PY3104 Notes - Summary Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society PDF

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PY3104 NOTES PRINCIPLE OF COUNSELLING INTRODUCTION – Lecture 1, Chapter 1 Counselling is a process where the client and counsellor work together to come up with different ways to experience various situations.  Collaborated effort to look at client's issues 1. To identify the right course of action 2. To help/facilitate resolve difficulties 3. Find ways of coping Cultural intentionality is acting with a sense of capability and flexibly deciding from among a range of alternative actions. The culturally intentional individual has more than one action, thought, or behaviour to choose from in responding to changing life situations and diverse clients.  The culturally intentional counsellor or therapist remembers a basic rule of helping: If a helping lead or skill doesn’t work—try another approach!

Counselling

Focus on normal developmental concerns  Daily life issues  Intensive & Personal

Psychotherapy

Treatment of deep seated issues  Interpersonal Therapy  Psychodynamic  Gestalt  Cognitive-behavioural  Rational-emotive behavioural  Person-centred  Existential

Interviewing

Basic process used for gathering data, providing information & advice to clients, and suggesting workable alternatives for resolving concerns.

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GOALS OF LISTENING/THERAPY 1. Understand Client’s: a. Thoughts b. Feeling c. Behaviour 2. Search for Client’s: a. Strengths – Able to survive so far & seek help b. Positives – Doing well in other aspects c. Power – Help cope with a difficult situation 3. To allow in-depth awareness of client’s own emotional experience 4. To encourage more useful ways of thinking, & new behavioural actions. 5. To rewrite an more positive life story 6. Positive development and growth

CAUTIONS IN COUNSELLING 

If client wants direct answer/solution o “I understand it would be easier if I can just give you the solution, however, it is not my job to tell you what to do or how to live your life. I am only here to open up alternatives in your life but the choice remains your to decide.”

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STRATEGIES Approaches

1. Eclectic approach draw on elements of several different models when working with clients. 2. Directive suggesting courses of action and giving ‘homework’ exercises a. Singaporeans’ preferred approach 3. Non-directive with the client taking the lead in what is discussed

Micro-skills Hierachy

1. Ethics, Multicultural Competence, Neuroscience, and Positive Psychology/Resilience 2. Listening/Interviewing Skills a. Attending and Empathy Skills b. Observation Skills c. Questions d. Encouraging, Paraphrasing, and Summarizing e. Reflecting Feelings 3. Five stages of Counselling a. Empathic relationship b. Story and strength c. Goals d. Restory e. Action 4. Influence client’s actions & decisions a. Focusing b. Empathic Confrontation c. Reflection of Meaning and Interpretation/Reframe d. Stress Management, Self-Disclosure, Feedback, Natural and Logical Consequences, Directives, Instruction, Psychoeducation, and Therapeutic Lifestyle Changes 5. Apply skills to theory: Crisis counselling & CBT 6. Skills Integrations 7. Determine personal style 8. Transcendence

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HOW TO LEARN MICRO-SKILLS 1. Introduction. Focus on a single skill or strategy and identify it as a vital part of the helping process. 2. Awareness, Knowledge, and Skills. Read about the single skill or strategy and/or hear a lecture on the main points of effective usage from your instructor. Cognitive understanding is vital for skill development. However, understanding is not competence, nor does it show that you can actually engage in an effective interview, counseling, or therapy. 3. Observation. View the skill in operation via a transcript and process analysis—or better yet, watch a live demonstration or view a videotaped presentation. 4. Multiple Applications. Review different applications of the skills, variations according to diversity and other cultural dimensions, and additional ways in which the skill or strategy can be used. 5. Action: Key Points and Practice. The main issues of the chapter are summarized. Ideally, use video or audio recording for skill practice; however, role-play practice with observers and feedback sheets is also effective. Seek immediate feedback from your practice session. Use the Feedback Sheets. How did those who watched the session describe your interaction? 6. Portfolio of Competencies and Personal Reflection. Here you develop a summary of your interviewing, counselling, and psychotherapy abilities. Questions will ask you to summarize the meaning of the chapter for practice now and in the future.

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GOING INTO DETAILS ON THE MICROSKILL HIERACHY

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PART 2: ATTENDING & EMPATHY SKILLS – Chapter 3 GOALS AND COMPETENCY OBJECTIVES Awareness and Knowledge  Develop a solid understanding of how attending behavior, attention, and selective attention form the basis for all counselling and therapy.  Understand how basics of neuroscience explain and expand the importance of attention and empathy.  Learn how teaching microskills of listening is useful therapeutic strategy. Skills and Action  Increase your skill in listening to clients, and communicate that interest.  Establish an empathic relationship with your clients. Adapt your attending patterns to the needs of varying individual and cultural styles of listening and talking Goals of Interviews Intentionality Acting with a sense of capability; choosing from among a range of alternative actions, thoughts, and behaviours in responding to changing life situations Intentional interviewing

Concerned with how many potential responses may be helpful  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 individuals and cultures 

If you work intentionally in the interview, you can anticipate predictable client responses

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Basic Listening for Normal clients Goals  Encourage clients to continue speaking and explore.  Build rapport/trusts with the client  Allow us to predict clients’ behaviours Types of Attending Behaviours (3 V)

1. Listening 2. Talking + Observation o Vocal quality 

Pitch, Volume, Rate, Emphasis, Breaks and hesitations

o Verbal tracking  Note topic shift, range of concerns, concrete or abstract 3. Nonverbal means + Observations o Culturally appropriate visual/Eye Contact o Body Language  Postures, shifts, distances, movements Non-Attention

Used only when a client: 1. Speaks about the same subject over and over. 2. Only wants to discuss negative topics. Types: 1. 2. 3. 4.

Reduce eye contact. Shift body posture, vocal tone and quality. Change subject to other and more positive topic. Observe silence.

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PART 3: OBSERVATIONS – Chapter 4 Basic Listening Skills for Less-Verbal Clients Goals Draw out:  General picture of the situation  Key facts: Emotions & Reasons Methods

    

Build trust at the client’s pace Accept some randomness Search for concrete specifics Seek short-concrete answers Use questioning and other listening skills

Example: Working with Children 

They may require considerable help from the interviewer before they are willing to share at all.

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Begin sessions by sharing something fun/interesting o Games, clay, and toys in the counselling room

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They tend to like doing something with their hands while talking o Allowing them to draw is useful o Drawings can be interpreted too

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Open-ended questions are too difficult for them.

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PART 4: QUESTIONS FOR OPEN COMMUNICATION – Chapter 5 (Lecture 2) GOALS Awareness and Knowledge 

Understand the two key styles of questioning: open and closed questions.



Choose the question stem and style that are most likely to achieve a useful anticipated result that clarifies the client’s story.



For example, what questions often lead to talk about facts, how questions to feelings or process, and why questions to reasons. Could/would questions tend to be the most open.

Skills and Action  Draw out and enrich client stories by bringing out a more complete description, including background information and needed details. 

Open or close client talk, intentionally, according to the individual needs of the client.

QUESTIONS    

Systematic framework for directing the interview. Open new areas for discussion – when clients do not provide important info/avoid topics Pinpoint and clarify issues. Aid in self-exploration.

1. TYPES OF QUESTIONS Opened

 Cannot be answered in a few words  Facilitate deeper exploration of client issues  Encourage clients to talk and provide maximum info  Begin with what, how, why, or could/ would. For example, “Could you tell me what brings you here today?”

Closed 

Can be answered in very few words.

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Obtain specifics answer – Yes or No (Categorical)

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Increase interviewer’s control

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Close down client’s talk

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Begin with is, are, or do.

Example: “Are you living with your family?”

2. STYLES OF QUESTION Who?  Who is the client?  Who else may be involved? (Husband/friend) o Bring them along ~10min but focus remains on client What?

   

What is the client’s personal background? What is happening? What are the specific details of the situation? What is the client’s issue?

When?

 

When did it begin? When does the issue/problem occur? o What immediately preceded the occurrence of the problem? o What is the trigger?

Where?

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Where does the concern/ problem occur?

How?

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How does the client react to the issue/challenge? How does he/she feel about it?

Why?

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Why does the problem/ difficulty/ issue occur? o Reasons?

What else?



Can you tell me more? or how ..? o Encourage openness o Brings out remaining details

Could/Can/Would?   

Could you tell me about your concerns? Can you tell me what you would like to discuss today? Would you tell me how that came about? o The way to externalise the questions in your mind to the clients.

**CAUTIONS IN QUESTIONING 1. Bombardment/grilling a. Clients become defensive – seems rude/like interrogation

11 b. Interviewer appears in control - client appear helpless 2. Multiple questions a. May confuse clients by throwing out several questions at once 3. Questions as statements or “why” Questions a. May seem judgemental/lack empathy/attacking to the clients b. Seem like you do not understand the clients

12 3. EXAMPLES OF QUESTIONS What else? / To probe more

       

Client change or closes topic

 

Clarify Client’s Meaning

   

Opening Questions

      

“What important things are happening in your life right now or with your family?” What else is going on in your life? “Looking back at what we’ve been talking about, what else might be added? “Have we missed anything?” “Could you tell me a bit about what occurs to you at this moment?” Could you tell me more about that? How did you feel when that happened? What would be your ideal solution? Note it down. Bring it up later. o “You avoided the topic earlier, could you tell me more?” If client refuses, change to indirect questioning o “What do you feel about this “topic” o “Is it very hard to talk about?” o “Why do you not wish to talk about it?” “You mentioned that your husband is disrespectful, can you elaborate what did he do?” “You said that work problems are what is troubling you, so what about your family relationship?” “How is your relationship with your wife, siblings, parents?” “Can you give me a specific example?” What brings you here today? Prompted you to see me? How did the week go for you? How can I help you today? Is there something on your mind that you would like to talk about? How are you coping? How are you today? What would you like to talk about today? How have things been since we last talked together? Last time we talked about ……; how did it go this week?

* “Why” is usually the area we are exploring in therapy with clients. They do not know why. Don’t ask why questions. Non-talkative Clients

   

Informal/indirect approach Ask generic/current event questions to get comfortable Careful self-disclosure to show client that you understand Slowly ask about the topic or wait till client speaks up

4. EMPATHY AND MICROSKILLS

13 Empathy

 

Experiencing the world as if you are the client, but remaining separate Communicating to the client that you understand.

Basic Empathy  Interviewer’s feedback is align with client’s story  Can be demonstrated through effective use of basic listening skills Additive Empathy  Responses that include an addition of what the client has said. It gives a link of what has been said earlier or a new perspective 

Is primarily used in the change-oriented stage and is effective for increasing a client's self- awareness; softening the impact of confrontation; and exploring and resolving the barriers to change



Can be demonstrated through skilful use of listening and influencing skills

Subtractive Empathy  Responses that distort or take away from the meaning expressed and experiences of the client  Poor use of listening and influencing skills Positive Regards

Selectively attending to positive aspects and responding to the client as a worthy human being  Closely related to the search for strengths and positive assets  Look at all clients positively, regardless of who they are and what they have done -> can be challenging  You do not have to agree, just regard humanity as positive

Respect & Warmth

Respecting points of view different from one’s own. Demonstrate through:  Open posture, Smiling, Vocal qualities

Concreteness

Seek specific feelings, thoughts, descriptions, and examples of action

Immediacy

Non-Judge mental

  

“Could you give me an example of . . .?” Interviewer’s lead need to be very specific in: Directive Feedback or Interpretation

    

Be in the moment with the client Change of tense may speed up or slow down the interview Shifting to new tense from client’s constant tense may be useful Suspend your own opinions and attitudes; be neutral Expressed through vocal qualities, body language, and neutral

14 Attitude  

statements There are no absolutes on how to use non-judgmental attitude Interviewers may be challenged by dishonest, violent, sexist and/or racist clients

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PART 5: ENCOURAGING, PARAPHRASING, AND SUMMARIZING – Chapter 6 

Emotion – the system that tells us how important something is.



Attention – focuses us on the important and away from the unimportant things.

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Cognition – tells us what to do about it.

GOALS Awareness and Knowledge  

Value active listening in the communication process. Identify the role of intentional participation, decision making, and responding to client conversation.

Skills and Action 

Help clients talk in more detail about their issues of concern and help prevent the overly talkative client from repeating the same facts. Clarify for the client and you, the interviewer, what is really being said during the session.



Check on the accuracy of what you hear by saying back to clients the essence of their comments and providing periodic summarizations.

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Develop cognitive empathy and facilitate client cognitive understanding for clearer decision making and more effective action.

1. INTRODUCTION TO ACTIVE LISTENING SKILLS 

When we attend and clients sense that their story is heard, they open up and become more ready for change.



This leads to more effective executive brain functioning, which in turn improves cognitive understanding, organization of issues, and decision making.

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Emotional regulation is the second critical aspect of executive brain functioning.

2. CAUTION IN UTILISING ALS     

Aware of Cultural differences Avoid Stereotypes Consider age & gender differences Be empathic, non-judgmental, accepting Avoid being mechanical (Acting just based on textbook)

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Be observant of your client’s behaviours & emotions

17 3. TYPES OF ACTIVE LISTENING SKILLS Encourager

Paraphrase

   

Verbal & Nonverbal expressions Minimal verbal utterances (“ummm” and “uh-huh”) Restatement – repeat small statements Head nods, open-handed gestures, positive facial expressions

 

Encourage clients to keep talking Help client to elaborate both cognitive & affective thought.

  

Most important cognitive empathic listening skill. Continuously feedbacking key words & phrases Reveal client’s view of world & not counsellor



Include main cognitions, ideas, and exact words

   

Clarifies confusing stories Stop clients from repeating Allow client to move on to new topic/explore A checkout for accuracy of counsellor’s understandings

   

“I hear you saying…” “It sounds like …” “So it feels, like the situation is…” “Am I hearing right? /Is that close?”



Similar to paraphrasing



Includes cognitive, feeling & emotions



Encompasses a longer period of conversation than paraphrasing

Summarizing

o Entire interview o Issues discussed by the client over several interviews o Beginning/Mid/End Interview  

Puts together & organizes client conversation Supports brain’s executive functioning



See the world as how client experiences it

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Checkout for accuracy



You saw yourself as guilty and anxious. Since then you haven’t

18 gotten along too well. We also discussed a plan of action for the week. How did that go? (Begin Session) 

So far, I’ve seen that the plan didn’t work too well. You felt guilty again when you saw the idea as manipulative. Yet one idea did work. (Mid-session)

PART 6: REFLECTING FEELINGS – Chapter 7 GOALS Awareness and Knowledge 

Discover the nature and central importance of reflecting feeling and what to expect when you use this skill.



Understand and appreciate affective empathy and its relationship to cognitive empathy and mentalizing.

Skills and Action 

Facilitate client awareness of their emotional world and its effect on their thoughts and behaviour.

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Help clients sort out and organize their mixed feelings, thoughts, and behaviours toward themselves, significant others, or events.

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Clarify emotional strengths and use these to further client resilience (focus on positive thoughts)
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