5 Basic clinical skills and competencies PDF

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Joana Duarte...

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11-02-19 Basic clinical skills and competencies -

Asking questions Active listening Reflection of feelings

Questioning Are questions important in a session? ● What? ● When? ● Why? ● Who? ● Where? ● How? - Different questions lead to different responses - Open questions - deeper exploration - Who - What - When - Where - Why - Closed questions - information and specifics - Do - Is - Are - Open and empowering to the client - Could - Can - Would Open questions - What leads to facts - What happened? - What are you going to do? - Why can lead to discussion of reasons - Why is that meaningful to you? - Why do you think that happened? - How may lead to exploration of process or feelings - How could that be explained? - How do you feel about that? - Could, can, or would suggest less counselor control

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Could you tell me more about your situation? Would you give a specific example? Can you tell me what you’d like to talk about today?

Open questioning 1. Begin the interview - What would you like to talk about today? - Could you tell me what you’d like to see me about? - How have things been since we last talked together? - The last time we met we talked about your plan to face up and talk with your partner about not having time for you. How did it go this week? 2. Elaborate and enrich client’s story - Could you tell me more about that? - How did you feel when that happened? - Given what you’ve said, what would be your ideal solution? - What might we have missed so far? - What else comes to your mind? - Open questions near the end of the session: - What else is going on on your life? - Looking back at what we’ve been talking about, what else might be added? OR What might we have missed? - You may even have thought about something and not said it. Could you tell me a bit about whatever occurs to you at this moment? - Ask specific examples to clarify what is happening. - Check if your perception/experience of client’s world is accurate. 3. Concrete specifics of client’s world - Could you give me a specific example of that situation? - What does she/he do specifically that brings out this feeling (specify accordingly)? - What do you mean by XXXX? - Could you specify what you do before and after X? 4. Assessment - Who: - Who is the client? - What is the client’s personal background? - Who else may be involved? - What: - What is the client’s concern? - What is happening? - What are the specific details of the situation? - When: - When does the issue occur? - When did it begin?

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How: Why: -

What immediately preceded the occurrence of the issue?

How does the client react to the challenge? How does the client feel about it? Why does the problem occur? Why is the client concerned about it?

Potential problems - Multiple questions - Hard for client to keep track of the questions being asked - Important to ask only one question at a time - Grilling - Bombarding someone with questions - Not giving the client time to reflect or answer the questions - Questions as statements - Don’t ask leading questions - Questions as statements can sway the answer of the client - Using questions are statements can also sound judgemental to the client - “Why” questions - Can cause the client to become defensive - Can sidetrack the goal of the questions - Why questions can signify a lack of empathy from the therapist Active listening - Active listening - Encouraging - Paraphrasing - Summarising - Listening is an active process - Active listening demands serious attention to empathy - It’s necessary to truly be with and understand the client as fully as possible - These skills are basic to empathetic understanding and enable us to communicate to clients that they’ve been heard Encouraging - Encourage client to keep talking - Use language similar to client’s language - Encouragers - Verbal - “uh huh;” repetition of keywords - Non-verbal - head nods, open gestures, positive facial expressions

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Restatements - Repetitions of two or more words exactly as used by the client Silence can be another type of encourager Excessive head nodding or gestures and too much parroting can be annoying and frustrating

Paraphrasing - Facilitate client’s exploration and clarification of issues - Feeds back to the client the essence of what has been said - It is not parroting - It’s using some of your own words plus the exact main words of the client - Often fed back to the client in a questioning tone of voice - Four dimensions 1. A sentence stem - I hear you saying… / Looks like the situation is… 2. Key words, used by the client 3. Essence of what the client has said, in briefer and clearer form 4. Check out for accuracy - Am I hearing you correctly… / So what you’re saying is… Summarising - Clarify and distil what the client has said over a longer time span - May be used to: - Begin or end a session - Move to a new topic - Clarify complex issues - organise thinking - Facts, thoughts, and emotions are included - Same four dimensions as paraphrasing Reflecting feelings - From my point of view as therapist, I am not trying to “reflect feelings.” I am trying to determine whether my understanding of the client’s inner world is correct — whether I am seeing it as he or she is experiencing it at this moment. Each response of mine contains the unspoken question, “Is this the way it is in you? Am I catching just the color and texture and flavor of the personal meaning you are experiencing right now? If not, I wish to bring my perception in line with yours.” - On the other hand, I know that from the client’s point of view we are holding up a mirror of his or her current experiencing. The feelings and personal meanings seem sharper when seen through the eyes of another, when they are reflected. (Rogers, 1986) -

Why is it important to listen to and reflect feelings? - Identification of the key emotions of a client - Facilitates in-depth exploration - Promotes emotional awareness

Reflecting versus paraphrasing - Paraphrasing - Focus on content - Reflection of feelings - Focus on key emotional words Don’ts -

Introduce topics that the other person didn't express Push your own interpretations Mix your on ideas. Try to fix or change or improve what the client said Encouragement, reassurance, and well-intentioned comments Focus on trying to get the feelings right Move on too quickly

How do you know you’re doing it right? - The client goes further into their problems - Even if the client says “No, it’s not like that, it’s more like…” and then may feel further into it to see how it actually feels - The client may sit silently, satisfied that you get everything up to now - The person may show a release, a relaxing, a deep breath, a sigh - The client verbally expresses being understood (“That’s exactly how I feel”) How do you know you’re doing it wrong? - If nearly the same thing is said over again it means the client feels you haven’t got it yet - The client’s face may get tight, tense, confused - If the person changes the subject (especially to something lees meaningful or less personal) it means he gave up on getting the more personal thing across right. - When you feel you’re off track, go back to the last point that was on a solid track inside, and ask the person to go on from there. - “I know I didn’t understand it right but I want to” Key takeaways - Attending and questioning help the client open up. - Active listening, through the skills of encouraging, paraphrasing, and summarising is needed to communicate that you have heard the other person fully. - Encouragers help the client to keep talking. Paraphrases feed back to the client the essence of what has just been said, but is not parroting. Summarisations are similar to paraphrases but more time and information are involved; they may be use to begin and end the session, and to clarify complex stories. - The check out gives an opportunity to determine the accuracy of the summary. - A non-judgmental and accepting attitude are essential, and without them you will sound

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mechanical Reflecting feelings helps the client to identify key emotions, explore deep feelings and emotions, and increase emotional awareness and validation. Reflecting is different from paraphrasing in that the focus is in the emotion words. Non-verbal cues of emotion are important sources of information....