3 Area #1- Not Feeling Listened To Three Common Assumptions about Listening (Barker, L., & Watson, K., 2000)Speakers control communication more than listeners.We can wait to listen well when we really have to.When someone starts talking people automatically listen.
4 Realities of Listening Listeners control communication because they can open up communication by engaging or shut it down by tuning out.Listeners use their will to tune in or out to a person.The listener often is the one who puts his/her interpretation into things.Listeners evaluate whether messages are important and valuable or not.Listeners decide to follow through on what the speaker says or to not to that.Listening is not automatic. Rarely can listeners answer more than 4 details of a conversation correctly.Listening takes time and practice.Listeners only remember a small portion of what has been said- 50% immediately after talk, 10% after 1 day.
5 Listening Pitfalls Tuning Out or Halfheartedly Listening Rehearsing Our ResponsesAssuming Meanings From What the Speaker SaysJumping to Conclusions
6 Four Listening Preferences People- OrientedAction OrientedContent OrientedTime Oriented
7 People Oriented Listening Other focusedDemonstrates caring and warmthNonjudgmentalClear verbal and nonverbalsRelates to where the other is coming fromFocuses on building relationshipsNotices changes in other’s moods & incongruencies in them quickly
8 People Oriented Listening ProblemsBecomes overinvolved in other’s feelingsToo empathic and may overlook faultsMore prone to burnout because internalizes and adopts other’s feelingsSometimes considered overly expressive by othersNondiscriminating in relationships- nice to everyoneExs: counselors, service professionals, teachersTell stories, use illustrations.Use “we” and focus on teamwork.Be personal.
9 Action-Oriented Listeners Concentrate on the task at handFrustrated with disorganized peopleComes across as impatient to othersFocuses on expectationsAble to redirect others towards the most important points of thingsIdentifies inconsistencies in messages where things don’t add up
10 Action-Oriented Listeners ProblemsImpatient with people who talk too longJumps to conclusions quicklyDistracted by disorganizationToo blunt- pushes people too far too fast in conversationsMay ask blunt questionsComes across as criticalMinimizes the importance of the emotional/feelings in communication because they are too task and thing orientedExs: Attorneys, financial analystsKeep points to 3 or lessBe short and to the point.Speak quickly.
11 Content-Oriented Listeners Evaluate every angle of thingsLikes digging below the surface to dissect problemsValue technical informationWants people to back up what they say with examples and supportsValues complexities
12 Content-Oriented Listeners ProblemsOverly detailedMay come across as intimidating because knows so muchAsks pointed questionsDevalues info. from people who don’t know their jobTakes time to make decisions after studying all the angles of thingsExs: scientists, mathematicians, engineersProvide the data.Quote experts and statistics.Use charts and graphs.
13 Time Oriented Listeners Sets time boundaries for conversationsGives guidelines for conversationDoes not want “wasted” timeTells others when they are “wasting” time
14 Time Oriented Listeners ProblemsImpatient with time wasters as he/she see itInterrupts othersNot good at concentrating and just hearing others in the momentRushes others by watches and clocksSquelches creativity because so focused on time and clocksGo under time limits if you can.Avoid unnecessary exs.Watch their impatience level.
15 Top Ten Listening Hindrances (Barker, L. & Watson, K., 2000) Interrupting the speaker.Not looking at the person who is talking.Rushing the speaker and communicating thereby that his/her message is unimportant. Not letting the speaker tell the whole thing.Showing interest in things other than the conversation at hand.Getting head of the speaker and finishing or concluding what he/she is saying.
16 Top Ten Listening Hindrances (Barker, L. & Watson, K., 2000) Not doing what the speaker requests.Saying, “yes- BUT” which shows that the speaker doesn’t matter as much as what you wantStopping the speaker by relating things to yourself.Forgetting what the speaker talked about.Asking too many questions about details. Not doing what the speaker requests.
17 Nonverbal Listening Body language= up to 93% Words can hide secrets whereas body language gives more clues1st 10 seconds= most importantCautions: defining things by a single gesture alone without contextCultural background must be consideredFirst obtain baseline behaviorFactors to consider:Status in society fashion subcultureThe gaze of person- direction, length of gazeWhat eyebrows doTouch- spatial relations and how touch is used
18 Nonverbal Listening Direct look Lean slightly in Smile gently State the person’s name and shake handTake turns communicatingAngling your body toward the speakerUse regular head nodsReflect the speaker’s emotions
19 Issue #2- Client’s Expectations Advertisements/Marketing of Your practiceInsurance panels Bios.Your websiteWhat they thought they gave consent forTheir understanding of what therapy is/is notWhat they think your title or credentials are or meanWhat they think your certifications, licenses or certificates are forHow they perceive the environment physicallyHow they perceive you, office staff, colleagues, other clients
20 Issue #3- Informed Consent Extent and nature of servicesPros and cons (counseling in general, electronic counseling, phone counseling, techniques used, setting)LimitationsIn clear, understandable, non-technical languageSpecified provider nameTherapist’s responsibility to make sure the client understands (e.g. if cannot read, blind, etc.)Defines role of counselor (versus mediator, court guardian, expert witness)Expectations of both therapist and client behaviorsRisks/benefits of therapyQualifications of the therapistFinancial considerations and responsibilities
21 Issue #4- Assessment/Diagnosis Why we as the questions we doWhat the diagnosis meansWho knows whatUnethical- therapist as moral agent, client no longer autonomous person coming for helpEthical- based on observation of concrete, observable or clients self reported behaviors compared to “norms” and researched and studies standardswith respect to client perspectives and worldviewwith full information and informed consentunder a specific “contract” outlining terms of the clinical relationship
22 Issue #5- Treatment Planning What goals the client will by intoClient desiresWhat client perceives to have worked/not worked so farHow involved client wants to get in the therapeutic processHow goals are measuredOperational definitions of measurable goalsHow achievable goals areCompeting demands therapist’s hopes, clients’ hopes. Referring agency, insurance company, family/friends, employers/schools/physicians
23 Issue #6- Client’s Perceptions of your Competency How the client defines competencyBoard requirements regarding licensure, certifications, and disclosure statements in officeClient’s assumptions about your title and ability to clarify or correct theseTechniques used
24 Issue #7- Readiness or Resistance A) RESPONSE QUALITY RESISTANCESilenceMinimal talkIncessant talkB) RESPONSE CONTENT RESISTANCEIntellectualizing everything to avoid discussion of emotionsPreoccupation with symptomsSmall talkRhetorical questions bout the counselors decisions on hmwk, assumptions of Dx, etc.
25 Issue #7- Readiness or Resistance C) RESPONSE STYLE RESISTANCEDiscounting (yes BUT ____)Limiting topics in sessionBlaming othersSecond guessing the counselor (“are you saying or meaning ___?”)Reporting only positivesSeductivenessForgetting supplies or materialsDisclosure at last minuteHabitually breaking promisesD) LOGISTIC MANAGEMENT RESISTANCEPoor appointment keepingPayment delay or refusalPersonal favor asking
26 Common Defense Mechanisms (Clark, A.J., 1991) Outside awareness initiallyHabitualUseful (in client’s perception)Denial- rejecting responsibility“I don’t have a problem.”“Nobody ever told me.”“I didn’t know.”Displacement- shifting responsibility to a vulnerable substitute“I couldn’t control my behavior because of that stupid overbearing teacher.”“A few drinks just cause me to do things I don’t expect.”Identification- acting like someone he/she admires“I have a good heart just like my brother.”“My family may have it’s flaws but we all are hard working.”“I can be just as competitive as the next guy when things comes down to it.”
27 Common Defense Mechanisms (Clark, A.J., 1991) Undoing- Trying to reverse an unhealthy behavior by doing something opposite“I drank all weekend but when I came to my senses I realized this isn’t me so I threw all the liquor in the house down the drain.”“I know I mouth off and get out of control but I am the most gentle and apologetic person afterwards.”
28 Common Defense Mechanisms (Clark, A.J., 1991) Intellectualization- avoiding unpleasant feelings which are perceived as “negative” and make someone feel vulnerable“Drinking on occasions is not like getting drunk, you know.”“I just have a different way of getting things done than what my boss wants.”Projection-attributing unacceptable behaviors to others that are really characteristic of self“It seems like you don’t want this counseling to help me. You disagree with me.”“They said I didn’t perform on my job.”“If that fool would have gotten out of the way I wouldn’t have hit him in the drunk driving incident anyway.
29 Common Defense Mechanisms (Clark, A.J., 1991) Rationalization-Justifying one’s behaviors“Everyone lies to their parents.”“All people steal some of the extra supplies on the job that aren’t being used.”“Most parents get frustrated with their kids and lose control at times.”Reaction formation- Exaggerating claims of highly moral actions and attitudes“I would never get tempted to do anything like that.”“I organized the community fair against that kind of behavior.”
30 Common Defense Mechanisms (Clark, A.J., 1991) Regression-returning to an earlier stage of maturation and development“I had these kids young. It is my time to live . What’s wrong with dressing in their clothes and going to clubs. I missed out.”Repression-Resisting discussing or approaching topics or barring self or others from certain topics“I don’t recall anything like that.”“I don’t ever remember disobeying my parents.”
31 Dealing With Defense Mechanisms Relationship stageIdentify specific defenses for that clientGenerally will be the same ones they use with youUse advanced empathy to understand and help them understand why they habitually relied on themSentence completion exercises helpIntegration stageDistortions are confrontedLack of congruency is brought to the client’s attentionAccomplishment stageProductive actions and alternatives are highlightedClient is encouraged to act differently as he or she would like to beAlternative behaviors are maintainedA strengths-based approach is used
32 Issue #8- Perceptions of Process Variables Still critical foundations for successEmpathyNon possessive warmthGenuinenessWhose are these? (Counselor Versus Client?)Hypothesis #1: Good counselors enhance treatment when they have high levels of these variables.Hypothesis #2: Clients determine the levels of variables. Good clients elicit high variables but poor clients elicit low variables.NON-POSESSIVE WARMTH- mutual functionEMPATHY/GENUINENESS- under control of the therapist
33 Client’s Perceptions of What Predicts Therapeutic Alliance (Duff, C. T Client’s Perceptions of What Predicts Therapeutic Alliance (Duff, C.T., & Bedi, R.P., 2010)Therapeutic alliance=most robust predictor of outcome than techniquesThree critical factors: making encouraging statements, making positive comments about the client, greeting the client with a smileOthers listed:Asked me questionsIdentified and reflected back feelingsWas honestValidated my experienceMade eye contact with meReferred to details discussed in previous sessionsSat still and did not fidgetSat facing meTold me about similar experiences he/she hadLet me decide what to talk aboutKept the administration outside of our sessions
34 Mattering To Others (Rayle, A.D., 2006) Internal need to feel significant:A) general matteringB) interpersonal matteringWhy do I exist? What difference do I make?Do others notice me?Are my interactions with others different because of me?Do I have the social supports I desire?*** Counselors can have a significant role in shaping mattering.***
35 Issue #9- Successful Intervention Elements of Helpful Counseling Interventions (Miller, G., 1997)Promote empathy, encouragement, and positive approach to addressing problemsAssist clients in attending to previous unattended areasShifts clients from a problem focus to a solution focusPlants the seed that there will be a time where the issue does not have to have a negative hold on the client (Getting the client to imagine not having the problem anymore)Shift from constructing problems/analysis to constructing solutionsReinforcing how the client manages to get byEmphasis on increasing the frequency of healthy behaviors
36 Issue #10- Confidentiality/Privacy Has to do with private information being protected through reasonable expectation that it will not be further disclosed except for the purpose for which it was providedAreas Protected:Whether or not a person has been a clientThe frequency and intervals of appointmentsTypes of treatment or services receivedReasons for treatmentSpecific words, behaviors or observations during treatmentClient diagnosisCourse and prognosis of treatmentSummaries and recommendations
37 Confidentiality/Privacy Requires informed consent- specifying what consenting to, with discussion to client about advantages and disadvantages and potential limitations of disclosureShould be in your policies and procedures about confidentiality, possible breaks of confidentiality and how this is should be handledShould be in writing and signed by all parties
38 Confidentiality/Privacy Information cannot be disclosed in court proceedings unless both: 1) a subpeona has been issued 2) a court order has disclosure. Then court must find that the need for information outweighs the public policy for confidentiality (42 CFR and 45 CFR 164,512 (e) (1) (ii)By law confidentiality continues even after the death of the patient, death of the therapist or sale of the practice to others“When in doubt don’t give it out.”
39 Issue #11- Therapist Openness/Disclosure Reasons to DiscloseFostering therapeutic allianceModeling freedom for clients to discloseReducing client’s sense of being alone in his/her problemsIncreasing sense of realness in the counselorSidney Jourard’s idea of “dyadic effect”: “disclosure begets disclosure”- people are more likely to be open with interviewers who themselves are open than with interviewers who express little or nothing of themselves”Reasons against DisclosureShifting focus off the clientUsing counseling timeRole confusion
40 Therapist Openness/Disclosure What May Be Disclosed:Professional identity/credentialsEducational backgroundProfessional experiencesProfessional Successes or failuresCounselor Cognitions and emotions related to the client life ExperiencesPersonal FeelingsPersonal Life Successes or FailuresPersonal ValuesPersonal BeliefsPersonal Attitudes on TopicsTo Be individualized to each client
41 Three Dimensions of Self Disclosure (Jeffrey, A., & Austin, T., 2007) The amount of disclosureThe intimacy of information sharedThe duration of disclosureWithin each there are the issues of where the disclosure is positive or negative, personal or demographic, similar or dissimilar, past or present.
42 What Clients Said Was Helpful Disclosure Acceptance and EncouragingEnsuring AttentionBody LanguageSilence (Listening)Open and Closed Ended QuestionsReflection of the Content of SessionsDisclosure of FeelingsReflection of FeelingsSelf DisclosureConfrontationKey- developing an understanding of what each operationally means to a given client
43 How Clients Judged if Disclosure Was Helpful It built my confidence.It helped me share more.I felt relieved afterward.I had more respect for the therapist and/or the clinical relationship.
44 Frequency of Reasons to Self Disclose (Simone, D. H. , McCarthy, P Frequency of Reasons to Self Disclose (Simone, D.H., McCarthy, P., & Skay, C.L., 1998, p.179)Promote feelings of universality-85Encourage client and instill hope- 81Model coping strategies- 71Build rapport and foster alliance-68Increase awareness of alternative views- 67Provide reality testing-38Decrease client anxiety-37Prevent client idealization of counselor-36Increase self disclosure through modeling/reinforcement-31Increase counselor authenticity-29Decrease client resistance-8Dilute transference near termination-7Challenge the client-4Decrease general transference-3Prevent transference with clients who have poor reality testing-3Provide counselor satisfaction-1Decrease counselor anxiety-0
45 Frequency of Reasons Not to Self Disclose (Simone, D. H. , McCarthy, Frequency of Reasons Not to Self Disclose (Simone, D.H., McCarthy, ., & Skay, C.L., 1998, p.179)Avoid blurring boundaries- 107Stay focused on the client-99Prevent concern about counselor welfare-67Prevent merging-54Prevent premature closure-45Avoid information overload and confusion-40Prevent client feeling burdened by counselor problems-39Avoid interfering with transference-28Prevent client demoralization by counselor success/failure-25Avoid giving client information to manipulate counselor-20Avoid counselor discomfort-14Prevent client questioning counselor’s ability to help-11Avoid questions about counselor’s mental helath-9Prevent client communicating information about counselor-4Avoid losing credibility as an expert-3
46 Questions to Consider Regarding Disclosure Have I paused to evaluate this potential disclose beforehand?Why am I disclosing?How will this help the client’s goals in counseling?Are there conditions which necessitate this disclosure? If so, what?Are there other ways of approaching the client’s issue that may be as effective as disclosure?Is there any potential harm or danger to the client from this potential disclosure?Does the client have the ego strength for this disclosure?Will this disclosure blur professional boundaries?How will this disclosure help the client emotionally (instilling hope, moving toward counseling goals, feeling less alone)?Could the client end up feeling demoralized by my disclosure?Will this disclosure help with reality check?Possibly test out a lower level disclosure first (e.. an obvious topic the client may be wondering about) versus a more detailed deliberate disclosure
47 Self Disclosure With Children/Teens (Capobianco, J. , & Farber, B. A Self Disclosure With Children/Teens (Capobianco, J., & Farber, B.A., 2005 & Gaines, R., 2003)Children/teens require a higher degree of self disclosure.Children may elicit and require a higher level of therapist disclosureAll information on you is a type of disclosure for a child/adolescent (mannerisms, dress, décor, word you use/don’t allow, etc.)Children/teens generally less rigid than adults.Find the meaning for the child (what is the symbolism behind it?)Keep in mind age, maturity level, culture, an individual variables unique to this child/teen.Our reactions to the child’s behaviors disclose something to (e.g. how we handle misbehaviors, how to set boundaries, how we handle parent/child interactions, play allowed
48 Issue #11: Cultural Sensitivity Counseling is culture infused so the working alliance must be culture infused when necessaryThe worldview, orientation, race, ethnicity, identity factors, abilities, religion, socioeconomic status, language, music, hobbies, traditions, beliefs, etc.Three areas of competency:Domain I: Self: active awareness of personal assumptions, values, and biasesDomain II: Cultural awareness: Other- Understanding the worldview of the clientDomain III: Culturally Sensitive Working Alliance: (respect, goal formation, collaboration throughout)
49 Discursive Empathy (Sinclair, S.L. & Monk, G., 2005) Also called “discursive” empathyNot only 1) perceiving the client’s viewOr 2) communicating this to the clientBut also … 3). incorporating the culture framework and backdrop4). while keeping our separatenessInvolves “deconstruction”- exploring assumptions and what they are made up of to reinforce or challenge themWhat this achieves:1. clarifies the client’s position and values2. helps the clients become more reflexiveIncreases client’s ability for choice, freedom and self-development“no study found that showed that empathy is harmful”
50 Issue #12: Doing Confrontation Open, Honest identification of self defeating thoughts or behaviorsidentify the cyclehelp client increase awareness of thoughts and behaviors which keep the unhealthy cycle goingFunctionsbringing contradictions to lighthelping develop congruencyadmit personal needskeys:timinggenuineness and empathy of counselorfoundations of rapport and trust built
51 Issue #12: Doing Confrontation Types of Confrontationbody language and words do not match uptwo verbal comments do not match upwords and long term behaviors are incongruentone person’s behaviors influence the system negatively
53 Issue #1: Therapist Expectations What I Expect of The Mental Health FieldWhat I Believe Is Expected of Me In My Job SettingMy Company Should My Company Actually
54 The Interpersonal Cycle of Burnout ( Geurts, S. ,Schaufeli, W The Interpersonal Cycle of Burnout ( Geurts, S.,Schaufeli, W., & DeJonge, J., 1998)Cognitive thoughts regarding injusticeSocial comparisonCommunication with colleaguesReactions to ambiguous criteria for successEQUITYEXPECTED CONTRIBUTIONSEXPECTED BENEFITSSense of negative norms in the settingDiscrepancies between investments and outcomesAvailability of positive alternativesDiscrepancies between “shoulds” and actualities
55 Issues In Job Satisfaction Graduate School Instruction/Expectations Client loadsAbility to help othersAbility to have freedom to schedule and build practice in own personal styleTime frame for building a caseloadRole models witnessed- grad school, practicum, internship, mentors, TV, coursework, volunteering, etc.Dealing with uncontrollable variablesThe practice versus the businessEnthusiasm to help versus practical mgmt. of tasks involvedThe many facets of counseling: Community, private practice, teaching, administration, assessment, crisis work, consultation
56 Issues in Burnout: Institutional Goals QUESTION: DOES EVERYONE EXPERIENCE IT?10 year life span60%-90% depression rates in mental health professionalsIs the pay worth the “emotional” cost?Mission of the organization versus personal mission- partnership?Administrative tasks, counseling tasks, associated tasksProportion of job/home/personal life expected from this settingHow is this job affecting my home? Interpersonal? Other life?
57 Issues in Burnout: Institutional Goals Healthy Unhealthy Strong commitment of employees Weak commitment of counselors Strong availability/support from staff Isolation, weak involvement of staff Co-worker relationships- encouraged Minimal opportunities for rel. Support supervision Low collegial support Specific, concrete expectations Ambiguous/changing expectations Freedom for some autonomy Discouraging new ideas/creativity Reasonable deadlines Excessive unrealistic time pressure Some staff retention High turnover of staff Sense of purpose/fulfillment Doubt as to meaning/purpose Clients who want help Mandated clients Realistic specific goals Goals which cannot be achieved Solid clinical identity Need to be liked by clients Facilitator, counselor Responsible for change Separation self/client Self tied to client outcomes Setbacks are one part Setbacks as personal
58 What Agencies Can Do to Support Wellness Educate your staff and supervisors on the concepts of impairment, vicarious traumatization, compassion fatigue and wellness.Develop or sponsor wellness programs (such as in-service trainings and day-long staff retreats)Provide clinical supervision (not just task supervision)Encourage peer supervisionMaintain manageable caseloadsEncourage/require vacationsDo not reward "workaholism"Encourage diversity of tasks and new areas of interest/practiceEstablish and encourage EAPs
59 Issue #2- Time ScheduleBalancing counseling tasks with non-counseling tasks (setting, time mgmt., how this fits in with initial goals for entering fieldProposalsBlocking time for tasksScheduling certain days for certain functionsExercise:Ordering the clients in your schedule- cards
60 Issue #3- Client Vs. Therapist Goals SpecificMeasureableAchievableBroken down into manageable partsConcrete, behavioralEvidence basedTailored to the specific clientTry camera check method to make goals concrete and behavioral. Tends to help produce operational definitions.
61 Client Vs. Therapist Goals Problems are rarely so well defined and linear:if only ___, then ___.Many interactional variables occur at the same time.Any given person only has a portion of the information.Sometimes the most important variables are not always revealed.Timing of decisions may be as important as the “rightness or wrongness” of decisions.Decisions are interdependent- one decision affects others.Goals in decision making may sometimes be contradictory.Plan for correction and modification.
62 Exercises: What’s Wrong With These Goals? Poor Goals Improved GoalsTo improve client’ssense of self confidence.To help the client havegreater self satisfaction.To improve communicationskills.
63 Exercises: What’s Wrong With These Goals? Poor Goals Improved GoalsFor parent and child tofight less.To feel less depressed.For things not to get to theclient as much as they do.
64 Issue #4- Not Paying Attention To Stress/Burnout As It Occurs Emotional Exhaustion“I feel drained by this work.”“ I feel used up by the end of the workday.”“ I am fatigued when I get up in the morning and have to face another day on the job.”“Working with people all day drains me.”“I feel like I’m at the end of my rope.”“I have no energy left after I counseling people.”
65 Not Paying Attention To Stress/Burnout As It Occurs Sense that one can no longer give as much of oneselfto clients professionally“I feel like this job takes too much out of me.”“This job is more tiring and less pleasurable than it used to be.”Increasingly cynical attitudes about the counseling field“I can see why my clients are fed up with the system.”Negative/critical self evaluations“I don’t feel like I am making as much of a difference in people’s lives as I ‘should’ be or I would like to be making.”
66 Factors in Burnout Cognitive Expectations: Self Setting Clients Time spent in fieldTypes of casesPersonal “controllability” over caseload, scheduling, etc.Degree of balance in life in general
67 Irrational Beliefs of Burnout Prone Therapists (Deutsch, 1984) “I should always work at my peak level of enthusiasm and competence.”“I should be able to cope with any client emergency.”“ I should be able to help every client.”“Client lack of progress is my fault.”“I should always be available when clients need me.”“I should be able to work with all types of clients.”“I should be on call always.”
68 Irrational Beliefs of Burnout Prone Therapists (Deutsch, 1984) “Client needs come before my own needs.”“I am responsible for my client’s behaviors.”“I have power to help, control, or fix a client.”It’s selfish to put myself first.There’s no time for self care.I can’t do this on my own.
69 The Cognitive- Behavioral Cycle FeelingsThoughts/BeliefsIntensified FeelingsGoalsBehaviors/ActionsNOTE: personal patterns as a therapist of theseToxic ThoughtsSHOULDSIF ONLY _____ THEN _____ABSOLUTES: ALWAYS/NEVERSTRONG/WEAKGOOD/BADHAVE TOGOAL OF DOING “ENOUGH”Toxic ActionsJust keep trying harder/doing moreGive up/withdraw
70 Cognitive Debating Strategies Is this a fact or just an opinion?Is there any other way of looking at this?According to whom?Is this belief life giving or death producing?If this belief is not helpful to me how can I continue telling myself this?
71 Healthier Self Messages I would like to do my best with this effort, but I donot have to be perfect.I'm still a good person even when I make a mistake.I can do something well and appreciate it, without it being perfect.I will be happier and perform better if I try to work at a realistic level, rather than demanding perfection of myself.It is impossible for anyone to function perfectly all the time.Signs of burnout are not my fault as a “weak” person.
72 Issue #5: Balancing Competing Responsibilities To assess clientsTo diagnose clientsTo provide relevant treatment for DSM IV disordersTo do insurance paperworkBillingCase notesUp to date education/CEUsConsultation with colleaguesAwareness of and adherence to agency policies
73 Issue #6: Dealing With Problem Spots Struggles of CounselorsAdmitting that they have any problemsAdmitting that they need outside helpSetting boundaries regarding time in session and feesMarketing for servicesKnowledge of and skill development in business relationsNegotiating on client’s behalf
74 Caseload Versus Workload Caseload= highly related to burnoutHighly intense clientsMandatory referred clientsTypes of clientsVariations of diagnosesWorkload- the actual amount of time spent in client contact and work related functionsMediator variablesSupport systems(e.g. community mental health center example)Self perception of level of effectiveness
75 Issue #7: Maintaining Counselor Wellness Defining Counselor Wellness Both an outcome and a process Involves several dimensions
76 Physical Sleeping Eating healthy Alertness/being aware and attentive to clientsAbility to physically accomplish the tasks of counselingRegular schedule of mealsSufficient liquid intakeAwareness of hunger and thirstLimiting sugar intakeRoutine physical examsSelf monitoring personal physical needsCreating a warm environment: music, flowers, picturesBreaks (with non-counseling content)
77 EmotionalSkills in helping clients identify and process their feelings and issuesBalancing insight, awareness and actionAllowing for balance between social time and time aloneProfessional training/competencyCaseload evaluationVacations/breaksDaily recognition of small victories in spite of challengeFlexible thinkingRevisiting successful client filesRe-evaluating personal growth throughout time in practiceJournal of successes and victoriesAccountability with colleagues- to help affirm strengthsInvolvement in interests or projects outside themselvesLimited the number of one way relationships
78 Behaviors of Healthy Self Care Look at own unresolved issues with clients or supervisee’s clientsHave a network of other supervising counselors to speak withSet aside time for healthy lifestyle behaviors: eating, sleeping, exercisingAllow space from the clinical settingPermit self to not be a caretaker and caregiver for everyone (e.g. see “Letting Go” Poem)Take time off when necessaryReconceptualize being a supervisor not as one with all the answers (promotes burnout) but a more experienced facilitatorKeep a clear contract (modify if necessary) in writing what job roles and tasks areCharge an appropriate feeKeep your own professional development up to dateKeep an idea about expectations ahead of time so there is some structure for supervision sessionsHave an idea ahead of time about how you will let go of stress at the end of the work day
79 Includes Life Tasks Of Wellness (Myers, J. E, Sweeney, T. J Includes Life Tasks Of Wellness (Myers, J.E, Sweeney, T.J., & Witmer, J.M., 2000)Spiritualitya sense of where I am in the universepersonal and private beliefs about self, others, and the worldhope and optimisma sense of meaning and purpose
80 Self Directionmindfulness and intentionality toward achieving personal goalshigher levels of perceived self controlacceptance of the whole self (shortcomings and strengths)realistic beliefs- reduction in irrational thoughts, absolutes, and polarized thinking, or magnifying one aspect of situationsemotional awareness and regulationdeveloping creative problem solvinggoal setting and plans for a personal and cultural identity
81 Work and Leisuresatisfaction at challenges of task completion and quality of worka sense of competencybalancing work and relaxation (doing versus being)
82 Work and Leisure Leisure (Iwasaki, Y., 2003) 2 Coping Models: The Deterioration Model- the presence of stressors reduces levels of resources that could have a negative effect on well being, all about conserving resources and protecting their lossThe Counteractive Model- Stressors elevate proactive resources which enhance well being
83 Leisure (Kleiber, D.A., Hutchinson, S.L., & Williams, R., 2002) Four Functions of Leisure1) Serves as a distraction away from negative life events- temporary suspension from them (Pallative coping & Leisure mood enhancement)2) Generating optimism about the future- cognitive reappraisal, consideration of possible perspectives3) Reconstruction of one’s life story- back to “normal”4) To assist with personal transformation- writing the story and planning for different endings
84 Friendship relational connection with others asking for help when neededextending outreach to others
85 Love building trust in ability to give and receive from others stability in close relationshipsknowing someone really cares for youGoal of Counseling= to develop a personal wellness plan
86 Concept of Counselor Stamina (Osborn, C., 2004) Stamina- strength to withstand and hold up under pressureSeven Principles of Counselor Stamina:Selectivity- intentional choosing what one will and will not dotaskspopulations servednumber of caseslimiting “specialty” areasreasonable goals/objectives
87 Concept of Counselor Stamina (Osborn, C., 2004) 2.Temporal selectivity- time consciousnesssessionsplanning daysjuggling taskswork/personalspacing of sessions
88 Concept of Counselor Stamina (Osborn, C., 2004) 3. Accountability- partnering with credible colleaguesStandard of careEthicsCurrent practice4. Measurement/management- conserving and budgeting resourcesRole clarificationsSupportive, positive capable personnel choices
89 Concept of Counselor Stamina (Osborn, C., 2004) 5. Inquisitiveness- fascination with people and their journey in life“mutual puzzling”Desire for ongoing learning6. Negotiation-flexibilityDiagnosis within contextCultural and personal sensitivityRe-evaluation of “counselor as expert”
90 Concept of Counselor Stamina (Osborn, C., 2004) 7. Acknowledgement of agencyFocus on personally meaningful goals
91 Resiliency Resiliency Hardiness- mediates effects of stress Feeling in controlCommitment to the workChange is a challenge
92 Resiliency“More than education, more than experience, more than training, a person’s resilience will determine who succeeds and who fails.”Adaptation under adversityThe ability to recover from psychological harmNot being defined by earlier negative experienceTo jump, to spring back, to reboundSurvival, adaptation, recovery, risk assessment
94 Personality Qualities of Resilient People Acceptance of realityStrongly held valuesSense that life is meaningfulOptimism without distortionHopeThe ability to make do with whatever is set before themCognitive flexibilityBalance between expressing and concealing emotion and between positive and negative emotion
95 Dispositional Resilience (Rossi, N. E. , Bisconti, T. L Dispositional Resilience (Rossi, N.E., Bisconti, T.L., & Bergeman, C.S., 2007)Is resilience a personality trait?1)Commitment (involvement with people)2) Control (influence over outcomes rather than powerlessness)3) Challenge (learning from experience)Those who support this view claim that virtues can be cultivated if innate inclination: self discipline, compassion, friendship, work, perseverance, honesty, loyalty, truth, selflessness (Hall, S.E., 2006)Stress cultivates dispositional resilience (more effective coping strategies, support seeking)
96 Hope Theory (Grewal, P.K., & Porter, J.E., 2007) Two components:1) Agency- belief that goals can be met, goals are manageable and achievable2) Pathways- Actual behavioral plans of implementing goalsMay need to be taught:Recalling past successesNaming and reconceptualizing goalsAccountability for actions and follow through
97 Approach goals- moving toward a desired outcome Four Categories of Hopeful Goals (Cheavens, J.S., Feldman, D.B., Woodward, J.T., Snyder, C.R., 2006)Approach goals- moving toward a desired outcomeForstalling negative outcomes- deterring unwanted consequencesMaintenance goals- sustaining the status quoEnhancement goals- augmenting positive outcomes
98 Reasonable Hope Weingarten, K., 2010 1. Relational- community of others2. A Practice- not in isolation, not just one goal3. Maintains that the future is open, uncertain, and influenceable- realistic but full of possibilities4. Seeks Goals and Pathways to Achieving Them- willing to do trial and error and modify as needed5. Accomodates doubt, contradictions, and despair- life can be messyCan also be vicarious
99 Post Traumatic Growth (Rolli, L., Savicki, V., Spain, E., 2010) Emotions, Mood, and AffectEmotions- short-term focused, intense, adaptiveMood- long term pervasive, less intense, and continuousAffect- involves both emotion and moodsCultivating positive affect in the face of trauma is an essential ingredient for posttraumatic growthBroadening of focusFinding resourcesDefending against the effects of stressCan co-exist with negative emotions but act as diversion and balance
100 Narratives Of Resilience Hauser, S.T., & Allen, J.P. Reconstructing the story as able to be modifiedPromote internal locus of control and manageable client goalsSeeing things working outEnvisioning the stress and trauma being disruptedCreating a long term vision
101 Protective FactorsPersonal- intelligence, emotion regulation, temperament, coping strategies, locus of control, attention, genetic influences, absence of antisocial behaviors, history of academic success, help skills, ego control, flexible, positive appraisalsFamily-stable caregivers, basic needs met, atmosphere of love and nurturance, security, positive parenting strategies, parental monitoringCommunity-neighborhood quality, community organizations, quality schools and businesses
102 Risk FactorsPersonal- disabilities, emotional instability, mental health diagnosis (self or close love one), uneven temperament, poor or no coping strategies, avoidance, withdrawal, external locus of control, family history of negative genetic influences, antisocial behaviors, academic challenges, low self efficacy, inflexible, negative appraisalsFamily-unstable caregivers, basic needs unmet, atmosphere of inconsistency, harsh or negative parenting strategies, parental monitoringCommunity-dangerous or unsafe neighborhood quality, no or few community organizations, poor schools and businesses, limited resources
103 Issue #8: Empathy Without Loss of Self Hearing the client’s account without putting self into itFeeling parallel emotions but actively reminding self that in a session and someone else’s storyHelping the client going through the issue(s)Can share with client in words the client relates to the feeling elicited by the incident but in such a way that it does not become the clinician’s storyAwareness of signs of overload- muscle tension, fatigue, which clients you can’t handle at a certain tie, lack of boundaries, poor eating/sleeping habits, disorganizationBalance between relating to what the client reports yet being detached enough
104 Empathy Without Loss of Self The Most Important Factor: Social Support SystemsPersonal life/family/friendsCommunity involvementColleaguesWhat social supports do that helps:Facilitating compassionFocusing on similar elements among all people-normalizing feelingsReducing self blameFacilitating realistic self acceptance
105 EXERCISE: PLANNING FOR WELLNESS Word Associations:Health-Healing-Replenish/renewal-Escape-Coping-Fulfillment-Satisfaction-
106 Issue#9: Developing a Balanced Life LeisureLeisure directly related to ability to copeTrue leisure related to sense of self spirituallyTrue leisure related to healthy connectednessTrue leisure promotes balance“I can let things happen in the moment.”“I try to see the beauty in everything.”“Playfulness is not necessarily unproductive or wasteful.”“I can periodically revisit how I am feeling and what I need.”“Meanings of my personal and career goals are allowed to change with age and life stage.”Examples:Arts, cooking, music, meditation, physical activity, walking, physical labor, prayer, hobbies, et.
107 Issue #10: What Cases You Can/Can’t Handle Effects of Traumatic CasesNegativePersonal trauma historyFemale versus maleOveridentification with traumatic elementsExtremely in depth detailed trauma workLong term trauma workTrauma cases with little sense of justice and closureFirst responders- anxiety, substance abuse, burnout, PTSD riskSleep interruptionsChronic fatigueMilder versions of the victims symptomology
108 What Cases You Can/Can’t Handle Effects of Traumatic CasesDoes this effect or influence counselor burnout?Positive33% actually felt more positive- made a difference- involvement in disaster or traumaPersonally helpful to some degree if help counselor reaffirm resilience about their own life stressorsSense of coherence- all humans go through some traumatic things to some degreeWillingness to get therapy personally if indicatedOngoing involvement in supervisionPost traumatic growthWitnessing the resiliency of others
109 What Cases You Can/Can’t Handle Mixed ResultsLength of years as a therapistLevel of compassionDepends on degree of previously unresolved things
110 Compassion Fatigue Examples: Dreaming the client’s dreams Experiencing intrusive thoughts and imagesHyperarousalSleep problemsDifficulty concentratingBeing easily startledSense that no one understands my distressNOTE: May also extend to family of the counselor and support systems of the counselor
111 Vicarious Traumatization Reactions to cases of those abused or in traumanot a pathological reactionbased on empathic reactions to trauma survivors triggered by our own application of our counseling skills“empathy at full throttle”, “exaggerated empathy” (Rothchild, B., 2002)Less than 10% in most casesExamples:Child abuse, terrorism victims, physical or emotional abuse victims, natural disaster victims, violent crime victims, people with sudden violent deaths
112 Critical Factors For Processing Traumatic Cases Key how the clinician processes the inner experience of the traumatic materialHow personally they take their ability to control or fix things around themHow much they have worked on their journey toward a professional identity to this pointHow well they can compartmentalize life between professional and personalWhat meaning the clinician assigns to the event (assumptive worldview)Access and willingness to use resources for self careBalancing all aspects of personhoodRegular consultation and supervisionResisting “savior syndrome”
113 Those Most Prone To Burnout Issue #11: My IdentityThose Most Prone To BurnoutThose who desire excellenceThose who pride themselves on “really caring”Those who were “on fire” beforeThose whose life meanings are intricately tied to others’ reactions
114 Behaviors Which Indicate Burnout drag yourself into work most daysfind yourself repeating the same thingsgive advice as a shortcut rather than helping clients learn and growbegin sessions late and/or end earlydoze off or space out during sessionsexperience a noticeable decline in empathydo things that seem ethically questionablepush your theory, technique or agenda rather than listening and adjustingfeel relieved when clients cancelself disclose in ways that don't help the clientdo things more for your purposes than for the clientdefining clients in dehumanizing waysloss of/significant change in faith/meaning in lifegeneral pessimismgreater struggles with self/professional identity
115 Behaviors Which Indicate Burnout lack of assertivenessstruggles dealing with ambiguitychronic clock watchinginterpersonal difficultiesmore debates and struggles with colleagues
116 Burnout Beliefs I feel I am an incompetent counselor, I am not confident in my counseling skills.I feel frustrated by my effectiveness as a counselor.I do not feel like I am making a change in my clients.The quality of my counseling is lower than I would like.I am not a good counselor.I feel ineffective as a counselor.It is hard to establish rapport with my clients.I feel like I have a poor professional identity as a counselor.I am not connected to my clients.
117 Burnout Beliefs Due to my job as a counselor, I become physically ill. I feel like I need a vacation.I feel drained after sessions.I have a chronic feeling of general fatigue.My job as a counselor makes me feel depressed.I feel stressed by the size of my caseload.I feel bogged down by the system in my workplace.I am treated unfairly in my workplace,I feel negative energy from my supervisor.I feel frustrated with the system in my workplace.I feel negative energy from my coworkers.I often feel irritated in my workplace.I feel that there is too much emphasis on paperwork in my workplace.
118 Burnout Beliefs I have Iittle empathy for my clients. I have become callous toward clients.I am no longer concerned about the welfare of my clients.I am not interested in my clients and their problems.I am relieved when clients do not show up for sessions.I have become inattentive in sessions.
119 What I Can/Can’t Control Serenity Prayer Exercise:Goals for myself What I can’t control What I can controlI want to be helpfulto people who havelimited life skills orresources.I want to make achange in other’s lives.
120 Cognitive-behavioral Technique: Watch where you put your BUTS Feelings BUT Positive self statement Concerns Strengths based Questions affirmation Stresses
121 Exercise: What Do I Want To Be Remembered For? Plan a eulogy for yourself. Write at least 3-5 important variables that you want memorialized about yourself.What are you doing to pursue these now?
122 Exercise: Create a Self Pledge Balance of time.Responding to client demandsSetting boundaries professionally and personally.Re-assessing my goals.Doing one thing just for myself.Allowing leisure for some time every day.
123 How Personal Therapy May Help Increased empathy for what others, especially clients go through.2. Ability to catch and challenge triggers so they don’t repeat themselves.3. Personal issues are caught before they spill over into client relationships.4. There is less risk of an ethical violation or losing your practice.5. Burnout may be thwarted.6. Options of actions can be considered.
124 BibliographyAckerman, S.J., & Hilsenroth, M.J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 38, Ackerman, S.J., & Hilsenroth, M.J. (2001). A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy, 38, Angus, L.E., & Kagan, F. (2009). Therapist empathy and client anxiety reduction in motivational interviewing: “She carries with me the experience.” Journal of Clinical Psychology in Session, 65(11), Bachelor, A., & Salame, R. (2000). Participants’ perceptions of dimensions of the therapeutic alliance over the course of therapy. Journal of Psychotherapy Practice and Research, 9,
125 BibliographyBaer, R.A., Smith, G.T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, Barber, J.P., Connolly, M.B., Critis- Cristoph, P., Gladis, L., & Siqueland, L. (2000). Alliance predicts patients’ outcome beyond in-treatment change in symptoms. Journal of Consulting and Clinical Psychology, 68, Barker, L. & Watson, K. (2000). Listen up: How to improve relationships, reduce stress, and be more productive using the power of listening. St. Martin’s Press: New York: New York. Beck, M., Friedlander, M. L. &Escudero, V. (2006). Three perspectives on clients’ experiences of the therapeutic alliance: A discovery-oriented investigation. Journal of Marital and Family Therapy, 32(3),
126 BibliographyBedi, R.P. (2006). Concept mapping the client’s perspective on counseling alliance formation. Journal of Counseling Psychology, 53, Bedi, R.P., Davis, M.D., & Williams, M. (2005). Critical incidents in the formation of the therapeutic alliance from the client’s perspective. Psychotherapy: Theory, Research, Practice,Training, 42, Berger, C., Angera, J.J., Rawls, D.T., Rapaport, R.J., Bartels, E., & Black, R.J. (2002). College counseling centers with counselors in private practice: Guidelines to negotiate ethical challenges. Journal of College Counseling, 5, Bobevski, I., & McLennan. J. (1998). The telephone counseling interview as a complex,dynamic, decision process: A self-regulation model of counselor effectiveness. The Journal of Psychology, 132(1),
127 BibliographyBreda, C. S., & Bickman, L. (1997). Termination of mental health services for children. Journal of Child and Family Studies, 6(1), Brehmer, B. (1992). Dynamic decision making: Human control of complex systems. Acta Pschologein, 81, Burwell-Pender, L., Halinski, K.H. (Winter 2008). Enhanced awareness of countertransference. Journal of Professional Counseling: Practice, Theory, and Research, 36(2), Carney, J.S., & Granato, L.A. (2000). The business of counseling: Planning and establishing a private practice. Counseling and Human Development, 32(5), Cheavens, J.S., Feldman, D.B., Wodward, J.T., & Snyder, C.R. (2006). Hope in cognitive psychotherapies. On working with client strengths, Journal of Cognitive Psychotherapy: An International Quarterly, 20(2),
128 BibliographyClark, A.J. (Summer 2010). Empathy: An integral model in the counseling process. Journal of Counseling & Development, 88, Clark, A.J. (April 2010). Empathy and sympathy: therapeutic distinctions on counseling. Journal of Mental Health Counseling, 32(2), Clark, A.J. (2004). Empathy: Implications of the three ways of knowing in counseling. Journal of Humanistic Counseling, Education, and Development, 43, Clemence, A.J., Hilsenroth, M.J., Ackerman, S.J., Strassle, C.G., & Handler, L. (2005). Facets of the therapeutic alliance and perceived progress in psychotherapy: Relationship between patient and therapist perspectives. Clinical Psychology and Psychotherapy, 12, Collins, S., & Arthur, N. (June 2010).Culture-infused counselling: A fresh look at a classic framework of multicultural counseling competencies. Counselling Psychology Quarterly, 23(2),
129 BibliographyConstantine, M.G., & Gainor, K.A. (2001). Emotional intelligence and empathy: Their relation to multicultural counseling knowledge ad awareness. Professional School Counseling, 5(2), Cook, J.E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. Cyber Psychology & Behavior, 5, Daniel, T., & McCleod, J. (2006). Weighing up the evidence: A qualitative analysis of how person-centered counselors evaluate the effectiveness of their practice. Counseling and Psychotherapy Research, 6(4), Dixon Rayle, A. , & Myers, J.E. (2004). Wellness in adolescence: The roles of ethnic identity, acculturation, and mattering. Professional School Counseling, 8, Dixon Rayle, A. (Fall 2006). Mattering to others: Implications for the counseling relationship. Journal of Counseling & Development, 84,
130 BibliographyDuff, C.T., & Bedi, R.P. (March 2010). Counsellor behaviours that predict therapeutic alliance: From the client’s perspective. Counseling Psychology Quarterly, 23(1), Elliott, G.C., Kao, S., & Grant, A.M. (2004). Mattering: Empirical validation of a social-psychological construct. Self and Identity, 3, Feller, C.P., Cottone, R.R. (2003). The importance of empathy in the therapeutic alliance. Journal of Humanistic Counseling, Education, and Development, 42, Feng, B., & Lee, K.J. (April-June 2010). The influence of thinking styles on responses to supportive messages. Communication Studies, 61(2), Fernald, P.s. (2000). Carl Rogers: Body-centered counselor. Journal of Counseling & Development, 78, Fitzpatrick, M.R., & Irannejad, S. (Fall 20008). Adolescent readiness for change and the working alliance in counseling. Journal of Counseling & Development, 86,
131 BibliographyFitzpatrick, M.R., Kovalak, A.L., & Weaver, A. (June 2010). How trainees develop an initial theory of practice: A process model of tentative identifications. Counselling and Psychotherapy Research, 10(2), Gellhaus Thomas, S.E., Werner-Wilson, R.J., & Murphy, M.J. (March 2005). Influences of therapist and client behaviors on therapy alliance. Contemporary Family Therapy, 27(1), Gibson, D.M., Dollarhide, C.T., & Moss, J.M. (2010. Professional identity development: A grounded theory of transformational tasks of new counselors. Counselor Education & Supervision, 50, Gold, J.M. (2008). Rethinking client resistance: a narrative approach to integrating resistance into the relationship-building stage of counseling. Journal of Humanistic Counseling, Education, and Development, 47, Greason, P.B., & Cashwell, C.S. (2009). Mindfulness and counseling self-efficacy: The mediating role of attention and empathy. Counselor Education & Supervision, 49, 2-18.
132 BibliographyHamilton, B., & Roper, C. (2006). Troubling ‘insight’: power and possibilities in mental health care. Journal of Psychiatric and Mental Health Nursing, 13,Handley, T. (August 2009). The working alliance in online therapy with young people: Preliminary findings. British Journal of Guidance & Counseling, 37(3),Harmon, C., Hawkins, E.J., Lambert, M.J., Slade, K., & Whipple, J.L. (2005). Improving outcomes for poorly responding clients: The use of clinical support tools and feedback to clients. JCLP, 61(2),Hartley, G.D. (1995). Empathy in the counseling process: The role of counselor understanding in client change. Journal of Humanistic Education & Development, 34,Hathaway, S.R. (200). Some considerations relative to nondirective counseling as therapy. Journal of Clinical Psychology, 56(7),Hersoug, A. G., Hoglend, P., Havik, O., Von Der Lippe, A., & Monsen, J. (2009). Therapist characteristicsinfluencing the quality of alliance in long-term psychotherapy. Clinical Psychology and Psychotherapy, 16,
133 BibliographyJohnston, P.J. (1988). Changing the image of a counseling center: Strategies for inexpensive advertising. Journal of Counseling and Development, 66, 250. Josefowitz, N., & Myran, D. (December 2005). Towards a person-centered cognitive behavior therapy. Counselling Psychology Quarterly, 18(4), Karver, M., Shirk, S., handleman, J.B., Fields, S., Crisp, H., Gudmundsen, G., & McMakin, D. (March 2008). Relationship processes in youth psychotherapy. Journal of Emotional and Behavioral Disorders, 6(1), Kensit, D.A. (2000). Rogerian theory:A critique of the effectiveness of pure client-centered therapy. Counselling Psychology Quarterly, 13, Knapp, S., & VandeCreek, L. (2008). The ethics of advertising, billing, and finances in psychotherapy. Journal of Psychology: In Session, 64(5), Liebert, T., Archer, J., Munson, J., & York, G. (Janury 2006). An exploratory study of client perceptions of internet counseling and the therapeutic alliance. Journal of Mental Health Counseling, 28(1),
134 BibliographyLyubomirsky, S., King, L., & Diener, E. (2005). The benefits of frequent positive affect: Does happiness lead to success? Psychological Bulletin, 131(6), Mason, M. J. (Summer 2009). Rogers redux: Relevance and outcomes of motivational interviewing across behavioral problems. Journal of Counseling & Development, 87, McLaughlin, J.E., & Boettcher, K. (2009). Counselor identity: Conformity or distinction? Journal of Humanistic Counseling, Education, and Development, 48, Meier, P.S., Barrowclough, C., & Donmall, M.C. (2005). The role of the therapeutic alliance in the treatment of substance misuse: A critical review of the literature. Addiction, 100, Meissner, W.W. (2006). The therapeutic alliance- a proteus in disguise. [Electronic version]. Psychotherapy: Theory, Research, Practice, Training, 43(3), Mellin, E.A., Hunt, B., & Nichols, L.M. (Spring 2011). Counselor professional identity: Findings and implications for counseling and interprofessional collaboration. Journal of Counseling & Development, 89,
135 BibliographyMiville, M.L., Carlozzi, A.F., Gushue, G.V., Schara, S.L., & Ueda, M. (April 2006). Mental health counselor qualities for a diverse clientele: Linking empathy, universal-diverse orientation, and emotional intelligence. Journal of Mental Health Counseling, 28(2), Munder, T., Wilmers, F., Leonhart, R., Linster, H.W., & Barth, J. (2009). Working allianceinventory- short revised: Psychometric properties in outpatients and in patients. Clinical Psychology & Psychotherapy, 17, Nolan, S. (December 2008). “The experiencing of experience”: A pragmatic reassessment of Rogerian phenomenology. European Journal of Psychotherapy and Counselling, 10(4), Otani, A. (1989). Client resistance in counseling: Its theoretical rationale and taxonomic classification. Journal of Counseling and Development, 67, Pearson, Q.M. (1999). Integrative empathy: Training counselors to listen with a theoretical ear. Journal of Humanistic Counseling, Education, and Development, 38, Pembroke, N. (2005). A trinitarian perspective on the counseling alliance in narrative therapy. Journal of Psychology and Christianity, 24(1),
136 BibliographyQuilliam, S. (2004). Body language: Learn to read and use the body’s secret signals. Firefly: Buffalo, NY.Reeves, M., & Deimer, M. (July-August 2011). Adaptability: The new competitive advantage. Harvard Business Review,Restifo, S. (June 2010) Patients’ performance anxiety and related aspects as factors in resistance to change. Australian Psychiatry, 18(3),Richards, K.C., Campenni, C.E., Muse-Burke, J.L. Self-care and well-being in mental health professionals: The mediating effects of self-awareness and mindfulness. Journal of Mental Health Counseling, 32(3),Roberts, F.M. (1997). The therapy sourcebook. Contemporary Books, Chicago, IL.Rochlen, A,B., Rude, S.S., & Baron, A. (Spring 2005). The relationship of client stages of change to working alliance and outcome in short term counseling. Journal of College Counseling, 8,Rothaupt, J.W., & Morgan, M.M. (October 2007) Counselors’ and counselor educators’ practice of mindfulness: A qualitative inquiry. Counseling and Values, 52,
137 BibliographySchubert, J. (Winter 2007). Engaging youth with the power of listening. Reclaiming Children and Youth, 15(4), Sinclair, S.L., & Monk, G. (August 2005). Discursive empathy: A new foundation for therapeutic practice. British Journal of Guidance and Counselling, 33(3), Stevens, C.L., Muran, J.C., Sfran, J.D., Gorman, B.S., & Winston, A. (2007). Levels and patterns of the therapeutic alliance in brief psychotherapy. American Journal of Psychotherapy, 61(2), Stoltz, K.B., & Kern, R.M. (2007). Integrating lifestyle, the therapeutic process, and the stages of change. The Journal of Individual Psychology, 63(1), Tambling, R.B., & Johnson, L.N. (2008). The relationship between stages of change and outcome in couples therapy. The American Journal of Family Therapy, 36, Tannen, T., & Daniels, M.H. (February 2010). Counsellor presence: Bridging the gap between wisdom and new knowledge. British Journal of Guidance & Counselling, 38(1), 1-15.
138 BibliographyTentoni, S.C. (1997). A marketing technique to increase visability and use of health center counseling services. Journal of American College Health, 46(2), Thompson, S.J., Bender, K., Lantry, J., & Flynn, P.M. (2007). Treatment engagement: Building therapeutic alliance in home-based treatment with adolescents and their families. Contemporary Family Therapy, 29, Tursi, M.M., & Cochran, J.L. (Fall 2006). Cognitive-behavioral tasks accomplished in a Person-centered relational framework. Journal of Counseling & development, 84, Vanaerschot, G. (2007). Empathic resonance and differential experiential processing: An experiential process-directive approach. American Journal of Psychotherapy, 61(3), Watson, J.C., & Greenberg, L.S. (2000). Alliance ruptures and repairs in experiential therapy. Psychotherapy in Practice, 58(2), Yalom, I.D. (1998). Inside therapy: Illuminating writings about therapists, patients, and psychotherapy. St. Martin’s Press: New York: New York.