Confrontation, reflecting, focusing & influencing

The final basic counseling skills post, focuses on the more advanced skills: (confrontation, influencing, focusing, & reflection of meaning). Included below is a “quick & dirty” overview of these skills….

“Confrontation is not a direct, harsh challenge.  Think of it, rather, as a more gentle skill that involves listening to the client carefully and respectfully; and, then, seeking to help the client examine self or situation more fully. Confrontation is not “going against” the client; it is “going with” the client, seeking clarification and the possibility of a creative New, which enables resolution of difficulties. (Ivey, et al, 2010, p. 241)


Of all the basic counseling skills, I am notoriously fearful of confrontation.  My supervisor utilizes motivational interviewing to engage in a form as way to elicit change.  However, I’ve noticed that confrontation doesn’t have the same connotation as it does in daily life.  In my own family, confrontation is a dirty word that we avoided at all costs.  Consequently, when there confrontation did occur, the air was filled with an awkwardness that you could cut with a knife.  In the end, cause we were never good at airing our differences, the end result was always misunderstanding….

So with this as my own personal background, the idea of confronting clients is especially terrifying.  To be honest, I’m afraid of a creating misunderstand and realize  at times its necessary to bite the proverbial bullet.  Confronting clients is a risk-taking venture that challenges the therapeutic relationship that you work hard to build.  However, the potential payoff is that we can provide the client an opportunity to challenge their own beliefs and perceptions.  My course textbook describes confrontation as involving three steps:

“First: Listen and identify conflict in clients’ mixed messages, discrepancies, and incongruity” (Ivey, et al, 2010, p. 243).

Discrepancies can be a divergence between one’s actions and beliefs, or simply feelings of ambivalence. For example, my therapist once directly confronted me after I told her for the fifty-millionth time that I need to start exercising and losing weight. She responded, you’ve been wanting to do this for five years but have never gotten around to it, what has been stopping you?

“Second: Clarify and clearly point out issues to clients and help them work through conflict to resolution.” (Ivey, et al, 2010, p. 243).

Relationships difficulties can be an excellent source of ambivalence. I like to start out by asking questions that can clarify the issues my client is struggling with.  Having all the facts and viewpoints in a particular situation is the next logical step to helping the client find a resolution…

“Relationship is critical here as we make the conflict clearer to the client”  (Ivey, et al, 2010, p. 243).

The scariest step for me is where you make the nature of the conflict clear to the client.  This can involve paraphrasing, or summarizing what the client has said.  This can often provide the client an opportunity to reflect on what they have said.

Finally: Listen, observe, and evaluate the effectiveness of your intervention on client change and growth” (Ivey, et al, 2010, p. 243).

Evaluating the client’s response is useful in ascertaining where the client is along the stages of change. My textbook concludes by noting that “confrontation itself is a not a distinct skill; it is a set of skills that may be used in different ways. The most common confrontation uses the paraphrase, reflection of feeling, and summarization of discrepancies observed in the client or between the client and her or his situation. (Ivey, et al, 2010, p. 256)

“Focusing is a skill that enables multiple tellings of the story and will help you and clients think of creative new possibilities for restorying Use selective attention and focus the interview on the client, problem/concern, significant others (partner/spouse, family, friends), a mutual “we” focus, the interviewer, or the cultural/environmental/contextual issues. You may also focus on what is going on in the here and now of the interview” (Ivey, et al, 2010, p. 241).

I am a student therapist who is also in therapy  I find the biweekly sessions simultaneously therapeutic and educational.  Every time I see my therapist I leave with several insights about my life that had previously not occurred to me.  I think it helps that I have started to see a new therapist.  I marvel at how naturally he utilizes these counseling skills without a single thought.

However, I must admit, there are times when the technique of focusing aren’t especially useful.  For example, previous therapists I have had, haven’t utilized this skill very adeptly.  Consequently, I found attempts to focus our conversation on certain issues to be frustrating.  When based on limited understanding I find myself struggling to find the opportunity to discuss the issues I struggle with most. I believe firmly focusing is not useful as a skill without a simultaneous attempt to ensure you and your client are on the same page.

“The goal of reflection of meaning is to facilitate clients in finding deeper meanings and values that provide a guiding sense of vision and direction for their lives. e goal of interpretation/reframing is to provide a new way of restorying and understanding thoughts, feelings, and behaviors, which often results in new ways of making meaning. Clients usually generate their own meanings, whereas interpretations/reframes meanings that are close to core experiencing. A reflection of meaning looks very much like a paraphrase but focuses on going beyond what the client says. Often the words ‘meaning,’ ‘values,’ ‘vision,’ and ‘goals’ appear in the discussion” (Ivey, et al, 2010, p. 293-294).

The final advanced skill discussed in my textbook are various influencing techniques.  These skills provide a more direct approach to client change and are useful in helping the client see things from a different perspective.  Five influencing skills were discussed: (Ivey, et al, 2010).

  1. SELF-DISCLOSURE – I have learned to be cautious about self-disclosure & am mindful to do so in if it provides something beneficial to the client. Self-disclosure provides the client e a unique perspective on a similar experience as food for thought.
  2. FEEDBACK – Feedback in encouraging the client to acknowledge strengths or recognizing how far they have come.
  3. INFORMATION/PSYCHO-EDUCATION – When I utilize psycho-education, it is usually to help the client  understand symptoms and/or diagnoses in order to manage their overall well-being more effectively.
  4. LOGICAL CONSEQUENCES – For example, I might discuss the client’s potential options in a particular situation, in order to determine the best alternative.  By writing them out and seeing it in front of them, this can be a useful and influential tool to see things more clearly.
  5. DIRECTIVES – the textbook (Ivey, et al, 2010), discusses direction as another influential tool, although this is something I don’t use very often – if at all.

References

Ivey, A.E; Bradford Ivey, M; & Zalaquett, C.P. (2010). Intentional Interviewing and Counseling.  Belmont, CA:  Brooks/Cole.

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Questions & Listening Responses


Reflective Listening…

For my new position as a PLMHP, I’m asked to review a Clinical Training Manual in which we’re provided an overview of basic counseling skills.  In this clinical training manual it describes essential skills for the beginning therapist.  This manual defines reflective listening as follows:

“listening is not a passive skill eflective listening can be broken down into four components: listen, understand, clarify, and energy” (Capstone, n.d.).  

“Listening involves the nonverbal communications that occur while someone is talking and includes active listening sills discussed here.   Understanding involves paraphrasing what the client has said and helps to establish trust and rapport with the client, since they feel that you understand what they are saying” (Capstone, n.d.).  Finally, reflective listening involves clarifying, when necessary, in order to make sure you understand what the client is saying.  Additionally, when utilized properly, reflective listening “injects energy into the conversation” (Capstone, n.d.)

Asking questions

Next, in this series is information pertaining to those basic communication skills that are most relevant to my experiences as a new therapist.  Establishing effective communication requires an ability to ask questions and provide listening responses that encourage elaboration.  One of my course textbooks provides the following advice on asking effective questions:

“Effective questions open the door to knowledge and understanding. e art of questioning lies in knowing which questions to ask when. Address your first question to yourself: if you could press a magic button and get every piece of information you want, what would you want to know? Thee answer will immediately help you compose the right questions.” (Ivey, et al, 2010, p. 93)

As a new therapist, the questions I ask are useful in getting a conversation started.  Open questions are useful in eliciting elaboration from the client on their life story.  An example of closed questions can be when we paraphrase what the client says for clarification &/or reflection. Finally, the manner in which questions are asked determines the responses I receive.  What follows is a “quick and dirty” definition of open questions and closed questions…

Open Questions

“Open questions are those that can’t be answered in a few words. ey encourage others to talk and provide you with maximum information. Typically, open questions begin with what, how, why, or could: For example, “Could you tell me what brings you here today?” You will find these helpful as they can facilitate deeper exploration of client issues” (Ivey, et al, 2010, p. 94).

Closed Questions

“Closed questions can be answered in a few words or sentences. ey have the advantage of focusing the interview and obtaining information, but the burden of guiding the talk remains on the interviewer. Closed questions often begin with is, are, or do: For example, “Are you living with your family?” Used judiciously, they enable you to obtain important specifics” (Ivey, et al, 2010, p. 94).

Listening responses

“Listening is the attending, receiving, interpreting, and responding to messages presented aurally” (Prout & Watkins, 2014, p. 132).  In this respect, it requires more than hearing and understanding what our client is saying.  Effective communication of what we hear, is essential to ensure we are interpreting our client accurately.    “Verbal person centeredness (VPC) focuses on …highly person-centered communication, which is characterized by explicit recognition of the other person’s feelings and encouragement to elaborate and contextualize those feelings according to the perspective of the other.” (Ivey, et al, 2010, p. 44).   What follows is a description of different types of listening responses that are useful in guiding the course of the conversation with a client…

Encouragers

Encouragers are minimal responses such as head nods, hand-gestures or the infamous “Uh-huh”.  They are utilized to indicate you are listening and “help clients feel comfortable and keep talking in the interview” (Ivey, et al, 2010, p. 151).  Now, I personally would caution against utilizing these encourages too much.  When I start receiving the frequent “uh-huh” responses in rapid succession, I realize I’ve neared the end of our conversation.  Doing this to my therapist could be quite distracting…

Seeking Clarification

At times the client may be making contradictory statements.  On occasion, the therapist isn’t entirely certain about how to interpret the meaning in what the client is saying.  Seeking clarification simply requires restating what you heard the client said,  it lets the client know you are listening & provides reassurance you are both on the same page.

Paraphrasing

Paraphrasing simply involves restating & summarizing what the client is saying.  It can be useful in helping the client to reflect on what they just said.  However can be annoying when used too frequently. My textbook describes the paraphrase as consisting of four elements (Ivey, et al, 2010):

  1. A SENTENCE STEM: “it sounds like…”
  2. KEY DESCRIPTORS USED BY THE CLIENT: “….you’re struggling to make sense of his response to your questions about the relationship…”
  3. STATE IN SUMMARY WHAT YOU HEARD THE CLIENT SAID: The above response, can be my question after hearing the client describe recent changes in the relationship as she describes how frustrated and confused she is feeling….
  4. FINALLY,  THE GOAL OF A PARAPHRASE IS TO ASK FOR ACCURACY.  

Reflections

Reflections of content can provide the client an opportunity to reflect thoughtfully on what they are saying.  For example, if a client expresses confusion regarding a comment somebody made, I might ask, “what confuses you.”  However, reflections can also be more complex and privide the therapist to test their hypothesis.  For example I might say, “it sounds like you’re frustrated by the lack of communication.”

Summarizing

“Summarizing what the client has said is different from paraphrasing the mes- sage. When you are ready to summarize you have arrived at a succinct and clear understanding of the client’s perspective. You are encapsulating not only what the client said but also adding and integrating the material that was generated by your responses to the client” (Ivey, et al, 2010, p. 148).

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References

Capstone, (n.d.) Clinical Skills & Clinical Skill Enhancement. Capstone Behavioral Health.
Ivey, A.E; Bradford Ivey, M; & Zalaquett, C.P. (2010). Intentional Interviewing and Counseling.  Belmont, CA:  Brooks/Cole.
Prout, T.A. & Wadkins, M.J. (2014).  Essential interviewing and counseling skills.  New York, NY: Springer Publishing Company.

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