PLEASE UPLOAD EACH TECHNIQUES SEPARATELY
Techniques Summaries: Chapter 6, Chapter 7, and Chapter 8 (ATTACHED)
These assessments are designed to help you become an active learner through consistent immersion in the concepts taught in this course. I want you to write professionally in the 3rd person, such as “Reflective listening is a technique that involves”…. no use of 1st person. I predict that you will learn about yourself as you learn the course content. Length: 3 pages double-spaced 12-point Times New Roman font). If you use references, use APA style.
Here is the format:
TECHNIQUES TEMPLATE TECHNIQUE OR INTERVENTION:
THEORY OF WHY IT WORKS?
BARRIERS TO SUCCESS (WHAT COULD PREVENT SUCCESS)?
SPECIFIC MECHANISM (The “HOW”) OF CHANGE
GOALS/OUTCOME OF THE TECHNIQUE
GIVE AN EXAMPLE OF THE TECHNIQUE IN ACTION
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Chapter 6 Reflecting Skills: Reflecting Feelings
“The Importance of Understanding Emotions
Understanding another person’s emotions helps us better understand the whole person because
emotions give a window into motivation, current mental state, behavior, and worldview (Izard,
2009). It might even save your life. As an example, Daniel Goleman, the author of Emotional
Intelligence (Goleman, 2006), describes an incident in Iraq where a group of soldiers who were
distributing relief supplies were surrounded by an angry mob of people who thought the
soldiers were there to arrest one of the villagers. Using emotional intelligence, the officer in
charge ordered the soldiers to kneel, point their guns at the ground, and smile, all of which
defused the situation without anyone being hurt. The officer, Lieutenant Colonel Christopher
Hughes, was able to transmit the message through nonverbal means that the soldiers were
nonthreatening and friendly.
Goleman’s story is in support of the thesis that there is a kind of intelligence quite different
from what IQ tests capture (Goleman, 2003). If the soldiers had attempted to explain their
mission to the villagers, it might have been a logical move but not emotionally smart.
Emotional intelligence has been described as the “ability to monitor one’s own and others’
feelings and emotions, to discriminate among them, and to use this information to guide one’s
thinking and actions” (Salovey & Mayer, 1990, p. 189).
There is little doubt that helpers must possess this emotional intelligence in the same way that
an engineer must have the intellectual ability to understand higher mathematics. Yet emotional
intelligence can be developed just as mathematical skills can be enhanced (Goleman, 2003).
The ability to recognize and express another person’s feelings can be learned, and it has power
to deepen the relationship and allow the client to release emotional burdens.”
“The Skill of Reflecting Feelings
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Being able to recognize emotions in others and convey that you understand their feelings is a
special ability. This skill of reflecting feelings tells your client that you recognize the emotional
background of the story. The building block skill of reflecting feelings is essentially the same
technique as paraphrasing. This time, however, the focus is on emotions rather than on content
and thoughts. Reflecting feelings involves listening and then expressing in your own words the
emotions stated or implied by the client. These emotions may be hidden in the content of the
story or in the nonverbal responses of the client. The emoticon is an attempt to communicate
the emotions that can’t be expressed in a text message or e-mail.
Here is an example of how clients may not openly express a feeling, but it is implicit in the
message. The client says, “I just lost my job,” and looks down. The client’s feelings (shock,
hurt, embarrassment) are beneath the surface of the nonverbal messages and the simple
description of the event. Reflecting feelings shows the client that you understand the deeper
message.
Benefits of Reflecting Feelings
There are four therapeutic benefits of reflecting feelings. First, reflecting feelings makes the
client becomes more keenly aware of the emotions surrounding a topic. Many clients under
disclose, and any method or technique that allows them to more fully experience and express
their feelings is therapeutic (Peluso & Freund, 2018; Whelton, 2004; Young & Bemak, 1996).
Let us suppose that the helper makes a reflection such as, “I can tell that you are terribly angry
about that.” The client’s response may be one of surprise, “Yes, I guess I am.” Because a
reflection is done in a nonevaluative manner, it communicates understanding of feelings that
clients may not be conscious of or think they have no right to feel.
The second therapeutic benefit of reflecting feelings is that it brings the client to deeper and
deeper levels of self-disclosure. An accurate reflection focuses clients on emotions and teaches
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them to become aware of and report feelings. It stimulates the client to express other, perhaps
more deeply felt, emotions (Goldman, 2017). Even if the reflection is not quite accurate, the
client will provide a correction that is more on target. For example, when my daughter was
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years old, some neighborhood kids slammed the door in her face, and she came home crying.
I said, “That must have really hurt your feelings.” She replied, “Yes, and I was embarrassed
and angry too!” I became aware that identifying one feeling evokes other emotions, and I also
learned that kids can learn to label emotions very early—especially a therapist’s kid.
Third, an accurate reflection of feelings has the almost magical power to deepen the
relationship between client and helper (Peluso & Freund, 2018). Nothing transmits
nonjudgmental understanding more completely. This is why reflecting feelings, which
originated in the client-centered tradition of Carl Rogers (1961), has gained such wide usage.
It taps the enormous healing properties of the therapeutic relationship. A beginning helper who
can accurately reflect feelings provides support and understanding without any other tools.
Finally, reflecting feelings brings genuine relief from emotional pressure (Hoffman, Vallejos,
& Cleare-Hoffman, 2015). Take, for example, the client whose wife had left him but would not
say why. He came for help, crying about the lost relationship. He ran the emotional gamut,
from confusion to shock to disgust to affection to rage. Experiencing all these conflicting
emotions in one session can make anyone feel “crazy.” Even though there were still conflicting
feelings, by the end of the first session, the client felt more in control simply because the
feelings were sorted and labeled. Untangling the emotional knots seems to be healing even if
no real action is taken. Somehow, we can accept our feelings as normal reactions when we
bring them to the surface and parcel them out. Reflecting feelings by saying, “You feel so
betrayed, and yet you still feel a bond of affection,” can help to normalize what the client
perceives as a deeply conflicting emotional experience.
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Why It Is Difficult to Reflect Feelings
Reflecting feelings is one of the most valuable tools of the helper, but it is not an easy one to
learn. Theodore Reik, the famous analyst, claimed that to hear deeply, one must learn to
become sensitive to the unexpressed and listen with the “third ear.” Referring to the fact that
the client may not even be aware of these feelings, Reik said, “The voice that speaks in (the
client) speaks low but (the helper) who listens with a third ear, hears also what is expressed
almost noiselessly, what is said pianissimo” (Reik, 1968, p. 165).
One reason that feelings may be hard to hear is that our upbringing, family background, and
culture affect the way we express them (Matsumoto, 2009; Tsai, Levenson, & McCoy, 2006).
For example, many individuals with Appalachian and English roots may express emotions in
very subtle ways. Some Native Americans, East Indians, and Europeans come from cultures
where open expression of feelings is rude or a sign of weakness. For instance, there was a
conference in Amsterdam on the “underexpression” of emotions as a mental health issue in
Europe. When a client’s family background or culture is constantly sending the message “Don’t
let anyone see your feelings,” helping is more difficult because the helper is going against
family and cultural mores. Getting to feelings may require more time and effort, and even then,
expression may seem faint by comparison. This can be frustrating when the client does not
seem to respond to your reflections. For some clients, though, even a small crack in the voice
may be quite a strong emotional sign and should be valued as a deep disclosure.
Culture Check Gender
A person’s gender training also has a bearing on emotional expression and the ability to detect
emotions in others (Lambrecht, Kreifelts, & Wildgruber, 2014). Traditional male upbringing
means “never let them see you sweat” and “big boys don’t cry” (Kottler, 1997; Wong,
Steinfeldt, LaFollette, & Tsao, 2010). Consequently, it may be difficult for some to openly
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display feelings in the helping relationship and in their other relationships, too. When feelings
leak out, traditional males may feel weak or out of control. Feminine socialization, on the other
hand, is associated with better ability to identify emotions, is more relationship-oriented, and
encourages telling another person how you feel (Kring & Gordon, 1998; Madrid & Kantor,
2009), even on Facebook and Twitter (Parkins, 2012). However, women are also trained to
repress certain emotions, such as anger or even confidence, that are not considered feminine.
Emotional health means recognizing one’s own feelings and appropriately expressing them.
When a helper sees a cultural handicap to emotional expression and helps the client recognize
what is being suppressed, the client may be able to overcome cultural conditioning and own
and accept those emotions.
How to Reflect Feelings
Step 1: Identifying the Feeling or Feelings
Like paraphrasing, reflecting feelings involves two steps. The first step is identifying the
client’s feelings; the second step is articulating the underlying emotions that you detect in the
client’s statements. You can learn the first step in your practice sessions as you listen intently.
Imagine how the client feels in this situation, and then try to label the feeling. The best way to
do this is to think of yourself as the client, taking into account all the facts and also considering
what you know about the client’s personality and history. In other words, do not try to think
about how you would feel in this situation; instead, become the client and think about how the
client must feel. Table 6.1 helps you to find another word that is closer to what the client is
expressing. Studying this list will help you improve the accuracy of your reflections. Do not
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forget that nonverbal signals are major clues to the client’s feeling state. Although reading and
responding to vignettes in this book will be a good training exercise, practicing with classmates
will be more realistic as you must pay attention to the nonverbal expressions as well as the
words.”
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Chapter 7 Advanced Reflecting Skills: Reflecting Meaning and
Summarizing
“Summarizing
Summarizing is the final reflecting skill in the nonjudgmental listening cycle (NLC). Although
it is easier to learn than reflecting meaning, we place it here because you cannot adequately
summarize until you have paraphrased and reflected feelings and meanings in a client’s story.
Summarizing pulls together everything a client has said in a brief synopsis of the session up to
that point. The summary helps the client make some sense of the tangle of thoughts and feelings
just expressed in the session. In other words, it is a big reflection. The client hears the story in
a more organized way, and it starts to become clearer. The summary ties some of the major
issues that have emerged into a compact version of the story. It may include any of the
following: (1) content, (2) major feelings, (3) meaning issues and themes, and (4) future plans.
Of all the reflecting skills, it could be considered the broadest brush, bringing together main
content, themes, and feelings in the client’s story by concisely recapping them. But summaries
are not to be used only at the end of a session. Summaries may be used in the beginning, middle,
and end. Because summaries have different purposes, they can be divided into four types:
focusing, signal, thematic, and planning summaries.
Focusing Summaries
At the beginning of a session, a summary may help to focus the conversation before it begins.
A focusing summary is an intervention that brings the discussion to bear on the major issues
and themes, places the spotlight on the client’s responsibility for the problem, and reminds the
client of the goals. For example:
“In the last few sessions, it seems like we have been dealing with two major issues. The first is
the way that you are trying to renew your social network and find some supportive friends since
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your breakup with Jesse. The other issue is your mixed feelings about living back home with
your parents.”
Focusing summaries are not only to remind clients about their goals from previous sessions.
They can even be used at the first session with a new client. For example, a helper says:
“Let’s review what I know so far. Your mother called and made this appointment for you
because you were arrested about a month ago for public intoxication. One of the conditions of
your probation is that you receive help for your drinking problem. Your probation officer
referred you to our agency. So, you’re here to do something about the problems you’ve been
having with alcohol. Is this about right?”
Brammer (1973) points out that a focusing summary at the beginning gets the client on track
immediately. Contrast this with the traditional opening statements such as, “How have things
been going this week?” or “What would you like to talk about today?” When a client begins
the session by reacting to a focusing summary, the conversation turns to the reason why the
client is seeking help and goals.
Signal Summaries
In the middle of a session, the signal summary tells the client that the helper has digested what
has been said and that the session can move on to the next topic. If the helper does not
summarize occasionally, the client may feel that it is necessary to go over an issue several
times. A good time for a signal summary is when the client seems to have come to the end of
a story and pauses. In the example that follows, see whether you can spot the paraphrases (Ps),
reflections of feelings (ROFs), and reflections of meaning (ROMs) in this parent’s story.
Client: “So that’s about it . . . (pause).”
Helper: “Before we move on, let’s just summarize where we’ve been so far. You have tried to
get professional help for your daughter’s drug problem, and she has rejected it. Because she is
an adult, there is not much force you can apply. This makes you feel helpless, and when you
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see her, your relationship is very superficial because you can’t talk about the drug issue without
getting into a fight. You’ve always been the kind of person who likes to leap into action when
a problem arises, and here is a situation where there is little to do. That’s what makes it
especially frustrating.” (summary)
Client: “Yes, but that’s the way it is. Now I guess I need to talk about how I can go on with my
life under these circumstances.”
Helper: “Okay, let’s talk about that.” (door opener)
Thematic Summaries
A theme is a pattern of content, feelings, or meanings that the client returns to again and again
(Carkhuff, 1987). The thematic summary is an advanced reflecting skill because it means that
the helper has to be able to make connections among the content, emotions, or meanings
expressed in many client statements or even over many sessions. When this kind of reflection
is made, it often provides new information to the client, who may be unaware that the issue is
resurfacing so often. Sometimes these themes are referred to as “core issues” because they
represent problems that appear in a variety of circumstances.
Rather than signaling a transition to a new topic, the thematic summary tends to push clients to
an even deeper level of understanding or exploration. Here are some examples of thematic
summaries:
“There seem to be two issues that keep coming up. One of them is the anger you feel in a
number of different close relationships, and the other is your sense that you haven’t been able
to reach your potential in your career.”
“As you have been talking, I seem to notice a pattern, and I’d like to check it out. You seem to
want to end relationships when they begin to lose their initial excitement and romance.”
“From everything we’ve talked about over these past few weeks, one major issue seems to be
that, over and over again, you hesitate to make a commitment to a career or to a relationship or
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to take any important action because you are afraid you might let your parents down by failing.
Is this right?”
It is difficult to practice using thematic summaries because it presumes that you have seen a
client for some time and usually for more than one session. It takes time for important themes
to emerge. Identification of themes is an intuitive process. You must think back on the whole
of your experience with the client and try to cull the big issues. Even though identifying themes
is an advanced skill, it is discussed here because it is possible you may notice these themes as
you practice. You may have seen advanced practitioners identify these themes in recorded
sessions. Remember, too, that themes are the helper’s constructions or interpretations; they
should be used only when you have enough information to be fairly certain that you have
identified a theme. It is best to propose themes tentatively, because if incorrect, a thematic
summary can have the effect of making the client feel analyzed and labeled.
Planning Summaries
Planning summaries entail a review of the progress, plans, and agreements made during the
session. The planning summary brings a sense of closure and ends the session on a hopeful
note. Here are two examples:
“Well, it seems like we’ve identified several things in this first session that we want to pursue.
First, you are unhappy with the way you tend to become overly dependent on your friends. You
want to follow your own interests. In fact, you want to get to know yourself better. With this
in mind, we thought about your entering a counseling group at the local mental health center.
Besides that, you’d like to identify some goals for your career. That is something you and I can
begin to work on right away. We’ll set up an assessment program and talk more about this over
the next several weeks. How does all this sound?”
“Let’s recap what we have talked about so far. On the one hand, you have accomplished your
financial goals, but you are far from satisfied with your relationships with friends and family.
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You have said that this is because you are not very assertive. It sounds as though this is the area
we need to discuss in our next session. What do you think?””
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Chapter 8 Challenging Skills
“When Should We Use the Challenging Skills?
During the initial stages of the relationship, the helper strives to understand the client’s unique
worldview by getting the client to open up. As a client tells the story, the helper listens
attentively using the nonjudgmental listening cycle (NLC). After several cycles, the helper
begins to detect distortions, blind spots, and inconsistencies and may then use challenging skills
to help clients function with more accurate information about themselves. With heightened
self-awareness, they are better able to make decisions and to operate free of illusions and “vital
lies.” Challenging is consistent with the primary goal of empowering clients by encouraging
them to explore their thoughts, feelings, and behaviors and to take steps toward their dreams
and goals.
When challenging skills are used, the aura of safety and support, so carefully constructed by
the helper, is at risk (Moeseneder, Ribeiro, Muran, & Caspar, 2018). There is a fundamental
shift from relationship building to a focus on the goals set by the client and helper, conveying
to the client that the helping relationship is not a friendship but a business partnership during
which the helper may have to hold the client’s feet to the fire in order to attain the agreed-upon
outcomes. Clients need to be challenged when:
They are operating on misinformation about the self. For example, a client may underestimate
her intelligence, feeling that she is not capable of attending college when there is evidence to
the contrary.
They are operating with mistaken ideas and irrational beliefs. For example, the client believes
she must be perfect.
They misinterpret the actions of others. This tendency is called mind reading and is a common
problem among couples. A client may act on assumptions without confirming them, making
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statements such as the following: “I could tell by the way he acted that he did not want to date
me anymore.”
They are blaming others rather than examining themselves. For example, a client may blame
the boss at work but refuse to look at his own responsibility for the poor relationship or his own
work performance.
Their behavior, thoughts, feelings, and values are inconsistent. For example, a client talks about
how much she values honesty but at the same time discusses how she hides her financial
difficulties from her partner.
They are not operating according to their own values.
They are not working on the goals that they participated in setting.
In this chapter, we will focus on two building blocks, or basic skills, used to challenge clients
and help them deal with problems more consciously. The first of these is giving feedback:
providing information and your honest reaction to the client. The skill of giving effective
feedback is one that has wide application in helping, including group work, couples counseling,
and individual and family therapy. Second, we tackle the skill of confrontation, the challenging
skill that is the art of pointing out inconsistencies and blind spots in the client’s story.”
“Confrontation”
Confrontation is the second challenging skill we will address in this chapter. Confrontations
point out discrepancies in client beliefs, behaviors, words, or nonverbal messages. As a result
of confrontation, client awareness of inconsistencies is stimulated, and the client is motivated
to resolve them. In essence, it is an educational process that brings information to the client’s
attention that has been previously unknown, disregarded, or repressed. The most powerful
confrontation urges the client to resolve the inconsistencies. Confrontation creates emotional
arousal and can lead clients to develop important insights and motivate them to change their
behavior.
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What Is a Discrepancy?
A discrepancy is an inconsistency, mixed message, or conflict among a client’s thoughts,
feelings, and behaviors. In fact, every problem contains discrepancies. For example:
A client says that she wants an equal, sharing relationship but goes out only with domineering
people.
A client says that she loves her job, but she complains about it constantly.
A client states that he wants to improve his marriage, but he forgets to go to marriage
counseling sessions.
A client is intelligent and tenacious but is convinced he will not do well in school.
Why Should Discrepancies Be Confronted?
Ivey and Simek-Downing (1980) say that “the resolution or synthesis of incongruities may be
said to be a central goal of all theoretical orientations” (p. 177). In fact, most well-known
therapeutic systems use confrontation to some degree. The Gestalt therapist Fritz Perls
confronted clients about incongruities in their nonverbal and verbal behavior (which he labeled
“phony”). Albert Ellis, the founder of rational emotive behavior therapy, liked showing clients
the gap between their beliefs and rationality by directly exposing them to the “nuttiness” of
their ideas. Albert Ellis used loud voice tones or even curse words to intensify confrontations.
Some early group therapy methods for treating substance abuse (the Synanon approach,
Straight Inc.) used personal attacks and abusive confrontation to create client movement in
dealing with deeply ingrained behavior patterns. However, there is little evidence to support
the use of such strong confrontation. In fact, it appears that, even with substance abusers, a
consistent highly confrontational therapist style is not as effective as a moderately
confrontational one (see Figure 8.1 and Miller, Benefield, & Tonigan, 1993). This information
has added support to a theoretical approach called motivational interviewing (MI), which has
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been successfully practiced and researched in addictions programs. In MI, helpers are careful
to acknowledge the client’s point of view while pointing out the conflict. They use
confrontations but qualify them as “double-sided reflections.
In this double-sided reflection, the helper acknowledges the client’s statement that he wants to
continue to drink for social reasons and at the same time does not pull any punches by
reminding the client of the problems alcohol has caused him. The helper’s agreeing with part
of the client’s statement softens the blow of the confrontation, making it moderately
challenging. To use anything stronger could create a rupture in the helper/client relationship,
which is the very thing that keeps the client in treatment and engaged with the helper (Eubanks,
Muran, & Safran, 2018).
In this chapter, we urge you to consider how to raise inconsistencies without alienating the
client. Confrontation is an advanced reflecting skill that should be developed after the early
helping building blocks of invitational and reflecting skills have been firmly established.
Research confirms that highly trained (doctoral) counselors used confrontation more often than
students (Tracey, Hays, Malone, & Herman, 1988). At the same time, doctoral-level counselors
demonstrated less dominance and verbosity than student helpers. It appears, then, that as
helpers gain experience, they use confrontation more frequently, talk less, and are less pushy.
Cognitive Dissonance and Confrontation: Why Confrontation Works
Do you remember the concept of cognitive dissonance from your first Introduction to
Psychology class? Cognitive dissonance theory states that we are motivated to keep cognitions
such as values, beliefs, and attitudes consistent (Festinger, 1957). When people experience
inconsistencies in their thoughts, feelings, and behaviors, this creates tension, and they are
motivated to reduce the tension. As a consequence, we can either convince ourselves that the
incongruity is unimportant or else change one of the incompatible elements. Let us take the
example of quitting smoking. Smokers are aware of the health risks but also continue smoking.
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The conflict between smoking behavior and putting oneself at risk creates cognitive
dissonance. Smokers may reduce the dissonance in a number of ways: to either ignore or
misinterpret the facts about health risks or else tell themselves that they are “addicted” and
therefore quitting is not under their control (self-handicapping strategy) (Jenks, 1992). Either
way, smokers are pushing the risks out of awareness. One study of college students who
smoked asked them to view an online program about the effects of smoking (Simmons,
Heckman, Fink, Small, & Brandon, 2013). They were then asked to make a video recording of
their own negative experiences with smoking, then they watched their recording. The
researchers found that the students whose awareness of the risks had been heightened were
more motivated and had higher rates of smoking cessation than those in comparable treatments.
Heightening of awareness led to motivation.
Consider also the case of Donna, a 25-year-old woman who describes her job as good-paying
but also as repetitive and boring. She needs the job to help her mother, who is struggling to
survive on social security. Donna wants to go to college because she is not intellectually
challenged in her present position, but the costs are too great. This creates dissonance. She
deals with the tension caused by these conflicting thoughts by telling others and herself that
education and intellectual challenge are not really important. We all use such defense
mechanisms to distort reality so that we can reduce anxiety. In this case, the distortion masks
the fact that Donna does really want to go to college, and the lack of intellectual stimulation
does bother her. For her, going to college may not be possible, but pretending that her desire
does not exist is creating a giant “blind spot” in her life. Many times, clients use defense
mechanisms to escape dissonance rather than making choices based on thinking and planning.
When helpers confront people with these discrepancies, anxiety often resurfaces, but so does
awareness of choices. Donna may realize that there may be nontraditional and incremental
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ways of taking classes she has not considered, but first she must be confronted with her
tendency to push the inconsistency out of awareness.
Kiesler and Pallak (1976) reviewed dissonance studies and found a link between dissonance
and physiological arousal (Cooper, Zanna, & Taves, 1978; Croyle & Cooper, 1983; Pittman,
1975; Zanna & Cooper, 1974). It seems that clients actually change their attitudes in order to
reduce the stress when the helper makes the client aware of the two incompatible elements.
The confrontation causes anxiety because the client then becomes aware of this split, which is
normally kept out of awareness by psychological defenses. The client’s frozen position has
provided some security, but now the client is acutely aware of both sides of the conflict again
and becomes uncomfortable but motivated to change (Elliott & Devine, 1994). Being aware of
the inconsistency is now being used to help clients with disordered eating. Clients are asked to
confront the discrepancy between their vision of themselves as thin and costs of pursuing that
ideal (Stice, Rohde, Shaw, & Gau, 2019). In the case of Donna, the helper might encourage
Donna to become more aware of her need to be intellectually stimulated and ask her to talk
about the competing need to take care of her mother. Without blind spots and defense
mechanisms, it is possible to make decisions that are more reality-based and personally
satisfying (Claiborn, 1982; Olson & Claiborn, 1990).
Although we may use confrontation to bring buried elements into consciousness, we must
remember that clients do not really like it because it produces negative emotions (Harmon-
Jones, 2000; Hill et al., 1988). If the helper’s confrontation is too powerful and the client’s
emotional arousal is too great, the client not only will reject the message but also may be less
willing to explore feelings and trust the helper (Hill et al., 1988). Thus, therapists tend to use
confrontations sparingly because doing so is strong medicine; they should combine it with a
liberal helping of support, or else they risk causing a rupture in the relationship (Barkham &
Shapiro, 1986; Norcross, 2011; Strong & Zeman, 2010).
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“Other Ways of Challenging
Besides pointing out discrepancies using confrontation, there are other methods for challenging
clients to pay attention to discrepant, irrational, or troubling issues and focusing the
conversation in that direction. Among these are relationship immediacy, teaching the client
self-confrontation, challenging irrational beliefs, and using humor. These are more advanced
skills, but we mention them here because you will likely run into them early in your training
through films or reading. We hope that you will mentally note that they fall in the category of
challenging skills and that supervision is necessary as you learn to use them.
Relationship Immediacy
When you meet someone for the first time, think about what issues are the most difficult to
discuss. It is easier to talk about past problems and previous relationships rather than present
issues and relationships. It is easier to discuss issues that are positive and uplifting rather than
those that are negative or depressing. It is also easier to talk about issues that concern neither
of us, such as the weather, rather than talking about what is going on between us right now. By
the same token, it is sometimes difficult for the helper to bring up issues affecting the helper
or the relationship between helper and client. However, the ability to give honest feedback and
discuss the helper/client relationship openly gives it a special meaning that separates it from
social interactions. The relationship can be a laboratory where clients learn about their effect
on others. Relationship immediacy (Kiesler, 1988) is a technique that helpers use to give clients
here-and-now feedback about their effect on another person—the helper. Relationship
immediacy is a comment by the helper about what is happening in the relationship right now.
Immediacy statements by the helper should have three characteristics:
The helper uses the word I in the statement to indicate that this is the helper’s perspective.
The helper describes the client’s behavior or the helping relationship issue in nonjudgmental
terms.
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The helper expresses personal feelings in a way that does not overload or burden the client.
These three characteristics are illustrated in the following helper statement: (1) “I am aware
that (2) when I make a suggestion, such as the one about your supervisor, we seem to end up
in a struggle and the issue gets dropped. (3) I am a little concerned about whether or not we are
communicating.”
Helpers use relationship immediacy because the client’s interactions with the helper are
probably similar to the client’s interactions with significant others. For example, a client might
talk incessantly, not leaving room for the helper to respond. Using an immediacy challenge,
the helper might say, “You tell me that other people say you don’t listen to you. As I am sitting
here, I don’t feel listened to either. Can we talk about that?” In this vein, Murray (1986) cites
the example of a young woman who came to therapy because she felt she was overly dependent
on her father. For example, whenever she had car trouble, she turned it over to him. After a
month of therapy, she brought in her auto insurance policy, which she was having trouble
deciphering, and handed it to the therapist, who began reading it. After a moment, the therapist
laughed and exclaimed, “Look, I’m behaving just like your father.”
Relationship immediacy is “you-me” talk. It challenges the client to focus on the helper’s
impressions of the therapeutic relationship. Relationship immediacy can enhance intimacy in
a relationship because it acknowledges the mutual bond and gives the client liberty to look at
feelings toward the helper. It is one of the best ways of dealing with so-called resistance and
transference reactions. Relationship immediacy is also an invitation to examine the
client/helper relationship conflict as a microcosm of the client’s difficulties. It can be used to
address or prevent ruptures by asking the client to honestly assess the quality of the therapeutic
bond. It should only be used if it seems that the relationship issues between client and helper
relate to the client’s goals or if the therapeutic relationship is strained and needs to be repaired.
Relationship immediacy can be of the “here-and-now” variety such as, “Right now, I feel a lot
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of tension between us because we brought up the alcohol issue. What is your reading on that?”
Alternatively, the helper can ask the client to reflect on the relationship as it has progressed up
to that point. For example, “Over the past few weeks, I have found that our relationship seems
to have changed. My experience is that the sessions are much more fun and productive. What
do you think?”
Teaching the Client Self-Confrontation
Although it is good to have the input of others, it may be more useful to have the client learn
to self-confront, a skill that could provide lasting benefit when the helping relationship is over
(Visser, 2016). Self-confrontation has been studied as a complex assessment and research tool
(Hermans, Fiddelaers, de Groot, & Nauta, 1990; Lyddon, Yowell, & Hermans, 2006). But the
method can be applied more simply as a research project that the client conducts with the
assistance of a helper. One way to teach self-confrontation is to ask the client to write down
every conflict in the client’s life. For example, “I am in love with this woman, and I keep trying
to develop a relationship, but she has made it clear I am only a friend,” or “My parents want
me to get better grades, but I really don’t want to go to college.” If given as a writing
assignment, the client might be asked to respond to questions such as:
What is it that I don’t really want to do?
What would it say about me if I changed in the ways people want me to?
In what ways am I lying to myself?
What possibilities in my life am I not paying attention to?
What conclusions am I drawing about life that have no evidence to support them?
The helper then guides the discussion of these issues in the past, present, and future and helps
the client explore the issues collaboratively. Together client and helper try to identify key
themes in the client’s life and ultimately identify a plan to solve the dilemmas.
Challenging Irrational Beliefs
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Some cognitive therapists challenge clients’ strongly held beliefs when these beliefs are
responsible for clients’ emotional suffering. Challenging beliefs involves making the client
aware of their irrational nature and teaching them to dispute these disturbing thoughts when
they arise. Although the helper highlights the irrational ideas in the session, disputing and
replacing irrational thoughts becomes a form of self-confrontation, and the client practices
confronting erroneous beliefs as homework. Following is a short list of irrational beliefs
adapted from Ellis and Velten (1992). Ellis has longer lists of common irrational beliefs, but
this will give you a feel for the general categories.
Shoulding and musting: “I must be the best in my class. I should have learned this by now.”
More rational challenge: “Have you ever tried saying, ‘I would like to be the best in my class’
without laying a ‘must’ or ‘should’ on yourself? I think it is those words that cause you to feel
so upset when you can’t reach perfection.”
Awfulizing: “When I don’t get it right the first time, it is a tragedy, a catastrophe, and it is
awful.”
More rational challenge: “Isn’t it more accurate to say that it’s unpleasant but not the end of
the world?”
Low frustration tolerance: “I can’t stop myself from calling my ex-girlfriend. I can’t wait to
buy things when they are on sale, and I get myself into big credit card debt.”
More rational challenge: “So it’s uncomfortable for you to wait, right? But is it really true that
waiting is impossible, or is it just annoying?”
Blaming: “No one even tried to help me. It’s their fault that I wasn’t able to register for classes,
not mine. This is the worst school.”
More rational challenge: “I wonder about this idea that it is the responsibility of other people
to get you registered and help you when you didn’t even request assistance.”
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Overgeneralizing—“always” or “never” attitudes: “I went to one AA meeting, and all they did
was drink coffee and smoke cigarettes. The organization is crazy. No one gets helped there.”
More rational challenge: “I’d like to take issue with this idea that attending one AA meeting
gives you enough information to make this blanket statement. Isn’t it possible that there were
some positive aspects of the meeting? Tell me why you think you must look at this in black
and white. Is it really true that you get nothing from a meeting like this?”
You can probably see how confronting a person’s beliefs can feel like a very strong
intervention. It takes a great deal of skill to challenge beliefs in a way that does not alienate the
client. The goal is for both client and helper to gang up on the irrational beliefs while
maintaining a good working relationship.
Humor as Challenge
Humor can be one way of relating to clients and teaching them to view situations in a different
way. It can be a needless distraction, but humor can also be a way of making a confrontation
(Arminen & Halonen, 2007). Both stories and humor seem to bypass the client’s defenses.
Clients tend to accept humorous stories because they are not seen as preachy or mean. Once, a
client told me about her fears that, as a divorced woman, everyone would be looking at her and
treating her differently. I responded by agreeing that although she lived in a city of one million
people, at first rumors would be spreading like wildfire. There would be newspaper headlines
and, of course, television news. I reassured her that after the requests from talk shows were
rebuffed, she would be able to resume her private life once again. She laughed with me and
admitted that her fears were overblown as usual. I was able to get away with this because I
knew the client well, and she did not perceive me as laughing at her. That is, of course, the
primary precaution of using humor as confrontation. It could belittle the client or convey that
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you think those concerns are unimportant. Again, there is no substitute for knowing your client
and having the kind of relationship where you can talk about ruptures when they occur.”
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