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Intentional Interviewing

and Counseling Interviewing

and Counseling Interviewing

Facilitating Client Development in a Multicultural Society

Allen E. Ivey, Ed.D., ABPP Distinguished University Professor (Emeritus)

University of Massachusetts, Amherst Consultant: Microtraining/Alexander Street Press

Mary Bradford Ivey, Ed.D., NBCC Amherst, Massachusetts Schools

Consultant: Microtraining/Alexander Street Press

Carlos P. Zalaquett, Ph.D., M.A., Lic., LMHC Professor, �e Pennsylvania State University

Australia Brazil Mexico Singapore United Kingdom United States

NINTH EDITION

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© 2018, 2014 Cengage Learning

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Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society, 9th Edition Allen E. Ivey, Mary Bradford Ivey, Carlos P. Zalaquett

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Love is listening. Paul Tillick, Ph.D., Licentiate of �eology

University Professor, Harvard University Most influential theologian of the last century

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iv

Derald Wing Sue, Ph.D. Professor, Columbia University, originator of the Multicultural Competencies, nationally and internationally known for writing on microaggressions, past president of the Society for Counseling Psychology President’s Committee on Race

Patricia Arredondo, Ed.D. President, Arredondo Advisory Group, author of the Multicultural Competencies and Guidelines, past president of the American Counseling Association, National Latina/o Psychological Association, APA Society for Counseling Psychology

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Eduardo Duran, Ph.D. Private practice, consultant, author of Native American Postcolonial Psychology and Psychology and Psychology �e Soul Wound describing historical trauma of Native Americans, �e Soul Wound describing historical trauma of Native Americans, �e Soul Wound professor of psychology in several graduate settings, continues to teach and lecture in community settings all over the world

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�omas Parham, Ph.D. Vice chancellor, University of California, Irvine, past president of the Association for Multicultural Counseling and Development and the Association of Black Psychologists (Distinguished Psychologist), 100 Black Men of America Wimberly Award

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Paul Pedersen, Ph.D. Professor emeritus Syracuse University, first White scholar to introduce multicultural issues to the helping fields, author of 40 books, American Psychological Association Award for Distinguished Contributions to the International Advancement of Psychology

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To the multicultural scholars who have changed the nature and practice of counseling and psychotherapy

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v

ABOUT THE AUTHORS

Allen E. Ivey is Distinguished University Professor (Emeritus), University of Massachusetts, Amherst. He is the founder of Microtraining Associates, an educational publishing firm, and now serves with Microtraining/Alexander Street Press as a consultant. Allen is a Diplo- mate in Counseling Psychology and a Fellow of the American Counseling Association. He is past president and Fellow of the Society for Counseling Psychology. He is also a Fellow of the American Counseling Association (where he made the first presentation on neuros- cience and counseling), Society for the Psychological Study of Culture, Ethnicity, and Race, and the Asian American Psychological Association. He has keynoted conferences in 25 countries, but is most proud of being named a Multicultural Elder at the National Multicultural Conference and Summit. Allen is author or coauthor of more than 40 books and 200 articles and chapters, translated into 25 languages. He is the originator of the microskills approach, which is fundamental to this book.

Carlos P. Zalaquett is a professor in the Department of Educational Psychology, CounCarlos P. Zalaquett is a professor in the Department of Educational Psychology, CounCarlos P. Zalaquett - seling, and Special Education at the Pennsylvania State University, and a licensed men- tal health counselor in the State of Florida. He is also vice president for the United States and Canada of the Society of Interamerican Psychology, president of the Pennsylvania Mental Health Counselors Association, and past president of the Florida Mental Health Counseling Association, the Suncoast Mental Health Counselors Asso- ciation (SMHCA), and the Florida Behavioral Health Alliance. Carlos is the author or coauthor of more than 50 scholarly publications and five books, including the Spanish version of Basic Attending Skills. He has received many awards, including the University of South Florida’s Latinos Association’s Faculty of the Year, the Tampa Hispanic Heritage’s Man of Education Award, and the SMHCA Emeritus Award. His current research uses a neuroscience-based framework to compare brain activity and self-reported decision making. �is cutting-edge research integrates mind, brain, and body in the exploration of human responses central to counseling and psychotherapy. He is an internationally recognized expert on mental health, counseling, psychotherapy, diversity, and education and has conducted workshops and lectures in 11 countries.

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Mary Bradford Ivey is a consultant with Microtraining/Alexander Street Press and a Mary Bradford Ivey is a consultant with Microtraining/Alexander Street Press and a Mary Bradford Ivey former school counselor. She has served as a visiting professor at the University of Massachusetts, Amherst; Keene State College University of Hawai‘i; and Flinders University, South Australia. Mary is the author or coauthor of many articles and of 16 books, translated into multiple languages. She is a Nationally Certified Counselor (NCC) and has held a certificate in school counseling. She is also known for her work in promoting and explaining developmental counseling in the United States and inter- nationally, with a special background to the prevention of bullying. Her elementary counseling program was named one of the 10 best in the nation at the Christa McAuliffe Conference. She is one of the first 15 honored Fellows of the American Counseling Association for her extensive contributions to the multicultural and social justice field, as well as her well-known video demonstrations and writing. Co

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vi

CONTENTS List of Boxes xi Preface xiii

SECTION I The Foundations of Counseling and Psychotherapy 1

CHAPTER 1 Intentional Interviewing, Counseling, and Psychotherapy 3 Introduction: Interviewing, Counseling, and Psychotherapy 4 Cultural Intentionality: �e Flexible, Aware, and Skilled Counselor 8 Resilience and Self-Actualization 10 �e Microskills Hierarchy: �e Listening and Action Skills of the Helping Process 11 Neuroscience and Neurobiology: Implications of Cutting-Edge Science for the Future

of Counseling and Psychotherapy 16 Office, Community, Phone, and Internet: Where Do We Meet Clients? 19 Your Natural Helping Style: Establishing Your Baseline 20 Key Points: �e Art of Applying and Taking Action As You Work �rough �is Book 23 Portfolio of Competencies and Personal Reflection 25

CHAPTER 2 Ethics, Multicultural Competence, Neuroscience, and Positive Psychology/Resilience 27 Introduction: Ethics and the Counseling and Psychotherapy Process 28 Awareness, Knowledge, and Skills of Ethics, Multicultural Competence, Positive Psychology,

and �erapeutic Lifestyle Changes 30 Awareness, Knowledge, Skills, and Action for Multicultural Competence 38 Positive Psychology and �erapeutic Lifestyle Changes: Building Client Resilience 43 Action: Key Points and Practice of Ethics, Multicultural Competence, Positive Psychology,

and �erapeutic Lifestyle Changes 51 Practice and Feedback: Individual, Group, and Microsupervision 53 Portfolio of Competencies and Personal Reflection 54

CHAPTER 3 Attending and Empathy Skills 56 Introduction: Attending Behavior: �e Foundational Skill of Listening 57 Awareness, Knowledge, and Skills of Attending Behavior and Empathy Skills 58 Empathy: Awareness, Knowledge, and Skills 66 Neuroscience and Empathy 68 Observe: Attending Behavior and Empathy in Action 70 Attending and Empathy in Challenging Situations 73 �e Samurai Effect, Magic, and the Importance of Practice to Mastery 74 Action: Key Points and Practice of Attending Behavior and Empathy Skills 76 Practice and Feedback: Individual, Group, and Microsupervision 77 Portfolio of Competencies and Personal Reflection 81

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Contents vii

CHAPTER 4 Observation Skills 83 Introduction: Are You a Good Observer? 84 Awareness, Knowledge, and Skills: Principles for ObservationAwareness, Knowledge, and Skills: Principles for ObservationA 85 Nonverbal Behavior 85 Verbal BehaviorVerbal BehaviorV 90 Observe: Is �is Interview About Studying or Racial Harassment? 94 Discrepancies, Mixed Messages, and Conflict 97 Action: Key Points and Practice of Observation Skills 99 Practice and Feedback: Individual, Group, and Microsupervision 100 Portfolio of Competencies and Personal Reflection 104

SECTION II The Basic Listening Sequence: Organizing a Session to Be More Fully Empathic and to Promote Creative Solutions 107

CHAPTER 5 Questions: Opening Communication 109 Introduction: Questions 110 Awareness, Knowledge and Skills: Questions for ResultsAwareness, Knowledge and Skills: Questions for ResultsA 112 Observe: Questions in the Interview 116 Multiple Applications of Questions 119 Action: Key Points and Practice of Questions 124 Practice and Feedback: Individual, Group, and Microsupervision 125 Portfolio of Competencies and Personal Reflection 129

CHAPTER 6 Encouraging, Paraphrasing, and Summarizing: Active Listening and Cognition 132 Introduction: Encouraging, Paraphrasing, and Summarizing 133 Awareness, Knowledge, and Skills: Encouraging, Paraphrasing, and SummarizingAwareness, Knowledge, and Skills: Encouraging, Paraphrasing, and SummarizingA 135 Basic Techniques and Strategies of Encouraging, Paraphrasing, and Summarizing 136 Observe: Listening Skills and Children 139 Multiple Applications: Additional Functions of the Skills of Encouraging, Paraphrasing,

and Summarizing 143 Multicultural Issues in Encouraging, Paraphrasing, and Summarizing 144 Practice, Practice, and Practice 147 Action: Key Points and Practice of Encouraging, Paraphrasing, and Summarizing 148 Practice and Feedback: Individual, Group, and Microsupervision 149 Portfolio of Competencies and Personal Reflection 152

CHAPTER 7 Re�ecting Feelings: The Heart of Empathic Understanding 154 Introduction: Reflection of Feeling 155 Awareness, Knowledge, and Skills: �e Emotional Basis of Counseling Awareness, Knowledge, and Skills: �e Emotional Basis of Counseling A

and �erapy 157 �e Skill Dimensions of Reflection of Feeling 160 Observe: Reflecting Feelings in Action 164

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viii Contents

Multiple Applications of Reflecting Feelings 166 Action: Key Points and Practice 170 Practice and Feedback: Individual, Group, and Microsupervision 172 Portfolio of Competencies and Personal Reflection 175

CHAPTER 8 How to Conduct a Five-Stage Counseling Session Using Only Listening Skills 178 Introduction: �e Basic Listening Sequence: Foundation for Empathic Listening in

Many Settings 179 Awareness, Knowledge, and Skills: �e Five-Stage Model for Structuring

the Session 181 Decision Counseling and the Five Stages 183 Observe: Using the Five Stages of Interviewing in Decision Counseling 185 Multiple Applications: Integrating Microskills with Stress Management and

Social Justice 191 Taking Notes in the Session 193 Action: Key Points and Practice 194 Practice and Feedback: Individual, Group, and Microsupervision 195 Portfolio of Competencies and Personal Reflection 195

SECTION III Transitioning from Attending and Listening to In�uencing Skills: Focusing and Empathic Confrontation 199 How Memory Changes Are Enacted in the Session 200

CHAPTER 9 Focusing the Counseling Session: Contextualizing and Broadening the Story 203 Introduction: Focusing Essentials 204 Awareness, Knowledge, and Skills of Focusing 206 �e Community Genogram: Bringing Cultural/Environmental/Contextual into the Session 209 Observe: Focusing in Action 213 Multiple Applications of Focusing 217 Action: Key Points and Practice 221 Practice and Feedback: Individual, Group, and Microsupervision 223 Portfolio of Competencies and Personal Reflection 226

CHAPTER 10 Empathic Confrontation: Identifying and Challenging Client Con�ict 228 Introduction: Empathic Confrontation, Creating the New 229 Awareness, Knowledge, and Skills: Empathic Confrontation for Results 230 �e Skills of Empathic Confrontation: An Integrated �ree-Step Process 232 Observe: Empathic Confrontation in the Interview 233 Observe: �e Client Change Scale (CCS) 237 Action: Key Points and Practice of Applying Empathic Confrontation in the Real World 247 Practice and Feedback: Individual, Group, and Microsupervision 248 Portfolio of Competencies and Personal Reflection 252

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SECTION IV Interpersonal In�uencing Skills for Creative Change 255

CHAPTER 11 Re�ection of Meaning and Interpretation/Reframing: Helping Clients Restory Their Lives 257 Introduction: �e Skills of Reflecting Meaning and Interpretation/Reframing 259 Awareness, Knowledge, and Skills of Reflection of Meaning and Interpretation/Reframe 262 Observe: �e Skills of Reflection of Meaning and Interpretation/Reframing in Action 266 Multiple Applications of Reflection of Meaning and Interpretation/Reframing 267 Neuroscience and Ethical Decision Making 274 Action: Key Points and Practice of Applying Reflection of Meaning and Interpretation/

Reframing Skills in the Real World 275 Practice and Feedback: Individual, Group, and Microsupervision 276 Portfolio of Competencies and Personal Reflection 280 Our �oughts About Charlis 281

CHAPTER 12 Action Skills for Building Resilience and Managing Stress: Self-Disclosure, Feedback, Logical Consequences, Directives/ Instruction, and Psychoeducation 283 Introduction: Action Skills for Resilience and Stress Management 284 Awareness, Knowledge, and Skills of Stress Management 285 Awareness, Knowledge, and Skills of Empathic Self-Disclosure and Feedback 290 Observe: Self-Disclosure and Feedback 292 Awareness, Knowledge, and Skills of Natural and Logical Consequences 295 Observe: Case Study Applications of Natural and Logical Consequences 296 Awareness, Knowledge, and Skills of Directives, Instruction, and Psychoeducation 300 Awareness, Knowledge, and Skills: Making Action Skills Work 302 Observe: Integrating �erapeutic Lifestyle Changes Into the Session 304 Action: Key Points of Influencing Skills and Stress Management 306 Practice and Feedback: Individual, Group, and Microsupervision 308 Portfolio of Competencies and Personal Reflection 311

SECTION V Integrating Skill into Theory for Effective Practice, Personal Style, and Transcendence 315

CHAPTER 13 Counseling Theory and Practice: How to Integrate the Microskills with Multiple Approaches 317 Introduction: Microskills, Five Stages, and �eory 318 Awareness, Knowledge, and Skills of Crisis Counseling 318 Observe: Crisis Counseling First Session Transcript 324 Suicide Watch: Awareness and Knowledge 328 Awareness, Knowledge, and Skills of Cognitive Behavioral �erapy 330 Observe: Cognitive Behavioral Session Transcript 332 Action: Key Points of Counseling �eory and Practice 339

Contents ix

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Practice and Feedback: Individual, Group, and Microsupervision 340 Portfolio of Competencies and Personal Reflection 342

CHAPTER 14 Skill Integration, Determining Personal Style, and Transcendence 343 Introduction: Defining Skill Integration 344 Awareness, Knowledge, and Skills: Review of �eories of Counseling and Psychotherapy 344 Awareness, Knowledge, and Skills: Case Conceptualization, the Interview Checklist, Treatment

Planning, and Action Planning to Prevention Relapse 348 Multiple Applications of Skill Integration: Referral, Treatment Planning, Case Management,

and Relapse Prevention 352 Action: Key Points and Practice for Skill Integration and Determining Personal Style 358 Practice and Feedback: Individual, Group, and Microsupervision 360 Portfolio of Competencies and Personal Reflection 362

Appendix I The Ivey Taxonomy: De�nitions of the Microskills and Strategies with Anticipated Client Response 369

Appendix II Ethics 375 Ethics and Morals: Professional and Personal 375 A Brief History of the Multicultural Foundation of Ethics 375 Ethical Codes 376 Confidentiality: Our Moral Foundation 376 Diversity, Multiculturalism, Ethics, and Morality 377 Ethics, Morality, and Competence 378 Informed Consent 379 Privacy Rules 379 Social Justice as Morality and Ethics in Action 381

Appendix III The Family Genogram 384 �e Individual Develops in a Family Within a Culture 384 Using a Family Genogram to Understand Family Issues 386

Appendix IV Counseling, Neuroscience/Neurobiology, and Microskills 387 �e National Institute of Mental Health Brain-Based Initiative: Is Neurocounseling

Our New Direction? 388 �e Holistic Mind/Brain/Body and the Possibility of Change 389 �e Brain Lobes and �eir Implications for Counseling and Psychotherapy 391 Executive Functioning, Emotional Regulation, Hormones and Other Structures 392 �e Limbic System: Basics of Emotion 394 Left Brain Versus Right Brain, or an Integrative Team 395 Neurons, Neural Networks, and Neurotransmitters 396 Microskills and �eir Potential Impact on Change 400 �e Default Mode Brain Network: What’s Happening When the Brain Is at Rest? 402 Social Stress and Its Impact on the Body 406 YouTube Videos for Further Study 415

Reference 417 Name Index 423 Subject Index 428

x Contents

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xi

LIST OF BOXES 1.1 National and International Perspectives on Counseling Skills 8 1.2 Research and Related Evidence That You Can Use 14 1.3 Client Feedback Form 22 2.1 Sample Practice Contract 31 2.2 The RESPECTFUL Model 33 2.3 A Story of How the Soul Wound Develops 34 2.4 Stories of Microaggressions 40 2.5 National and International Perspectives on Counseling Skills 41 2.6 A Six-Point Optimism Scale 44 2.7 Additional Therapeutic Lifestyle Changes 50 3.1 Attending Behavior and People with Disabilities 60 3.2 National and International Perspectives on Counseling Skills 62 3.3 Research and Related Evidence That You Can Use 63 3.4 Feedback Form: Attending Behavior 79 3.5 Guidelines for Effective FeedbackGuidelines for Effective Feedback 80 4.1 Research and Related Evidence That You Can Use 86 4.2 National and International Perspectives on Counseling Skills 87 4.3 Mirroring in the Session, Frame by Frame 89 4.4 The Abstraction Ladder 91 4.5 Feedback Form: Attending Behavior 101 5.1 National and International Perspectives on Counseling Skills 121 5.2 Research and Related Neuroscience Evidence That You Can Use 123 5.3 Feedback Form: Questions 128 6.1 The Neuroscience of Empathy: Cognition, Emotion, and Theory

of Mind (Mentalizing) 134 6.2 The Convention on the Rights of the Child 143 6.3 Cumulative Stress and Microaggressions 144 6.4 Developing Skills to Help the Bilingual Client 145 6.5 Feedback Form: Encouraging, Paraphrasing, and Summarizing Feedback Form: Encouraging, Paraphrasing, and Summarizing Feedback Form: Encouraging, Paraphrasing, and Summarizing 151 7.1 Nonverbal Examples of Underlying Emotions 162 7.2 National and International Perspectives on Counseling Skills 163 7.3 Research and Related Evidence That You Can Use 164 7.4 Feedback Form: Observing and Reflecting Feelings 174 8.1 Neuroscience Informs the Decision Process 184 9.1 Research and Related Evidence That You Can Use 208 9.2 The Community Genogram: Three Visual Examples 210 9.3 National and International Perspectives on Counseling Skills 218 9.4 Feedback Form: Focus 224

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xii List of Boxes

10.1 Research and Related Evidence That You Can Use 232 10.2 Confrontation, Creativity, and Neuroscience 242 10.3 Feedback Form: Confrontation Using the Client Change Scale 251 11.1 Research and Related Evidence That You Can Use 264 11.2 Questions Leading Toward Discernment of Life’s Purpose and Meaning Questions Leading Toward Discernment of Life’s Purpose and Meaning Questions Leading Toward Discernment of Life’s Purpose and Meaning 273 11.3 Feedback Form: Reflecting Meaning and Interpretation/Reframe 279 12.1 The Stress Response System 287 12.2 Example Stress Management Strategies 288 12.3 Alicia’s Action Plan 294 12.4 Directives, Instruction, and Psychoeducational Strategies 302 12.5 Feedback Form: Self-Disclosure and FeedbackFeedback Form: Self-Disclosure and Feedback 310 12.6 Feedback Form: Logical Consequences, Instruction/Psychoeducation,

Stress Management, and TLCs 311 13.1 Organizing a Crisis Team in a Major Earthquake 320 13.2 Research Evidence That You Can Use 324 13.3 Research Evidence That You Can Use 339 13.4 Feedback Form: Counseling Theories 341 14.1 Checklist for the First Session 349 14.2 National and International Perspectives on Counseling Skills 351 14.3 Maintaining Change Worksheet: Self-Management Strategies for Skill Retention 357 14.4 Transcribing Sessions 361 II.1 Confidentiality and Its Limits 376 II.2 Professional Organizations with Ethical Codes 382

III.1 Drawing a Family Genogram 385

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xiii

PREFACE Welcome to the ninth edition of Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society, the original, most researched system in the basics of skilled counseling and psychotherapy. You will find a completely updated and rewritten revision, based on the latest research, and made even more user friendly through restructur- ing and a new organization.

�e microskills approach has become the standard for interviewing, counseling, and psychotherapy skills training throughout the world. Based on more than 500 data-based studies, used in well over 1,000 universities and training programs throughout the world, the culturally sensitive microskills approach is now available in 20 translations. �e empha- sis is on clarity and providing the critical background for competence in virtually all coun- seling and psychotherapy theories.

Easy to teach and learn from, students will find that the content, transcripts, case illustrations, and exercises help ensure that they can immediately take to the “real world” the concepts presented in the textbook.

An alternative version of this text is available. Essentials of Intentional InterviewingEssentials of Intentional Interviewing (3rd ed.) covers the skills and strategies of interviewing, counseling, and psychotherapy in a briefer form, with less attention to theory, research, and supplementary concepts.

The Microskills Tradition and Basic Competencies �e backbone of this book continues the original emphasis on competencies. What counts is that students first develop a foundation by becoming competent in listening and empathic skills. �is is followed by step-by-step movement through the microskills hierarchy, through which the major aspects of a successful interview are introduced. Students who work with this book will be able to

● Engage in the basic skills of the counseling or psychotherapy session: listening, influenc- ing, and structuring an effective session with individual and multicultural sensitivity.

● Conduct a full session using only listening skills by the time they are halfway through this book.

● Master a basic structure of the session that can be applied to many different theories: 1. Develop an empathic relationship with the client. 2. Draw out the client’s story, giving special attention to strengths and resources. 3. Set clear goals with the client. goals with the client. goals 4. Enable the client to restory and think differently about concerns, issues, and challenges. restory and think differently about concerns, issues, and challenges. restory 5. Help the client move to action outside the session.

● Observe counseling and therapy in action through the many interview example transcripts throughout the book. We consider this a central part of learning the application of skills and theories with many diverse clients.

● Integrate ethics, multicultural issues, and positive psychology/wellness into counseling practice.

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xiv Preface

● Analyze with considerable precision their own natural style of helping and, equally or perhaps more important, how their counseling style is received by clients.

● Become able to integrate basic aspects of neuroscience into the session. Develop a client- centric approach, full of genuine desire to help others and advance our communities and societies.

Empathy and empathic communication have become even more central to the microskills framework. While they have always been there, they are now a centerpiece, associated with each and every skill. Students will be able to evaluate each intervention for its quality of empathic understanding and whether or not it facilitates the interview process. Every transcript in this text includes process discussions that illustrate the various levels of empathy. Students will be able to evaluate on the spot how their interviewing leads affect the client.

�e Portfolio of Competencies is emphasized in each chapter. Students have found that a well-organized portfolio is helpful in obtaining good practicum and internship sites and, at times, professional positions as well. Students may complain about the workload, but if they develop a solid portfolio of competencies, use the interactive website to reinforce learn- ing, and engage in serious practice of skills and concepts, it will become clear how much they have learned. �e portfolio concept and the authors’ videos increase course satisfaction and ratings.

New Competency Features in This Ninth Edition �e coming decade will bring an increasing integration of mental and physical health services as we move to new, more sophisticated and complete systems to help clients and patients. Innovations in team practice are bringing counselors and psychotherapists together more closely with physicians, nurses, and human service workers. Furthermore, neuroscience, neurobiology, and brain research are leading to awareness that body and mind are one. Actions in the counseling session affect not only thoughts, feelings, and behaviors but also what occurs in the brain and body. Many exciting new opportunities await both students and instructors.

�is ninth edition of Intentional Interviewing and Counseling seeks to prepare Intentional Interviewing and Counseling seeks to prepare Intentional Interviewing and Counseling students for culturally intentional and flexible interviewing, counseling, and psychotherapy. �e following features have been added or strengthened as we prepare for this new future.

● Listening lights up the brain. �e power and importance of attending behavior and empa- thy are now further validated by neuroscience research showing that specific parts of the brain are activated during empathic listening.

● Crisis counseling, suicide assessment and prevention, and a transcript of cognitive behavioral therapy are given increased attention. Students can take the learning from earlier chapters therapy are given increased attention. Students can take the learning from earlier chapters therapy to develop beginning competence in these critical aspects of practice. �e CBT transcript shows the specifics of work with automatic thoughts and demonstrates clearly how students can use this strategy.

● Included is a newly integrated chapter on the action influencing skills (Chapter 12). action influencing skills (Chapter 12). action influencing skills �e skills of self-disclosure, feedback, logical consequences, directives/instruction, and psychoeducation are now presented together through data and transcripts of a four- interview case study with a single client, who makes progress and becomes able to free herself with the counselor to discuss deeper, more critical relationship issues.

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Preface xv

● Our emphasis on multicultural and social justice has once again been enlarged. With this multicultural and social justice has once again been enlarged. With this multicultural and social justice edition, we introduce Eduardo Duran’s concept of the Soul Wound and the historical and intergenerational issue of cultural and individual trauma. New to this edition are specific session recommendations to help clients who have encountered racism, sexism, bullying, and the many forms of harassment and oppression.

● �e critical issue of recognizing stress and its dangerous impact on the brain and body is stress and its dangerous impact on the brain and body is stress emphasized throughout, while also noting that appropriate levels of stress can be positive and necessary for learning, change, and building resilience to master more serious and challenging stress. Research in wellness and neuroscience has revealed the importance of positive psychology and therapeutic lifestyle changes (TLCs) as a supplement to stress management and all theoretical approaches.

● �e fifth stage of the interview—action—has been given increased attention with the action plan. �e action plan is a systematic, comprehensive approach to homework and generalization from the interview to the “real world.” Albert Ellis gave us the term homework, which for some clients feels like school. �e action plan is more systematic, with an emphasis on collaboration and client decision as to how to take the interview into daily life.

● Self-actualization, intentionality, and resilience are clarified and given increased emphasis as resilience are clarified and given increased emphasis as resilience goals for the interview. Resilience, especially, has become more central as an action goal to enable clients to adapt and grow as they experience stress. A new section focuses on what we would like to see for our clients as a result of the counseling session. Of course we want to facilitate their reaching their own desired ends, but we also seek to encourage the development of resilience skills to better cope with future stresses and challenges.

● Increased attention and emphasis is given to transcripts in most chapters, showing how the transcripts in most chapters, showing how the transcripts skills are used in the interview and their impact on client conversation, leading to personal growth. We see how empathy is demonstrated and rated in the session. �e Client Change Scale illustrates how the client is learning and progressing the session. At times, reading key transcripts aloud will bring the interview even more to the here and now.

● Increased integration of cutting-edge neuroscience with counseling skills. Counseling and psychotherapy change the brain and build new neural networks in both client and counselor through neural plasticity and neurogenesis. Special attention is paid to portions of the brain (with new illustrations) that are affected in the helping process. Neuroscience research stresses a positive wellness orientation to facilitate neural development, along with positive mental health. An updated neuroscience/neurobiology appendix with additional practical implications is also included. Students will find that virtually all of what we do in the helping fields is supported by neuroscience research.

● One of the most important changes in this edition is a refined and more precise definition of empathy. Drawing from neuroscience, paraphrasing is now associated with cognitive empathy, reflection of feeling with affective empathy, and mentalizing (understanding the client’s world more holistically) with the summary.

● CourseMate, our optional online package, a popular and effective interactive ancillary, has been updated. �e many case studies and interactive video-based exercises provide practice and further information leading to competence. Downloadable forms and feedback sheets make it easier for students to develop a Portfolio of Competence. Students who seriously use these resources report that they understand the session better and perform better on examinations.

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xvi Preface

Supplementary Materials �is text is accompanied by several supporting products for both instructors and students.

MindTap MindTap for Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society, Ninth Edition, engages and empowers students to produce their best work—consistently. By seamlessly integrating course material with videos, activities, apps, and much more, MindTap creates a unique learning path that fosters increased comprehension and efficiency.

For students: ● MindTap delivers real-world relevance with activities and assignments that help students

build critical thinking and analytic skills that will transfer to other courses and their professional lives.

● MindTap helps students stay organized and efficient with a single destination that reflects what’s important to the instructor, along with the tools students need to master the content.

● MindTap empowers and motivates students with information that shows where they stand at all times—both individually and compared to the highest performers in class.

Additionally, for instructors, MindTap allows you to: ● Control what content students see and when they see it with a learning path that can be

used as is or matched to your syllabus exactly. ● Create a unique learning path of relevant readings, multimedia, and activities that move

students up the learning taxonomy from basic knowledge and comprehension to analysis, application, and critical thinking.

● Integrate your own content into the MindTap Reader, using your own documents or pulling from sources such as RSS feeds, YouTube videos, websites, Googledocs, and more.

● Use powerful analytics and reports that provide a snapshot of class progress, time in course, engagement, and completion.

Online Instructor’s Manual �e Instructor’s Manual (IM) contains a variety of resources to aid instructors in preparing and presenting text material in a manner that meets their personal preferences and course needs. It presents chapter-by-chapter suggestions and resources to enhance and facilitate learning.

Online Test Bank For assessment support, the updated test bank includes true/false, multiple-choice, matching, short answer, and essay questions for each chapter.

Cengage Learning Testing powered by Cognero Cognero is a flexible, online system that allows you to author, edit, and manage test bank content as well as create multiple test versions in an instant. You can deliver tests from your school’s learning management system, your classroom, or wherever you want.

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Preface xvii

Online PowerPoint �ese vibrant Microsoft® PowerPoint® lecture slides for each chapter assist you with your lecture by providing concept coverage using images, figures, and tables directly from the textbook.

Acknowledgments Our Thanks to Our Students National and international students have been important over the years in the development of this book. We invite students to continue this collaboration. Weijun Zhang, a former student of Allen, is now the leading coach and management consultant in China. He wrote many of the National and International Perspectives on Counseling Skills boxes, which enrich our understanding of multicultural issues. Amanda Russo, a student at Western Kentucky University, allowed us to share some of her thoughts about the importance of practicing microskills. We give special attention to Nelida Zamora and SeriaShia Chatters, both former students of Carlos. Nelida worked with us closely in the development of two sets of videos, Basic Influencing Skills (3rd ed.) and Basic Influencing Skills (3rd ed.) and Basic Influencing Skills Basic Stress Management Skills for Basic Stress Management Skills for Basic Stress Management Skills Alexander Street Press/Microtraining Associates. Nelida Zamora also gave permission to use a transcript of her demonstration session with Allen in Chapters 9 and 10. SeriaShia Chatters helped develop the DVD sets and book videos, important in making the nature of helping skills clear. She is now a faculty member at �e Pennsylvania State University. Our graduate students at the University of South Florida volunteered their time to participate in the videos that are on the supplemental website. We are especially appreciative of the quality work of Kerry Conca, Megan Hartnett, Jonathan Hopkins, Stephanie Konter, Floret Miller, Callie Nettles, and Krystal Snell.

Our Thanks to Our Colleagues Machiko Fukuhara, president of the Japanese Microcounseling Association and president of the International Council on Psychology, Inc., has been central in Mary and Allen’s life, work, and writing for many years. �omas Daniels, a distinguished Canadian professor, has also been with us as stimulating coauthor, friend, and provocateur. �ese two have been central in the development of microcounseling and its expansion internationally.

James Lanier has been a good friend and influential colleague. He is the person who helped us move from a problem-oriented language to one that is more positive and hopeful. Robert Marx developed the Relapse Prevention form of Chapter 14. Mary and Allen’s two-hour meeting with Viktor Frankl in Vienna clarified the centrality of meaning in counseling, along with specifics for treatment. William Matthews was especially helpful in formulating the five-stage interview structure. Lia and Zig Kapelis of Flinders University and Adelaide University are thanked for their support and participation while Allen and Mary served twice as visiting professors in South Australia.

David Rathman, Chief Executive Officer of Aboriginal Affairs, South Australia, has constantly supported and challenged this book, and his influence shows in many ways. Matthew Rigney, also of Aboriginal Affairs, was instrumental in introducing us to new ways of thinking. �ese two people first showed us that Western individualistic ways of thinking are incomplete, and therefore they were critical in bringing us early to an understanding of multicultural issues.

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xviii Preface

�e skills and concepts of this book rely on the work of many different individuals over the past 30 years, notably Eugene Oetting, Dean Miller, Cheryl Normington, Richard Haase, Max Uhlemann, and Weston Morrill at Colorado State University, who were there at the inception of the microtraining framework. �e following people have been personally and professionally helpful in the growth of microcounseling and microtraining over the years: Bertil Bratt, Norma Gluckstern-Packard, Jeanne Phillips, John Moreland, Jerry Authier, David Evans, Margaret Hearn, Lynn Simek-Morgan, Dwight Allen, Paul and Anne Pedersen, Patricia Arredondo, Lanette Shizuru, Steve Rollin, Bruce Oldershaw, Oscar Gonçalves, Koji Tamase, Elizabeth and �ad Robey, Owen Hargie, Courtland Lee, Robert Manthei, Mark Pope, Kathryn Quirk, Azara Santiago-Rivera, Sandra Rigazio-DiGilio, and Derald Wing Sue.

Fran and Maurie Howe have reviewed seemingly endless revisions of this book over the years. �eir swift and accurate feedback has been significant in our search for authenticity, rigor, and meaning in the theory and practice of counseling and psychotherapy.

Jenifer Zalaquett has been especially important throughout this process. She not only navigates the paperwork but is instrumental in holding the whole project together.

Julie Martinez has now worked with us as consulting editor through six editions of this book. At this point, we almost feel that she is a coauthor. Elizabeth Momb, our action editor, has been a blessing and her expertise and patience are “over the top.” It is always a pleasure to work with the rest of the group at Cengage Learning, notably Rita Jaramillo, Vernon Boes, and Kimiya Hojjat. Our manuscript editor, Peggy Tropp, has become a valu- able adviser to us and has been a joy with her understanding support. We would also like to acknowledge the efforts of our project manager, Lynn Lustberg of MPS Limited.

We are grateful to the many thoughtful reviewers for their valuable suggestions and comments for this new edition. �ey shared ideas and encouraged the changes that you see here, and they also pushed for more clarity and a practical action orientation.

Again, we ask you to send in reactions, suggestions, and ideas. Please use the form at the back of this book to send us your comments. Feel free to contact us also by email. We appreciate the time that you as a reader are willing to spend with us.

Allen E. Ivey, Ed.D., ABPP Mary Bradford Ivey, Ed.D., NCC, LMHC Carlos Zalaquett, Ph.D., MA, LMHC, Licensiado en Psicología email: allenivey@gmail.com mary.b.ivey@gmail.com cpz1@psu.edu

To the Student: Demystifying the Helping Process Demystify: make less mysterious or remove the mystery from.

—Webster’s Online Dictionary

Demystify: to make something easier to understand. —Cambridge Advanced Learner’s Dictionary & Thesaurus

What makes counseling and psychotherapy work? �e actual nature of what is happening in the session remained mysterious until 1938, when Carl Rogers, founder of person-centered counseling, began to provide answers. As the first to demystify, he used the newly invented wire recorder to record live counseling sessions. He soon found that what therapists said they

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Preface xix

did in the interview was not what actually happened. Among his important discoveries was that an empathic relationship between counselor and client is fundamental to success.

As audio technology progressed, recording and analyzing interviews became common. Nonetheless, questions remained. Among them were “What are the key behaviors facilibehaviors facilibehaviors - tating client growth?” Finding the central components of this interpersonal relationship called therapy remained elusive. “What is listening?” “Is nonverbal behavior an important aspect of successful therapy?” “How best can we structure an effective session and treat- ment plan?”

Demystifying the behaviors of a successful counseling session. Until the microskills approach came along, the counseling and psychotherapy field had not yet identified the specific actions and behaviors of effective interviewing. With colleagues at Colorado State University, Allen obtained a grant from the Kettering Foundation to research the interview in depth. For the first time, the group was able to video record using 2-inch-wide videotape (compare that to your smartphone—the world changes). Until this point, no one had examined how verbal skills are related to nonverbal behavior.

Attending, the first behavioral skill. �e importance of listening (later termed attending behavior) came to the CSU group almost by chance. To test our new technology, we videotaped Rhonda, our secretary, in a demonstration session. She totally failed to attend to the student she was interviewing—looked away, had awkward verbal hesitations, and shifted her body uncomfortably. She frequently changed the topic, seldom following the interviewee. When we reviewed the video, we identified attending behavior dimensions for the first time: appropriate eye contact, comfortable body language and facial expression, a pleasant and smooth vocal tone, and verbal following—staying with the client’s topic. �ree of the key elements of listening and communicating empathy turned out to be nonverbal, a major discovery for our highly verbal profession.

When Rhonda and Allen viewed the videotape, she noticed the same behaviors we listed above. After a short discussion period, Rhonda went back for another video session and listened effectively, and even looked like a counselor. All that happened in a half-hour!

Taking microskill learning home. �e next level of demystification came when Rhonda returned after the weekend. “I went home, I attended to my husband, and we had a beautiful weekend!” We had not expected that learned interview behavior would generalize to real life. We became aware of the importance of teaching communication microskills to clients and patients. Children, couples, families, management trainees, psychiatric patients, refugees, and many others have now been taught specifics of communication via the skills taught in this book. �ink of microskill teaching as an effective counseling and therapy change strategy in itself.

Demystify your own helping style through video. �is book, Intentional Counseling and Interviewing, asks you to look at yourself on video as you practice counseling skills. �e majority of you now have smartphones, computers, or small cameras that provide the opportunity to see yourself as others see you. Go through practice sessions with classmates and friends and obtain valuable feedback.

�e microskills demystification goes viral. Allen’s first book was translated into multiple languages and has become a regular part of the curriculum in counseling, social work, psychology, and other departments in the United States and abroad. Working for her doctoral degree at the University of Massachusetts, Mary soon joined Allen and was the first

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xx Preface

person to teach listening skills to managers. Carlos, trained in the microskills as part of his graduate program in Chile, soon taught them as part of the first course on counseling skills in South America and has translated the skills into Spanish.

What about multicultural issues? About a year after the identification of key skills of listening, Allen was enthusiastically teaching a workshop. He talked of attending behavior, including the importance of eye contact, but then a beginning counselor from Alaska challenged him and described her experience with Native Inuits. She pointed out that traditional people could see direct eye contact and close face-to-face interaction as uncaring or even hostile. One can still attend, but we need to consider the natural nonverbal and verbal communication style of each culture. �is led us to give central attention to multicultural issues, as you will see throughout this text.

And now, the demystification of neuroscience and neurobiology. Our most recent venture has been into this newly relevant field. Research in neuroscience has further demystified the helping process. Not too surprising is the discovery that almost all of what has been done in our field is validated by neuroscience: counseling changes the brain (and the body). Neurobiology has become relevant as we learn the impact of stress and trauma on mental and physical health. Appendix IV provides a detailed basic discussion with many and physical health. Appendix IV provides a detailed basic discussion with many and illustrations. We recommend referring there for more specifics as you read and discover neuroscience within the chapters.

�e National Institute of Mental Health is leaving the pathology model of the present Diagnostic and Statistical Manual of Mental Disorders in favor of brain-based assessment and Diagnostic and Statistical Manual of Mental Disorders in favor of brain-based assessment and Diagnostic and Statistical Manual of Mental Disorders treatment. Research on what happens in therapy is changing rapidly. �e holistic brain/ body approach now includes exploration of how personal interaction even changes DNA and gene functioning, depression as a biological disease, and how social conditions affect human development. Such findings are leading to a new holistic approach suggesting new strategies for facilitating physical and mental health.

Many clients will come to you with some knowledge of the brain, because of extensive coverage of new findings in the media. Even with a beginning knowledge of key brain processes, you can now explain the importance of focusing on stress management, increasing emotional regulation, and using counseling and therapy collaboratively to build resilience and developmental growth. Whether we come from a traditional psychoanalytic, a cognitive behavioral, or an environmentally oriented approach, how we affect the client’s brain and body will be clarified by neuroscience, neurobiology, and related fields.

To be continued. �e learning process of demystification constantly brings something new and exciting. You may want to visit a rather basic YouTube introduction to neuroscience and counseling by Allen and Mary, using the search terms allen ivey or spark lecture. More generally, the search terms neuroscience and neuroscience and neuroscience neurobiology will lead you in fascinating direc-neurobiology will lead you in fascinating direc-neurobiology tions on YouTube and elsewhere. At the conclusion of this book, you will find many more specific suggestions for exploring the helping process on YouTube and the Internet.

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1

ISECTION The Foundations of Counseling and Psychotherapy

S ection I presents the conceptual underpinnings of effective counseling and therapy. Building on this foundation, the first half of the book focuses on listening skills and the structuring of an effective session. Later chapters will discuss influencing skills and strategies, designed to provide you with many possibilities for empowering your clients to take charge, find meaningful goals, and change their lives. �e book concludes with integrative applications and illustrates how these skills can be applied to multiple theories of counseling and therapy, and how you can integrate this learning with your own way of being to advance your own personal style of helping.