Reading B

Introducing the session and building rapport are most critical in the first session, and they will remain central in all subsequent sessions. Most sessions begin with some variation of “Could you tell me how I might be of help?” or “What would you like to talk about today?” “Hello, Lynette.” “It’s good to meet you, Marcus.” A prime rule for establishing rapport is to use the client’s name and repeat it periodically throughout the session, thus personalizing the session. Once you have completed the necessary structuring of the session (informing the client about legal and ethical issues), many clients are immediately ready to launch into a discussion of their issues. These clients represent instant trust. Our duty is to honor the client and continue to work on relationship issues throughout the session.

Some situations require more extensive time and attention to the rapport stage than others. Rapport building can be quite lengthy and blend into treatment. For example, in reality therapy with a delinquent youth, playing Ping-Pong or basketball and getting to know the client on a personal basis may be part of the treatment. It may take several sessions before clients who are culturally different from you develop real trust.

Structure

Structuring the session includes informed consent and ethical issues, as outlined in Chapter 2. Clients need to know their rights and the limitations of the session. If this is part of an ongoing series of sessions, you can help maintain continuity by summarizing past sessions and integrating them with the current session. At times, even telling clients about the stages of the session may be useful, so that they know what they are about to encounter.

Listen for preliminary goals

Although most definitive setting of short- and long-term goals happens at stage 3, initial goals are helpful during the first session(s). These early goals provide an initial structure for you as you seek to understand and empathize with the client. The early goals are revised and clarified after a fuller story has been brought out. Goal setting at this first stage is particularly important in brief counseling and coaching.

Share yourself as appropriate

Be open, authentic, and congruent. Encourage clients to ask you questions; this is also the time to explore your cultural and gender differences. What about cross-cultural counseling when your race and ethnicity differs significantly from clients? Authorities increasingly agree that cultural, gender, and ethnic differences need to be addressed in a straightforward manner relatively early in counseling, often in the first session (for example, see Sue & Sue, 2013).

Observe and listen

The first session tells you a lot about the client. Note the client’s style and when possible, seek to match her or his language. As the relationship becomes more comfortable, you may note that you and the client have a natural mirroring of body language. This indicates that the client is clearly ready to move on to telling the story and finding strengths (stage 2).

Stage 2: Story and Strength – Gathering Data: Drawing Out Stories, Concerns and Strengths (“What is Your Concern?” “What are Your Strengths and Resources?”)

Draw out the client’s story

What are the client’s thoughts, feelings, and behaviors related to her or his concern? We draw out stories and concerns using the skills of the basic listening sequence. Open and closed questions will help define the issue as the client views it. Encouragers, paraphrases, and checkouts will provide additional clarity and an opportunity for you to verify whether you have heard correctly. Reflection of feeling will provide understanding of the emotional underpinnings. Finally, a summarization provides a good way to put the client’s conversation into an orderly format.

Elaborate the story

Next, explore related thoughts, feelings, and interactions with others. Gather information and data about clients and their perceptions. The basic journalistic outline of who, what, where, when, how, and why provides an often useful framework to make sure you covered the most significant items. In your attempts to define the central client concerns, always ask yourself, what is the client’s real world and current story?

Draw out strengths and resource stories

Clients grow best when we identify what they can do rather than what they can’t do. Don’t focus just on the difficulties and challenges. The positive asset search should be part of this stage of the session. This might be the place for a comprehensive wellness search.

Failure to treat

Failure to treat can be the cause of a malpractice suit. This most often occurs when counselors fail to draw out stories and clients are unclear about what they really want, often resulting in no clear goals for the session. When the story is clear and strengths are established, you can review and clarify goals. Clients who participate in goal setting and understand the reasons for your helping interventions may be more likely to participate in the process and be more open to change.

Stage 3: Goals – Mutual Goal Setting (“What Do You Want to Happen?”)

Mutuality and an egalitarian approach

Your active involvement in client goal setting is necessary. If you and the client don’t know where the session is going, the session may wander with no particular direction. Too often the client and counselor assume they are working toward the same outcome when actually each of them wants something different. A client may be satisfied with sleeping better at night, but the counselor wants complete personality reconstruction. The client may want brief advice about how to find a new job, whereas the counselor wants to give extensive vocational testing and suggest a new career.

Refining goals and making them more precise

If you searched for broad goals early in the relationship, they can provide a focus and general direction. In stage 3, it helps to review early goals, divide them into subgoals if necessary, and make them truly clear and doable. It has been suggested that if you don’t have a goal, you’re just complaining. Authorities on brief counseling and coaching favor setting goals in the first part of the session, together with relationship building. With high school discipline problems, less verbal clients, and members of some cultural groups, setting a clear joint goal may be the key factor in relationship building. If you adapt your counseling style to each client, you will have a better chance of succeeding.

Summarizing the difference between the present story and the preferred outcome

Once the goal has been established, a brief summary of the original presenting concern as contrasted with the defined goal can be very helpful. Consider the model below as a basic beginning to working through client issues. This is a possible opening to stage 4, restorying, using a supportive confrontation.

“Kaan, on the one hand, your concern/issue/ challenge is [summarize the situation briefly], but on the other hand, your goal is [summarize the goal]. What occurs to you as possibilities for resolution?”

Needless to say, this will be expressed in more words and differently than in these model sentences. Nonetheless, as part of goal setting, the present situation and the desired situation need to be contrasted. Interestingly, even Carl Rogers has been known to ask clients what their session goals might be.

Define both the problem and the desired outcome in the client’s language. The summary confrontation should list several alternatives that the client has considered. The client ideally should generate more than one possibility before moving on to stage 4. You may want to use hand movements, as if balancing the scales, to present the real and the ideal. Using such physical movements can add clarity to the summary confrontation of key issues.

Define a goal, make the goal explicit, search for assets to help facilitate goal attainment, and only then return to examine the nature of the concern.

Stage 4. Restory – Working: Exploring Alternatives, Confronting Client Incongruities and the Conflict, Restorying (“What Are We Going to Do about It?”)

Starting the exploration process.

How does the counselor help the client work through new solutions? Summarize the client conflict as just described in the preceding section, “On the one hand…” Be sure that the summarization of the issue is complete and that the facts of the situation and the client’s thoughts and feelings are part of this summary.

Use the BLS to facilitate the client’s resolution of the issue(s). Imagine a school counselor talking with a teen who has just had a major showdown with the principal. Establish rapport, but expect the teen to challenge you; he or she likely expects you to support the principal. Do not judge, but gather data from the teen’s point of view. If you have developed rapport (stage 1) and listened during data gathering (stage 2), the teen will likely search for solutions in a more positive fashion. Follow by asking what he or she would like to have happen in terms of a positive change. Work with the teen to find a way to “save face” and move on.

Encourage client creativity

Your first goal in restorying is to encourage your clients to discover their own solutions. To explore and create with the teen above, listen well and use summarization: “You see the situation as… and your goal is… The principal tells a different story and his goal is likely to be…” If you have developed rapport and listened well, many teens will be able to generate ideas to help resolve the situation.

The basic listening sequence and skilled questioning are useful in facilitating client exploration of answers and solutions. Here are some useful questions to assist client problem solving. The last two focus on a wellness approach and would be common in brief counseling.

• “Can you brainstorm ideas – just anything that occurs to you?”
• “What other alternatives can you think of?”
• “Tell me about a success that you have had.”
• “What has worked for you before?”
• “What part of the problem is workable if you can’t solve it all right now?”
• “Which of the ideas that we have generated appeals to you most?”
• “What are consequences of taking that alternative?”

Counselors and psychotherapists all try to resolve issues in clients’ lives in a similar fashion. The counselor needs to establish rapport, define the issue, and help the client identify desired outcomes.

Relate client issues and concerns to desired outcomes

The distinction between the problem and the desired outcome is the major incongruity that may be resolved in three basic ways. First, the counselor uses attending skills to clarify the client’s frame of reference and then feeds back a summary of client concerns and the goal. Often clients generate their own synthesis and resolve their challenges. Second, counselors can use information, directives, and psychoeducational interventions to help clients generate new answers. Third, if clients do not generate their own answers, the counselor can use interpretation, self-disclosure, and other influencing skills to resolve the conflict. Finally in systematic problem solving and decision making, counselor and client generate and brainstorm alternatives for action and set priorities among the most promising possibilities.

Aim for decision and a new story

This exploration/brainstorming/testing of theoretical strategies facilitates client decision making and the generation of a new story. Once a decision has been made or a new workable story developed, see that plans are made to put these ideas into action in the real world. You need to help clients generalize feelings, thoughts, behaviors, and a plan for action beyond the session itself.

The above outline is specific to decisional counseling, but you will find it virtually identical to motivational interviewing and crisis counseling. Different theories will vary in their use of skills and emphasis at this stage. However, the earlier parts of the session tend to be relatively similar among varying theoretical viewpoints.

Stage 5: Action – Concluding: Generalizing and Acting on New Stories (“Will You Do it?”)

The complexities of life are such that taking a new behavior back to the home setting may be difficult. How do we generalize thoughts, feelings, and behaviors to daily life? Some counseling theories work on the assumption that behavior and attitude change will come out of new unconscious learning; they “trust” that clients will change spontaneously. This indeed can happen, but there is increasing evidence that planning for change greatly increases in likelihood that it will actually occur in the real world.

Consider the situation of the teen in conflict with the principal. Some good ideas may have been generated, but unless the teen follows up on them, nothing is likely to change in the conflict situation. Find something that “works” and leads to changes in the repeating behavioral problems. As you read through the list of generalization suggestions below, consider what you would do to help this teen and other clients restory and change their thoughts, feelings, and behaviors.

Change does not always come easily, and many clients revert to earlier, less intentional behaviors. Work to help the client plan for change to ensure real-world relevance. Following are three techniques that you can use to facilitate the transfer of learning from the session, increasing the likelihood that the client will take new learning home and try new behaviors.

Contracting

The most basic way to help clients maintain and use new learning is the establishment of an informal or written contract to do something new and different. Ideally, this should be clear and specific enough that the client can actually do it easily. With more complex issues, contract for things that represent part of the solution. If we ask clients to change their behavior totally, they likely will fail and may not return for another session.

Homework and journaling

Assigning homework so that the effect of the session continues after the session ends has become increasingly standard. Some counselors assign “personal experiments” to clients who do not like the idea of doing “homework.” Negotiate specific tasks for the client to try during the week following the session. Use very specific and concrete behavioral assignments, such as “To help your shyness, you agree to approach one person after church/synagogue/mosque and introduce yourself.” Ask the client to keep a journal of key thoughts and feelings during the week; this can become the basis of the follow-up session. Another possibility is paradoxical intention: “Next week, I want you to deliberately do the same self-defeating behavior that we have talked about. But take special notice of how others react and how you feel.” This helps the client become much more aware of what he or she is doing and its results.

Follow-up and support

Ask the client to return for further sessions, each with a specific goal. The counselor can provide social and emotional support during difficult periods. Follow-up is a sign that you care. Use the telephone for behavior maintenance checks. Using email is possible, but may result in loss of privacy. Many counselors and therapists call clients but do not give them their email. If you work in an agency and give a phone number to a client, use an office number that is always attended.

Chapter 13 offers a wide array of strategies and techniques to ensure that clients can use learning from the session more effectively. There you will find specifics regarding assertiveness training, communication skills psychoeducation, and an array of stress management strategies. Special attention will be paid to research-based therapeutic lifestyle changes (TLC), including how to suggest that clients engage in healthful behaviors such as exercise and meditation and use their spiritual resources. For maximal impact and behavior transfer, we suggest a combination of several techniques and strategies over time.

Behaviors and attitudes learned in the sessions do not necessarily transfer to daily life without careful planning. Consider asking your client at the close of the interview, “Will you do it?”