Solution Manual & Test Bank for Choices: Interviewing and Counselling Skills for Canadians, 7th edit

Solution Manual & Test Bank for Choices: Interviewing and Counselling Skills for Canadians, 7th edition by Bob Shebib

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 1 Professional Identity: Ethics, Values, and Self-Awareness

Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Test Bank Chapter One Professional Identity: Ethics, Values, and Self-Awareness Multiple Choice Questions 1. Ethics are a. skills and techniques for working with clients b. government legislation that regulates professionals c. what one considers to be important d. principles and rules of proper conduct e. personal beliefs governing behaviour (Answer: “d” page 3) 2. Which of the following professionals are licensed to prescribe medication? a. psychiatrists b. psychologists with a Ph.D. degree c. social workers who have received specialized training d. any counselling professional with at least a Master’s degree e. chiropractors (Answer: “a” page 2) 3. Social justice commitment implies that counsellors a. work with law enforcement officials to combat crime b. treat all clients the same c. respect individual difference d. use advocacy to promote human rights and income redistribution e. assess clients based on community standards (Answer: “d” page 3) 4. Professional ethics a. are designed to protect both clients and counsellors b. encourage dual relationships with clients

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 1 Professional Identity: Ethics, Values, and Self-Awareness

c. require the use of psychiatric diagnosis d. enable counsellors to blend personal values with agency standards e. define the benefits of counselling (Answer “a”, page 3) 5. Which of the following represents a “dual relationship?” a. co-signing a loan for a client b. buying a car from a client c. dating a client d. social involvement with a client e. all of the above (Answer: “e” page 5) 6. With respect to physical contact with clients a. it is never acceptable b. touch may be an important component of working with children c. touch, while a natural part of human interaction, has no place in professional counselling d. it is acceptable only when the counsellor and the client are the same gender e. should be confined to a hand shake, but only if initiated by the client (Answer: “b” page 5) 7. Absolute confidentiality means a. counsellors can share information only with the police if there is an emergency b. counsellors cannot share information with anyone c. counsellors can share information only within the agency d. counsellors can share information if they have permission from the court e. counsellors must consult supervisors before sharing information (Answer: “b” page 6) 8. Relative confidentiality means a. counsellors can share information only with the police if there is an emergency b. counsellors cannot share information with anyone c. counsellors can share information with their clients’ family members d. counsellors can share information if they have permission from the court e. confidentiality cannot be guaranteed because of legal constraints

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 1 Professional Identity: Ethics, Values, and Self-Awareness

(Answer: “e” page 6) 9. The Tarasoff case established a. the “duty to warn” principle b. that professionals must maintain absolute confidentiality c. criteria for reporting child abuse and neglect d. protection for counsellors who maintain relationship confidentiality e. none of the above (Answer: “a” page 6) 10. The principle that clients have a right to freedom of choice is known as a. empowerment b. self-determination c. informed consent d. advocacy e. ethics (Answer: “b” page 9) 11. Professional values are concerned with: a. rules governing confidentiality b. the importance of choice c. a reflection of what the profession considers important d. the benefits of counseling e. the price of counselling (Answer: “c” page 8) 12. Which of the following best defines the term self-determination? a. acknowledgment that clients have a right to make their own decision b. respect for cultural and other diversity variables c. recognition that every client is different d. belief in the dignity of clients e. goal setting (Answer: “a” page 9) 10. Objectivity is a. the capacity to understand without imposing bias or distortion b. treating clients as objects 1-4

Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 1 Professional Identity: Ethics, Values, and Self-Awareness

c. setting goals for counseling d. allowing clients to disagree e. imposing personal ideas (Answer: “a” page 15) 11. Non-maleficence means a. honour the clients’ right to self-determination b. gender equality c. do no harm d. the importance of everyone getting the same treatment e. using advocacy to promote client rights (Answer: “c”, page 12) 12. Regression involves a. refusing to acknowledge the existence of feelings or problems b. returning to behaviour from an earlier stage of one’s life c. not thinking about stressful thoughts or feelings d. shifting emotions from one person or object to another e. developing excuses (Answer: “b” page 23) 13. Rationalization involves a. intelligent thinking about problems b. denial c. objectivity d. conscious use of skills e. using excuses to protect self-image (Answer: “e” page 23) 14. Suppression involves a. avoiding painful thoughts by not thinking about them b. putting clients down c. pushing clients to discuss painful feelings d. confrontation e. refusing to acknowledge the existence of problems (Answer: “a” page 23) 1-5

Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 1 Professional Identity: Ethics, Values, and Self-Awareness

15. Vicarious trauma is best described as a. burnout b. lack of self-awareness c. the damage done to clients by incompetent professional d. emotional, cognitive and physical damage arising from hearing client stories e. survivor guilt (Answer: “d” page 27)

True-False Questions 1. Vicarious trauma is another name for burnout 2. Clients must be assured that everything they say is subject to absolute confidentiality.

3. The Tarasoff case led to the “duty to warn” principle.

4. Values are legal constraints on practice.

5. The first step to resolving any ethical dilemma is to gather facts.

6. Objectivity is a violation of the ethical principles of most professional associations.

7. Dual relationships are prohibited by professional codes.

8. Self-awareness is desirable but not essential for competent practice 9.

10.

11.

12.

Defence mechanisms were first described by Sigmund Freud Competent counsellors are perfectionistic.

Counsellor needs may interfere with counselling.

Self-determination implies that a counsellors work hard to insure that goals are met.

13. Ethical dilemmas arise when a choice must be made between competing values and courses of action 14. Advocacy skills can help promote client self-determination 15. Counsellors must treat clients fairly, regardless of their personal feels toward them.

Answers: True – 3, 5, 7, 9, 11, 13, 14, 15; False – 1, 2, 4, 6, 8, 10, 12

Short Answer Questions 1. What is the difference between burnout and vicarious trauma?

Answer: Burnout is a state of emotional, mental, and physical exhaustion. Burnout can adversely affect health and lead to a range of emotional problems such as anxiety, inability to cope with the normal demands of work, depression, excessive worry, discouragement, pessimism toward clients, loss of a sense of purpose, general irritability, and an inability to find joy in one’s career or life.

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 1 Professional Identity: Ethics, Values, and Self-Awareness

Vicarious trauma occurs when people in the helping professions develop the same symptoms as their clients who have been traumatized.

2. Define what is meant by the terms values and ethics?

Answer: Ethics are concerned with proper conduct whereas values concern what people consider worthwhile.

3. Define dual relationship.

Answer: A relationship where there is both a counselling role and some other role such as business, social, sexual. All professions caution or forbid practitioners from entering into dual relationships. However, the unique demands of working in small towns or rural settings may make some dual relationships unavoidable.

4. Discuss what is meant by the term self-determination.

Answer: Self-determination prioritizes clients’ rights to autonomy and freedom of choice. Self-determination is enhanced when counsellors help clients access or identify resources.

5. List the steps to resolving ethical dilemmas.

Answer: Step One: gather facts; Step Two: Identify ethical issues and violations; Step Three: Identify possible options and strategies. Action steps should also consider the benefits, risks and possible outcomes of any action. By definition, an ethical dilemma involves a tough decision between competing interests or values.

6. List some ways that counsellors can lose objectivity Answer: Making assumptions based on incomplete information, simplistic reasoning, or bias; over-identification, over-involvement.

Paper Topics and Research Projects 1. Develop a personal wellness plan for dealing with the challenges and stress of working as a counsellor.

2. Write a paper based on interviews one or more counsellors from the field regarding ethical dilemmas they have faced. Consider questions such as:  What were the competing values and alternative courses of action that had to be considered?  How was the dilemma resolved?  What were the risks and benefits of the chosen course of action?  What might you have done?

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 1 Professional Identity: Ethics, Values, and Self-Awareness

2. Discuss the ethical and value issues associated with providing help to homeless people who choose not to enter a shelter during cold Canadian winters.

3. Identify a range of strategy choices for effecting change within organizations. How might your approach differ if you were employed by the organization targeted for change?

4. Who should get the service? The client most in need of it, but least likely to succeed or the one most likely to succeed. Develop sample guidelines for a hypothetical agency that outlines which clients should get service. Assume that the agency can only meet 50% of its requests for service.

7. Use concepts from Chapter 1 to write a paper that answers the question “who am I?” As part of this, explore your personal values and beliefs including how they might help and hinder your work as a counsellor.

8. Review the code of ethics for your discipline. Identify what you consider to be the 5 most important principles. What is your rationale for choosing each one? Identify ethical dilemmas that might arise related to these principles.

9. Essay topic: The ethics of online counselling: Issues, challenges, opportunities.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Chapter 2 The Skills, Process and Pitfalls for Counselling Test Bank Multiple Choice Questions 1. Research on the brain has demonstrated that counselling a. stimulates neurogenesis b. cannot stimulate neurogenesis c. does not result in fundamental changes to the brain d. should be supplemented with appropriate medication e. can dampen the effects of medication (Answer: “a”: page 34) 2. Psychotherapy a. targets only the behavioural domain b. targets severe emotional difficulties c. focuses on working with psychopaths d. usually utilizes Freudian techniques e. uses advocacy to effect systemic change (Answer: “b”: page 35) 3. Which of the following statements is true? a. counsellors are versatile, but psychotherapists use only standardized techniques b. there is no clear dividing line between the terms “counselling” and “psychotherapy” and they are often used interchangeably c. counsellors pay attention to the social environment d. psychotherapists prescribe medicine e. psychotherapy requires a degree in medicine (Answer: “b”: page 35) 2-8

Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 2 The Skills, Process and Pitfalls for Counselling

4. A “one-size-fits-all” approach to counselling a. respects diversity b. recognizes the importance of equal treatment for all clients c. insures uniformity in the application of principles d. prevents counsellors from tailoring their approach to meet the needs of individual clients. e. is a requirement of all ethical codes (Answer: “d”: page 36) 5. Brief counselling a. is seldom effective b. offers potential for many positive outcome c. should only be offered by seasoned professionals d. unethical e. works best when the emphasis is not on feelings (Answer: “b”: page 38) 6. The term “positive regard” is best defined as a. being real and honest with clients b. remaining optimistic c. recognizing the inherent worth of people d. paying attention to strengths e. none of the above (Answer: “c”: page 43) 7. Which of the following is a core condition a. silence b. asking questions c. attending d. summarizing e. genuineness (Answer: “e”: page 43)

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 2 The Skills, Process and Pitfalls for Counselling

8. Attending means a. contracting re: role and purpose b. showing up on time c. modifying one’s approach to meet individual needs d. communicating physical and psychological interest e. focusing on key aspects of the interview (Answer: “d”: page 43) 9. Paraphrasing is a. a restatement that clarifies the essence of what a client has said b. one of the core conditions described by Rogers c. repeating verbatim what a client has expressed d. condensing essential content e. an incomplete sentence (Answer: “a”: page 44) 10. Empowering skills a. help clients develop control and self-esteem b. are an abuse of power c. helps counsellors manage the flow of the interview d. require involuntary clients to accept counselling e. are strictly prohibited by professional codes of ethics (Answer: “a”: page 46) 11. Which of the following is an example of a directive? a. How do you feel? b. What do you expect to achieve from counselling? c. It sounds like you are feeling sad d. “Uh huh” e. Tell me more (Answer: “e”: page 45)

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 2 The Skills, Process and Pitfalls for Counselling

12. According to the text, which of the following is a phase of counselling? a. transition b. normative c. consolidation d. adjunct e. action (Answer: “e”: page 48) 13. A trauma-informed approach a. recognizes that people respond in unique ways to trauma b. requires that counsellors assume responsibility for client decisions c. insures psychological safety before dealing with basic needs d. requires that all traumatized clients are referred for psychological evaluation e. minimizes pressure on clients to make choices (Answer: “a”: page 38) 14. Catharsis is best described as a. a mental disorder b. a brain test c. suppression of feelings d. release of feelings e. emphasis on Catholic doctrine (Answer: “d”: page 55) 15. Pseudo-counselling is a. counselling based on Freudian principles b. the “illusion of work” c. counselling performed by licensed professionals d. counselling performed by unlicensed professionals e. a counselling approach developed by Carl Rogers (Answer: “b”: page 59)

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 2 The Skills, Process and Pitfalls for Counselling

True-False Questions 1. All human behaviour has a purpose.

2. Counsellors should be consistent in their use of skills regardless of the motivation of their clients.

3. Professional counsellors must attain competence in all areas of the work.

4. The goal of counselling is client and counsellor empowerment 5.

6.

7.

8.

9.

A one-size-fits-all model of counselling insures that people are treated equally.

Attending communicates physical and psychological presence.

Genuineness is the capacity to be real and consistent with clients.

Active listening requires counsellors to do most of the talking.

Silence in counselling should be avoided if it makes clients uncomfortable.

10. Counsellors should routinely self-disclose as a way of reminding clients that they are human.

11. Each phase of counselling is distinguished by different activities and skills.

12. The skill of tuning in is used to anticipate feelings and concerns that clients might bring to the interview.

13. Catharsis happens when clients experience release from talking about problems.

14. The core conditions are questioning, appropriate use of silence, and empowerment.

15. Defence mechanisms are problematic ways of responding to stress.

Answers: True – 1, 6, 7, 11, 12, 13; False – 2, 3, 4, 5, 8, 9, 10, 14, 15

Short Answer Questions 1. List some ways that clients can be helped even if their involvement with a counsellor is brief 

When clients are ambivalent about change, support from the relationship can tip the scales in favour of change by creating an atmosphere of trust and safety.



Counsellors can motivate by conveying optimism that change can occur, particularly when they focus on client strengths, not weaknesses.



Short sessions can provide an outlet for clients to ventilate feelings.



Counsellor empathy and nonjudgmental responses help clients accept their feelings as normal.



Questions and reflective responses can help clients organize ideas and plan for systematic change.



A client’s way of thinking about a problem and its resolution can shift when counsellors offer fresh ideas or reframed reflections (i.e., looking at a problem from a new perspective).

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 2 The Skills, Process and Pitfalls for Counselling



Counsellors can help remove barriers to change through information or the provision of resources

2. List the four phases of counselling? What skills are associated with each phase?

Answer: Preliminary, beginning, action, ending.

3. Identify the six skills associated with active listening.

Answer: attending, paraphrasing, summarizing, questioning, empathy, silence.

4. Explain why good listening requires counsellors to be good responders.

Answer: Questions insure the comprehension is complete. Summarizing, paraphrasing and empathy confirm understanding and act to encourage further expression when they are presented nonjudgmental.

5. What is the strengths approach to counselling?

Answer: This approach assumes that people have capacity and resources that can be utilized for problem solving. Counsellors look for every opportunity to recognize and mobilize client strengths.

6. Identify some of the reasons why counselling might be unsuccessful.

Answer: Client variables such as blaming others, unrealistic expectations, poor motivation, unconscious self-sabotage, destructive personality, organic factors and poor capacity for insight. Counsellor variables such as burnout, vicarious trauma, personal problems, and loss of objectivity. Common mistakes such as advice giving, pseudo-counselling, and rescuing.

7. What are the key features of trauma-informed approach to counselling?

Answer: Trauma awareness, emphasis on safety and trustworthiness, opportunity for client choice and collaboration, and a strengths-based focus.

Paper Topics and Research Projects 1. Choose one of the success tips in this chapter to explore in an extended essay.

2. Explore the use and misuse of counsellor power and authority 3. Imagine that you are seeing a counsellor for the first time. Explore your fears and expectations regarding the counselling process. Discuss what counsellor attitudes, skills and responses you would find most helpful. How do you think your experience might be the same or different for other people?

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 2 The Skills, Process and Pitfalls for Counselling

4. Review how the terms “counselling” and “psychotherapy” are defined and discussed in professional books and articles. Conclude your paper by offering your own definition of each.

3. The textbook emphasizes the importance of counsellor versatility. Write an essay that supports this notion. Use concrete examples to support your arguments.

4. One essential theme of the text is that effective counsellors need to be versatile and not rely on a “one size fits all” approach to clients. Our natural tendency to repeat our comfort style acts against the goal of versatility. For example, many people tend to be quiet when they first meet people, then open up as they become more relaxed. For many situations, this is a good way to begin relationships, but it is not the only choice. Consider, for example, that in some social service encounters with clients, the preferred choice is for the counsellor to more extroverted in order to reach out to quieter or isolated clients. We assume that not all people will respond favourably to your preferred style and situational variables may require different approaches. Consequently, it is important to develop a range of different strategy choices for handling beginnings so that you are not locked into repeating the same established pattern each time.  

Identify a skill that you wish to develop.

Detail your rationale (reasons) for picking this particular skill. Include some discussion of your current limitations.

 

Describe your typical use (or non-use) of this skill.

Discuss the circumstances (with reference to clients) you might encounter in a social service setting) under which your typical style might be an asset and a limitation. Be specific.

Identify a goal for development. This goal will represent a style choice that you wish to add to your skill repertoire.

Outline an action plan for reaching your goal.

 

5. Write a paper that explores the risks of burnout and vicarious trauma. Identify a range of strategies that counsellors can use to avoid these unfortunate outcomes, then adapt these to develop your own plan of prevention.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Test Bank Chapter Three

Relationship: The Foundation for Change Multiple Choice Questions 1. One of the following is considered a “core condition?” a. unconditional positive regard b. confrontation c. active listening d. self-disclosure e. contracting (Answer: “a”, page 70) 2. According to Rogers, genuineness is a. a measurement of the validity of counselling b. the extent to which the counselling relationship can be sustained over time c. being real and authentic d. a learned skill e. whether counsellors have proper credentials (Answer: “c”, page 72)

3. Unconditional positive regard is a. the extent that clients are open and honest b. the extent that counsellor responses are real and authentic c. the need to work from a recognized theory-based model d. a counsellor’s ability to think objectively e. accepting the client as a person of worth and dignity (Answer: “e”, page 79)

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 3 Relationship: The Foundation for Change

4. The counselling contract a. should be strictly adhered to in order to maintain focus and purpose b. is prepared by the counsellor c. may change over the life of the relationship or even in a single session d. should remain relatively intact as counselling progresses e. none of the above (Answer: “c”, page 73) 5. A counselling contract is best described as a. a negotiated agreement between clients and counsellors b. the professional code of ethics c. an intake interview d. short-term counselling e. legal issues that influence the helping relationship (Answer: “a”, page 73) 6. An anticipatory contract a. measures client motivation b. signals readiness to provide service c. presents details on the services available at the agency d. seeks agreement on how future events might be handled. e. looks at how past experiences have impacted client expectations (Answer: “d”, page 76) 7. Abraham Maslow is famous for developing a. modern theories of counselling b. procedures for working with resistant clients c. human stages of growth and development d. theories on the nature of counselling relationships e. the hierarchy of needs (Answer: “e”, page 78) 8. Immediacy involves a. providing quick service in crisis situations b. evaluating and deepening relationships

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 3 Relationship: The Foundation for Change

c. focusing on problem solving d. anticipatory contracting e. evidence-based service delivery (Answer: “b”, page 78) 9. A dependent relationship is a. a sign that the client is overly reliant on the counsellor for decision making b. a desirable outcome of effective counselling c. part of the contract d. inevitable in counselling e. necessary for promoting client self-determination (Answer: “a”, page 83) 10. Transference is a term first introduced by a. Abraham Maslow b. Socrates c. Bob Shebib d. Freud e. a Canadian social worker in 1950 (Answer: “d”, page 84) 11. Which of the following might signal transference or countertransference? a. strong feelings of attraction or anger b. addiction c. learned helplessness d. presence of a mental disorder e. immediacy (Answer: “a”, page 84-86) 12. Countertransference involves a. strategies for dealing with transference b. the tendency of counsellors to inappropriately shift feelings to clients c. resistance to referral d. intake bias e. failure to utilize the strengths approach (Answer: “b” page 86)

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 3 Relationship: The Foundation for Change

13. Counsellor self-disclosure a. is unprofessional and prohibited by codes of ethics b. should be routine and consistent with each client c. is appropriate only after a trusting relationship is achieved d. is best confined to the action stage as a way to model expected outcomes e. has the potential to be an important part of counselling (Answer: “e”, page 82-83) 14. Counsellor self-disclosure should a. shift the focus from the client to the counsellor b. only meet the needs of the client c. meet both client and counsellor needs d. be used routinely with all clients as a way to model genuineness e. not require counsellors to reveal feelings (Answer, “b”, page 87) 15. Which of the following is a task of the ending phase? a. dealing with feelings about the ending b. review of the extent that goals have been reached c. referral d. relationship closure e. all of the above (Answer: “e”, page 88-91)

True-False Questions 1.

2.

3.

4.

5.

The stage for the relationship is set before a counsellor’s first meeting with a client.

Immediacy is a commitment to provide prompt service.

Setting goals is a core condition.

Carl Rogers is the founder of client-centred therapy.

Counsellors should avoid discussion of their clients’ past experiences with counselling.

6. Contracts can focus on relationships, the work to be done, or the potential problems that might be encountered.

7. Counsellor self-disclosure violates ethical standards prohibiting dual relationships.

8. Basic survival is the first priority of Maslow’s Hierarchy of needs.

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 3 Relationship: The Foundation for Change

9. Transference involves referring clients for appropriate community support.

10. A dependent relationship is necessary in the beginning phase in order to meet the goals of counselling.

11. The ending phase may trigger powerful feelings for both clients and counsellors.

12. Relationship work is best confined to the beginning and action phases of counselling.

13. Contracting can empower clients.

14. Sessional contracts answer the question, “What are we hoping to talk about and accomplish today?”

15. Unconditional positive regard is judgmental.

Answers: True - 1, 4, 6, 8, 11, 13, 14; False - 2, 3, 5, 7, 9, 10, 12, 15

Short Answer Questions 1. Describe the types of counselling contracts.

Answer: Relationship contracts define how the counsellor and the client will work together. Such variables as communication style, personal values, differences (gender, age, race, etc.) and past experiences with counselling can be explored. Anticipatory contracts involve planning for predictable events (e.g., obstacles, giving feedback).

Work contracts focus on the overall objectives of counselling. Sessional contracts concern the work that will be done in the current session or interview.

2. Suggest statements and questions that a counsellor might use to initiate anticipatory contracting with clients who have had problems such as, anger management, compliance with medication, relapse from drug recovery, etc.

Answer:  What do you need from me if you are off your medication?  Suppose I am with you when you are angry. What should I do?  Imagine that you have had a relapse. At that point, predict what I might do to help you get back to recovery.

3. What is the difference between transference and countertransference. Give examples from your own life that illustrate each concept.

Answer: Transference refers the natural tendency of clients to communicate with their counsellors in the same way they communicated with significant people in their past.

It might involve a full range of feelings from attraction to aversion. Countertransference is a similar concept, but it involves inappropriate transfer of feelings from counsellors to clients.

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 3 Relationship: The Foundation for Change

4. Describe Maslow’s Hierarchy of needs.

Answer: Maslow’s hierarchy of needs ranks orders needs in terms of priority. Maslow theorizes that lower order needs must be satisfied before pursuing higher order needs.

Thus counsellors should address unmet needs as a first priority.

5. Describe the work of the ending phase and how it can benefit clients Answer: review of goals, procedures for further contact, referral, relationship closure, including discussion of feelings and unfinished business. Handled properly, the ending phase presents an opportunity to help clients to deal with the pain of loss and ending as well as setting goals and plans for next steps in their lives.

6. What are some important considerations for relationships with youth?

Answer: need for clear boundaries; limits on confidentiality; recognition of possible history of abuse and neglect and the need for a trauma-informed approach; trust issues; importance of a warm, trusting and predictable relationship for adolescents during a time of rapid emotional, social and physical change.

Paper Topics and Research Projects 1. Prepare a report with one detailed example illustrating the development of a relationship with a client (successful or unsuccessful.) Include a typescript of relevant dialogue with your analysis of the interaction. What did you learn from this experience?

2. Work with a partner to negotiate a relationship contract. Prepare a video illustrating your work (maximum 10 minutes.) Submit a report that discusses your use of skills and an analysis of the effectiveness of your work.

3. Beginnings: Self-Awareness and Goal Setting Exercise This assignment has two purposes: a. to increase your self-awareness regarding how you handle beginnings (most of us tend to repeat established patterns). b. to start the process of developing a range of different skills and strategies for handling beginnings.

Not all clients will respond favourably to your preferred style and situational variables may require different approaches. Consequently, it is important to develop a range of different strategy choices for handling beginnings so that you are not locked into repeating the same established pattern each time.

Describe how you typically handle beginnings. Include details regarding your behaviour (verbal and nonverbal), your feelings, and your thoughts. What first

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 3 Relationship: The Foundation for Change

impressions are you likely to leave with others? You might find it useful to interview others (e.g., classmates).

Discuss the circumstances (with reference to clients) you might encounter in a social service setting) under which your typical style might be an asset and a limitation. Be specific.

Identify a goal for development (related to how you handle beginnings.) This goal will represent a style choice that you wish to add to your skill repertoire.

4. Endings: Self-Awareness and Goal Setting Exercise This assignment has two purposes: a. to increase your self-awareness regarding how you handle endings (most of us tend to repeat established patterns). b. to start the process of developing a range of different skills and strategies for handling endings.

Not all clients will respond favourably to your preferred style and situational variables may require different approaches. Consequently, it is important to develop a range of different strategy choices for handling endings so that you are not locked into repeating the same established pattern each time.

Reflect how you have typically handled endings (e.g., death, end of a relationship, long separations). Include details regarding your behaviour (verbal and nonverbal), your feelings, and your thoughts.

Discuss the circumstances (with reference to clients) you might encounter in a social service setting) under which your typical style might be an asset and a limitation. Be specific. Identify a goal for development (related to how you handle endings.) This goal will represent a style choice that you wish to add to your skill repertoire.

5. Write a paper illustrates (include detailed practice or hypothetical case examples) how you might utilize Maslow’s Hierarchy in your work as a counsellor. Your work should also include a critical evaluation of this theory including examples that illustrate how and when people might sacrifice lower level needs to realize higher order needs.

6.

Write an essay detailing the unique challenges of working with one of the following groups: a. Youth b. Seniors c. Women d. Men

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Test Bank Chapter Four

Listening & Responding: The Basis for Understanding Multiple Choice Questions 1. Listening requires a. disengaging from the perspective of the other person b. hearing both verbal and nonverbal messages c. interpreting meaning from your perspective d. absolute silence e. helping others to understand your point of view (Answer: “b”, page 95) 2. Compared to the visual circuit of the brain, the auditory circuit responds a. simultaneously b. five times slower c. about ten times faster d. sometimes slower, sometimes faster e. without regard to past learning (Answer: “c”, page 98) 3. Good listeners a. predict what others might say b. use skills such as summarizing and questions to insure they understand c. make assumptions based on past experiences d. remain silent e. offer advice to help clients solve problems (Answer: “b”, page 98- 99) 4.

Closed-minded listeners are a. open to new perspectives

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 4 Listening & Responding: The Basis for Understanding

b. able to control their own assumptions c. unable to embrace new ideas d. recognize that everyone’s frame of reference is different e. able to focus without allowing distractions (Answer: “c”, page 98) 5. Attending is best described as a. encouraging clients to adhere to the work ethic b. making appropriate use of silence c. controlling the interviewing with questions and directives d. the way counsellors communicate to clients that they are ready, willing, and able to listen e. managed involvement (Answer: “d”, page 103) 6. “Attended Silence” means a. controlling internal and external distraction during silent moments b. being physically present during the interview c. using questions to understand the meaning of silence d. keeping quiet e. allowing silence to continue indefinitely (Answer: “a”, page 112) 7. An “egocentric” counsellor a. focuses all their attention on the client b. ensures that goal setting is remains a central focus c. hears only messages that support established opinions and beliefs d. utilizes best-practice tools and techniques e. builds the counselling relationship using active listening skills

(Answer: “c” page 105)

8. Paraphrasing describes a. restating a client’s words in one’s own words b. asking questions

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c. the use of idioms d. “attended silence” e. responses which focus on client feelings (Answer: “a”, page 117) 9. Proxemics describes a. how people use space and distance b. setting goal priorities c. body language d. cultural norms with respect to body language e. how close agencies are situated relative to their clients (Answer: “a”, page 109) 10. Metacommunication is best defined as a. speech punctuated by metaphors b. effective use of silence c. the message that is heard beyond the words that are spoken d. grandiose thinking e. using a broad range of communication and counselling skills (Answer: “c”, page 111) 11. Metacommunication is a. a sign that the counsellor is incompetent b. is a rare occurrence when counsellors are well-trained c. can reasonably be ignored d. a signal that counselling is successful e. may arise from multiple factors (Answer: “e”, page 111) 12. Which of the following is an example of a paraphrase a. can you describe it differently? b. looking at things from a different angle, you seem to be saying…. c. you’re feeling angry. d. tell me more. e. That’s not right.

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(Answer: “b”, page 117-118) 13. After listening patiently to a client, a counsellor restated the main ideas. This is an example of a. empathy b. content summary c. paraphrase d. theme summary e. parroting (Answer: “b”, page 120) 14. Which of the following statements about content summaries is true? a. they make judgments about relevance b. they are risky and should be avoided c. they focus only on feelings d. they are useful for organizing ideas and data e. they are edited for essential themes (Answer: “d”, page 120) 15. Selective attention a. is a sign that counsellors are not listening b. enables counsellors to screen out verbal and nonverbal cues that are unimportant c. helps counsellors to hear all of what has been said d. is a mental disorder involving hallucinations e. must be avoided (Answer: “b”, page 104)

True-False Questions 1. Listening means agreeing.

2. Active listening means remaining silent 3. Previous experience influences what we pay attention to 4. Good listeners screen out nonverbal communication to avoid becoming distracted.

5. We can never perfectly understand how other people experience their world.

6. Active listening involves hearing what is said as well as what is left unsaid.

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7. Active listening is not helpful for defusing critical incidents such as negotiating the release of hostages.

8. Attending refers to the natural tendency of counsellors to be distracted by their own issues.

9. Silence in counselling is generally an indication that something has gone wrong.

10. Nonverbal cues can reveal the meaning of silence.

11. Kinesics concerns the power and energy that counsellors bring to the session.

12. Proxemics describes how people use space and distance.

13. When counsellors paraphrase they repeat verbatim what they have heard.

14. Selective perception describes the natural tendency to screen out irrelevant information.

15. Content summaries require an unedited condensing of the client’s words.

Answers: True: 3, 5, 6, 10, 12, 14, 15; False: 1, 2, 4, 7, 8, 9, 11, 13.

Short Answer Questions 1. Explain how egocentricity can adversely affect counselling.

Answer: When counsellors only hear ideas and feelings that support their own established opinions and beliefs, they are unable to learn from or empathize with their clients effectively.

2. What is metacommunication. Give an example.

Answer: Metacommunication is how the message is heard which may differ sharply from what is said. For example, a teacher may simply ask to see a student after class, but the what the student hears is “Please see me after class. You are in trouble.” (metacommunication in italics) 3. What is the difference between a content summary and a theme summary?

Answer: Content summaries are unedited summaries of a client’s words. Theme summaries edit unnecessary detail by identifying the key patterns and areas of urgency 4. Explain how nonverbal communication impacts communication. What are some of the elements of nonverbal communication?

Answer: It may confirm, contradict, or embellish content. It can substitute for verbal messages or it may convey important information about the sender’s feelings.

5. List six common meanings of client silence in counselling. Suggest strategy choices for dealing with each.

Answer: The client is thinking, unsure what say or do, encountering painful feelings, dealing with issues of trust, quiet by nature, or the topic has reached closure.

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6. What is the difference between paraphrasing and repetition?

Answer: While paraphrasing provides an opportunity for clients to hear their words and ideas from a different angle while repetition simply repeats what has been said. Paraphrasing tends to promote insight as well as further discussion and elaboration.

7. What is role bias?

Answer: Counsellors will pay more attention to cues that are consistent with their professional focus, training, and responsibility. An employment counsellor will be interested in career and vocational data, whereas a marriage counsellor will be more alert to information on familial communication. This is necessary and appropriate; however, attending to one issue runs the risk that other important areas for inquiry are overlooked. For example, an employment counsellor who does not recognize the symptoms of a mental disorder or substance abuse will have limited effectiveness when dealing with clients who have these issues.

Paper Topics and Research Projects 1. Choose one of the success tips in this chapter for extended discussion.

2. Prepare a report on how good listening skills can be used for conflict resolution. Use illustrative examples.

3. Work with a colleague and record a ten-minute interview where you focus on using summarizing and paraphrasing skills. Include a typescript of relevant dialogue with your analysis of the interaction. Submit a report that discusses your use of skills and an analysis of the effectiveness of your work. What did you learn from this experience? Typically, you will see both positive and negative elements. In either case you will want to understand what happened so that you may generalize and apply your learning to other helping situations.

Attempt to identify and support viable alternative responses, i.e. what might you have said or done differently. Often there may be several perspectives on the same event. Attempt to increase your objectivity by considering alternate points of view or explanations. As well, consider your feelings and biases and how these assisted or hindered the work. Try to use supplemental books and articles from the library to support your ideas.

4. Critically evaluate your ability to listen effectively. What elements of the six skills of active listening do you think you need to develop? Seek feedback from others. Suggest goals for developing your listening skills.

5. Explore the nature of nonverbal communication in a selected different culture. Try to have at least one interview with a member of this culture.

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6. Prepare a ½ hour PowerPoint Presentation on effective listening. Include a maximum of ten slides with no more than 30 words on each slide.

7. Interview people who describe themselves as quiet. Explore the principal reasons why they tend to be quiet. Consider specific reasons related to issues such as (but not restricted to) selfesteem, inner dialogue, culture, social learning, and the behaviour of others.

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Interviewing Skills: The Search for Meaning Multiple Choice Questions 1. As a rule, open questions are a. best avoided in the early phases of the interview b. difficult to answer with a simple yes or no c. problematic because they lead clients to the “expected answer.” d. best utilized only after a trusting relationship is established e. the best tool for obtaining specific information (Answer: “b”, page 128) 2. Which of the following is an example of an open question? a. Tell me more. b. How do you think you should respond? c. Were you the first one to notice the problem? d. I’d be interested in hearing more about this? e. It seems like you are felling quite distressed.

(Answer: “b”, page 128) 3. Which of the following is an example of a closed question? a. Are you going to look for work today? b. Perhaps it’s time to end our session. c. Why not? d. What prompted you to act? e. Where on earth did you get that idea?

(Answer: “a”, page 127-128) 4. Closed questions a. usually begin with “Who” “What” “Where” When” or “Why” b. encourage clients to give detailed answers c. can be answered with a “yes” or “no” 5-29

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d. manipulate clients to give the correct answer e. should not be used in counselling (Answer: “c”, page 128) 5. Indirect questions a. are statements that have the same effect as questions b. are used to provide essential focus to the interview c. establish counsellor control of the interview d. should be avoided because they are confusing to clients e. can be answered yes or no (Answer: “a”, page 123) 6. Which of the following is an example of an indirect question? a. My opinion is that you should tell him yourself. b. Why don’t you deal with him instead of his wife? c. Do you think it might be possible? d. I’m curious about your ideas? e. How often do you think you might get a chance like that?

(Answer: “d” page 129) 7. Leading questions a. manipulate clients b. promote the change process c. communicate to clients that we are following their directions d. promote client self-determination e. are essential for focusing the interview (Answer: “a”, page 135) 8. Which of the following is an example of a leading question? a. How do you feel? b. What do you think you should do? c. Don’t you think you should tell her? d. Why don’t you tell me what your preference is? e. Go on, tell me more.

(Answer: “c”, page 135-135)

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9. The cognitive domain is concerned with a. thinking b. behaviour c. feelings d. where clients live e. thinking, feelings, and behaviour (Answer: “a”, page 132) 10. The question, “What are you thinking?” is an example of an a. open question targeting the behavioural domain b. open question targeting the affective domain. c. embedded question targeting the cognitive domain d. open question targeting the cognitive domain e. indirect question targeting the affective domain (Answer: “d”, page 128 - 129) 11. To manage a rambling interview, one strategy that a counsellor can use is to a. ask more closed questions b. use open questions to give clients a chance to tell their stories c. extend the interview time frame d. be flexible to allow the client to stay in control e. share their anger with the client (Answer: “a”, page 142) 12. With respect to interviewing youth a. core conditions are less important b. counsellors need to define the contract c. closed questions are preferred d. they may have intense reactions to seemingly innocuous issues e. the relationship should resemble a personal friendship (Answer: “d”, page 143-144) 13. According to Shulman, the illusion of work happens when a. counsellors do not fulfill their commitments b. conversations are empty and meaningless c. counsellors operate outside of their range of competence

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d. clients lie about the progress they are making e. all of the above (Answer: “b”, page 149) 14. Which of the following is an example of a directive? a. It sounds like you are feeling sad. b. What do you mean? c. Did you mean to say that you are finished with the relationship? d. What are you going to do? e. Tell me more.

(Answer: “e” page 151) 15. According to the text, which of the following is a type of interview transition? a. unexpected b. strategic c. empathic d. self-initiated e. purposeful (Answer: “b” pages 153-156)

True-False Questions 1. Multiple questions should be avoided unless they are complementary.

2. Catharsis is a medical test that measure cognitive capacity.

3. A good interviewer can rely exclusively on questions.

4. Genuineness means be real and open.

5. “Why” questions are effective for promoting insight.

6. Closed questions are a good way to encourage clients to share details.

7. “W-5" questions are always open questions.

8. Concreteness refers to counsellor rigidity.

9. Indirect questions are manipulative.

10. Jargon refers to the unique words and language that professionals use.

11. The cognitive domain is associated with how people feel.

12. The affective domain is concerned with how people impact others.

13. Phase transitions move the interview from one phase to another.

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14. The affective domain concerns emotions.

15. “Tell me more” is an example of a directive.

Answers: True: 1, 4, 7, 10, 13, 14, 15; False: 2, 3, 5, 6, 8, 9, 11, 12.

Short Answer Questions 1. What are four major reasons for asking questions?

Answer: gathering information, providing focus, promoting insight, and catharsis.

2. What are some of the pitfalls of questioning?

Answer: Asking leading questions which bias answers; excessive questioning which leave clients feeling bombarded; asking multiple questions which overwhelm or confuse clients; irrelevant or poorly timed questions, and “why” questions which may be experienced by clients as demands for justification.

3. Describe the different types of questions and their use.

Answers: Open questions begin with who, what, where, when, why, or how, and they encourage more expansive answers. Closed questions can be answered with a yes or no and they typically begin with words such as can, did, have, is, will, would, and do. They are useful when specific information is needed. Indirect questions are really statements that act as questions. They soften the interview by removing an interrogative tone that can arise from excessive questioning. Competent counsellors make intelligent choices on which type of question to use including whether questioning is appropriate or not.

4. What are the six key questions for every interview?

Answer: They represent key reference points for major tasks to be accomplished during any given interview.

1. What brings you here today?

2. What are your expectations of me?

3. What do I need to know about your situation?

4. What do you mean by ...?

5. What did we accomplish?

6. What have we missed?

Question 1 helps to establish direction and goals for the interview. Question 2 clarifies roles. Question 3 helps counsellors learn and it helps clients “tell their stories” which 5-33

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is often a very significant aspect of growth. Question 5 is used to review and evaluate progress as well as the relationship. Question 6 insures that nothing important was over looked.

5. For each of the six key questions listed in question 4, suggest an alternative.

Answer:      

What motivated you to come for counselling?

How do you think I might work with you on your issues?

Can you tell me the most important things I need to know?

Can you clarify…?

What progress have we made towards your goals?

What remains to be discussed?

6. How can counsellors promote concreteness?

Answer: With questions; probes for detail and examples; exploration of feelings, thoughts, and behaviour, and with the use of summarizing and paraphrasing responses.

7. List 5 major tips for interviewing youth.

Answer: See Table 5.2 on page 134.

Paper Topics and Research Projects 1. Write a report with one detailed example illustrating your use of interviewing questions. Include a typescript of relevant dialogue with your analysis of the interaction. Typically, you will see both positive and negative elements. In either case you will want to understand what happened so that you may generalize and apply your learning to other helping situations. Attempt to identify and support viable alternative responses, i.e. what might you have said or done differently. Often there may be several perspectives on the same event. Attempt to increase your objectivity by considering alternate points of view or explanations. Consider your feelings and biases and how these assisted or hindered the work. Try to use supplemental books and articles from the library to support your ideas. What did you learn from this experience that will help you to become a better counsellor?

2. Monitor your use of questions in everyday life. Look for patterns and habits. For example, do you tend to ask more closed questions than open questions? Do you use questioning as your main communication skill? Spend a full day communicating without questions, but do not reveal to others what you are doing. Write a paper that summarizes and discusses the implications of your observations and experiences. How

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did the people you interacted with respond? Reflect on the implications of their reactions.

3. Work with a partner to explore an issue or problem that he or she is currently experiencing. Prepare a video illustrating your use of counselling and interviewing skills (maximum 10 minutes). Submit a report that discusses your use of skills and an analysis of the effectiveness of your work.

4. Critically evaluate a television interview using concepts from this chapter. Identify specific skills (types of questions) utilized by the interviewer as well as questioning pitfalls that led to the interview being less effective. To what extent did the interviewer use appropriate responses to promote concreteness?

5. Based on what has been covered so far in this book, compose a paper describing the elements of effective counselling. Describe what you consider to be the five most important concepts and ideas that have been addressed so far in this course.

6. Ask students to identify key world events that have occurred during their lifetimes.

Ask them to interview one or more seniors (65+) to discuss explore the significant world events that have occurred during the senior’s lifetime (e.g., assassination of Kennedy, moon landing, the FLQ. Compare to their own significant world events.

7. Prepare an extended paper on one of the success tips from this chapter.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Test Bank Chapter Six

The Pursuit of Empathetic Understanding Multiple Choice Questions 1. Emotional intelligence is defined by Goleman as a. understanding cultural differences with respect to emotions b. one’s ability to identify emotions as they happen c. neural alarms d. being able to switch between the three domains of feelings, behaviour and thinking e. capacity to endure emotional trauma (Answer: “b”, page 163) 2. Which of the following is true with respect to emotional expression? a. cultures are very similar b. most people prefer to keep their emotions private c. there may be wide variations between cultures d. age is not a factor e. research has shown that gender differences are small (Answer: “c”, page 166)

3. Which of the following is true? a. people respond to life style events in their lives with the same emotions b. nonverbal cues have universal meaning c. lack of eye contact is a sign of disrespect d. circumstances and context are not always good predictors of feelings e. all cultures encourage the expression of emotions (Answer: “d” page 166) 4. Ambivalence is best defined as a. emotional intelligence b. the confusion and stress that comes from emotions 6-36

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c. multiple feelings about the same event or situation d. a mental disorder involving multiple personalities e. the science of culture (Answer: “c”, page 166) 5. Affect describes a. how people express emotions b. how others impact us c. the interaction between counsellors and clients d. successful strategies for intervention e. how we impact others (Answer: “a”, page 168) 6. Flat affect means a. the person has died b. the person has little or no impact on others c. there is an absence of emotional expression d. responses are normal e. emotions fluctuate rapidly (Answer: “c”, page 168) 7.

Affective disorders concern a. disturbances in thinking b. disturbances in mood c. the impact of mental disorders on family and friends d. schizophrenia and other psychotic illnesses e. phobias (Answer: “b”, page 168) 8. Which of the following is defined in the text as a type of empathy? a. immediacy b. genuineness c. confrontational d. inferred e. compassion (Answer: “d” page 173-178) .

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9. Invitational empathy a. means waiting for clients to express the need for empathy b. inviting clients to share their feelings c. being sympathetic to the feelings of clients d. responding to a client’s feelings e. suggesting that a client feel a certain way (Answer: “b”, page 174-175) 10. Basic empathy requires counsellors to a. respond to feelings that are explicitly expressed b. respond to nonverbal communication c. pick up on feelings that are avoided d. express sympathy e. keep the conversation on a surface level (Answer: “a”, page 175-176) 11. Inferred empathy a. picks up on nonverbal and other indirect indicators of emotions b. manipulates clients c. should be avoided d. projects feelings on others e. responds to feelings that are clearly expressed (Answer: “a”, page 176-177) 12. Which of the following is most likely to involve the nonverbal channel of communication? a. sympathy b. basic empathy c. invitational empathy d. inferred empathy e. genuineness (Answer: “d”, page 176-177) 13. Which of the following statements is true? a. when clients share feelings, empathy is often the preferred counsellor response

.

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b. empathy should be avoided until a trusting relationship is developed c. empathy is always appropriate d. empathy requires that counsellors are willing to share their own emotional reactions e. empathy should be avoided when interviewing criminals (Answer: “a”, page 179) 14. Which of the following best suggests an empathic response? a. You don’t have to feel so sad. b. I know exactly how you feel. c. Your situation makes me feel so upset. d. Don’t feel bad. It’s not your fault e. You seem confused.

(Answer: “e”, pages 175-181) 15. Which of the following is an example of inferred empathy? a. I feel sorry for you b. What were your feeling when your first found out c. The way you shake your head suggests that you feel the situation is hopeless d. I’ve often felt exactly the same way e. You should not feel guilty about what happened (Answer: “c”, page 176-177)

True-False Questions 1. People in different cultures express emotions in the same way.

2. Ambivalence suggests that the person has a mental disorder.

3. Affect describes how people are impacted by their problems.

4. As a rule, when clients express feelings, counsellors should respond with empathy.

5. Empathy is a fundamental building block for the helping relationship.

6. Clients reactions to empathy may vary from relief to anger.

7. Invitational empathy and inferred empathy are identical.

8. Basic empathy is superficial; thus it has no real value in counselling.

9. Inferred empathy picks up on nonverbal cues.

10. Empathy is always welcomed by clients.

11. Exposure to violence can blunt our ability to be empathic.

12. We can know how others feel if we have had the same experiences.

13. Sympathy is an important component of empathy. .

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14. Cutoffs are responses that inhibit further expression of feeling or thought.

15. Empathy requires counsellors to manage their own emotional reactions.

Answers: True: 4, 5, 6, 9, 11, 14, 15; False: 1, 2, 3, 7, 8, 10, 12, 13

Short Answer Questions 1. Describe empathy and its importance in counselling.

Answer: Empathy is the process of accurate understanding the emotional perspective of another person, and the communication of this understanding. Appropriate empathy gives people a chance to “tell their emotional story,” which results in a release of feelings. For many people, simply being able to express their emotions in a nonjudgmental setting is extremely therapeutic. Empathy is central to Roger’s personcentred approach.

2. What is meant by the term ambivalence? Give an example.

Answer: Ambivalence involves multiple or mixed and often contradictory feelings.

For example, someone might feel simultaneously excited and fearful about a new job.

What’s important is that both feelings are present. As a rule, empathy acknowledging ambivalence is best communicated with statements such as, “you’re feeling …, and at the same time, you’re feeling…”. In this regard “and” is preferable to “but”.

3. How might clients react to empathy?

Answer: With relief, increased insight, increased trust, anger, or embarrassment.

4. List and define the three types of empathy.

Answer:  Invitational: involving encouragement to clients to explore emotions.  Basic: response to clearly articulated emotions.  Inferred: response to emotions based on nonverbal cues. Invitational empathy guides clients to the emotional domain.

Often, expressing, understanding and resolving or accepting emotions are more important than problem resolution. People often know (intellectually) how to handle their problems, but emotions can cloud or confuse reasoning.

5. What is the difference between sympathy, compassion and empathy?

Answer: Sympathy is our own emotional reactions to a client’s situation whereas empathy involves understanding a client’s emotions and communicating this understanding. Compassion is important in helping relationships as it conveys .

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humanness and concern.

Paper Topics and Research Projects 1. Prepare a book report on one of Carl Roger’s classic texts such as “On Becoming a Person” or “Client-Centred Therapy.” In your report, answer questions such as:  What are the major ideas in the book that define Roger’s philosophy?  What is Roger’s view of empathy?  To what extent are Rogerian concepts still relevant today?

2. Prepare a report with one detailed example illustrating your use of empathy skills (successful or unsuccessful.) Typically, you will see both positive and negative elements. In either case you will want to understand what happened so that you may generalize and apply your learning to other helping situations. Attempt to identify and support viable alternative responses, i.e. what might you have said or done differently.

Often there may be several perspectives on the same event. Attempt to increase your objectivity by considering alternate points of view or explanations. Consider your feelings and biases and how these assisted or hindered the work. Try to use supplemental books and articles from the library to support your ideas. Include a typescript of relevant dialogue with your analysis of the interaction. What did you learn from this experience?

3. Work with a partner to explore an issue or problem that he or she is currently experiencing. Prepare a video illustrating your use of counselling and interviewing skills (maximum 10 minutes). Submit a report that discusses your use of skills and an analysis of the effectiveness of your work.

4. "Trading Places": Reflect empathically on what it might be like to be a consumer of the agency where you are doing your field placement (internship). Describe the experience on three dimensions - cognitively, emotionally, behaviourally, as if you were the client speaking.

5. Submit a report that explores gender differences and emotions. Include recent research on that compares male and female brains.

6. Research and write a report on “mirror neurons.” Discuss recent findings and their implications for counsellors. Explore how mirror neurons might make counsellors more vulnerable to vicarious trauma.

7. Write an essay based on one of the Success Tips in this chapter. Include relevant research.

.

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Supporting Empowerment and Change Multiple Choice Questions 1.

In 2017, approximately what percentage of the Canadian population was over 65 a. 5% b. 16% c. 25% d. 30% e. 35%

(Answer: “b”, page 197) 2.

Secondary gain is defined as a. the benefits that people derive from their problems b. unexpected positive outcomes of counselling c. advantages to family and friends from a client’s counselling d. how change in a problem can impact other problems e. the benefits for family and friends when clients change

(Answer: “a”, page 203) 3.

Which of the following best describes “learned helplessness.” a. clients who have become lazy b. a situation where people have become overly dependent on others c. capacity to sustain effort over time in the face of obstacles d. clients who are overly anxious about change e. clients who do not believe their efforts will make a difference

(Answer: “e”, page 194) 4.

The stages of change model is also known as a. contemplative change model b. cognitive behavioral model c. transtheoretical model 7-42

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d. confrontation model e. brief therapy approach to change (Answer: “c”, page 204) 5.

At the precontemplative stage clients are a. actively involved in the change process b. not thinking about change c. ambivalent about making changes d. are preparing for change e. struggling with a relapse

(Answer: “b”, page 204) 6.

At the contemplative stage clients are a. reflecting on their past failures b. not thinking about change c. struggling with a relapse d. are preparing for change e. ambivalent about making changes

(Answer: “e”, page 205) 7.

Motivational interviewing a. uses authority to jump start change b. assumes that clients are ready for change c. makes use of the “intervention” model d. requires a collaborative, non-confrontational approach e. uses confrontation to overcome denial

(Answer: “d” page 205-206) 8.

“Change talk” is apparent when clients a. mention discrepancies between the way their life is and the way they would like it to be b. counsellors confront clients on the need to change c. are confronted by family d. counsellors shift strategies when what they are doing is not working effectively e. clients begin to model the behaviour of their counsellors

(Answer: “a”, page 200- 201) 9. “Sustain talk” is apparent when clients 7-43

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a. confirm the wishes of their counsellors b. mention that they are ready for change c. are actively involved in the change process d. favour the “status quo” e. get ready for change (Answer: “d”, page 200-201) 10.

Cognitive Behavioral Counselling a. has not proven to be an effective tool for change b. focuses on behaviour while minimizes the impact of thinking c. was pioneered by Carl Rogers d. helps people modify thinking behaviour, and emotions, e. should only be utilized by qualified psychiatrists

(Answer: “d”, page 207) 11.

Reframing is best defined as a. building a base of trust b. a skill that helps client shift their thinking by suggesting alternate explanations or meanings c. confronting irrational thinking d. altering the structure of the counselling process e. renegotiating the counselling relationship

(Answer: “b”, page 214) 12.

Which of the following is not a valid reason for helping clients set goals? a. giving direction b. motivating c. measuring progress d. defining roles e. meeting agency quotas

(Answer: “e” page 219-220) 13.

The “miracle question” involves a. imagining that problems have disappeared b. unrealistic expectations for counselling outcomes c. unexplained outcomes d. whether it will take a miracle for change to occur e. use of prayer and spirituality 7-44

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(Answer: “a” page 229) 14.

Contingency planning a. helps clients anticipate obstacles b. involves searching for the root causes of problems c. helps clients to review past mistakes d. takes advantage of precounselling change e. helps clients compile a “bucket list”

(Answer: “a”, page 226) 15.

Which of the following is a brief counselling technique? a. looking for exceptions b. gestalt approaches c. outreach to needy clients d. advocacy e. free association

(Answer: “a”, page 228-232)

True-False Questions 1.

2.

3.

4.

5.

Selective attention errors arise when people only look at part of the situation.

Confrontation is an essential part of motivational interviewing.

Clients at the contemplative stage are ambivalent.

At the precontemplative stage clients are not thinking about change Motivational interviewing requires that counsellors become comfortable with confrontation.

6. Clients cannot be helped at the precontemplative stage.

7. Rolling with resistance emphasizes confrontation.

8. According to Ellis, emotions and behaviour are caused by thinking.

9. Motivational interviewing discourages the use of empathy.

10. Outcome goals concern the procedures of counselling.

11. Effective goals should be concrete and measurable.

12. Precounselling change should be discouraged until realistic goals can be set.

13. The miracle question helps clients identify potential changes.

14. Counsellors empower clients when they recognize strengths and capacities.

15. Hardships and difficulties often have positive spin-offs.

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Answers: True: 3, 4, 8, 9, 11, 13, 14, 15; False: 1, 2, 5, 6, 7, 10, 12, 14.

Short Answer Questions 1. What are some important counselling principles to remember when working with seniors?

Answer: Seniors will want to be involved in decision making regarding counselling and the services that will impact their lives. Many seniors will want to focus on new ways to find meaning and structure for their lives, so counselling that helps them find a sense of purpose is very empowering. Counselling strategies need to be customized to meet the unique medical, psychiatric, financial, social, and psychological needs of senior clients.

2. Identify and discuss the implications of the five stages in the transtheoretical or stages of change model?

Answer: precontemplative, contemplative, preparation, action, and maintenance. A central assumption of this model of change is that different skills are appropriate depending on which stage of change the client is at. Clients may be at different stages of change for different issues in their lives. For example, a client may be precontemplative with respect to substance misuse, but at the action stage with respect to finding a job.

3. To what extent, if at all, is empathy used in Motivational Interviewing?

Answer: Empathy is the preferred choice to confrontation. Empathy is a crucial component. It helps to create a climate where clients are free to explore their values, perceptions and goals. With empathy, clients feel understood and they may naturally move to “change talk.”

4. What are the basic assumptions behind Albert Ellis’ ABC model?

Answer: Ellis believes that problematic emotions and behaviour “C” (consequences) arise from faulty thinking “B” which is triggered by activating events “A.” The key to change is to become aware of faulty thinking, then take steps to alter it.

5. What is thought stopping?

Answer: It is a tool for breaking the habit of repetitive self-defeating thought patterns.

Because neural pathways can become very strong, it is important for clients to learn strategies for replacing unhelpful thought habits with helpful ones. Thought stopping cues interrupt unhelpful thinking with immediate helpful thoughts. With practice, helpful thinking will become more dominant.

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6. What are the essential steps of action planning?

Answer: Step 1 involves identifying alternative ways to reach goals. Step 2 requires evaluation and selection of an action strategy. Step 3 focuses on developing and implementing plans. Step 4 features evaluation.

7. What is a “baseline?” Why is it important?

Answer: It is a measure of what is happening now. This enables clients and counsellors to have a reference point to measure change. Thus, for example, a baseline measurement might record that a client is consuming 5 alcoholic drinks per day.

Changes to this level will signal whether consumption is increasing or decreasing.

Sustained positive or negative changes to baselines are significant.

8. What is the difference between “change talk” and “sustain talk?”

Change talk favours change while sustain talk favours the status quo.

Paper Topics and Research Projects 1. Write a paper that explores how the concepts of motivational interviewing and cognitive behavioural counselling can be integrated 2. Prepare a report with one detailed example illustrating your use of goal setting skills in an interview (successful or unsuccessful.) Include a typescript of relevant dialogue with your analysis of the interaction. What did you learn from this experience?

Typically, you will see both positive and negative elements. In either case you will want to understand what happened so that you may generalize and apply your learning to other helping situations. Attempt to identify and support viable alternative responses, i.e. what might you have said or done differently. Often there may be several perspectives on the same event. Attempt to increase your objectivity by considering alternate points of view or explanations. Consider your feelings and biases and how these assisted or hindered the work. Try to use supplemental books and articles from the library to support your ideas.

3. Work with a partner to explore an issue or problem that he or she is currently experiencing. Explore how their behaviour and emotions are related to unhelpful thinking patterns. Endeavour to use cognitive behavioural techniques. Submit a report that discusses your use of skills and an analysis of the effectiveness of your work.

4. Compare cognitive behavioural counselling to the person-centred approach pioneered

by Carl Rogers.

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5. Review the professional literature (journal articles/research reports, and present empirical evidence that supports the effectiveness of either Cognitive behavioural counselling or motivational interviewing.

6. Monitor your thinking, behaviour and emotional responses over the next week.

Using concepts derived from Ellis’ ABC model identify examples that suggest unhelpful thinking patterns such as perfectionism, mind reading, rumination and selective perception. What patterns and core beliefs are evident? Set cognitive and behavioural goals for change.

7. Imagine you are speaking directly to a client explaining the principles of cognitive behavioural counselling. What might you say? Consider how this explanation might change for different clients.

8. Prepare a report that details personal efforts to develop goals and an action plan for a selected area in your life. Include a baseline of current functioning as well as benchmark criteria for measuring progress.

9. Research and write a paper on one of the success tips in this chapter.

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Difficult Situations: Engaging with Hard-to-Reach Clients Multiple Choice Questions 1. Anger is a. an indicator that violence is imminent b. a sign of failure in counselling c. indicative of a psychiatric disorder d. a normal emotion e. a common outcome of counselling (Answer: “d”, page 267 2. The term psychological reactance describes how a. problem behaviours may increase if a person believes that his or her personal freedom is threatened b. people react to violence c. defense mechanisms impact behaviour d. chemical changes affect brain functioning e. counsellors have a tendency to avoid dealing with anger (Answer: “a”, page 238) 3. Which of the following counsellor behaviours will tend to increase client resistance? a. immediacy b. self-disclosure c. pressuring the client to change d. contracting e. core conditions (Answer: “c”, page 242) 4. Which of the following is true? a. age is not a factor in predicting violence .

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b. c. d. e.

alcohol lessens inhibitions and is associated with increased violence LSD and glue sniffing lessen the risk of violence the highest risk age and gender for violence is men from 40 to 49 years of age anger is a dangerous emotion

(Answer: “b”, page 251-253) 5. Which of the following is the best predictor of potential violence? a. command hallucinations b. social and personal stress events c. head injury or organic brain disease d. history of violent behaviour e. schizophrenia (Answer: “d”, page 251) 6. During the anxiety phase (escalating toward violence) client warning signs include a. increased agitation b. acting out behaviour c. threats d. displays of weapons e. psychosis (Answer: “a” page 257) 7. When clients reach the defensive phase (escalating toward violence), the best response is: a. calm them with a gentle touch b. set realistic and enforceable limits c. use a commanding voice tone establish control d. avoid compromise as this demonstrates weakness and will lead to further demands e. none of the above (Answer: “b”, page 258) 8. When dealing with clients who make veiled reference to what they might do, Gavin de Becker suggests that counsellors a. ignore the reference b. change the subject c. ask the client to be specific about their intentions d. notify the police e. let the client know that you will not tolerate such statements

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(Answer: “c”, page 259) 9. When dealing with potentially violent clients, compromise a. should be avoided b. is neither possible, nor desirable c. sets up a pattern whereby clients get what they want through threat d. makes it harder to set limits at a later date e. may help clients find a way to retain their dignity (Answer: “e”, page 260-261) 10. Which of the following statements is true? a. setting limits violates the trust of the counselling relationship b. failure to set limits can lead to acting-out behaviour c. angry clients rarely respond to limit setting d. it is usually better to state the limit with clear negative consequence e. limit setting exposes counsellors to significant risk (Answer: “b”, page 261-262) 11. Critical incident debriefing is a tool a. for interviewing and counselling potentially suicidal clients b. used to systematically record the reasons for a violent event c. that has been found to be helpful for people who have been traumatized d. that evaluate a client’s potential for violence e. used during the tension reduction phase to help clients understand the reasons for their violent behaviour (Answer: “c”, page 263) 12. Resistance is a term first introduced by a. Carl Rogers b. Sigmund Freud c. Gavin de Becker d. The Canadian Association of Social Workers e. Civil rights leaders (Answer: “b”, page 235) 13. Confrontation a. is the best method for promoting client change 8-51

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b. c. d. e.

has no place in professional counselling impedes the important goal of keeping the counselling relationship pleasant is a hostile act should be used sparingly

(Answer: “e” page 245) 14. Which of the following statements is true? a. mental illness is a strong predictor for violence b. clients who are violent are likely to have a mental disorder c. recent research has made it easy to predict who will become violent d. violence arises from a complex mix of psychological, social, biological, and physiological factors e. past behaviour is of little value in predicting who might become violent (Answer: “d”, page 253) 15. When counselling involuntary clients, it is important to a. restore their sense of power and control b. establish control c. use confrontation to confront resistance d. let them know that that they will be held accountable e. avoid discussion of the fact that they are involuntary (Answer: “a”, page 240)

True-False Questions 1. Confrontation is essential in order to effect change 2. When people perceive that their freedom is in jeopardy they may increase undesired behaviour.

3. Some resistance is normal and perhaps desirable.

4. At the defensive phase clients may lose the ability to think rationally.

5. Resistance is a symptom of a mental disorder.

6. Substance abuse increases the risk of violence 7. Confrontation should be used sparingly.

8. Unsolicited confrontation tends to foster resistance.

9. Violent clients usually have a mental disorder.

10. Counsellors should never compromise with angry clients as this demonstrates weakness.

11. Setting limits reinforces acting-out behaviour.

12. The anxiety phase provides early warnings of increasing anger and agitation.

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13. History is weak predictor of future violence.

14. The office should give both the counsellor and the client a clear path to the doorway.

15. The tension reduction phase is characterized by a gradual reduction in aggressive behaviour.

Answers: True: 2, 3, 4, 6, 7, 8, 12, 14, 15; False: 1, 5, 9, 10, 11, 13.

Short Answer Questions 1. What are some choices when clients ask counsellors personal questions?

Answer  Give a direct answer  Explore the meaning behind the question  Explore the implication of different answers  Empathy  Silence 2. Describe the different types of confrontation.

Answer: Feedback confrontation provides new information and it can be used to provide critical comment or to identify strengths. Confrontation of incongruities targets inconsistencies or contradictions.

3. What is the meaning of the term resistance?

Answer: It represents the client’s reaction to being pushed to do something they do not want. It can be used as a sign that the counsellor needs to do less of whatever is creating the resistance.

4. What responses tend to increase resistance?

Answer: unsolicited advice, pushing for change, preaching, moralizing, blaming, arguing, warning, power struggles, defensiveness, and judging.

5. What responses tend to decrease resistance?

Answer: empathy, no defensiveness, genuineness, respect, rolling with resistance, reflective responses, strengths approach, and radical acceptance.

6. What are the phases of violence as defined by the National Crisis Prevention Institute?

Answer. The phases are a textbook model and not a predictor of how each situation will evolve. Four phases (anxiety, defensive, acting-out, and tension reduction) are each characterized by particular indicators. For example, in the anxiety phase early warning 8-53

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signs such as pacing and other signs of agitation signal marked changes in the client’s behaviour. Each phase demands specific response strategies

Paper Topics and Research Projects 1. Write a reflective paper that addresses your concerns and personal feelings about dealing with angry and potentially violent clients. What aspects of your personal experience might make it difficult for you to deal with such clients?

2. Interview selected people in the social service workplace regarding their experiences dealing with aggressive and potentially violent situation subject Sample questions:  Have they ever been a victim of violence in the workplace?  If they have been a victim of violence, what precipitated it? Might it have been prevented?  In their experience, which clients are more likely to become violent? Why?  Does their agency have a policy around dealing with potentially violent clients?  What strategies have they used successfully to deal with potentially violent clients?

3. (For students doing concurrent field work training) Critically analyze your agency’s safety policy and procedures for dealing with potentially violent clients. Suggest adjustments that would make your work site safer. Caution: Remind students to be sensitive to the agency right to confidentiality regarding its internal operation.

4. Explore the topic of assertiveness including a detailed analysis (with examples) of the difference between passive, aggressive and assertive behaviour.

5. Assertive confrontation: Develop ineffective and effective confrontation responses for each of the scenarios below. Present your examples in a role play.

Scenario #1: You are a member of a student work group composed of yourself and three other students. For the third time in a row Joyce has not completed her share of the work.

Scenario #2: Your male friend who you have known for six months continues to make offensive (but not obscene) sexist remarks.

Scenario #3: You have been working with Gary for two months to help him to develop job-finding skills. He has noticeable body odour.

Scenario #4: You are in a task group. It seems to you that every time you want to speak, Phyllis cuts you off. After a group session, she invites you to coffee where she exclaims, ``wasn’t today great? Our group is so close and we work so well together.''

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think is too low.

6. Develop a detailed plan for addressing workplace violence (in a real or hypothetical setting.

7. Design an eight-week program for men who have anger management problems.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Test Bank Chapter Nine

Mental Disorders and Substance Abuse Multiple Choice Questions 1. The DSM is a a. classification system for mental disorders b. physicians’ guide to physical illness c. dictionary of different counselling philosophies d. book on best practice treatment strategies e. guide to the latest brain research (Answer: “a”, page 274) 2. Which of the following statements are true? a. most mental illnesses are caused by bad parenting b. as many as 1/3 of the homeless population have a mental disorder c. mental illness is usually not treatable d. fifty percent of all Canadians will experience a serious mental disorder e. most mental disorders start in middle-age (Answer: “b”, page 273, Table 3.1) 3. Psychiatric diagnosis a. relies on blood testing to confirm validity b. is based on standardized criteria in the DSM c. can be confirmed by X-Rays d. is the responsibility of all people who work as professionals in the helping field e. can only be made by a trained psychologist (Answer: “b”, page 272)

4. Which of the following statements is true? a. Bipolar disorder is no longer considered a mental disorder b. Substance misuse is no longer part of DSM 9-56

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c. DSM 5 has five axes d. Schizophrenia is an example of mood disorder e. Asperger’s syndrome has been eliminated from DSM 5 (Answer: “e”, page 274) 5. The Global Assessment of Functioning Scale (GAF) was used historically to a. measure the demographics of mental disorders around the world b. make cross-cultural decisions c. scale a person’s highest level of social, occupational, and psychological functioning d. rate the severity of psychotic symptoms e. compare how different individuals handle mental disorders (Answer: “c”, page 274) 6. Persons with schizophrenia a. have split personalities b. experience alternating moods of depression and mania c. have a mental disorder that usually develops after age 40 d. often experience hallucinations and delusions e. all of the above (Answer: “d”, page 277) 7. Which of the following is considered a “positive symptom”? a. hallucinations b. blunted or flattened affect c. poverty of speech d. social withdrawal e. anxiety (Answer: “a”, page 278) 8. Which of the following could be considered a delusion? a. hearing voices from the radio b. seeing things c. belief that one is God d. manic symptoms e. attempts to deceive others by lying

.

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(Answer: “c” page 279-280) 9. Which of the following is an example of a “negative symptom”? a. delusional psychosis b. social withdrawal c. delusions d. hallucination e. ambivalence (Answer: “b”, page 279) 10. Which of the following statements is true? a. the symptoms of alcohol withdrawal may be clinically indistinguishable from schizophrenia b. poor parenting causes schizophrenia c. clinicians treat schizophrenia by stimulating positive symptoms d. when clients are hallucinating it is important that counsellors actively challenge the reality of their hallucinations e. auditory hallucinations are rarely seen in clients with schizophrenia (Answer: “a”, page 297) 11. An individual is unable to think logically and they jump from one idea to another.

This is known as a. delusional behaviour b. creative thinking c. hallucinating d. disordered thinking e. obsessive compulsive disorder (Answer: “d”, page 280) 12. Dissociative drugs a. result in feelings of detachment from reality b. are used to treat depression c. help medics to deal with drug overdose d. include opioid such as heroin and opium e. help people focus (Answer: “a”, page 296)

.

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13. Which of the following is an opioid? a. prozac b. fentanyl c. marijuana d. peyote e. alcohol (Answer: “b”, pages 296) 14. Threats of suicide a. suggest the person the person has no serious intent b. are usually not given by people who complete suicide c. should not be talked about because discussion may increase risk d. usually mean that the person is just seeking attention e. need to be taken very seriously (Answer: “e” page 304) 15. When counselling someone who is suicidal, the “intent question” a. may promote the idea of suicide b. opens up dialogue about a person’s desire to die by suicide c. should only be asked in emergency situations d. may cause a client to withdraw further e. will unnecessarily complicate the counselling interview (Answer: “b”, page 306)

True-False Questions The “intent question” should be avoided.

Hallucinations and delusions are examples of positive symptoms, A delusion is usually auditory.

Delusion is another term for hallucination During manic periods, people may experience extreme agitation and need little sleep.

Thought insertion is the belief that thoughts are being inserted in one’s brain by others.

7. Women are more likely than men to have an eating disorder.

8. Bulimia involves heavy drinking followed by aggressive behaviour.

9. Mood stabilizers are used to treat bipolar disorder 10. Withdrawal from alcohol can be extremely dangerous.

1.

2.

3.

4.

5.

6.

.

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11. People with co-occurring disorders have a substance use problem and a mental disorder.

12. People who talk about suicide aren’t serious about killing themselves.

13. Counsellors should not ask people if they intend to kill themselves as this might plant the idea in their minds.

14. Brain plasticity refers to the damage done to brain’s frontal cortex by untreated mental illness 15. Tolerance is the need for more of the same substance (drug) to obtain the same effect.

Answers: True - 2, 5, 6, 7, 9, 10, 11, 15; False 1, 3, 4, 8, 12, 13, 14

Short Answer Questions 1. What are some of the important facts about mental illness in Canada Answer: No one is immune as 1 in 5 will get a mental illness in their lifetime. Virtually everyone will be affected. Almost 1/3 of people who are homeless have a mental disorder. The overall cost of mental illness is over 14 billion dollars per year.

Psychiatric problems are the second leading cause of hospital admission or those age 25 – 44. Mental illness can be treated.

2. How is mental illness diagnosed.

Answer: At this time there are no biological tests for major mental disorders.

Diagnosis is made using criteria form the Diagnostic and Statistical Manual for Mental Disorders.

3. What is the DSM? Briefly describe its structure.

Answer: It is the Diagnostic and Statistical Manual of Mental Disorders. This manual, used by physicians and psychologist in North America and many other countries lists the criteria for mental disorders.

4. What are some of the significant warning signs that a person might have a mental disorder?

Answer: Compulsions, obsessions, self-harm, substance abuse, delusions, hallucinations, identity confusion/memory loss, paranoia, inappropriate anxiety, euphoria, or sadness, mood swings, suicidal thoughts, eating and body image problems.

5. What is bipolar disorder?

.

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Answer: This disorder is characterized by alternating depression and mania. During manic phases people typically experience heightened energy, and an euphoric mood.

Irrational behaviour during the manic phase can be extremely problematic. (Page 322) 6. List the different types of psychiatric medications.

Answer: Antipsychotic, antidepressant, mood stabilizers, antianxiety, psychostimulants, and addiction medications.

7. What is meant by the terms “tolerance” and “withdrawal” Answer: Tolerance refers to the fact that, with continued use, individuals may need more of the same substance (drug) to get the same effect. Withdrawal refers to the physical symptoms, which can be extremely uncomfortable and dangerous, that arise when a person comes off drugs.

8. Give an example of the “intent question.”

Answer: “Are you thinking of killing yourself”?

Paper Topics and Research Projects 1. Research and write your own: a. Success tip b. Brain byte c. Conversation 2. Critically explore the strengths and limitations of the DSM for use by people in the helping professions 3. Write a paper on the topic of mental illness that explores the following issues and questions:   



Think about clients who have had mental disorders such as schizophrenia.

Identify best practices skills and strategies. What works? What doesn’t work?

In what ways are persons with mental illness the same or different than persons w/o mental illness? What unique challenges do people with mental illness present?

How do you know if someone has a mental disorder?

4. Research the topic of AIDS and report on the latest research findings. All of your source material should be no more than four months old.

5. Research best practice counselling strategies for working with people who have an eating disorder. .

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6. Research the principles of psychosocial rehabilitation (P.S.R.). Demonstrate your knowledge of the principles by setting up a case plan for Janine: Janine finished high school at 17 and was preparing to pursue a career as a dental hygienist at a local college. The summer before her first semester she suffered her first psychotic break when she was 17. Now 27, the past ten years look to her like a nightmare from which she never woke. Her first admission to a psychiatric ward came after her parents returned from a night out to find her naked on the front lawn.

After two weeks in the hospital she was diagnosed with schizophrenia, stabilized on medication and released. She received no ongoing support other than bimonthly meetings with her psychiatrist to monitor her medications. Janine resisted accepting her diagnosis, often preferring the freedom and excitement of being off medication to the hideous side-effects that she suffered with her anti-psychotic medication. Off medication, she felt a sense of control even if meant the return of frightening hallucinations.

The next ten years saw her in and out of the hospital over a dozen times. Addicted to street drugs, she was only able to sustain herself through prostitution. Her family, while initially supportive, increasingly dreaded her visits and they gradually decreased their support. Through it all Janine felt alone feeling that “even God has abandoned me.” Two weeks ago, Janine awakened suddenly to a loud noise, then realized she has been sleeping in a dumpster that was now being emptied. Unaware how she got there she scrambled to safety, barely escaping with her life, but breaking her wrist in the process.

Traumatized by this latest experience Janine has begun to accept the need for treatment. Her family “reluctantly agree to give her one last chance.” Her psychiatrist remains pessimistic and thinks that “at best she can be stabilized on medication and live out her life in a supported environment.”

Imagine that you are a mental health worker at Acme Mental Health. Draw on the philosophy of P.S.R, to develop a three month plan for working with Janine.

7. Research how evolving discoveries about the brain and brain plasticity are enabling neurologists to treat a range of mental disorders and brain injuries.

8. Choose a major mental disorder (schizophrenia, bipolar, depression). Prepare a onetwo page brochure that might be used to educate families on the disorder and its treatment.

9. Develop a short PowerPoint presentation that might be used to help a group of clients with mental disorders better understand their condition as well as strategies they can use to support their recovery.

.

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10. Develop a PowerPoint presentation for families who are dealing with a member who has a mental disorder.

11. Explore the implications of eliminating Asperger’s Syndrome from DSM 5.

.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Test Bank Chapter Ten

Cultural Intelligence Multiple Choice Questions 1. A person who seeks protection because of persecution in their country of origin is a/an a. foreign criminal b. international immigrant c. protection status immigrant d. refugee e. indigent (Answer: “d”, page 215) 2. Approximately what percentage of Canada’s population were born in another country? a. five per cent b. fifteen per cent c. twenty per cent d. fifty per cent e. impossible to estimate (Answer: “c”, page 312) 3. Marginalization is best defined as a. the process by which people become Canadian citizens b. racial discrimination c. a person who has a worldview that is at odds with mainstream Canadian society d. a measure of the gap in income between the richest Canadians and the poorest e. formal or informal exclusion of groups or individuals from full participation in society (Answer: “e”, page 314)

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4. Residential schools a. were appreciated by indigenous people b. left a legacy of physical and sexual abuse c. provided much needed assimilation services to indigenous people d. are an example of cultural appropriation e. were resented by mainstream Canadians because they gave indigenous people unfair advantages (Answer: “b”, page 318) 5. People who have “collectivist” perspective believe a. one’s personal wishes are less important that family and community responsibilities b. that it is important to accumulate wealth c. one has little control over what happens d. one’s life is controlled by others e. in the importance of the work ethic (Answer: “a”, page 322) 6. Visible minorities in Canada generally believe that a. discrimination is rare b. mainstream social service agencies meet their needs c. racism is a major problem d. claims of prejudice are wildly over-estimated e. their worldviews are respected by service providers (Answer: “c” page 319) 7. Cultural appropriation a. is a measure of adaptation to a new culture b. describes appropriate counselling skills for working with minority groups c. is another term for discrimination d. involves adopting elements of another person’s culture in a disrespectful way e. is the belief that one’s own culture is superior (Answer: “d”, pages 314) 8. Culture shock is best described as a. psychological problems associated with adjustment to a new country 10-65

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b. the need for immigrants to adapt quickly to their new culture c. friction between the immigrant culture and their new society d. the impact of immigrants on the host culture e. negative attitudes towards immigration (Answer: “a”, page 314) 9. Which Canadian legislations defines categories of immigrants a. The Canadian Immigration and Refugee Protection Act b. The New Immigrant Act c. The United Nations Bill of Rights d. The Canadian Charter of Rights and Freedoms e. Immigration Classification Act (Answer: “a”, page 315) 10. Metis are defined as persons with a. mixed First Nation and European ancestry b. restricted Indian status c. legal immigrant status from India d. any person with more than 25% Indian ancestry e. an elder (Answer: “a”, page 333) 11. Which of the following statements is true? a. eye contact is a sign of trust and respect in all cultures b. feelings are universally expressed in the same way by all cultures c. an emphasis on verbal expression and emotional disclosure is appropriate regardless of the culture d. keeping one’s emotions private is an indicator of maturity for some cultures e. in almost all cultures personal distance is 1 – 1.5 metres (Answer: “d”, pages 324-325) 12. Stereotyping a. results in broad and inaccurate generalizations b. avoids loss of objectivity c. reflects the importance of individual differences d. assists counsellors to make important generalizations e. insures that one’s World view does not impact judgment 10-66

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(Answer: “a”, page 329-330) 13. Ethnocentrism is best defined a. World view b. belief that one’s values, beliefs, and traditions are superior c. cultural background d. values, beliefs and behaviours e. none of the above (Answer: “b”, page 314) 14. Residential schools are associated with what group a. Japanese during the second world war b. Indigenous people c. Chinese immigrants during the early 1900’s d. French disidents e. Vietnam defectors during the 1970’s (Answer: “b”, page 334) 15. Which of the following statements is true? a. Canadians with Western origin discourage children becoming independent from their families b. all cultures value separation from family c. in Canada collectivism tends to be favoured d. among Asians high priority is individualism e. in many cultures separation from family is neither sought nor desired (Answer: “e”, page 321)

True-False Questions 1.

2.

3.

4.

5.

6.

7.

A Rogerian approach favours exploration of feelings All cultures value separation from family as a sign of maturity.

Worldview measure an individual’s depth of understanding about other cultures.

In general, North Americans place high value on collective identity.

All cultures value the importance of eye contact as a way to communicate respect.

Stereotyping is a useful way to make cultural generalizations.

Métis have mixed First Nation and European ancestry.

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8. Boarding schools contributed to the development of First Nations communities in Canada.

9. Culture shock occurs when members of the dominant culture are over whelmed by immigrants.

10. Questions of a spiritual nature should be avoided in counselling.

11. Fear of stigma is one reason why ethnic minorities avoid seeking help from the mental health system.

12. Ethnic groups are generally dissatisfied with mainstream counselling services.

13. Effective counsellors consider family and community helping networks.

14. Xenophobia is defined as fear, suspicion or distrust of people who are different.

15. Ethnocentrism enables counsellors to adapt their approach to different cultures.

Answers: True - 1, 2, 7, 11, 13, 14; False - 3, 4, 5, 6, 8, 9, 10, 12, 15.

Short Answer Questions 1. List the obstacles faced by many immigrants to Canada?

Answer: language barriers, unemployment or underemployment, poverty, discrimination, culture shock, parent child relationship issues, and male-female role adjustment challenges.

2. What is culture shock?

Answer: Psychological reaction to the stress of living in a new country that might include bewilderment, increased self-consciousness, embarrassment, shame, and low self-esteem.

3. What is meant by the term “worldview?”

Answer: A person’s belief system.

4. What is the difference between “individualism” and “collectivism?”

Answer: An individualistic identity places high value on self and immediate family while a collectivistic identifies places high value on community and state.

5. What are some of the unique features that characterize First Nations approaches to healing?

Answers: medicine wheels, storytelling, teaching and sharing circles, use of elders.

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 10 Cultural Intelligence

Paper Topics and Research Projects 1. Write a paper exploring the concept of cultural appropriation.

2. Explore how counsellors can effectively engage and work with clients from a different culture.

3. Prepare a presentation using PowerPoint or other media on the topic: How to improve cross-cultural communication.

4. Pick a culture or diversity group other than your own. Research the values, customs, spiritual beliefs, and worldview of this group. What challenges might you face working with individuals from this group?

5. Select a religious faith other your own to research. What are the major beliefs and rituals of this religion? If possible, arrange to attend one of their religious gatherings.

Assume you are counselling a client who has strong beliefs rooted in this faith. What are the implications of this for your work? Prepare a report that summarizes your findings.

6. (Group project) Imagine you have been recruited to consult with a small community agency (staff of 15 and an annual budget of 1 million dollars) to revamp their counselling services to be more culturally sensitive. Their current client group is: 50 Caucasian; 20% Asian; 10% French and 20% First Nations. All of the current staff, except one, is Caucasian. Develop a long-term detailed plan that considers such variables as: office design, staffing; service delivery models; community interface; outreach, and others.

7. Explore (with specific examples) how counselling choices might need to be varied to meet the needs of people from different cultures, worldviews, and spiritual orientations.

8. Write a reflective paper that explores your worldview. What elements of your worldview might be an asset or a hindrance in your work as a counsellor?

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Test Bank Chapter Eleven

Neuroscience and Counselling Multiple Choice Questions 1. What percentage of the body’s energy fuels the brain a. 10% b. 20% c. 30% d. 40% e. 50% (Answer: “b”, page 344) 2. Neuroscience is a. a new force in counselling b. pseudoscience c. based on behavioural management principles d. closely linked to psychoanalysis e. an imaging technique (Answer: “a”, page 344) 3. Neuroplasticity is a term used to describe a. an innovative approach to brain surgery b. the permanent nature of most brain injuries c. how the brain metabolizes drugs d. the brain’s ability to change e. the fact that the brain does not change over the lifespan (Answer: “d”, page 350) 4. How many hemispheres does the human brain have? a. two b. three

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Shebib, Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition Chapter 11 Neuroscience and Counselling

c. four d. five e. an indeterminate number (Answer: “a”, page 358) 5. Which of the following is considered a brain lobe a. amygdala b. hypothalmus c. brain stem d. parietal e. spinal chord (Answer: “d”, page 359-361) 6. Broca’s area is concerned with a. language b. emotions c. sensory perception d. motion e. sexual desire (Answer: “a”, page 361) 7. The occipital lobes are responsible for a. touch b. vision c. hearing d. smell e. taste (Answer: “b”, page 360) 8. Charles Bonnet Syndrome results in a. visual hallucinations b. neuropathic pain c. delusions d. paralysis e. inability to speak

.

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(Answer: “a”, page 361) 9. The limbic system is primarily concerned with a. control of our arms and legs b. flexibility of movement c. emotions d. regulating heart beat e. hearing (Answer: “c”, page 362) 10. Neural transmission is a a. brain disorder b. counselling technique that harnesses brain plasticity c. chemical signals from one neuron to another d. rigid pattern of thinking caused by repetitive actions e. breakdown of myelin that results in multiple sclerosis (Answer: “c”, page 367) 11. Dopamine, serotonin and glutatmate are examples of a. neurotransmitters b. parts of the endocrine system c. parts of the brain d. proteins e. street drugs (Answer: “a”, page 370) 12. Alzheimer’s a. is caused by a brain tumor b. an example of a neurocognitive disorder c. only happens to people over 65 d. can be cured with medication e. is fatal for about 65% of those with the disease (Answer: “b”, page 377) 13. Sundowning is best described as a. depression .

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b. hallucinations caused by brain lesions c. relief experience by people treated with prozac d. late day confusion often experienced by people with dementia e. a counselling strategy designed to calm people with mania (Answer: “d”, page 378) 14. The part of the brain associated with higher order thinking, good judgment and decision making is the a. amygdala b. temporal lobe c. central nervous system d. occipital lobe e. frontal lobe (Answer: “e”, page 360) 15. The hippocampus is responsible for a. decision making b. language and speech c. vision d. hearing e. storing memories (Answer: “e”, page 364)

True-False Questions 1. The brain is 10% water.

2. In recent years neuroscience research has disputed most traditional approaches to counselling.

3. Neuroplasticity refers to the brain’s ability to change.

4. There are sixteen lobes of the brain.

5. The amygdala plays a critical role in processing emotions.

6. The hippocampus is responsible for storing memories.

7. The endocrine system secretes hormones.

8. Neuroscientists have identified about 12 different neurotransmitters.

9. Inhibitory neurotransmitters calm the brain and inhibit other neurotransmitters from firing.

.

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10. The reward pathway of the brain releases dopamine to reward activities that it finds pleasurable.

11. Alzheimer’s disease is curable.

12. Myelin is damaged in people with multiple sclerosis.

13. Alzheimer’s can be diagnosed with a simple blood test.

14. About 40% of people over 65 will have some memory loss, and this is normal.

15. The “FAST” test may indicate that a stroke has occurred.

Answers: True - 3, 5, 7, 9, 10, 12, 14, 15 False - 1, 2 4, 6, 8, 11, 13

Short Answer Questions 1. List the six key forces in counselling Answer: psychoanalysis, behaviourism, humanism, multiculturalism, social justice, and neuroscience 2. Describe the amygdala Answer: It is an important part of the brain’s limbic system that plays a role in the regulations of emotions such as fear and anger.

Paper Topics and Research Projects 1. Suggested topics for a research paper: a. The links between neurotransmitter dysfunction and mental disorders. b. A comparison of counselling with a neuroscience perspective to counselling without a neuroscience perspective. c. The neuroscience of mindfulness. d. The developing adolescent brain and its implications for counselling youth. e. The effect of trauma on the brain and its implications for counselling. f. The brain over the lifespan.

2. Write an in-depth research report that explores the neuroscience of one of the following disorders: a. Depression b. Epilepsy c. Schizophrenia d. Substance Misuse e. Anxiety

.

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3. Present research finding on how commonly used street drugs affect the brain. Identify the immediate, short-term, and long-term impact of these drugs on the brains of users. What are the counselling implications of this research?

4. Write a book report on a recent (last five years) publication on the brain.

5. Write an extended paper on one of the Success Tips from this chapter.

6. Reflect on your learning in this course and submit a paper outlining your personal philosophy of practice, e.g., your preferred style, the major concepts or theoretical orientation that guide your practice, your assumptions about interviewing, counselling and helping.

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MANUAL Bob Shebib Douglas College (Emeritus)

Choices: Interviewing and Counselling Skills for Canadians Seventh Canadian Edition Bob Shebib

Toronto ISBN: 978-0-1352-2208-9 Copyright © 2020 Pearson Canada Inc., Toronto, Ontario.

All rights reserved. This work is protected by Canadian copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the Internet) will destroy the integrity of the work and is not permitted. The copyright holder grants permission to instructors who have adopted Choices: Interviewing and Counselling Skills for Canadians, Seventh Canadian Edition,

by Shebib to post this material online only if the use of the website is restricted by access codes to students in the instructor’s class that is using the textbook and provided the reproduced material bears this copyright notice.

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Contents Introduction to Instructor Resources Chapter 1

Professional Identity: Ethics, Values, and Self-Awareness

Chapter 2

The Skills, Process, and Pitfalls of Counselling

Chapter 3

Relationship: The Foundation for Change

Chapter 4

Listening & Responding: The Basis for Understanding

Chapter 5

Asking Questions: The Search for Meaning

Chapter 6

Empathic Connections

Chapter 7

Supporting Empowerment and Change

Chapter 8

Difficult Situations: Engaging with Hard-to-Reach Clients

Chapter 9

Mental Disorders and Substance Abuse

Chapter 10

Cultural Intelligence

Chapter 11

Neuroscience and Counselling

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Introduction to Instructor Resources Choices: Interviewing and Counselling Skills for Canadians, Manual includes online instructor resources organized in three separate sections for each of the chapters: 1. Learning objectives 2. Answers to selected text exercises.

3. Teaching strategies and class activities 4. Additional resources 5. Additional paper topics and research projects Suggestions for Using Choices: Interviewing and Counselling Skills for Canadians ●

Semester Organization Although the chapter sequence is designed to meet the needs of most courses, you can structure presentation and assigned readings to meet your curriculum needs.

Chapter 6 Empathic Connections, for example may be presented out of sequence in whole or part. Many programs have separate courses on ethics and working with culturally diverse populations, so Chapter 1 and Chapter 10 may be deferred to these courses. Some programs may be able to defer Chapters 7 – 9 to an advanced course and focus on the first six chapters as an introduction to basic interviewing and counselling skills. This edition’s new chapter on neuroscience and counselling (Chapter 11) may be integrated into course content at any point.

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Class Structure Students need substantial practice time to become familiar with and comfortable with the concepts in the book. Small learning groups (see below) are effective for establishing the necessary trust and continuity to facilitate this learning. As well, students can be encouraged to practice basic listening and communication skills in their everyday encounters with others including family and friends. Structure class time to allow for a balance of theory, instructor demonstrations, and student practice.

Beyond lectures: Educators know that hands-on learning far better than long lectures. Here’s an article that contains some useful ideas for enhancing class time with experiential methods. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3592730/

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Instructor Demonstrations Throughout the course, it is important that students be able to see live demonstrations. Short instructor demonstrations with student volunteers are recommended. Try to meet with the student volunteer to insure that the issues they discuss are appropriate. Some students may reveal too much and it is the responsibility of the instructor to prevent this from happening.

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Use of Media Video and audio taping is a powerful means of helping students recognize their use of skills as well as missed interview opportunities.

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Links to Practicum If students are involved in field practice (practicum or internship) encourage them to practice skills in their agency setting. As well, their experiences (successes and challenges) can be explored in class discussion.

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Chapter Exercises Each chapter in the text has exercises designed to help skill development, enhance understanding of concepts, and promote self-awareness. Most instructors will find that there are too many exercises for a single semester course, however selected exercises can be assigned as homework and students can be encouraged to select exercises to meet their own learning needs. Possible answers for selected text exercises are included with each chapter in the Instructors manual.

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Competence Candidly discuss with students the importance of working within one’s competence. In an introductory course on counselling, the goal is to master basic listening and response skills. Practice interviews can legitimately target issues such as: information gathering, decision making, problem solving, management of feelings, and offering support and encouragement. Students should be cautioned that they are not therapists and they should be cautioned about exploring more complex areas (e.g., mental health diagnosis and treatment of disorders).

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Ethics and Confidentiality Emphasize from the onset the importance of confidentiality, particularly with respect to discussions in the learning groups. Caution students to resist the temptation to discuss practice interview content with other students, family, and friends.

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Self-disclosure: How much is appropriate?

Learning exercises will involve opportunities to practice with student colleagues.

This works best with “real” rather than role-played information, but there may be times when it is more appropriate to work with simulations. However, encourage students to be prudent about what they share. Intimate self-disclosure is not necessary. This is an appropriate time for instructors to offer some introductory comments regarding counsellor self-disclosure. Emphasize that it should not be routine and that it should be offered only if there is evidence that it will assist clients. It should not shift the focus of attention from the client to the counsellor.

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Giving and Receiving Feedback Before learning groups begin their work, time should be invested in helping students recognize the potential for growth when effective feedback is available as well as the dangers when feedback is ineffective. Conduct a discussion on the skills of giving and receiving feedback.

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Use the following questions to stimulate ideas: a.

What are the essential skills, strategies and attitudes for giving effective feedback to others? b.

What skills, behaviours and attitudes will create the right conditions that will encourage people to offer (and continue to offer) you constructive criticism.

At this point, a discussion about individual differences is desirable. Ask students to reflect on how they like to get feedback. For example, some prefer “direct and to the point,” while others prefer a gentle approach with critical comment mixed with positive feedback. Remind students of the implications of this for working with clients who will also have feedback preferences. ●

Teaching Assistants If you have a class size much more than optimal (i.e., greater than 15 students), consider offering a graduate student (e.g. Master of Social Work) an opportunity to do their field work helping with the learning groups.

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Reflective Learning Encourage students to maintain a journal that records their insights, feelings, and progress.

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Practice Interviewing and Experiential Learning During practice interviews students often discover that others are struggling with many of the same questions and anxieties as themselves. For example, many beginning students fear that they will say the wrong thing and seriously damage their clients. Interview practice in a trusting group gives students a safe opportunity to develop and practice their skills.

What to Watch for and Manage During Practice Interviews: Students who o bombard other with excessive feedback. Focusing on one or two skills at a time will make feedback more manageable. o are reluctant to offer critical comment and only make general statements such as “you did great.” o are overly intent on analyzing others. o are overly defensive to feedback. o quickly move to advice giving or rescue responses (this is common for many beginning learners)

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Help Students Anticipate Challenges Discuss the following realties with students as they begin the course: i.

ii.

Learning new skills often results in a period (sometimes extended) of awkwardness. This is normal and an indicator that new learning is taking place.

Encourage students to share these feelings with colleagues.

Family and friends may be suspicious of their attempts to utilize new v

communication skills in everyday encounters. Some may be threatened by their new knowledge and skills. Remember that if they change, others must also change to accommodate. This is a chance for students to experience some of the pressures and obstacles that clients face with they attempt a change program. ●

Learning groups Typically, teaching from this text requires instructors to blend theory, demonstrations and opportunities for practice. One good way for students to practice is in small learning groups of 3- 5 colleagues who will work as a team for the complete semester. Learning groups should have regularly scheduled class time for practice interviewing. For these groups to be effective, a safe environment must be established. After groups are formed and before groups begin their work, spend time helping the group to establish a contract.

Whenever possible, students in practice interviews should be encouraged to be themselves, i.e., share real and current issues and feelings as opposed to role playing. While role playing may have some utility, it lacks the spontaneity of real life interactions.

Suggest to students that when they evaluate a learning group interview that the interviewer is given an opportunity to self-evaluate before any feedback is offered.

Use Handouts 1 and Handout 2 below to guide student discussion. (Suggestion: Preview the fact that the contracting process for their small group parallels the contracting process with clients)

NOTE TO INSTRUCTORS: Help us make the instructor resources for Choices better! Please suggest ideas (e.g., test questions, essay topics, teaching strategies, audio-visual resources) for inclusion in the online resources.

Send your suggestions to Bob Shebib, email: shebib@telus.net. All suggestions will be greatly appreciated.

If adopted, full credit will be given.

Student Handout Number 1 . vi

Learning Group Contract For most of this course you will be working in a small group with 3 student colleagues.

Your group will have continuous opportunities to practice interviewing and counselling skills.

Most often, practice interviews will not involve role playing, but rather exploration and discussion of real issues. Consequently, it is important that you develop a strong working relationship and a contract or agreement on how you will work together.

Some sample questions for your group to explore to begin to develop your contract: a. b. c. d. e. f. g. h. i.

what problems have you encountered in previous working groups that you wish to avoid? (Discuss without breaching confidentiality) what have you liked about previous working groups that you wish to duplicate? what you hope to learn? what you want from colleagues in terms of help/feedback? how do you "like your feedback"? (consider individual differences) what you are willing to do to contribute to the success of your group? Risk Taking?

Self- disclosure? how will you address any communication problems or difficulties that arise in your group? what will be your process for reviewing and revising your contract? what “rules” do you wish to establish, e.g., for example, confidentiality, division of work, risk taking absences?

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Student Handout Number 2 Prior Experiences in Groups Think about your previous experiences in groups. If you worked in a group that did not function well, self-examine your role and contributions to the problems and unrealized solutions: ■ ■

in what ways did your feelings, attitude and behaviour hinder the group? did you tenaciously cling to ideological positions and established patterns at the expense of the group? To what extent were you flexible and adaptive?

Consider that your attitudes and behaviour in future groups will always be shaped (helped or hindered) by prior experience. For example, if you felt your trust was betrayed, you may become guarded or hyper vigilant. This is understandable, but this behaviour is a reaction to your experience and it will not help you make a healthy adaptation to future groups.

Discuss.

Identify how you and the group might have behaved differently to realize a different ending.

This will help you to develop insight and skills for working in new groups or relationships.

Someone once said that "the lesson is repeated until it is learned." If you find yourself in different relationships and groups where the same or similar problem repeats, you may have more to do with it that you might imagine. Examine how your frame of reference might have led you to under or overreact to events. Have the courage to look at self, own your responsibility, and change.

Think about the fact that everyone has a different frame of reference. What is important for one person may be minor or unimportant to another. This perspective applies not only to content that is deemed relevant or not, but also to the priority that is given to different variables such as styles of communication, methods of operating, values, conflict resolution, division of work, etc. Culture, values, age, gender, past experience, current vulnerability and a host of other factors lead to a broad range of individual differences. So, with respect to groups, what is important to you?

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Instructor’s Manual Chapter One Professional Identity: Ethics, Values, and Self-Awareness Learning Objectives 

Identify the Canadian professionals that provide counselling services.

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Identify how counsellors can work within the limits of their competence.

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Define and describe professional ethics, including standards related to dual relationships and confidentiality.

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List and describe the core values of counselling.

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Identify principles for understanding and resolving ethical dilemmas.

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Understand the importance of counsellor objectivity and self-awareness.

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Understand and manage personal needs and values in counselling.

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Recognize and address burnout and vicarious trauma as workplace hazards

Comments and Possible Answers to Selected Text Exercises Self-Awareness Instructors: The self-awareness questions in this chapter and the others to follow highlight the ongoing responsibility for counselling professionals, namely, to pursue self-awareness.

Essential elements of this include such variables as: identifying skill strengths and weaknesses, personal areas of vulnerability, knowledge of biases, understanding the impact of one’s own socialization and culture, learning about personal needs and they might hinder counselling, exploring one’s impact on others. Encourage students to set goals and to develop appropriate action plans in this area. Refer them to Chapter 7 for goal setting and action planning strategies.

To develop self-awareness, emphasize strategies such completion of the self-awareness exercises in each chapter, seeking feedback from others, including (where appropriate) clients. Suggestion: Have the class discuss how they can create conditions that will support others to give honest and timely feedback – e.g., non-defensive responses, identifying targets (goals for feedback), positive reinforcement of the process. Journaling and the use of audio and video tapes can also provide needed data. Discuss how risk-taking outside of one’s .

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comfort zone can increase skill as well as self-awareness.

1. What strong beliefs do members of your cultural/ethnic group hold?

Discussion Points  Assist students to share how their beliefs are the same or similar to those of the dominant culture. Explore implications for counselling.  Students may identify as bi-cultural, tri-cultural or not aligned with any single culture. Others may note that their cultural values often collide with those of their parents who hold strongly to traditional values. 2. Use the questions and situations below to examine your values related to sexual orientation issues. a. If a client of yours is gay or lesbian, how might it influence the way you work with him or her? b. What would you do if a friend told you an anti-homosexual joke or story? What if the person telling the joke was a client or a colleague? c. Do you have gay or lesbian friends? d. Do you think homosexuality is an illness? e. Your daughter discloses that she is lesbian. Predict how you might feel, think, and behave. f. Your best friend confides that he feels he is the wrong gender. How do you respond? g. What are your views on same-sex marriage?

Discussion Point  Explore how professional counsellors are often working with clients whose values differ from theirs. How can this be managed, particularly in situations where their clients values elicit strong emotional responses?

3. Write an essay that explores your values and beliefs Explore issues and questions such as:       

 

Why do you want to become a counsellor? What priority needs do you expect to meet through your work? In what ways might your personal needs be an impediment? Are people inherently good or bad? What is your understanding of the meaning of life? Should people have the right to take their own lives? Should immigrants be required to speak one of Canada’s two official languages? What are the characteristics of the client you would most and least want to work with?

(Be specific regarding as many variables as possible, such as age, gender, personality, culture, and religion.) Why would you choose these characteristics? What topics or issues are likely to evoke strong personal reactions from you? What does authority mean to you? How do you behave and feel when you are relating to people in authority? 1-2

Chapter 1: Professional Identity: Ethics, Values, and Self-Awareness  

Where do you draw your strength? When you die, what do you most want to be remembered for?

4. Explore your personal strengths and limitations. Use the following topics to structure your assessment:               

any tendency to fall into the advice-giving trap capacity to be assertive (as opposed to shyness or aggressiveness)  degree of self-confidence comfort dealing with a wide range of emotions need to control or be in charge capacity to relate to diverse populations (age, gender, culture, religion, etc.) ability to give and receive feedback (positive and critical) need to be helpful anxieties and fears competence in initiating relationships (beginnings) ability to deal with conflict self-awareness regarding how others see you overall awareness of personal strengths and limitations values and attitudes that will help or hinder your work as a counsellor capacity and willingness to change

Based on your answers, identify what you consider your five major strengths and your five major limitations to be.

5. Evaluate your capacity for handling feedback from others. Are you generally open and nondefensive when others critically evaluate your behaviour or performance? Do you tend to avoid asking for feedback? Do you actively solicit feedback? Interview friends and colleagues for their opinions.

6. Are you excessively dependent on your clients? Rate yourself for each statement below using the following scale: 4 = always 3 = frequently 2 = sometimes 1 = rarely 0 = never a. b. c. d. e. f. g.

I feel responsible for the feelings, thoughts, and behaviour of my clients.

I get angry when my help is rejected.

I feel worthless or depressed when clients don’t change.

I feel compelled to help people solve problems by offering unwanted advice.

I want to take care of my clients and protect them from painful feelings.

When clients don’t like me, I feel rejected or inadequate.

I do things to make my clients like me, even if what I do is not helpful.

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Manual for Choices, Seventh Canadian Edition

h. I avoid confronting or challenging clients. i. I tell clients what they want to hear. j. I feel most safe when I’m giving to others. k. When clients fail, I take it personally. l. I spend too much time proving to myself and my clients that I’m good enough. m. I tend to be very controlling with clients. n. I tolerate abuse from clients to ensure they like me. o. I feel responsible for solving my clients’ problems.

Carefully review any statements where you scored 4 or 3. Use your awareness of problem areas to develop a program of self-change.

7. Imagine that you are a client. What might your counsellor need to know about you (e.g., values, needs, preferences) to work effectively with you?

8. Take an inventory of your friendship circle. To what extent do your friends come from the same cultural group and have the same values base as your own? Predict what might happen if you broadened your circle to include more diversity. Develop a plan to learn about the cultures and world religions in your community.

Comment: Engage the class in a brainstorming session on ideas for increasing knowledge. Examples: attend diverse religious ceremonies, volunteer for a multicultural event, read books about different cultures, interview people from diverse communities, cultivate multi-cultural events, mark religious holidays for different religions on a calendar then try to acknowledge or celebrate these holidays.

Skill Practice 1. Interview one of more colleagues who deliberately introduce issues, feelings, or behaviours that represent “triggers” for you. What did you learn from this interview?

2. Imagine that you are addressing a situation where you believe a colleague has acted unethically, for example, by breaching confidentiality or speaking rudely to a client. Assume that you have decided to approach the colleague informally to share your observation. Roleplay what you might say.

Concepts 1. Can we promise our clients absolute confidentiality? Why or why not?

Answer: We can only promise relative confidentiality because of such realties as duty to warn others of intended harm by the client or responsibility to report child abuse.

2. What are some advantages and disadvantages to allowing clients access to files?

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Chapter 1: Professional Identity: Ethics, Values, and Self-Awareness

Answer: Advantages - Empowers clients to be involved in the process. It helps counsellors remain accountable for their assessments. It provides an opportunity to share perceptions.

Disadvantages - May lead to counsellors editing important information or observations in order to avoid conflict. Clients may react with anger. Some clients may not be emotionally able to handle the information.

3. Under what conditions would you make exceptions to the principle of self-determination?

Answer: In emergencies where the client is unable to make a decision for themselves.

If the client’s behaviour might harm others. When clients lack the emotional or intellectual ability to act on their own behalf.

4. Use the concepts in this chapter to explore ethical issues and strategies for each of the following situations: a. An elderly, frail woman suffering from inoperable cancer decides to kill herself.

Comment: Use this question to explore religious, moral, and legal issues regarding right to die, assisted suicide. Consider how different cultures might respond to this - e.g., hari-kari in traditional Japan. Related issues to consider: mental health status, professional responsibility to do no harm. b. A client decides to give his life’s savings to his church.

Issues to consider: Mental health status, coercion or manipulation, rights of others in the client’s family. While clients have the right to dispose of their assets as they wish, counsellors can and should assist clients to avoid impulsive decision making.

For example, a client in the manic phase of bipolar disorder might impulsively give his money to the church.

Similarly, a client with schizophrenia might hear voices telling him to give everything away. In either case, it is clear that the client’s ability to make a rational and informed decision is impaired and counsellors should take action. The longterm interests of the client are best served by actions which prevent him giving away his assets. c. A 16-year-old male client boasts that if his girlfriend tries to leave him, he will kill her.

Comment: Consider whether this is an idle threat or a serious intent. Discuss how one’s professional duty to inform intended victims applies even if this supersedes the client’s right to confidentiality. At the same time, preventing a client from harming someone else is also in his long- term best interests.

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Manual for Choices, Seventh Canadian Edition

d. A client from a counselling relationship that terminated six months ago phones to ask you for a date.

Comment: Use this question to explore when, if ever, a counsellor should be free to form a different relationship with a former client. Reference the CCA Code, sections B11 and B12 which provide some reference points, but no clear direction.

See Conversation 2.2 on page 45. It is never acceptable to have sexual relations with a client. e. Your client leaves your office in anger, determined to “teach my wife a lesson for the way she treated me.”

Comment: see question “c” above. f. Knowing that you are in the market for a new car, your client, a used-car salesperson, offers to help you buy a car at the wholesale price.

Comment: In this case the injunction forbidding dual relationships applies.

Counsellors should not allow themselves to realize personal gain or loss from their relationship with a client.

Supplementary discussion questions: What if you know that buying the car will assist your client to meet a necessary sales quota? What if you buy the car and it is a “lemon?” If you buy, how might this affect your counselling relationship? g. Your client is a young woman (age 17) with sexual identity issues. She inquires about your sexual orientation.

Comment: Self-disclosure should be offered only when it will benefit the client and when it will not compromise the helping relationship. Thus, in different circumstances it might be appropriate to share this information, while in others it would be inappropriate.

Supplementary discussion: How might the client’s reasons for knowing change your answer? Suppose, for example, that your client was dealing with his own sexuality? If you are gay, do you think you have a responsibility to share this? h. Your client asks for your e-mail address so that he can keep in touch.

Comment: Counselling relationships are time-limited and when their intended purpose is achieved, the relationship should be terminated.

On the other hand, clients may have need for additional service in the future. It is appropriate to provide agency contact information including your business email, but generally, it would be risky and ill-advised to provide personal email, phone number, or home address.

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i.

Your client, a bisexual male, has tested HIV-positive but informs you that he does not wish to tell his wife. He says that he will practise safe sex.

Supplementary discussion: While Canadian law requires a person with HIV or any other sexually transmitted disease that could cause serious harm to disclose their status to their partner before engaging in sexual activity, the duty to warn has not been established by the courts. For a detailed discussion of this issue see www.aidslaw.ca and search for Criminal Law & HIV Non-Disclosure Law in Canada

j. You receive a call from the client’s wife. She says she is concerned about her husband and asks whether you think her husband might be gay.

Supplementary discussion: Generally, clients have a right to at least relative confidentiality and disclosure to his wife would not be appropriate. However, an interesting dilemma arises if the husband in question is the man described in question “I” above. k. Your colleagues begin to talk about a client. You are with them at a local restaurant.

Comment: A restaurant is not an appropriate place to discuss clients. You could simply state that you are not comfortable having this discussion in this public place and you would prefer to meet later to discuss the matter. Or, you could excuse yourself from the group. At the very least, you should not participate. This is not easy given the social pressure to be part of the colleague group. Your problems may be compounded if you are a student or if you are new to the agency and have little power to effect change. l.

One of your colleagues tells you that she has just returned from a one-day workshop on hypnosis. She says that she can hardly wait to try it on some clients.

Comment: Counsellors must insure that they “do no harm.” In this respect they have a responsibility to confront colleagues when they believe their actions have the potential for harm. A one-day workshop is insufficient preparation for using hypnosis as a counselling tool. Professionals who are concerned about the behaviour of colleagues have a responsibility to discuss this directly with them. If this confrontation is unsuccessful, it is appropriate to raise concerns with your supervisor. In some circumstances, such as those involving harm to clients (e.g., a counsellor in sexual relationship with the client) the matter must be reported to a supervisor and/or the appropriate professional body.

m. You encounter one of your colleagues having lunch with a client. You notice that they are drinking a bottle of wine.

Issues: professional boundaries, dual relationships, responsibility of professionals 1-7

Manual for Choices, Seventh Canadian Edition

to deal with the behaviour of colleague professionals. Drinking with a client violates appropriate boundaries. In order for counselling to be successful, conditions different that personal friendship must be maintained. In this case, you should first air your concerns with your colleague, but subsequent discussion with colleagues or professional bodies may also be warranted. n. You have an erotic dream about one of your clients.

Comment: Discuss how it is normal to have feelings (positive and negative) towards clients. Of prime importance is monitoring our reactions in order to maintain objectivity. In some cases, we may not be able to do so, and then discussion with colleagues and supervisors, or referral to another worker emerge as alternatives. o. While you are counselling a student (in your role as school counsellor), he discloses that he is selling marijuana to classmates. (Would your answer be different if you were a counsellor in a community agency unconnected to the school?)

Comment: Debate whether the duty to warn principle applies in this case. p. You are a counsellor working with a young, gay client. He has been socially isolated and is slow to trust anyone, but over time you have managed to form a strong working relationship. Imagine that he approaches you with a request that you walk with him in the annual gay pride parade. What variables would you consider in making your decision? What are the implications of going with him? What are the implications of not going?

Issue: Dual relationship. q. Your client is down to her last two dollars. She offers to buy your coffee.

Issue: Her financial state and the fact that buying you a coffee might be important to her. When clients offer gifts or favours, it is important to consider both the intrinsic value of the gift (meaning to the client) and the extrinsic value. While it is unethical to accept large monetary gifts from clients, it may be acceptable to accept small tokens of appreciation. r. Your car is broken and requires an expensive repair. Your client has been struggling to set up a mobile repair service, but business has been slow. He offers to fix your car for a discounted price.

Issue: Dual relationship.

5. A good friend invites you to a small dinner party. When you arrive, you are introduced to the other guests, including a marital-counselling client whom you have been working with for the past year. You note that her companion for the evening is not her husband. From observing 1-8

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their behaviour, there is no doubt that this is a romantic relationship. She has never mentioned this relationship in the past. What would you do for the rest of the evening? Should you disclose this relationship to the woman’s husband? If she asks you to keep your knowledge of this relationship from her husband, could you continue to see them for marital counselling?

6. Assess the extent to which you believe that each of the following counsellor behaviours might be acceptable using the following rating scale: 5 = always 4 = often 3 = sometimes 2 = seldom 1 = never Be prepared to defend your answer. How might your answer vary depending on the circumstances? seeing a client after having had one alcoholic drink accepting an invitation for dinner at a client’s home hugging a client inviting a former client to a party at your home dating a former client having sex with a client driving your client home discussing your client with a supervisor assisting a client to end his or her life accepting a client’s decision to commit suicide allowing your teenager to babysit for your client buying a car from your client lending money to a client reporting your client to the police (after the client tells you that he or she committed a crime) reporting suspected child abuse by your client sharing personal experiences, feelings, problems, and so on with your client getting angry with your client discussing a client with your family or friends (without mentioning names) giving a present to a client or receiving a present from a client sharing information about clients with other counsellors warning a person that your client has threatened to harm him- or herself telling a client’s partner that he or she is HIV-positive advising a client to leave an abusive marriage crying in the presence of a client counselling a friend or neighbour at your agency (adapted from Shebib, 1997) Comment: Use student answers to stimulate debate and to illustrate how difficult it is 1-9

Manual for Choices, Seventh Canadian Edition

to have exact guidelines for practice.

7. Give examples of appropriate physical contact between counsellors and clients. How might cultural, age, or gender variables affect your answer?

Comment: Encourage students to explore personal and family customs and values.

Interviews with people from other cultures is always useful. Caution: Avoid using multi-cultural students as spokespersons for their culture.

8. The case below is based on a case record completed by a social work student. Use the CCPA and CASW codes to evaluate the appropriateness of the language used.

I visited the Smith home to investigate allegations of child neglect. I was met at the door by Mrs. Smith, a single parent. I was surprised by her size; she was morbidly obese and smelled as if she had not showered in weeks. Rolls of fat hung out of Mrs. Smith’s shirt, and portions of her legs were covered with dirt. Mrs. Smith’s slovenly appearance suggests she is unable to care for herself, much less her children (Reamer, 1998, p. 93).

Comment: Discuss differences between fact, opinion, assumptions and inference 9. Explore the issues involved in discussing clients with friends and relatives. Is it acceptable to discuss clients if you change their names and other identifying data? Defend your answer.

10. Should some clients be forced to attend counselling?

11. Do you think gallows humour is ethical? Defend your answer.

12. Review the codes of ethics for three or four different Canadian professional organizations.

What common and unique features can you identify?

Comment/Suggestion: Select 5 or six codes from different professions and ask groups of students to analyze one of the codes. Mix the members of the various research groups so they can share their observations and analysis.

13. Work in a small group to develop confidentiality guidelines for electronic storage and sharing of data. What are the risks of sharing information with other professionals using email?

14. Social Media a. Discuss the ethics of using Google or other search engines to find posted information about a client without their consent. Suppose a search reveals information that is contradictory to discussions held during a counselling session. Or, what if a search finds posted information critical of the counsellor b. What personal information about themselves is appropriate for counsellors to post online? c. Explore the appropriateness of counsellors connecting with clients on Facebook.

What about former clients?

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Discussion Points    

Discuss how the Internet cannot guarantee information security.

Explore how Internet posts can seriously compromise professional image.

This is a good point to warn students about posting any information or stories about clients, even if names or identifying data are excluded.

Discuss social media using the Amanda Todd case, a 14-year-old who died by suicide in Vancouver. Before dying, she posted details of her despair on the Internet.

15. Imagine that you are director of a social service agency. With limited funding, you have to make a difficult decision to fund one program and terminate another.

Both programs have been successful. Discuss how you might approach the resolution of this ethical challenge.

Discussion Points Should a program that serves the greatest number of clients have priority over a program that serves those with the greatest need?

Teaching Strategies/Classroom Activities 1. Use the short inventory of counselling ethics (page 14 of the Shulz text - see Resources) as a way to demonstrate that there potentially many (and often conflicting) responses to ethical situations.

2. Conduct a class discussion that addresses the questions: When and how should counsellors confront the ethical behaviour of colleagues? What can (should) counsellors do to when the policies of their agency are not helpful to clients?

3. Set up a debate.

Resolved: Those children over 14 years of age should have the right to seek and receive confidential counselling services.

4. Present the following scenario to the class: Imagine that your client will have access to additional funding if he meets certain criteria. Such funding will greatly assist the client to deal with his problems. Would you be willing to “stretch” your assessment to ensure that he qualifies?

6. Ask student to work in a small group to develop a model response to the following client question: “Will you keep what I say confidential?”

6. Case scenarios and questions to stimulate class discussion on ethics. You could 1-11

Manual for Choices, Seventh Canadian Edition

also use a debate format to explore selected scenarios. ● Your best friend suffers from a catastrophic illness that has left her incontinent and paralyzed from the neck down. After many months living in this condition she asks if you will assist her by providing drugs that will help her end her life. What would you do? ● Reverse the roles - suppose you were the one who became paralyzed. ● Should the media report suicide? What are the arguments for yes? For no?

7. Form small groups to explore ethical issues and strategy choices for each of the following scenarios:  A client indicates that he has re-established contact with his daughter after ten years. He asks that you loan him $25 so that he can buy her a birthday gift. 

You stop for coffee and you notice that your server is one of your clients. He says “coffee is on me.”



Your client tells you that she has been using heroin but asks you to promise that you will not tell any of the other staff. Historically, this client has had trouble with trust, but over a period of time she has come to trust you.



You are at a movie when you run into a colleague who is with a young male client from the agency. She later tells you that it was very innocent and that she has no interest in the client. She asks if you would mind keeping the incident between the two of you.



A client tells you he is having problems with another worker who he describes as “cold and mean”. He asks if you think his perception is correct. (note: you have the same problem with this worker).



You work a residential setting. You suspect that one of the staff, Sandy, a single working mother is taking leftovers home. This is strictly against agency policy. At the same time, you are aware that Sandy has had trouble making ends meet, more so since her younger child's struggle with cancer.



April handles contracting on behalf of your agency. She is responsible for compiling statistical reports that form the basis of funding proposals. Her efforts have resulted in numerous profitable grants. You suspect that some of her stats are fudged. Corrected stats would probably result in loss of funding for some of your projects.

● Who would you hire? Assume you are a member of a hiring panel for a social service agency. Fred is described as an efficient and unusually competent worker who has demonstrated superior ability to work with difficult clients. At the same time, his current colleagues have judged him as blunt and at time rude in his dealings with the team. Fred is not seen as a team player. Ruth, on the other hand, is well liked by her colleagues, fits in with the team, and is quick to offer assistance 1-12

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to colleagues. Her work with clients has been assessed as average. (Your agency deals with troubled and resistant youth).

7. Form small groups to explore the ethical and relationship issues suggested by the following case study. Note: present each part sequentially allowing 5-10 minutes for group discussion.

Part One: Paul, a social service worker at a community mental health centre is invited to his sister’s engagement party. Her fiancé’s first cousin, Lisa, a client at the agency, is also invited. Paul’s relationship with Lisa (his client) has been chaotic.

Part Two Paul decides to attend the party. Lisa seems somewhat agitated and proceeds to tell a series of very off-coloured, somewhat racist jokes which, although some guest find hilarious, leave many guests uncomfortable.

Part Three Later, Lisa reveals to the guests that Paul is her client at the Kettle. She proclaims, “I have been in love with him since the day we met”.

Part Four Later at the party, one of the other guests approaches you to tell you that he has some important information about Lisa he’d like to tell you.

Part 5 It’s Monday morning after the party. What should Paul do now?

Discussion focus: Ask the class to consider how (and if) Paul, Lisa’s worker might discuss the following issues with Lisa:  Lisa’s agitation (is she off her medication?)  Lisa’s General behavior  Privacy  Lisa’s “love comment”  That you were approached by someone wishing to share  Lisa and Paul’s’ relationship

Resources 1. Web Resources 1-13

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a. http://www.ccpa-accp.ca/ The Canadian Counselling and Psychotherapy Association site contains links to Canadian counselling and mental health professional associations as well as guidance and professional development information. b. http://www.casw-acts.ca/ The Canadian Association of Social Workers site has links and information on ethics for social workers. c. http://www.scu.edu/ethics This site provides articles and links on the topic of ethics. d. http://kspope.com Search for dual relationships and boundary issues. e. www.counselormagazine.com Search for ethics in counseling.

2. Shulz, W.E. (2000) Counselling ethics casebook 2000. Ottawa: Canadian Counselling Association, 2000. This Canadian text is linked to the Canadian Counselling and Psychotherapy Association Code of Ethics. It provides examples and assistance for dealing with ethical issues and dilemmas.

3. Pawlak, E.J. (1999) Organizational tinkering. In Compton, B., and B. Galaway (1999) Social work processes. 6th ed. Pacific Grove, CA: Brooks/Cole. This is an excellent reading on how practitioners can affect organizational change.

4. Reamer, F.G. (2002) “Ethical Issues in Social Work.” In Roberts, A., and Greene, G eds. (2009) Social workers desk reference, 2nd Ed.. New York: Oxford University Press.

5. Steinman, S.O, N. Richardson, & T. McEnroe (1998) The ethical decision-making manual for helping professionals, Pacific Grove,CA:Brooks/Cole.

6. Proulx, M., & Layton, D. (2001). Ethics and canadian criminal law. Toronto: Irwin Law

7. Pope, K. S., Vasquez, M. J. T., MyiLibrary, American Psychological Association, & Canadian Psychological Association. (2011). Ethics in psychotherapy and counseling (4th ed.). Hoboken, N.J.: Wiley

8. Banks, S., (2012) Ethics and Values in Social Work (4th edition). Palgrave Macmillan;

Supplementary Material and Additional Exercises 1-14

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1. Suppose you are working in an agency that is dependent on government funding. You are responsible for keeping statistics on your clients. If you make a few small “adjustments” in the figures you know that your agency will qualify for increased support which can be used to help a large number of needy people. What are the implications of your choices?

2. What are some strategy choices for counsellors when they are interviewing clients who make sexist or racist remarks? Explain your answer.

3. Imagine that you become sexually attracted to a client. Is this unethical? What are your response choices?

4. There are many people who work in social services who are not governed by professional codes of ethics. How should the ethics of their practice be monitored and controlled?

5. What barriers (real or self-imposed) do clients face when they contemplate making an ethical complaint? What are the risks for counsellors who make formal complaints about the ethical behaviour of colleagues?

6. Ask students to reflect on their personal values. Challenge them to consider how they mesh with professional values and ethics.

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Chapter 2: The Skills, Process and Pitfalls of Counselling

Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Two The Skills, Process and Pitfalls of Counselling Learning Objectives 

Define what is meant by counselling.



Describe the necessary range of skill versatility for counsellors.



Describe the essential elements of a trauma-informed approach to counselling.



Identify and classify the skills and strategies of counselling



Summarize the developmental objectives of the four phases of counselling.



Describe counselling pitfalls.

Comments and Possible Answers to Selected Text Exercises Self-Awareness 1. Think of a recent or current problem that you are facing. Describe the ways that counselling might be used to assist you in addressing this problem. Using concepts from this chapter identify what might be the major activities for each phase of counselling.

Suggestions for instructors: This question can be used a useful start to talking about how the skills of counselling are also the skills of effective everyday listening and communication. Students can also be invited to share answers to questions such as: How comfortable would you be sharing your problem with a counsellor? What fears and expectations might you take to the counselling experience? Subsequently, their observations and insights might be used to increase their understanding and sensitivity to clients who see them for counselling. Students may describe different paths to success and this can be used as a segue to discuss individual differences 2. Review the tasks of each of the phases of helping. With which phase do you feel most comfortable? Least comfortable?

Suggestions for instructors: Use this question to help students self-identify as task oriented or process oriented. Discuss how students who are overly task oriented may 2-15

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too quickly move to action and problem solving while those who tend to focus too much on process might impede client progress. Explore how balance is important.

3. Describe a situation in which you gave advice to or rescued someone. Do you have a tendency to give advice or rescue others? Seek feedback from others who know you to see if their perceptions agree with your self-evaluation.

Comment for instructors: Many students will self-identify as rescuers. Encourage them to examine which personal needs they meet from rescuing. Ask them to pay attention to the ways that they rescue. Reinforce that self- awareness is the first step to managing rescuing.

Some follow-up questions:   

How do you respond when others give your advice? When do you find advice to be helpful/not helpful? How does your reaction change if the advice is solicited or unsolicited?

4.

What stressful and/or traumatic events have shaped your life?

Warning: Exercise caution debriefing this question as some students may have unresolved trauma that should not be aired in a classroom discussion. Private journaling may be a better choice. Use the class to identify resources and general strategies for dealing with trauma.

Skill Practice 1. Imagine that you are responding to the following client questions: What is counselling? How does it work?

Suggestion: Use the text concepts as an initial reference point: Counselling is a time-limited relationship in which counsellors help clients increase their ability to deal with the demands of life. Typically, people seek or are referred to counsellors because of an unmanageable crisis, such as the loss of a job, relationship problems, or feelings of distress. The immediate goal of counselling is to provide assistance so that people seeking help (clients) can gain some control over their problems. The long-term goal of counselling is to restore or develop a client’s ability to cope with the changing demands of their lives (empowerment).

Counselling helps by creating a safe setting for clients to share their feelings and explore options for change. Systematic questioning helps organize thoughts and well- timed inquiries encourage clients to explore ideas that may have been avoided or overlooked.

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Encourage students to use role play to present answers to the two questions in everyday language. Example: “Counselling is something everyone might need at some point to help them deal with problems, decisions, or feelings. Counselling is a safe place to share feelings and explore options for dealing with issues. I won’t tell you what to do, judge you, or interfere with your decisions. My job is primarily to listen and perhaps offer a few questions to help you explore.”

2. Interview colleagues or counsellors form the field. Explore their answers to the following question: What are some of your biggest counselling mistakes? What did you learn from them?

Instructors: Lead a discussion on how we learn from mistakes. Highlight some of your own experiences and growth that emerged from failure. Comment that this principle can also be used to help clients reframe their own mistakes as growth opportunities. As well, counsellors can ask clients questions such as “How have the problems (mistakes) you have made contributed to you being a stronger person?”

Concepts 1. Rate the extent that you think each of the following statements is true: (Be prepared to defend your answers).

It is important for counsellors to develop a personal style so that they treat all clients the same way.

Answer: Effective counsellors vary their approaches to meet the needs of individual clients and situations. This is a central theme of this book reflected in the book title, “Choices.” Styles or counsellor skill choices may even change for the same client as the relationship or circumstances change. For example, a client may become more comfortable sharing feelings once trust develops, then empathic responses that may have been rejected in the early stages of the relationship become acceptable. At the same time, core values of caring and respect are constants for all clients throughout the counselling process.

The counselling process has a lot in common with the process used by other professionals, such as doctors and lawyers; thus, competent counsellors gather information, diagnose the problem, and offer solutions or advice to their clients on the best resolution.

Answer: Although counsellors may offer information and make suggestions, counsellors are not on what clients should do. The counselling process emphasizes client finding their own answers. Counsellors help clients manage the process of problem solving and decision making. Counsellors also recognize 2-17

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the important role that feelings play in problem resolution.

Usually clients who seek help are in crisis, and their ability to make decisions is significantly impaired. Therefore, it is important that counsellors are comfortable with making important decisions on behalf of their clients.

Answer: Counsellors need to avoid disempowering clients by making decisions for them and they should do this only in the most extreme circumstances.

The application of skills or techniques detracts from spontaneity.

Answer: As one learns new strategies and techniques there may be a period of awkwardness and this may detract from spontaneity. With practice, learned skills become integrated.

Professional counsellors strive to be free of biases.

Answer: Ideally this is true, but everyone has biases. Counsellors need be self- aware of their biases and they need to take steps to insure that they do not adversely affect their work.

Counsellors who have personal experience with the problem or issues that their clients are experiencing will be more effective.

Answer: Personal experience may help counsellors understand some of the feelings and challenges that clients face. At the same time, personal experience can cloud objectivity, particularly if assumptions are made about what clients mustbe feeling. Counsellors who have the same experiences as clients may be less inclined to let clients tell their story. They may also impose solutions based on what was best for them rather than on what is best for their clients.

The counselling process evolves sequentially through a number of phases, with each phase having specific tasks and requiring specific Answer: Generally, this is true, but there may be wide variations in practice.

For example, some clients move quickly to the Action phase, others move back and forth between phases. The phases of counselling are best viewed as a reference point, not an agenda for action.

Effective counsellors are consistent. They use the same skills in the same way throughout the counselling process.

Answer: Trust levels may dramatically affect how and when skills are utilized. Thus, confrontation is rarely effective before a trusting relationship is developed.

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If the principles of counselling are applied effectively, all clients will be helped.

Answer: There are no guarantees of success, however skilled the counsellor.

Everything that happens in the counselling interview must be treated as confidential and shared with no one. This is the law in Canada Answer: Legal restrictions, such as the requirement to report child abuse, and the operational requirement that workers may be asked to discuss cases with supervisors, preclude counsellors guaranteeing absolute confidentiality.

Effective counselling involves blending the client=s needs with those of the counsellor so that everyone involved is satisfied.

Answer: Counselling is not reciprocal. The work of counselling is structure to meet the needs of clients. Thus, the onus is on the counsellor to adapt to meet the unique style, values, and culture of the client.

The skills of counselling are also the skills of effective everyday communication.

Answer: Effective listening and communication skills can enhance and deepen personal relationships.

2. Write a short essay supporting the following argument: the capacity to accept help from another person is a sign of strength.

Answer: Taking help allows us to learn from others, pool ideas, receive critical feedback, get support, share painful feelings, and organize thoughts, 3. In what ways might advice-giving disempower clients?

Answer: Although first impressions may suggest otherwise, not all problems are in need of behavioural solutions. There is great therapeutic value in being able to talk about painful and confusing feelings, but advice giving circumvents this opportunity.

Advice giving may result in a solution that is owned by the counsellor, not the client.

Some clients may feel compelled to follow good advicebecause of the authority and influence of their counsellors. Advice giving may lead to dependency or transferring responsibility for decisions and outcomes to the counsellor. Counsellors need to consider whether advice giving arises more from their own needs.

4. What do you think are the advantages and disadvantages of working from a fourphase model of counselling?

Answer: In reality the process may be much more fluid and less predictable than stage theory suggests. However, the model can provide a general route map on 2-19

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process and the use of skills. The phases of counselling provide a systematic and useful checklist of the key activities and logical steps that are part of the change or problem-solving process. By referring to the phases of counselling, counsellors and clients can remain clear on where they are in the counselling process, what has been done, what remains to be accomplished, and what options remain open.

5. Identify and explore clients’ legal rights to access file information in your jurisdiction.

Answer: For follow-up discussion: In what ways would legal rights and responsibilities help or hinder your work? If you were a client, what would you want to know? What are the advantages and disadvantages of clients having full access to files?

6. List the pros and cons of displaying each of the following in your office: a. family portrait b. motivational posters Answer: Clients may differ in their reactions to any office decor. Some might find particular items reassuring; others might be intimidated. Counsellors should consider how individuals and client groups might react. The office is the counsellor space and some clients may react negatively if they see objects and displays that distance the counsellor from themselves. For example, a picture from a counsellor’s family vacation in Hawaii would be ill-advised for an office setting dealing with clients who are on welfare.

7.

From a brain perspective, why is it important to adopt a strengths based-approach when dealing with clients who have been traumatized?

Answer: Trauma may damage the hippocampus and the amygdala affecting memory and one’s ability to handle emotions. A strengths based approach helps to change the focus of the prefrontal cortex from negative to positive thinking which, in turn, may increase motivation for risk taking and resilience to setbacks.

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Teaching Strategies/Classroom Activities 1. Ask students to write a few paragraphs answering the following questions: What is counselling? Why does it work? When they are finished distribute envelopes for their answers. Seal the envelopes and collect them for storage until the end of the course.

During the final class return the envelopes to the students and conduct a class discussion on how their views and understanding have changed. (See Teaching Strategies/Classroom Activities, #1, Chapter 10 for the follow-up to this activity) 2. Carousel Brainstorming. Pin four sheets of flip chart paper in the four corners of the room. Number each station from one - four. Attach one of the four questions below to each flip chart. Divide the class into four groups and ask each student to go to their respective station. Ask them to work as a group to answer the question at their station, but only allow two to three minutes for this activity. At the end of two minutes instruct the groups to move to the next station to work on the next question (which will already have recorded answers from the previous group). Continue until each group has rotated through each of the four stations. Now ask, them to return to their first stop to review how other groups have added to their original ideas. Ask each group to prepare a short five-minute class presentation highlighting what they consider to be the most important concepts.

Suggested Questions for the Carousel Question 1:

What skills and attitudes are associated with effective counselling?

Question 2:

What is counselling and how does it help clients?

Question 3:

What is the importance of counsellor self-awareness for effective counselling?

Question 4:

How do the responses of counsellors tend to differ from those of friends and family of the client?

3. Show the video “Is Everyone Here Crazy” (15 minutes), which is part of the National Film Board of Canada’s “Without Work” series. Announce that assessment is an important part of counselling (give no further explanation) and ask students to complete an assessment of Carmen, the video’s lead character. Almost all students will accurately note her problems and the mistakes she is making in her job search.

Record these on a flip chart or blackboard. Typically, people will note problems but fail to notice her personal and social strengths. Invite the students to identify as much strength as they did weaknesses. Now talk about the importance of a strengths assessment approach in counselling. Ask them to brainstorm ways to uncover client strengths (e.g., personal, family, community, skill, past success, work history/ethic) 4. Ask students to describe their most difficult client in 10 words or less. Students will

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Chapter 2: The Skills, Process and Pitfalls of Counselling

typically list words that are negative or problematic such as “angry” “resistant” “demanding” and so forth. Now, invite the students to describe the same client using 10 words that capture strengths. Talk about the importance of a strengths assessment approach in counselling.

Resources 1. Web Resources a.http://www.psychotherapy.net Search for video counselling tools (rent or purchase) b. http://www.psywww.com This site offers links to a wide range of psychology topics. Each major topic links to the web’s most significant sites for that theme. Encourage students to use this site to access information for research papers. c. http://www.allaboutcounseling.com A wide variety of counselling issues and links to professional organizations.

Students can use this site to access information about different counselling approaches, mental health issues (e.g., use of medications) and a comprehensive array of other topics. d. http://www.cpcab.co.uk A British site offering some interesting videos on a variety of topics.

3. Can you spare a moment? [video recording]: the counselling interview. Published Northbrook, Ill.: Video Arts International, 1987; Mississauga, Ont.: International Telefilm [distributor] ; Vancouver, B.C. : AEMAC [distributor], c1997. This video clip staring John Cleese offers an amusing yet insightful snapshot of the principles of effective counselling.

4. Ivey, A.E., Ivey, M., Zalaquett, C. (2013). Intentional interviewing and counseling: Facilitating client development in a multicultural society Monterey, (8th ed) CA: Brooks/Cole. This text is very useful for illustrating and evaluating counsellor response options available in an interview.

5. Roberts, A.R., and G. Greene, eds. (2009). Social workers desk reference (2nd ed).

New York: Oxford University Press. This comprehensive reference text contains over 170 articles covering up-to-date information on the full spectrum of social work practice.

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Chapter 2: The Skills, Process and Pitfalls of Counselling

Supplementary Material and Additional Exercises 1. Reflect on your competence (what the skill is; how to use the skill) across the broad range of counselling skills listed in this chapter. Rate yourself on a scale of 1 to 5 for each of the following counselling skills.

5 = very strong 4 = strong 3 = satisfactory 2 = needs development 1 = needs considerable development attending allowing appropriate silence paraphrasing summarizing questioning showing empathy congruence showing positive regard relationship contracting sessional contracting promoting immediacy (open discussion and evaluation of the relationship) directives simple encouragers (“Yes”, “Tell me more”, “head nods”, etc.) counsellor self-disclosure using humour open-ended statements responding to nonverbal cues managing transitions defining client capacities and rights redefining problems as challenges and opportunities for learning identifying resources

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Chapter 2: The Skills, Process and Pitfalls of Counselling

skills training modelling behaviours, skills, or attitudes offering advice and information making referrals answering questions reassuring fostering optimism reinforcing (rewarding, praising) acting as an advocate for the client providing direct aid

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Chapter 3: Relationship: The Foundation for Change

Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Three Relationship: The Foundation for Change Learning Objectives 

Explore the features of a counselling relationship. 



Explain the importance of the core conditions of warmth, empathy, and genuineness. 



Demonstrate ability to negotiate relationship, anticipatory, and work contracts.



Demonstrate skills for maintaining the counselling relationship.



Examine relationship endings.

Comments and Possible Answers to Selected Text Exercises Self-Awareness This section will help students to reflect on their own relationships. Questions in this section can be used to stimulate reflection on the qualities of strong relationships. As a self-awareness follow up, students can be asked to reflect on the extent that their current personal style reflects these attributes. As well, they can be encouraged to experiment in order to develop the virtues, skills and attributes that contribute to strong relationships.

1. What were (or are) the attributes of your most positive relationship with another person? The most negative? How can you use this information to be a more effective counsellor?

Comment: Class or small group discussion can be used to explore commonalities and differences with respect to how people view relationships as positive or differences. Help students understand that client priorities may be very different from their own.

2. Pay attention to the people you see and meet over the next week. Who evokes strong emotional reactions? Who seems most similar to your parents or other authority figures? Now examine your feelings and try to identify transference reactions—feelings that you carry over from prior relationships and that are not based on objective reactions to the current relationship.

3. Most of us tend to repeat established patterns when we begin new relationships. Seek feedback from others who know you and explore questions such as the following:

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Chapter 3: Relationship: The Foundation for Change  

What first impressions are you likely to leave with others? How do their perceptions compare with your intentions or inner feelings?

Now consider the following questions:    

What are your typical feelings, thoughts, and behaviours as you begin new relationships? How are beginnings the same or different for you when you are relating to different individuals or groups (e.g., clients, colleagues, or supervisors)? What works for you? What doesn’t?

4. Examine your own needs with respect to keeping the counselling relationship warm and pleasant. How far would you go to ensure this as an outcome? Under what conditions might you need to sacrifice pleasantness?

Comments: The helping relationship does not have to be unpleasant. However, there are times when it is important to deal with difficult and emotional issues. This might stimulate some client anxiety or arouse the client’s defences. If counsellors are not willing to accept these realities, they may avoid addressing tough areas.

5. This exercise is designed to expand your self-awareness regarding issues that might affect your counselling relationships. Complete each sentence quickly, without attempting to edit your thoughts.       

The one thing I have to have from other people is . . . What’s missing in my personal life is . . . Something that people do that bothers me is . . . The one type of person I’d hate to work with is . . . Relationships would be better if . . . What I like most about people is . . . What I dislike most about people is . . .

Comment: This self-awareness exercise is structured to help students heighten their awareness about personal needs and biases.

6. Think about significant relationships in your life that have ended because of separation, death, or other reasons. How did you respond emotionally and behaviourally to these endings? In retrospect, are there things you wish you had said or not said? What remains unresolved in these relationships? (Suggestion: If this exercise evokes strong emotions, you may find it useful to debrief with a friend or colleague.)

Discussion point: 3-26

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

Unresolved grief which counsellors encounter frequently from their clients and the importance of paying attention to endings.

7. In your answer to the previous question, what behavioural patterns are evident? What are the implications of your insights for your work as a counsellor?

Comment: Exercise questions 6 and 7 are designed to help students heighten their awareness about endings. Many people have difficulty with endings. This can be problematic when working with clients as this phase can be a time of considerable growth and insight for them.

8. Rate the extent to which you think it would be appropriate for you to disclose the information listed below. Use the following scale: 5 = always appropriate 4 = usually appropriate 3 = sometimes appropriate 2 = usually not appropriate 1 = never appropriate Be prepared to defend your answers with examples.

Details of your education and training Your philosophy of counselling Information about your age, marital status, and number of children Your sexual orientation Particulars about your life, such as personal problems that you have faced Details about your everyday life, such as your hobbies, reading preferences, and vacation plans Intimate details about your personal life, such as marital problems and recovery from addictions Feelings such as anger, boredom, confusion, or sexual attraction that are influencing the interview To what extent were your answers influenced by your comfort level with each of the categories?

Comment: Often as not, the answer to the above examples is “sometimes appropriate.” Selfdisclosure is an option that should be exercised intelligently based on the needs of individual clients and situations, not on the personal needs of the counsellor to tell his or her story. Routine (compulsive) self-disclosure often misses the mark.

9. Evaluate your general comfort with self-disclosure and intimacy. What areas of your life are you reluctant or unwilling to talk about? To what extent would your friends and colleagues 3-27

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describe you as open or closed? Do you tend to be guarded about sharing information, or do you generally disclose a great deal to others? How does your comfort with disclosure vary depending on whom you are talking with (e.g., family, friends, authority figures, clients, colleagues, and strangers)? What are the implications of your answers for your work as a counsellor?

Comment: Exercises 8 and 9 should alert students to the fact that there are no simple answers or recipes that guide self-disclosure. Each situation may require a different response. Remind students that all counsellor self-disclosures should meet two basic criteria: First, the disclosure should meet the needs of the client, not the counsellor.

Second, the disclosure should not shift the focus of the work. Knowing how and when to self-disclose give counsellors the ability to make intelligent choices.

Encourage students to use their insights to set personal goals in this area. For some students, this may mean curbing a tendency to over-disclose. Others may need to learn to be more open, particularly with respect to sharing feelings.

10. Imagine you are a client with little knowledge of counselling going for your first interview. Assume you are seeking help managing depression. What are some of the things you would want to know about the counselling process and your pending relationship with the counsellor?

Skill Practice 1. Interview friends and colleagues on the topics of warmth, empathy, and genuineness. Ask them to describe how they know when someone exhibits these inner qualities.

2. Talk to people who are happy in their work. Ask them to describe how they sustain their energy and enthusiasm.

3. Orchestrate an immediacy encounter. Contract with a colleague to spend one hour evaluating and strengthening your relationship. Use the following open-ended statements to develop themes for your discussion, but be sure to explore your ideas and responses: 

The thing I value most in this relationship is . . .



The one thing that is missing in our relationship is . . .



When I first met you, my reaction was . . .



You are most like . . .



When I think about sharing feelings with you . . .



For us to become closer, I would have to . . .



What I want most from you is . . .



When I think of the future of our relationship, I . . .

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Periodically, share how you are feeling using a statement such as “Right now I’m feeling ...”

You are free to add other significant themes in your relationship that are not suggested in the above list. When you are finished, discuss what changes you would like to make in your relationship.

Comment: Exercise 3 promotes intimacy which can be satisfying and fulfilling for some, or difficult for others who are not comfortable with its demands. Suggested additional follow-up questions for individual reflection or class discussion: 

What was your comfort level with the encounter? To what extent, if any, did it change as the discussion continued?



What was easy? Difficult?



What have you learned from this experience that will be useful in your work with clients?

4. On the basis of your observations and insights from the previous question, begin the process of developing a range of different skills and strategies for beginning relationships. This will help you avoid becoming locked into established patterns. Define personal goals for development in relation to how you handle beginnings. As part of this, detail three different beginning styles you wish to add to your skill repertoire. Describe when and how you will experiment with these three approaches. What problems do you anticipate might interfere with achievement of these goals?

5. Simulate a relationship contracting session with a colleague in the role of client.

Choose your own issue and setting.

6. Imagine you are interviewing a client who believes “counselling is a waste of time”.

Suggest several approaches.

Comment: 

Explore whether the client’s view is based on past experience. If so, review what didn’t work as a starting point for considering how this relationship could be different.



Use empathy: “Sounds like you feel your problems are unsolvable.”



Suggest that you share the client’s need to use time wisely. Ask: “what would need to happen for this to be a meaningful experience”?

Concepts 1. Under what conditions do you think it would be wise for a counsellor to avoid self-disclosure?

Comment: It is important to remember that counsellor self-disclosure is an option, 3-29

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not a requirement. It should be used for the benefit of the client. When the selfdisclosure contains sensitive information that might be used against the counsellor (e.g., past drug use); when it involves an unresolved issue for the counsellor; when clients might perceive it as undue pressure to reciprocate; when it has the potential to shift the focus away from the client; when it might betray the confidentiality of others.

2. Evaluate the potential appropriateness of each of the following counsellor self-disclosures (the counsellor is speaking to a client): a. Your situation reminds me of my own problems. Maybe we can pool our energies and find a solution that works for both of us.

Comment: Not appropriate as it shifts the focus to an area of unmet counsellor need. Such an approach might destroy the client’s confidence in the counsellor. b. I’m sorry to say that it’s none of your business whether I have children.

Comment: Harshly worded, unnecessarily abrupt. The client may be using the question as a way of communicating fear that the counsellor may not be able to understand the demands of being a parent. c. When my husband abused me for the first time, I knew the marriage was over and I left.

Comment: This response contains subtle advice. The client may not be thinking of leaving her husband, but the counsellor’s response suggests that this is the favoured action. d. (Addictions treatment centre, meeting a client for the first time) Hi, I’m John and I’m a recovering alcoholic, so I know what you’re going through.

Comment: This response might be mildly helpful, but it seems that the counsellor is using this routinely without consideration of individual needs.

Moreover, the comment “I know what you’re going through.” acts as a “cut-off.”

Even if the counsellor has had similar experiences, it is important to remember that each person’s feelings and reactions are different. The response also eliminates any opportunity for the client to tell his/her story which denies them the potential cathartic benefit of this process. e. I’m feeling confused. I think we need to stop for a minute and decide where we’re going.

Comment: This is a useful disclosure of current feelings. It models openness.

Moreover, it creates an opportunity to get back on track f. Your problems are really getting to me. They remind me so much of my own struggles. They bring back all my pain.

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Comment: This is very inappropriate shift of focus which puts the client in an awkward position. g. You have the most beautiful eyes.

Comment: While supportive, it could be misinterpreted as seductive thus confusing the boundaries of the relationship. h. I like what you’re wearing today. It’s really sexy.

Comment: As per example “g” this response may be supportive, but it carries an even greater risk of being misinterpreted. i.

Generally, I like to try to establish open communication in my relationships, so I push myself to be open with my feelings even when it’s difficult.

Comment: Potentially helpful disclosure.

j. Your attitude really makes me want to just give up on you.

Comment: It might be argued that (rarely) such a response might be useful for its shock value. k. This has been a bad day for me. There have been some cutbacks at the agency and I’m worried about losing my job, so if I seem a little preoccupied today I hope you’ll understand.

Comment: Not appropriate. Essentially, the counsellor has declared that they are unable to effectively engage. The counsellor needs to find a way to manage their feelings and stress without burdening the client. l.

What a weekend! We partied all night. I could hardly make it to work today.

Comment: Completely inappropriate.

3. Describe how counsellor self-disclosure might be appropriate in response to each of the following client statements or questions. Suggest a response. a. Have you ever felt so angry that you wanted to kill someone?

Comment: “I think all of us, me included, have our moments when anger takes over. I’m curious what it’s like for you when that happens.” b. My mother never gives me the support I need.

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Comment: “There have been times “when people have not given me the support I would like. When that happens, I have felt betrayed. But, everyone reacts differently. How do you feel?” c. I began using drugs when I was 11.

Comment: Usually, it is not necessary for counsellors to disclose their own past history of drug abuse. A decision to do so should be based on clear evidence that it is necessary to assist the client, for example, to feel less isolated, to reduce any sense that you might judge, or in some cases to encourage disclosure. If a decision to share is made, then it should be brief. For example, “I also made some bad decisions when I was young. Eventually, I realized that I needed to take action to deal with it.” d. Are you gay?

Comment: Both “yes” and “no” responses are self-disclosure. With questions such as this, you might choose to answer directly, or you might choose to avoid immediate self-disclosure by saying, “What’s behind your question? Are you worried that I might not understand what it’s like to be gay?” e. I’m terrified about going back to school. I don’t think I can handle it. It’s been so many years since I wrote an essay or read a book.

Comment: Appropriate self-disclosure might be very useful here. A counsellor who had a similar experience might say, “I went back in my mid-thirties. I still remember the first day walking into class and seeing everyone young enough to be one of my kids. Later, I found out there were as scared as I was about succeeding.” f. My teenage son is driving me crazy.

Comment: Details are not necessary, but a short self-disclosure such as the following can be helpful: “I’ve raised two teenagers as well and I know how tough some days were. They seemed to know just how to push my buttons.” g. I think this counselling session is a waste of time.

Comment: A self-disclosure such as the following also offers an opportunity to use the criticism as a way to recontract the counselling relationship: “I’ve also been wondering how we could improve our time together.” h. I really like you.

Comment: Counsellors need not be averse to sharing feelings about the relationship. Of course, they should be careful that their comments are not suggestive that the relationship should evolve into anything more than that 3-32

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defined by professional boundaries. You might say: “I like you too, and I appreciate your courage in openly addressing your feelings and problems during the time we have together.” i.

I don’t think anyone has ever been as depressed as I am.

Comment: Here it will be important to avoid any challenge of the client’s statement. There is no need to suggest that you or anyone else has had bigger problems. “I’ve had moments in my life when I felt the weight of the world. It was a lonely time for me.”

4. What are the issues (pros and cons) involved in counselling friends?

5. What themes might emerge as important and unique when developing counselling relationships in different fields of practice or settings, such as working with seniors, group homes for youth, foster homes, addictions settings, immigrant clients, correctional facilities, rural settings, hospitals and hospice settings, work in the LGBTQ (lesbian, gay, bisexual, transgender, questioning) community?

6. Explore how a counsellor’s age might be a factor when working with youth, such as counsellors who are very young and those who are much older.

Comment:  Clients might fear that older counsellors might not understand or that they will assume parental roles.  Younger workers might be subject to more manipulation, pressures to assume friendship roles, or challenges to self-disclose on issues such as whether they have ever smoked marihuana.

Teaching Strategies/Classroom Activities 1. Carousel Brainstorming. Pin four sheets of flip chart paper in the four corners of the room. Number each station from one - four. Attach one of the four questions below to each flip chart. Divide the class into four groups and ask each student to go to their respective station. Ask them to work as a group to answer the question at their station, but only allow two minutes for this activity. At the end of two minutes instruct the groups to move to the next station to work on the next question (which will already have recorded answers from the previous group). Continue until each group has rotated through each of the four stations. Now ask them to return to the first carousel stop to review how other groups have added to their original ideas. Ask each group to prepare a short five-minute class presentation highlighting what they consider to be the most important concepts.

Suggested Questions for the Carousel 3-33

Chapter 3: Relationship: The Foundation for Change



What are some of the risks associated with counsellor self-disclosure?



What are some of the advantages of counsellor self-disclosure?



Under what conditions should counsellors avoid self-disclosure?



Suggest guidelines or principles for effective counsellor self-disclosure.

2. Instructor demonstration interview. Use a volunteer from the class to simulate an interview one might have with a client to negotiate a relationship contract. The interview should contain the following elements: 

Discussion of the client’s past experiences with counselling (What worked well?



What did not work well?)



Your (counsellor and client) values and beliefs about counselling



How will we work together? Feedback style?



What will we work on? Goals



What do we expect from each other?



Logistics: time & frequency of meetings



Need to know information

3. Student practice interviewing. Following the demonstration interview (#2 above) have student groups practice relationship contracting.

4. Present these opportunities for practice to students: Imagine that you wished to use immediacy in each of the following situations.

Develop an introductory response to begin the encounter. a. You are dealing with a client who hints that he or she is sexually attracted to you. b. You are counselling a client who has become demanding. c. You are feeling confused and you are not sure what to do next in the interview. d. Your client continually questions your training.

Comment: As a rule, it is useful to use sessional contracting skills to set the stage for immediacy encounters. For example, a counsellor might say: “I wonder if we might put aside what we are talking about and spend a bit of time talking about what I think is happening between you and I. I’d also like to get a sense of how you see things. It could help us both insure that we are on the same track.”

Resources 1. Web Resources a. http://personcentered.com Search for “The Foundation of Person-Centered Therapy” by Jerold D. Bozarth.

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b. http://webspace.ship.edu Search for major personality theorists and search for Carl Rogers. c. Use Google or any search engine to access a vast number of videos with or about Carl Rogers. d. http://psychology.about.com Under “Profiles of Major Thinkers”, find a Carl Rogers biography and other links to his methods 2. Brammer, L.M., and G. MacDonald. The Helping Relationship: Process and Skills.7th ed. Needham Heights, MA: Allyn & Bacon, 1999.

3. A Carl Rogers Classic Rogers, C.R. (1951), Client-Centered Therapy: Its Current Practice, Implications, and Theory. Boston, MA: Houghton Mifflin, 1951. ———. On Becoming a Person. Boston: Houghton Mifflin, 1961.

4. Links to a wide array of counselling training videos (requires purchase or rental) http://www.psychotherapy.net

Supplementary Material and Additional Exercises 1. Two counsellors debate the issue of self-disclosure. One argues that counsellors should be willing to expose some of their personal issues to a client with the argument that this will help clients to see them as real and genuine. As well, he asserts that clients will be more willing to trust counsellors who are willing to share that they also have problems. The other responds that counsellors should keep their issues and feelings out of the work so that they can be objective. To what extent might there be truth in each view.

Comments: Appropriate self-disclosure should not shift the focus from the client to the counsellor. The counselling relationship is not based on reciprocity with the expectation that counsellors will take their turn sharing problems. At the same time, self-disclosure, appropriately timed has the potential to be a powerful helping tool.

As a rule, it is usually timelier for counsellors to share personal feelings based on the moment and the current relationship, than past history or details of unresolved issues.

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Chapter 4: Listening and Responding: The Basis for Understanding

Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Four Listening and Responding: The Basis for Understanding Learning Objectives 

Define the components of listening for understanding.



Identify and describe strategies for overcoming listening barriers.



Explain the importance of active listening.



Describe nonverbal communication.



List and explain the multiple meanings of silence in counselling.



Define and demonstrate paraphrasing skills.



Define and demonstrate summarizing skills.

Comments and Possible Answers to Selected Text Exercises Self-Awareness 1. Describe an encounter you have had where nonverbal communication was more important than the content of the verbal messages.

Comment: Emphasize that nonverbal communication is frequently more revealing than words. Explore what function the nonverbal communication served – e.g., to embellish, contradict, confirm. Speculate on what prevented nonverbal messages from coming to the verbal channel.

2. List words, phrases, and situations that you think are your emotional triggers that might make it difficult for you to listen.

Comment: Explain that it is normal for everyone to have triggers, but it is important to develop self-awareness so that they can be recognized and managed. Students will typically identify violence, child abuse, anger, rage, rape, dying, abortion, and ageing as personal triggers. Now, suggest that positive emotions such as love, attraction, identification can also be triggers. Use this as a basis for discussing how they might deal with triggers - e.g., debrief with others, seek counselling, reflective writing.

When triggers trigger overwhelming emotions or reactions, counsellors should not .

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work with that particular client or group of clients. Suggest that doing so and experience will, over time, lead to an increased ability to recognize and manage triggers 3. Over the next week or so, pay attention to the vocal pauses and silences that you and others use in everyday and professional communication. What indicators suggest comfort with silence? Discomfort?

Comment: Ask students whether discomfort with silence tends to push them to interrupt it. Sometimes, for example, clients experience anxiety as they deal with important issues and an ill-timed interruption may diminish the anxiety, but rob the client of an important opportunity to address an issue. During silent moments invite students to focus on what they were/are thinking. This will help them to uncover helpful and unhelpful self-talk. Many might think that the silence means they have done something wrong. In reality, the other person may just be thinking.

4. Deliberately alter your response time in a conversation to experiment with silence.

Comment: New skill choices are best developed through risk taking and practice, otherwise, familiar patterns are repeated. Some students may discover that others, whom they believed to be “quiet” become more vocal when given opportunity.

Discuss the implications of this.

5. Ask a colleague to observe your use of silence during an interview (e.g., attended silence, appropriate interruptions, length, etc.).

Comment: Exercises 3 and 4 will help students who tend to be uncomfortable with silence and they may find this exercise to be a significant learning experience. It will help them to understand that many people, given time, can and will respond.

Suggestion: ask students to compare any discomfort they felt as interviewers during silent moments with the feelings of their clients.

6. Videotape an interview or ask a colleague to observe your attending behaviour.

7. Metacommunication. Describe the possible meaning (for you) of each of the following: a. Your teacher asks you to see her right after class. b. Your partner forgets your birthday. c. A friend asks if you are free next Saturday morning.

Comment: Metacommunication involves the message heard, even though it is not explicitly stated. Past experience, insecurity, and anxiety all contribute to false interpretations. However, not all interpretations are inaccurate. Spontaneous answers to the .

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question, “What do you hear in addition to the words” will help students to answer this question.

Skill Practice Skill practice provides opportunities for students to develop and expand their repertoire of skills. 

Deliberately violating good listening principles may help some students to recognize elements of their own bad habits.



Students are often overwhelmed when they try to do everything, so focusing on one skill at a time is a good way for them to manage the skill development process.



Feedback will help them to develop self-awareness and increase their consciousness about what they are doing.

1. During interviews with some colleagues or clients, find opportune moments for brief periods of reflective silence; then continue the interview. Discuss with your colleague/client what the impact of the silence was on the interview.

2. Work with a colleague to explore the effects of poor listening. As an exercise, deliberately (but subtly) violate the principles of effective listening and attending. For example, interrupt inappropriately, ask unrelated questions, switch topics prematurely, and avoid eye contact and other indicators of interest. When you are finished, discuss how it feels to not have others listen to you.

3. Conduct an interview with a colleague on any topic of interest. Practise paraphrasing. Watch for verbal and nonverbal indicators that your paraphrase was correct.

4. Conduct a five- or ten-minute interview with a colleague on any topic of interest. As interviewer, you should practise summarizing skills. Try to offer both content and theme summaries. At the conclusion of the interview, offer a complete summary of the session. Ask your partner for feedback.

5. Conduct practice interviews with a colleague to experiment with spatial distance. Deliberately increase or decrease the distance between the two of you to learn about the effect of space. At what point did your space become violated? How did physical distance affect the quality of your verbal exchange?

6. Attempt to communicate with a colleague using only nonverbal cues and gestures.

7. Observe the nonverbal communication patterns of different age groups. What similarities and differences are apparent?

.

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8. Form a small group of four to five colleagues. Identify one of you who is willing to discuss a current problematic situation. Two or three people will observe the interview and two will act.

Counsellor 1: Conduct a 10-minute interview while paying careful attention to the detail of the problem. Deliberately avoid addressing feelings.

Counsellor 2: Conduct the interview while paying careful attention to emotions.

Deliberately avoid exploring the details of the problem.

During a debrief, compare the outcomes of the two interviews.

Concepts 1. Explain how silence can be used effectively in counselling.

Comment: Allows clients time to address feelings, gather thoughts and it may be culturally appropriate. If people have cognitive deficits, or mental disorders such as schizophrenia, they may need more time to respond. Counsellors can ask for a moment to think which can be a welcome breather for both themselves and their clients.

2. Paraphrase each of the following client statements: 

At a party the other night, I finally met someone with whom I can carry on an intelligent conversation. He seemed interested too, but he didn’t ask for my phone number.

Answer: You felt there was a connection, but it was lost.



It’s a dilemma! I don’t know whether to finish the school year or drop out and get a handle on some of my debts.

Answer: You’re undecided whether to pay your bills or continue your education.



My supervisor wants to see me today. I know she wants to talk to me because I’ve been late for work over the last few weeks.

Answer: You think you might be in trouble. (Note metacommunication).



First my car broke down, then the fridge. Now it’s the plumbing. I should marry someone who is good at fixing things.

Answer: You need a full time handy person.



I think that with AIDS and all the other diseases you can catch, we should all take precautions. You never know who might be infected.

Answer: You should treat everyone as if they might be infected. .

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Chapter 4: Listening and Responding: The Basis for Understanding



Well, to put it bluntly, I think my partner has a lover. But I could forgive that. I just want our relationship to be the way it was when we first met.

Answer: You long for happier days.



I’ve tried everything. I have a great résumé. I’ve called everyone I know. I look for a job five to six hours a day. Still, I can’t find work.

Answer: You think you’ve done all you can.



Lately, I’ve been thinking that there has to be more to life than work and play.

I’m not even sure if I believe in God, but I need to find some meaning for my life.

Answer: You need a purpose.



I just lost it. My anger built up and I hit her. She got so upset that she packed up and left with the kids. I’ve never done anything like that in my whole life. I realize that I didn’t solve anything by losing my temper. Now I may have ruined my marriage and turned my kids against me.

Answer: In other words, you think you went too far.



I guess I’m going to have to find some way of dealing with my drinking problem.

The other day I was so sick from drinking that I couldn’t even get out of bed. I just can’t let booze continue to jeopardize my work and my family.

Answer: You think it’s time for a change.

Comment: Many of the paraphrased responses are also empathic. Preview that in Chapter 6 the concept of empathy will be explored which will include the important extra dimension of reflection of feelings.

3. Interview people from different cultures regarding their use of nonverbal behaviour (e.g., greetings, saying goodbye, summoning a waiter, eye contact, physical contact, use of space).

4. Explain why counsellors might avoid paying attention to certain topics because of their own needs.

Teaching Strategies/Classroom Activities 1. Form groups of four. Identify two people who hold opposing views on an important topic like capital punishment, abortion, religion, politics, etc. Two people will act as observers.

Part One: Invite the participants to take turns discussing the identified issue, but only present arguments for their point of view.

.

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Part Two: Repeat the discussion, but this time ask participants to take responsibility for summarizing, paraphrasing and asking questions about their partner’s point of view.

Part Three: With the observers now participating, debrief. Explore how communication changed when the participants incorporated active listening.

2. Instructor demonstration interviews. Use volunteers from the class to show the effective use of attending, silence, summarizing and paraphrasing. Demonstrations can also highlight common problems in listening. Demonstrations should be quickly followed by opportunities for students to practice, then reflect.

3. Ask students to prepare a class demo that illustrates effective and ineffective attending, summarizing, paraphrasing and use of silence techniques. Their demo should include a narrated introduction and a summary of illustrative points.

4. Ask student to do practice interviewing and experiment with the use of silence.

Conduct a class discussion. Ask students to talk about their personal comfort level with silence. How did allowing more silence impact the interview.

5. Use the client statements in number 9 of the exercises as beginnings for role played interviews.

6. Invite a student to share a personal story for 3 uninterrupted minutes. Ask students to write theme and content summaries. In small groups, ask them to compare what they wrote. Discussion point:    

In what significant ways were their summaries different?

How did people make decisions to prioritize what they summarized?

What factors might account for the differences? (e.g., bias, prior learning, culture, etc.)

What is the relevance of this experience for work with clients?

Resources 1. Web Resources The web is full written and video resources on the topic of listening and communication. Here are a few. a. http://www.listen.org The International Listening Association which promotes the study of listening skills and techniques. b. http://www.drnadig.com Find article called “Tips on Listening,” by Larry Alan Nadig, under “Contents”. c. http://cyc-net.org .

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The International Child and Youth Care Network. Click on “reading” for access to practice hints, reference library and other useful connections.

2. Learning Seed. The art of listening [video recording], Lake Zurich, IL: 1993. This somewhat dated, but effective video explores seven laws of good listening: silence, the need to find something of interest in the person speaking, the importance of staying out of the speaker's way, how and when to take notes, the role of body language in listening, and the need to listen for feelings. Gender differences in communication are also explored. (You can find this video by searching the title in Google).

3. Listening for understanding [video recording]. University of Mid-America, New York, NY: Insight Media [distributor], 1981. Another old, but useful video. It uses a dramatization to show how assumptions can lead to communication disaster. Carl Rogers discusses how the natural tendency to interpret messages from one's own point of view leads to listening without understanding. The video is a bit dated, but nevertheless a good teaching tool. (You can find this video by searching the title in Google).

Paper Topics and Research Projects 1. Interview people who self report that they are quiet. Discuss the principal reasons why they tend to be quiet. Consider specific reasons related to issues such as (but not restricted to) self-esteem, inner dialogue, culture, social learning, and the behaviour of others. Why are so many people uncomfortable with silence?

2. Interview typescript. Prepare a report with one detailed example illustrating your use the active listening skills of silence, paraphrasing and summarizing. It does not matter whether the interview was successful or unsuccessful. Your learning is more important. Include a typescript of relevant dialogue with your analysis of the interaction. What did you learn from this experience? Typically, you will see both positive and negative elements. In either case you will want to understand what happened so that you may generalize and apply your learning to other helping situations. Attempt to identify and support viable alternative responses, i.e. what might you have said or done differently. Often there may be several perspectives on the same event. Attempt to increase your objectivity by considering alternate points of view or explanations. As well, consider your feelings and biases and how these assisted or hindered the work. Try to use supplemental books and articles from the library to support your ideas.

4. Work with a partner to explore an issue or problem that he or she is currently experiencing. Prepare a video (or audio) illustrating your use of the listening skills discussed in their chapter. (maximum 10 minutes). Submit a report that discusses your use of skills and an analysis of the effectiveness of your work.

5. The Brain: Explore neuroscience issues related to the brain and listening. Discuss the implications of your findings for counselling work. As well, consider the impact of brain injury (e.g., concussion, stroke, brain cancer) on one’s ability to .

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hear and process communication.

Supplementary Material and Additional Exercises 1. Use Handout 4.1 below as a tool for students to measure attending behaviour.

Handout 4.1: Checklist for Attending Yes

No

Did the Interviewer . . .? use nonverbal behaviour that suggested comfort with and acceptance of the client’s ideas? (eye contact, open posture, relaxed) manage outside distractions and fidgeting? give time to the client to express ideas without inappropriate interruption? manage personal assumptions and attitudes that detracted from the counsellor’s ability to be present for the client? use questions and responses that showed openness to learning?

2. Handout 4.2

Handout 4.2: Helping People “Tell and hear their story” Listening is a process that enables us to understand the content and meaning of another's communication. Successful listening involves more than being quiet. It must be facilitative. Essential components of this skill include: ■ periodic (sometimes frequent) listening checks involving summaries of essential themes and content. Pay attention to repeated patterns, critical events.

■ paying attention to both the verbal and nonverbal channels of communication.

■ use of basic interview skills to probe for detail, definition and example.

■ suspension of bias, assumption of ignorance, awareness of how one's experiences and reactions might contaminate meaning Directions: .

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Interviewers: Before beginning your interview, share with your observers any goals you have set for the day, e.g., use of silence. Conduct a ten-minute interview with your "client" colleague. Stay on topic. Do not end the interview before the allotted time is up. The goal of this interview is to refine your listening skills. Use active listening skills to help your client “tell their story” and “hear their story” Remain client centred. In this interview your goal is to use the following skills: attending, silence, questions, empathy, paraphrasing, and summary. You are not allowed to: 

use self-disclosure.



offer advice or involve yourself in trying to problem solve.

Observers: Monitor the time and signal the interviewer when one minute is remaining.

Monitor any goal areas set by the interviewer. Provide general and specific feedback on the interviewer’s style. When there is one minute left in the interview signal the interviewer to make a final summary. Take notes.

DO NOT INTERFERE WITH THE INTERVIEW UNDER ANY CONDITIONS STAY "INVISIBLE" Feedback time = 5 - minutes (interviewer self-evaluation first, client reaction, then observers) Clients: You may talk about any topic you wish. Suggestion: Your life story. Try to keep your responses brief so your partner has a chance to practice skills. Give your interviewer opportunity to offer listening checks. Correct any inaccuracies or distortions. Do not role play.

3. Web Browsing. Ask students to browse the web to find what they consider to be the best 5-7-minute video clip on listening and communication skills. Pick a few examples for a “show and tell” class review.

4. Ask students to work in a small group to produce a 5-minute video clip on some aspect of listening skills.

.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Five Interviewing Skills: The Search for Meaning Learning Objectives      

Describe the importance of asking questions. Explore essential questions (open, closed, and indirect) and how they might be used effectively. Identify and describe common questioning pitfalls. Explore strategies for interviewing youth and seniors. Explain how to promote concreteness in counselling. Recognize the five different types of interview transitions.

Comments and Possible Answers to Selected Text Exercises Self-Awareness 1. Pick an issue that you have very strong feelings about (e.g., abortion, capital punishment, or Canadian politics). Conduct a five- to ten-minute interview with a colleague to explore his or her views on the same topic. However, do not reveal any of your feelings or thoughts on the topic. After the interview is over, discuss the experience.

Comment: Discuss that self-disclosure is an option, not a requirement. This exercise is a useful exercise to help students learn to curb self- disclosure and become more objective. Discuss how difficult it may have been to stop self-disclosure.

2. Think about an experience where you had a strong reaction to being questioned. What were your thoughts and feelings during the encounter? How did you react?

Comment: Discuss how excessive questioning can lead to clients feeling interrogated. Discuss alternatives such as indirect questions, empathy, silence, directives.

3. Ask a friend or colleague to monitor your interactions over the next week or so regarding your use of questions. Seek feedback,

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4. Conduct an interview with a colleague. Use questions inappropriately (e.g., ask irrelevant questions, change the topic frequently, bombard with questions, and ask leading questions).

After the interview is completed, discuss how it felt to be in both the interviewer and the client role. What did you learn about yourself from this experience?

Comment: Questions 2 – 4 can be used to help students realize that, while questions are an important tool for effective interviewing, they can also damage relationships by leaving clients feeling interrogated or manipulated. Use as a springboard to discuss alternatives to continued questioning.

5. Reflect on the variables that might make it difficult for you to self-disclose to a counsellor.

What issues in your life would you be reluctant or unwilling to discuss? How do you think you might react if a counsellor pursued these topics?

Comment: Talk about the pressures clients might feel to disclose and how counsellors can be more sensitive to this reality.

6. Think about some of your personal and work relationships. Are you more likely to be the one asking questions or the one answering questions? In what ways does this impact the power dynamics of the relationship?

Comment: Challenge students to think of ways they expand their repertoire so they are not locked into one approach.

7. On a scale of 1–10 (1 = easy; 10 = tough) rate how difficult it might be for you to conduct a client interview with the following themes or topics:       

Death Spiritual issues Sex and intimacy Mental health issues Hygiene Aging Your relationship with him/her

What can you learn about yourself from your answers?

Comment: Without self-awareness, counsellors may skip over or avoid areas where they have discomfort. Answers to this question signals targets for personal work.

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Skill Practice 1. Conduct a 10-minute focused interview with a colleague. Your task is to explore one topic in as much depth as possible. However, in this interview you are not allowed to ask questions. Use a range of skills other than questioning. (Note to the client: Try not to be overly cooperative.) After the interview is over, discuss the experience. See how many different strategies you can identify for getting information (in addition to open and closed questions).

Comment: As a natural extension of this exercise, ask students to practice not asking questions during the next week – for example, challenge them to go a whole day without asking questions.

2. As a conditioning exercise for interviewing quiet clients, conduct an interview with a colleague. Set up the interview so that your colleague does not respond verbally. Use a variety of techniques other than questions.

Comment: Empathize with possible reasons for silence (fear, shame, trust, confidentiality concerns), allow silence, tell client you will not try to force them to talk, ask client to go for a walk with you.

3. Videotape an extended interview with a colleague. Classify each response that the counsellor makes in terms of type—open question, closed question, summary, and so on.

Identify patterns. Are there skills that are overused or underused?

Comment: Consciousness about the use of skills allows for greater control and choice.

Concepts 1. Classify each of the following questions as open, closed, or indirect. a. How do you feel about your brother?

Answer: Open b. I’m puzzled over your reaction.

Answer: Indirect c. Do you have time to see me next week?

Answer: closed d. I’d like to know something about your strategy.

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2. Reword the following closed questions as (a) open questions and (b) indirect questions. a. Are you enrolled in the secretarial program?

Open: What program are you taking?

Indirect: I’m interested in knowing whether you are enrolled in the secretarial program. b. Did the principal refer you?

Open: Who sent you here?

Indirect: I have no idea who asked you to come to see me. c. Are you feeling sad?

Open: How are you feeling?

Indirect: You may have some feelings about the issue. d. Do you want to talk about your feelings?

Open: What do you want to do about your feelings?

Indirect: I’m wondering whether you want to explore or discuss your feelings. e. Did you tell her how you felt?

Open: What, if anything, did you say to her about how you felt?

Indirect: I have no idea whether you talked to her about your feelings.

3. Imagine that you are responding to the following client statements. Suggest follow-up responses that are open questions, closed questions, indirect questions, and directives. a. I have mixed feelings.

Open Closed: Indirect: Directive:

What do you mean?

Are you feeling both sad and angry?

I’m not sure what you mean by mixed feelings.

Describe your mixed feelings.

b. The next step is to solve the bloody problem.

Open: Closed: Indirect: Directive:

What are your thoughts on how to solve it?

Do you think it might be useful to list the possible alternative ways that you could you to solve it?

Perhaps you already have a plan.

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more. c. It’s been a long time.

Open: Closed: Indirect: Directive:

How long?

Has it been too long?

A long time can mean different things.

Go on.

d. I know exactly what she means.

Open: Closed: Indirect: Directive:

What’s that?

Does that bother you?

I wonder if that’s something you wish to share with me.

Describe what you know.

e. You have no idea how I feel.

Open: What is it that you feel?

Closed: Do you want me to know how you feel?

Indirect: I would like to know how you feel.

Directive: Help me understand. f. I’m really angry with you.

Open: about?

Closed: Indirect: Directive:

What are you angry Is it because I was late?

I’m open to hear about your anger.

Tell me about your anger?

g. There are some significant things happening in my life right now.

Open: Closed: Indirect: details.

Directive:

What are they?

Do you want to talk about it?

I’d really like to hear the Describe them.

h. I’m not sure I can handle this problem. I need help.

Open: Closed: Indirect: Directive:

What would help?

Do you want to talk about it?

I sense you have some ideas about the type of help you need.

Define what you mean by help.

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4. Each of the following client statements has one or more problems with concreteness. First, identify the concreteness problem. Second, suggest a possible counsellor response to promote concreteness. a. I still have feelings for her.

Problem: Feelings not defined and client does not specifically identify Closed: Do you mean that you have it figured out?

Concreteness probes: (Ask each question separately): What are those feelings? Who is she? b. I’ve given it a lot of thought.

Problem: Insufficient detail Concreteness probe: Please expand on your ideas. c. I hardly sleep at night.

Problem: Time details lacking.

Concreteness probe: How long has this been a problem? How long, on average, do you sleep? d. I’ve tried to control my kids, but nothing seems to work.

Problem: Insufficient detail Concreteness probe: What are some of the strategies you have used? e. She’s an elderly person.

Problem: Lack of definition Concreteness probe: How old is she? f. I feel bad.

Problem: Vague language Concreteness probe: When you say “bad” what exactly do you mean?

5. Each of the following counsellor statements contains phrases or jargon that may be unfamiliar to clients. Reword each using everyday language. a. It seems as though your son has a lot of interpersonal difficulty, and it is generating acting-out behaviour.

Answer: Your son seems to be having trouble making friends and I wonder if he’s dealing with it by skipping school and using drugs.

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b. Cognitively, he seems well within the mean.

Answer: He has normal intelligence c. It appears to me that you are feeling ambivalent.

Answer: You seem to have mixed feelings. d. After intake, it seems appropriate to make a referral to one of our community resources.

Answer: We can give you information about places that can help. e. Your affect is euthymic Answer: You feel normal.

6. Work in a small group to brainstorm jargon that is used in a setting that you know. Next, reword these terms and phrases so that they are easily understandable.

Comment: Use this exercise to explore how jargon can easily become embedded in the vocabulary of most settings. Although the words and phrases may be familiar to the staff, clients may be confused by it. Follow-up: Ask student to share their own experiences where they have been baffled by jargon.

7. Watch a talk show. See if you can identify the interviewing skills that are used. Look for evidence of improper interviewing technique.

8. Identify six or more different choices for obtaining the following:   

The price of a bottle of soda.

Information about your client’s feelings.

Your client’s reason for seeking help.

Answer: How much is this soda? (open); Is the price $1.00? (closed); I’m wondering about the price of this soda. (indirect); Tell me the price. (directive); The price of this soda is… (incomplete statement); Silence with/without nonverbal gestures.

9. Imagine that you are a counsellor preplanning an interview with each of the following clients.

What information do you think you might need? Identify questions and directives that you might use.   

A patient who has been physically restrained in a hospital emergency ward after a drug overdose.

An elderly woman who is going blind.

A man who seeks help for anger management.

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

A parent of a child who has been taken into custody.

10. Interview Aerobics Prepare flash cards with the names of various skills on each card (e.g., open question, closed question, paraphrase, summary, empathy, indirect question, directive, silence, wild card [any skill], self-disclosure, contracting). Then use them in an interview with a colleague.

Note: The exercises below are designed to help you develop a range of skills. The more comfortable you are with a wide array of responses, the more you will be able to respond based on the needs of the client and the situation.

Exercise 1: Shuffle the cards. The counsellor listens carefully to what the client says and then selects the first card in the stack and follows the directions on that card. For example, if the next card reads “closed question,” the counsellor must ask a closed question, even if that might not be the best response. (Note: Do not look at the card until the client has finished speaking.)

Exercise 2: Work in a group of three (counsellor, client, coach). During the interview the coach chooses an appropriate skill card for the counsellor to use.

Exercise 3: Conduct an interview using the cards in any order that you choose. Continue interviewing until all of the cards are used. Cards may be used more than one time.

Exercise 4: Conduct an interview using the cards in any order that you wish. However, you can use each card only once.

Exercise 5: Develop your own strategy for using the cards.

Comment: Considerable class time is recommended for this powerful exercise. It will help students increase their consciousness about the use of particular skills. Ask students which cards they found difficult. Then, encourage them to continue practicing those they found difficult until their comfort level rises. As a rule, students have fun with this exercise. Some may wish to make their own cards for study or cue purposes.

Teaching Strategies/Classroom Activities 1. Mid-Semester Review Exercise. Divide the class into small groups. Assign one of the following topics to each of the groups Group One: Prepare a class presentation that summarizes and illustrates the concept of concreteness. Be prepared to demonstrate your ideas. You are not restricted to the ideas in the text, so be creative.

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Group Two: Prepare a creative class presentation on the topic of questions.

Be prepared to demonstrate your ideas. You are not restricted to the ideas in the text, so be creative.

Group Three: Your job is to summarize what you consider to be the ten most important concepts and ideas that have been addressed so far in this course (text, class, journal, practicum, etc.)

Group Four: Prepare a class presentation that deals with the issue of transitions.

Be prepared to demonstrate your ideas. You are not restricted to the ideas in the text, so be creative.

Group Five: Your job is to address the topic of culture, interviewing and counselling. Be prepared to demonstrate your ideas. You are not restricted to the ideas in the text, so be creative.

Group Six: Your group is responsible for preparing a class presentation on contracting: what it is, when to do it, strategies and techniques. Be prepared to demonstrate your ideas. You are not restricted to the ideas in the text, so be creative.

2. Divide the class the class into dyads (interviewer & client roles). If desired, a third observer may be appointed. Announce a focus topic for the interview such as the client’s future career plans. Ask all clients to leave the room so that you may give further instructions to those in the counsellor role. Tell the clients that they will be asked to keep their responses relatively brief in order that the interviewers can have opportunity to practice skills.

With the clients out of the room, give the following directions:    

Interview your partner, stay on topic, and probe for detail, example and definition.

But, you must observe the following rule: No Questions. Ask the interviewers to keep the rule a secret until the end of the interview.

Bring the clients back into the room and allow about 5 - 10 minutes for the interviews.

At the end of the interview allow about 5 more minutes for each dyad to debrief.

The interviewers may now reveal the ‘no questions” rule

Comment: Most students (and even most experienced practitioners) will find this challenge very difficult. Next, use a student volunteer to do a demonstration interview. Attempt to illustrate a broad range of skills, but adhere to the “no questions” rule. For example, use empathy, self-disclosure, directives, silence, simple encouragers, indirect questions, sentence completion, summaries, and paraphrase. Following the interview, review the various skills that you were able to demonstrate.

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Now discuss the circumstances where working with “no questions” is desirable such as:     

interviewing people who resist questions guarded or resistant clients cultural issues to reduce tone of interrogation to add variety to your interviews

Suggestion: Add a homework assignment that asks students to practice this in their everyday life. Debrief next class. Often, students, particularly those with teenagers will report dramatic positive results with this challenge.

3. Do a demonstration interview with a class volunteer to show the effective use of open and closed questions.

4. Text Exercise #10 (Interview Aerobics) is strongly recommended. You will need to prepare flash cards with the names of skills on one side. A demonstration interview will help students.

5. Ask students to do practice interviewing using the key questions identified in the text:      

What brings you here today?

What are your expectations of me?

What do I need to know about your situation?

What do you mean by...?

What did we accomplish?

What have we missed?

Encourage students to use their own wording for each of the questions. Remind them to follow up each question with appropriate probes for more information and summaries to confirm understanding. This is a reference model only and, in practice, it must be customized to meet the needs of each client and situation.

6. Students frequently forget about the importance of sessional contracting. Remind them to build interview purpose into every encounter.

7. Introduce W-5 questions + How (Who, what, where, when, why) as a tool for exploring an issue. In dyads, ask students to explore a colleague’s issue using the W5 + how structure.

8. Ask students to practice using directives with each other. Many students will have trouble doing this as they perceive directives to be harsh and controlling. During class discussion explore how directives can indeed be harsh and controlling, they are a valuable tool choice for controlling pace and direction. Discuss how timing and nonverbal cues soften the impact of directives.

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Resources 1. Web Resources a. http://www.ipt-forensics.com Search for "Guidelines on Investigatory Interviewing of Children: What Is the Consensus in the Scientific Community?" by Hollida Wakefield (2006). American Journal of Forensic Psychology, 24(3), 57–74.

Supplementary Material and Additional Exercises 1. Practice Interviewing. Distribute the Interview Checklist below and ask students to use it as an observation tool for practice interviewing.

Directions: After each interviewer response, classify it and place a check mark in the box. Some responses may illustrate more than one skill. For example, suppose a counsellor says, “Tell me what you are hoping to achieve today.” This is a directive, but it is also an example of contracting.

Interview Checklist Skill

Place a check mark every time skill is used

Contracting Silence Open?

Closed?

Indirect?

Empathy Summary/Paraphrase Directive Self-disclosure Touch Humour Minimal Encourager Advice/Suggestion Providing Information Confrontation Supportive Comment 2. Observers guide for interview aerobics (text exercise 10). Ask observers to use the guide below only when students doing the practice exercise are stuck.

Empathy: • focus on feelings. Basic format: So, you feel 5-55

Chapter 5: Asking Questions: The Search for Meaning

Open Question: • Begins with: Who, Where, Why, What, When, or Why Closed Question: • “yes” or “no” begin with: Can... Do... Will... Are... Is...

Directive: • provides direction: begin with: Tell (tell me more), Give (give me an example), Slow down, Expand..., Stop..., Go on...

Sentence completion: • a sentence stem for clients to complete. Example: So, from what you have been saying it seems that , You are feeling , So, the best way of looking at the situation is .

Summary: • can summarize content or themes. Begins with statements such as: “To summarize ....”

“From what you have been saying the main points are .... , Sometimes a single word or phrase can be used.

Paraphrase: • a counsellor response that provides “other” words that capture the client’s meaning.

Might begin with: “in other words....” or “To put it another way. ” Self-Disclosure: • “here and now” involves transparency about the counsellor’s current feelings or thoughts.

Samples: “I’m confused,” “I’m wondering,” “Right now I’m feeling. . ”

2. 

Additional ideas for student practice interviews: Allow for a “tag team” approach where one student interviews then hand the interview over to another student who continues from the tag point.



Schedule a short consultation break in the middle of the interview. Ask the client to leave the room, and then observers can offer suggestions.



Prepare prompt cards which can be used by observers to suggest strategies. Caution: ask students to use the cards sparingly as they can easily overwhelm the student counsellor if they are used too much. Usually, once or twice during a ten-minute interview is sufficient.



After debriefing an interview, redo the same interview incorporating feedback suggestions.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Six Empathic Connections Learning Objectives    

Explain the importance of emotions in counselling. Define what is meant by empathy. Identify the types of empathic responses, including when and how to use them. Explore key principles (generalizations) for using empathy. Important: Exercises involving emotions may be difficult for some students if they trigger memories or exacerbate current emotional struggles. For simulations or role plays, caution students to choose issues that can be appropriately shared in the limited time frame available for class practice. Identify supports such as student counselling services that can be accessed. Monitor interactions to make sure that students are not pressured to share at inappropriate levels of intimacy.

Self-Reflection 1. Begin a log to track your feelings. At periodic intervals (e.g., every hour), record words and phrases that best describe how you are feeling at that moment. Try to be as precise as possible, using terms that capture the essence and intensity of how you feel. Maintain your log for at least one week. a. What patterns or cycles are apparent? Are there times of the day or week when you are more likely to feel particular emotions? b. How could you have altered your emotions (e.g., to increase pleasurable feelings and decrease negative feelings)? c. What have you learned about yourself from this exercise that will assist you in your work as a counsellor?

Comment: This exercise will also help students to develop their empathic vocabulary as limited word choice is often one of the biggest impediments for beginning counsellors.

Self-awareness of one’s own feelings is the cornerstone of effective empathy. Such awareness positions counsellors to recognize and distinguish their feelings from their clients. When students pay attention to their own feelings, they are more likely to make client feelings a priority in the work.

2. Recall the 10 families of emotions: anger, fear, strength, weakness, joy, sadness, confusion, shame, surprise, and love. Rate your ability to show or express each one on a scale of 1 to 5 (5 = strong, 1 = unable to express). .

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a. What are the emotions that you have more difficulty expressing? Are there feelings you would never express? b. How do your ability and willingness to share emotions vary depending on the person you are with?

Comment: Explore with the students how this exercise can help them build awareness of their “triggers” or areas of increased vulnerability. Discuss how reluctance to express emotions can lead to a reluctance to explore or hear similar emotions in clients.

3. Would you find it easier to tell your friends (your parents, family, etc.) that you love them or that you are angry with them?

4. What did you learn about expressing emotions when you were growing up? Explore how this might help or hinder your work in your field of practice. For example, if you grew up in a family or culture where emotions were seldom expressed, consider how this has impacted your current willingness to show your feelings or to encourage others to share their emotions.

Comment: Exercise 3 and exercise 4 can lead to a lively and useful discussion about what people learned about expressing emotions in their own families. For some, expressing emotions was not acceptable and they learned to suppress feelings. Others may have learned to suppress “negative’’ feelings. These learned patterns can have enormous implications for their counselling work.

5.

Describe in detail how you feel, think, and act when you experience specific emotions. For example, you might write, “When I feel scared, I want to escape. My breathing is shallow. I tend to look away. I become quiet. I think I might vomit.” (Hint: Use your imagination to visualize situations where you might experience the specific emotion.)

Comment: Exercises 1 to 5 are designed to help learners become more self-aware regarding their own emotional experience. This self-awareness is an essential prerequisite for keeping their emotional reactions from contaminating their ability to understand clients’ feeling. Many learners will find that they have limited vocabulary and this exercise will alert them to the need to develop their lexicon of ways to describe emotions.

Encourage all students to become more sensitive to their rhythms (e.g., midafternoon tiredness). Discuss how this might impact their ability to connect with clients during these moments and how they might address it - e.g., wellness program, nutrition or exercise break, scheduling non-client work).

Some students will describe backgrounds where love was rarely expressed, but anger was frequent. In their own lives they find it easier to express anger. Encourage these students to set specific goals that will enable them to develop their ability to express love and affection.

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Some students have trouble expressing anger or even disappointment. Often this is related to a background where their emotions were suppressed or they were punished for disagreeing. Cultural values can also be a factor. Encourage these students to set specific goals for expressing justifiable anger or disagreement.

Suggestion: Pair students who have trouble expressing anger with those who have trouble expressing love. Ask them to share perspectives and challenge them to learn from each other

Learning Group 1. Work in a small group of four or five students. Take turns making a brief statement about something current in your life that involves emotions. In response, other members attempt to identify the predominant feelings expressed.

Comment: This exercise will help develop comfort with sharing and hearing emotions.

Caution students against judging emotions and/or trying to “treat” them by offering wellmeaning but misguided advice such as, “don’t feel that way.”

2. Practice Interview: Work in pairs with one person acting as a client sharing the details of something current that involves emotions, and the other person acting in the counsellor role.

Allow about 15 minutes for the interview. As counsellor, use the three types of empathic responses to keep the interview focused on feelings. When the interview is over review the experience with each other using the following questions as a guide:  

Client: What was easy and difficult about sharing your feelings? What responses from your partner were helpful? Unhelpful?

Counsellor: What aspects of responding with empathy did you find most challenging?

Comment: Remind students about the importance of confidentiality.

3. The purpose of this exercise is to develop your ability to “track” the flow of an interview, including identifying the use of particular interviewing and counselling skills. Work with student colleagues. One student will be the counsellor, another the client, with the others as observers. Videotape a 15-minute segment of a counselling interview. Classify each counsellor response (e.g., open question, closed question, silence, empathy, self-disclosure, or mixed response). Use the following table to compile interview statistics. Place a check in the box each time a particular skill is used. Notice that the table is organized to divide the interview into time segment

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0–5 minutes

6–10 minutes

11–15 minutes

Open question Closed question Indirect question Silence Empathy Self-disclosure Directive Summary Paraphrase Other (specify) After the interview, discuss these questions: a. Did the counsellor use a variety of different responses? b. To what extent did the counsellor vary his or her approach as the session progressed? c. What interview transitions were apparent? Were they appropriate? Consider, for example, whether the transition occurred prematurely, before concrete understanding or exploration was completed. d. What skills were overused or underused? e. Which responses were productive? Which responses were counterproductive?

4. Interview colleagues or friends from diverse ethnic groups to explore how different individuals express emotions.

Comment: Note that the people they interviewed had a particular cultural background, but they are not necessarily representative of how others from their group might express emotions.

Within cultures, there may be patterns, but also wide options for variability.

5. In a small group, predict and describe the possible emotions that different individuals in the following scenarios might experience. What nonverbal cues might you observe in each case?

Comment: For each example below, the emotions expressed may shade from low to high level intensity depending on the client. Moreover, clients may experience more than one emotion at the same time. As well, a wide range of emotions and nonverbal cues may be possible for each situation and the answers are only representative of this possible range. Ask students how they might react in the same or similar circumstance. Class sharing should alert them to the variations in emotions that others might experience. a. man, whose wife of 60 years has just died

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Possible emotions: grief, sadness, relief, intense loneliness, abandoned Nonverbal cues and additional comments: crying, silence, pacing b. young teenager on a first date Possible emotions: nervousness, excitement, regret Nonverbal cues and additional comments: blushing, fidgeting, excessive talking, fumbling for words, “standing up” the date c. middle-aged man fired from his job Possible emotions: anger, shame, confusion, relief, depressing, acceptance Nonverbal cues and additional comments: substance abuse, physical violence, isolation, intense activity to find a new job d. 20-year old man told by his doctor that he has schizophrenia Possible emotions: disappointment, sadness, anger, relief Nonverbal cues and additional comments: withdrawal e. mother discovering her teenage daughter using drugs Possible emotions: shock, disbelief, anger, confusion, guilt Nonverbal cues and additional comments: crying, shaking head, yelling f. a woman subjected to on-line harassment Possible emotions: isolated, hopeless Nonverbal cues and additional comments: withdrawal, suicidal behaviour g. person who lost his life savings in the stock market Possible emotions: terrified, depressed, shamed, guilty Nonverbal cues and additional comments: suicidal gestures, withdrawal, selfdepreciating comments h. prisoner about to be sentenced Possible emotions: fear, shame, regret, sense of resolution Nonverbal cues and additional comments: downcast eyes, nervous laugh i. angry client Possible emotions: fear, anger, Nonverbal cues and additional comments: shouting, swearing, intense eye contact, silence, hypersensitivity 6-62

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j. client seeing a counsellor for the first (or last) time Possible emotions first time: hope, anxiety, suspicion Possible emotions last time: sadness, anger, gratitude Nonverbal cues and additional comments first time: not showing up, holding back, silence, terse answers, outpouring of thoughts and emotions Nonverbal cues and additional comments last time: not showing up, presenting gift, verbal attack, k. patient in hospital waiting for major surgery Possible emotions: fear, hope Nonverbal cues and additional comments, praying, crying, slow or fast speech l. child entering a foster home Possible emotions: resentment, anger, confusion, relief Nonverbal cues and additional comments: running away, crying, lashing out m. man who has just abused his wife Possible emotions: shame, anger, regret, sense of entitlement Nonverbal cues and additional comments: substance abuse, yelling, apologetic behaviour n. couple on the day of their marriage Possible emotions: love, joy, nervousness, regret Nonverbal cues and additional comments: smiling, laughing, crying o. immigrant who has left his wife and children at home while he settles Possible emotions: sadness, guilt, hopeful Nonverbal cues: isolation, over involvement with work p. serial killer Possible emotions: driven, compelled, satisfied, weak Nonverbal cues and additional comments: attempts to overcome weakness through aggression q. compulsive gambler after a big win or after losing his paycheque Possible emotions: shame, fear, euphoria, compelled 6-63

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Nonverbal cues and additional comments and additional comments: denial of seriousness of the addiction, making promises to stop, relapse r. 11 year-old girl who has been sexually abused by her father Possible emotions: shame, fear, self-blaming Nonverbal cues and additional comments: sexual promiscuity or sexually provocative behaviour, depression s. man who has sexually abused his daughter Possible emotions: guilt, shame, depression Nonverbal cues and additional comments: denial, rationalization

6. Identify feeling words and phrases that best describe how each of the following clients may be feeling: a. “Everyone in my life keeps putting me down. Even my own children constantly criticize me.”

Possible emotions: belittled, crushed, taken for granted b. (shaking) “Fifteen hard years with the same company and what do they do? They dump me with three weeks’ notice.”

Possible emotions: Abused, shocked, hurt c. (a 6-year-old boy, crying while speaking to recreation staff) “No one wants to play with me. No one likes me” Possible emotions: lonely, rejected d. “If I ever started crying, I don’t think I could every stop.”

Possible emotions: helpless, hopeless, overwhelmed e. (An ex-offender to parole officer) “Have you ever been to jail?”

Possible emotions: suspicious (i.e., that the parole officer might not understand), inquisitive f. (A16-year-old boy) “I’d rather live on the street than go to another foster home.

Five foster homes in five years. I’ve had enough!”

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g. (A Gay man) “I didn’t expect to live to see forty.”

Possible emotions: regret (e.g., that he/she did not plan ahead), surprise h. “Why do you want me to go to see a psychiatrist? Do you think I’m crazy?.

You’re the one that’s crazy.”

Possible emotions: judged, fear of being labeled, angry i. (patient speaking to a paramedic) “Leave me alone. I just want to die.”

Possible emotions: despair, hopeless, resigned to fate

Comment: Here again, the key is to identify possibilities. In real situations, clients may present with predictable or sometimes surprising feeling reactions to a situation. Open-minded counsellors do not presume, rather, they remain alert to verbal, nonverbal and contextual cues that suggest emotions. Empathic responses provide opportunity to make and deepen emotional understanding.

7. Interview people from different cultures. If possible, interview first-generation immigrants who have been in this country for only a short time. What are the differences between their use of nonverbal communication (e.g., eye contact, spatial distance, touching) and yours?

Concepts 1. Assume that the clients below are speaking to you and that an empathic response is appropriate. Suggest a response to each statement. a. (Youth speaking to a youth justice worker) “You don’t care about me. All you guys are the same. You tell me that you want what’s best for me. You’re just in this job for the money Empathic response: You find it hard to trust me because you think that if I really had your best interests in mind I’d let you make your own decision whether to come or not. b. (Client, smiling.) “For the first time, things are really starting to come together for me.

My kids are all doing well in school, my marital problems are on the upswing, and I finally put some money aside for a rainy day.”

Empathic response: Finally, you have a sense of hope for better times. c. (Parent to a teacher.) “I don’t know what to do. I know you said I should try to help my son with his homework and show some interest in his work. But he comes home from 6-65

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school and goes straight to his room. When I ask about his homework, he always says that there wasn’t any. When I offer to help, he makes it clear he’d rather do it on his own.”

Empathic response: You want to be involved in helping your son do better at school, but he rejects all offers. d. (Teenager, crying.) “I’m pregnant. This will kill my dad, but first he’ll kill me.”

Empathic response: You’re terrified about telling your father. You don’t believe he will be able to accept it. e. “Everyone always says how together I am. But I don’t feel together.

Sometimes I get so wound up that I think I’m going to burst.”

Empathic response: Despite what others see, you’re under tremendous pressure. f.

(Man, 57, talking about his family problems.) “I have to make every decision. I can never count on my wife or kids for help.”

Empathic response: You feel very alone and unsupported.

g. (Parent to a teacher.) “My son does not have ADD. I don’t care what you say.

I’m not going to put him on drugs.”

Empathic response: You’re determined to keep your son off medication. h. (Client shouting.) “I am calm” Empathic response: You think I’m pushing you and it’s making you feel frustrated. (Note to instructors: this is a very difficult exercise and most students will pick up on the client’s anger, but it is the client’s reaction to the counsellor that should be the essence of empathy) i.

(50-plus woman talking to a 23-year-old worker.) “You’re pretty young to be working here.

Empathic response: Are you concerned that I might not understand the issues you face such as the stress of trying to deal with 3 children on a Welfare budget.

j.

(Patient in an ambulance.) “Don’t let me die.”

Empathic response: You’re scared and you want me to help.

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Comment: The empathic responses for each are sample responses only. Other choices may be equally or more valid.

2. Each of the following client statements expresses more than one feeling. Identify feeling words and phrases that best describe the mixed feelings. Next, formulate an empathic response. a. “Thanks for seeing me today. It really felt good to get things off my chest. No one has ever listened to me the way you did. I hope you don’t think I’m crazy or stupid.”

Empathic response: Although talking about it leaves you feeling relieved and heard, you’re afraid that I might judge you. b. (Eyes welling up with tears.) “It’s over. I don’t care to be with him anymore.”

Empathic response: It hurts and you’re struggling with the reality that the relationship can’t continue. c. “I was brought up to believe you should handle your problems on your own.

Look at me now–sitting here pouring my guts out to a counsellor.

Empathic response: You pride yourself on your independence, so coming here feels unnatural. d. “To tell you the truth, I’d like to just march right in, look him in the eye, and tell him exactly where to go. I don’t know what to do.”

Empathic response: Although you know what you like to do, you feel confused about what’s the best course of action. e. “Finding out that my former girlfriend had my baby was totally shocking.

After we broke up, she didn’t even tell me she was pregnant. I’d love to be a father, but I don’t want a relationship with her. Maybe it would be best if I just forget the whole thing. But I want to do what’s right.”

Empathic response: You’re torn. Part of you wants very much to do the right thing, to be involved with your child. At the same time, you know that you can’t resume your relationship and you wonder if it would be best if you just stay out of the picture. f.

“Living on your own is the pits. Now I don’t even know where my next meal is coming from. I used to love being married. I felt as if life really had meaning. But at least now, I don’t have to worry about being beat up by my husband every time he gets drunk. It’s just so difficult. Maybe I should give him another chance.”

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Empathic response: Although you now feel safe, you miss your marriage. g. (Woman, 79, crying.) “My daughter keeps saying that she is coming for a visit, but it has been weeks since I have seen her. (Wipes away the tears) It’s not that important. I really do not want to be a bother. Just feeling sorry for myself this morning.”

Empathic response: You feel hurt and you really miss your daughter. You worry about being a burden. h. (A civil engineer from Syria who immigrated to Canada.) “I was so excited to begin my new life in Canada when I came three years ago. But all my dreams have disappeared.

The only work I’ve been able to find is driving a cab.”

Empathic response: Your hopes have evaporated as you discover that the reality is very different than what you envisioned. i.

(12 year old girl.) “I flashed my breasts on the Internet while I was in an on-line chat room. Now my life is ruined. Everyone at school calls me a slut. I have no one.

Empathic response: You think that you went too far and now you feel hopeless, alone and trapped.

j.

“The 2015 terrorist killings in Paris really messed me up. I haven’t been able to sleep and I constantly think about my kids. I don’t travel or even go to the movies anymore.

It could happen here.”

Empathic response: Nothing feels safe anymore and you feel helpless.

Comment: Exercise 2 targets ambivalence. Urge students to avoid using the conjunction “but” in their empathic responses.

3. This exercise allows you to apply tough empathy. The statements below may evoke strong personal reactions. Assume that the person is speaking to you and that you are responding with empathy, even though empathy may not be the preferred response.

Note for Instructors: These exercises can be very difficult for many students, but if they are encouraged to persist they will learn valuable skills for keeping their own emotional responses in check. Remind them that empathy does not mean agreeing.

If they were working with the clients below, empathy will give them an opportunity to develop a relationship. Without a relationship, they will not be in position to influence change. When clients feel understood, counsellors achieve credibility and they are more likely to be trusted - necessary prerequisites for engaging clients in the change process. a. “Canada was much better when it was white and Christian. With such high unemployment, don’t you think it’s time to stop letting every damn immigrant 6-68

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into the country? No wonder I can’t get a job.”

Empathic response: You resent how immigration has changed the country and you believe that it has prevented you from finding work. b. “I’m not ashamed to admit it. Once in a while, I hit my wife. It’s no big deal.”

Empathic response: You don’t hide the fact and you feel okay with what you do. c. “I don’t care what you say. I won’t give up on you until you convert and save your soul.”

Empathic response: You’re determined to rescue me. d. (Employer.) “I want to die. I’ve thought about it for months and I just don’t want to live anymore” Empathic response: It’s not a spur of the moment decision. You’re clearly set on ending your life. e. “What’s the big deal if I have to steal a bit from Safeway to make sure my kids are fed? It’s not like it hurts anyone.”

Empathic response: You love your kids and you’ll steal to make sure they are taken care of. f.

(Student to teacher.) “I suppose this course is going to be like all the others. Lots of reading, a bunch of papers. I only hope there’s some relevance to it all.”

Empathic response: Although you feel pessimistic that this course will waste your time you’d like it to be a useful experience.

g. (Client, 35-year-old.) “I had no idea she was only 15. She was the one who wanted to have sex. From the look in her eyes, I could tell she was begging for it. It’s really unfair that I’m now charged with rape. Besides, 15 is old enough for someone to make up their own mind.”

Empathic response: So, as you see it, you only did what both of you wanted and now you’re the victim of an archaic legal system. h. “This counselling isn’t very helpful.

Empathic response: You feel frustrated because you’re wasting your time. i.

“I really don’t worry too much about AIDS. What can I do about it? If I’m meant to get it, then I’ll get it. So what? We all have to die sometime.”

Empathic response: You believe it’s out of your control, a matter of luck or karma.

j.

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way I put him down. I should learn to keep my mouth shut. When I see him, I’ll apologize.”

Empathic response: You feel responsible and now you want to make amends k. (Client, with angry tone.) “No one is willing to talk to me about the fact that I might be dying. I can accept it, but every time I ask the big question, people change the topic.”

Empathic response: What you want the most is for people to talk to you and tell you the truth. l.

“There’s no way I’m going to pay for her stupidity. If she didn’t want to get pregnant, she should have taken the pill. Now she expects me to support the baby until he’s 18. I don’t care if I am the father. Not a chance!”

Empathic response: You’re determined to stay out of the picture.

What do you think are the advantages of responding with empathy to the above clients?

Comment: This question (advantages of responding with empathy) provides an opportunity to reinforce the fact that empathy is not the same as agreeing. We can (and should) attempt to understand the emotions and perspective of others even (especially) when we do not agree or support their perspective. In counselling, this helps to establish relationship which is a critical variable for initiating and sustaining change. Tough empathy challenges counsellors to control any natural tendency to challenge or confront.

4. Each of the following client statements might be a routine inquiry for information or could be an indirect way of expressing feelings. Assume that the client is expressing feelings and formulate an empathic response. a. b. c. d. e.

How old are you?

Have you ever been unemployed?

Have you ever lived in a foster home?

Did you use drugs when you were my age?

Have you ever taken psychiatric medications?

Answer: Empathic responses to the above client statements can take the form “Are you worried that I might not understand?” Of course, there are other responses that are potentially valid that do not use empathy – e.g., simply answer the question.

Empathy is preferred when the question arises from emotions.

5. Record a television program. Watch it with the sound turned off. Pay attention to the nonverbal communication of the actors. Now watch it with the sound turned on. How successful were you in correctly reading the nonverbal cues?

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Comment: This exercise will increase awareness of nonverbal behaviour. Caution students not to have a recipe approach to interpreting Nonverbal cues and additional comments -e.g., crossed arms may signal that the person is defensive, or it may just mean that they are cold.

6. The following is the transcript of a portion of a counsellor's interview. The worker is an employment counsellor at a Vancouver social service agency. Critically evaluate the counsellor’s responses (e.g., appropriateness of questions, use of empathy, etc.). What attitude do you think the counsellor conveys to his client? Suggest alternative responses based on empathy.

Counsellor: Hello. Are you Leah? I’m Mr. Short. Won’t you come into my office? (brief small talk in office) Counsellor: So, what is your problem? How can I help you?

Comment: Greeting the client with her formal name would be better. The counsellor tries to put the client at ease. As a rule, it is preferable to ask more neutral questions re purpose such as “What brings you here today?”

Client: Well, I don’t really know where to begin. Right now, my life is a mess. I’ve gotten along well so far, but lately ... well, I’m just not coping very well. (client pauses, wipes tears with a tissue) Counsellor: Okay, calm down. Try not to cry. Have you been to this agency before?

By the way, how old are you?

Comment: The counsellor inappropriately suppresses feelings by telling her not to cry. Changing the subject further reinforces that fact that he is not available to hear feelings. An empathic response such as “It sounds like you are feeling a lot of stress” would have been better.

Client: No, this is the first time. I wonder if anyone will ever give me a chance.

Sometimes I feel, why not give up? I feel so scared all the time. Don’t get me wrong—I really want to work, to be independent, to buy my kids all the things I haven’t been able to afford. I just don’t know if I can do it. I haven’t worked in 10 years. Plus, there’s the problem of daycare ... the things you read... it’s hard to know whom to trust. Things just seemed so much easier when my husband was alive.

Counsellor: You say you haven’t worked in 10 years. What was the last job you held? What did you do? What are your job skills?

Comment: Here again, the counsellor is ignoring the emotional content of his client’s message.

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Client: Mostly, I’ve worked as a secretary. It was okay, but I don’t want to do that anymore. I really don’t have a clue what I’d like.

Counsellor: So, you know you want to get out of clerical work, but you’re unsure what else you might do or like.

Comment: The counsellor’s response is accurately empathic.

Client: Yes, exactly.

Counsellor: Have you considered social services? There are lots of good programs that you could complete in a short time.

Client: No, I don’t think I’d like that.

Counsellor: How can you be sure until you give it a try? Sometimes volunteer work is a really good way to find out if you like it.

Client (hesitates): Well ... I guess so.

Counsellor: Actually, I was in the same boat as you. Then I volunteered. Next thing I knew I was back in school. Now I’m working full time and loving it. I have a friend who works at the volunteer bureau. Why don’t I give her a call and set up an appointment for you?

Client (hesitates): Okay ... thanks.

Counsellor: No problem. I was glad to be of help. I’ll phone her, then I’ll give you a call. It’ll probably be next week or so.

Comment: In this section of dialogue, it is clear that the counsellor is not listening to his client. He is preoccupied with imposing his own preferred solution.

Exasperated, the client finally gives up. Perhaps this client will never return.

Teaching Strategies/Classroom Activities 1. Emphasize the importance of practicing empathic skills by encouraging students to increase their empathic responses in everyday communication. In subsequent class discussions invite students to share how increasing empathy changed or impacted their relationships. Ask them to identify how empathic responses were different from their usual reponses.

2. Empathy is a very powerful skill. During practice interviewing student groups may find that the emotional level of their interviews reach unexpected high levels which can result in:  increased insight  embarrassment  anger towards the counsellor 6-72

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increased trust and rapport

Discuss these realities with students. Emphasize the importance of allowing sufficient time to process emotions. Reinforce the importance of confidentiality.

3. Carousel Brainstorming. Pin four sheets of flip chart paper in the four corners of the room. Number each station from one - four. Attach one of the four questions below to each flip chart. Divide the class into four groups and ask each student to go to their respective station. Ask them to work as a group to answer the question at their station, but only allow two minutes for this activity. At the end of two minutes instruct the groups to move to the next station to work on the next question (which will already have recorded answers from the previous group). Continue until each group has rotated through each of the four stations. Now ask, them to return to their first stop to review how other groups have added to their original ideas. Ask each group to prepare a short five-minute class presentation highlighting what they consider to be the most important concepts.

Suggested Questions for the Carousel   

What is Empathy? Why is it important?

When should you use empathy as the preferred response? When should you avoid it?

How do you achieve empathic understanding?

4. Warning: This exercise deals with psychologically stressful material. Ideally, it should be directly supervised by the instructor. Student observers may have strong emotional connection to issues being shared and, for some, it may trigger powerful feelings. Allow time for debriefing where this can be addressed.

Procedure: (stress confidentiality).

Directions  

pick 2-3 positive life events that you would be willing to share with your partner.

2-3 stressful life events that you would be willing to share with your partner.

Caution: Ask student to avoid issues that involve unresolved trauma.

Use interviewing and empathy tools to explore feelings and meanings related to the events described. Try, as much as possible to focus on current understandings and feelings: -"how do you feel now about this event?" "looking back, what sense do you make of it?" as opposed to "storytelling." Talk about what you are experiencing throughout the exercise. This exercise deals with psychologically sensitive material.

You decide at what level you wish to share. If you are keeping a journal, record feelings about the process of self-disclosure. What issues did you censor? How did this limit your counsellor’s understanding?

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6. Do a demonstration interview with a class volunteer to show the effective use of empathy. Ask for a volunteer who would be willing to address a real and current issue in his/her life that involves strong feelings. Caution: Talk to the student briefly to insure that the issue is one that is appropriate for public sharing. See #1 above for possible risks.

6. Ask student groups to prepare a class demo that illustrates effective and ineffective empathy. The demo should include a narrated introduction and a summary of illustrative points.

7. If you are using small groups for skill practice, this would be a good time to invite the groups to do a mid-term review of their contract. Note how this process can parallel similar work they might do with long term clients. Ask them to engage in questions such as the following:      

What are the specific behaviours that have contributed to your group being effective?

What are the specific behaviours that have contributed to your group being less effective?

What can your group do to improve its effectiveness? What changes do you want to make?

What has been the major learning that members have realized about groups as a result of their participation in your group?

What are the skills/ issues that your group is still struggling to understand?

What are some suggested revisions to your contract?

Resources 1. Web Resources a. http://www.psychologytoday.com Search “empathy” for Psychology Today articles on the topic of empathy. b. http://www.eq.org Emotional intelligence. A comprehensive list of links on the topic of EQ. c. www.youtube.com – Search for “Carl Rogers and Gloria” Classic “Gloria” interview with Carl Rogers d. http://www.preciousheart.net Search for comprehensive list of emotions and feeling words e. http://cultureofempathy.com Search for mirror neurons and empathy.

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2. Three Approaches to Psychotherapy. [video recording] / Psychological Films; producer, director, Everett L. Shostrom. 1965.

This classic video, also known as the Gloria films, chronicles the work of three therapists who worked with the same client (Gloria) using their distinct approaches.

Carl Rogers demonstrates Client Centered Therapy, Albert Ellis demonstrates Rational Emotive Psychotherapy, and Fritz Perls demonstrates Gestalt techniques.

Roger’s section (part one) serves as an excellent depiction of the use of empathy skills. The video, although now somewhat dated, continues to be shown worldwide to psychology and counselling classes since its production in 1965 (to watch the video, search the above title on Google). A second series, also produced by Everett Shostrom in 1977 includes another excellent interview demonstration by Carl Rogers.

Supplementary Material and Additional Exercises 1. Write and perform a song that teaches the essential concepts related to empathy.

2. Form a small group: Prepare two class demos that illustrate: a. ineffective empathy (e.g., ignore feelings, change the subject, give advice, etc.) b. effective empathy 3. Class Discussion: Some people suggest that if you empathize with people who have committed horrible offences such as crimes against children that you condone their behaviour. How might you respond to these assertions?

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Seven Supporting Empowerment and Change Learning Objectives         

Identify the elements of empowering clients. Explore the strengths approach. Understand the goals and skills of crisis intervention. Appreciate the complex and diverse challenges of working with seniors.  Describe the principles and strategies of motivational interviewing.  Identify and describe the stages of change model.  Explore the principles and strategies of cognitive behavioural counselling. Understand the process of problem solving. Understand the principles and techniques of brief counselling. 

Comments and Possible Answers to Selected Text Exercises Self-Reflection 1. Reflect on areas in your life where change is possible, is necessary, or has already occurred.

Classify your stage of change with each issue based on the stages of change model: precontemplative, contemplative, preparation, action, maintenance. What could potentially “move” you from one stage to another?

Comment: Exercises such as this give students experience that will enhance their capacity to understand and empathize with clients Knowledge of the stages of change model is essential for tailoring skills and strategies that have a greater potential for connecting with clients. This exercise will help students link the stages of change model to their own lives.

2. Start a log that chronicles your automatic thinking, for example, when you meet someone new, before asking a question in class, when you want to ask for help, etc.

Comment: The first step to cognitive change is to become aware of thinking patterns.

Subsequently, these can be evaluated as helpful, neutral, or unhelpful. Change then focuses on increasing helpful thinking responses as replacements for those deemed to be unhelpful or erroneous. Checklist links can be found in the Resources section

.

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3. Think of a crisis that you have faced. Try to recall your reactions in each of the three major domains: feelings, thinking, and behaviour. What helped you cope with and recover balance following the crisis? What factors acted against recovery?

Comment: Consideration of the domains helps to safe guard a narrow focus on only one area.

It reminds students of the importance of considering all three domains 4. Use the concepts from this chapter to practice goal setting and action planning for yourself.

Pick one or more target areas (behaviour, feelings, thoughts, skills, or relationship). Develop a baseline.

Comment: Developing skills for identifying baseline is a necessary prerequisite for measuring change. This exercise provides opportunity to operationalize text concepts and it will acquaint students with the rewards and challenges of goal setting and action planning.

5. Practice mindfulness: a. Go for a walk. Focus on coordinating your breath with your steps. b. Eat a banana or other fruit. Pay careful attention (sequentially) to the structure, colour, and feel of the fruit. Next, slowly chew it while focusing on the taste and feel of the fruit in your mouth. c. Breath meditation. Find a quiet place where you can be comfortable. Observe your breathing by attending to the flow of air through your nose and into your lungs. Watch your thoughts, and when a judgment arises, silently label it “judging.” (Adapted from Siegel, 2010, p. 83) Comment: Suggest students consult online and print resources on the topic of mindfulness.

There is a huge volume of information and practice suggestions.

6. Interview seniors. Discuss their current needs and expectations. Meet with colleagues to share your findings and to explore implications for counselling this group.

Learning Group 1. Working with a colleague, take turns exploring a time in your life when you were unmotivated.

What feelings were associated with this period? What helped you get unstuck?

Comment: This exercise will help students explore the change process and increase their sensitivity regarding the feelings and difficulties associated with change. Encourage students to consider the other two domains as well – cognitive and behavioural. Explore the impact of feelings on thinking and behaviour 2. Working with a partner, use selected brief counselling techniques from this chapter to help him or her deal with a problem area.

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Comment: Skill building exercise are an opportunity for students to learn from the client role.

Experience as a client helps students become more sensitive to the feelings that their clients might experience when they are in a counselling relationship.

3. Conduct a practice interview with a colleague that focuses on goal setting.

Comment: This exercise provides practice interviewing for specificity and for utilizing the SMART system for identifying goals.

4. Conduct an interview with a colleague (as client) using the principles of cognitive behavioural counselling. Explore a problem area that the client identifies as real and current where they wish to make a change. Try to help your client: a. identify automatic thoughts b. evaluate automatic thoughts c. develop strategies for controlling and modifying automatic thoughts that are not helpful d. set a goal for action (homework) Comment: Repeated practice of the this exercise challenge will help students become comfortable with the process. Emphasize the importance of practice to learn new ways of thinking and responding. Plans for this can be identified in the counselling interview, but homework is essential to reinforce and practice change.

Concepts 1. Suggest questions you might ask clients to assess their stage of change.

Answer: “Are you thinking about making a change in your life. If so, when?” “To what extent do you believe you need to make changes?” “What previous attempts have you made to deal with...?” “If you are planning on making a change, what is your plan?” “How long have you successfully managed...?”

This online SAMHSA site offers an assessment model: http://www.ncbi.nlm.nih.gov/books - Search for NBK64241 (Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction.)

2. Identify which stage of change best describes each of the following clients: a. “I hardly know anyone who smokes anymore. I’ll get there too one day.” b. “What’s the point of looking for work? Since the big stock market crash there aren’t any jobs out there anyway.” c. “It’s been almost six months since my last drink. I don’t even crave it like I used to.

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d. “I wish I could find a way to get off drugs.”

Answer: a - contemplative; b - precontemplative; c - maintenance; d -contemplative 3. Identify errors in thinking for each of the following client statements: a. “I’ll never get a job.” b. “She didn’t even say hello when she saw me at the store. I guess she doesn’t like me.” c. “I have to be number one.”

Answer: a: magnifying problem, focusing only on the negative; b: making assumption, “mind reading,” c: perfectionism 4. Suggest reframed responses for each of the following client statements: a. I can’t do it.

Reframed response: So far, you haven’t yet discovered the way to do it.

Comment: Use of the word “yet” conveys hope and belief that the solution is possible. b. (a student counsellor) I feel so unnatural and phony expressing empathy all the time.

Reframed response: It may be that this is new for you and any new behaviour can seem unnatural for a while until it becomes part of your style. c. I really want my kids to avoid making the same mistakes I did. I don’t know why they don’t listen to me.

Reframed response: It sounds like you learned a lot from your mistakes.

Maybe your kids need to be able to learn from their own mistakes. d. If he really loved me, he’d send me flowers.

Reframed response: Perhaps he has a different way of expressing his love and he may not be aware how important this is to you. e. My life is a mess.

Reframed response: Sounds like you’d like to have more happiness in your life. (Note: most problem statements can be reframed as goals targeting what the situation would look like if the problem were solve.

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f. I’m tired of being depressed all the time.

Reframed response: Your body is telling you it’s time to make a change.

5.

Name at least 10 different ways to motivate clients.

Possible answers: rewards, fun, praise, challenge, goal setting, humour, provide interesting and relevant reading material, empathy, use of friends and family, ask clients what motives them, ask client to generate motivational rewards, e.g., “If I achieve/do... then I will allow myself to have and evening away from the kids.”

6. Evaluate how effectively the following statements meet the criteria for effective goals: a. to be a better person Comment: Vague goal, “better” needs to be defined. b. to get my boss to stop hassling me Comment: Ineffective goal as it is not in the person’s control. c. to drink less Comment: A good intention, however, it lacks specificity and a time frame. d. to be able to disagree with someone without dismissing them or their ideas Comment: Appropriate goal, but it could be improved by specifying the options for disagreeing - e.g., respond with empathy, summarizing, thoughtful attention. e. to improve my fitness by next year to the point where I can run 1 km in 15 minutes Comment: Appropriate goal assuming it is realistic (achievable) or sufficiently challenging.

6. Practice brainstorming techniques. Identify 5-7 different action strategies for a client who wishes to quit drinking Answer: 12 step groups, reading about addiction, studying health effects, physical exercise, new friends, yoga and other stress management techniques, counselling, asking friends and family for help, moving to a new area, harm reduction (less drinking or switching from hard liquor), prayer, join a group, develop new hobbies, take Antabuse (medication used in the treatment of addiction).

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Teaching Strategies/Classroom Activities 1. Present demonstration interviews on each of the following:       

assessing stage of motivation rolling with resistance helping clients find strengths in adversity using solution talk (see Supplementary Resources below) use of the miracle question looking for exceptions goal setting

After each demonstration interview provide time for student practice and debriefing 2. Ask students to utilize The Change Continuum (page 268 in the text) to assist a student colleague to work on a selected area for change. This is a good time to discuss with students the value of having visual tools. In the field, flip charts, for example are useful for engaging clients who are less verbal.

Resources 1. Web Resources a. http://www.motivationalinterviewing.org Links and resources on the topic of motivational interviewing. b. http://www.selfgrowth.com Search for articles and resources on goal setting. c. http://www.benfurman.com Search for “miracle question”.

2. Three approaches to psychotherapy. 11 [video recording] / Psychological Films; producer, director, Everett L. Shostrom. 1977. In Part Three of this three-part series, Arnold Lazarus demonstrates Multimodal Behavior Therapy. Lazarus introduces his "BASIC-ID" model as a way of setting goals for change in the areas of behaviour, affect, sensation, imagery and cognition.

3. Maslow, A.H. Motivation and Personality. New York: Harper & Row, 1954.

Maslow’s classic text.

4. Miller, W.R., and S. Rollnick. Motivational Interviewing: Preparing People for Change, 3rd Ed., New York: The Guilford Press, 2012.

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5. Saleeby, D. (2002). The strengths perspective in social work practice. 3rd. New York: Allyn & Bacon. This widely adopted text is considered by many educators to be the definitive text on the strengths approach to counselling.

Supplementary Material and Additional Exercises 1. Below are sample lead’s that might be used or adapted to help clients focus on solutions: 

       

Let’s imagine it’s ten years from now and that your life is how you want it to be.

How does it differ from today? What changes have taken place? Have any of them already begun to happen?

Assume for a moment that your past has nothing to do with your current problem, how would you approach your problem differently?

Sometimes people already know what they need to do in order to solve their problems. Is this true for you?

You’ve faced a lot of problems in your life. What have you learned from dealing with other problems that might help you to deal with this one?

You’ve gone through a lot, yet you’ve survived. Many people would not have made it. How did you find the strength?

Suppose that one day you’re asked to give a speech on how you dealt with your problems. What would you say?

If you were to try something different next time, what would you do? Try to be creative, even a bit absurd.

Has your situation taught you something important about life, about yourself, or about other people? What could it be?

Focus on exceptions: Are there any times, however rare, when your problems have been absent and you feel happy? Have there been times when you managed to resist the temptations to (use drugs, run away, fight, etc.). How did you do that?

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Eight Difficult Situations: Engaging with Hard-to-Reach Clients Learning Objectives 

Understand the nature of client resistance.



Describe techniques for dealing with resistance. 



Explain the use of confrontation.



Identify key variables for violence risk assessment.



Identify and describe strategies for preventing violence.



Describe strategies for intervening at each phase of violence.



Understand the importance of debriefing critical incidents



Describe counselling interventions for dealing with angry and potentially violent situations.

Comments and Possible Answers to Selected Text Exercises Caution: Exercises in this chapter may elicit strong personal reactions, particularly for students who have experienced abuse or trauma. Ensure that appropriate supports are in place.

Self-Awareness 1. Self-evaluate your personal comfort when confronting others. a. What people would you have difficulty confronting? b. Do you avoid confronting? c. Think of times when it was reasonable to confront but you didn’t. What prevented you from confronting? d. Finish the following sentence: When I confront, I feel . . .

Comment: This exercise will help students examine their assumptions and explore their feelings about confrontation. Use class discussion to explore the difference between assertive confrontation and aggressive confrontation.

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2. Review your experiences dealing with individuals who are angry, resistant, or potentially violent. What is your natural reaction when someone’s anger starts to escalate? Do you tend to fight back? Or do you withdraw? What aspects of your experience will help you deal effectively with difficult situations? What aspects will impede your ability?

Comment: This is one exercise that could trigger memories of past or current abuse. Self-awareness will help students avoid under or over-reacting to situations. Class discussion can explore the “flight/flight/freeze” continuum.

3. Reflect on your thoughts, feelings, and behaviour when you were forced or pressured to do something against your will. How might your reactions help you to understand and work with clients who are “involuntary?”

Comment: Reflections such as this increase students’ ability to be empathic to clients.

Skill Practice 1. Work with a colleague to role-play an appropriate counsellor confrontation in each of the following situations: a. a youth who has hygiene problems b. a colleague who has, in your opinion, behaved in an unprofessional manner c. a client who consistently arrives late for appointments Comment: This exercise presents two separate challenges. First, for students to overcome any internal barriers that inhibit them from confronting others. Second,to develop their confrontation skills. Suggest that students might consider the following steps: Step One: Ask students to identify the variables that suggest that confrontation may be appropriate. As well, challenge them to consider alternatives choices for achieving their objective. Contract to confront, e.g., “I have something I’d like to say to you.

Would you be open to discussing it? If so, is now a good time?”

Step Two: Introduce the area/topic of confrontation, e.g., “The issue is hygiene.”

Step Three: See if the client has insight, e.g., “Do you have a sense of what I want to tell you.” In some cases, clients already have insight and this gives them an opportunity to present the issue in their own words. If not, proceed to Step Four.

Step Four: In simple non-judgmental terms describe or present the area of concern, e.g., “I’m wondering if you are aware that you have bad breath. Sometimes, this can be a medical issue, or it may be that you’re simply not aware of it. There have been 8-85

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times when I have not been aware of something about me that I need help from others to understand.”

Step Five: Allow time for clients to respond.

Throughout the process empathy and respect for the client or other person should be a priority. Remind students of the difference between aggressive and assertive responses.

2. Evaluate the effectiveness of each of the confrontations below; suggest improvements: a. Try to do better next time.

Comment: lack of specificity regarding the behaviour that is deficient. b. You’re an idiot.

Comment: Name calling is never an appropriate way to confront. c. You’re saying that you’re okay, yet you’re crying.

Comment: An appropriate confrontation with concreteness. Of course, crying does not always signal sadness. Hence the need to explore its meaning with the client. d. Grow up and act your age.

Comment: Judgmental. e. As long as you continue to act like a doormat, you’re going to get abused.

If you are serious about protecting yourself, leave him.

Comment: Judgmental. Inappropriate advice giving.

3. Interview counsellors from different settings regarding their experiences with violent or potentially violent clients. Discuss strategies that they have found effective.

Comment: This exercise is designed to help students develop a repertoire of skills. Class sharing of the highlights of their interviews should generate a comprehensive list of basic and innovative strategies.

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4. Work in a small group. Assume that you are members of an inner-city needle exchange centre. Develop detailed policies and procedures for dealing with violent and potentially violent clients.

Comment: Policies should deal with such matters as:         

intake procedures file alerts regarding difficulty clients protocol for handling overdose handling of needles and other drug paraphernalia critical incident team response interview safety issues (e.g., re interviewing alone, after hours, street outreach, etc.) denying access to service protocols for notifying the police critical incident debriefing

5. Suppose you review the file on your next client, a 16-year-old male, and discover that he was loud and abusive with his previous counsellor. What are some possible explanations for this client’s behaviour? Suggest some strategies for working with this client.

Answer: The client may be reacting to a provocative worker. The worker may have been overly sensitive to legitimate expressions of anger or concern. The client may have been on drugs (or coming off them), have a naturally aggressive style, or under undue stress. Core conditions (empathy, genuineness, and caring) combined with appropriate use of basic counselling skills are appropriate ways to begin working with such clients. Counsellors can also take preventive measures in the event that the client becomes abusive, e.g., alert other staff for backup, interview with a partner, and avoid being alone in the office.

6. Work in a small group to explore the potential benefits and risks of each of the following actions: a. b. c. d. e. f. g. h. i.

having an unlisted phone number making home visits alone making home visits only when accompanied by a colleague conducting joint interviews for potentially hostile clients using only your first name with clients knowing that a client has a history of violence interviewing a client with a police officer present refusing to see a client with a history of violence striking a client to defend yourself 8-87

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j. calling the police k. warning an intended victim l. seeing a client who has been drinking Comment: The purpose of this exercise is to motivate student to make safety issues a consideration. For example, an unlisted number prevents clients from obtaining an address or calling the counsellor at home. Women who live alone should avoid having their first name listed. Making home visits alone presents obvious safety issues involved, but if the counsellor is sure about the particular client or client population, the home visit is an excellent way to accommodate clients who can’t come to the office. As well, it is empowering because the clients can meet their counsellors on their own territory.

7. The setting is a residential centre for youth. Your last interview with Peter was particularly distressing. It ended with his throwing the chair against the wall, swearing loudly at you, and then storming out of your office, slamming the door in the process and breaking one of the hinges. This incident seems to have been precipitated by his frustration at not being allowed to smoke in the centre. Develop a plan for dealing with Peter during the next interview and in the coming months. Suggest specific leads you can use in the next interview. Consider three possible scenarios: a. He displays remorse over what happened. b. He downplays the serious nature of the incident. c. He’s still angry.

Comment: Versatility will be needed to deal with the scenarios. With scenario “a” the client may benefit from reviewing what happened. This will help him begin to recognize triggers as well as potential ways he might have dealt with his own anger.

In scenario “b” the client needs to learn that his behaviour impacted others.

Confrontation might be effective. In scenario “c” further processing of his feelings is important. Peter will need to learn strategies for expressing anger appropriately.

8. Work with one or two colleagues to practise assertiveness: a. Expressing anger b. Saying “No” to a request c. Sharing positive feelings such as love or affection d. Accepting a compliment e. Expressing disagreement (Suggestion: Role play aggressive and passive responses for each of the preceding scenarios, then discuss how assertiveness differs.)

8. Conduct an extended role play based on the following situation: You have just begun a new job as a youth worker in a residential group home. Your client is a 14-year-old boy who has been in care since he was six years old. During that time, he has lived in over 17 foster homes. After meeting you he says, “Why should I trust you? You guys are all alike. You make all sorts of promises, but nothing ever happens. This is 8-88

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just a job for you, but it’s my life. Next month, there will probably be another new worker”.

Concepts 1. Research legal and ethical codes to explore your responsibility to notify intended victims of violence. Talk to counsellors and agencies for their opinions.

Comment: This exercise is designed to help students develop their knowledge base.

Class sharing of the highlights of their interviews should generate a comprehensive list of basic and innovative strategies.

2. Write a short concept paper that describes what you believe are the elements of effective confrontation.

Comments: Class discussion on this paper could review the nature of assertive versus aggressive behaviour (for confrontation in one’s personal life). Assertiveness is behaviour that enables a person to realize his or her rights by expressing feelings, ideas, or thoughts without denying the rights of others and without guilt or undue anxiety. This definition emphasizes the importance of mutual respect and reciprocity.

Of course counselling relationships are structured to meet the needs of the client, but as with personal relationships, counsellors have a responsibility to be caring and appropriate when confronting. Sessional and relationship contracting will insure that confrontation is presented in a manner consistent with the client’s needs and style. As a rule, confrontation is most effective when it is solicited (sessional contracting). Some other principles of effective confrontation:       

Make sure it's not your main mode of communication.

Don't let anger build up. But, if you're not in full control, wait.

Express justifiable anger, then let it go. Don't hang on to it.

Absolutely don't become violent or aggressive Make "I" statements expressing how you feel.

Express your anger only to the people you are angry with.

Don't destroy relationships by name calling, "hitting below the belt" and bringing up old unfinished issues.

Monitor intensity. Avoid high intensity anger.

Class discussion on assertiveness is also an appropriate time to explore passive behaviour characterized by responses such as:     

self-depreciating thoughts or statements such as "I'm not important," "I'm nobody," "I don't deserve to be happy." not expressing ideas, opinions, or feelings allowing others to take advantage of you in financial, emotional, social, and sexual area not taking legitimate risks offering repetitive and unnecessary apologies 8-89

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non-verbal behaviours such as silence, crying, weak and unsteady voice, poor eye contact.

3. Hamachek (1982) says, “Do not confront another person if you do not wish to increase your involvement with that individual” (p. 230). Develop a rationale that supports this statement.

Comment: Effective confrontation is designed to assist clients develop new insights and behaviours. It is not used as a means to punish. Thus, when counsellors confront they should also be willing to invest time to assist clients to acquire this understanding and to develop new skill sets.

4. How can assertively expressed anger deepen relationships?

Comment: Assertive anger respects the rights of others. It is offered without destructive comments such as name calling and threats. It provides an opportunity to air difficulties and solve problems before they cause permanent damage to the relationship.

Teaching Strategies/Classroom Activities 1. Mediation and conflict resolution.

Part One: Ask the class to work in small groups to develop a specific model outlining the steps that you might follow in helping people seeking a resolution to their particular conflict.

Try to:    

identify the principles and steps that you will follow, example: helping participants identify those issues, however limited, upon which they agree specify any rules of conduct that you might negotiate with the participants, example: no name calling identify words and phrases that enhance negotiation and collaboration- example: using the phrase, "what would it take to solve this problem?" consider problems that might arise during the mediation and how you might address them. Example: behaviour that sabotages the process.

Part Two: Each group is asked to develop a role demonstration for one of the following that illustrates the principles of their model. Develop a credible personality and point of view for each of the participants. The model demonstration should last approximately 10 minutes. 

Two people are in conflict over a group assignment. One contends that the other has not done his/her share of the work. The other asserts that this is "bull." The conflict is further complicated by other issues of friction between the two 8-90

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





including the fact that they don't like each other.

The two participants are in conflict over an alleged breach of confidentiality.

Both accuse the other of "bad mouthing" and revealing private matters. The conflict is further complicated by many other issues of friction between the two.

Two people "don't get along." Mostly, they'd like to avoid each other but the realities of working together require that they learn to work as a team.

Historically, their relationship has been characterized by "put downs," and thinly disguised passive aggressive behaviour. There are multiple issues of friction between the two.

A teacher/student conflict. The "presenting problem" is over the grade assigned by the instructor. The student feels that the instructor "has it in for her and doesn't like her." The instructor believes that the student has produced "marginal work" but demands outstanding grades.

2. Invite a panel of counsellors or social workers from diverse settings to talk about their experiences dealing with difficult and potentially violent clients.

3. Invite a representative from the local police force or RCMP to talk to the students about basic safety and violence preventive measures.

4. If your educational setting has a drama program, arrange for student actors to simulate difficult and resistant clients.

5. Ask students: “What is the most dangerous place to be in this city.” Predictably, most will target inner city areas or other locations known for drug use or high crime. When they have finished brainstorming, give them the answer. “The most dangerous place to be is in a relationship or with your family.” Then discuss the fact that in Canada most violence comes from people we know, not strangers.

6. Work in a small group. Discuss success strategies that you have used to deal with trauma. Given the limited time available, details of the trauma event should not be revealed. Keep the focus.

7. Pre-trauma counselling. Pretend your job is to set up a training program for people who will be working where there has been a catastrophic incident - e.g., aftermath of a major plane crash, earthquake, etc. Develop a program that seeks to “inoculate” participants from the vicarious trauma that might result from their involvement.

8. Do a demonstration interview with a class volunteer to show the effective use of confrontation.

9. Arrange for small groups of students to visit selected settings (e.g., hospital emergency rooms, transition homes, half-way homes, inner city services) to talk with staff about violence and safety in the workplace.

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10. Review and (if possible) demonstrate procedures for administering Narcan for a drug overdose.

Resources 1. Web Resources a. https://www.prevnet.ca/ Canadian site focusing on intervention and prevention program to deal with bullying. b. http://www.redcross.ca Search for resources related to violence and bullying c. http://www.crisisprevention.com The Crisis Prevention Institute provides information about training programs and resources for nonviolent crisis information including a newsletter with topical articles on the subject. d. http://www.socialworkers.org/ National Association of Social Workers (NASW) website – search for “Domestic Violence” to find articles on the subject. e. http://www.phac-aspc.gc.ca Public Health Agency of Canada. Search for National Clearinghouse on Family Violence f. http://www.socialworkpodcast.com/ Search for the episode “Client Violence: Interview with Dr. Christina Newhill”.

2. Crisis Prevention Institute. The principles of effective limit setting [video recording] /Brookfield, Wis.: Crisis Prevention Institute, 2000. This 24-minute video shows how effectively set limits when dealing with difficult clients. The video focuses on how to: use both verbal and nonverbal communication strategies, avoid personal power struggles, set clear and reasonable limits, and enforce consequences.

3. Crisis Prevention Institute. Nonviolent crisis intervention: learning to defuse explosive behaviour. Brookfield, WI:CPI Publishing, 1997. This 26-minute video is designed to assist people who work with potentially disruptive, aggressive, and/or out-of-control persons. The video teaches techniques for safe non-harmful behaviour management.

This video is an excellent adjunct to the conceptual material discussed in this chapter 4. Crisis Prevention Institute. Non-violent crisis intervention: the preventive techniques [video recording]. Cleveland, OH:CPI Publishing:1993. This video reviews early warning indicators that a client may be headed towards violence. This video is an 8-92

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excellent adjunct to the conceptual material discussed this chapter.

5. De Becker, G. The Gift of Fear: Survival Signals That Protect Us from Violence.

Boston: Little, Brown and Co., 1997.This easy to understand popular book is an easyto-read book that offers many tips to readers on recognizing potentially dangerous situations.

5.

http://www.cctatr.com/ Website of the Canadian Centre for Threat Assessment and Trauma Response (CCTATR). CCTATR provides information and training seminars on threat assessment in situations such as evaluating and responding to school shootings. Their research an models are widely used in North America.

6. http://www.apa.org American Psychological Association. Search for an article on how to stay safe when dealing with violent clients.

Supplementary Material and Additional Exercises 1. Techniques for Saying No and Delivering Other Bad News  Make sure that the setting is private. Sit down or standing up may be construed as a desire to leave quickly or seen as unkind.  Be direct, clear and brief. Don’t waffle, hint or avoid the “bottom line. Tell the truth.  Don’t make a hasty retreat. Expect that anger, defensiveness and counterattack are the habitual ways that some clients respond to frustration. See if there is a way to compromise or help the client save face.  Be available to respond with empathy and compassion. Show that you understand, even if you are unable to give the person what they want. Show you are human. 

    

Express willingness to answer questions and to explain the rationale of your position.

But, don’t undermine the authority and integrity of • Maintain and manage your own feelings. No matter how the client reacts, your job is to stay in professional role.

Stay calm.

Be available to listen which is more important that the ability to talk.

Whenever possible assist clients to exercise choices.

Individualize your responses to meet the unique needs and styles of different clients.

Take care of yourself. Anticipate potentially violent situations and take and take remedial action.

Be sure to debrief with a colleague or supervisor after difficult encounters. If necessary, take a break to insure that your reactions do not contaminate your ability to deal with other clients.

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2. Work in dyads to interview each other regarding concerns and personal feelings about dealing with angry and potentially violent clients. Explore aspects of your experiences might make it difficult for you to deal with such clients.

3. How might you prepare yourself to handle the physical and emotional trauma that might ensue from a 9.1 magnitude earthquake that hits this area later this year?

4. What factors do you think might impact how a given individual deals with trauma?

5. Suggest strategies for managing your own feelings and reactions when working with clients who have committed crimes that seriously conflict with your values - e.g., child rape, murder, sexual offenses.

7. John, a married man with three children now ages 11, 12, 13, is about to be released after serving 10 years of a life sentence. His wife has visited him regularly while he has been in jail and he has had periodic visits with his children. Described as a model inmate, John is a trained electrician with a solid work history prior to his incarceration.

After a night of drinking, he killed a man during a street fight. What are some of the challenges that John might face on release? Suggest counselling strategies.

8. Consider a situation where Richard, age 16, posts his intention to “get even” with all the people at his school who have bullied him. Investigate threat assessment concepts and strategies to detail how this situation might be handled. Hint: use the resources of The Canadian Centre for Threat Assessment and Trauma Response (CCTATR). http://www.cctatr.com. What is the appropriate role of youth workers in such situations?

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter 9 Mental Disorders and Substance Abuse Learning Objectives 

Understand the nature and breadth of mental illness in Canada. 



Explain the structure, use, and limitations of the Diagnostic and Statistical Manual of Mental Disorders (DSM).



Describe the characteristics of and treatment for major mental disorders, including schizophrenia, mood disorders, anxiety disorders, eating disorders, and personality disorders.



Explore the mental health issues of children and youth.



Describe the nature and impact of substance abuse.



Identify best-practice approaches for working with clients with substance use problems, including those with co-occurring disorders.



Identify suicide warning signs and strategies for dealing with clients who are suicidal. 

Comments and Possible Answers to Selected Text Exercises Self-Awareness 1. If you were responsible for defining mental illness, how would you define it?

Comments: This exercise should lead to some interesting class discussion as students struggle to define what is “normal.” Remind them how social norms and changing attitudes have shaped what has been defined as mental illness. Some examples: 

 



Drapetomania was a psychiatric diagnosis introduced in the mid-1800s in 1851 by Louisiana physician Samuel A. Cartwright. It was a term used to explain the tendency of black slaves to flee captivity. Prescribed treatments included whipping and amputation of the toes.

Homosexuality was listed in the DSM as a mental disorder until 1973.

Since 1968 DSM has grown from 185 to over 350 different disorders.

Review changes to DSM 5, for example the implications of dropping the term .

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“mental retardation”. Review how what is considered a mental illness is ultimately decided by the American Psychiatric Association (in the West).

Supplementary questions: What new mental disorders might be “discovered” or introduced in coming years? What mental disorders might disappear? Why do you think there are so many more mental disorders now than in 1968?

2. Explore how you and your family or friends might react to the following events and situations: a. b. c. d. e.

You or someone else has a mental illness.

You or a member of your family is HIV-positive or has AIDS. Someone has lost a job.

You or someone in your family has an eating disorder.

Someone you know commits suicide.

Comments: This is a self-awareness exercise that helps students examine values and attitudes towards mental illness and other social problems. In a class discussion, compare how different cultures might respond.

Supplementary question: What pressures might lead an individual or family to hide the existence of a mental illness. Answer: stigma, shame, fear.

3. Examine your own attitudes and beliefs about mental illness. How have your values been shaped by personal experience? By the media?

4. Should counsellors be required to prevent clients in advanced stages of fatal illnesses from killing themselves?

5. How can you manage your own negative feelings that might be triggered when you are working with clients who have personality disorders?

Comment: Self-awareness is critical. Use of supervision and/or colleagues to debrief. Ensuring personal wellness. Reminding yourself not to take client behaviours personally.

6. Under what conditions do you think a person with a mental disorder should be forced to treatment?

Skill Practice 1. A client asks you to explain his or her diagnosed mental disorder. What might you say?

Assume that the doctor has told the client very little about the nature of the disorder. .

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Role-play your response with a colleague. Practise your response using different mental disorders (e.g., schizophrenia, depression, borderline personality disorder, etc.).

Comment: (borderline personality disorder example) First explore what she knows. Avoid textbook explanations. Suggest that she has a strong commitment to relationships which are very important to her, but that she always ends up being hurt so it will be important for her to learn how to have relationships where she does not get hurt. Suggest that leaning emotional control and managing self-defeating thinking will be important components of any change process. Discuss how this strengths approach can assist clients to focus on their capacities and keep the emphasis on problem solving.

2. Clients with personality disorders might challenge you with provocative behaviour such as: a. b. c. d. e.

missing sessions jumping from crisis to crisis open displays of anger or paranoia anti-authoritarian attitudes dependency

Suggest strategy choices for dealing with each of these behaviours Comment: Table 9.3, page 275 presents counselling approaches for dealing with personality disorders. As always, strategies should be flexible and include skills such as: limit setting, immediacy to discuss relationship issues, and counselling to help clients regulate emotions. When discussing personality disorders, it is important to emphasize how difficult they are to diagnose and the fact that clients often meet the criteria for more than one. This diagnostic classification remains controversial within the mental health professional community 3. Practice a suicide intervention interview with a colleague who plays the role of someone who is contemplating suicide. Try to complete an assessment of risk and protective factors. At an appropriate point in the interview, ask the intent question.

Comment: Remind students that the intent question, asked properly will not put the idea of suicide in their client’s mind.

4. Imagine that you are a youth worker (community based) who is working as part of a multidisciplinary team with the following clients: 

Neema, age 7, goes from being completely calm to blindly running, screaming, and hitting anyone in his path. He’s triggered by changes in his environment, even seemingly small and insignificant stressors.

.

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

Rebecca, age 10, throws herself on the ground as soon as she enters the schoolyard.

She clings to her mother, begging to be taken home.



Emilio, age 12, loves wrapping plastic bags around his penis and masturbating during class. His behaviour was so disruptive that he needed to be placed in a special class away from other students.



Nasim, age 9, poured gasoline on the family cat, and then tried to burn the house down.



Pierre, age 15, was introduced by the teacher to the rest of the class. She jumped on the desk, pretending that she had a gun, screaming obscenities and threatening to kill everyone.



Pierre, age 9, is preoccupied with arranging the books and materials at his work desk to the point that he cannot engage with class activities.



Pari, age 18, is prone to intense emotional reactions. When stressed, she threatens suicide or cuts herself. She is sexually promiscuous and uses any street drug available. When asked about her cutting, she says, “I don’t know why I do it. It just feels good. It makes the pain go away.”

What might be an appropriate role for a community-based child and youth care counsellor on the multidisciplinary team in each case? What additional information would you need to develop a case plan from a child and youth counselling perspective?

Comments: Explore the importance of helping people understand that these young people are not simply being “bad” and that significant behavioural reactions can be the result of a variety of factors including genetics, brain chemistry, and trauma. Child and youth care counsellors can assist in the development and implementation of behaviour management plans that add structure, consistency, and reward. It would be important to have an accurate assessment of each client and knowledge of what medications, if any they are taking. In addition, it would be important to know about any family issues or history that might be affecting behaviour. Abuse and trauma are additional factors to consider.

Child and youth care workers and other professionals need to be clear about their role and the limits of their competence for working with each of these clients.

Integration and consistency in case management are essential.

5. Imagine that a client is showing some of the signs of a serious mental illness.

Brainstorm different ways to address this. Assume your goal is to motivate your client to seek assessment and treatment. What are some of the different responses you might expect to hear from the client?

Answer: Timing will be important – try to establish trust relationship and pick of time and setting where there will be sufficient time to address the matter. Ideally, it’s .

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best to start by trying to establish whether the client has insight or concern regarding the symptoms. Other alternatives: put your concerns to the client using specific behavioural examples, but don’t overwhelm and remember the importance of empathy and allowing the client space to respond; utilize family, consider need for emergency intervention if there is a danger to the client or others. Clients may respond with a full spectrum of emotions ranging from anger to relief.

6. A person reveals that he is thinking of suicide. He asks that you promise not to tell anyone. How might you respond?

Answer: Try to redirect the conversation to encourage him to talk about his feelings.

Avoid getting into a power struggle on the question.

7. Practise asking the intent question with student colleagues.

8. You are a youth care counsellor working in a high school. Recently, one of the grade 11 students killed herself. In an Internet posting, she detailed her depression and along history of being subject to cyber-bullying. You have been asked to participate as part of a team to develop a bullying and suicide prevention program for the school.

Describe the potential role for youth care workers in such a program.

Comments: Develop strategies for dealing with bullying when it happens. Create a respectful learning environment. Ensure the setting is safe. Teach children social and problem management skills. Involve parents and encourage them to monitor Internet use. Teach empathy skills. Monitor and deal with systemic problems including poverty, prejudice. Encourage children who are bullied to report it, then intervene to reduce effects and deal with perpetrators. Educate everyone regarding the warning signs of suicide. Use a team approach as this is a complex issue requiring everyone’s attention.

9. Suggest counselling options for working with clients who have “negative symptoms associated with psychosis.”

Comments: Research suggests that the “negative symptoms” common in schizophrenia have a greater debilitating impact on a person’s life than “positive symptoms.”

Sometimes, medications used to treat symptoms such as depression can help, but, for the most part, psychiatric medications treat the positive symptoms only. Counsellors can target: helping clients pursue activities, set goals, develop life skills including social skills, employability skills training and support, day programs and drop-in centers, and psychoeducation with families. Here’s a helpful article on the topic: Search http://www.psychiatrictimes.com for an article titled “Negative Symptoms in Schizophrenia: The Importance of Identification and Treatment” .

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10. Discuss the counselling implications of the use of cannabis among young teens.

Answer: There a many articles and research studies demonstrating the harmful effects of cannabis use on the adolescent brain. With cannabis now legal in Canada, teens may falsely conclude that the drug is harmless. Wide availability and peer pressure may, and probably will, lead to increased experimentation and consumption. Providing information so that youth can make informed decisions regarding using is important. The aim of this is to debunk the many myths about this drug. Below is a link to an article that contains some useful information on this theme. Search for teens and pot use, what parents need to talk about. https://www.denverpost.com Motivational interviewing techniques can be used conduct interviews with youth that avoid the power struggle trap. Youth at different stages of change will respond to different strategies. For example, one who already motivated to reduce or cease usage might profit from counselling that focuses on how to deal with peer pressure, how to say “no”. This same strategy would not be useful for someone at the precontemplative phase.

Concepts 1. Why do people stop taking their psychotropic medication? Describe what a counsellor might say to a client who refuses to take or appears to be off his medication Comment: side effects, lack of routine or ability to take medication on a regular basis, desire for return to symptoms (e.g., mania), and cost. If anticipatory contracting has already led to a discussion of the possibility that the client might go off meds, then a plan for intervention is already in place.

Counsellors should first address the client’s reasons for stopping understanding that, from the client’s perspective, these are very valid reasons. Empathize with this reality. Then, see if the client is willing to consider strategies for overcoming problems. For example, if side effects are an issue, the client might consult with his/her doctor for alternatives. Another strategies (depending on the issue) might be long lasting medications or injections.

2. Scan magazines to identify feature stories highlighting dieting. Discuss how these might have an impact on readers’ self-image and behaviour.

Comment: This exercise can spearhead class discussion on how the mass media promote unrealistic images of physical and social health, images which few, if any, of us can match. Explore how they can lead to eating disorders. Caution: some students may have had or are currently dealing with an eating disorder.

2. Imagine that you are a counsellor working with a 21-year-old woman who asks you to .

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explain what borderline personality disorder means. What might you say? Assume she has been diagnosed with it, but her doctor has told her little about the nature of the disorder.

Comment: Client often poorly understand the nature of their disorder and the medications they are taking. Counsellors can play a major role in helping clients develop basic knowledge and the steps they need to take to promote their recovery. Consequently, it is important that counsellors develop the ability to present this in language that clients can understand.

With the 21-year old woman described above, the counsellor might say: “A big part of what this means is that you struggle to deal with your emotions. Relationships are really important to you and you expect a lot from them – sometimes maybe too much. If people let you down, it might be a trigger for you to start cutting or thinking about taking your own life.”

4. Rudy has a history of serious depression. During a recent visit, he seemed unusually “upbeat.” He took the opportunity to thank you for all your help. What might be happening for Rudy?

Comment: People contemplating suicide may have a sense of finality which gives them some peace. Others may give away possessions.

5. This chapter describes personality disorders as “stable instability.” What does this mean?

Comment: Unstable patterns of thinking or behaviour are the client’s “normal”.

6. In what specific ways might street drugs “self-medicate” mental disorders?

Comments: Crystal meth may be used to deal with depression. Alcohol can be used to deal with anxiety. Heroin may be used to combat physical and psychological pain.

Marijuana may help some deal with stress. The drugs do little to deal with the underlying problems and people may find that they need more and more of the substance to get the same effect.

7. Suggest how answers to the question, “what has kept you from killing yourself so far?” might be used to assist clients.

Comments: This question can help identify strengths and protective factors.

8. Discuss why there is societal (and often self-imposed) stigma attached to having a mental disorder, while no stigma is attached to having a physical disease such as diabetes.

Answer: Stigma about mental illness is widespread. It may arise for many reasons including; belief that the condition is self-imposed, belief that will power can overcome it, fear that the person with a mental disorder is dangerous (a myth often perpetuated by the media, books and movies), or belief that the person is “possessed”. .

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Teaching Strategies/Classroom Activities 1. Carousel Brainstorming - Mental Health: Pin four sheets of flip chart paper in the four corners of the room. Number each station from one - four. Attach one of the four questions below to each flip chart. Divide the class into four groups and ask each student to go to their respective station. Ask them to work as a group to answer the question at their station, but only allow two minutes for this activity. At the end of two minutes instruct the groups to move to the next station to work on the next question (which will already have recorded answers from the previous group).

Continue until each group has rotated through each of the four stations. Now ask, them to return to their first stop to review how other groups have added to their original ideas. Ask each group to prepare a short five-minute class presentation highlighting what they consider to be the most important concepts.

Suggested Questions for the Carousel Question 1: You suspect that your client has a mental disorder. What might you say or do to encourage them to seek assessment and training?

Question 2: Why might a client choose to come off psychiatric medication?

Question 3: What impact does a mental disorder have on a family?

Question 4: What role can helping professionals such as counsellors, social workers, employment counsellors, and youth workers play in supporting people with mental disorders?

2. Ask students to brainstorm best and creative practice skill responses for responding to the situations described below. Remember: Having a range of options or choices allows for maximum versatility. Your client:         

starts hallucinating. is delusional. seems to be off medication has an illness makes it difficult for him/her to trust you? with a mental disorder asks, “Do you think I’m crazy.” announces that he/she is in love with you. tries to convert you. asks that you pray with him/her accuses you of spying on him.

3. Assign student groups. Ask each student group to develop a model interview for one of the above (#2) scenarios.

.

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Resources 1. Web Resources a. http://suicideinfo.ca Canadian based website providing information, training, and research on suicide. b. http://www.samhsa.gov US government sponsored site (Department of Health and Social Services) that offers a huge information base and links to mental health and co-occurring disorders sites c. http://www.nami.org The National Alliance on Mental Illness is a grassroots mental health organization for people living with serious mental illness. Their site provides information and links to advocacy, research, support, and education. d. http://www.mentalhealth.com This is a free encyclopaedia of mental health information. The Web site includes information about mental disorders, treatments, and research. Also included is an online magazine. d. http://www.mentalhealth.com Search for exercise and mental health counselling.

Supplementary Material and Additional Exercises 1. Imagine that someone in your family was diagnosed with schizophrenia. What impact do you think this might have on the family? How do you think different members of your family might react?

2. Imagine that someone in your family was diagnosed as HIV positive. What impact do you think this might have on the family? How do you think your family might react?

3. Pre-plan an interview strategy for exploring the effects of unemployment on an individual and his/her family. a. Meet with another partner and interview each other regarding your personal experiences with unemployment. Consider feelings, thoughts, behaviour, including self and others in your exploration. b. Interview selected people regarding their experiences with mental illness.

.

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4. Peter has been described as a psychopath (antisocial personality disorder).

Suggest a range of strategies for working with Peter. Canadian Robert Hare’s classic book might be used as a reference for more information on this topic: Hare, R. D. (1993). Without conscience: the disturbing world of the psychopaths among us. New York: Toronto: Pocket Books, c1993.

5. Ask students to explore their experiences with death and dying. Ask them to consider this question, “How might these experiences help or hinder your work if you were counselling clients who are suicidal?”

Comment: This self-awareness exercise re death may be difficult for some students who have limited experience with the topic, or those who have had recent/unresolved personal bereavement. Allow sufficient time for debrief.

6. Ask student to research medical conditions that can generate psychiatric symptoms.

7. Essay topic: A critical analysis of DSM 5. Explore the strengths and limitations of this manual.

8. Essay topic: Recent brain research on the causes of mental illness.

9. Shea, S.C. (1998) Psychiatric interviewing: The art of understanding (2nd ed).

Philadelphia: W.B. Sanders.

This is a good resource for students who are seeking more detailed information on strategies for interviewing those with mental disorders.

10. Simmie, S., & Nunes, J. (2001). The last taboo: A survival guide to mental health care in Canada. Toronto: McClelland & Stewart.

An excellent first-person account by a Canadian journalist’s (Scott Simmie) struggle with bipolar disorder.

11. Design a community education program to help people understand basic information about mental disorders.

.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Ten Cultural Intelligence Learning Objectives 

Define cultural intelligence.



Understand the Canadian multicultural mosaic including the diversity of its’ citizens and the challenges faced by immigrants, including the impact of oppression and racism.



Describe the key elements of cultural understanding



Explain the basics of multicultural counselling.



Demonstrate knowledge of skills and attitudes necessary for working with First Nations people.



Describe the importance of spirituality in counselling.

Comments and Possible Answers to Selected Text Exercises Caution: Students from different cultures should not be put in the position of being called on as spokespersons for their cultures. This inappropriately puts them in an “expert” role where they may not be able to objectively represent their culture and the diversity within it. Similarly, students who have overcome personal difficulties such as addiction can offer their own perspective, but it is important to restrict them from assuming excessive power in the classroom.

Self-Awareness 1. Develop a personal plan for increasing your multicultural sensitivity. Include strategies for experiential learning (e.g., increasing your circle of multicultural friends, involvement in multicultural events, etc.).

Comment: Multicultural involvement is the powerful and preferred way to learn about divergent cultures. Challenge students to consider the extent that their friends and contacts are from their own culture and if it is limited, to consider the implications of this restriction.

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culture?

Comment: Answers may range from curiosity or interest to fear. Try stimulating discussion by asking student how people might react emotionally, and then personalize it by asking them to what extent this applies to them.

3. To what extent does your cultural membership give you privilege?

Comment: This question is most relevant for students who come from the dominant culture.

Brainstorm other realities that might confer privilege such as race, gender, socioeconomic status, and ability.

Stimulate discussion on this topic by asking students to interpret the following saying, “The early bird gets the worm.” Typically, they will stress the importance of diligence and initiative in order to succeed. Now observe that they answered the question from the perspective of the bird. Ask, “How would your answer have changed if you had commented from the perspective of the worm.” Conclude that this exercise has something to teach us about power and privilege.

4. In what ways is your worldview the same as or different from that of your parents? Your colleagues? Your teacher?

5. Take a cultural inventory of your friends. To what extent do they come from different cultures?

6. What does being Canadian mean to you? What values are linked to being a Canadian?

7. Explore your spiritual values through the following questions: a. b. c. d. e. f. g.

Are religions good or bad?

Is my religion the only correct one?

Should cults be illegal?

What does spirituality mean to you?

Should spiritual issues be introduced by counsellors?

When is it appropriate to discuss religion with clients?

What are the implications of your religious views when working with someone with a similar perspective and when working with someone with radically different views?

8. Pedersen (1994) says, “Counsellors who presume that they are free of racism seriously underestimate the impact of their own socialization” (p. 58). Explore the validity of this quote with respect to your own life.

.

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9. Spend an hour with someone who speaks another language that you do not understand. Communicate only in their language. What did you learn this experience that will add to your understanding of working with new immigrants?

Skill Practice 1. Interview several people who are culturally different to learn about their worldviews.

2. Spend an hour or so with a person from a different culture. Use the sample questions from this chapter to begin an exploration of his or her worldview.

3. Practice different choices for responding to a client who asks, “Do you believe in God?” Class discussion can provide good opportunity to review important concepts related to selfdetermination and power.

5. Suggest how you might work with a client, Ruth, who is dealing with the following problem: Ruth is a devout Christian who is very close to her family. She has become romantically involved with Jacob, a Jewish man, but her father insists that she marry within her own faith.

6. Invite an Aboriginal person to share with you some of his or her experiences in a residential school. Remember that this is a very sensitive topic, so be prepared to be empathic in response to powerful feelings that might be revealed.

Concepts 1. In what ways do diversity issues such as ethnicity, gender, and sexual orientation affect counsellor effectiveness?

Comment: Explore ideas related to concepts of privilege, ethnocentrism, selective perception, bias, objectivity and stereotyping. Even when counsellors meet clients with similar background it is important that they remain open to individual differences.

Moreover, if they (counsellors) assume that they understand they may deny their clients one of the most therapeutic outcomes of counselling, the opportunity to tell one’s story.

2. Research how mental illness may be interpreted by different cultures.

Comment: Some variables: how family and community view the illness, issues of shame, preferred ways of treating.

3. Describe how counsellors can be sensitive to cultural norms while honouring individual differences. .

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Comment: Counsellors need to be broadly informed about different cultural and religious traditions while remembering that these are generalizations that may or may not apply to individual members of those subgroups. In a multicultural country such as Canada, it is not unusual for people to be bicultural, perhaps raised by parents with traditional values, but heavily influence by Western norms.

4. What are some of the barriers that clients from ethnic minorities face when seeking counselling services?

Comment: Language, imposition of Western approaches to counselling, different world views of counsellors who are versed in minority values and traditions.

5. Explore the religions of the world (e.g., attend services and festivities, acquire a multi-faith calendar).

Comment: Assign this as a homework exercise, then process student experiences in group discussion.

6. How can counsellors assist clients to explore spiritual and religious issues without imposing their own religious values?

Comment: Self-awareness about one’s own spiritual/religious values is a necessary prerequisite. Professionals need to accept that it is unethical to promote their own religious view and they should not use their positions of power and influence in manipulative ways. Discussions about spirituality and religion have a place in counselling and they should not be avoided 7. Do you think it’s appropriate for counsellors to privately pray for their clients?

8.

Use library databases or the online database of Statistics Canada (www.statcan.gc.ca) to research the demographic characteristics of your community. Identify the places of birth and mother tongues of the local immigrant community. Explore statistics related to Aboriginal groups in your area. What are the implications of your data for counsellors who hope to work in your area?

Comment: This question has two purposes: First, for students to develop research skills for exploring demographic issues. Second, to help they identify priorities for professional development.

9. Invite an Aboriginal person to share with you some of his or her experiences in a residential school. Remember that this is a very sensitive topic, so be prepared to be empathic in response to powerful feelings that might be revealed.

Comment: Personal stories create powerful learning opportunities. Non aboriginal .

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teachers can honour the fact that aboriginal stories are best told by aboriginals.

10. What unique problems might arise when counsellors and clients are from the same culture?

Comment/Possible answers: Increased acceptance, expectation they will be more tolerant and lenient, labeled as traitors. All cultures have derogatory terms to describe their members who they perceive to have joined the dominant culture - e.g. “red apple” (red on the outside, but white on the inside).

11. Think about specific customs and beliefs that you might encounter when you work with clients from different cultures. In what areas do you have difficulty working with objectivity?

(Possible examples: arranged marriages, male dominance in the family, female genital mutilation) Comment: This self-awareness exercise can be an excellent tool for small group discussion or one-one sharing.

12. Pedersen (1994) says, “Counsellors who presume that they are free of racism seriously underestimate the impact of their own socialization” (p. 58). Do you agree or disagree with this statement?

Comment: We all have biases and preferred ways of seeing the world. Members of dominant cultures are vulnerable to seeing things from this perspective. While it would be rare for professionals to be overly racist, they could easily overlook comments or perspectives that are oppressive or insensitive to minority groups.

13. Identify choices for this client question, “What are your religious/spiritual beliefs?”

Comment/Answer: Answer the question directly; ask what is behind the question; empathize with what might be fear or worry that you won’t understand; initiate discussion on the importance of spirituality for the client; ask what difference the answer might make.

Teaching Strategies/Classroom Activities 1. Hans Rosling’s book (see citation below), can be used to design a number of different learning activities that challenge common misperceptions about poverty and world health. Use the book’s test on page 3 as an introductory exercise. This can be followed by fact-based discussions that introduce students to a new, and positive, way of looking at the world. Note: This is the book that Bill Gates endorsed and provided a free copy to all university graduates (USA) in 2018.

Rosling, H., (2018). Factfulness: Ten reasons why we’re wrong about the world – and why things are better than you think, New York:Flatiron books See also: Gapminder.org/whc .

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2. (See Teaching Strategies, #1, Chapter Two - reproduced below) Ask students to write a few paragraphs answering the following questions: What is counselling? Why does it work? When they are finished distribute envelopes for their answers. Seal the envelopes and collect them for storage until the end of the course. During the final class return the envelopes to the students and conduct a class discussion on how their views and understanding have changed.

Return the envelopes to the students and conduct a class discussion on how their views and understanding have changed.

3. (This exercise can be offered at the close of the course depending on which chapter signals course completion Course review. Form class groups and assign one of the following topics below to each group. Ask each group to use class and text concepts to prepare a ten minute class presentation.     

The Ten Rules of Effective Counselling Seven Common Counselling Errors: How to spot them, How to prevent them.  Goal Setting: Why? When? How? Counselling: What is it? Why it works? Brief Encounters: Selected Strategies

Alternate topics: 

The importance of self-awareness



The central role of empathy in counselling

4. Use this exercise if you had class members work in the same small group for the semester. It is designed to assist them to end their group, to extract learning from the experience, and to plan next steps. Work in your small group to explore questions and issues related to endings. Use the following questions and discussion prompts as a discussion guide, but your group is free to add its own a. As individuals what have we accomplished? Use self disclosure and feedback to explore progress. b. As a group what did we accomplish? c. What feelings were characteristic of our time in this group? Feelings about the end of this group? d. What might we have done differently to enhance our effectiveness? e. Unfinished business, regrets. .

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f. Next steps for each individual. Identification of areas for future work. g. Suppose that you found yourself in the same group for another course.

What would you want to be the same or different?

5. Invite representatives from First Nations to discuss their history and culture.

6. Form the class into small groups.

Directions for groups: Imagine that you are part of a staff team at Acme Social Services, a very large (100 staff) team serving the needs of a community of about 100,000 people. Your job is to come up with a strategy for making Acme more culturally competent. A recent demographic survey of the region revealed the following:        

Percentage of Immigrants: 42% Asian (Chinese): 60% Asians (India): 11% Aboriginal: 5% Middle Easterner: 15% Other: 9% 15% of agency clients are immigrants or visible minorities. Percentage of visible minorities among staff: 2%

7. Ask students to imagine that will become part of a team of social service workers, counsellors and mental health workers who have been asked to travel to a Central American Country that has suffered a devastating earthquake. Their primary role is to assist with the psychological impact of the disaster. The team leaves tomorrow!

Discussion questions: ●

How might you prepare yourself to handle the physical and emotional trauma that might ensue from exposure to the death and trauma.

●

In the next 24 hours before we leave - what information would you want to acquire? What cultural knowledge would be essential? What would you want to do before we leave?

●

Predict the problems you might be challenged to address.

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Suggest “do’s” and “don’t” for working with the people (individuals, families, children, and communities) directly impacted by the disaster.

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

How can we deal with our own reactions to minimize the effect of secondary trauma (vicarious trauma)?



After staying one-month, we will return home. Anticipate how you might be changed by the experience. What problems might you face?

Resources 1. Web Resources a. http://gapminder.org On line graphs, charts, and material support for the concepts discussed in Hans Rosling’s book (see Teaching strategy 1 above) b. https://www.infoplease.com Search for information about world religions. c. http://www.phac-aspc.gc.ca Public Health Agency of Canada. Links to information on mental health in Canada d. http://www.cic.gc.ca Citizenship and Immigration Canada. An important government site linking to immigration laws and resources. e. https://sites.lsa.umich.edu Search for group activities for exploring power and privilege f. https://humaneeducation.org Search for teaching activities to help students explore and understand privilege 2. Kelly, E.W. (1995). Spirituality and religion in counseling and psychotherapy: Diversity in theory and practice. Alexandria, VA: American Counseling Association.

This text is part of a growing body of literature that addresses the topic of spirituality in counselling.

3. Sue, E.W., and Sue, D. (2015). Counseling the culturally diverse, 7th edition, New York: John Wiley and Sons A widely used and quoted text on this topic.

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Paper Topics and Research Projects 1. Write a reflective paper that explores your world view. What elements of your worldlier might be an asset or a hindrance in your work as a counsellor?

2. Pick a culture or diversity group other than your own. Research the values, customs and worldlier of this group.

3. Reflect on your learning in this course and submit a paper outlining your personal philosophy of practice, e.g., your preferred style, the major concepts or theoretical orientation that guide your practice, your assumptions about interviewing, counselling and helping.

4. Select a religious faith other your own to research. What are the major beliefs and rituals of this religion? If possible, arrange to attend one of their religious gatherings.

Prepare a report that summarizes your findings.

5. Explore (with specific examples) how counselling choices might need to be varied to meet the needs of people from different cultures.

6. Essay on the topic of cultural appropriation.

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Bob Shebib Choices: Interviewing and Counselling Skills for Canadians, 7/e Manual Chapter Eleven Neuroscience and Counselling Learning Objectives 

Acquire a basic understanding of the brain and mind.

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Describe how neuroscience is emerging as a new force in counselling.

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Identify methods for studying the brain, including neuroimaging.

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Explore how the concept of neuroplasticity can be used in counselling.

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Explain the basic structure of the brain.

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Understand the function of neurons and neurotransmitters.

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Describe the range of acquired brain injuries.

Comments and Possible Answers to Selected Text Exercises Self-Awareness How might your genetics be affected by your life experiences?

1. Think about how you might react if you or a member of your family was diagnosed with Alzheimer’s. Reflect on the overall impact for you, your friends and your community.

2. Make a list of things you could do to “exercise” your mind.

3. Imagine that you are an individual whose parent has Huntington’s disease. Share your thoughts on the pros and cons of taking the genetic test to determine if you will develop the disease.

4. What are your strongest neural pathways? What events or experiences made them strong?

Which are helpful to you in leading your life? Which are problematic?

5. Do you think biology and neuroscience will be able to explain the “mind?”

Skill Practice Change your neural patterns by visualizing (imagining) change. Identify a situation in your life where you would like to change how you think, behave, or act. Set a specific goal. Now close

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your eyes and visualize the ideal result. Use thought stopping to manage unhelpful thinking.

Option: work with a partner who can assist you with prompts that help you visualize – e.g., Where are you? Who else is present? Imagine that you are to…. (situational details). Now, imagine yourself saying…. You are feeling (add positive emotion consistent with success).

1. Suggest how a counsellor might deal with a client recently diagnosed with Alzheimer’s at the early stages who remarks, “My life is over.”

Comment: Use empathy to acknowledge the frustration and sense of hopelessness that the client is experiencing. Avoid platitudes that “band-aid” the severity of the situation. Focus on current capacities and strengths. In addition, the following may be helpful: o o o o o o o o o o

Support groups Education regarding symptoms, treatment options, and housing Establishing routines and structure adds to a person’s sense of control and security Promote exercise and nutrition which will help to deal with anxiety and depression Encourage goal setting to establish a sense of purpose Encourage family involvement and participation in favorite activities or food Support family, encourage them to reassure their loved one that he or she will not be abandoned Arrange medical assessment and treatment for depression (if present) Frequent, positive feedback recognizing successes Collaborate – seek their input on needs and wants

2. What unique issues might arise for a client age 40 who develops early onset Alzheimer’s?

Potential issues:     

Job and career related issues may make it increasingly difficult to maintain the same job as before they developed Alzheimer’s.

Financial insecurity related to potential job loss Dealing with children who may still be at home Relationship challenges with spouse, family and friends Need to develop a plan for handling the progression of the illness

3. Your client is a 75-year-old man living with his wife, age 68. They have been happily married for over 40 years. Three years ago, she was diagnosed with Alzheimer’s and the disease has progressed rapidly. She has reached a point where she can no longer be left alone. Often, she has trouble recognizing family and friends and, on occasion, even her

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husband. He is in good health and determined to keep his wife at home. However, he admits that the burden of her care is becoming overwhelming. Develop a plan for supporting him in the coming months.

Answer:      

Support groups Government assistance for at-home care Potential use of volunteers Helping him access and utilize information regarding treatment and progression of the disease Use of respite care to enable him to maintain personal health and wellness Discussion regarding potential next steps

4. Talk to your circle of family and friends. Ask them, “What words and phrases do you think of when you hear the word Alzheimer’s?” Now ask them, “What would you say, feel, and think if someone close to you said they had Alzheimer’s?” Share your answers in a group discussion with classmates.

5. You client has recently experienced a stroke. He says, “My life is over.” Suggest counselling priorities for working with this client.

Comment: See question one comments. Recent advances have increased the options for the treatment of strokes and with appropriate therapy there is considerable hope that he may regain some or even most of his pre-stroke capacity. Help him access resources.

6. Your client is a woman, age 28, who has been diagnosed with multiple sclerosis. In recent months, her symptoms have become more pronounced where she is having difficulty caring for her twin boys, age 6. She also reports that this is putting a severe strain on her 10-year marriage to her high school sweetheart. As her counsellor, how might you assist her to deal with her challenges.

Answer: Refer her and her husband to the local MS social service agency (if available).

They may have support groups for both her and her husband. See if she is eligible for any home-based support services including respite care. Provide or refer the couple for marriage counselling. On-line resources are potentially useful sources of information and/or links to family support resources.

7. Your client is a 20-year-old man who has recently been diagnosed with epilepsy. He reports that he feels ashamed and embarrassed by his condition. Suggest a simple, response (without jargon) to help him deal with his feelings. Use neuroscience concepts.

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Answer: You might address the fact that epilepsy is the same as any other biological illness using, for example, the notion that we don’t judge people who have diabetes. It is not evidence of personal or moral weakness. It can and does happen to people from all strata of society.

8. A third-grade teacher is adamant that her nine-year-old student diagnosed with ADHD is just “being bad.” Suggest a neuroscience response to the teacher.

Answer: Explain that ADHD, while exacerbated by many social and genetic factors can be linked to problems with brain neurotransmitters such as dopamine and norepinephrine.

Detailed discussion of this can be found in online articles. Use the search term, neuroscience and attention deficit disorder.

Concepts 1. Scientists are a very early stage using technology to “read the mind.” Suggest ethical issues that might arise if this technology is perfected.

Answer: How should this technology be used in the courts – e.g. to determine if a person is telling the truth, to aid eye-witness technology. Who should have access to the tools? Should people be forced to submit to such mind reading? If so, under what circumstances and under whose authority?

2. Describe how neuroplasticity can be used to explain cognitive behavioural counselling concepts.

Answer: Explanations should be customized for each client. Here’s a simple example of what a counsellor might say to introduce the matter: “Over time we develop strong patterns of thinking and feeling that tend to repeat themselves. When these patterns of habits of the brain are unhelpful, they can be overcome by taking advantage of the brain’s ability to change. This takes practice and repetition which will gradually replace unhelpful patterns with helpful ones. We know how to do this.”

For additional information search online, for example, The National Center for Biotechnology Information - https://www.ncbi.nlm.nih.gov/. Use search term cognitive behavioral counseling and psychosis. Dispute the common myth that we only use part of our brain.

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Answer: A commonly repeated statement is that “we use only 10 percent of our brain at any given time.” Functional magnetic resonance imaging (fMRI) research has demonstrated that most of our brain is active at any given time.

3. How can we best help our clients utilize information on the Internet?

Answer: First, become informed ourselves. On line resources such as http://thoughtco.com can be useful. Use search term, internet research tips.

4. If the brains of psychopaths are damaged, to what extent should they be held accountable for their behaviour.

Teaching Strategies/Classroom Activities 1. Engage students in interview simulations where they are challenged to explain selected neuroscience concepts to clients. Challenge them to develop a range of responses that meet the needs of different clients on topics such as the following: a. Neuroplasticity b. Cognitive Behavioural Counselling c. The effect of trauma on the brain 2. Assign as homework. Ask students to research and write their own “Brain Byte” in the format used in the book. It must be neuroscience related to counselling. During class use small group format for students to share.

3. Use a classroom activity designed to teach students about neuronal activity. One such activity can be found at ncbi.nlm.nih.gov. Use search terms, neurons and classroom activity.

4. Choose a mental disorder (e.g. schizophrenia, bipolar). Divide students into small groups, each of which is identified by a particular region of the brain such as frontal lobe, amygdala, hippocampus or a major neurotransmitter (e.g., serotonin, dopamine). Allow one-half hour (or more) for each group to review research on the known connections (if any) between the identified mental disorder and their assigned region of the brain or neurotransmitter. Use a large group discussion to share results.

Resources 1. Web Resources 11-117

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a. https//www.medicalnewstoday.com Search for common misconceptions about the brain. b. https://neurosciencenews.com Online site offering up-to-date neuroscience research news c. http://www.neuropsychotherapist.com Online journal that explores therapy and counselling from a neuroscience perspective d. https://science.howstuffworkds.com Search for morality and the brain e. https://www.healthline.com Search for brain interactive 3D model f. https://library.med.utah.edu Search for anatomy of the brain. Warning: this site features brain dissection and is extremely graphic. g. https://faculty.washington.edu Search for neuroscience for kids. It’s also a great introduction to the brain for counsellors.

The site covers a wide range of topics. h. https://www.drugabuse.gov Search for the neurobiology of drug addiction. i. https://www.edutopia.org Search for brain based learning resources.

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