PLEASE UPLOAD EACH TECHNIQUES SEPARATELY
Techniques Summaries: Chapter 9, Chapter 10, and Chapter 11 (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
Chapter 9 “Why Assessment?
Assessment means gathering and organizing information about a client and the
client’s problems. Helpers collect information in a variety of ways, beginning with
the first contact as the helper studies the client’s behavior and listens to the story.
Formal assessment methods include testing and filling out questionnaires and
forms. Informal assessment encompasses all the other ways a helper learns about
a client, including observing and questioning. Formal assessment may occur at a
specific time in the helping relationship, but informal assessment is an ongoing
process because a client’s progress and the temperature of the therapeutic
relationship must be tested throughout. ”
“Because each client’s situation is unique, it is impossible to predict how much
time to give to each stage of the helping process. Still, a rule of thumb is to spend
one session primarily in relationship building, with the only assessment activities
being the collection of basic demographics, observation of the client’s behavior,
and whatever else you can glean from the client’s story. The second and possibly a
third session are spent in a more in-depth assessment before moving on to a goal-
setting phase, which might include testing. Therefore, if a client is seen for 10
sessions, about 10% of the time may be devoted to assessment. Beginning a
relationship with a formal assessment can be a mistake because the initial
moments of any human encounter are so important (Gladwell, 2005). Imagine
how you would feel if you went for a doctor’s appointment and were asked only
to fill out forms, contribute blood samples, and answer questions but were not
allowed to talk about the reason for your visit.
When clients have been invited to tell their stories, they give much more
information during the formal assessment period that follows. They leave the first
session believing that they have made a start on solving problems, instead of
feeling dissected by tests and probing questions. Key data need to be collected at
the first interview, but there are several ways to handle this. For clients who can
read and write, asking them to come in early to fill out paperwork can be an
effective way of collecting information about their background and current
functioning.
Assessment Is a Critical Part of Helping
Sometimes you will hear that gathering a lot of historical information about a
client is not worthwhile. Certain theories emphasize the present and the future
rather than the past, and so they ignore history and personality data. It is true that
some helpers do spend an inordinate amount of time gathering background
information and administering tests. On the other hand, by failing to collect
critical data, you take the chance of making a serious mistake. You must know
your customer thoroughly (Gelso, Nutt Williams, & Fretz, 2014; Lukas, 1993).
Once I interviewed a 65-year-old man who had been a shoe salesman in
Cleveland. He had led an interesting life before retiring about 2 years before we
met. He reported no real difficulties, and, as he was very convincing, I couldn’t
understand why he had consulted me. As a courtesy, I talked separately to his 28-
year-old son, who had waited patiently outside. The son told me his father had
been a physician in Texas and 5 years ago developed a syndrome, which was
thought to be Alzheimer disease, a severe brain disorder with a deteriorating
course. When the client could not remember, he simply filled in gaps in his history
with very convincing fiction. That incident (and many others) taught me that it is
best to get as much information about a client as possible and information from a
variety of sources. If I had tested the client’s memory or talked to his son first, I
might have saved some time. More important, had I relied on the client as the
sole source of information, I might have sent him away without treatment.
Conducting superficial assessments, however, does not always lead to such
spectacular embarrassment. It is very common, though, for helpers to accept the
client’s story without a critical thought. Even the most astute helper can make
drastic mistakes. It is important to listen to what clients leave out and where they
minimize or deny. Also, it is easy to forget to ask specific questions, so using a
structured form for assessment is advised. Just because a client is well groomed
and comes from a prominent family does not mean that you should not ask about
drug abuse, intimate partner violence, or suicidal thoughts. Our prejudices and
worldview color our definition of pathology. Even the Diagnostic and Statistical
Manual of Mental Disorders (DSM) of the American Psychiatric Association, the
diagnostic bible, recognizes that misdiagnosis can occur when the helper is not
familiar with a client’s cultural background and interprets symptoms within his or
her own cultural context (Alarcón, 2009). The next section indicates how
assessment can provide the helper with critical information about the client that
charts the course of treatment.
Reasons to Spend Time in the Assessment Stage
Assessment Helps You Determine Whether the Client is a Good Candidate for the
Help You Can Provide
Counseling or psychotherapy from a trained professional is not the best treatment
for everyone. The client must have the capacity to form a relationship, motivated
to change, and able to attend sessions and understand what is going on (see
Truant, 1999). There may be better avenues of help for the client than “talk
therapy.” There are educational, online learning, occupational, chemotherapy, and
support group alternatives. When a client arrives for treatment, the first thought
should be: Is this the right place for this client? For example, in our university
clinic, counselors are only available one day each week. Thus, we need to assess
clients to make sure that they are stable enough to get along on their own
between sessions. We refer those who are not to a more intensive treatment
center.
Assessment Gives Crucial Information to Plan Useful and Realistic Goals
The main purpose of assessment is to gather information that will be useful in
planning the goals that will guide the helper and the client. Assessment must have
both breadth and depth. As far as breadth is concerned, the helper must throw
the net broadly enough to make sure nothing crucial escapes. That is why many
treatment facilities use a standardized assessment or psychosocial intake form
that requires details about the client’s medical, psychological, and social history as
well as current functioning. Depth refers to getting detailed information on
specific issues such as suicide, the existence of mental disorders, and the
“presenting problem” or specific issue that acted as a catalyst for the client’s
decision to seek help.
Assessment Helps Clients Discover Other Factors Related to the Problem
A woman came to a community clinic asking for help in dealing with problems at
work. She recognized that her job was stressful, but she found that she was
unusually irritable with her co-workers and wanted to work on that problem. After
some reflection and homework by the client, we discovered that her angry
outbursts all happened between 1:00 p.m. and 2:00 p.m. on days when she had
not eaten lunch. The client knew that she became grumpy when she was hungry,
but she had never connected this with her behavior on the job. A physician helped
the client to deal with a problem of low blood sugar, and her extreme irritability
diminished, which in turn helped in her relationships and her work. We might
easily have treated the problem as anger without ruling out physical causes. In
another case, we found that a client’s anxiety was at least partially due to drinking
eight cups of coffee per day.
Assessment Helps us Understand the Psychological Impact of the Client’s
Environment
For example, is the client living with family, in a shelter, or alone? Does the client
suffer isolation from not speaking the dominant language or belonging to a
religious minority? If the client is a child, what is happening at school every day
that might be affecting the problem? Is the child bullied, rejected by classmates,
or encouraged by a teacher?
Assessment Helps us Recognize the Uniqueness of Individuals
We all have the tendency to generalize and stereotype. Unless we ask clients
about family and cultural background issues, we may make assumptions about
them through our personal cultural lens. The behavior of people from different
cultural groups may be judged as being more pathological than of those who
share our own background. A systematic assessment helps us be less manipulated
by these strong social influences and more objective because we are recording the
answers to standard questions rather than merely relying on our own impressions.
Assessment can also be useful in helping clients recognize their own unique
personality, values, strengths, and interests (Armstrong & Rounds, 2010; Gallagher
& Lopez, 2019).
Assessment Uncovers the Potential for Violence
Assessment can identify individuals who are at risk for violence toward self or
others, especially by collecting a thorough history. Although it is not possible to
always accurately predict violent behavior, a history of self-inflicted injury or harm
to others can cue us to examine the client’s situation more thoroughly and take
precautions (see Granello & Granello, 2007; Juhnke, Granello, & Granello, 2011).
(See also Table 9.1.) School counselors are recognizing the need to identify
potential for violent behavior in the aftermath of school shootings and in the wake
of renewed interest in bullying (Bernes & Bardick, 2007; Felix, Sharkey, Green, &
Tanigawa, 2011).”
“Assessment Helps Clients Become Aware of Important Problems
Frequently, painful issues are pushed out of awareness or remain unrecognized
until brought to the surface through assessment (Granello, 2010). A common
example of this is substance use. When clients are asked to list and discuss the
problems that alcohol has caused, the results can be surprising. Many alcohol
treatment centers take thorough histories and use motivational interviewing as a
beginning step in breaking down the alcoholic’s denial system (Miller & Rose,
2009).
Assessment Helps the Helper Choose Which Techniques to Use
When you think about learning helping techniques, chances are that you have not
considered assessment as a critical part of that process. Yet how do you know
which techniques to use? The answer is derived from two sources of knowledge:
information about your client and information about the client’s problems. If you
know that your client is very religious, for example, you will be able to select
techniques that the client will embrace. If you know when and where your client
has panic attacks, you will be better able to identify an effective plan. We have to
think about what methods to use with which clients for what particular problem
(Paul, 1967). The next section covers the basic techniques of assessment that are
appropriate to use at all stages of treatment to gain knowledge about clients.”
Chapter 10 Change Techniques
“Lowering and Raising Emotional Arousal
The fourth therapeutic factor in the REPLAN system is “L” for lowering and raising
emotional arousal. The purpose of this set of change techniques is to reduce the
impact of negative emotions and increase positive emotions. This goal is
accomplished in three different ways:
Reduce negative emotions: Helpers are called upon to help clients reduce
overpowering feelings of depression, anger, stress, and fear, primarily through
methods of stress reduction and cognitive techniques.
Facilitate expression of strong emotions that are being ignored: At other times,
helpers arouse emotions to act as catalysts for change: for example, helping
clients get in touch with repressed anger or sadness and allowing them to
recognize the powerful nature of unresolved feelings.
Activate positive emotions: Helpers also facilitate positive emotions such as joy,
gratitude, serenity, interest, hope, pride, amusement, inspiration, awe and love,
trust/faith, compassion, gratitude, and forgiveness (Fredrickson, 2009; Vaillant,
2013). Positive emotions also tend to weaken negative ones.
In this section, we will address each of these methods for raising or lowering
emotional arousal and identify some key techniques that helpers use in each
circumstance.
Reducing Negative Emotions
The three most common negative emotions that clients seek help for are
depression/guilt, anxiety, and anger. Earlier in this chapter, you learned the
countering technique, which is used to help clients reduce self-criticism. Reducing
negative thinking also tends to reduce depressive feelings, and cognitive therapy
has been the primary method for treating depression, by psychological means,
since the early 1990s.
Although depression, anxiety, and anger are treated differently, we only have
room here to talk about one of these troubling emotional states, so we have
chosen to present techniques for coping with anxiety. Anxiety is a very common
complaint, and there are several basic anxiety-reducing techniques that can be
learned and applied rapidly. In this section, we present two methods, relaxation
training via muscle relaxation, and meditation, which are both effective and low-
risk.
Reducing Anxiety and Stress
Although a little anxiety may actually enhance performance at times, it can easily
run out of control, causing distress and interfering with relationships and job
performance. Modern life, with more crowding, more work pressure, and more
choices, has led to greater stress levels for just about everyone. The emotional
arousal associated with anxiety or fear may have been useful in more primitive
times because the “fight or flight” syndrome chemically sparked physical
readiness to deal with potential harm, putting the amygdala in overdrive (Siegel,
2012). What once may have increased the chances for survival now threatens our
health because the physiological by-products of stress cannot be easily dissipated
in a sedentary lifestyle. Today’s helper is frequently called upon to help clients
learn to reduce the causes of stress by helping them acquire time management
skills; develop habits for self-care, including exercise and good nutrition; and gain
a healthier outlook on life. In addition, helpers assist clients in lowering stress by
reducing emotional arousal through quieting techniques. Helpers also need to
sustain their own mental health by utilizing stress-reducing resources such as
hatha yoga, meditation, being in nature, using religion and spirituality, and good
nutrition and exercise (see Corey, Muratori, Austin, & Austin, 2018).”
“The most fundamental and time-honored method for helping clients reduce
arousal is relaxation. Relaxation training brings about relief from symptoms of
anxiety and lets clients experience the positive sensations associated with
lowered muscle tension (Pagnini, Manzoni, Castelnuovo, & Molinari, 2013). This
technique is explained in detail here because it is part of most stress reduction
programs and forms the basis of systematic desensitization and biofeedback.
Relaxation Training
Edmund Jacobson’s progressive relaxation technique (1938) was, for many years,
the favored method for teaching clients deep muscle relaxation. Muscle relaxation
had been found to reduce anxiety in clients with phobias by pairing relaxation
with exposure to fearful stimuli, a process called systematic desensitization.
Jacobson’s method, if faithfully followed, enables the client to identify and relax
every major muscle group in the body. The traditional training process may
actually take several months in weekly sessions, but abbreviated versions have
been used successfully (Gatchel & Baum, 1983; Harris, 2003). Following is a simple
and even briefer format developed by Witmer (1985), which can be learned in
three or four sessions, each lasting about 20 minutes. Every session is identical
and provides a complete tensing and then relaxing of all the major muscle groups
(see Table 10.4). Please note that for most problems, relaxation alone is probably
not as effective as a treatment program that also incorporates mental or cognitive
control of anxious thoughts such as thought stopping or countering (Donegan &
Dugas, 2012; Hinton, Hofmann, Rivera, Otto, & Pollack, 2011; Stevens et al., 2007).
Still, relaxation training has been consistently shown to work as a treatment for
various kinds of anxiety and can easily be included as an adjunct to other quieting
strategies.
The Technique of Deep Muscle Relaxation.
Step 1: Preparation. Ask the client to find the most comfortable position with eyes
closed. This position may be sitting or lying down, but in either case, there should
be support for the head. The legs and arms should not be crossed. The procedure
is best practiced without the distractions of noise or glaring lights. Instruct the
client to speak as little as possible and to avoid moving except as necessary to
achieve a more comfortable position. The client may be instructed to raise one
finger to indicate when an instruction has been understood or completed.
Step 2: Tighten and Relax. Ask the client to progressively tighten and then relax
each muscle. There are a variety of ways to move the body to tense each area.
Experiment and allow the client to try out different ways that feel best to tense
that area but do not hurt. Encourage the client to hold each tensed muscle about
6–7 seconds until the experience of tightness is fully felt. If the posture is held too
long, cramps and spasms may result. While a muscle group is tensed, ask the
client to focus attention on that area, simultaneously relaxing other parts of the
body and holding the breath. After tensing the muscle group, the client is asked to
relax and breathe diaphragmatically to let go of all muscle tension. It may take
some time to learn how these muscle groups are properly tensed.”
“Step 3: Relax Fully and Breathe. Following the tensing of a muscle group, instruct
the client to exhale and relax fully and completely. This relaxation is to be
accompanied by slow, deep, diaphragmatic breathing and should last 20 seconds
or so. The tension and relaxation of the same muscle group is then repeated
before moving on. Diaphragmatic breathing consists of inhaling and exhaling
below the ribs rather than in the upper chest. It is the relaxed breathing
demonstrated by sleeping babies and practiced by singers. Help clients learn
diaphragmatic breathing by placing one hand on the chest and the other on the
diaphragm/stomach area. Diaphragmatic breathing occurs when the stomach
hand goes up and down, but the chest hand remains relatively immobile.
Step 4: The Body Scan. The most important phase of the lesson is the body review,
or body scan. This phase is critical because the client is learning to self-monitor. In
this step, the client is asked to return to specific, discrete areas of tension during
the relaxation procedure and relax them. This process allows the helper to
individualize the relaxation so that clients can spend time on the areas that they
tend to tighten. Tell clients that a body scan can be used on their own, at any time
during the day, to check bodily tension.
Step 5: Assign Practice. The first administration of the relaxation technique should
be recorded for the client, or a standardized commercially available version of the
technique should be provided. Ask the client to practice the relaxation technique
twice daily, usually once upon rising and once in bed before falling asleep. Have
the client note which of the six areas of the body show the greatest sources of
tension during the day, and ask the client to report this information at the next
session.
Meditation for Lowering Emotional Arousal and Increasing Positive Emotions
Meditation may be one of the most effective means for decreasing anxiety, panic,
and persistent anger and depression (Burns et al., 2011; Kabat-Zinn et al., 1992;
Lane, Seskevich, & Pieper, 2007; Young, 2012). Moreover, meditation is not merely
a method for reducing tension; it actually produces positive states of happiness,
alertness, improved concentration, fearlessness, optimism, joy, and feelings of
well-being (Chandler, Holden, & Kolander, 1992; Fredrickson, Cohn, Coffey, Pek, &
Finkel, 2008; Singh, 2003; Smith, Compton, & Beryl, 1995). Meditation has been
used to treat and prevent substance abuse (Dakwar & Levin, 2009; Gelderloos,
Walton, Orme-Johnson, & Alexander, 1991; Shafii, 1974, 1975; Young et al., 2011;
Zgierska et al., 2009). Along with prayer, meditation is a key tool in the 12 steps of
Alcoholics Anonymous. Meditation is utilized in about 60% of addiction treatment
programs (Priester et al., 2009).
There are several forms of meditation, but we will talk about two: mantra
meditation and mindfulness. Mantra meditation has a long history in Western and
Eastern thought. A mantra is a word or phrase repeated slowly and at intervals,
mentally, not aloud but with the “tongue of thought” (Singh, 2003). For those who
are spiritually inclined, any name of God can be used. Others have found it
effective to repeat a word such as one or peace (Benson, 1984). If you are
interested in learning more about mantra meditation, read Rajinder Singh’s book
Inner and Outer Peace through Meditation (2003). It contains complete and
simple instructions for nondenominational spiritual meditation and exercises for
getting started. A recent study of this technique finds that it is an effective way for
counselor trainees to reduce stress (Gutierrez, Conley, & Young, 2016). For those
who are not attracted to a spiritually oriented meditation, Patricia Carrington’s
The Book of Meditation (1998) and Meditation for Dummies (Bodian, 2016) are
good resources.
Mindfulness is a form of Theravadin Buddhist meditation that has found its way
into a number of new therapies without its religious accoutrements. These include
mindfulness-based stress reduction (Kabat-Zinn et al., 1992), mindfulness-based
cognitive therapy (Segal, Williams, & Teasdale, 2002), dialectical behavior therapy
(Linehan, 1993), and acceptance and commitment therapy (Hayes, Luoma, Bond,
Masuda, & Lillis, 2006). Mindfulness is not merely an activity conducted in a
meditation sitting; it is also a way of life. It involves paying strict attention to what
is happening in the present moment without judging. Mindfulness as a
therapeutic tool contrasts with traditional cognitive therapy because mindfulness
does not challenge or replace negative thoughts. It substitutes “present
awareness” for negative thinking. As a negative thought enters, it is noted without
judgment and allowed to pass through the mind. Mindfulness practitioners think
that arguing with thoughts tends to strengthen them, whereas allowing them to
flow through consciousness unchallenged reduces their potency.
Whether one uses mantra or mindfulness-based meditation, a noticeable benefit
is a reduction in the constant chattering of the mind and the mental images that
produce anxiety. For example, have you ever tried to sleep and found plans for the
next day going around in your head? Meditation is a means of putting such
thoughts to rest for a while. Unlike relaxation techniques, meditation has the
effect of producing mental quietude, not just physical rest. Like relaxation,
meditation must be practiced on a regular basis for at least 15 minutes per day for
several weeks before real benefits can be realized (Benson, 1984). After that, at
least 30 minutes per day should be devoted to meditating. Regularity is crucial,
and longer meditations are considered to be more beneficial than several short
meditations. Like any skill or technique you learn, a teacher is essential (Singh,
2003). Refer clients to a class if you are not qualified to teach them or you do not
practice meditation yourself.
Raising Emotional Arousal and Facilitating Expression
Be aware that emotionally stimulating techniques can be traumatic and
potentially harmful to clients. Arousing techniques, in their simplest and most
benign form, include encouraging clients to talk about troubling experiences and
feelings rather than avoiding them. At the extreme, helpers may evoke powerful
emotions that make the client feel out of control. Because some arousing
techniques can produce harmful reactions, we will discuss moderately arousing
methods that encourage clients to focus on their emotions but do not pressure
them to do so. The more confrontational and cathartic methods require very
advanced skills to be used only by experienced practitioners within strict ethical
guidelines and in conjunction with close supervision (Young & Bemak, 1996). They
are mentioned here because, sooner or later, every helper will see these methods
on films or at conference workshops.
Besides the risks associated with arousing and expressive techniques, there is
what Goleman (2006) calls a ventilation fallacy. Because expressing anger feels so
good immediately, we are seduced into thinking that we have dispelled it. In fact,
the opposite may be true (see Tavris, 1989). Expressing anger tends to arouse a
person more, increasing the likelihood of feeling anger later, whereas managing or
reducing anger may be more effective in preventing outbursts (LeCroy, 1988).
Techniques that Stimulate Emotional Arousal and Expression
The term catharsis is the most commonly used term in the context of arousal and
expression, but it has become a catchall that actually encompasses two separate
activities: (1) stimulating emotional arousal of the client and (2) encouraging
emotional expression by the client (Young & Bemak, 1996). Arousing techniques
put the client in touch with deeply held emotions. Expressive techniques, on the
other hand, allow the client to communicate these emotions to the helper.
The nonjudgmental listening cycle (NLC) and especially reflection of feelings are
the primary methods that helpers use to allow clients to experience and express
their emotions as deeply as possible. More advanced methods for enhancing
emotional awareness and emotional expression are often used in Gestalt therapy
(Perls, 1977; Prochaska & Norcross, 2009), psychodrama (Moreno, 1958), and a
number of group approaches. Emotional arousal has been activated through
hypnosis and drugs (Wolberg, 1977), psychodramatic methods (Moreno, 1958),
guided imagery (Witmer & Young, 1985), free association in psychoanalysis, the
empty-chair technique (Polster & Polster, 1973), focusing (Gendlin, 1969, 1978),
flooding and implosive therapy (Stampfl & Levis, 1967), bioenergetics (Lowen,
1967), play therapy (Kottman & Meany-Walen, 2018), and many others. Research
has generally supported the use of emotional expression as a therapeutic change
technique (Rosner, Beutler, & Daldrup, 2000) even if many of the more radical
approaches have been discredited (Norcross et al., 2006).
Because these listed techniques are advanced and require thorough training and
supervision, we will focus on one specific method that most helpers can
incorporate immediately: journal writing. Using the “Stop and Reflect” section,
you can experiment with this method yourself.”
“Creating Positive Emotions
Positive psychology is a term that was coined by Abraham Maslow in 1954.
Maslow and other humanistic psychologists were concerned about the
overemphasis on pathology and diagnosis. Since that time, focusing on strengths
has remained alive in the work of Carl Rogers and many others who have studied
“positive emotions, positive character traits, and enabling institutions” (Seligman,
Steen, Park, & Peterson, 2005, p. 410). More recently, positive psychologists,
counselors, social workers, and others have begun to accumulate a body of
research supporting the use of strength-based helping techniques, including
gratitude, meditation, forgiveness, utilizing personal strengths, humor, creativity,
optimism, humility, authenticity, and many others. One of the most important
voices in this movement is Barbara Fredrickson (2001), who has found that these
methods evoke positive emotions, and that is why they work. She found that
creating positive emotions both broadens the ability to see alternative solutions
and builds resistance to negative feelings. Her popular book, Positivity (2009), is
not about how to maintain a positive attitude but how to produce positive
emotions as a bulwark against the stresses of the world and our own negative
emotions.
Gratitude to Increase Positive Emotions
Gratitude is a feeling that results when one recognizes a benefit that is
unwarranted and unexpected. It involves feelings of wonder, thankfulness, and
appreciation (Emmons & McCullough, 2003). Gratitude may be directed toward
others or a higher power. Inducing gratitude has been found to be associated with
happiness, decreased depression, relationship satisfaction, improved sleep, and
better social functioning (Harvard Medical School 2019; Young & Hutchinson,
2012).
The timing of a gratitude intervention is important. Getting clients to focus on
gratitude following a major calamity is a mistake. Gratitude is something to build
into one’s life over the long term, not something to distract or cheer up someone
after a serious loss. Clients who are prescribed gratitude interventions should not
be instructed to ignore or gloss over problems, but they should also be aware of
good things that are happening in their lives. For example, we saw a client named
Portia who had been out of work for some time but recently found a job as a retail
manager in an upscale shop. Although the pay is low, she receives good benefits,
including health insurance and retirement. At her counseling visit, the client
discussed the fact that she finds her job boring. She resents having to put up with
rich clients she says do not respect her. She feels that her talents are not being
recognized by her boss. I was aware that Portia had said 2 months before that
having a job was crucial to her happiness and financial well-being. She was elated
when she signed on but is now unhappy with her work. We discussed alternatives
to her present situation and developed a plan to help her look for a new job. In
the meantime, Portia was asked to keep a gratitude journal about the good things
in her life in order to counteract some of the negative thoughts and feelings she
was experiencing. Those negative thoughts could impede her present job
functioning as well as her ability to find a new job.
Techniques for Increasing Gratitude.
The gratitude journal is the most popular method for practicing gratitude. A client
can be instructed to write daily or weekly record five things for which he or she is
grateful. These can be simple things such as “no lines at Walmart.” Sometimes,
clients seem to write the same things and do not pay attention after a few entries.
To counteract this, clients are instructed to use a different letter of the alphabet
each day and write five things to be grateful for that begin with that letter. In
addition, clients may need reminders to work on gratitude. These can be sticky
notes, automated text messages, or e-mails. Clients can set up reminders and
even journal on their smartphones using a number of available gratitude
applications such as Zest and Mojo. A more personal technique is the gratitude
visit. Clients are instructed to write and then deliver a letter to someone to whom
they feel grateful but whom they have never acknowledged.”
Chapter 12 Activating Client Expectations, Hope, and Motivation
Before learning the techniques for activating expectations, hope, and motivation, it is
important to recognize the immediate obstacles most clients are experiencing when
they first come for help: discouragement, lack of confidence, and demoralization.
Remember that seeking professional help is often a last resort. The clients have already
tried several ways to solve their problems. They have probably consulted clergy, family,
and friends. They have come to believe that there may be no way out of their difficulties.
Therefore, before the clients can attack their problems, they must first overcome the
conviction that their situation is hopeless.
The Demoralization Hypothesis
According to Jerome Frank (de Figueiredo, 2007; Kissane, 2017; Frank & Frank, 1991),
those who seek professional help are demoralized. Demoralization is described by Frank
as a “state of mind characterized by one or more of the following: subjective
incompetence, loss of self-esteem, alienation, hopelessness (feeling that no one can
help), or helplessness (feeling that other people could help but will not)” (p. 56). Frank
also proposes that client symptoms and mental demoralization interact. In other words,
according to the demoralization hypothesis client problems and symptoms are worsened
by the sense of discouragement and isolation. For example, sleeplessness may be seen
as a minor annoyance by one person, whereas the demoralized individual sees it as yet
another sign of the hopelessness of the situation. Seligman (1975) experimentally
discovered an aspect of demoralization called learned helplessness , which is a state
analogous to depression. In that research Seligman found that dogs and people exposed
to unsolvable problems became so discouraged that their later performance on solvable
problems was negatively affected. Many clients do not give the helping process their full
effort because they have little confidence that anything can help them. Thus, it is often a
first task of the helper to instill some hope that some of the presenting problems can be
solved. With renewed hope, the client will be more fully invested in the therapeutic
project.
Motivation and Readiness
Instead of classifying demoralized clients as resistant or unmotivated, you can think of
people as being at various stages of readiness for change. Steve de Shazer (1988)
classified clients as visitors , complainants , or customers . The analogy is that clients
who come to a professional helper are like clients in a retail store. Some are browsing
(visitors), others have a need to buy something and are checking out the prices and
options (complainants), and still others have come to the store looking for a specific
product, planning to buy something right away (customers). Salesclerks know they need
to treat each kind of shopper differently, from giving a brief greeting (visitors) to
describing options and features (complainants) to finalizing a sale (customers). Similarly,
helpers who do not recognize these differences in readiness will try to force a client into
a particular treatment. For example, most people are not prepared to enter substance
use disorder on the first day they seek help. Some clients need education (visitors), and
others require help thinking about the problem and weighing their options
(complainants). Only customers are prepared to take direct action to solve the problem.
One readiness approach that has shown considerable success is motivational
interviewing (MI) (Miller & Rollnick, 2013). This person-centered/cognitive approach has
been used most often with addictions. The method is based on the idea that clients
come for help at different stages of readiness. Using a nonjudgmental, nonadversarial
approach, practitioners try to help clients become more aware of the issue surrounding
a problem behavior and explore the costs, benefits, and risks associated with it. Special
training is required to practice motivational interviewing, but you already know the first
step—listen with empathy (Forman & Moyers, 2019). After that, motivational
interviewers carefully identify discrepancies, accept client resistance, and allow the
client to be self-directing. As you can see, the process is composed of many of the
building blocks you have already learned. The client’s motivation is unique to that
person and so each case must be understood individually.
The Stages of Change
Another way of looking at readiness is the stages of change theory, which is a part of the
transtheoretical model of psychotherapy (Prochaska, DiClemente & Norcross, 1992;
Prochaska & DiClemente, 1983). According to this approach, we first get ready to
change, we change, and then we try to maintain that change. At each step we need a
different kind of help. In the stages of change model, there are five stages. In the first
stage of precontemplation, the person is not even thinking about taking action—for
example, not even considering quitting smoking or drinking. In the contemplation stage,
clients are planning to change within 6 months. At this point they have become
conscious of both the positive and negative consequences of potential change. Yet
clients at this stage are ambivalent about making a change and are not ready to take
direct action to address the problem. People can be aware of the problem and yet
remain stuck in this stage for years. The preparation stage describes clients who have
taken some steps toward change during the last 12 months and are ready to consider a
specific action plan. For example, a client who needs to do more physical exercise has
joined a gym and is planning to begin a program, or the client may have obtained a self-
help book and seems to be taking some small concrete steps for improving self-esteem.
But it is really in the action stage that we find clients who have already made specific
changes in their lives. For example, the client has stopped drinking, started attending AA
meetings, or entered a treatment program. Although treatment has begun, the process
is not complete. The final stage of change is maintenance, which characterizes
individuals who have already changed their lives and behavior, such as by quitting
smoking or having instituted better communication in their relationships. The
maintenance stage may be the most critical and can last from 1–5 years. It is critical
because relapse is a constant threat. Relapse is a stage that propels clients back to an
earlier stage of readiness. Clients move back and forth between the stages especially as
they experience relapse. The most important implication of this theory is that people
benefit from different interventions depending on which stage of change they are in.
Clients do better in programs that tailor their treatments to the clients’ stage of change
than in those that do not (Norcross & Lambert, 2018). Those who are more ready
(further along in the stages) do better than clients who are at earlier stages.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
