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How are influencing responses different from listening responses?
First, influencing responses reflect more of a helper-directed style whereas listening responses use a more client-centered style.
Second, listening responses focus on the clients’ understanding of themselves, but influencing responses focus on the helper’s understanding of the client.
Third, the helper is more passive when using listening responses. On the other hand, influencing responses require more active participation and expression from the helper.
Chapter 6, p.125-126
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What are the six different influencing responses? Briefly describe each.
1. Questioning – open or closed questions to encourage elaboration or information from client.
2. Interpretations – statements based on helper’s ideas that identify themes or patterns and make implied client messages explicit.
3. Information Giving – communication of data or facts about experiences, events, alternatives, or people.
4. Immediacy – describes something while it is occurring within the helping interview
5. Self Disclosure – sharing of personal information or experiences with client
6. Confrontation – challenging discrepancies or inconsistencies in client behavior and communication.
Chapter 6, p.126
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What are five guidelines to follow when questioning in the helping interview?
1. Questions should relate to the client’s concern
2. Give the client sufficient time to respond
3. Ask one question at a time
4. Avoid accusatory or antagonistic questions
5. Do not rely on questioning as the primary response mode during an interview
Chapter 6, p.129
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How can interpretation benefit the helping interview?
When interpreting clients’ messages, a helper identifies the implicit parts of a message, or information that the client does not talk about directly. These responses promote insight and help clients to examine their behavior from a different perspective, resulting in better understanding of problems.
Chapter 6, p.130
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Give an example of when information giving is appropriate.
A client who reports being abused by her partner may need information about her rights and alternatives.
Chapter 6, pg 134
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List and give examples of the 3 categories of immediacy.
1. Helper immediacy- “I am glad to see you today.”
2. Client immediacy- “You are really smiling now-you must be very pleased about it.”
3. Relationship immediacy- “I am glad that you are able to share that with me.”
Chapter 6, pg 140
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List 2 reasons for using self-disclosure.
1. Self disclosure can be used to help clients consider other and different alternatives and views.
2. Self disclosure can increase trust.
Chapter 6, pg 144
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Describe 3 of the five ground rules when using self disclosure.
1. Timing (when)- most effective when the client therapist rapport is established
2. Breadth (how much)- moderate amount of self disclosure is most effective. Not enough self disclosure can lead to more distance and too much can be counterproductive.
3. Duration- The amount of time used to give information about self. When the amount of time increases on the part of the therapist this directly affects on the part of the client decreasing.
Chapter 6, pg 145
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What is confrontation?
Confrontation is an influencing response in which the helper describes discrepancies, conflicts, and mixed messages apparent in the client’s feelings, thoughts and actions.
Chapter 6, pg 147
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Describe the 3 purposes of confrontation.
1. Help the client explore other ways of perceiving themselves or an issue leading to different actions or behaviors
2. Help the client become more aware of discrepancies or incongruities in thoughts, feelings, and actions
3. Deal with mixed messages to describe discrepancy or contradiction to the client
Chapter 6, pg 147-148
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Why is it important for a helper to focus on a client’s strengths and resources?
A focus on client’s strengths and resource furthers collaboration between helper and client, deemphasizes stigmas associated with their problems, avoids labels, and enhances the client’s sense of self-efficacy.
Chapter 7 pg 165
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What is the ABC Model?
The ABC model of behavior is a functional assessment that suggests that the behavior (B) is influenced by events that precede it, called antecedents (A), and by some types of events that follow behavior, called consequences (C).
Chapter 7 pg 167
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The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) uses an evaluation system that consists of an assessment of five codes. List three of the five codes or axes.
Axis I: Clinical disorders/ other disorders that may be a focus of clinical attention
Axis II: Personality disorders and mental retardation
Axis III: General medical conditions
Chapter 7pg 171-172
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In general, practitioners need to consider referrals for psychiatric evaluation and/or mental evaluation in what two circumstances?
The two circumstances are as follows:
1. The client presents with a psychiatric emergency.
2. The client presents with symptoms that suggest disease process in which brain structure and chemical function are apparent.
Chp 7 pg 176
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What is Person-in-Environment (PIE) classification system and how does it differ from DSM-IV?
PIE is a classification system that helps practitioners understand the interrelationships between the individual clients and the environment in which the client resides. PIE is not considered a diagnostic system like the DSM-IV.
Chp 7 pg 176
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What are the four factors PIE assesses?
PIE assesses the following factors:
Factor I: Social Role Problem Identification
Factor II: Environmental Problem Identification
Factor III: Mental Health Problem Identification
Factor IV: Physical Health Problem Identification
Chp 7 pg 176
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Why is history taking important to the therapeutic process?
History taking is used as part of the overall assessment process that helps the practitioner fit the pieces of the puzzle together concerning the client’s presenting issues and current life context.
Chp 8 pg 190
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When might a mental status exam be necessary?
After the initial interview, a mental status exam might be necessary if the therapist is in doubt about the client’s psychiatric status or possible cognitive disorder.
Chapter 8 p.193
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When conducting a mental-status exam eight categories are noted. Identify three of those categories:
- 1. Physical appearance
- 2. Attitude and response
- 3. Perception
Chapter 8 p.194 and box 8.2
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Why is it important to prioritize issues with a client?
It is important to prioritize issues with a client because if a client tackles too many issues at one time they will become overwhelmed and anxious. As a result, the client may decide to discontinue therapy.
Chapter 8 p. 197
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When assessing contextual factors associated with an issue identify three of the five areas that are important to discover:
1. Where it occurs (Place)
2. When it occurs ( Time)
3. Cultural, ethnic and racial affiliations
Chapter 8 p. 200-201
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How can a social network map be useful to helpers?
A social network map can help provide information that can be used to plan treatment goals and intervention strategies for clients.
Ch. 8, p 203
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When helpers are identifying client antecedents, what 3 things should they try to discover?
When helpers are exploring client antecedents they should be looking to discover: (1) what current conditions exist before and after the issue that make it more likely to occur, (2) what current conditions exist before and after the issue that make it less likely to occur and (3) what previous conditions or setting events exist that still influence the issue.
Ch. 8, p 204
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What is a limitation of interview leads?
Interview leads alone are not enough to accurately assess a client. The helper must not only ask the right questions but use the information from client responses to provide an accurate assessment.
Ch. 8, p 208
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What is an outcome goal?
An outcome goal represents what the client wants to have happen as a result of the treatment process. Outcome goals are an extension of the types of problems that the client experiences and reflect the changes a client wants to achieve.
Chapter 9, p. 231, paragraph 1
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What are the implications for goal setting and treatment selection according to the Trans-theoretical Model of Client Change?
1. Need to have an understanding of what it means to change, if we are to affect change in clients.
2. A client’s readiness to change is a critical factor in developing goals and selecting intervention strategies.
Chapter 9, p.231-232, paragraphs 6 and 1
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What are the 5 interview leads associated with identifying client goals?
1. Provide a rationale for goal setting
2. Elicit outcome statements
3. State goals in positive terms
4. Determine who owns the goal
5. Weigh advantages/disadvantages of goal attainment
Chapter 9, page 232, paragraph 6
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When looking at the helping process, the biggest problem, both ethical and legal, is whether the counselor can help a client. What two factors are needed to continue the counselor-client relationship?
Although it is determined on a case-by-case basis, it is the counselor’s willingness and competence to help the client pursue the selected goals that affects the counselor-client relationship. Willingness means the interest a helper has in working with the client toward identified goals and their overall functioning. Competence refers to the knowledge and skill a helper has and whether the helper is aware of alternative intervention strategies and various ways to handle particular concerns.
Chapter 9, page 236, paragraph 1
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What are the three dimensions commonly used to measure the direction and level of change in goal behaviors?
frequency
duration
intensity
Chp 9, pg 248.
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Why is shaping important when setting sub goals?
Shaping helps someone learn a small amount at a time, with reinforcement or encouragement for each task completed successfully. Gradually, the person learns the entire amount to achieve the overall result through these day to day learning experience that successively approximate the overall outcome.
Chp 9, pg 245
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When working with a client on setting goals, why would you want the client to state a goal in positive terms versus negative terms?
It is almost always easier to work on developing or increasing a behavior (response or acquisition) than on decreasing a response (response decrement). It is easier to have the client work on doing something or doing it more than stopping something or doing less.
Chp 9, pg 244
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What is the focus of a rapid-assessment-instruments (RAIs)?
A rapid-assessment-instrument is a pencil-and-paper assessment that focuses on specific areas of improvement.
Chp 9, pg 251
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What is the overall purpose of a posttreatment evaluation?
The overall purpose of a posttreatment evaluation is to assess the extent to which the effects of intervention have been maintained at the conclusion of a treatment strategy.
Chp 9, pg 255
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According to Lambert (1992), what is the percentage make-up of what produces or contributes to change in clients and in treatment outcomes?
Client characteristics contribute to 40%; the therapeutic relationship accounts for 30%; hope and expectancy factors account for 15%; and theories and techniques contribute for 15%.
Chp 10, pg 272
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Give two examples of Evidence-Based Practice and tell how their approaches are different.
Assertive Community Treatment (ACT) and Dialectical Behavior Therapy (DBT) are two examples of Evidence-Based Practice. ACT is a proactive, assertive, and persistent treatment approach. DBT is a theory or principle-driven approach.
Chapter 10, page 280-281
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What is a decision rule?
It is a series of mental questions the helper constantly asks himself or herself during interviews in order to match interventions to clients and their identified concerns.
Chapter 10, page 282
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What 3 things need to be assessed when determining a client’s treatment plan?
You need to assess the client’s current functioning, receptivity to treatment and readiness to change, and resources available.
Chapter 10, page 283
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What is mode of treatment?
The mode of treatment is the mechanism or format of service delivery, which typically includes individual treatment, couples and/or family treatment, group treatment, and medication, and it is often indicated by the nature of the client’s issue.
p. 286, Mode of Treatment
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Empowered consent is the preferred term, but how is it different from informed consent?
Empowered consent is designed to provide complete and meaningful disclosure in a way that supports the client’s freedom of choice and implies collaboration rather than just being told about the treatment approaches.
p. 289, paragraph right above ‘Consciousness Development’
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When developing a treatment plan format, what are five sections that should be included? What should not?
Aside from basic information (name, therapist, start/end date), you should include presenting concerns, strengths/resources, goals and treatment, therapist interventions and client implementations, and duration. Prognosis shouldn’t be included in the treatment plan, because sometimes the course of treatment changes. Treatment plans are legal documents that can be requested by the courts.
p. 295, bottom of page and p. 307
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