CNS 559 Techniques in Counseling

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CNS 559Techniques in Counseling

• Ivey, A. Bradford Ivey M. (1999). Intentional
  interviewing counseling. Brooks Cole.

11/19/2009
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BEFORE YOU START

• The first act of a teacher is to introduce the
  idea that the world we think we see is only a
  view, a description of the world. Every effort
  of a teacher is geared to provide this point to
  the apprentice. But, accepting it seems to be
  one of the hardest things we can do. We are
  complacently caught in our particular view of the
  world which compels us to fell and act as if we
  knew everything about the world. A teacher, from
  the very first act performed, aims at stopping
  that view. (Carlos Castaneda)
• People enslave themselves with their own ideas
  and then win freedom again by reconstructing
  their lives. (George Kelly)

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Intentionality

• What would you say in response to the following?
• Client (talking about conflict on the job)
• I just dont know what to do about Bob. It
  seems hes always on me, blaming me even when I
  do a good job. Hes new on the job, I know.
  Perhaps he doesnt have much experience as a
  supervisor. But hes got me all jumpy. Im so
  nervous I cant sleep at night, and yesterday I
  even lost my lunch. My family isnt doing well,
  either. Sandy doesnt seem to understand whats
  going on and is upset. Even the kids arent
  doing well in school. What do you suggest I do?
• How would you respond?

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Intentionality

• Different people respond to the same event
  differently according to individual, family and
  cultural background.
• But some are stuck or immobilized with only a few
  responses which are ineffective.
• Intentional interviewing is not concerned with
  which single response is correct, but, with how
  many potential responses are helpful.

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Intentional Interviewing

• Acting with a sense of capability and deciding
  from a range of alternative actions.
• The intentional individual has more than one
  action, thought, or behavior to choose from in
  responding to changing life situations.
• The intentional individual can generate
  alternatives in a given situation and approach a
  problem from different vantage points, using a
  variety of skills and personal qualities,
  adapting styles to suit different cultural
  groups.

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Cultural Intentionality

• People of different racial/ethnic groups, of
  varying language, gender, spiritual orientation,
  sexual preference, age, degree of ability, and
  socioeconomic class may respond to helping
  interventions in different ways.
• Diversity is becoming the mainstream.
• In addition, those who have experience trauma
  (war, rape, child abuse, etc.) may represent
  distinct cultural groups.
• How might each group be stuck or immobilized and
  what would be our goals as helpers?

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SECTION I
INTRODUCTION
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Chapter One
Toward Intentional Interviewing And Counseling
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Development

• The aim of interviewing and counseling
• Development of the clients own unique potential.
• Development occurs in a family and multicultural
  framework.

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Intentional Interviewing and Counseling
---Different theories call for different patterns
of skill usage. --Different situations
call for different patterns of skill
usage. --Different cultural groups call for
different patterns of skill usage.
DETERMINING PERSONAL STYLE AND THEORY
SKILLS INTEGRATION Sequencing skills
in different theories
Five Stages of the Interview 1.
Rapport/Structuring 2. Defining the problem 3.
Defining a goal 4. Exploration of alternatives
confronting incongruity 5. Generalization to
daily life
INFLUENCING SKILLS AND STRATEGIES,
Interpretation/Reframe, Logical consequences,
Self-disclosure, Feedback, Information/Advice,
Directives
REFLECTION OF MEANING
FOCUSING
CONFRONTATION
THE FIVE-STAGE INTERVIEW STRUCTURE Completing an
interview using only the basic listening
sequence and evaluating that interview for
empathic understanding
Basic Listening Sequence
REFLECTION OF FEELING
ENCOURAGING, PARAPHRASING, AND SUMMARIZATION
CLIENT OBSERVATION SKILLS
OPEN AND CLOSED QUESTIONS
ATTENDING BEHAVIOR Culturally individually
appropriate eye contact, vocal qualities, verbal
tracking skills, and body
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What Is Microcounseling?

• Single skills approach to interviewing helping
• Basic training model
• 1. Warm-up skill
• 2. Skill instruction
• Video model
• Written or didactic training
• Skill practice to mastery
• 3. Generalization

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Key Research Findings 350 Data-based Studies

• Skill definable, teachable, and affect clients
• Skills not practiced will be lost over time
• Microtraining appears more effective than
• Traditional training
• Encounter groups
• Other skill programs
• Useful in multiple settings
• Teaching clients/patients skills of living
• Counseling, medicine, management, social work,
  legal trial training
• Paraprofessional training, nutrition education,
  sport psychology, teaching

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4 Levels of Mastery

• Identification
• Basic Mastery
• Demonstrate use in interview daily life
• Active Mastery
• Achieve specific impact on client
• What does the client DO as a result of your
  effort?
• Teach Mastery
• What can your trainees DO as a result of your
  teaching?

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Narrative Theory

• Story
• Positive Asset

• Restory
• Action

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Practice Skills

• Conduct an interview
• Seek to use only the attending skills
• Culturally individually appropriate eye
  contact, vocal qualities, verbal tracking skills,
  and body
• Use the Attending Behavior Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?

Add Attending Behavior Feedback Sheet
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Chapter Two
Attending Behavior
Basic To Communication
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Attending Behavior
3 V B

• Visual-eye contact
• Vocal qualities
• Verbal tracking
• Body language
• Individually and culturally sensitive

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Cultural Differences in Attending

• Eye contact
• Direct vs. averted gaze
• Vocal tone
• Loud vs. soft
• Verbal tracking
• Direct vs. indirect and more subtle
• Body language
• Forward trunk lean vs. sitting side by side
• Speech rate
• Slow vs. fast
• Varied tone vs. monotone
• Space
• Near vs. far

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Becoming a Samurai

• Shizuru points out that microskills are very
  Zen. Masters of the sword learn detailed skills
  one by one. In the process of learning,
  performance decreases. Practice leads to mastery
  and a natural style. They retire to the mountain
  to meditate and absorb the skills. Tennis, golf,
  ballet, piano, and others depend on the same
  process.
• You may find the single skills of microtraining
  awkward. Relax, practice sills to mastery, and
  they will become natural to you. Only accept what
  feels right for you personally.

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Basic Skills Practice Model

• Divide into groups.
• Select leader.
• Assign roles-interviewer/ee, observers
• Planning-select topic, plan roles
• Practice session-short 3-5 minutes focus on
  skills, not on solving problems
• Feedback and review
• Change roles

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Practice Skills
Your voice seems to be shaking with emotion.

• Conduct an interview
• Seek to use attending and open ended questions
• Use the Attending Behavior Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 46)

Add Attending Behavior Feedback Sheet
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SECTION II
HEARING CLIENT STORIES
HOW TO ORGANIZE AN INTERVIEW
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Chapter Three
Hearing Client Stories
How to Organize an Interview
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How can questions help you and your client?

• MAJOR FUNCTIONS
• Help clients talk more freely
• Encourage or discourage certain types of talk
• But questions ten to come form your same of
  reference.
• SECONDARY FUNCTIONS
• Bring out specifics which might have been missed
• Essential for effective diagnosis
• Help client talk about facts, feelings, or reasons

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Questions

• Closed Is, are, do
• Open
• WHAT --- tends to lead to discussion of FACTS
• HOW --- FEELINGS, PROCESS
• WHY --- REASONS
• COULD --- MAXIMALLY OPEN (permits client to say
  no)

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Some Key Issues Around Questions

• Bombardment / Grilling
• Multiple questions
• Questions as statements
• Cultural differences
• Why questions
• Control dimensions

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How Shall We Talk To Clients?

• Problem
• Concern
• Issue
• Challenge
• Disorder
• Opportunity for change

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Practice Skills
How has this helped you deal with the stress this
week?

• Conduct an interview
• Seek to use only skills discussed in this chapter
• Questioning
• Use open ended questions
• Use the Questions Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001,
• p. 76)

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Chapter Four
Observation Skills
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Positive Assets and the Search for Strengths

• What is the client doing right?
• What are the exceptions to the problems?
• What are the clients strengths?
• Is there a positive social support network?
• WE BUILD TOWARD THE FUTURE ON OUR STRENGTHS!

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Less Verbal Clients

• Build trust at their rate, not yours
• Accept randomness
• Search for concretes and specifics
• Accept short concretes and specifics
• Focus on strengths as well as the immediate
  concern

(You may have to be lively and more talkative
and fill in the space without taking ownership
of the session.)
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Key Points About Nonverbal Communication

• Encouraging behaviors
• head nods
• trunk leans
• posture, gestures
• Note client nonverbals
• face, hands, gestures, etc.
• changes in response to your comment

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Key Points About Nonverbal Communication
(Continue)

• Note discrepancies between nonverbal movements
• expect some clients to be sophisticate in this
  area
• Movement harmonics and client mirroring
• may help you understand clients world
• may help rapport
• can relax a hyperactive client
• can energize a depressed client

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ISSUES IN OBESERVATION

• CONTEXT
• environment
• power relations
• space
• gender roles
• time of day
• weather
• special concerns of client which may affect other
  areas of interview

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Issues In Observation (Continue)

• OBSERVATION Objective elements of client
  behavior
• Nonverbals
• specific words used
• behavioral sequences (A-B-C)
• concrete specifics of the concern
• IMPRESSIONS
• You or your clients constructs describing the
  situation
• behavior or sequence (This may be based on your
  personal experience or theory)

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Movement Harmonics

• Are you and the client in synchrony?
• Note how client moves differently form you and
  you differently from the client.
• Watch for echoing.
• At times, move deliberately in harmony with the
  client, but be authentic.

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Nonverbal Behavioral Observation Examples

• Facial
• timing and change in eye contact breaks
• pupil dilation
• blushing or becoming pale
• smiling or frowning
• life or sparkle in eyes.

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Nonverbal Behavioral Observation Examples
(Continue)

• Arms and hands
• closing fist
• open palm
• crossed or open arms
• sudden movements
• jiggling

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Nonverbal Behavioral Observation Examples
(Continue)

• Legs
• crossed or uncrossed
• jiggling
• Full body
• turned toward or away from you
• Trunk lean toward or against

All modified by cultural and individual
differences! Never stereotype!!
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Verbal Behavior - Issues

• Selective attention- what is the client focus?
• Topic jumps- when does the client change focus?
• Key words- use client main words
• Verbal underlining though vocal tone
• Abstract or concrete ?
• I-statements

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Phrases For Interviewer Use

• Auditory Condition
• I hear
• Youre sounding
• It sounds like
• Tell me
• Repeat any auditory-sounding phrases

• Visual Condition
• I see
• Your view is
• Youre seeing
• Show me
• Repeat any visual-sounding phrases mentioned by
  the subject.

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Phrases For Interviewer Use (Continue)

• Kinesthetic condition
• That feels
• Are you in touch with
• Youre feeling
• Put me in touch with
• Your sense of
• Repeat any kinesthetic-sounding phrases

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Visual Auditory Kinesthetic
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Discrepancies Internal To Client

• Between non-verbal behaviors
• Between verbal statements
• Between what one says and what one does
• Between statements and nonverbal behavior

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Discrepancies Between Client and External World

• Between people
• Between client and a situation

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Practice Skills

• Watch the counseling session.
• Describe what you see your impressions on the
  Behavioral Observation Form p.99.
• Visual/eye contact patterns
• Vocal qualities
• Attentive body language
• Movement harmonics
• Interview someone in class you do not know,
  focusing on the above skills
• Observer make notes on the above form
• (Ivey Bradford, 2001, p 99)

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Add Behavioral Observation Form
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Practice Skills

• Conduct an interview
• Seek to use attending and open ended questions
• Use the Observation Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 103)

Add Observation Feedback Form
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Chapter Five
Encouraging, Paraphrasing, and Summarizing
Hearing the Client Accurately
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Functions of Encouraging and Paraphrasing

• Indicating to clients that they have been heard.
• Encouraging them to move on and talk in more
  depth.
• Stop clients from repeating the same story over
  an over.
• Checking on how accurately you have heard what
  has been said.
• Encourage may be the most potent.

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Encourage - The Potent Skill

• Nonverbal
• Head nods
• Gesture
• Facial Expression
• Silence
• Verbal
• Uh-hum Yes
• Tell me more
• And then?
• Restatement
• Key word(s)
• Exact phrases

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Paraphrase
Mary, looks like you are deciding between a
boring job which is safe, or taking a new
direction.

• Sentence stem
• - I hear you saying
• - Looks like
• - Feels as if
• Key facts/constructs
• - Use clients own words for touchy main things
• Distill/clarify/shorten with minimal distortion
• Check-out for accuracy

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Summarization
So far I have heard you say. . .

• Put the facts and feelings together accurately
• Useful in
• beginning an interview
• organizing facts and feelings
• bringing session to close in organized way

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Summarization (Continue)

• Similar to paraphrase/ reflection of feeling
  except for time dimension.
• Use listening skills to draw out clients story.
• Note patterns and the general flow of the
  clients comments.
• Summarize and distill using the clients key
  words for the touchy, important things.

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Helping Concrete Clients Discover Formal
Operational Patterns

• Draw out second
• (or 3rd, 4th) story

• Draw out clear linear story
• What happened first, next, what was the result?

• Search for repeating key words

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Helping Concrete Clients Discover Formal
Operational Patterns (Continue)

• Paraphrase back the repeating words, patterns,
  and behaviors
• Introduce If , then concrete examples within
  all the stories
• Be patient!!!!
• How often does this happen?
• How are the two stories the same?

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Helping Abstract, Formal Clients Become Concrete

• Ask for concrete examples.
• Search for specific details.

I get the general picture. Tell me about one
time the situation occurred?
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Practice Skills

• Conduct an interview
• Seek to use only the 3 skills of this chapter
• Encouraging, Paraphrasing and Summarizing
• Use questions only as a last resort
• Use the Encouraging, Paraphrasing, and
  Summarizing Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 128)

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Chapter Six
Noting and Reflecting Feelings
A Foundation of Client Experience
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The Reflective Listening Skills

• Encouragers
• Brief nonverbal and verbal indications you are
  with others
• Head nods, gestures, repetition of key words.
• Purpose to help others continue talking and to
  ensue that they know they ware listened to.

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The Reflective Listening Skills (Continue)

• Paraphrasing
• Feeding back the essence of what you have heard.
• Purpose to clarify complex issues and to help
  people move on to new information without
  repeating over and over.

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The Reflective Listening Skills (Continue)

• Reflection of feeling
• Feeding back emotions
• Underlying the problem.
• Purpose is to defuse emotional issues
• Recognize important emotions underlying decisions

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The Reflective Listening Skills (Continue)

• Summarization
• A longer time span to feed back emotions and
  thoughts
• Important factual issues in an organized fashion
• Purpose to organize complex issues systematically
  for later problem solving.

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Reflection of Feeling Major Functions

• Discuss emotions underlying life experience
• Encourage client discussion of feelings
• Sort out mixed/ambivalent feelings

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Reflection of Feeling Major Functions (Continue)

• Avoid intellectualizing
• We tend to make many of our decisions from an
  emotional base
• Particularly important to discuss feelings
  underlying difficult situations (divorce) or
  trauma

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Labeling Feelings

• Sad
• Mad
• Glad
• Scared
• Mixed, Ambivalent
• Metaphorical

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Reflection Of Feeling

• Name or personal pronoun
• Feeling(s) labeled
• Paraphrase context or reason
• Present tense is best
• Check-out for accuracy
• John, it sounds like you feel torn-apart because
  of your decision.

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Reflection Of Feeling (Continue)

• You feel I hear you saying Sounds like
• Name feeling (sad, mad, glad, sacred, metaphor)
• Paraphrase context because
• Present tense more effective
• Check-out for accuracy
• John, it sounds like you feel torn apart because
  of your divorce. How does that fit for you?

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Emotional Orientations

• Sensorimotor
• here and now experience of emotion
• Concrete
• Names and describes feelings
• Formal
• Discusses patterns of feelings
• Dialectic/systemic
• Feelings change with the context and view of
  situation

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Maintaining Or Decreasing Emotion

• To maintain
• Your own comfort and nonverbals Im with you,
  those feelings are just right, breath with it.
• Hold to deeper relatively short time you can
  come back again later.

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Maintaining Or Decreasing Emotion (Continue)

• To decrease
• Slowed rhythmic breathing
• Discussion of coping strengths, empowering
  concrete, closed questions gradually moving out
  of emotional experience
• Positive reframing of story and behavior
• Comment that story needs to be told

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Increasing Emotional Expression

• Observe nonverbals
• Laughing/crying are clear
• Breath, facial flushing, movement

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Increasing Emotional Expression (Continue)

• To increase
• Repetition to increase affect
• What are you seeing/hearing/feeling?
• Imagery

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PRACTICE SKILLS

• Conduct an interview
• Seek to use attending, open ended questions,
  paraphrasing, and reflection of feelings comments
• Use the Noting and Reflecting Feelings Feedback
  Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 150)

Add Noting and Reflecting Feelings Feedback
Sheet
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Chapter Seven
Selecting and Structuring Skills to Meet Client
Needs
How to Conduct a Complete Interview Using Only
Listening Skills
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Story Telling The Basic Listening Sequence

• We need to talk away war stories
• Hospital experiences
• Trauma
• Divorce, death, major issues of life

• BLS oriented to bring out stories

• Helping clients make their own meanings

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Basic Listening Sequence

• Open questions --------------------Broad summary
• Closed questions-------------------Specifics
• Encourages-------------------------Understand key
  words
• Help client move on
• Paraphrases------------------------Clarity of
  facts
• Reflects feelings--------------------Emotional
  expression
• Summary---------------------------Accuracy check
• Help organize facts feelings

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The Positive Asset Search

• Begin session with comments on strength.
• Emphasize strengths periodically during session.
• Use the BLS to bring out specific client
  strengths
• Paraphrase negative thinking and reframe in a
  more positive fashion.
• Find the strength in weaknesses.

If you cant find something good in the client,

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Empathy

• Basic listening sequence is essential in this
  process.

Experiencing the clients world as if you were
the client.
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Empathy (Continue)
Im having problems making ends meet. I just
cant seem to find a new job. Im just so tired
and depressed.
Your concerned about how you are going to meet
your financial needs. You feel depressed about
loosing your job.

• Basic empathy interview responses are
  interchangeable with client.

• Additive empathy adds to process.

• Subtractive empathy takes away from, is less than
  client experience

That is not a very positive attitude. Your not
going to find a job feeling sorry for yourself.
You seem to have a lot of concerns and sadness
surrounding the loss of your job. Talk more
about how this sadness and the loss of job
effects your sense of self.
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A Five-Point Scale For Empathy
Client Im really stuck right now. I havent
studied and my exam is coming up. I got caught
up with my parents divorce.
What interviewer statement would represent the 5
levels of empathy?
5. Additive
4. Slightly Additive
3. Basic Empathy
2. Slightly Subtractive
1. Subtractive
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Dimensions of Empathy
A Five-point Scale for Empathy (Continue)

• Positive regard
• seeing the client as a worthy human being
• Respect and warmth
• Respecting points of view different form you own
• Smiling and nonverbal behavior
• Concreteness
• being specific and clear

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Dimensions of Empathy

• Immediacy
• here and now and I-you talk
• Nonjudgmental
• avoiding evaluation
• Authenticity and congruence
• being yourself and allowing the client the same

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Five Stages of the Interview

• Rapport and structuring
• Hello and This is what will happen.
• Gathering information, defining the problem and
  identifying assets
• Whats your concern? Whats right?
• Determining outcomes
• What is your ideal solution?

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Five Stages of the Interview(Continue)

• Exploring alternatives, confronting incongruity
• What are we going to do about it?
• Generalization
• Will you do it?

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If you dont know where you are going, you may
end up somewhere else.
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Five Stage Interview (Continue)

• Rapport/Structuring
• Attending
• Client observation
• Gathering data
• Defining concern
• Positive asset search
• Basic listening sequence
• Focusing

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Five Stage Interview (Continue)

• Determining outcomes
• BLS
• Focusing
• Exploring alternatives
• Confronting incongruity discrepancy
• Listening skills
• Influencing skills
• Focusing

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Five Stage Interview (Continue)

• Generalization
• Transfer of learning from the interview
• Influencing supplemented by listening and focusing

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The Circle Of Decision Making
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Practice Skills

• Watch an interview, rating the empathic
  responding on a 5-point scale, and provide
  specific behavioral evidence for your decision
• Use the Empathy Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 186)

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Practice Skills
Add Structuring the Interview Feedback Sheet

• Divide into small groups
• Conduct an interview demonstrating all 5 stages
  of an interview
• Use the Structuring the Interview Feedback
  Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 188)

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SECTION III
HELPING CLIENTS GENERATE NEW STORIES THAT LEAD TO
ACTION
ADVANCED SKILLS AND STRATEGIES
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Chapter Eight
The Skills of Confrontations
Supporting While Challenging
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ConfrontationStep 1. Identify discrepancies,
incongruities and mixed messages

• Discrepancies internal to client
• Between non-verbal behaviors
• Between verbal statements
• Between what one says and what one does
• Between statements and nonverbal behavior

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ConfrontationStep 1. Identify discrepancies,
incongruities and mixed messages (Continue)

• Discrepancies external to client
• Between people
• Between client and a situation
• Discrepancies between you and the client

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ConfrontationStep 2 Working toward resolution
Support while challenging!

• Identify discrepancy and summarize the issue for
  the client.
• How do you put these two together?
• Through questioning, draw out the conflict or
  mixed messages.
• Be non-judgmental.
• Periodically summarize as you work through issues.

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ConfrontationStep 2 Working toward resolution
Support while challenging! (Continue)

• Use positive asset search to facilitate movement.
• Consider silence and time out from the issue.
• Carefully, share your own perspectives.
• Consider not confronting, and just listening.

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Kubler-Ross Stages Of Death And Dying

• Denial and isolation
• Anger
• Bargaining
• Depression
• Acceptance

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CIS Death And Dying

• Denial same term
• Partial examination
• Anger, bargaining characteristics of those
  starting to look at things or who dont want to
  look at them fully.

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CIS Death And Dying (Continue)

• Full examination
• Depression a natural result of loss.
• Creation of new Acceptance
• New patterns - Transcendence

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Symptoms Of Normal Grief Lindeman

• Somatic distress
• tightness in chest
• Choking
• shortness of breath occurring in waves from 20-60
  minutes
• Mental pain as well
• Preoccupation with image of deceased.
• Guilt about own actions, hostile to others.

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Symptoms Of Normal Grief Lindeman (Continue)

• Loss of usual patterns of conduct.
• All precipitated by visits, mention of deceased,
  and by receiving sympathy.
• Natural tendency to avoid syndrome.

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Confrontation Impact Scale

• Generation of a new solution
• Development of new, larger, and more inclusive
  patterns of behavior-transcendence

• Denial
• Partial examination
• Acceptance and recognition, but no change

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Practice Skills

• Use BLS to draw out a conflict in the client and
  then to confront this conflict or incongruity
• Seek to use attending, open ended questions,
  paraphrasing, and reflection of feelings comments
• Use the Confrontation Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 220)

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Chapter Nine
Focusing the Narrative
Exploring the Story from Multiple Perspectives
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How Can Focusing Help You and Your Clients?

• Major function Direct client topic flow
  to all areas of importance
• Secondary functions Broaden perspectives on
  issues
• Observe how client focuses
• Help client open or close discussion

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Focusing The Narrative

• Client
• Main theme/concern/problem
• Others
• Family
• Mutuality
• Interviewer
• Cultural/environmental/contextual issues

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The Community Genogram Alternative Constructions

• The star with the client as center
• Abstract circles and squares
• The community map
• The community of origin, the history of community
  in development, or the present community
• Help the client to find her or his own space an
  method

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The Family Chart or Genogram Alternatives

• Traditional model
• Drawings such as a tree, a network, etc.
• Oral history
• New definition of family
• Issues of adoption, gay families, extended
  families, and others.

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Community Genogram
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Community Genogram
1 mile
¼ mile
¼ mile
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Working With Family Charts or Community Genograms

• Ask for positive stories about family and
  community. Build strengths first.

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Working With Family Charts or Community Genograms

• Early on, avoid dysfunctional emphasis. Family
  genograms often focus on problems rather than
  challenges and opportunities.
• Consider anchoring strengths solidly before
  dealing with client problems and issues.

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The Individual Develops With A Family Within A
Cultural Context

• Focusing a on the family
• What occurs for you when you focus on your
  family?
• Can you generate an image of your family?
• What does it mean to you?

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The Individual Develops Within A Family Within A
Cultural Context

• Focusing on the multicultural context will
  require trust and an explanation.
• What occurs for you when you focus on your
  ethnicity/race, gender, sexual preference,
  spirituality, physical issue, history of trauma,
  socioeconomic background?

115
116
The Individual Develops Within A Family Within A
Cultural Context

• Can you generate a positive image from that
  cultural background?
• What does it mean to you?

116
117
Practice Skills

• Use all 7 types of focus comments, systematically
  outlining the clients issue
• Use the Focus Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 247)

Add Focus Feedback Sheet
117
118
Chapter Ten
Eliciting and Reflecting Meanings
Helping Clients Explore Values and Belief
119
How can Reflection of Meaning Help You and Your
Clients?

• Major function
• Discover underlying values, deeply help thoughts
  and feelings underlying life experience
• Secondary functions
• Facilitate client understanding of their own
  experience
• Explore values and life goals

120
Meaning As Core Of Human Experience
But, note that all are interconnected and a
change in any one part of the system my affect
others as well.
BEHAVIORS
MEANING
THOUGHT
FEELINGS
120
121
Eliciting and Reflecting Meaning

• Questioning to discover underlying meaning
• What sense do you make of it?
• What does that mean to you?
• Why is that important to you?
• What value does that have?

122
Eliciting and Reflecting Meaning

• Reflect meaning using clients key words
• You mean
• You value
• You care
• Paraphrase/shorten/
• distill what client is saying
• . Check-out for accuracy of your listening

123
Dereflection on Overemphasis on Negative

• Client talks about problem or issue
• Basic listening sequence
• Elicit meaning
• (What does this mean to you?)
• Reflect the meaning

124
Dereflection on Overemphasis on Negative

• Draw out positive dimension or strength
• What positive do you learn through that?
• (Support from others, personal strength)
• Draw it out by using BLS
• Reflect the more positive meaning

125
Dereflection on Overemphasis on Negative

• Join the two (confront) with a summary

In this situation. . . , On one hand and on
the other hand
What does the positive say to the negative?
126
One View of Logotherapy
He who has a why to live for can beat with
almost any how-
Nietzsche

• In facing the hell of the concentration camp,
  Frankl took pleasure in

Risking self to save 3 men
Religion
Art
A small piece of bread Writing
Humor Relationships
A moment of solitude Hiding

• But, most of all. Thinking of his wife

Sunset Nature
Joy of no smokestack
126
127
Spiritual Meanings are Important

• Research reveals that clients can benefit from
  spiritual imagery in the helping process
• The majority of US clients believe that they have
  a personal relationship with God
• An issue of meaning that we have tended to ignore

127
128
Some Suggestions For Allowing Spiritual Issues To
Enter The Interview

• Let the client take the lead
• Community genograms often reveal past history of
  spiritual interest
• Ask for positive strengths that the client uses
  both now and in the past to work with
  difficulties
• Be aware that spirituality will be defined with
  each client while religion may be part of
  spirituality or placed separately.

128
129
Practice Skills

• Draw out the interviewees negative experience
  through eliciting reflecting meaning
• Search for key words Could you tell me more
  about . . .
• Use BLS skills
• Use the Reflecting Meaning Feedback Sheet
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 271)

129
130
Chapter Eleven
Influencing Skills
Six Strategies for Change
131
1 -2 - 3 Pattern

• Listen
• Assess and influence
• Check out and observe consequences

132
Interpersonal Influence Continuum
The Moderate Triad
Encourage Paraphrase Reflection of
feeling Reflection of meaning Open
questions closed questions Focusing Information/ad
vice Self-disclosure Feedback Interpretation/refr
ame Logical consequence Directives Confrontation
Moderate
High
Low
ATTENDING BEHAVIOR AND CLIENT OBSERVATION
132
133
Reframing/Interpretation
Goal Provide an alternative, more useful frame
of reference

• Use BLS to draw out data
• Provide a new view/interpretation
• Your own Feminist Spiritual
• Cognitive Cultural Psychoanalytic
• Check-out

134
Logical Consequences

• BLS to understand situation
• Encourage

• Provide data on both positives and negatives
• Summarize issue in a nonjudgmental fashion
• Let the client decide

135
Self-Disclosure

• I statements talking about self.
• Verb for content or feeling.
• Object coupled with adverb and adjective
  descriptors.

136
Self-Disclosure
My experience of divorce was similar to yours.
Im delighted our interview plan went well.

• And remember-genuineness, timeliness, and tense.
  (Present)
• Use only a modest amount of self-disclosure.

137
Feedback

• Client in charge
• Focus on strengths and something the client can
  do something about
• Concrete and specific
• Relatively nonjudgmental
• Lean and precise
• Check out how feedback was received

138
Information / Advice / Opinion / Suggestion

• Attend and be sure client is ready and willing.
• Be clear, specific and timely in what you say.
  Only give as much as the client wants to hear.

• Check out the clients reaction.

139
Directives
Indicate clearly what action you wish client /
patient to take.

• Appropriate attending behavior
• Usually more assertive
• Clear and concrete
• Vague Be happy this next week.
• Concrete You indicated you would take 2 walks
  and meet a friend once this next week.
• 3. Check out do they hear you?

140
Example Directives

• Specific suggestions for action
• Paradoxical instructions
• Imagery
• Role-play/enactment
• Gestalt empty chair, nonverbals

• Free association
• Positive reframing
• Relaxation
• Systematic desensitization
• Language choice
• Thought-stopping

141
Example Directives

• Relaxation
• Systematic desensitization
• Language choice
• Meditation
• Family therapy communications
• Homework

142
Thought Stopping A Useful Directive

• We tend to have silent repeating things we are
  saying quietly to ourselves in our minds.
• All-too-often these are negative self-defeating
  thoughts. (Can result in depression, sadness).

143
Thought Stopping A Useful Directive

• Thought stopping seeks to stop negative thinking
  as it starts and replace it with positives.
• Alternatives Just say Stop! to yourself.
  Snap a rubber band. Substitute two positives for
  each negative thought. Positive images.

144
Positive Imagery

• Guided imagery with relaxing scene
• Positive images of strength
• Positive spiritual images

144
145
Positive Imagery

• May be helpful to locate positive feelings
  specifically in the body.
• Avoid imaging problems or negative thoughts
  unless you have solid relationship and
  supervision.

146
Practice Skills

• Divide into small groups
• Conduct an interview
• Use Influencing skills drawing out the
  interviewees story
• Use the Influencing Skills Feedback
• What mastery level was demonstrated?
• What mastery level was the observer?
• (Ivey Bradford, 2001, p 308)

Add Influencing Skills Feedback
146
147
Practice Skills

• Conduct an interview
• Use all the counseling skills
• Use the Counseling Skills Form
• What mastery level was demonstrated?
• What mastery level was the observer?

Add Counseling Skills Form
147
148
SECTION IV
SKILL INTEGRATION
149
Chapter Twelve
Skill Integration
Putting It All Together
150
Frank Parsons Vocational Model 1908

• Consider personal traits

• Examine environmental factors

• True reasoning between individual and
  environment

Trait and factor theory basic in vocational
counseling for nearly a century.
151
Decisional Counseling

• Stage 1 Rapport and structuring
• Stage 2 Clarify the decisional
  problem/concern (Include positive assets)
• Stage 3 Determine outcomes
• Stage 4 Generative alternative decisions
  (consider consequences)
• Stage 5 Generalization

152
Interview Plan - Useful To Have In Mind Even
Before You Start

• How do you plan to establish rapport and tell the
  client what is going to happen?
• How will you draw out the client issues and
  identify positive assets?
• How will you ensure that you have asked clients
  about their goals?

153
Interview Plan-Useful To Have In Mind Even
Before You Start (Continue)

• How do you plan to go about exploring
  alternatives and generating new ideas?
• What are your plans for generalization?

154
Treatment Plan
Useful as summary of past sessions and planning
for the future.

• Summarize rapport with client and how well these
  sessions are structured
• Problem definition and summary of assets

154
155
Treatment Plan (Continue)

• Define outcomes realized already and outcomes
  needed for the future
• Routes toward problem resolution
• Generalization-specific plans

156
Time Spent in the Five Stages

156
157
Practice Skills

• View video of a counseling session
• Divide into small groups
• Use form Interview Plan and Objectives form
• Complete form
• (Ivey Bradford, 2001, p 348)

Add Interview Plan and Objectives form
157
158
Practice Skills

• View video of a counseling session
• Divide into small groups
• Use form Creating a Long-Term Treatment Plan
• Complete form
• (Ivey Bradford, 2001, p 349)

Add Creating a Long-Term Treatment Plan form
158
159
Chapter Thirteen
Integrating Microskills with Theory
Sequencing Skills and Interview Stages
160
Person-Centered Counseling Microskills

• Stage1 Rapport/Structuring
• Tends to move immediately to listening to client
  via BLS
• Minimal structuring
• Few, if any questions used

161
Person-Centered Counseling Microskills
(Continue)
Stage 2

• Gathering Data
• BLS drawing out facts/feelings, but emotions are
  central
• Constant emphasis on positive assets

162
Person-Centered Counseling Microskills
(Continue)

• Stage 3 Defining Goals
• Obtain clients definition of ideal self which
  can be contrasted with real self
• Reflection of meaning important

163
Person-Centered Counseling Microskills
(Continue)
Stage 4 Confronting Incongruity Between Ideal
and Real Self

• Examine life patterns
• Minor emphasis on decision and action
• BLS, reflection of meaning, feedback skills

164
Person-Centered Counseling Microskills
(Continue)

• Stage 5 Generalization
• Relatively little attention
• Encourage satisfaction with ones self

• Encourage satisfaction with ones self

165
Assertiveness Training

• Establish rapport and structure
• Define the problem/asset search
• Discuss the concern using BLS
• Define a strength or positive asset
• Role-play the problem situation
• Define outcomes
• Review role-play and select behavior for change
• Be very concrete and specific in behavioral
  definition

166
Assertiveness Training (Continue)

• Generate alternatives
• Role-play again to practice new more assertive
  behavior
• May require several role-plays to produce real
  change
• May add new behaviors

• Generalization
• Highly specific and concrete for taking change to
  real world

167
Determining Personal Style and Theory

• We all develop within a family in a cultural
  system.
• Each of us is unique and, yet, somehow the same.
• Developing a personal style requires you to
  respect your own natural way of being, but also
  to recognize that others differ from you.

168
Determining Personal Style and Theory (Continue)

• Developing a personal style will

• increase awareness of the complexity of
  interviewing and counseling
• require you to learn many different theoretical
  and practical approaches to helping

168
169
Determining Personal Style and Theory (Continue)

• Developing a personal style will

• increase your sensitivity to multicultural issues

• require you to respect yourself for your
  uniqueness and the fact that you, too, are a
  special person
• ask you to define concretely what is your
  natural style?

170
Relapse Prevention

• Generalization not planned is likely to be
  lamented.
• Choose behavior to be retained
• How often to be used?
• How will we know a slip has occurred?

171
Relapse Prevention (Continue)

• Generalization not planned is likely to be
  lamented.
• Strategies to anticipate difficulties in
  retention
• Understand the relapse process
• Differences between learning skill and actually
  using it
• Support network, who will help?
• High risk situations?

172
Relapse Prevention (Continue)

• Generalization not planned is likely to be
  lamented.
• Strategies to increase rational thinking
• What is unreasonable emotional response to
  relapse?
• How can one think more effectively in tempting
  situations?

173
Relapse Prevention (Continue)

• Generalization not planned is likely to be
  lamented.
• Strategies to practice support skills
• What additional skills are needed (assertiveness,
  relaxation)?
• Strategies to provide appropriate outcome
• What are probable outcomes of success?
• Generate a reward for success

174
Relapse Prevention (Continue)

• Generalization not planned is likely to be
  lamented.
• Predicting the circumstances of the first lapse
  or slip
• Outline details of how it might occur
• Concrete and spell out situation
• Help client deal with the anticipated
  disappointment and emotional consequences

175
The Essence of SOIC

• Brief, focused on doable issues
• What are you doing right?
• Where are your supports?

• Can you tell the story in a more positive way?
• When are things going well?
• Draw on positives!

176
Solution-Based Therapy

• Rapport / structuring
• Expect success-develop relationships
• Concern definition
• Minimal, search for exceptions
• Develop positive assets

177
Solution-Based Therapy (Continue)

• Goal setting
• What do you want to happen?
• 4./5. Work generalization
• Brainstorm
• Contract for success

178
Start Solution-Based Thinking at the Very
Beginning

• Even As We Start You Can Ask
• Are things better in anyway?
• Whats different/changing?
• Whats keeping it from getting worse?

179
Positive Asset Search

• Anchor positives, work from strength
• Individual, family,
• community,
• spiritual,
• cultural

179
180
Scaling is Useful
Derived from Wolpes Lazarus (1966) Anxiety
Hierarchy
On a scale of 1 to 10, with ten meaning the
concern is fully resolved, and 1 meaning that the
concern has become a big problem, where would you
put yourself today?
Chapter 13, p. 373
Wolpe, J., Lazarus, A. (1966). Behavior therapy
techniques. Elmsford, N.Y., Pergamon.
181
Questions

• What, specifically, do you want
• to have happen? Be as precise
• as possible.
• What is different in your life when the situation
  is better?
• What concretely are our joint goals, lets write
  them out together.
• In addition, normalize the narrative.

Chapter 13, p. 370-374
182
Questions (Continue)

• Lets focus on the exceptions.
• Tell me about times when the concerns are absent
  or seem a little bit less.
• What is different about these times?
• How do you get that more positive result to
  happen?

Chapter 13, p. 370-374
183
Questions (Continue)

• Lets focus on the exceptions.
• How does it make your day go differently?
• What did he/she do or say when it went better?

Chapter 13, p. 370-374
183
184
Questions Continue)

• Lets focus on the exceptions.
• How did you get her to stop?
• How is that different from the way you usually
  handle it?

Chapter 13, p. 370-374
184
185
If you dont know where you are going, you may
end up somewhere else!
Chapter 13, p. 374
186
Questions (Continue)

• What concretely are our
• joint goals, lets write
• them out together.
• What, specifically, do you want to have happen?
  Be as precise as possible.
• What is different in your life when the situation
  is better.

Chapter 13, p. 374
187
Miracle Question
Suppose when you go to sleep tonight, a miracle
happens and the concerns (not problems) that
brought you in here today are resolved. But
since you are asleep, you dont know the miracle
has happened until you wake up tomorrow what
will be different tomorrow that will tell you
that a miracle has happened?
188
Stages 4 and 5 Working on the Concern and
Generalizing New Ideas to the Real World
Tolman notes It is most useful to present
patients with the smallest and simplest task that
the therapist can come up with, worded to
correspond with the clients world view.
189
Practice Skills

• Divide into small groups
• As directed use either
• Solution-Oriented Interviewing and Counseling
  Feedback
• Assertiveness Training Feedback
• Person-Center Interview Feedback
• The observer completes the appropriate form
• (Ivey Bradford, 2001, p. 386-388)

Add Solution-Oriented Interviewing and
Counseling, Assertiveness Training, and
Person-Center Interview Feedback forms.
189
190
Chapter Fourteen
Determining Personal Style and Future
Theoretical/Practical Integration
191
Determining Personal Style and Theory

• We all develop within a family in a cultural
  system. Each of us is unique and, yet somehow
  the same.
• Developing a personal style requires you to
  respect your own natural way of being, but also
  to recognize that others differ from you.

Chapter 14, p. 391-392
192
Developing A Personal Style Will

• Increase awareness of the complexity of
  interviewing and counseling
• Require you to learn many different theoretical
  and practical approaches to helping

Chapter 14, p. 391-392
193
Developing A Personal Style Will

• Increase your sensitivity to multicultural issues
• Require you to respect yourself for your
  uniqueness and the fact that you, too, are
  special person
• Ask you to define concretely
• what is your natural style?

Chapter 14, p. 391-392
194
Intentional Interviewing and Counseling
Summary of Major Competencies
At what level of competence are you?
(Identification, basic mastery, active mastery,
and teaching mastery)

• Attending behavior
• Questioning
• Client observation
• Encouraging
• Paraphrasing
• Summarizing
• Reflecting feelings

Chapter 14, p. 392-395
195
Intentional Interviewing and Counseling
Summary of Major Competencies
At what level of competence are you?
(Identification, basic mastery, active mastery,
and teaching mastery)

• Basic listening sequence
• Positive asset search
• Empathy
• Five stages of interview Confrontation
• Story-positive asset-restory-action
• Confrontation

Chapter 14, p. 392-395
196
Intentional Interviewing and Counseling
Summary of Major Competencies
At what level of competence are you?
(Identification, basic mastery, active mastery,
and teaching mastery)

• Confrontation Impact Scale
• Focusing
• Reflection of meaning
• Noting concreteness abstractions in self
  clients
• Assessing Developing Orientation
• Develop Questioning skills
• Interpretation/reframe

Chapter 14, p. 392-395
197
Intentional Interviewing and Counseling
Summary of Major Competencies
At what level of competence are you?
(Identification, basic mastery, active mastery,
and teaching mastery)

• Logical consequences
• Self-disclosure
• Feedback
• Information/advice/opinion/
• instruction/suggestion
• Directives
• Analysis of the interview
• Family genogram

Chapter 14, p. 392-395
198
Intentional Interviewing and Counseling
Summary of Major Competencies
At what level of competence are you?
(Identification, basic mastery, active mastery,
and teaching mastery)

• Community genogram
• Decisional counseling
• Person-centered counseling
• Assertiveness training
• Solution-oriented interviewing counseling
• Teaching skills to client
• Defining personal style and theory

Chapter 14, p. 392-395
199
Practice Skills

• Divide into small groups
• Use form Counseling Skills form.
• Conduct an interview
• Complete form

Add Counseling Skills Form
199
200
APPENDIX
200
201
Crucial is our ability to assess developmental
level on the spot

• and as therapy/counseling progress through
  treatment.

202
Sensorimotor Issues
Watch for

• Random, disorganized bits and pieces of
  thought, emotion, and action.
• Splitting-inappropriate emotion to the situation.
• I am my emotions.

203
Sensorimotor Strengths Weaknesses