let’s role-play it again, only change the one behavior we agreed to.” ▲ Effective concrete orientation technique. ▲ Basic technique used in assertiveness training. “I’ve heard your problem with Adrian. Now could we role-play it here and now. I’ll be Adrian and I’ll try to behave as he did.” Role play is evaluated for behavioral specifics. “Now let’s do it again. I’d like to see you more assertive. We’ve agreed-More eye contact and a firmer vocal tone. Further role-plays until client can engage in new behavior. Enactment via the Gestalt empty chair Gestalt empty-chair nonverbal techniques ▲ “Talk to your parent, as if. . .” ▲ “One hand is a fist, the other is open. Have one hand talk to the other.” ▲ Similar to a role-play, but the client plays both people or both parts. ▲ Makes the issue concrete. ▲ Acting / movement connects the client to sensorimotor emotions. Enactment via language change Language Choice ▲ “Change ‘can’t’ to ‘won’t.’” ▲ Forces clients to be in charge of their own behavior. ▲ Particularly effective with self-directed formal-operational clients, who may need help changing their thinking and behavior. Free association Free association ▲ Originating in the psychoanalytic movement, this strategy enables clients to reflect back from the here and now to times in the past when they might have had similar thoughts and feelings to what you are observing now. ▲ This often provides a critical link that helps both you and the client understand the historical basis of the present issue. “I hear you. Could you just let your mind go freely now and tell me the first thing that comes to your mind?” Free association Free association ▲ “Stay with that feeling, magnify it. What flashed into your mind?” ▲ Most effective with full formal-operational clients who are self-directed. ▲ Works best if sensorimotor modalities of emotion brought into play. Other Directive Strategies Paradoxical Instruction ▲ “Do the problem behavior / thinking / action at least three times.” ▲ May be effective with client’s who refuse to follow directions. ▲ Useful in developing awareness and in promoting change. “During the coming week, I want you to deliberately engage in that problematic behavior. But also note what you are feeling inside and what happens in relation to others.” Other Directive Strategies Systematic desensitization ▲ More complex strategy effective for deep-seated anxiety problems associated with specific issues. Deep muscle relaxation Construction of an anxiety hierarchy Matching objects of anxiety with relaxation ▲ Several carefully planned sessions may be needed to practice relaxation under stress. Other Directive Strategies Meditation ▲ “Be still. Focus on one point. Relax. Let all thoughts slip from your mind.” ▲ Some clients may prefer meditation as a mode of relaxation. ▲ More characteristic of client-directed, formal-operational approach. Other Directive Strategies Family therapy communications ▲ “Don’t talk to me. . . Talk to him now.” ▲ Most directives can be adapted to family and group counseling. COMPETENCY PRACTICE EXERCISES Take one or two of the most interesting and potentially useful exercises suggested here and try it/them out. 1. Try the directive strategy on yourself. Most can be done alone if you take time to really do it and study the process. What happens? What occurs for you? What did you learn? Would you like to continue and practice that method further Most directives can be adapted to family and group counseling. COMPETENCY PRACTICE EXERCISES 2. Find a classmate or friend, get the person’s permission, and the two of you try the strategy on each other. What happens? What occurs for you? What did you learn? Would you like to continue and practice that method further? SUMMARY ▲ Self-disclosure, feedback, consequences, information and psychoeducation, and, directives all aim at client change. ▲ Relationship and client story and strengths remain important. ▲ Consult with your clients and let them know when you are using an influential skill ▲ Use the Client Change Scale to assess the effectiveness of your interventions. ▲ Do the evaluation with the client to facilitate planning and change. Key Points 1-2-3 pattern ▲ In any interaction with a client, first attend to and determine the client’s frame of reference, then assess her or his reaction before using your influencing skills. Finally, check out the client reaction to your use of the skill. Key Points Interpersonal influence continuum ▲ The influencing and attending skill may be classified from low to high degrees of influence. Encouragers and paraphrasing are considered relatively low in influence, whereas confrontation and directives are considered more influential Key Points Moderate triad ▲ The “swing skills” of the interpersonal influence continuum are focusing and open and closed questions. They provide a framework for determining the topic of conversation while keeping a balance between influencing and attending skills. Key Points Self-disclosure ▲ Indicating your thoughts and feelings to a client constitutes self-disclosure, which necessitates the following: 1. Use personal pronouns (“I” statements). 2. Use a verb for content or feeling (“I feel . . . ,” “I think . . .”). 3. Use an object coupled with adverb and adjective descriptors (“I feel happy about your being able to assert yourself . . .”). 4. Express your feelings appropriately. ▲ Self-disclosure tends to be most effective if it is genuine, timely, brief, and phrased in the present tense. Key Points Feedback Feed back accurate data on how you or others view the client. Remember the following: 1. 2. 3. 4. 5. 6. 7. The client should be in charge. Focus on strengths. Be concrete and specific. Be nonjudgmental. As appropriate, provide here-and-now feedback. Keep feedback lean and precise. Check out how your feedback was received. Key Points Logical consequences ▲ This skill predicts the probable results of a client’s action, in five steps: 1. Listen to make sure you understand the situation and how it is understood by the client. 2. Encourage the client to think about positive and negative consequences of a decision. 3. Provide your data on the positive and negative consequences of a decision in a nonjudgmental manner. 4. Summarize the positives and negatives. 5. Let the client decide what action to take. Key Points Information and psychoeducation ▲ Many times clients need the counselor’s knowledge and expertise around key life issues. The counselor knows the community and resources available. He or she also knows the likely pattern and key issues of a divorce, the death of a family member, or other life issue. ▲ Psychoeducation is a more systematic way to teach clients of new life possibilities; this may range from training in communication skills to developing a successful wellness plan. Key Points Directives ▲ Involve your client with the choice of directives, even to the point of telling her or him what is to happen and what to expect as a result. Appropriately assertive body language, vocal tone, and eye contact are important, as are clear, concrete verbal expressions and checking out the degree of client participation. Key Points What else? ▲ Most of the influencing skills require you to be concrete and specific, although the ability to work abstractly is particularly important in interpretation/reframing. ▲ Remember to involve your client as a co-participant as you utilize influencing skills. COMPETENCY PRACTICE EXERCISE AND SELF-ASSESSMENT Chapter 12 Individual Practice Group practice Self-assessment Group Practice Exercise 9: Practicing the influential skills IIC Directives, Logical consequences, Self-disclosure, Feedback, Information and psychoeducation. Follow the complete process for each of the 5 influencing strategies. Separate into groups of four. Select a group leader. Assign roles for the first practice session. Interviewer Client Observer 1 Observer 2 Group Practice Exercise 9: Practicing the influential skills IIC Directives, Logical consequences, Self-disclosure, Feedback, Information and psychoeducation. Select and plan a topic. A relationship problem RESPECTFUL model Discrimination A decision with several alternatives Provide concrete information Select a specific directive strategy Group Practice Exercise 9: Practicing the influential skills IIC Directives, Logical consequences, Self-disclosure, Feedback, Information and psychoeducation. Conduct a practice session with focus on: Self-disclosure Feedback Logical Consequences Information/Psychoeducational Directives Group Practice Exercise 9: Practicing the influential skills IIC Directives, Logical consequences, Self-disclosure, Feedback, Information and psychoeducation. Review the Session Observers use the appropriate Feedback Form for each specific influencing strategy. Observer 1 pinpoint client focus statements. Observer 2 pinpoint interviewer focus statements. Client uses Client Feedback Form. (Ch. 1) Rotate roles and repeat for each participant and each influencing strategy. CLIENT FEEDBACK FORM IIC (from Ch. 1) In practice sessions, it is very helpful to get immediate feedback. As you practice the microskills, use the Client Feedback Form. FORM IIC Influentencing Skills Feedback Form (in this Ch.) In practice sessions, it is very helpful to get immediate feedback. As you practice the microskills, we encourage you to use the feedback forms provided. We provide feedback forms for each specific skill. Group Practice Exercise 9: Practicing the influential skills IIC Directives, Logical consequences, Self-disclosure, Feedback, Information and psychoeducation. Discussion Questions How does the interviewer draw out the client’s decisional issues with the BLS? How did the interviewer help the client consider the alternative positive and negative consequences? How did the client respond to the interviewer comments? Use the CCS to rate client response. What did the interviewer do next when his/her skills were not immediately successful? What did you observe nonverbally about this session? Group Practice Exercise 9: Practicing the influential skills IIC Directives, Logical consequences, Self-disclosure, Feedback, Information and psychoeducation. Discussion Questions How does the interviewer draw out the client’s story with the BLS? Note the interviewer’s exact words, if possible. Did the interviewer include a check-out so the advice could be discussed in an egalitarian manner? How did the client respond to the interviewer comments? Use the CCS to rate client response. What did the interviewer do next when his/her skills were not immediately successful? What did you observe nonverbally about this session? Group Practice Exercise 9: Practicing the influential skills IIC Directives, Logical consequences, Self-disclosure, Feedback, Information and psychoeducation. Discussion Questions How does the interviewer draw out the client’s story with the BLS? Describe as clearly as possible the directive strategy used by the interviewer. How did the client respond to the interviewer comments? Use the CCS to rate client response. What did the interviewer do next when his/her skills were not immediately successful? What did you observe nonverbally about this session? Was the interviewer able to bring “here and now” feeling and content into the session? Client Change Scale (CCS) The Creation of the New Denial 1 Full Examination Decides to Live With But No Partial Incongruity Change Examination 2 Denies or Discusses fails to hear part, but not incongruity. all of incongruity. 3 Discusses incongruity completely, but will not change. 4 Discusses and is fully aware of decision impact. Decides to Change From Incongruity 5 Discusses and alters choices when faced with incongruity. PORTFOLIO OF COMPETENCE What Is Your Level of Mastery of this Skill? IIC Influential skills are core competencies of intentional interviewing and counseling. Use the following as a checklist to evaluate your present level of mastery. Check those dimensions that you currently are able to do. Those that remain unchecked can serve as future goals. PORTFOLIO OF COMPETENCE IIC SELF-ASSESSMENT This chapter is about interpersonal influence, and it covers considerable material. You cannot be expected to master all these skills until you have a fair amount of practice and experience. Use the following to guide your self-assessment: What are your thoughts about the major ideas presented in this chapter? Where do you stand regarding the influencing skills currently? Where would you like to go in terms of next steps? SELF-ASSESSMENT Self-Evaluation of Influential Skills IIC Go to Chapter 12 for a full description of these levels Level 1: Identification and classification. Level 2: Basic competence. Level 3: Intentional competence. Level 4: Psychoeducational teaching competence. SELF-ASSESSMENT Self-Evaluation of Influential Skills IIC Five skill areas are identified in this chapter. They are listed here with the levels of competence. Check off those areas for which you have competence so far. Be patient with yourself, as mastery of these skills will take time. DETERMINING YOUR OWN STYLE AND THEORY: CRITICAL SELF-REFLECTION ON INFLUENCING SKILLS CRITICAL SELF-REFLECTION ON INFLUENTIAL SKILLS You were introduced to five influential skills. With which of these skills do you feel most comfortable? Which might you seek to use? Which might you avoid? How do you feel about the idea of consciously influencing the direction of the interview? What single idea stood out for you among all those presented in this chapter, in class, or through informal learning? What are your thoughts on multicultural issues and the use of this skill? What other points in this chapter struck you as important? How might you use ideas in this chapter to begin the process of establishing your own style and theory? Write your ideas in your journal.