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The Skilled Helper

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Focus on ways to help them manage their problems and develop opportunities ... perfectionism, difficulty taking risks. Step A. Summary. Develop a sense of hope ... – PowerPoint PPT presentation

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Title: The Skilled Helper


1
The Skilled Helper
  • Gerard Egan

2
Rational Problem Solving
  • Initial Awareness
  • Urgency
  • Search for remedies
  • Estimation of costs
  • Deliberation
  • Rational decision
  • Rational emotive decision
  • Yankelovich (1992)

3
Overall aims of counselling as a skilled helper
Egan, 2002
  • Provide a quiet confidential environment
  • Enable the client to talk openly about themselves
    without being judged
  • Help the client gain greater awareness of
    themselves and their situation
  • Focus on ways to help them manage their problems
    and develop opportunities

4
The Three Stage Model
  • Stage one The problem situation as it is.
  • Stage two The clients preferred scenario.
  • Stage three Action programs.

5
http//www.bradburyac.mistral.co.uk/revs16.html
Source
6
Stage I Current Scenario What's going on?
  • 1. Goal Help clients fully understand their
    current situation
  • a) Helping clients tell their story
  • b) Identifying blind spots in the clients
    perception
  • c) Focusing on strengths rather than weaknesses
  • 2. In psychology this is essentially the
    diagnostic interview however, we will can help
    clients give better information and understand
    their own situation better when we apply
    counselling skills

7
A. Step A Helping the client tell his/her
story
  • 1. Goal Help clients be specific about their
    experience and actions so they understand their
    story more fully
  • 2. Key micro-skills
  • a) Basic Empathy validate clients feelings
    create setting where client feels safe sharing
    feelings
  • b) Probes ask questions that guide the client to
    examine their feelings, experiences, behaviours
  • c) Summaries help keep clients on target and
    moving forward in telling their story

8
Step B Identifying blind spots
  • Goals Help the client see inconsistencies in the
    story identify roadblocks to success
  • 2. Key microskills
  • a) Basic Empathy Summaries reflect to the
    client what you heard so client can consider the
    situation from a different perspective
  • b) Probes Challenges ask focused questions
    that encourage the client to examine the
    situation (and their own role) more critically

9
Step C Leveraging / Picking Issues to
Address
  • Goals Help clients decide which issues to work
    on, based on need, readiness, resources
  • 2. Key microskills
  • a) Summaries present the clients entire
    situation so they can judge which area they want
    to address and whether they are ready
  • b) Probes Ask clients about resources (internal
    and external) that may be available to help
  • c) Problem-solving Teach clients the process of
    problem-solving so they can be more proactive

10
Stage I Case Example
  • Scenario A year 11 adolescent to her school
    counsellor My class doesn't like me, and right
    now I dont like them! Why do they have to be so
    mean? They make fun of mewell, they make fun of
    the way I talk. Ive been going to speech therapy
    and I know Im doing a lot better. I wish theyd
    stop making fun of me.
  • What do you say next?!?

11
Responses that dont help
  • Probes that keep us at the information level of
    rather than moving toward solutions
  • (1) What types of things do they say?
  • (2) How long as this been going on?
  • (3) Who is teasing you ?

12
Responses that dont help cont
  • Responses that ignore the clients feelings or
    rely on persuasion rather than empathy
  • (1) Im sure they dont mean anything by it
  • (2) Just ignore them

13
Rule 1 RememberIf a client expresses a
feeling, respond to it!
  • a) At first, this may seem awkward, but you will
    rapidly find that validating the clients
    feelings encourages her to provide more
    information
  • b) How do we respond to that feeling? Use a Basic
    Empathy Response!
  • c) After we validate the feeling, we can move on
    to other responses to gather more information,
    provide information, challenge blind spots, etc

14
Basic Empathy Responses
  • Using the formula
  • (1) You feel angry / hurt because theyre making
    fun of you over something you cant help.
  • (2) You feel upset because they wont accept you
    as you are.
  • Using my own words
  • (1) It bugs you that they wont accept you as you
    are
  • (2) Youre mad that theyre teasing you about
    your speech rather than getting to know you

15
Other Helpful Responses
  • Probes that may help the child identify blind
    spots in her perspective
  • (1) How have you responded when they tease you?
  • (2) What have you done to try to solve the
    problem?
  • b) Summary / Probe aimed at problem-solving
  • (1) It sounds like youve been teased by other
    kids about your speech, and youve tried to
    explain to them that theres nothing you can do
    about it.

16
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17
Stage II Preferred Scenario
  • Goal Help clients identify what they want for
    their future and what they are willing to do in
    order to achieve that future
  • a) Identifying possibilities for the future
  • b) Setting the agenda for change
  • c) Making a commitment to the process
  • 2. This is the stage most often overlooked by
    helping professional we need to help clients
    think about where they want to GO before we help
    them get there

18
Step A Identifying Possible Futures
  • Goal Help clients identify possible outcomes for
    the future that they may not have considered (in
    other words, what do you want?)
  • 2. New Microskills and Characteristics that
    Support Stage II
  • a) Future-oriented probes Focuses client on
    preferred outcomes (rather than actions)
  • b) Brainstorming Helps clients identify
    possibilities they have not previously considered
  • c) Creativity Not a skill, but a characteristic
    that can be encouraged through microskills

19
Advanced Skill Future-Oriented Probes
  • Goals
  • a) Help clients focus on the preferred scenario
    and think about what they want
  • b) Help clients take ownership for making changes
    in their lives that are aimed at a goal
  • c) Help clients focus on outcomes not process
  • d) Help clients regain hope for a future they
    desire rather than focusing only on the problem
    they are currently facing

20
Examples
  • a) What would this situation look like if you
    were managing it better?
  • b) What changes in your present lifestyle make
    sense?
  • c) What would you be doing differently with the
    people in your life?
  • d) What behaviour patterns would be in place that
    are not currently in place?
  • e) What current behaviour patterns would be
    changed?
  • f) What would you have that you dont have now?
  • g) What would this opportunity look like if you
    developed it?

21
Advanced Skill Brainstorming
  • Goal Help clients open up new possibilities
  • 2. Rules for Brainstorming
  • a) Suspend judgment help clients suspend theirs
  • b) Come up with as many possibilities as possible
  • c) Do not criticize any suggestions just record
    them
  • d) Encourage quantity, worry about quality later
  • e) Use one idea as a takeoff point for another
  • f) Help clients let go and develop wild
    possibilities
  • g) When you run out of ideas, put the list aside
    and come back to it later to try some more

22
Creativity Helps Clients (and Clinicians) Solve
Problems
  • Some characteristics of creative people
  • a) Optimism / confidence / hope
  • b) Acceptance of ambiguity and uncertainty
  • c) Tolerance of complexity
  • d) Willingness to take risks
  • e) Divergent thinking (there is always another
    option)

23
Characteristics that may hinder progress
  • Fear,
  • Fixed habits,
  • dependence on authority,
  • perfectionism,
  • difficulty taking risks

24
Step A help clients discover possibilities for
a better future cont
  • Step A. Summary
  • Develop a sense of hope
  • Look at possibilities
  • Brainstorming possibilities for future
  • If you know what u want then you can see problems
    and solutions clearer.

25
Step B Set Agenda for Change
  • Goal Select outcomes the client might work
    toward (turn possibilities into goals) (in other
    words, what do you really want?)
  • 2. Key Microskill Summaries help clients review
    the options they brainstormed and set their goals
    for the future
  • 3. A warningMaintain the focus on outcomeswere
    not yet talking about what they can do were
    still talking about they want for their lives

26
Step B. Help clients craft problem-management
goals cont
  • Sort through possibilities and prioritise them.
  • Goals need to be
  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Time frame

27
Good intentions to Specific Goals.
  • Help clients move from good intentions through
    broad aims to specific goals
  • a) Good intentions I need to do something about
    my speech
  • b) Broad aims Adds content to what the client
    wants to work on. I want to be able to
    communicate better.
  • c) Specific goals States exactly what the goal
    looks like. I want to be able to give clear
    presentations.

28
Step C Making a Commitment
  • Goals Help clients set goals that dont cost
    more than they are worth (in other words, what
    are you willing to pay for what you want?)
  • 2. Key Microskills
  • a) Basic Empathy Response Help clients clearly
    hear and understand the goals they are
    considering
  • b) Probes May need to help client identify
    resources to help them achieve the desired
    outcomes
  • c) Challenges May need to help client be very
    realistic about what they are willing to do

29
Evaluating Goals and Commitments
  • Questions to ask clients about goals
  • (1) What is your state of readiness for change in
    this area at this time?
  • (2) To what degree are you choosing this goal
    freely? / Whats pushing you to choose this goal?
  • (3) To what degree are you choosing this goal
    from among a number of possibilities?
  • (4) How highly do you rate the appeal of this
    goal? / In what ways does the goal not appeal to
    you?
  • (5) In what ways can the goal be reformulated to
    make it more appealing?

30
Questions on client commitment
  • What is my state of readiness for change in this
    area at this time?
  • How badly do I want what I say I want?
  • How hard am I willing to work?
  • To what degree am I choosing this goal freely?
  • How highly do I rate the personal appeal of this
    goal?

31
  • The goal is to ensure that the client is
    committing himself freely, willingly and with an
    understanding of the true costs of the commitment

32
Stage II Example
  • Yr 11 student is still being teased about her
    speech. She has expressed her frustration, we
    have validated her feelings, and she has
    recognized that she hasnt done enough to try to
    solve the situation in a constructive way.
  • How can we help this client move toward a future
    she wants?

33
Responses that dont help
  • Moving too quickly toward action strategies
    solves the problem the way we would want it
    solved, not the way the client wants it solved.
  • a) Have you tried?
  • b) You should just tell them!
  • c) The best way to handle this is to!
  • d) Just tell your teacher!
  • e) Lets bring one of them to speech so theyll
    understand what youre going through!

34
Focusing on the Future
  • Future-oriented probes help the client think
    about what she wants
  • (1) What would like to see happen in this
    situation in the future?
  • (2) What would the situation look like if it were
    less problematic?
  • (3) What do you wish they would do instead?
  • (4) (Note that none of these focus yet on what
    the client should do to solve the problem)

35
Opening up Possibilities.
  • Brainstorming helps clients think about futures
    havent considered
  • (1) List all possible desirable futures you can
    think of
  • (2) Dont be afraid to be wild and creative

36
Examples
  • (1) Theyd stop teasing her
  • (2) Theyd be her friend
  • (3) Theyd be nicer to her overall
  • (4) Theyd start trying to help her fit in
  • (5) Shed stop worrying about being teased
  • (6) Shed know what to say to people when they
    tease her

37
Selecting the Desired Outcome
  • Turn Possible Futures into Specific Goals
  • (1) Review the possible futures identified in the
    brainstorm activity
  • (2) Make sure each goal is stated specifically

38
Examples
  • (1) I want to know what to say to people when
    they tease me
  • (2) I want to be able to talk to my classmates
    without being teased about my speech.
  • (3) I want to be able to meet people without
    worrying about what theyre thinking about my
    speech

39
Stage II and action
  • Work of Step A. developing possibilities may be
    enough to identify needs and wants and a few
    possible goals, then move into action.
  • For other clients Step B. is a trigger for
    action. They see the future in a different way.
  • For some clients the search for incentives and
    commitments is the trigger for action- a what's
    in it for me will move them into action.

40
Are they ready?
  • a) Is she ready to let go of her anxiety about
    speech?
  • b) Is she willing to acknowledge her speaking
    difficulty openly and freely ?
  • c) Is she able to try different responses when
    people tease her to see what works?
  • d) Can she pursue this goal even if is hard to
    do?
  • (1) What roadblocks does she anticipate?
  • (2) Is she willing to take risks to overcome
    these roadblocks?

41
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42
Stage III Action Strategies What do I have to
do to get what I need or Want?
  • Goal Help clients identify actions that will
    help them achieve the preferred outcome
  • a) Making a list of possible actions
  • b) Determining which actions provide the best fit
  • c) Formalizing a plan for achieving those goals

43
Step A Identify Possible Actions (Finally we can
talk about what to do)
  • 1. Goal Help clients identify different possible
    courses of action to achieve the outcome selected
    in Stage II
  • 2. Key microskills
  • a) Brainstorming To open up new possibilities
  • b) Probing To help clients focus on resources
    that may help them achieve their goals

44
Step A. Help clients review possible strategies
to achieve goals.
  • If task is difficult, Driscoll offers the
    following
  • Alternatives are best sought cooperatively, by
    inviting our clients to puzzle through with us
    what is or is not a more practical way to do
    things. But we must be willing to introduce the
    more practical alternatives ourselves, for
    clients are often unable to do so on their own.
    Clients who could see for themselves the more
    effective alternatives would be well on their way
    to using them. That clients do not act more
    expediently already is in itself a good
    indication that they do not know how to do so
    (1984, p. 167).

45
Develop a framework
  • Develop a framework for stimulating clients
    thinking about strategies.
  • Individuals what individuals can help?
  • Models and exemplars who is currently doing what
    client wants?
  • Communities What community of people are there
    that can help?
  • Places Are there places that can help?
  • Things What things exist that can help?
  • Organizations Are organisations available to
    help?
  • Programs are there ready-made programs for
    people in clients position?

46
Social Support
  • Social support is a key element in change.
  • Social support has been examined as a predictor
    of the course of mental illness. In about 75 of
    studies with clinically depressed patients,
    social-support factors increased the initial
    success of treatment and helped patients maintain
    their treatment gains. Similarly, studies of
    people with schizophrenia or alcoholism revealed
    that higher levels of social support are
    correlated with fewer relapses, less frequent
    hospitalizations, and success and maintenance of
    treatment gains (see Behavioral Science Step
    Force of the National Advisory Mental Health
    council, 1996, p.628)

47
Explore support networks
  • To explore support networks, at action arrow use
    questions such as
  • Who might help you do this?
  • Whos going to challenge you when you want to
    give up?
  • With whom can you share these kinds of concern?
  • Whos going to pat you on the back when you
    accomplish your goals?

48
Linking strategies to action
  • Step A. should stimulate action on the part of
    the client.
  • Many clients, once they begin to see what they
    can do to get what they want, begin acting
    immediately.
  • They dont need a formal plan.

49
Step B Selecting the Best Fit
  • Goal Help clients select actions that will move
    them toward their goal
  • Guidelines Keep goals realistic, specific,
    consistent with clients values, etc
  • New microskill Balance Sheet Helps clients
    evaluate the strategies they are considering

50
Criteria
  • Criteria for selecting goal-accomplishing
    strategies similar to step B.
  • Specific specific enough to drive behaviour.
  • Substantive challenge the clients resources and
    when implemented achieve the goal.
  • Realistic can be carried out with the resources
    the client has, are under the clients control and
    are unencumbered by obstacles.
  • Keeping with the clients values not counsellors.

51
Step B. Help clients choose strategies that best
fit their resources cont
  • Strategy Sampling
  • Sample possibilities.
  • Balance Sheet method (costs/benefit exercise)
  • Not to be used with every client
  • Tailor to needs of client.
  • Use relevant parts as probes eg how will this
    decision affect you? Significant others?

52
Advanced skill Balance Sheet Method
  • a) What are the benefits of choosing this
    strategy? For me? For others?
  • (1) To what degree are these benefits acceptable?
  • (2) In what ways are these benefits unacceptable?
  • b) What are the costs of choosing this strategy?
    For me? For others?
  • (1) To what degree are these costs acceptable?
  • (2) In what ways are these costs unacceptable?

53
Step C Making a Plan
  • Goal Help clients develop a specific plan for
    putting selected strategies into place
  • 2. How plans help
  • a) Without a plan, clients may remain stuck due
    to a lack of direction they may try different
    things but it will not be focused or
    goal-directed
  • b) Plans help clients anticipate obstacles,
    consider solutions, incorporate resources
  • c) Plans help clients move toward action

54
Step C. Helping clients make plans.
  • After id and choosing strategies to accomplish
    goals, clients need to organise these into a
    plan.
  • A plan is a clear step- by- step action program
    of accomplishing a goal or a set of goals.
  • Counsellors help clients develop a plan and the
    sequence of actions i.e. What should I do first,
    second and third etc? that will get them what
    they want, their goals.
  • A plan can emerge whilst discussing possible and
    best-fit strategies.

55
Step C. Helping clients make plans cont
  • Shaping the plan three simple questions
  • What are the concrete things that need to be done
    to accomplish the goal or sub-goal?
  • In what sequence should these be done? What
    should be done first, second, and third?
  • What is the time frame? What should be done
    today, What tomorrow, what next month?

56
Step C. Helping clients make plans cont
  • Humanizing the technology of constructive change.
  • Planning is often not as neat as described in
    textbooks.
  • Most clients too impatient to work with planning
    outlined.
  • May set realistic goals, but no discipline to
    develop reasonable plans.
  • Cannot be too pedantic, mechanistic or awkward in
    your attempts to help clients engage in these
    steps run the risk of alienating clients.

57
Step C. Helping clients make plans cont
  • Principles to guide constructive change process
  • Build a planning mentality into the helping
    process from the start.
  • Adapt the constructive-change process to the
    style of the client.
  • Devise a plan for the client and then work with
    the client on tailoring it to his or her needs.

58
Stage III Example
  • Our year 11 client has decided that her first
    goal is to learn how to respond when people tease
    her. This will require her to be more open about
    her speaking difficulties and to be willing to
    try different responding techniques until she
    finds one that will work.
  • How can we help her plan her actions?

59
Brainstorm
  • Brainstorm a list of all possible actions she
    might take to help her become more open about her
    speaking difficulties
  • a) Begin to talk to people about speech
  • b) Invite friends to speech therapy
  • c) Invite non-friends to speech therapy
  • d) Exaggerate her speaking difficulties
  • e) Give a class presentation
  • f) Find other people who have speech difficulties

60
Evaluate Costs and Benefits
  • a) Telling others about speech
  • (1) Cost Possible embarrassment Benefit
    Desensitization, education of others
  • (2) Worth it? YES (if she works up to handling
    the embarrassment)
  • b) Try different responses to teasing (Specific
    responses still need to be selected)
  • (1) Cost Might make a mistake, make it worse
    Benefit May help to reduce teasing
  • (2) Worth it? YES, depending upon the response

61
Make a Plan
  • Action 1 Invite best friend to therapy
  • (1) Select a friend, role-play the request
  • b) Action 2 Develop responses to teasing
  • (1) Brainstorm responses and role-play
  • (2) Try them with easy partner evaluate
    success
  • (3) Use them in real-world situation
  • c) Action 3 Plan classroom presentation
  • (1) Prepare content in therapy room role-play

62
http//www.bradburyac.mistral.co.uk/revs16.html
Source
63
Action!
  • Goal Helping the client achieve the goals set in
    Stage III that are focused on the future defined
    in Stage II that solves the problem identified in
    Stage I
  • 2. Using counselling strategies will help clients
    become more successful at achieving action
  • a) Identifying facilitating and restraining
    factors
  • b) Adjusting action plans to overcome roadblocks
  • c) Evaluating and enhancing motivation

64
Moving from Planning to Action!
  • Goal To achieve their desired outcome, clients
    must have a clear strategy in mind (their plan)
    and they must be able to adapt it to the specific
    situations they face (flexibility).

65
Key skills and resources
  • 1. Self-contracts agreement specifying
    goal-directed feelings, behaviours, and thoughts
  • 2. Self-help groups strength in numbers, in
    being with those who are working on similar goals
  • 3. Feedback helps the client stay on track

66
Thoughts about Action!
  • 1. If the client is engaging in action, we have
    done a good job of matching needs to goals to
    plans.
  • 2. If not, we need to consider other strategies
    for supporting action
  • a) Overcome procrastination
  • b) Reinforce incentives / rewards for action
  • c) Develop backup-plans
  • d) Move toward independence

67
Overcoming Roadblocks To Action
  • 1. There are many possible roadblocks
  • a) Inertia Without effort, things stay the same
  • b) Entropy Without tending, plans disintegrate

68
Overcoming Roadblocks To Action cont
  • Try not to blame difficulty just on motivation
  • a) Low motivation may just be a sign of
    reluctance
  • (1) Are the goals still consistent with the
    clients desires?
  • (2) Is the cost of accomplish the goals too
    great?
  • (3) Is the task harder than the client expected?
  • b) Low motivation is a sign that the we should
    revisit the helping model and check our plan.

69
Action Example
  • Our Yr 11 client has selected her plan
  • a) Invite friend to therapy
  • b) Practice responses to teasing and try them
  • c) Prepare classroom presentation

70
Action Example cont
  • The next step is to help her monitor her progress
    and ensure that she is moving in the right
    direction.
  • How do we do it?

71
Action Example cont
  • Some strategies for ensuring action
  • a) Encourage her to make a self-contract
    specifying the timeline for taking action
  • b) If she is having difficulty, encourage her to
    identify roadblocks and brainstorm solutions
  • c) Review the incentives for taking action if
    they are not sufficient, increase the reward
  • d) Incorporate hierarchies aimed at the goals so
    she can take small steps in the right direction

72
Case Summary.
  • By using counselling skills within the context of
    the helping model, we helped the client
  • A. Identify and understand the current situation,
    including blind spots in her perception
  • B. Evaluate desired outcomes and select the ones
    she wants and is willing to work for
  • C. Develop a specific plan for achieving her
    desired outcomes and preparing for success
  • D. Continually monitor her progress and make
    adjustments in her plan as necessary

73
(No Transcript)
74
Summary
  • Counselling is not a separate aspect of therapy
    it is simply the way we interact with clients
    (all clients on all issues)
  • Microskills for attending, listening, responding
    can become incorporated into all aspects of our
    interaction (both professional and social)

75
Summary cont
  • Clinicians and clients should always know where
    they are in the process of change
  • The helping model can help everybody keep track
    so they are always moving forward

76
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