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Helping skills clara hill 4th edition pdf

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Copyright © 2014 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher.

Electronic edition published 2014. ISBN: 978-1-4338-1679-6 (electronic edition).

Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org

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Cover Designer: Minker Design, Sarasota, FL Cover art: Breton Girls Dancing, Pont-Aven, Collection of Mr. and Mrs. Paul Mellon, Photograph Copyright 2001 Board of Trustees, National Gallery of Art, Washington, 1888, oil on canvas, .730 × .927 (28¾ × 36½); framed: .613 × .1.060 × .035 (24⅛ × 41¾ × ⅜). Reprinted with permission.

The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association.

Library of Congress Cataloging-in-Publication Data

Hill, Clara E., 1948- Helping skills : facilitating exploration, insight, and action / Clara E. Hill. — Fourth edition. pages cm




Includes bibliographical references. ISBN-13: 978-1-4338-1678-9 ISBN-10: 1-4338-1678-4 1. Counseling. 2. Counseling psychology. 3. Helping behavior. I. Title.

BF636.6.H55 2014 158.3—dc23


British Library Cataloguing-in-Publication Data A CIP record is available from the British Library.

Fourth Edition



To my husband, Jim Gormally, my fellow traveler in the process of learning helping skills;

to my children, Kevin and Katie, who have tested my helping skills; and to my students, who have taught me how to teach helping skills.




I Overview

Chapter 1. Introduction to Helping What Is Helping? Is Psychotherapy Effective? Facilitative Aspects of Helping Problematic Aspects of Helping When Do People Seek Help From Others? On Becoming a Helper Overview of This Book DVDs Concluding Comments What Do You Think?

Chapter 2. An Overview of the Helping Process Assumptions Underlying the Three-Stage Model The Three-Stage Model Facilitative Conditions A Model for the Process and Outcome of Helping Concluding Comments What Do You Think?

Chapter 3. Ethical Issues in Helping General Ethical Principles Ethical Issues for Beginning Helpers Working Through an Ethical Dilemma Concluding Comments What Do You Think?

Chapter 4. Self-Awareness Self-Knowledge and Self-Insight State of Heightened Self-Focus What Do You Think?

Chapter 5. Cultural Awareness Defining Culture Dimensions of Culture Cultural Issues in the Helping Process Ethical Behavior Related to Culture Becoming a Culturally Competent Helper Difficulties Helpers Have Related to Cultural Issues My Own Experiences of Culture

What Do You Think?

II Exploration Stage

Chapter 6. Overview of the Exploration Stage Theoretical Background: Rogers's Client-Centered Theory Goals for the Exploration Stage Exploration Stage Skills Concluding Comments What Do You Think?

Chapter 7. Skills for Attending, Listening, and Observing Overview of Attending, Listening, and Observing Cultural Issues in Attending, Listening, and Observing Relax and Be Natural but Professional Nonverbal Behaviors That Facilitate Attending Paraverbal Behaviors That Facilitate Attending Behaviors That Facilitate Active Listening and Observing Examples of Inappropriate and Appropriate Attending, Listening,

and Observing Difficulties Helpers Experience in Attending, Listening, and

Observing Concluding Comments What Do You Think?

Chapter 8. Skills for Exploring Thoughts and Narratives Rationale for Exploring Thoughts and Narratives Restatements and Summaries Open Questions and Probes for Thoughts Closed Questions About Thoughts Disclosures of Similarities A Comparison of Skills for Exploring Thoughts What Do You Think?

Chapter 9. Skills for Exploring Feelings Rationale for Exploring Feelings Cultural Considerations in Working With Feelings Reflection of Feelings Disclosure of Feelings Open Questions and Probes About Feelings Focusing A Comparison of Skills for Exploring Feelings What Do You Think?

Chapter 10. Integrating the Skills of the Exploration Stage Choosing Goals to Facilitate Exploration Choosing Skills to Match the Goals and Intentions Implementing the Skills of the Exploration Stage

The Process of the Exploration Stage Cultural Considerations Difficulties Implementing the Exploration Stage Coping Strategies for Managing Difficulties Example of the Exploration Stage What Do You Think?

III Insight Stage

Chapter 11. Overview of the Insight Stage What Is Insight? Theoretical Background: Psychoanalytic Theory Developing Conceptualizations About Client Dynamics Goals and Skills of the Insight Stage Concluding Comments What Do You Think?

Chapter 12. Skills for Challenging Clients and Fostering Awareness Rationale for Using Challenges Theoretical Perspectives on Challenges Types of Challenges Guidelines for Presenting Challenges Difficulties Helpers Experience Using Challenges What Do You Think?

Chapter 13. Skills for Facilitating Insight Open Questions and Probes for Insight Interpretations Disclosures of Insight What Do You Think?

Chapter 14. Skills for Immediacy Types of Immediacy Rationale for Using Immediacy Guidelines for Using Immediacy Example of Immediacy Difficulties Helpers Have in Using Immediacy What Do You Think?

Chapter 15. Integrating the Skills of the Insight Stage Steps for Integrating Insight Skills Caveats About Using Insight Skills Cultural Considerations Difficulties Helpers Might Experience in the Insight Stage Strategies for Overcoming Difficulties in Implementing the Insight

Stage Example of an Extended Interaction in the Insight Stage What Do You Think?

IV Action Stage

Chapter 16. Overview of the Action Stage Rationale for the Action Stage Deterrents to Action Philosophical Underpinnings Markers for Knowing When to Move to Action Theoretical Background: Behavioral and Cognitive Theories Goals of the Action Stage Skills of the Action Stage What Do You Think?

Chapter 17. Steps for Working With Four Action Tasks Relaxation Behavior Change Behavioral Rehearsal Decision Making What Do You Think?

Chapter 18. Integrating the Skills of the Action Stage Implementing the Action Skills Difficulties Helpers Might Experience in the Action Stage Strategies for Overcoming the Difficulties What Do You Think?

V Integration

Chapter 19. Putting It All Together: Working With Clients in the Three-Stage Model Session Management Dealing With Difficult Clients and Clinical Situations Example of an Extended Interaction Concluding Comments What Do You Think?






My interest in training helpers has developed from teaching helping skills classes to undergraduate and graduate students for more than 40 years. When I first taught these courses, I felt frustrated in trying to find the right textbook that would embody my philosophy of helping and address the needs of my students. Few, if any, helping skills texts integrate the importance of affect, cognition, and behavior in the process of change. Some concentrate on feelings while disregarding the role of challenge and action in facilitating critical life changes, whereas others highlight insight at the expense of affective exploration and behavior change. Several popular texts focus solely on a problem-solving approach, which neglects the critical role of affect in helping clients express, understand, and alter that with which they are dissatisfied in their lives. Other books do not provide the crucial theoretical and empirical foundation for the helping skills. To address these limitations, I used the knowledge garnered from my experiences as a student, teacher, counselor, supervisor, and researcher to write a book that teaches helpers to assist clients in exploring their feelings and thoughts, gaining new insights about their problems, and moving toward positive behavior changes.

My Philosophy of Helping

This text introduces an integrated model that is grounded in practice, theory, and research. Grounding the model in practice and theory is important to take advantage of the work of accomplished clinicians and theoreticians who have articulated a rich theoretical knowledge base. Rogers, Freud, Bowlby, M. Erikson, Mahler, Skinner, Ellis, Beck, and others have provided brilliant insights into the nature of human beings, the mechanisms of change in counseling and therapy, and the techniques for assisting individuals to achieve their potential and accomplish their goals. The three-stage model is grounded in the contributions of these sage theorists, and readers are introduced to the salient aspects of their work.

The model involves three stages: exploration, insight, and action. The exploration stage is based on client-centered theory (e.g., Rogers, 1942, 1951, 1957, 1959). Psychoanalytic and interpersonal theories (e.g., Freud, 1940/1949; Teyber, 2006; Yalom, 1980) form the foundation for the insight stage. The action stage is based on behavioral (e.g., Goldfried & Davison, 1994; Kazdin, 2013; Watson & Tharp, 2006) theories. These major theories are integrated in this three- stage model because all have proven to be effective in helping clients (see Wampold, 2001).

The helping process can be conceptualized as involving moment-by-moment interaction sequences (Hill, 1992). Helpers develop intentions for how they want

to help clients. These intentions are based on what they know about clients and what they hope to accomplish with clients at a given time. With these intentions in mind, helpers select verbal and nonverbal skills with which to intervene. In turn, clients react to the interventions in ways that influence how they then choose to behave with helpers. Thus, helping involves not only the overt behaviors but also the cognitive processes of helpers (i.e., intentions) and clients (i.e., reactions). Awareness of intentions assists helpers in selecting effective interventions. In addition, attention to the clients’ reactions to the interventions can aid helpers in planning future interventions.

Finally, I sought to write a book that both supports students’ development as helpers and provides challenges to facilitate the development of helping skills. Becoming an effective helper is an exciting and challenging process. For some, this undertaking can be life changing. Many students are fascinated by the process of becoming helpers, and they pose thoughtful questions as they struggle to learn the skills and develop confidence in their ability to assist others. Because the focus of this book is on helpers (not clients), I pose many questions that relate to the helpers’ development and concomitant feelings and thoughts.

What This Text Does Not Provide

It seems necessary to clarify the focus of this book by also indicating what this text does not provide. It is beyond the scope of this book to provide information about counseling children, families, or clients who have serious emotional or psychological difficulties. Although the helping skills taught in this book are crucial and form the foundation for work with all these groups, helpers will need much more extensive and specialized training before they will be qualified to work with these groups.

Furthermore, I do not address the diagnosis of psychological problems or identify characteristics of psychopathology, which are two important topics that require extensive additional training. I encourage helpers to pursue additional training in assessment and psychopathology after developing a working knowledge of basic helping skills. I believe that all helpers, even those working with healthy populations, should be able to recognize serious psychological disorders. This level of knowledge aids helpers in making appropriate referrals and working only with clients they have been trained to assist.

Goals for This Book

I have several goals for this book. After reading it, students should be able to articulate the principles of the integrated three-stage model of helping as well as the theoretical and research foundations underlying this model. They should

demonstrate an understanding of the interactional sequences of helping, including the intentions that helpers have for interventions with clients, the helping skills that are commensurate with these intentions, the possible reactions and behaviors demonstrated by clients, and the means through which helpers evaluate the interventions used. In addition, readers should gain a better understanding of themselves in relation to becoming helpers, including their thoughts about helping as well as their strengths and areas for continued growth. Finally, I hope to instill enthusiasm for the process of learning to help others—an enterprise that is certain to provide countless challenges and rewards throughout a lifetime.

Changes in the Fourth Edition

I continue to modify the model as I teach and do research on helping skills. I have also obtained extensive feedback from students about what they find helpful. The model feels like a living thing because of how I continually find ways to improve it. The fourth edition of this book differs from the first three editions in several ways:

I have added a separate chapter on self-awareness. Although covered before, I wanted to highlight this topic given its importance for helper growth. I have also added a separate chapter on cultural awareness. Students have been hungry for more information about the role of culture in the helping process. Although we are at an early stage in terms of understanding culture, we need to be aware of its role and sensitive to different reactions of clients based on their cultural backgrounds. I have added a greater variety of methods that helpers can use to challenge in the chapter on that topic. I continue to try to make the action stage clearer and easier to use. A summary of a specific research study has been added to each chapter, with highlights about how the results enhance our understanding of the role of helping skills in the helping process. There is now a glossary of the key words so that readers can refer to it when confused by some of the jargon. Much of learning any new system involves learning the language, so we want to make this as easy as possible.


As with the previous editions, this fourth edition of Helping Skills offers a Web- based “Instructor and Student Resource Guide” (http://pubs.apa.org/books/supp/hill4), the student portion of which features a


dozen Web Forms (in downloadable PDFs) that are referred to throughout this text to assist students in evaluating their helping skills and helper–client sessions. The Web Forms page also includes an Emotion Words Checklist—a downloadable version of this edition’s Exhibit 9.2 (see Chapter 9)—that students have found helpful to have handy in a printed format for easy reference during the exploration stage of a helper–client relationship. In addition, the student resources section of the Helping Skills Web site includes downloadable versions of the Labs for various chapters, as well as Practice Exercises for each of the skills chapters of the book.

In addition, two DVDs are available to demonstrate the model. Helping Skills in Practice: A Three-Stage Model was created to illustrate the three stages of working with a client struggling with concerns related to childhood, eating, and self-esteem. Dream Work in Practice was created to illustrate the three stages with a client who had a troubling recurrent dream. Both DVDs are available from the American Psychological Association.


I am grateful to the following students who worked with me extensively in researching different aspects of the different editions of this book: Jennifer Dahne, Judith Gerstenblith, Jennifer Jeffery, and Eric Spiegel.

I am also grateful to the many people who have read selected chapters or all of the book and provided valuable feedback on at least one of the editions: Rebecca Adams, Margaret Barott, Kevin Cramer, Elizabeth Doschek, Jessica England, Lisa Flores, Suzanne Friedman, Judy Gerstenblith, Melissa Goates, Julie Goldberg, Jim Gormally, Allison Grolnick, Kelly Hennessey, Beth Haverkamp, Jeff Hayes, Debby Herbenick, Pamela Highlen, Merris Hollingworth, Gloria Huh, Skyler Jackson, Ian Kellems, Kathryn Kline, Sarah Knox, Misty Kolchakian, Jim Lichtenberg, Rayna Markin, John Norcross, Kathy O’Brien, Sheetal Patel, David Petersen, Jennifer Robinson, Missy Roffman, Katherine Ross, Pat Spangler, Jessica Stahl, Nicole Taylor, Barbara Thompson, Linda Tipton, Terry Tracey, Jonathan Walker, Heather Walton, and Elizabeth Nutt Williams. There are also numerous anonymous reviewers who have read and reviewed the book for the American Psychological Association and provided invaluable feedback.

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