Reflection of meaning
encourage clients to explore their own meanings and values in more depth from their own perspective
A reflection of meaning looks very much like a paraphrase but
focuses beyond what the client says. Often the words "meaning, values, vision, and goals" app
Reflection of meaning anticipated result
the client discusses stories, issues, and concerns in more depth with a special emphasis on deeper meanings, values, and understandings.
Clients may be enabled to discern their life goals and vision for the future
what is meaning?
Purpose or significance of something
Reflection of meaning is from the ___________ worldview
Client's
Interpretation
explanation of the meaning or the significance of something
whose perspective is interpretation from?
Interviewer observation and perspective
skill function of reflection of meaning
� Find the deeply held thoughts and feelings (meanings) underlying life experience
� Expect self earch into deeper aspects of client life experience
� Facilitate clients' interpretation of their own experiences
� Assist clients to explore their values and
how do you elicit client meaning?
Use storytelling to discover the background of client's meaning-making
� Critical illness or loss force people to face deeper meaning issues
� How do meanings internalized from this experience serve or conflict with current life experiences
� Generating a
questions that orient towards meaning
� What does this mean to you?
� What sense do you make of it?
� How have your values been implemented?
� What is important (unimportant) to you?
� Which of your values support/oppose that action/feeling/thought?
how do you reflect the key meaning and value?
� Use the exact key words the client uses
� Reflect meaning, value and how the client makes sense of the world
� Structure similarly to a paraphrase or reflection of feeling
skills of reflection of meaning and interpretation/reframe
� Consider the relationship of reflection of meaning to other skills
� All four dimensions are operating simultaneously and constantly in any individual or group
� We are systems and any chance in one part of the system affects the total
what is interpretation/reframe?
� Provide the client with a new meaning or perspective, frame of reference, or way of thinking about issues
� Interpretations/reframes may come from your observations; they may be based on varying theoretical orientations or they may link critical ideas t
what is the anticipated result of interpretation/reframe?
� The client may find another perspective or meaning of a story, issue or problem. The new perspective could have been generated by a theory used by the interviewer, from linking ideas or information or by simply looking at the situation afresh
what is discernment?
� To separate, to determine, to sort out
� Determining the origin of our interior and exterior experiences
Process questions leading to discernment
� Family
o Sample question: what do you learn from your parents?
� Friends
o How important are your friends to you?
� Community
o How have people served as role models?
� Culture
o How does race and gender impact you?
� Significant other
o What does she o
Frankl: making meaning under extreme stress
� Frankl, a survivor of the German concentration camp Auschwitz, could not change his life situation
� The Jewish tradition of serving others facilitated his survival, he counseled his entire barrack helping them reframe their terrors and difficulties poi
logotherapy
A life philosophy that enables us to transcend suffering and find meaning in our existence
Logotherapists search for positive meanings that underlie behavior, thought, and action. Dereflection and modification of underlying attitudes are specific techniqu
compare and contrast Reflection of meaning vs. interpretation/reframe
Both interpretation/reframing and reflection of meaning seek implicit issues and meanings below the surface of client conversation.
Reflecting meaning is the art of encouraging clients to find new ways of examining their lives through your in-depth listen
why do we use interpretation and reframe together?
interpretation/ reframe is used because both skills focus on providing a new way of thinking or a new frame of reference for the client, but the word reframe is a gentler construct that usually comes from your here-and-now observations.
what is a good first step in ROM?
Questions and eliciting meaning
Example Reflection of meaning questions
What has given you the most satisfaction in your job?"
"What's been missing for you in your present life?"
"What do you value in your life? "What sense do you make of this heart attack and the future?"
"What things in the future will be most meaningful t
ROM key words
Reflection of meaning as a skill looks very much like a reflection of feeling or paraphrase, but the key words:
meaning, sense, deeper understanding, purpose, vision, or some related concept will be present explicitly or implicitly.
reflecting involves ____________direction
client
interpretation/reframe implies ________ direction
therapist
The client provides the new and more comprehensive perspective in __________________ whereas an ___________________ supplies a new way of being as suggested by the counselor.
reflection of meaning, interpretation/reframe
In ROM, who is more in control: therapist or client?
Client
where do interpretations/reframes come from?
They may come from observations of the counselor, they may be based on varying theoretical orientations to the helping field, or they may link critical ideas together.
ROM vs. I/R
Reflection of meaning focuses on the client's worldview and seeks to understand what motivates the client; it provides more clarity on values and deeper life meanings.
An interpretation/reframe results from counselor observation and seeks new and more use
Elicit client meaning sample questions
When in your life did you have existential or meaning questions? How have you resolved these issues thus far?"
"What significant life events have shaped your beliefs about life?"
"What are your earliest childhood memories as you first identified your eth
Decisional theory
A major issue in counseling for all clients is making appropriate decisions and understanding alternatives for action. Decisions need to be made with awareness of the cultural/ environmental context. Interpretation/ reframing helps clients find new ways o
Person-centered theory
Clients are ultimately self-actualizing. Our goal is to help them find the story that builds on their strengths and helps them find deeper meanings and purpose. Reflection of meaning helps clients find alternative ways of viewing the situation; interpreta
Brief solution-focused counseling
Brief methods seek to help clients find quick ways to reach their central goals. The session is conceived first as a goal-setting process and then methods are found to reach goals through time-efficient methods. Interpretation/reframing will be rare excep
Cognitive behavioral theory
The emphasis is on sequences of behavior and thinking and what happens to the client, internally and externally, as a result. Often interpretation/reframing is useful in understanding what is going on in the client's mind and/or linking the client to how
Psychodynamic theory
Individuals are dependent on unconscious forces. Interpretation/reframing are used to help link ideas and enable the client to understand how the unconscious past and long-term, deeply seated thoughts, feelings, and behaviors frame the here and now of dai
Multicultural counseling and therapy (MCT)
The person is situated in a cultural/environmental context, and we need to help clients interpret and reframe their issues, concerns, and problems in relation to their multicultural background. (See the RESPECTFUL model, Chapter 1.) MCT is an integrative
Caution about interpretation/reframe
Redefining a suicide attempt as a demonstration of bravery may offend your client or family.
Telling your anxious client that the psychiatrist's prescription of medication demonstrates the biological basis of the client's disorder is inappropriate.
eliciting meaning
What does 'XYZ' mean to you?" Insert the key important words of the client that will lead to meanings and important thoughts underlying key words. "What sense do you make of it?" "What values underlie your actions?" "Why is that important to you?" "Why?
reflecting meaning
Essentially, this looks like a reflection of feeling except that the words meaning, values, or intentions substitute for feeling words. For example, "You mean . . . ," "Could it mean that you . . . ," "Sounds like you value . . . ," or "One of the underly
Self-Disclosure
As the counselor, share your own related past personal life experience, here-and-now observations or feelings toward the client, or opinions about the future. Selfdisclosure often starts with an "I" statement. Here-andnow feelings toward the client can be
What is the anticipated result of Self-Disclosure?
When used appropriately and empathically, the client is encouraged to self-disclose in more depth and may develop a more egalitarian relationship in the session. The client may feel more comfortable in the relationship and find a new solution relating to
Benefits of self disclosure
As the session progresses, self-disclosure can encourage client talk, create additional trust between counselor and client, and establish a more equal relationship.
Dangers of self disclosure
countertransference, which can be defined as unwise conscious or unconscious entanglement with the clients' issues, causing the boundaries between you and the client to be violated. Your own subdued or even unconscious feelings may resurface through ident
When self disclosure is too distant from the client's concern
the client may be talking about anxiety over a required classroom oral presentation. You may start talking about a recent bout of speech anxiety you experienced when you had to speak on a panel to a large audience. Make your self-disclosures relevant and
5 Skills/Key Aspects of self disclosure
1. Listen. As with all influencing skills, first attend to the client's story carefully, and then assess the appropriateness of any self-disclosure you might make. Be sure that it is relevant to the client's issue.
2. Self-disclose and share briefly. Imme
Genuineness
To demonstrate genuineness, the counselor must truly and honestly have the feelings, thoughts, or experiences that are shared. Second, self-disclosure must be genuine and appropriate in relation to the client. For example, if you are working with a client
Immediacy
using here and now
Timeliness
knowing WHAT to say WHEN
Feedback
Present clients with clear, nonjudgmental information on how the counselor believes they are thinking, feeling, or behaving and how significant others may view them or their performance.
Anticipated Result of Feedback
Clients may improve or change their thoughts, feelings, and behaviors based on the therapist's feedback.
Feedback guidelines
1. The client receiving feedback should be in charge.
2. Feedback is best received when you focus on strengths and/or something the client can do something about
3. Feedback should be concrete and specific
4. Feedback should be relatively nonjudgmental an
Positive Feedback
� Helps the client re-story his concerns
� Looks for right things about the client
� Help client discover their strengths and positive assets and useful resources
Corrective feedback
� Delicate balance between negative feedback and positive suggestions for the future
� Focus on behaviors that may be hurting the client or hindering growth
� Stick to the feedback guidelines
� Praise and supportive statements convey your positive thought
Feedback and the client who avoids certain topics
� Some clients switch topics, give brief/vague responses, or avoid sensitive issues
� If issue needs to be faced, meet the client and use confrontation skills as part of the feedback
� Examples
o On one hand I hear you wanting to resolve this issue but on
When you must give negative corrective feedback
keep your vocal tone and body language nonjudgmental and stick to the facts, even though the issues may be painful.
Negative Feedback
is necessary when the client has not been willing to hear corrective feedback. For example, in cases of abuse, planned behavior that hurts self or others, and criminal behavior, negative feedback�including the negative consequences the client's actions ca
Some central potential values of self-disclosure and feedback are that they
Provide an opportunity that might otherwise be missed for the client to gain from your experience and knowledge.
Can enhance the relationship and encourage the client to be more open and selfdisclosing.
Bring more here-and-now immediacy to the session
Following are some of the main cautions in using the sometimes controversial skills of self-disclosure and feedback:
Beware of the possibility of counselors' misusing the power they have in the session.
Clients tend to trust what counselors have to say, sometimes too readily.
Keep both self-disclosures and feedback statements brief and to the point.
Return the focus to
1-2-3 pattern
In any interaction with a client, first attend to and determine the client's frame of reference, then assess her or his reaction before using your influencing skills. Finally, check out the client's reaction to your use of the skill.
self-disclosure
Indicating your thoughts and feelings to a client constitutes self-disclosure, which necessitates the following:
1. Use personal pronouns ("I" statements).
2. Use a verb for content or feeling ("I feel . . ." "I think . . .").
3. Use an object coupled wit
Feedback
Feed back accurate data on how you or others view the client. Remember the following:
1. The client should be in charge.
2. Focus on strengths.
3. Be concrete and specific.
4. Be nonjudgmental.
5. As appropriate, provide here-and-now feedback.
6. Keep fee
Stress in therapy
� Stress: a psychological and physical response to change, whether that change is actually happening now or anticipated in the future
Positive stress
� Positive stressors tend to make us happy and joyful in many ways
� Examples
o Buying a house
o Get married
o Starting a new job
o Moving to a new city
Stress and stressors
� Appropriate stress encourages neurogenesis, new synapse connections and is required for learning and change in counseling and psychotherapy
� Stress can be good or bad
� It makes life interesting and exciting
� Negative stressors bring most clients to c
Positive stress
� Neurogenesis and learning
� Frontal cortex strengthened
� Gray and white matter increased
� Reduction in size of the amygdala
� Longer, healthier life
Destructive stress
� Excess cortisol and neural loss
� Limbic system and negative feelings take control
� Neural loss and brain shrinkage
� Enlargement of the amygdala
Stress management
� Instructional strategies to enable clients to live with and deal with stress effectively
� Stress can lead us to make poor decisions, fail to decide on important issues, or suffer emotional breakdown
� Most therapists draw on stress management strategie
Therapeutic life style changes
� Instructional strategies oriented toward physical and mental health, bringing together neuroscience, medicine and counseling
Stress management and therapeutic lifestyle changes
� Designed to improve the physical and mental health of clients
� Relaxation, meditation, irrational beliefs, thought stopping and time management are some of the skills and strategies used to manage stress and change lifestyle
Anticipated result of stress management
� Clients will use this information to practice managing their stress and change their lifestyle to improve physical and mental health
� Physical and mental symptoms will improve over time
Concepts into action: psychoeducational stress management strategies
� Communication skills training
� Assertiveness training
� Thought stopping
� Positive guided imagery
� Homework
Communication skills training
� Teach client communication skills to help develop better interpersonal relationships
Assertiveness training
� Follows a model similar to that of communication skills training
� Teach clients more appropriate and useful modes of social interaction
Thought-stopping
� Almost everybody engages in negative self-talk
� Thought-stopping: ending negative self-talk
� Effective intervention increases self-esteem and personal effectiveness
� Applicable to a wide range of difficulties
o Perfectionism, excessive culture-based
Steps of thought stopping
� Step 1: learn the basic process
� Step 2: transfer thought stopping to your daily life
� Step 3: add positive imaging
� Step 4: make positive images and thoughts a habit
Guided imagery focusing on a relaxing scene
� Often the most powerful directive
� Helps clients relax and reduce tension
� Positive images represent positive strengths
� Children and young people like the freedom and creativity from this strategy
Homework
� Generalizing goals and actions beyond the session
� Homework is concerned with a ction- generalizing thoughts, feeloings and behaviors to the real world
� Work with client to do something different or new after the session
� Homework assignments include
Enactment via the Gestalt empty chair
Empty-chair nonverbal techniques
� Talk to your parent as if...
� One hand is a fist, the other is open. Have one hand talk to the other
� Similar to role-play, but the client plays both people or both parts
� Makes the issues concrete
� Acting/movement c
Encourage physical exercise and nutrition
� Encourage physical exercise and nutrition
� Sound body, sound mind
� Exercise improves blood pressure and reduces stress and depression
� Proper eating habits, stretching and mediation improve life
� Teach clients how to nourish their bodies
Social relationships
� Isolation and alienation have detrimental mental and physical health consequences
� Counseling and psychotherapy are about social relationships
� Human relationships are key to well being
� Much of our work is helping client improve their relationships
Cognitive challenge
� Do something different and challenging
� Doing what we already do well may be useful but not as growth-producing as the creation of the new
Logical consequences
Explore specific alternatives with the client and the concrete positive and negative consequences that would logically follow from each one. "If you do ______, then ______ may result.
Anticipated result of logical consequences
Clients will change thoughts, feelings, and behaviors through better anticipation of the consequences of their actions. When you explore the positives and negatives of each possibility, clients will be more involved in the process of decision making.
Negative consequences
could include leaving a smoothly functioning and friendly workgroup, disrupting long-term friendships, and moving teenage children to a new school.
Positive consequences
might be the pay raise, a better school system, and money for a new home, plus the opportunity for further advancement.
Logical consequences skills
1. Draw out story and strengths.
2. Generate alternatives.
3. Identify positive and negative consequences.
4. Provide a summary.
5. Encourage client decision and action.
Logical consequences main idea
Ideally, this is a gentle skill used to help people sort through issues when a decision needs to be made.
Decisions can have both negative and positive consequences.
The focus is on potential outcomes, and the task is to assist clients to foresee conseque
instruction and psychoeducation
Instruction and psychoeducation are closely related. Instruction, providing information or advice, is brief, consisting of relatively short comments to facilitate action in the real world. Psychoeducation is more comprehensive. Many times clients need the
stress management main idea
Changing the stressors or changing your reactions to them are key goals of stress management. Several strategies can help you achieve these goals, including relaxation, meditation, irrational beliefs, thought stopping, time management, and many other tech
big 6 of TLC
Exercise, sleep, nutrition, social relations, cognitive challenge, and meditation
Skill integration
Integrate the microskills into a well-formed counseling session and generalize the skills to situations beyond the classroom.
Anticipated result of skill integration
Developing counselors will integrate skills as part of their natural style. Each of us will vary in our choices, but increasingly we will know what we are doing, how to intentionally flex when what we are doing is ineffective, and what to expect in the se
Treatment planning
in the form of specific written goals and objectives, is increasingly standard and often required by agencies and insurance companies. When possible, negotiate specific goals with the client and write them down for joint evaluation. They should be as conc
Case management
For human service professionals, social workers, and school counselors, case management will be as or more important than treatment planning.
Case management requires the professional helper to coordinate community services for the benefit of the client a
How do we prevent relapse?
By maintaining change
Change that is not planned and contracted with the client is less likely to occur.
Maintaining client change worksheet
Include in the plan a list of people who can be counted on for support, the triggers to the unwanted behaviors, po
Logical consequences are important in
Crisis counseling
Stress management, lifestyle changes, crisis counseling, and many counseling and psychotherapy theories will use
Instruction and psychoeducation
When is CBT most effective?
� Substance use disorder
� Schizophrenia and other psychotic disorders
� Depression, stress, and anxiety
� Bipolar disorder
� Somatoform disorders (physical pain)
� Eating disorders
� Insomnia
� Personality disorders
� Anger and aggression
� Criminal beha
Philosophy of CBT
� Thoughts influence our feelings and actions
� Purpose is to explore thought patterns
� Behavior is maintained by its consequences
Consequences that accelerate behavior are ______________; those that decelerate behavior are _______________
reinforcers, punishers
o Example: candy versus loss of points
� Help clients see that their beliefs are ineffective or irrational
� Enable client to "think differently
CBT
1. A base of cognitive response are key to change
2. Time limited with specific goals
3. A sound relationship is needed but is not central
4. Based on aspects of Stoic philosophy ? "It is not things, but what one thinks of things that counts"
5. Structure
Self-healing
� CBT encourages self-healing and aims to increase clients' competency and provide coping skills they can use when facing new concerns and challenges
Systematic desensitization
� De-conditions anxiety
� Pair responses incompatible with anxiety to previously-arousing stimuli
� Example: if you are afraid of snakes, therapist would teach you deep muscle relaxation and then have you imagine approaching a snake in hierarchical stages
Self-care
� Sleep
� Exercise
� Eat healthy
� Plan ahead
� Reading, outdoors, pets, activities
� Attitude- positivity
� Relationships