Demystifying the counseling process

Allen E. Ivey

Mary Bradford Ivey

Carlos P. Zalaquett

Counseling in a Multicultural World

3nd Edition

Essentials of Intentional

Interviewing

Chapter 7

HOW TO CONDUCT A FIVE-STAGE COUNSELING SESSION USING ONLY LISTENING SKILLS

Chapter Goals

Develop further competence with the basic listening sequence (BLS), the foundation of effective interviewing, counseling, and psychotherapy.

Understand and become competent in the five stages of the well-formed session: empathic relationship—story and strengths—goals—restory—action.

Learn the basic system of decisional counseling and how it relates to other theories of helping.

Chapter Goals

Conduct a complete decisional session using only listening skills and the five stages.

Have a good start on Rogerian person-centered counseling, as well as most other theories of counseling and therapy, through your awareness, knowledge, and skills with the basic listening sequence and the five stages.

Assess your current knowledge and competence:

Self-Assessment Quiz:

The chapter quiz will help you determine your current level of knowledge.

Portfolio of Competencies:

Fill out the downloadable Self-Evaluation Checklist to assess your existing knowledge and competence on the ideas and concepts presented in this chapter.

Take both before reading the chapter to determine baseline and again after to assess progress!

MindTap:

Web-based MindTap’s programs bring the concepts and skills to action with many practical exercises and supplements.

Watch the case studies, video clips of sessions, and interactive exercises presented in each chapter to make learning more meaningful and effective.

Basic Listening Sequence

Integrates Several Key Skills

BLS Skills Usage

Open Questions begin the session

Closed Questions diagnosis and clarification

Encouragers evoke details throughout

Paraphrase reflect essence of client talk

Reflection of Feeling examine key emotions

Summary review and interviews

Attending/observation skills underlie the process.

Listen to clients using the BLS to obtain overall background of client’s story and learn about the facts, thoughts, feelings, and behaviors that go with the story.

Use checkouts to obtain feedback on the accuracy of your listening.

Clients will let you know how accurately you have listened.

Basic Listening Sequence

Using Only Listening Skills

BLS skills need not be used in a specific order.

The therapist needs to adapt the skills to meet client needs.

The counselor observes and flexes use of skills to support the client.

Basic Listening Sequence

Using Only Listening Skills

Empathic

Empathy

Five-Stage Interview

Using Only Listening Skills

Building rapport is critical before the client will trust you to help.

Structuring helps the client know how the interview will proceed.

Your ability to recognize and respect multicultural differences may be key to the success of your interview.

Empathic Relationship: Initiate Session

Five-Stage Interview

Listen to the client’s story--find out why the client is present.

Gather data about clients and their perceptions.

Focus on client strengths as well as client issues.

Story and Strengths: Gathering Data

Five-Stage Interview

Comp: Please change the two hyphens to an em dash

12

Don’t assume you and your client have the same goal.

Define the problem and the outcome in the language of the client.

Search for positive assets to help achieve the goal.

Five-Stage Interview

Goals: Set Goals Mutually

Encourage clients to find their own solutions.

Facilitate exploration of issues and solutions.

Generate alternatives.

Plan for action beyond the interview.

Five-Stage Interview

Restory: Explore and Create

Role-playing: practice new behaviors.

Homework: counselor assigns weekly tasks.

Family or group counseling: involve spouses or family members therapy.

Relapse prevention: identify and prevent high-risk situations threatening achieved change.

Follow-up and support: periodic checks on behavior maintenance.

Action: Conclude

Strategies for Client Change, Five-Stage Interview

Diversity includes multiple dimensions:

Ethnicity/race

Disabilities

Sexual orientation

Spirituality/religion

Individual differences

Demonstrate empathic understanding.

Be aware that you cannot fully enter the client’s experience.

Multiculturalism

The Impact of Diversity on Empathic Understanding

Notes are essential to professional work and required for clients’ records.

Avoid allowing writing to take precedence over listening.

Taking notes is only a problem if it makes the interviewer anxious.

With client permission, audio- or video-tape can be used.

Notes and recordings can be made available to the client.

Taking Interview Notes

Demystifying the counseling process

Attending, the first behavioral skill

Taking microskill learning home via action

Microtraining goes viral and multicultural

Transtheoretical character of microskills

Video your sessions

Becoming specific about multicultural issues

And now, neuroscience

To be continued

Demystifying counseling

Chapter 7

Skills Practice

A Practice Interview Using Only Listening Skills

Skills Practice

Find a volunteer client.

Review informed consent.

Obtain permission to audio- or videotape the session.

Take the client through the Five-Stage Interview.

Practice Exercise

Using Only Listening Skills

Review a transcript of the session and classify your comments as listening skills.

Ask a volunteer to review the recording or transcript of the session and use the Attending Behavior Feedback Form. (next slides)

Ask the client to complete the Client Feedback Form. (Chapter 1)

Practice Exercise

Using Only Listening Skills

Stage 1: Relationship

Describe the nature of the rapport.

Was rapport adequate to move to the next stage?

Did the interviewer provide structuring?

Stage 2: Story and Strength

Define concerns.

Identify assets.

Are only listening skills used?

Was at least one positive client asset identified?

Feedback Form

Using Only Listening Skills

Stage 3: Goals

Are only listening skills used?

Was at least one outcome or goal identified?

Stage 4: Restory

Are only listening skills used?

Were alternatives generated to address a solution?

Feedback Form

Using Only Listening Skills

Stage 5: Action

Generalize

Were specific plans made for after the session?

Were follow-up plans made?

Terminate

Feedback Form

Using Only Listening Skills

212 SECTION II Hearing Client Stories: How to Organize an Interview

! e importance of Stage 1 relationship and Stage 3 goal setting cannot be overempha- sized. If you and your client agree to mutual goals for Stage 3, you have a solid basis for trust and and actually reaching those goals.

Failure to treat is one of the most common causes of malpractice suits. Clients and coun- selors who agree on goals in a clear fashion have a direction and contract for the sessions. Jointly revise goals as necessary. Clients who participate in goal setting and understand the reasons for your helping interventions may be more likely to participate in the process and are more open to change. Keeping a joint written record of goals and progress toward them will help clarify the purpose and direction of counseling and provide accountability standards for insurance companies.

Stage 1. Relationship—Initiating the Session: Rapport, Trust Building, and Structuring (“Hello”) Building Rapport “Hello, _____.” A prime rule for establishing rapport is to use the client’s name and repeat it periodically through the session. Some interviewers give extensive attention to the rela- tionship (rapport) stage, whereas others simply assume rapport and start immediately. Introducing the interview and building rapport obviously are most important in the fi rst interview with a client. In some cases relationship building will be lengthy and blend into treatment.

FIGURE 8-1 The circle of interviewing stages.

Relationship

(Initiating the session: rapport and structuring)

A ct

io n

(T

er m

in at

in g:

g en

er al

iz in

g

an d

ac tin

g on

ne

w s

to rie

s)

Restory

{Working: exploring

alternatives, confronting

incongruities and

conflict, restorying)

Go als

(M utu

al go

al se

ttin g:

wh at

do es

th e c

lien t

wa nt

to ha

pp en

?)

S tory and strengths

(G athering the data

draw ing out stories,

concerns, problem s,

or issues)

Relationship, Positive Assets,

and Wellness

Ivey_09_ch8_p199-236.indd 212Ivey_09_ch8_p199-236.indd 212 11/25/08 2:42:18 AM11/25/08 2:42:18 AM

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