PSY 4432 - Advanced Counseling Techniques

Texts:
Hackney, H.L. & Cormier, L. S., (2001). The Professional Counselor: A Process Guide to Helping: Fourth Edition. Boston: Allyn and Bacon.

Corey, G., Corey, M.S. & Callanan, P. (2003). Issues and Ethics in the Helping Professions: Sixth Edition. Pacific Grove, California Brooks/ Cole Publishing Company.

Gilliland, B.E. & James, R.K. (2001). Crisis Intervention Strategies: 4th Edition, Pacific Grove, California: Brooks/Cole Publishing Company

Course Objectives:
Advanced Counseling Techniques will fulfill the following course objectives:

1. Students will learn to perform counseling skills at least at minimum levels for entry into the human service field. The following skills constitute basic counseling techniques:

2. Students will learn to recognize differences between clients’ problems/cultures will have some rudimentary differential responses, especially as their culture influences their presenting problems.

3. Students will be introduced to three major theoretical approaches to psychotherapy and one established technique from each.

4. Students will learn the structure of the counseling process across four sessions:
presenting problem, treatment goal setting, use of appropriate technique, and closure.

5. Students will learn the structure of the social history interviewing technique as an example of information gathering

6. Students will incorporate the crisis model in dealing with clients in crisis.

Written Work: All written work must be neat, and proofread for grammar and spelling errors. You will lose credit for these errors. The behavioral observation must be typed with double-spacing and 1 1/2 inch margins. I am evaluating your products as though they were going into the public record.

SOAP Notes can be handwritten or typed and brought with you to your supervision session. (4 sessions of notes.)
Behavioral Observation must be typed.
Social History must be type

Video-tapes: Each student will create one crisis video-tape, to further develop their crisis skills, one social history video-tape with their partner, followed by four (4), 30 minute minimum v-t simulated counseling sessions with that same partner. Make additional time to review your tapes after each session. If needed, you will be trained to use the equipment. The rooms are locked. The keys are with Louise Jackson and there is a master key with the secretaries upstairs. You must give your student ID to borrow the key. Remember, after borrowing it to return it immediately as it is the only key for the entire building. Taping works best if they are scheduled when Dr. Jackson is available to loan you her keys.

Late afternoon taping is very difficult because no one is here to lock up after you have completed your session. Please schedule your sessions between 8am and 4:30pm Monday through Friday.

Supervision: Supervision sessions of approximately 45 minutes will be conducted with each student after each session. You and your partner will sign up for a regular supervision time to use throughout the quarter. You will be expected to self-critique your work as you learn your skills. Please bring your SOAP notes with you to supervision and you will receive your points immediately. Improperly written notes will be asked to be rewritten with some loss of points.

It is your responsibility to come to supervision prepared to discuss your session. Please view it prior to our visit. It is understood that you will keep your appointment, but if you need to change your time, do so in class so we can change the master schedule. Karen will be sitting in on some supervision sessions as part of the Teaching Associate assignment.

Performance Criteria: This training course is composed of two components: cognitive and skills. The cognitive component is measured by your performance on the essay exams, SOAP notes, and written reports. The skills component is measured by your performance in the counseling sessions, skill builders on exams, and the formal interview. You must pass the skills component of the course with a C or better to pass the course. If your skills are not at the minimum level, you will be given an Incomplete and asked to repeat the counseling sessions until skill level is a stable C

Research Article: Wisch, A.F. and Mahalik, J. R. Male therapists’ clinical bias: Influence of client gender roles and therapist gender role conflict. Journal of Counseling Psychology, v.46 (1), 51-60 Each student must read and summarize this article on gender bias in clinicians. Please include a critique and reaction section. (three pages maximum)

Grading: Grading will be determined by your performance in the following areas:

Reading Assignments:

Week	Topic	Reading
1-2	Introduction to the course
	Crisis Skills and Counseling Skills - 6-stage model
	Handling Specific Crises	Gilliland & James
	Chemical Dependency	Ch. 8
	Personal Loss	Ch. 9
	Violent Behavior in the Workplace	Ch. 10
	Practice in class
	Selecting partners
	Crisis Video 1

3	Counseling Skills Development	Prof. Couns. Ch. 1, 2, 3
	Assessing Client Problems	PC/Ch. 4
	Basic Skills: Basic Attending skills
	Feedback Skills: Paraphrasing etc.
	Question-Asking Skills/practice
	Informed Consent-Psychological Ethics Corey Text
	Social history
	Supervision crisis video

4	Person-Centered Therapy /td>
	Multi-Cultural Framework	Handouts
	Using Counseling Skills in Intake Process
	Social history video

5	Observational strategies/Scanning for information processing, blind spots, and patterns
	Reflecting Feeling and Meaning Skills/practice
	Resistance
	Anger Management	Handout
	The First Session: Structural Elements
	Practice Counseling in Class
	Counseling Demonstration
	Social history supervision

6	The Multi-Cultural Perspective Continued
	Counseling specific problems/cultures: CD, Abuse
	Non-compliance, Depression, Stress, Grief, Anger
	Demonstrations/practice
	SOAP Notes Format
	Supervision - Social History
	Corey film: The Art of Integrative Counseling and Psychotherapy
	“Ruth”
	Counseling session 1 Presenting Problem

7	February 26, 2004 Essay Exam 1 Crisis material, Professional Counselor Ch. 1 - 5 Lecture: Person-Centered Counseling- Rogers
	Choosing Appropriate Interventions	PC/Ch. 6
	Preferred Scenario lecture and demonstration
	Counseling supervision

8	Cognitive Interventions	PC/Ch. 8
	Ellis, Rational Emotive Therapy	Lecture
	RET demonstration, managing stress, anxiety, and anger
	Film: Rational Emotive Therapy with Children
	Counseling session 2 – Preferred scenario – treatment goal setting

9	Spring Break – March 8 - 12, 2004

10	Affective Interventions	PC/Ch. 7
	Synthetic Cultures Interventions	Handout
	Counseling supervision
	Research Article Summary due March 23

11	Gestalt Therapy Lecture	Lecture
	Gestalt Two-Chair demonstration
	Counseling session 3 – use of appropriate technique

12	Working with meaning: Psychological Themes
	Counseling Session 3 – Use of Appropriate Technique
	Discussion of Final Session - Closure	PC/Ch11

13	Guided Imagery, metaphor, and the use of drawings
	Supervision – CS3

April 19, 2004 Essay Exam 2 - PC/Ch. 6-9, and 11, Gestalt and REBT

14 - 15	Issues and Ethics of the Helping Profession: APA Ethics Ch. 4,5,7

Final Exam Week Ethics Exam Friday, May 7, 10;30- 12-30 - Open Book

The following are the elements for the first session, the presenting problem, and the second session, goal setting, using the preferred scenario. A check indicates that you included them in the session. The verbal comments follow each session regarding quality of the responses.

Rapport building _____________
Consent Form (if necessary) _____________
Transition to counseling portion of session ___________
Open question to begin __________
Presenting problem ___________
   What is it _____________
     following questions for clarification ____________
     following questions for additional information ___________
   To what extent is it a problem ____________
     following questions for clarification
   Who else is involved ___________
     what are their roles in the problem ____________
   How long has it been a problem _______________
     how did it start? ____________
   What efforts have you made to correct it?_____________
     how have they worked? ____________
   What do you want to get out of these sessions regarding the problem?_________
   What do you want to get out of this session regarding the problem? ___
Preferred Scenario _________________________________________
   Use of model or other device to work in ps ______________________
   Comparison with present scenario _____________________________
   Feasibility check __________________________________________
   One step toward (or more) ___________________________________
   Barriers to success considered _______________________________
   Motivation assessment to get movement ________________________

Skills utilized:
Body language _____
Eye contact ______
Minimal encourages _________
Open questions ___________
Paraphrases ______________
Content _________
Shaping/Leading __________
Reflections
Affect __________
Meaning __________
Empathy _________
Noticing statements ____________
Giving of support ___________
Appropriate use of silences __________
Summaries ___________
Use of techniques
Role plays _________
Models ___________
Directives ________

Distractions:
Nonverbals __________
Closed questions ______________
Multiple questions _____________
Too many questions _____________
Advice giving ______________
Judging ____________
Evaluating _____________
Faulty assumptions ____________

Urgings: _________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

1. Establish rapport
2. Informed Consent - go over forms about rights and responsibilities
3. Transition to presenting problem exploration
4. Open question - “What do you want to talk about today”?
4a. While talking to the client, observe body language, flushing, tensions, eye movements, mannerisms, tearing in eyes, trembling lips, and changes in breathing
5. To what extent is it a problem (how is it affecting your daily routines)?
6. Who else is involved?
7. How do you feel about the problem?
8. What are your thoughts about the problem (internal messages)?
9. When did you first notice it as a problem?
10. What efforts have you made to manage it before today?
11. What do you want to happen as an outcome of our sessions?

Remember to follow up your question with a paraphrase for clarification and mutual understanding, and other following questions to obtain additional information about the problem.

Remember to reflect feeling at one level of intensity higher than the client expresses it. This gives the client permission to express their deeper feelings.

Don’t try to solve the problem today. This is problem identification and exploration time.
Relax
Focus on the client not on yourself
Trust your instincts
Help by indirect strategies
Don’t rescue client from feelings
Don’t give advice

Advanced skills - session conceptualization skills

   Counselor makes transitions from one phase of session
     to another to maintain the smooth line
   Counselor explores presenting problem
   Counselor connects present events with earlier events
   Counselor assesses motivation
   Counselor times use of technique with sensitivity
   Counselor gains client’s cooperation for use of technique
   Counselor sets treatment goals
   Counselor uses technique with skill

The second session is focused around treatment goal setting. I have developed a technique around the Preferred Scenario concept of Richard Egan. The following is a step-by-step account of this process.

At the beginning of the second session you greet your client and check out how they are doing since you saw them last. This serves as a continuation of rapport building.

When this discussion is completed, you ask them what they want to work on today. You apply your basic counseling and active listening skills to process their response. As you work with them on this, you listen for a moment when they are looking to the future and change around theissue. At this time, you transition into treatment goal setting.

Transition is a process and may involve two or three statements which move the client from talking about the problem to thinking about treatment goals. The timing of it is important and the smoothness creates a willingness on the part of the client to move into setting goals.

You explain that you use a technique which involves talking and writing called, the Preferred Scenario, and you focus attention to a plain piece of paper and pencil on the table next to you.

On this paper, you draw a circle which you label Present. In the circle you draw several lines. Then you hand the pencil to your client and ask them to write feeling words and descriptive adjectives that describe the present situation with the problem. They spend some moments doing this.

When they are completed, you ask them to talk about the words they have chosen to describe their state. Usually, from this information, you glean even more information from them than during the first session, so it is very useful. In addition, it places them in context from which to create treatment goals.

When you have finished discussing the words, you draw a second circle, some distance from the first, labeling it Preferred, and include several lines in the circle. You ask them to write on these lines feeling words and descriptive adjectives about how they would like to be after completion of our sessions. This time, after each word, ask them to tell you about what they have written.

When they have completed this description, ask them to draw a path from Present to Preferred that would characterize their journey of growth and change. When it is drawn, ask them to tell you about the path, how it is their journey.

As they finish talking about the path, ask them to place on the path, lines which will serve as steps to take from how things are now to how you’d like them to be. The words in Preferred serve as goals, the steps as tasks to be taken to reach the goals.

Between the two circles, under the path, write out these goals and tasks in outline form. Upon completion of goals and tasks, ask the client if they are in a reasonable order to begin work. If yes, then close the session by gaining a commitment to work on the tasks between now and next session.

A reminder: Be sure you check with the client whether the goals and steps are realistic and feasible given the relatively short time table.

Make a copy of the PS and give one to the client. Remember to bring it with you to future sessions, as it may come in handy.

History of the Problem: (this section should contain a chronological description of the reasons for and events which prompted the client to seek help. Use the information in the Intake handout for additional comments.) (This section is probably longer than the first section, especially if the problem is a long-term one)

Family History - Personality description of the client’s mother and father and siblings. Discussion of their relationships and interactions. (Often clients will say “Good” or “Close” when asked about a relationship. It is your job to explore these generalizations and ask for specifics.) Also ask about home atmosphere, was it welcoming, cold, hostile? And about the client’s role in the family, was it mediator, clown, invisible one, scapegoat?
Remember to tie in the presenting problem where appropriate to family of origin.
Use the material in the handout for further information to ask in this section.

Educational - Vocational Review: (this section contains relevant information about the client’s school experience and work experience and give special attention to this if the problem appears in these areas of their life)

Present Family - If the client is married include this section. If they
are living with someone, include it. Special attention is given to similarities and differences between family of origin and this family.

Assessment Impression/Treatment Recommendations: (this section includes your impressions of the client and their problem and recommends four sessions with a specific counselor)

Thank you for agreeing to participate in this project. This is a series of simulated counseling sessions which serve as practical training for student counselors in the Applied Psychology major. There are two purposes to these sessions. First, you will act as a student counselor and help your partner resolve a crisis, collect information , explore the problem, work to set treatment goals, use appropriate technique to find solutions to their problem, practice closing the session and making referrals. Second, you will act as simulated client during the six sessions. As a simulated client, you will present a realistic problem, which may be real or manufactured.

This is not real counseling or psychotherapy. However, sometimes the sessions can appear real and can stir up some old unfinished business. If that happens, and you determine that you wish to talk to a psychotherapist, my supervisor will help you with a referral.

As a student client there are certain rights and responsibilities of which you must be informed:

Do you have any questions about these rights and ethics? Please sign and date this consent form. Your signature indicates understanding.