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Counseling: A Counseling: A Process ViewProcess ViewPhilip Glessner MFT, LADCPhilip Glessner MFT, LADC

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Definition Of CounselingDefinition Of Counseling

A supportive and empathic professional A supportive and empathic professional relationship that provides a framework relationship that provides a framework for the exploration of emotions, for the exploration of emotions, behaviors, and thinking patterns, and behaviors, and thinking patterns, and the facilitation of healthy changes.the facilitation of healthy changes.

Counseling is directed towards people Counseling is directed towards people experiencing difficulties as they live experiencing difficulties as they live through the normal stages of life-span through the normal stages of life-span development.development.

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Counseling FunctionsCounseling Functions

RemedialRemedial Functional ImpairmentFunctional Impairment

PreventivePreventive Anticipate and AccommodateAnticipate and Accommodate

EnhancementEnhancement Human PotentialHuman Potential

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Counseling And TheoryCounseling And Theory

Negligible differences in effects Negligible differences in effects produced by different therapy typesproduced by different therapy types

Common elements between theoriesCommon elements between theories Responding to feelings, thoughts and Responding to feelings, thoughts and

actions of the clientactions of the client Acceptance of client’s perceptions and Acceptance of client’s perceptions and

feelingsfeelings Confidentiality and privacyConfidentiality and privacy Awareness of and sensitivity to Awareness of and sensitivity to

messages communicated in counseling messages communicated in counseling

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Characteristics Of Effective Characteristics Of Effective HelpersHelpers

Self-awareness and understandingSelf-awareness and understanding Good psychological healthGood psychological health SensitivitySensitivity Open-mindednessOpen-mindedness ObjectivityObjectivity CompetenceCompetence TrustworthinessTrustworthiness Interpersonal AttractivenessInterpersonal Attractiveness

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Components Of The Components Of The Counseling ProcessCounseling Process

Relationship BuildingRelationship Building AssessmentAssessment Goal SettingGoal Setting InterventionIntervention Termination and Follow-UpTermination and Follow-Up

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Extratherapeutic Factors40%

Relationship Factors30%

Hope & Expectancy 15%

Model & Techniques15%

What Works in Treatment:A Review of 40 Years of Outcome Research

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Relationship Relationship BuildingBuilding

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Conditions Of An Effective Conditions Of An Effective Therapeutic RelationshipTherapeutic Relationship

Accurate EmpathyAccurate Empathy

Genuineness/CongruenceGenuineness/Congruence

Positive Regard/RespectPositive Regard/Respect

Client’s perception of relationship is Client’s perception of relationship is what counts!what counts!

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Counselor Skills Associated Counselor Skills Associated With Facilitative Conditions With Facilitative Conditions Nonverbal and verbal attending behaviorsNonverbal and verbal attending behaviors Paraphrasing content of client Paraphrasing content of client

communicationscommunications Reflecting client feelings and implicit Reflecting client feelings and implicit

messagesmessages Openness and self-disclosureOpenness and self-disclosure ImmediacyImmediacy Attending to Client's Theory of ChangeAttending to Client's Theory of Change Interactive vs. Didactic ApproachInteractive vs. Didactic Approach Promoting HopefulnessPromoting Hopefulness

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Functions Of A Therapeutic Functions Of A Therapeutic RelationshipRelationship

Creates an atmosphere of trust and safetyCreates an atmosphere of trust and safety

Provides a medium or vehicle for intense Provides a medium or vehicle for intense affectaffect

Models a healthy interpersonal Models a healthy interpersonal relationshiprelationship

Provides motivation for changeProvides motivation for change

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WAYS OF LISTENING WAYS OF LISTENING "Are you listening to me?""Are you listening to me?"

People like to be heard. To be heard helps reduce insecurity. It People like to be heard. To be heard helps reduce insecurity. It gives us a feeling of peace. And when someone really listens to us, gives us a feeling of peace. And when someone really listens to us, we often discover something about ourselves. Often we solve we often discover something about ourselves. Often we solve problems just when we are really listened to and feel heard. In this problems just when we are really listened to and feel heard. In this handout I will explain two ways of listening and encourage you to handout I will explain two ways of listening and encourage you to try to listen better to those around you.try to listen better to those around you.

ANALYTIC LISTENING: This is the kind of listening we usually do. ANALYTIC LISTENING: This is the kind of listening we usually do. During Analytic Listening I am evaluating in my mind as I listen to During Analytic Listening I am evaluating in my mind as I listen to you. I am busy judging and deciding what to say. I am analyzing. As you. I am busy judging and deciding what to say. I am analyzing. As a result, you don't feel a result, you don't feel heardheard. You may repeat yourself, or feel . You may repeat yourself, or feel annoyed. Maybe I can even repeat back to you what I "heard" but it annoyed. Maybe I can even repeat back to you what I "heard" but it just doesn't feel like I listened to you.just doesn't feel like I listened to you.

DEEP LISTENING: This is a rare talent. In deep listening, my mind is DEEP LISTENING: This is a rare talent. In deep listening, my mind is very quiet when I listen to you. My feeling is peaceful and curious. I very quiet when I listen to you. My feeling is peaceful and curious. I don't take anything personally. I don't judge or decide or figure don't take anything personally. I don't judge or decide or figure anything out. I don't try to remember anything. My mind is quiet anything out. I don't try to remember anything. My mind is quiet and open. As a result, you find you don't repeat yourself as much. and open. As a result, you find you don't repeat yourself as much. You feel a connection. You are likely to say, "I don't know why, but I You feel a connection. You are likely to say, "I don't know why, but I really felt you really felt you heardheard me." Your feelings will become more peaceful. me." Your feelings will become more peaceful.

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Session Rating Scale (SRS Session Rating Scale (SRS V.3.0)V.3.0)

Name ________________________ Age (Yrs):____ ID# _____________Sex: M / F Session # __ Date:___________________Name ________________________ Age (Yrs):____ ID# _____________Sex: M / F Session # __ Date:___________________

Please rate today’s session by placing a mark on the line nearest to the description that best fits your experience. Please rate today’s session by placing a mark on the line nearest to the description that best fits your experience.

RelationshipRelationshipI did not feel heard, understood, and respected. I felt heard, understood, and I did not feel heard, understood, and respected. I felt heard, understood, and

respected.respected.

I-------------------------------------------------------------------------II-------------------------------------------------------------------------IGoals and TopicsGoals and Topics We did We did notnot work on or talk about what I wanted to work on We worked on and talked about what I wanted to work work on or talk about what I wanted to work on We worked on and talked about what I wanted to work

on on and talk about and talk about.and talk about and talk about.

I------------------------------------------------------------------------II------------------------------------------------------------------------I

Approach or MethodApproach or MethodThe therapist’s approach is not a good fit for me. The therapist’s approach is a good fit for The therapist’s approach is not a good fit for me. The therapist’s approach is a good fit for

me.me.

I-------------------------------------------------------------------------II-------------------------------------------------------------------------IOverallOverallThere was something missing in the session today. Overall, today’s session was right for There was something missing in the session today. Overall, today’s session was right for

me.me.

I------------------------------------------------------------------------II------------------------------------------------------------------------I

Institute for the Study of Therapeutic ChangeInstitute for the Study of Therapeutic Changewww.talkingcure.comwww.talkingcure.com© 2002, Scott D. Miller, Barry L. Duncan, & Lynn Johnson© 2002, Scott D. Miller, Barry L. Duncan, & Lynn Johnson

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AssessmentAssessment

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Purposes Of AssessmentPurposes Of Assessment

Systematic way to obtain Systematic way to obtain information about the client’s information about the client’s problems, concerns, strengths, problems, concerns, strengths, resources, and needs.resources, and needs.

Foundation for goal-setting and Foundation for goal-setting and treatment planning.treatment planning.

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Assessment Assessment ConsiderationsConsiderations

Assessment is always an ongoing process, changing as you Assessment is always an ongoing process, changing as you learn more about the client. learn more about the client.

Who is complaining or alarmed? Who thinks there is a Who is complaining or alarmed? Who thinks there is a problem? What is the person complaining about? problem? What is the person complaining about?

What is the person motivated for? What does he or she What is the person motivated for? What does he or she want? want?

What does the person do well? (Find contexts of What does the person do well? (Find contexts of competence.) Skills, hobbies, sports, activities, avocations, competence.) Skills, hobbies, sports, activities, avocations, life experiences, etc. life experiences, etc.

Exceptions/previous solutions/times when situation was Exceptions/previous solutions/times when situation was better better

Best coping momentsBest coping moments What are the goals? How will we know when we are done? What are the goals? How will we know when we are done?

Get specific about the problem-free future. Get specific about the problem-free future.

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Assessment Considerations Assessment Considerations (Cont.)(Cont.)

What are the patterns of the problem? How is What are the patterns of the problem? How is it performed? Search for regularities of it performed? Search for regularities of action and interaction, time, place, body action and interaction, time, place, body behavior, etc. Get specific (so could imagine behavior, etc. Get specific (so could imagine seeing/hearing the problem on a videotape) seeing/hearing the problem on a videotape)

Scan for potentially harmful actions of clients Scan for potentially harmful actions of clients or others in clients' lives (e.g., physical or others in clients' lives (e.g., physical violence, drug/alcohol abuse, sexual abuse, violence, drug/alcohol abuse, sexual abuse, self-mutilation, suicidal intentions/attempts, self-mutilation, suicidal intentions/attempts, etc.) that may not be obvious or may be etc.) that may not be obvious or may be minimized during an initial interview. minimized during an initial interview.

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Assessment ToolsAssessment Tools Intake formsIntake forms Intake interviewIntake interview

Clinician questionsClinician questions Formal instrumentsFormal instruments

ASAM PPCASAM PPC DSM IVDSM IV DrIncDrInc SASSISASSI SOCRATESSOCRATES ………………....

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Assessment Tool “Rules Of Assessment Tool “Rules Of Thumb”Thumb”

Never diagnose with a test or screening Never diagnose with a test or screening instrument only.instrument only.

Tests are useful in validating information Tests are useful in validating information provided by the client in the subjective provided by the client in the subjective interview.interview.

Testing tools should only be used by those Testing tools should only be used by those with training in using that tool.with training in using that tool.

All testing tools have limitations.All testing tools have limitations. Never replace the expertise, training, and Never replace the expertise, training, and

experience of the clinician with a test.experience of the clinician with a test.

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Stages of Change Stages of Change (Meeting the client where (Meeting the client where

they are) they are) Precontemplation - "Precontemplation - "I really don't want to change. I really don't want to change.

Contemplation-Contemplation- I'll consider it." I'll consider it." Preparation- "Preparation- "I'm making a plan for it."I'm making a plan for it."

Action-Action- "I'm doing it, but not regularly." "I'm doing it, but not regularly." Maintenance- "Maintenance- "I'm doing it."I'm doing it." Termination- "Termination- "I have no desire to go back to my own I have no desire to go back to my own

ways."ways."

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Extratherapeutic FactorsExtratherapeutic Factors

These factors exist prior to and are These factors exist prior to and are independent of participation in independent of participation in treatmenttreatment

Client factorsClient factors Strengths Strengths ResourcesResources Areas of CompetenceAreas of Competence

Chance factorsChance factors

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Goal-SettingGoal-Setting

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Goal FunctionsGoal Functions

Define desired outcomesDefine desired outcomes Give direction to the counseling Give direction to the counseling

processprocess Specify what can and cannot be Specify what can and cannot be

accomplished in counselingaccomplished in counseling Client motivationClient motivation Evaluate effectiveness of counselingEvaluate effectiveness of counseling Measure client progressMeasure client progress

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Seven Qualities Of Well Seven Qualities Of Well Formed Treatment Goals* Formed Treatment Goals*

Saliency to the Client/CollaborativeSaliency to the Client/Collaborative

SmallSmall

Concrete, Specific, and BehavioralConcrete, Specific, and Behavioral

The Presence Rather Than the Absence of SomethingThe Presence Rather Than the Absence of Something

A Beginning Rather Than an EndA Beginning Rather Than an End

Realistic and Achievable Within the Context of the Client’s Realistic and Achievable Within the Context of the Client’s LifeLife

Perceived as Involving “Hard Work”Perceived as Involving “Hard Work”

* Berg and Miller (1992). * Berg and Miller (1992). Working with the problem drinker.Working with the problem drinker.

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InterventionsInterventions

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Categories Of Counseling Categories Of Counseling InterventionsInterventions

AffectiveAffective

CognitiveCognitive

BehavioralBehavioral

Interpersonal/SystemicInterpersonal/Systemic

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Affective ModelsAffective Models

Person-centered therapyPerson-centered therapy Gestalt TherapyGestalt Therapy Body awareness therapiesBody awareness therapies Psychodynamic therapiesPsychodynamic therapies Experiential therapiesExperiential therapies

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Cognitive ModelsCognitive Models

Rational-emotive therapyRational-emotive therapy Information-givingInformation-giving Problem-solving and decision-Problem-solving and decision-

makingmaking Transactional AnalysisTransactional Analysis

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Behavioral ModelsBehavioral Models

Behavior therapyBehavior therapy Reality therapyReality therapy Cognitive-behavioral therapyCognitive-behavioral therapy

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Systemic ModelsSystemic Models

Structural therapyStructural therapy Strategic therapyStrategic therapy Intergenerational systemsIntergenerational systems

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Collaborative TherapyCollaborative TherapyA collaborative therapy is one in which:A collaborative therapy is one in which: The expertise of clients is given at least as much The expertise of clients is given at least as much

weight as the expertise of therapists.weight as the expertise of therapists. Clients are regularly part of the treatment planning Clients are regularly part of the treatment planning

process. process. Clients are consulted about goals, directions and Clients are consulted about goals, directions and

responses to the process and methods of therapy.responses to the process and methods of therapy. The therapist asks questions and makes speculations The therapist asks questions and makes speculations

in a non-authoritarian way, giving the client ample in a non-authoritarian way, giving the client ample room and permission to disagree or correct the room and permission to disagree or correct the therapist. Therapists give clients many options and therapist. Therapists give clients many options and let them coach the therapist on the next step or the let them coach the therapist on the next step or the right direction. right direction.

Client status is elevated from passive needy Client status is elevated from passive needy recipients to active expert contributors. recipients to active expert contributors.

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The art of therapy revolves aroundhelping clients to bow out of their

symptoms gracefully

- Milton Erickson

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Termination and Termination and Follow-UpFollow-Up

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Indicators Of Counseling Indicators Of Counseling SuccessSuccess

Clients “own” their problems and Clients “own” their problems and solutionssolutions

Clients develop more useful insight Clients develop more useful insight into problems and issuesinto problems and issues

Clients acquire new responses to old Clients acquire new responses to old issuesissues

Clients learn to develop more Clients learn to develop more effective relationshipseffective relationships

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Accountability For Mental Accountability For Mental Health ProfessionalsHealth Professionals

Continuing educationContinuing education

Paying attention to relevant research Paying attention to relevant research findingsfindings

Applying research findings to clinical Applying research findings to clinical practicepractice

Validating efficacy of our workValidating efficacy of our work

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Outcome Rating Scale (ORS)Outcome Rating Scale (ORS)Name ________________________Age (Yrs):____ Sex: M / F Session #____Date:_______________________Name ________________________Age (Yrs):____ Sex: M / F Session #____Date:_______________________

Who is filling out this form? Please check one: Self _______Other_______ If other, what is your relationship toWho is filling out this form? Please check one: Self _______Other_______ If other, what is your relationship to this person? ____________________________this person? ____________________________

Looking back over the last week, including today, help us understand how you have been feeling by rating how well Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life, where marks to the left represent low levels and marks toyou have been doing in the following areas of your life, where marks to the left represent low levels and marks tothe right indicate high levels.the right indicate high levels. If you are filling out this form for another person If you are filling out this form for another person , , please fill out according to how you please fill out according to how you

think he or she think he or she is doing.is doing.

IndividuallyIndividually(Personal well-being)(Personal well-being)

I----------------------------------------------------------------------II----------------------------------------------------------------------IInterpersonallyInterpersonally

(Family, close relationships)(Family, close relationships)I----------------------------------------------------------------------II----------------------------------------------------------------------I

Socially Socially (Work, school, friendships)(Work, school, friendships)

I----------------------------------------------------------------------II----------------------------------------------------------------------IOverallOverall

(General sense of well-being)(General sense of well-being)I----------------------------------------------------------------------II----------------------------------------------------------------------I

Institute for the Study of Therapeutic ChangeInstitute for the Study of Therapeutic Changewww.talkingcure.comwww.talkingcure.com© 2000, Scott D. Miller and Barry L. Duncan© 2000, Scott D. Miller and Barry L. Duncan

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I Realize I Have Not Answered All Your Questions And In Most Cases My Answers

Have Only Served To Produce New Questions For Which I Have No Answers

Leaving You (and me) As Confused As Before.

However, I Believe We Are Now Confused On A Much Higher Level

And About Much More Important Things Than Before.