Crisis Intervention Counseling

Gestalt and Grief Therapy

Posted on by Mark Moran

Licensed counselors, Human Service professionals, and other specialized behavioral health therapists can help the bereaved through advanced therapies.  Cognitive Behavioral Therapy or CBT is one such example, but there are other humanistic approaches that are also patient centered in design.  Gestalt Therapy is one such humanistic approach that avoids psycho-analysis and looks to the present state of the person.  It looks for the fullness and wholeness of the entirety of the person and issue instead of reviewing merely smaller parts.  Designed by Fritz Perls. his wife, Laura Perls and John Goodman in the early 1940s, this approach helps individuals face and cope with emotion in the present moment (Good Therapy, 2018, p.1).

In regards to the bereaved, Gestalt can be an excellent way to help the grieving come more into contact with the emotions they are feeling in the present moment.  It can help the depressed focus on the emotions of the now moment and help them find resolution and self-awareness about these feelings.  This can usher forward a inner healing for some and help one find resolution with the present moment.  The important theme of Gestalt Therapy is that it focuses on the now and how one is feeling in the moment not how one felt in the past or the issues of the past.

Gestalt Therapy 

Gestalt focuses on the current emotional state of the client and emphasizes discussion of those emotions

Gestalt Therapy focuses on the now.  This is one of its defining qualities.  The counselor or therapist will help the client focus on what the client is experiencing in the moment and how to address those emotions in the now moment.  This now moment involves a mind and body connection and an awareness within the body of these feelings (Lindsey, 2022).  A strong counselor-client connection is important for the client to feel comfortable enough to identify these emotions and discuss them.  Furthermore, the Gestalt has a strong phenomenological emphasis on experiencing the process of emotion itself and exploring and evaluating it within the session.  This brings one closer to true feeling.  Within Gestalt, one is not so much looking for change, but acceptance and understanding of self to better cope and push forward in a productive and non-maladaptive way.

Fritz Perls wished for clients to find more self-awareness of oneself.  He hoped one to become more attune with one’s feelings and to better cope with them by identifying and feeling them (Guy-Evans, 2022).  Gestalt pushes for the here and now of the moment. It emphasizes that the past cannot change, but the present exists now and can produce transformation.  Hence, even past emotions are encouraged to be expressed in the present moment (Guy-Evans, 2023).   By understanding the emotion now, one can conclude the unfinished business of the past.

Gestalt Techniques

Gestalt Therapists will utilize a variety of techniques to help the client experience present emotion.  Many counselors encourage clients to utilize “I” statements.  When discussing an emotion such as anger, instead of stating “they made me angry”, the counselor encourages the client to say “I feel angry when”.  This again emphasizes the importance of individual emotion within the moment (Langmaid, 2024).

In addition to this, Gestalt therapists will identify various bodily manifestations correlated with emotion.  A person may clench a fist, look downward, raise one’s voice, tap their foot against the ground, twitch, or frown.  When these physical manifestations appear, the counselor will help the client identify these manifestations with the emotion felt.  Counselors should encourage the client to exaggerate these manifestations during the session.  This process in Gestalt is referred to as exaggeration (Good Therapy, 2018, p. 1). This will help clients become more aware of their emotions and how to better regulate them in the future.

The empty chair is perhaps the most famous Gestalt technique. It involves an empty chair where the client is able to speak to the person who is the source of the client’s frustration, abuse, or source of emotion.  It could represent an abuser, ex spouse, deceased family member, or even be a conversation between the self (Guy-Evans, 2023).  This permits the client to express present emotion but also allows the client to better understand that the power to heal does not depend upon another person but the power is within oneself.

Empathetic confrontation is sometimes a technique employed by therapists as well within Gestalt.  This was more widely common in its earlier phases, but in recent times is not as employed.  The purpose was to confront the false emotion or shield and help the true emotion to emerge.

Goals and Benefits of Gestalt Therapy

The primary goal of Gestalt is to help clients become more self aware of present emotion and how that emotion is affecting one’s life. It helps to push one to become more self aware and regulating of emotion and to find resolution by accepting the emotional reality that exists.  This promotes responsibility on the part of the client to accept certain emotions and work through them.

Guy Evans lists these benefits from Gestalt

  • Improved sense of self-control

  • Increased awareness of needs

  • Improved ability to monitor and regulate emotions

  • Improved communication skills

  • Increased tolerance for negative emotions

  • Improved mindfulness

  • Increased emotional understanding

  • Improved ability to view things from another perspective

  • Increased self-esteem

  • Increased decision-making skills

  • Increased interpersonal skills

  • Increased empathy for others

(Guy-Evans, O. (2023). “Gestalt Therapy: Definition, Types, Techniques, And Efficacy”.  Access here

Conclusion

Gestalt is another tool for the counselor.  It does not necessarily work for everyone.  It may need to be utilized with other therapies.  In some cases, clients who wish for more structure, or wish to focus on the past, may find it unhelpful.  While others who are still too traumatized by emotion, may find it disturbing.  It can definitely bring up strong emotions, so it should only be utilized in a secure setting with a strong client/counselor relationship.  Obviously, those who are only pastoral or only certified in grief counseling but lack a professional and clinical license in counseling should not utilize this therapy.

Please also review AIHCP’s Grief Counseling Certification and if it matches your academic and professional goals

For many though, it can help individuals find peace with the present moment and express emotion in a healthy and safe way.  It can help a person transform and move beyond past negative emotions and find new resolutions in life to move beyond the pain.  In grief, this is especially true.  It can provide for the bereaved an outlet to express current emotion and also sort through feelings and emotions with the deceased.

Please also review the American Academy of Grief Counseling’s Grief Counseling Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification as a grief counselor.

 

 

 

 

Additional Resources

“Gestalt Therapy”. (2018). Good Therapy.  Access here

Langmaid, S. (2024). “How Does Gestalt Therapy Work?” WebMD. Access here

Guy-Evans, O. (2023). “Gestalt Therapy: Definition, Types, Techniques, And Efficacy”. Simple Psychology.  Access here

Lindsay, C. (2022). “All About Gestalt Therapy”. PsychCentral.  Access here

 

 

Crisis Intervention Specialist: Essential Skills and Training

Posted on by Dominick Flarey

By – James M. Katz, BA

A Crisis Intervention Specialist stopping a domino effect.In the face of a crisis, having skilled professionals equipped with the right tools and knowledge can be a lifesaver—literally. This is where the role of a Crisis Intervention Specialist becomes crucial. They are the frontline responders who address mental health crises, employing suicide prevention techniques, providing trauma-informed care, and executing crisis management strategies. Their work is vital in navigating individuals through their darkest moments, ensuring safety and facilitating the path towards healing and stability. Understanding what a Crisis Intervention Specialist does and why their work is so important showcases the critical nature of their role in our communities.

This article will explore the path to becoming a Crisis Intervention Specialist, beginning with the required educational background and moving through the professional certification process. It will delve into the key skills necessary for success in the field, including crisis intervention techniques, intervention strategies, and the ability to define crisis intervention effectively. Additionally, the training path, including crisis intervention training and crisis intervention programs, will be discussed to provide a comprehensive overview of how professionals are prepared for this demanding yet rewarding career. On-the-job training and experience, financial aspects of pursuing this career, and career development and advancement opportunities will further delineate what it takes and what it offers to those who choose this path of service.
A crisis intervention specialist is a mental health professional who helps people during difficult and traumatic times. They provide support, hope, and care to individuals, families, and communities facing serious challenges. These specialists work in various settings, such as schools, hospitals, and community organizations, to offer immediate help and counseling to those in need.

Key Takeaways

  • Crisis intervention specialists support people in serious and traumatic situations.
  • They work in many places like hospitals, schools, and community centers.
  • Key skills include communication, problem-solving, and emotional resilience.
  • Educational paths include relevant degrees, certifications, and ongoing training.
  • Their work has a big impact on individuals and communities, offering immediate help and building resilience.

What is a Crisis Intervention Specialist?

Definition and Scope

A Crisis Intervention Specialist is a highly trained professional equipped to offer counseling, assessment, and treatment to individuals experiencing a crisis. These specialists, also known as crisis interventionists, are qualified mental health professionals with specialized training to support, provide hope, and deliver healthcare to individuals, families, and communities facing serious and often traumatic circumstances.

Key Responsibilities

The responsibilities of a Crisis Intervention Specialist are diverse and demanding. They assess and treat individuals with mental, emotional, or substance abuse problems, including issues related to alcohol, tobacco, and other drugs. https://www.franklin.edu/career-guide/mental-health-and-substance-abuse-social-workers/what-do-crisis-intervention-specialists-do This role may involve a variety of tasks such as individual and group therapy, crisis intervention, case management, client advocacy, prevention, and education.

Crisis Specialists often operate from private home offices, using telecommuting hardware and software to provide telephonic and text-based emotional support and resources. They are expected to manage documentation, access resources via web-based platforms, and provide strengths-based, unbiased crisis counseling to all individuals who reach out for help. Ensuring the highest standards for the delivery of evidence-based or evidence-informed crisis support, including suicide prevention and intervention, is a critical part of their job.

Additionally, these professionals must maintain professionalism in their workspace and ensure the privacy and confidentiality of each caller’s information. They actively participate in on-the-job professional development opportunities and remain flexible to new job duty assignments. Crisis Intervention Specialists work in various settings including crisis call centers, schools, government-based or military organizations, and mental health facilities such as hospitals and clinics. Some may travel extensively to respond to crises at different locations, while others might work remotely.

Their clinical skills include mental health and substance use counseling, behavioral analysis, rapid assessment, and verbal de-escalation, while crucial soft skills comprise empathy, patience, good communication, and problem-solving abilities.

Conducting Assessments and Evaluations

Crisis intervention specialists are trained to assess and evaluate individuals in distress. They quickly determine the severity of the situation and identify the immediate needs of the person in crisis. This helps in creating an effective plan to address the issue at hand.

Providing Immediate Support and Counseling

These specialists offer immediate support and counseling to those facing traumatic or high-stress situations. They provide a listening ear and practical advice, helping individuals navigate through their crisis moments.

Coordinating with Other Professionals

Crisis intervention specialists often work with other professionals, such as doctors, social workers, and law enforcement officers. This collaboration ensures that the person in crisis receives comprehensive care and support from various angles.

Essential Skills for Crisis Intervention Specialists

Communication and Interpersonal Skills

Crisis intervention specialists must be excellent communicators. They need to listen carefully and speak clearly to help people in tough situations. Good communication helps build trust and understanding. This is important when working with individuals, families, or groups.

Problem-Solving and Critical Thinking

These specialists often face complex problems that need quick solutions. They must think on their feet and come up with effective plans. Being able to solve problems quickly can make a big difference in a crisis.

Emotional Resilience and Self-Care

Working in crisis situations can be very stressful. Specialists need to stay calm and strong, even when things are tough. Taking care of their own mental health is also important so they can keep helping others.

Work Environments for Crisis Intervention Specialists

Hospitals and Mental Health Clinics

A crisis intervention counselor offering a helping hand to someone in need.Crisis intervention specialists often work in hospitals and mental health clinics, where they provide immediate support to patients experiencing severe emotional distress. These professionals are crucial in stabilizing individuals and preventing further psychological harm. They collaborate with medical staff to ensure comprehensive care.

Schools and Educational Institutions

In schools, crisis intervention specialists help students who are dealing with emotional or behavioral issues. They work closely with teachers and counselors to create a safe and supportive environment. Their role is vital in addressing crises that can impact a student’s ability to learn and thrive.

Community and Government Organizations

Specialists in crisis intervention also find roles in community and government organizations. Here, they assist individuals and families facing various crises, from natural disasters to personal emergencies. Their work helps strengthen community resilience and provides essential support during challenging times.

Required Educational Background

Degrees and Majors

The journey to becoming a Crisis Intervention Specialist begins with obtaining a bachelor’s degree. Prospective students often select majors that include psychology, sociology, gender and women’s studies, education, or social work . While a bachelor’s degree allows one to work in crisis intervention, it restricts direct one-on-one patient interactions. For those aiming to engage in individual intervention counseling, a master’s degree in social work or psychology becomes essential. Further educational advancement can lead to more specialized roles. Some individuals may choose to pursue a Ph.D., which not only enhances professional opportunities but also facilitates careers in academia or as crisis intervention instructors. This level of education involves significant contributions to the field, such as publishing in peer-reviewed journals.

Continuing Education

Continuing education plays a pivotal role in the career of a Crisis Intervention Specialist. Certifications, often pursued through reputable organizations like the American Institute of Health Care Professionals, are crucial for professional development. These certifications may cover various areas including intervention theory, treatment planning, nonviolent crisis intervention, and more.

The American Institute of Health Care Professionals, for instance, offers a comprehensive Continuing Education program that leads to Certification in Crisis Intervention Consulting. This program consists of seven courses, each provided in a dedicated online classroom with one-to-one faculty mentoring. The certification process underscores the importance of staying updated with the latest developments in healthcare, which is crucial for delivering effective patient care.
Moreover, some certifications, like the CIC-Cusp, require a minimum of 50 hours of continuing education within a four-year period to maintain the certification status. This ongoing learning is essential not only for personal growth but also for adhering to the evolving standards of crisis intervention practice.

Professional Certification Process

Types of Certifications

To become a recognized Crisis Intervention Specialist, individuals must obtain certification from a reputable professional organization. This certification is an official acknowledgment that the individual has met all the established standards set by the organization. Unlike licensure, which is government-regulated, certification is granted by professional bodies and does not adhere to any laws. For instance, the Crisis Specialist Certification is awarded after participants successfully pass a certification exam, which requires a minimum score of 80%. Candidates are allowed two attempts to pass this exam, and failing to do so necessitates retaking the course.
The American Institute of Health Care Professionals offers a model where certification is based on a core curriculum of Continuing Education (CE) Courses. This ensures that all certified members possess up-to-date knowledge and skills pertinent to their specialty. Certification in various areas such as intervention theory, treatment planning, nonviolent crisis intervention, and more, demonstrates an applicant’s expertise beyond a general degree and is highly valued in professional settings.

Maintaining Certification

Maintaining certification is crucial for a Crisis Intervention Specialist to ensure they remain competent and effective in their role. Certified professionals are required to undergo recertification every few years. This process involves completing additional training and passing the exam anew to stay aligned with the latest research and best practices. Continual learning and adherence to evolving standards are emphasized through required continuing education credits. These credits must be accumulated as per the certifying body’s standards to maintain certification status. Continuing education serves multiple purposes; it keeps professionals abreast of the latest developments in their field, maintains their skills, meets licensure requirements where applicable, and ultimately enhances patient care. The commitment to ongoing education reflects a professional’s dedication to their craft and their ability to provide the highest standard of care. In conclusion, the certification process for Crisis Intervention Specialists not only validates professional competence but also ensures continual growth and adherence to the highest standards of practice.

Key Skills for Success

Interpersonal Skills

Interpersonal skills are crucial for a Crisis Intervention Specialist, as they often act as the first point of contact in crisis situations. Effective communication is essential, not just in conveying information but also in de-escalating potential crises. Specialists need to be articulate and confident, capable of handling high-stress situations with clarity and composure. They should also be adept at building relationships and fostering trust quickly, which can be pivotal in crisis resolution. Demonstrating empathy and maintaining professionalism are key, as these traits help create a safe space for individuals in distress, allowing them to feel understood and supported.

Problem-Solving Abilities

Crisis Intervention Specialists must excel in problem-solving, particularly under pressure. The ability to analyze situations quickly, identify key issues, and implement effective solutions is fundamental. This requires not only a thorough understanding of crisis intervention techniques but also the ability to think critically and make decisions swiftly. The nature of crises means that no two situations are the same, thus flexibility and adaptability are essential. Specialists must be prepared to alter their strategies as situations evolve, ensuring that their interventions are responsive and effective.

Stress Management

Managing personal stress is equally important for Crisis Intervention Specialists. The role involves frequent exposure to highly stressful and emotionally charged situations, which can take a toll on one’s mental and physical health. Effective stress management strategies are necessary to maintain personal well-being and professional effectiveness. This includes recognizing the signs of stress, employing techniques such as deep breathing or mindfulness, and ensuring adequate rest and recovery. Specialists must also be adept at managing organizational stress, anticipating potential crisis impacts, and preparing accordingly to mitigate adverse effects on the organization and its members.

By mastering these key skills, Crisis Intervention, Specialists can provide essential support and guidance, helping individuals navigate through their most challenging moments while also maintaining their own health and resilience.

Challenges Faced by Crisis Intervention Specialists

High-Stress Situations

Crisis intervention specialists often find themselves in the middle of very stressful situations. They need to stay calm and think clearly, even when things are chaotic. Handling these high-pressure moments is a big part of their job.

Emotional and Psychological Impact

Working with people in crisis can take a toll on a specialist’s own emotions and mental health. They might feel sad or stressed after helping someone through a tough time. It’s important for them to find ways to cope with these feelings.

Managing Work-Life Balance

Balancing work and personal life can be hard for crisis intervention specialists. Their job can be demanding, with long hours and unexpected calls for help. Finding time to relax and spend with family is crucial to avoid burnout.

Impact of Crisis Intervention Specialists on Communities

Supporting Individuals in Crisis

Crisis intervention specialists play a crucial role in helping people during their most difficult times. They offer immediate support and guidance, helping individuals navigate through their crises. Their presence can make a significant difference in the lives of those struggling with mental, emotional, or substance abuse issues. By providing timely assistance, they help prevent situations from escalating further.

Strengthening Community Resilience

These specialists not only support individuals but also contribute to the overall resilience of the community. They work to build stronger support networks and educate the public on how to handle crises. This proactive approach helps communities become better prepared to face future challenges, fostering a sense of unity and strength.

Collaborating with Local Resources

Crisis intervention specialists often collaborate with local resources such as schools, hospitals, and community organizations. This teamwork ensures that individuals in crisis receive comprehensive care and support. By working together, they can address the various needs of those affected and provide a more holistic approach to crisis management.

Financial Aspects of the Career

Salaries and Benefits

The financial rewards of a career as a Crisis Intervention Specialist can vary widely based on several factors including the individual’s level of education, certifications, and specific job role within the field. Typically, entry-level positions may offer a starting salary range from $30,000 to $40,000 annually. However, those with advanced degrees and specialized certifications can expect significantly higher compensation, potentially exceeding $70,000 per year. In addition to salary, benefits play a crucial role in the overall compensation package for Crisis Intervention Specialists. Common benefits include health insurance, paid leave, and retirement plans. Some employers also offer tuition reimbursement programs, which are particularly beneficial for those pursuing ongoing education or additional certifications. These benefits not only provide financial security but also support the specialist’s career development and personal well-being.

Geographical Differences

Salaries and employment opportunities for Crisis Intervention Specialists can also be influenced by geographical location. Urban areas typically offer higher salaries compared to rural settings due to the higher cost of living and the greater demand for mental health services in densely populated regions. For instance, specialists working in cities such as New York or San Francisco may earn more than their counterparts in smaller towns or rural areas.
Moreover, some states and regions may have higher concentrations of employment opportunities in this field, often correlated with larger populations and more extensive healthcare systems. This geographic variability means that those willing to relocate may find more lucrative or plentiful job opportunities, which can significantly impact career trajectory and earnings potential.

By understanding these financial aspects, individuals interested in becoming Crisis Intervention Specialists can better plan their career paths and financial goals, ensuring they are adequately prepared for the varied opportunities and challenges in this field.

Career Development and Advancement Opportunities

Advanced Roles

Pursuing advanced degrees such as a master’s in counseling or psychology can significantly broaden a specialist’s scope of practice, enabling them to handle more complex cases and work in diverse settings. Specialists with a master’s degree are equipped to engage more directly with patients and are often preferred for positions that require individual patient interactions.

Moreover, obtaining a Ph.D. can propel a Crisis Intervention Specialist into higher echelons of their career, such as academic positions or roles as crisis intervention instructors. This level of education demands significant contributions to the field, including publishing in peer-reviewed journals and mastering the discipline’s fundamental principles. Such advanced roles not only enhance professional growth but also expand the range of career opportunities available in both public and private sectors, as well as in nonprofit organizations. Through these structured educational and certification paths, Crisis Intervention Specialists are well-prepared to advance in their careers, continually enhancing their ability to provide effective support and intervention during crises.

Career Advancement Opportunities for Crisis Intervention Specialists

Leadership and Supervisory Roles

Crisis intervention specialists can move up to leadership positions where they manage teams and oversee programs. These roles often involve guiding less experienced staff and ensuring the quality of services provided. This step up not only brings more responsibility but also the chance to shape the direction of crisis intervention efforts.

Specialization in Specific Populations

Some specialists choose to focus on working with particular groups, such as children, veterans, or individuals with substance abuse issues. Specializing allows them to develop deeper expertise and provide more targeted support. This path can lead to becoming a recognized expert in that area, opening doors to new opportunities.

Engagement in Research and Policy Development

Another avenue for career growth is getting involved in research and policy-making. By contributing to studies and helping to shape policies, crisis intervention specialists can influence the broader field. This work not only advances their careers but also helps improve practices and outcomes for those in crisis.Psychology. Crisis hotline, Support call, psychological help. Yellow hand drawn phone with rad and blue speech bubble.

Conclusion

Through an in-depth examination of the journey to becoming a Crisis Intervention Specialist, this article has elucidated the pivotal roles these professionals play in offering support during crises. Emphasizing the critical skills, requisite educational background, and the importance of continuous professional development and certification, it is clear that becoming a Crisis Intervention Specialist requires dedication, compassion, and a high degree of specialized training. Notably, the article showcased how these specialists not only provide invaluable support to individuals in dire need but also contribute significantly to the broader framework of mental health services.

The significance of ongoing education and the pursuit of advanced certifications underscore a commitment to excellence and an understanding of the evolving nature of crisis intervention. This field, which demands both personal resilience and deep empathy, offers professionals a unique opportunity to make a profound impact on lives during moments of vulnerability. As the landscape of mental health and crisis intervention continues to evolve, the dedication of those who choose this path remains an essential beacon of hope for individuals and communities navigating the complexities of crises.

If you’re a mental healthcare professional and want to become a Crisis Intervention Specialist then please review our Crisis Intervention Counseling Certification Program. Our program requires a student to complete 7 online Crisis Intervention Courses in order to qualify for certification. For more details, please visit our Online Crisis Intervention Counseling Certification program. 

FAQs

  1. What are the fundamental principles guiding crisis intervention?
    The four core principles of crisis intervention include: (1) immediate intervention to stabilize the affected individual or community post-event; (2) helping the victim understand the events that occurred; (3) assisting in problem-solving within feasible limits; and (4) promoting self-reliance to aid in recovery.
  2. What roles do crisis intervention specialists play?
    Crisis intervention specialists engage in various roles, such as: providing affective interventions to help clients express their emotions related to the crisis; offering cognitive interventions to eliminate negative beliefs contributing to the crisis; assigning behavioral tasks, like encouraging social interactions; and more.
  3. What qualities make an effective crisis worker?
    Effective crisis workers possess several key characteristics, including the ability to empathize with clients while maintaining professional detachment, a nonjudgmental attitude, a nonreactive demeanor, a high tolerance for stressful situations, and specialized training in crisis intervention.
  4. What responsibilities does a crisis intervention specialist have?
    A Crisis Intervention Specialist is responsible for assessing and treating individuals with mental, emotional, or substance abuse issues. This can include managing alcohol, tobacco, or drug abuse problems through individual and group therapy, crisis management, case management, client advocacy, and providing educational and preventive measures.
  5. What is a crisis intervention specialist?
    A crisis intervention specialist is a trained professional who helps people in serious and often traumatic situations. They provide support, hope, and healthcare to individuals, families, and communities.
  6. Where do crisis intervention specialists work?
    Crisis intervention specialists can work in many places, like hospitals, mental health clinics, schools, community organizations, and crisis call centers.
  7. What skills are important for a crisis intervention specialist?
    Important skills include good communication, problem-solving, critical thinking, emotional strength, and self-care.
  8. What education is needed to become a crisis intervention specialist?
    You usually need a relevant degree, like in psychology or social work, and specialized training. Continuing education is also important to keep up with new methods.
  9. How do crisis intervention specialists help communities?
    They support people in crisis, help make communities stronger, and work with local resources to provide better care.

Research Articles:

Fortifying the Foundations: A Comprehensive Approach to Enhancing Mental Health Support in Educational Policies Amidst Crises. Wiedermann CJ, Et Al. Healthcare. 2023; 11(10):1423.
Access link here 

Police, ambulance and psychiatric co-response versus usual care for mental health and suicide emergency callouts: A quasi-experimental study. Every-Palmer S, Et Al. Australian & New Zealand Journal of Psychiatry. 2023;57(4):572-582.
Access link here 

The Missing Piece: A Population Health Perspective to Address the U.S. Mental Health Crisis. Laura Sampson, Et Al. Daedalus 2023; 152 (4): 24–44.
Access link here 

Students’ Perceptions of Crisis Intervention: Using a Trauma Informed Approach Versus Restraint. Mary Triana, Millcreek Township School District Eric Bieniek, Slippery Rock University of Pennsylvania. 35TH ANNUAL NYAR CONFERENCE (MARCH 3-6, 2024)
Access link here 

 

Crisis Intervention Model: Essential Steps for Effective Response

Posted on by Dominick Flarey

By – James M. Katz, BA

A Crisis Intervention Counseling professional Helping a client
In moments of acute stress and upheaval, the deployment of an effective crisis intervention model can mark the difference between escalation and resolution. Within the framework of mental health and emergency response, such models serve as structured approaches for professionals, including members of a crisis intervention team, to provide immediate emotional support and mitigate the impact of the crisis. Recognizing the importance of these models is paramount in addressing a mental health crisis efficiently, ensuring individuals receive the necessary support during their most vulnerable moments.

This article navigates through various crisis intervention models, delving into their structures, methodologies, and applications. From the ABC Model of Crisis Intervention, which lays out a straightforward approach to crisis response, to Roberts’ Seven-Stage Crisis Intervention Model and the newer SAFER-R Model, the discussion extends to Lerner and Shelton’s 10 Step Acute Stress & Trauma Management Protocol. Each model offers unique perspectives and strategies on managing crisis interventions effectively. By exploring these different frameworks, the piece aims to guide professionals in choosing the right model to apply in diverse scenarios, fortifying their crisis intervention and response capabilities.

Key Takeaways

  • Crisis intervention models offer structured approaches for helping individuals in acute distress.
  • Different models, such as the ABC Model, Roberts’ Seven-Stage Model, and SAFER-R, provide unique strategies and frameworks.
  • Training and proper implementation of these models are crucial for their effectiveness in real-world scenarios.
  • Understanding the strengths and limitations of each model helps in selecting the most appropriate intervention for specific situations.
  • Integration of multiple models can enhance the overall effectiveness of crisis intervention efforts.

Understanding Crisis Intervention Models

Definition and Purpose

Crisis intervention is a short-term management technique employed to reduce the risk of long-term damage to individuals experiencing acute mental health crises. These crises can range from the trauma of losing a loved one to the stress of a severe illness. The primary aim is to stabilize the individual, provide immediate support, and prevent potential psychological trauma. By obtaining background information, establishing a relationship, and facilitating understanding and coping strategies, professionals can help individuals return to their mental baseline and avoid lasting harm.

Importance in Mental Health

The role of crisis intervention in mental health cannot be overstated. It serves as a critical response mechanism that can prevent the escalation of a crisis into a more severe mental health condition, such as major depressive disorder. Studies have shown that interventions can lead to reduced hospital return visits and shorter stays, which underscores their effectiveness compared to standard care. Furthermore, community mental health centers and local government agencies often employ crisis intervention teams that play a pivotal role in community support during natural or man-made emergencies, enhancing overall psychiatric outcomes.

These teams are equipped to assess and manage crisis situations promptly, providing essential support and referrals to further mental health resources. Their ability to intervene effectively can be crucial in preventing the development of more severe mental health issues and in supporting individuals in regaining control over their lives.

Types of Crisis Intervention Models

ABC Model

The ABC Model of Crisis Intervention is a streamlined approach that combines various methods from crisis counseling experts. Developed further by Kristi Kanel in 2014, this model focuses on three critical stages: establishing and maintaining rapport (A), identifying the problem (B), and coping (C). It emphasizes building trust with the client, understanding the crisis event and its impact, and developing strategies for coping with the situation.

Roberts’ Seven-Stage Crisis Intervention Model

Albert Roberts developed his Seven-Stage Crisis Intervention Model over many years, drawing on foundational crisis theory work by Caplan, Golan, and Lindeman. Published in 2005,  the model outlines a systematic process starting with a thorough assessment of the client’s emotional, cognitive, and behavioral reactions, rapidly establishing rapport, identifying key problems, exploring feelings, developing alternative coping strategies, implementing an action plan, and concluding with follow-up sessions to ensure the client’s recovery.

SAFER-R Model

The SAFER-R Model, created by Dr. George Everly in 1996,  is structured around the biopsychosocial needs of individuals during a crisis. It includes steps such as Stabilize, Acknowledge, Facilitate understanding, Encourage coping, and Recovery or Referral. This model is particularly noted for addressing immediate health and psychological needs, encouraging effective coping mechanisms, and ensuring social support systems are in place to aid recovery.
Lerner and Shelton’s 10 Step Acute Stress & Trauma Management Protocol

Developed by the American Academy of Experts in Traumatic Stress, Lerner and Shelton’s protocol provides a comprehensive 10-step approach to manage acute stress and trauma. Key steps include assessing safety, understanding the mechanism of injury, evaluating responsiveness, addressing medical needs, and providing support. This protocol is designed to help emergency responders effectively manage traumatic events and support individuals in navigating through trauma.

ABC Model of Crisis Intervention

Establishing Rapport

The initial stage of the ABC Model of Crisis Intervention focuses on developing and maintaining rapport, which is crucial for building a trusting relationship between the counselor and the individual in crisis. Effective rapport is achieved through both physical and emotional connections. Physically, counselors ensure there are no barriers such as tables or chairs between themselves and the individual, maintain solid eye contact, and orient their bodies towards the person, indicating positive regard. Emotionally, establishing safety and comfort involves validating the individual’s feelings, using empathetic statements, and maintaining a calm, even tone of voice. These attending behaviors demonstrate to the client that the counselor is genuinely engaged and listening, which encourages the individual to communicate more openly and freely.

Identifying the Problem

Once rapport is established, the next step involves identifying the problem. This phase is critical as it helps to clarify the nature of the crisis and the individual’s perceptions and emotions related to it. Counselors use a mix of open and closed questions to delve into the underlying issues that have led to the crisis. By understanding the precipitating events and the individual’s emotional responses, counselors can better address the specific needs and concerns of the person. This process includes recognizing any impairments in functioning, such as difficulties at work or school, and assessing the individual’s pre-crisis level of functioning. Ethical considerations are also crucial at this stage, ensuring that issues like potential harm to oneself or others are addressed.

Coping Strategies

The final stage of the ABC Model is focused on coping and adaptation. Here, counselors work with the individual to develop effective coping strategies that can help manage and mitigate the crisis. This involves exploring past coping behaviors to understand what has been effective or ineffective. Counselors encourage the development of new, healthier coping mechanisms and may suggest additional support such as therapy, support groups, or other community resources. The goal is to empower the individual to handle similar situations in the future more effectively and to establish a plan that includes follow-through on the coping strategies discussed. This stage is crucial for helping the individual regain a sense of control and moving towards recovery.

Roberts’ Seven-Stage Crisis Intervention Model

Stages Overview

The Roberts’ Seven-Stage Crisis Intervention Model, developed by Albert Roberts in 1991, is a comprehensive framework used to guide clinicians in systematically addressing and managing crisis situations. The model emphasizes a structured planning and implementation of interventions to ensure effective crisis resolution. It involves the following stages:

1. Plan and Conduct Crisis and Biopsychosocial Assessment: This stage includes assessing the risks of suicide, medical needs, and identifying protection and persistence resources such as family and other support systems.
2. Establish Rapport and Psychological Relationship: Clinicians focus on building trust and acceptance with clients, ensuring a therapeutic relationship is formed without judgment.
3. Identify Dimensions of the Problem or Crisis: Evaluating the issues and challenges faced by the clients, this stage shines a light on potential coping mechanisms.
4. Explore Feelings and Emotions: Active listening and empathetic responses are key to understanding the emotional state of the clients, enhancing the helping process.
5. Explore Alternative Coping Strategies: This involves assessing previously used methods and creatively finding new solutions that suit the client’s situation.
6. Develop an Action Plan: Clinicians work with clients to identify support networks and reference sources that can aid in the execution of the coping strategies.
7. Follow-Up Plan: Planning follow-ups is crucial to evaluate the client’s progress and ensure they are managing the crisis effectively post-intervention.

Implementing Each Stage

Implementation of each stage in the Roberts’ Seven-Stage Crisis Intervention Model requires a careful and tailored approach to each client’s unique situation. Clinicians begin with a thorough biopsychosocial assessment, including lethality measures, to grasp the full scope of the crisis. Establishing a rapid, collaborative relationship is crucial for effective intervention and client comfort.

As they move through the stages, clinicians explore the client’s feelings and the dimensions of their problems, including crisis precipitants or the “last straw” events. This exploration is supported by active listening, validation of the client’s emotions, and an avoidance of victim-blaming.
Generating and exploring alternatives is a collaborative process, where clinicians empower clients to generate their own solutions and provide access to untapped resources. The development of an action plan is a participatory process, ensuring clients are involved in every step and have various options for organizing and recording their plans.

The follow-up stage is flexible but structured, aimed at maintaining client safety and integrating trauma-specific services if necessary. Clinicians remain sensitive to the potential for re-traumatization and ensure that any necessary adjustments to autonomy are transparent and minimal.
By adhering to these stages, clinicians can provide a trauma-informed, effective response to clients in crisis, supporting them in navigating through and ultimately overcoming the crisis.

SAFER-R Model

Principles of the Model

The SAFER-R Model, developed by Dr. George Everly, is rooted in the biopsychosocial model and addresses the immediate needs of individuals in a crisis. This model is designed not as a therapy substitute but as a method for stabilizing and mitigating acute crisis reactions. It is widely recognized for its effectiveness in crisis intervention, especially in fields requiring quick and efficient psychological first aid, such as emergency services and military operations.

Steps to Implement the Model

1. Stabilize: The first step involves ensuring the individual’s basic needs are met. This includes assessing their safety, health status, and immediate physical needs like food or drink to help stabilize their condition.
2. Acknowledge: This step focuses on acknowledging the crisis event and the individual’s reactions to it. It involves listening to the details of the event without judgment and understanding the emotional impact on the individual.
3. Facilitate Understanding: At this stage, the responder helps the individual understand and normalize their reactions to the crisis. This involves encouraging the expression of difficult emotions and providing reassurance as they move towards recovery.
4. Encourage Effective Coping: This involves identifying and reinforcing the individual’s personal coping mechanisms. It also includes discussing physical self-care practices such as diet, hydration, and sleep, alongside exploring available social support to aid in stress reduction and return to normalcy.
5. Recovery or Referral: The final step assesses the individual’s recovery progress and determines the need for further care. If the individual’s condition is not adequately stabilized, referrals to mental health professionals are considered to ensure continued support and care.

By following these steps, practitioners can provide immediate and effective support to individuals experiencing a crisis, helping them navigate through their immediate challenges and commence the recovery process.

Lerner and Shelton’s 10 Step Acute Stress & Trauma Management Protocol

Steps Overview

Lerner and Shelton’s 10 Step Acute Stress & Trauma Management Protocol, developed by the American Academy of Experts in Traumatic Stress, offers a structured approach for emergency responders handling traumatic events. The protocol includes the following steps:

1. Assess for danger/safety of self and others: Ensure the safety of the patient, those around them, and the responder.
2. Consider the mechanism of injury: Determine how the trauma has affected the individual physically or mentally.
3. Evaluate the level of responsiveness: Check if the individual is under the influence of substances or otherwise impaired.
4. Address medical needs: Provide immediate medical care as necessary.
5. Observe and identify: Recognize signs of traumatic stress in the patient.
6. Connect with the individual: Establish rapport and begin to communicate with the patient.
7. Ground the individual: Encourage the patient to discuss the traumatic event and ground their experience in reality.
8. Provide support: Offer empathy and actively listen to the patient’s concerns.
9. Normalize the response: Validate the patient’s reactions to the trauma and reassure them that recovery is possible.
10. Prepare for the future: Help the patient anticipate future challenges and provide referrals for ongoing support.

Application in Crisis Situations

The word Crisis in bold lettering showing the need for Crisis Intervention CounselingIn crisis situations, the protocol provides practical tools to address a wide spectrum of traumatic experiences, from mild to severe. It aims to “jump-start” an individual’s coping and problem-solving abilities, stabilize acute symptoms of traumatic stress, and stimulate healthy, adaptive functioning. The protocol is particularly effective in connecting with emotionally distraught individuals, offering strategies to engage and support them through challenging emotional states.
For instance, emergency responders might use techniques such as Distraction, Disruption, and Diffusion to engage individuals who are displaying intense emotional reactions. These techniques help break through emotional barriers by matching or redirecting the individual’s emotional and physical state, thereby facilitating a more controlled and supportive intervention.

Overall, the Lerner and Shelton’s protocol is designed not only to manage the immediate effects of trauma but also to enhance the long-term well-being of those affected, increasing the likelihood of seeking further mental health intervention if needed.

Choosing the Right Model

When selecting a crisis intervention model, several critical factors should be considered to ensure the chosen approach aligns with both the practitioner’s capabilities and the specific needs of the client.

Factors to Consider

1. Philosophical and Professional Alignment:  Professionals should choose a crisis intervention model that resonates with their personal philosophy and professional style. It’s also vital to consider the requirements and protocols of the organizations they are affiliated with, as these often dictate the specific models and approaches to be employed.
2. Model Suitability and Goals: Each crisis intervention model, from the ABCD Model to Psychological First Aid, aims to stabilize, reduce symptoms, and restore adaptive functioning. Selecting the right model involves understanding the specific goals of each and matching these with the crisis at hand.
3. Client’s Needs and Crisis Type: The nature of the crisis—  whether it is acute, chronic, developmental, or situational—significantly influences the choice of an intervention model. A model that provides immediate problem-solving may be suitable for acute crises, whereas others that offer more emotional support may be better for chronic conditions.
4. Cultural and Contextual Sensitivity: The chosen model must be adaptable to the cultural context and sensitive to the unique circumstances of the client. This includes considering the client’s background, existing support systems, and risk factors.

Tailoring to Individual Needs

The effectiveness of a crisis intervention greatly depends on how well the model is tailored to meet the individual needs of the client. This includes:

1. Assessment of Immediate Needs:  Identifying the immediate needs of the client is crucial. This involves a rapid assessment of their physical and emotional safety and determining the most pressing concerns to address.
2. Building Rapport: Establishing a strong rapport is foundational in crisis intervention. The chosen model should facilitate a connection that makes the client feel understood and supported, enhancing the effectiveness of the intervention.
3. Empowerment and Participation: Engaging clients in the intervention process empowers them and can lead to more effective outcomes. The model should encourage clients to participate actively in developing coping strategies and making decisions about their care.
4. Adaptability and Flexibility: The model must be flexible enough to adapt to the changing dynamics of the crisis. This includes being able to shift strategies as the client’s needs evolve during the intervention process.

By carefully considering these factors and tailoring the intervention to the individual needs of the client, crisis intervention professionals can enhance their effectiveness, leading to better outcomes for those they serve.

Best Practices in Crisis Response

Strategic Crisis Response planning is necessary for developing a comprehensive crisis intervention plan before deployment and providing services. Knowing what sequence of crisis intervention processes to use for which individuals or groups, at what times, and under what circumstances is crucial to all effective early intervention programs. An effective strategic plan identifies and assesses target populations and determines the types of interventions, when to apply the interventions, and the resources required.

Ethical Considerations

Numerous crisis response programs, services, approaches, and methods have been developed to prevent, mitigate, and recover from the natural human stress reactions in the aftermath of tragic events. All crisis intervention modalities have the same goals: to stabilize, reduce symptoms, and return to adaptive functioning or to facilitate access to continued care. Ethical considerations are paramount in ensuring that interventions are both effective and respectful of the individuals’ rights and needs.

Case Management Strategies

Observe the signs and symptoms of distress and use appropriate crisis intervention tactics in response to those symptoms. Differentiate which signs and symptoms of acute stress have the potential for long-term effects and address those. Consider the needs of the individual and tailor crisis intervention to those needs. Time the crisis intervention based on the readiness of the individual rather than the actual passage of time.

Psychological First Aid (PFA)

Basic Elements

Psychological First Aid (PFA) is a supportive intervention designed to help individuals in the immediate aftermath of a disaster or traumatic event. It focuses on providing practical care and support, assessing needs and concerns, and helping people address basic needs. PFA is not about diagnosing or treating mental health conditions but about promoting a sense of safety, calm, and hope.

Use in Disaster Response

PFA is widely used in disaster response scenarios to provide immediate emotional and psychological support to affected individuals. It is designed to be simple and pragmatic, ensuring that responders can offer effective assistance without needing extensive mental health training. The approach is flexible and can be adapted to various cultural contexts and specific disaster situations.

Training and Certification

Training in PFA equips responders with the skills to offer immediate support and identify those who may need more intensive mental health care. Certification programs are available to ensure that individuals are adequately prepared to deliver PFA in crisis situations. These programs often include modules on active listening, empathy, and practical problem-solving skills.

Theories Underpinning Crisis Intervention Models

Crisis intervention is a relatively new field compared to other forms of therapy, and as such, crisis theory is still being developed. Most forms of therapies have an underlying theory based on research that provides a framework for treatment. The crisis intervention models were developed by experts in the field who provide crisis intervention and are based on both their experiences and research. Foundational theories by Caplan, Golan, and Lindemann have significantly influenced modern crisis intervention models. Intervention specialists have begun to make connections between the underlying emotions and circumstances common in crisis intervention, regardless of the type of trauma causing the crisis.

Conclusion

A cartoon character walking a tight rope as the hand of a crisis Intervention Counselor leads them across.
Throughout this discourse on crisis intervention models, we’ve traversed a panoramic landscape of methodologies, from the ABC Model’s structured simplicity to the depth of Roberts’ Seven-Stage Crisis Intervention Model and the biopsychosocial groundedness of the SAFER-R Model, signaling the cornerstones of crisis response. The essence captured within each model illuminates the imperative of tailored interventions, underscoring the diversity and complexity inherent in crisis situations. By distilling these models to their core principles, we’ve aimed to furnish professionals with the insights necessary to navigate the multifaceted realms of crisis intervention, highlighting the quintessential goal: stabilizing, supporting, and steering individuals through their most tumultuous times toward a semblance of their pre-crisis equilibrium.

Significantly, our journey through the various models reiterates the broader implications these methodologies bear on the fields of mental health and emergency response—emphasizing the need for an adept, compassionate, and informed approach to crisis intervention. As we culminate our exploration, the call to action extends beyond the confines of theory into the practical realms where these models find their application. It enjoins professionals to continuously refine their skills, advance their understanding, and remain agile in their methodologies, thus ensuring that individuals in crisis receive not just immediate relief but a pathway to recovery rooted in understanding, empathy, and effective intervention strategies. The commitment to adopting and adapting these models according to individual needs and crisis contexts consequently positions professionals to make a substantive difference in the lives of those they aim to serve.

If you’re a mental health counselor or in the healthcare, Mental healthcare, or emergency service industries and would like to learn more about crisis intervention counseling please consider reviewing the rest of our website. We offer an online Crisis Intervention Counseling program as well as Crisis Intervention Counseling courses for professional CE credits. For more information about our Certification in Crisis Intervention Counseling please visit our program’s webpage here. 

FAQs

What are crisis intervention models?

Crisis intervention models are structured approaches used by counselors to help individuals in crisis. They represent the clinical processes that can be used individually or in combination to meet the needs of a person in crisis.

Why is it important to choose the right crisis intervention model?

Choosing the right crisis intervention model is crucial because it should align with the counselor’s philosophy, personality, and professional style. Additionally, organizations may require specific protocols to ensure that volunteers are properly trained and can work well with other team responders.

What are some examples of crisis intervention models?

Some examples of crisis intervention models include the ABC Model, Roberts’ Seven-Stage Crisis Intervention Model, Lerner and Shelton’s 10-Step Acute Stress & Trauma Management Protocol, the SAFER-R Model, and the ACT Model.

What are the six steps involved in crisis intervention? Crisis intervention consists of six key steps:

• Step One: Define the Problem. This step involves identifying the specific problem that needs to be addressed.
• Step Two: Ensure Safety. The priority in this step is to secure the safety of all individuals involved.
• Step Three: Provide Support. Offering emotional and practical support is crucial at this stage.
• Step Four: Examine Alternatives. This involves exploring different solutions to the problem.
• Step Five: Make a Plan. Develop a clear plan of action to tackle the crisis.
• Step Six: Obtain Commitment. Secure a commitment to the plan from all parties involved.

What are the five phases of the crisis management model? The crisis management model includes five distinct phases:

• Phase 1: Early Warning and Signal Detection. Recognizing the signs that a crisis may be imminent.
• Phase 2: Preparation and Prevention. Taking steps to prepare and prevent the crisis.
• Phase 3: Damage Containment. Efforts to limit the impact and spread of the crisis.
• Phase 4: Recovery. Working towards normalcy and repairing damage.
• Phase 5: Learning and Reflection. Analyzing the crisis to improve future responses.

What are the four stages of crisis response? The response to a crisis can be broken down into four stages:

• Pre-crisis: The phase before the crisis occurs.
• Crisis: The actual occurrence of the crisis.
• Response: Actions taken to deal with the crisis.
• Recovery: Efforts to return to normalcy and learn from the crisis.

What are the three steps of the ABC model of crisis intervention? The ABC model of crisis intervention includes three primary steps:

• A: Developing and maintaining rapport. Establish a connection with the individual in crisis.
• B: Helping the individual identify and process their feelings and perceptions related to the crisis.
• C: Encouraging focus on coping and adaptation strategies. Assist the individual in finding ways to manage and adapt to their situation.

What is Psychological First Aid (PFA)?

Psychological First Aid (PFA) is a crisis intervention model used in disaster response. It aims to reduce initial distress and foster short- and long-term adaptive functioning and coping.

Why is ongoing training important in crisis intervention?

Ongoing training is essential in crisis intervention to ensure that counselors are up-to-date with the latest techniques and best practices. Proper training also ensures that they can effectively implement the chosen crisis intervention models and work well within their organizations.

What is Critical Incident Stress Management (CISM)?

Critical Incident Stress Management (CISM) is a crisis intervention model that focuses on providing support to individuals who have experienced traumatic events. It is often used in organizational settings and has a significant impact on first responders.

Additional Resources:

The Impact of Organizational Culture on Leadership Strategies in Crisis Management. Niña A. Martinez, Et Al. Excellencia: International Multi-Disciplinary Journal of Education (2994-9521), Vol. 1 No. 5 (2023). ARTICLES Published 2023-11-29

Access link here 

Review: Crisis responses for children and young people – a systematic review of effectiveness, experiences and service organisation (CAMH-Crisis). Deborah Edwards, Judith Carrier, Et Al. The Association for Child and Adolescent Mental Health. First published: 14 February 2023

Access link here

Solution Focused Brief Therapy Telemental Health Suicide Intervention. Finlayson, B.T., Jones, E. & Pickens, J.C. Contemp Fam Ther 45, 49–60 (2023).
Access link here

The spatial (in)stability of mental health calls for police service. Jacek Koziarski. (2022). Criminology & Public Policy 22:2, pages 293-322.

Access link here 

 

Finding the Real and Right Story in Counseling

Posted on by Dominick Flarey

Counseling is about the person and the person’s story.   Like so many things in life, everything is not usually black and white.  There are a variety of shades of color from multiple perspectives in life that can make the story of the client incomplete.  For starters, the client has  his/her own subjective experience with the events within the story.  The unique experience of the client may very well be true from the client’s point of view due to the subjective factors and information available.  In addition, the client may possess a variety of blinders to certain truths that may be painful to accept or realize.  In other cases, the client may have various personality disorders that completely distort the reality of the events.  Whether purposeful or not, these distortions can cause larger issues in the healing, changing and transformational process.

Counselor help clients tell their story but also help them see the real story and how to find the right story

Throughout the blogs on counseling techniques, we have discussed numerous skills a counselor must utilize to help a client find change.  This blog will bring many of these skills together in helping forge the client’s initial story into the real and right story (Egan, 2019, p. 270).  Egan guides the counselor in addressing the story told, but also how to help push the client forward into telling the real and right story.  This helps the client enter into a state of self discovery so that as the story progresses, the client not only heals but also changes and transforms with the reality of the story.

Of course, as a counselor, one cannot make a client change, nor can a counselor sometimes ruthlessly correct or tell a client he/she is wrong.  The skills of counseling help the counselor with empathy and patience, gently nudge and guide the client to truth and help the client choose to pursue that truth.  This stems first by forming a strong relationship of trust with the client. It involves basic attending skills of empathetic listening, observing and responding to help understand the client and better address the issues.  Through empathetic listening and excellent observations, one can begin to see if any discrepancies exist within the story and how to better empathetically confront the client to recognizing the real story and then challenging the client to the right story and course of action, all the while, supplying the client with resources and encouragement to move forward.

 

The Story

Egan emphasizes that when helping the client tell the story that the counselor needs to make the client feel safe in the encounter.  Egan also encourages counselors to understand the styles between different cultures and how different cultures may express stories.  Some clients divulge and talk, others are more quiet, while others supply numerous details and others are vague.  Some clients may tell the core of the story and leave out secondary issues, while others may approach the story the opposite direction.  Some clients may go off topic, while others may stay on topic (Egan, 2019, p. 274-275). This is why it is important to identify what is going on or what the client is feeling at the moment, identify what the client wants and how to get what the client needs.  In this regard, counselors can help clients identify key issues and help them discuss the past but in a productive way that helps the past not define them but help them learn (Egan, 2019, p. 181).  Egan also points out it is imperative to identify the severity of the initial story.  Will this client need basic counseling or require crisis counseling?  Clinical counselors may be able to better handle the issue presented or see the need for a specialist.  Pastoral counselors dealing with issues beyond basic loss and grief, may identify something more severe and need to refer the client to a clinical counselor.

Sometimes when helping a client tell their story, it can also be useful to utilize Narrative Therapy which helps differentiate the person from the issues.  At the end of the blog, there are links to better understand Narrative Therapy and its role in telling the story.

The Real Story

After identifying the key elements of the story, counselors can help clients start to see the real story by exposing with empathy any discrepancies or any blinders a client may possess.  Through empathetic confrontation, a counselor can help a client see both sides or different angles to the story that the client may not had seen initially.  In this way, the counselor challenges the client in the quality of their perception and participation in the story (Egan, 2019, p. 289).  In dealing with the real story, Egan also points out that counselors can help clients understand their own problems and be better equipped to own their own problems and unused opportunities.  When a client is gently nudged to the realities of the real story, a counselor can help the client see that the real issue is not impossible to rectify and begin to present problem maintenance structures which help clients identify, explore and act properly with their real issues (Egan, 2019,p. 292).  Challenging and encouraging like a coach, can help clients move forward to begin to make the right story in their life.

The Right Story

In telling the right story, the client is pushed to new directions.  The client no longer denies the need to change, but has to some extent acknowledged it.  In previous blogs, we discuss issues that correlate with change in a client.  When the client is ready to change, the client still requires guidance and help.  The counselor helps the client choose various issues that will make a true difference in his/her life.   When looking at these issues, the counselor helps the client set goals.  The goals should be manageable at first and lead to bigger things but only after smaller steps to avoid let down.  The counselor can help the client choose from various options and cost benefits, as well as helping the client make proper choices (Egan, 2019, p. 299-301).   The counselor, like a coach, helps the client push forward and improve in life.  Within the phase of telling the right story, the counselor helps the client with goals but also helps the client see the impact new goals can give to life as well as the needed commitment to those goals to ensure a continued transformation.  In previous blogs, we discuss the importance of helping clients face change and develop goals. In essence, goals are developed and strategies are conceived to meet those goals

Stages of Change 

Throughout the process, Egan points out that the process involves three stages.  First, telling the story so that it transforms into the real and right one.  Second, helping the client design and set forth problem managing goals and third and finally, setting into motion those plans with strategies (Egan, 2019).  These phases involve various skillsets that the counselor must employ at different phases and stages. It involves the counselor being a listener, advisor, encourager and coach.  The counselor applies basic attending skills, in previous blogs, and utilize those attending skills in productive responses and when necessary confrontations.  Everything is accomplished with empathy and patience but the skills, built upon trust, allow the counselor to awaken the client to new realities.  Following these earlier discussions, the counselor becomes and advisor and coach in helping the client find ways to change and implement new goals and strategies.  The counselor uses encouragement skills, coaching skills, and directive skills to help the client discover the power to choose wisely and act in a more healthy fashion.  Ultimately it is about the client discovering his/her own inner abilities to not only change but to sustain change.

Conclusion

No client is the same and many will have different innate virtues or vices, talents or deficiencies, strengths or weaknesses.  It is up to the counselor to help cultivate what is best in the client and help the client become his/her very best.  Through individual skills, the counselor can help within each session, but the counselor must try and fail with multiple different theories and therapies that work best for his/her client.  This involves realizing that each case is unique and different people will respond differently to different practices or approaches.  A counselor must forever remain creative and flexible in approaches and adhere to the standards of empathy which helps establish trust with clients.

Counselors play the role of listener, advisor and coach. Please also review AIHCP’s numerous mental healthcare certifications for Human Service and Healthcare professionals

A counselor can utilize a basic structure of identifying the problem, helping the client see where he/she wishes to be and help the client find ways to do it.  This involves working the client through the story and helping them see the real and right story moving forward.  It involves then goal setting and moving forward with action.  It makes the counselor more than a listener and advisor but also a coach.

Please also review AIHCP’s numerous counseling programs for those in the Human Service and Healthcare fields.  While clinical counselors have more ability to help clients deeper with issues, pastoral counselors in Human Service can also help.  This is why AIHCP offers these certifications to both clinical and non clinical Human Service professionals.  The programs in mental health include a Grief Counseling Certification, as well as a Christian Counseling Certification, Crisis Counseling Certification, Stress Management Consulting Certification and Anger Management Specialist Certification. The programs themselves are online and independent study and open to qualified professionals seeking a four year certification.  Please review AIHCP’s numerous certification programs.

 

 

Reference

Egan, G. and Reese, R. (2019). “The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed.) Cengage.

Additional Resources

Ackerman, C. (2017). “19 Best Narrative Therapy Techniques & Worksheets”. Positive Psychology. Access here

Bates, D. (2022). “Storytelling in Counseling Is Often the Key to Successful Outcomes”. Psychotherapy.net.  Access here

Guy Evans, O. (2023). “Narrative Therapy: Definition, Techniques & Interventions”. Simply Psychology.  Access here

“Narrative Therapy”. Psychology Today.  Access here

 

Signs of Mental Illness Video

Posted on by Dominick Flarey
Mental Health should receive the same care as physical health. Please also review AIHCP’s numerous healthcare based certifications

Mental health is health.  Too many stigmas exist that prevent individuals from seeking help when signs of mental illness occur. Unlike physical symptoms of sickness that are addressed immediately, mental illness falls to the side due to stigmas and embarrassment.  It is important to notice changes in emotional and mental health that persists longer than 2 weeks.  Many minor things as OCD, ADHD, or minor stress and depression issues can be resolved through professional care.

Please also review AIHCP’s numerous mental health certifications within Grief Counseling, Crisis Counseling Spiritual/Christian Counseling, Anger Management and Stress Management Programs.  The programs are online and independent study and open to qualified professionals.  Remember only those within the clinical side of Human Services can treat mental illness.  Pastoral counselors can refer or help others in non pathological issues.

 

 

 

 

Please review the video below

Counseling Techniques in Understanding Meaning and Cultivating Change

Posted on by Dominick Flarey

When clients experience stress, grief or loss, sometimes meaning is critical to understand.  The emotions and feelings need to find meaning in relation to the issue.  Counselors need to have the helping skills to aid the client in finding meaning again.  This is essential especially in Grief Counseling.  In grief and loss, the individual needs to find meaning in the loss and be able to connect the past with the present to move forward to the future.  New meanings in relationship to the loss help the person connect the dots and knit together the chapters of life into a logical story.  When meaning is not found and emotions rage without direction, then the stressor or loss can lead to grief pathologies of depression or prolonged grief.  Hence it is important for the counselor to be able to navigate the person through the emotion and find meaning.  This is more than understanding the process of grief and loss, or dealing with stress, but also being able to help the client find meaning through good counseling techniques that help the client find meaning.

In previous blogs, we discussed the importance of meaning re-construction, as well as Cognitive Behavioral Therapy or CBT, as key ways to help clients tie together pass loss or trauma to the present to move forward.  In this blog we will focus more on the micro skills and probing that is necessary to help clients find meaning via interaction, reframing and interpretation skills, and how to relate to the client.  Obviously, many of the other micro skills of attending the client, observation, focusing, responding, challenging and confronting are all implied within this blog and found in other previous blogs.

Please also review AIHCP’s multiple counseling blogs as well as certification programs in Grief Counseling, Stress Management, Crisis Intervention or Christian and Spiritual Counseling.

The Importance of Meaning

Finding meaning is critical to life. When bad things happen, counselors can help clients discover meaning

Meaning is essential to human existence.  This is why it is so important for individuals suffering from trauma, or abuse, or loss, or any situation to find meaning in their situation.  Sometimes it involves regaining it because it has been taken away, other times, it is discovering it for the first time.

Logotherapy is a type psychotherapy that helps individuals find meaning. It is based off Victor Frankl, the famous Holocaust survivor, who utilized meaning in life, even in its darkest hours, as a prisoner in a Nazi camp, to find hope.  Frankly administered to many of his fellow prisoners and helped them find also meaning despite the evil and trauma and abuse that surrounded them under Nazi rule.

Frankly believed everyone had a will to meaning.  This meaning is what pushes all in will and action and even helps one endure suffering and pain. These beliefs persist in the value and uniqueness of each human person.  It also is a platform for a person to move forward in life.  This has numerous applications in counseling and helping others. It involves understanding purpose in life despite pain, but the importance to define and push forward.  It involves understanding that life is far from fair but one can still find meaning through it.  Purpose is beyond bad things (Waters, E., 2019).

Frankly summarized his philosophy in six basic tenets.  Humanity is comprised of mind, body and soul but it is through the soul that we experience and find meaning.   He continued that life has meaning in all circumstances, good or bad.  He stated as well that humans have a will to meaning that pushes them.  He also listed humans also have freedom to access this meaning no matter the situation.  He stated in addition that true meaning is not merely an statement but something concrete that correlates with life and one’s values and beliefs.  Finally, he emphasized that all human beings are unique (Waters, E., 2019).

From Frankl and his classic work, “Man’s Search for Meaning”, counselors, but especially grief counselors have an excellent way to help reconstruct meaning to clients and cultivate true change in a client’s life.

Obviously, much of the work associated with David Neimeyer and meaning reconstruction are found from the ideas of Frankl.. Meaning helps tie together past, present and future into something that matters to the individual.  It helps make sense of the loss and allows the chapters of one’s life, even the bad ones, to have meaning to the overall story and book.  Obviously, counselors play a key role in helping clients evolve the story told initially into telling the right story that correlates with reality.  This involves intense counseling and sorting out feelings, but eventually these feelings can lead to a true meaning.  Reflecting and reframing are keys in achieving this for a client.

Reflection 

When individuals are discussing feelings and emotions, it is essential eventually, not initially, to guide them to meaning.  In the very beginning, it is important to allow raw emotion to be expressed, felt and processed, but it needs to eventually find meaning within the grieving process.  Counselors can help clients reflect on the emotion.  Ivey refers to the term “reflection on meaning” as a way to help clients find deeper understanding regarding issues, purpose, feelings and behaviors (2018, p. 258).  Ivey also points to the importance of interpreting and reframing these feelings.  Interpretation helps the clients understand their feelings and add meaning to them through a variety of perspectives or multicultural or psychodynamic ways.  The client is able to find new meaning, while the counselor provides the necessary reframing to explore new interpretations (2018, p. 258).

The counselor through reframing, can with empathy begin to offer different interpretations of the event itself,  One skill a counselor can utilize is linking.  Linking helps the client tie together two or more things that enables them to find new insight (Ivey, 2018, P. 265).  A counselor can tie family history, values and talents to the client in relationship to the issue, or tie the event to psychodynamic issues that exist within the client.  The linking helps the client find new perspectives on the issue at hand.

Counselors can help clients link and find self discovery through a variety of approaches.  Some counselors may utilize decisional theory that presents outcomes and alternatives for action.  Decisions need to be understood and made with the client understanding outcomes (Ivey, 2018, p. 268).  Another approach is person centered.  Linking is utilized to tie the problem together with the person’s strengths.  CBT is another way to help individuals review old ways of thinking, acting and behaviors and re-interpret them.   Reframing and linking can also be utilized with psycho-dynamic theories that help the person understand the person’s deeper subconscious past.  Finally, multicultural therapy can help a person link to and also reframe an issue with ones’ own ethnic and cultural backgrounds

 

 Reframing

A counselor’s response is key in helping one reframe and interpret meaning. In previous blogs, we discussed first attending the client, with basic responses, such as paraphrasing or summaries.  How one reflects how one feels helps open new dialogue and understanding.  Other ways to help discuss emotions and help build meaning and cultivation to change involves disclosures, feedback and consequences.

Counselors can help clients reframe and reinterpret events and emotions and help them find new meanings moving forward

Disclosures are excellent ways to involve oneself by sharing an appropriate story of one’s own life, but usually it involves oneself utilizing the phrase ” I think or I feel” in relationship to one’s issue or feeling or intended action.  Feedback is also critical in cultivating change.  It can be confirmatory or corrective. When corrective, it looks to help align a person back on track.  It involves empathy and nonjudgment when being applied but helps the client again find the proper perspective and route.  Remember, the client remains in charge and review how the client responds.  Empathetic confrontational approaches should be utilized.  Finally, logical consequences can be employed to help a client.  It summarizes the possible positive and negative consequences of a particular action.  The common phase includes “If you do…then…will possible result” (Ivey, 2018. p. 302).

Employing psychoeducation and instruction is also a key way to help push individuals to change and reframing.  By making the client understand the science and philosophy of their feelings, one can better take ownership to change.

Whatever link the counselor can utilize through whichever therapy, or phrasing is good.  Each individual is different.  The key is to help the person find a new perspective on the emotion, situation, stressor or loss.  This enables the person to form a new meaning which can help them tie the past with the present and into the future.

Fostering Resiliency

Through any change and new discovery,  counselors need to foster resiliency.  This helps the person emotionally and physically push forward into the new change and maintain the new meaning he/she has found.  This can be accomplished through a multitude of stress management techniques that involves multicultural approaches, psychoeducation, social skill training, assertiveness training, conflict resolution, bio or neurofeedback, positive reframing, CBT, time management, relaxation management and active planning techniques (Ivey, 2018, p. 288).  Ivey also lists the importance of Seven Therapeutic Lifestyle Changes.  He includes exercise, nutrition, sleep, social relations, cognitive challenges, meditation and cultural health.  Within these, he also lists the importance of prayer, hobbies, positive thinking, social outreach and avoidance of negative substances (2019, p. 288).

Egan, emphasizes that in cultivating change, counselors need to help client discover their own resilience.  Egan points out the difference between process resilience and outcome resilience.  In counseling, the counselor should be able to encourage clients to change in face of challenges, but also note outcomes.  With outcome resilience, the counselor comments on the change and how one has returned to one’s own self (Egan, 2019, p. 263).  Like a coach, the counselor hence cheers the person’s progress and ability to overcome.  Counselors need to also help clients identify resources for resiliency, within family, friends or other social support systems.  A counselor should help a client find ways to make better connections with families and friends as well.  In pushing forward, a counselor can help a person reframe issues, such as challenges or crisis as ways to grow and to understand that change is part of life (Egan, 2019, p. 265).  A client must continue, especially after loss, or trauma, to continue to keep things in perspective, maintain a healthy outlook,  find new ways for self discovery and maintain care of oneself (Egan, 2019, p.265).  A counselor can help a person maintain this progress.

Recall also, the previous blog which discusses the change scale in clients and how it is essential that the counselor discovers the level of acknowledgement and commitment to change a client may possess, as well as helping the client implement first order or second order changes depending on their situation.  The counselor can help the client with goals to implement the change and also be aware of possible setbacks and pitfalls.

Conclusion

Please also review AIHCP’s multiple mental health certifications, including AIHCP’s Grief Counseling Certification

In helping clients change, reflection and reframing are key in helping the client link and find meaning in the trauma or loss.  As time progresses, the client will be able to find meaning and connect the incident into one’s life narrative.  Counselors can help this transition through a variety of skills mentioned in this blog and throughout other blogs written for AIHCP.  These skills help the client understand the emotion and find linking to it.  This helps them discover new meaning and ways to reinterpret the event.  Furthermore the counselor helps the client move forward by fostering resiliency and helping the client continue to move forward.

Please also review AIHCP’s various mental health certifications.  These certifications are granted to professionals in the health care field and human service field.  Some may be licensed professionals while others may be pastoral in nature.  Obviously such licensures or lack of, grant or prohibit the extent of certain counseling therapies and techniques.

AIHCP’s programs include Grief Counseling, Crisis Counseling, Stress Management Consulting, Anger Management Consulting and also Christian Counseling and Spiritual Counseling.  The programs are online and independent study.

References

Egan, G. & Reese. R. (2019).”The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed). Cengage

Ivey, A. et, al. “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society” (9th Ed( (2018). Cengage.

Additional Resources

Morin, A. (2023). “How Cognitive Reframing Works”. Very Well Mind. Access here

Caraballo, J. (2018). “Reframing is Therapy’s Most Effective Tool, Here’s Why”. TalkSpace.  Access here

Ackerman, C. (2018). “Cognitive Restructuring Techniques for Reframing Thoughts”. Positive Psychology.  Access here

Waters, E. (2019). “Logotherapy: How to Find More Meaning in Your Life”. PsychCentral.  Access here

Focusing and Empathetic Confrontation in Counseling

Posted on by Dominick Flarey

Like in previous blogs, attending to the client, empathetically listening and observing, properly responding and encouraging are key elements in basic counseling.  Like a coach training a player or athlete, challenging and encouraging a client to change is like coaching.  It involves the counselor helping the client push forward, and like in coaching, this sometimes involves more than just challenging, but to also focus on the issue that needs addressed and then properly fix it.  A good coach will focus and see a flaw in the mechanics of a player and then challenge and confront the player and help guide the player to fixing it.  Counselors focus on the client’s story and then discover the core issues.  After finding the core issues, they offer empathetic confrontations to help push forward.   These skills represent later measures after basic attending, listening, observing and responding and look in later sessions to help the client find real and true change.  In this blog, we will first look at focusing and then conclude with empathetic confrontation.

Focusing in Counseling

According to Ivey, the skill of focusing is a form of attending of the client that enables a counselor to discover multiple views of the client’s story (2018, p. 221).   It helps the client think of new possibilities during the restory and call to action (Ivey, 2019, p. 221).  A counselor goes well beyond merely the “I” in the story but looks to broaden the story beyond merely the client but into other aspects of the client’s life.  How the counselor responds to the client hence can play a key role in where the story proceeds in the counseling sessions.  Counselors who direct the conversation through selective attention skills can take the “I” conversation into other social and cultural spheres of the client.  These other spheres of influence can be key clues into the client’s mindset. Ultimately, focusing is about helping the client address emotional issues.  It is client based and humanistic in approach.

How a counselor focuses on the multiple aspects of a client’s story is key to understanding the whole story. Please also review AIHCP’s Grief Counseling Certification

Ivey lists seven focus dimensions that counselors can utilize in responding and discussing issues.  The first is to focus on the client him/herself.  This involves direct questions regarding the client’s feelings.  The second involves focusing on the theme .  It involves asking the client about the issue itself and discovering details regarding the theme of the issue and how the client feels in the immediate moment.   The third dimension shifts focus to others within the client’s life.  It delves into questions about significant others, family members, friends or others involved in the issue.  The fourth dimension of focusing looks at mutual aspects of how the client and counselor can work together. It emphasizes “we” and how the counselor and client can find ways to deal with the issue.  The fifth dimension focuses on the counselor.  It involves how the counselor can paraphrase and share appropriate and similar experiences with solutions.  The sixth focus puts into perspective the issue in regards to the client’s cultural or environmental background and how they may play into the current issue.  Finally, focusing on the here and now delves into identifying how the client feels at the moment itself (Ivey, 2018, p. 221).

Focusing on a client’s cultural/religious/ethnic background can play a key in discovering issues that exist in the person.  It can help explain why a particular client responds and reacts a certain way.  It can also be used to find strengths for the person.  Ivey illustrates the importance of Community and Family Genograms that help map out the client’s background (2018, p.212).   A good family genogram will help clients identify issues from a cultural standpoint and understand better their relationship to their surrounding environment and its stressors.  In addition, it can also help clients discover new hidden strengths that exist within their family and culture.   Helping the diverse client take pride in their past and heritage can help build resiliency.  When stressors or issues occur, a client can utilize a term referred to as “body anchoring” where the client reflects upon a voice of a relative, famous individual, or cultural icon to help him/herself find confidence and strength to face the issue (Ivey, 2018, p. 220).  This also helps multicultural clients have the power to name issues that are effecting them.  Using focus on culture can be a very helpful tool when utilized correctly during a counsel session.  This type of focusing helps many diverse populations deal more effectively against microaggressions (Ivey, 2018, p. 248).

Ways to help find a client’s particular cultural awareness during focusing is through the Cross five stage model, named after William Cross (Ivey, 2018, p. 244).  Also referred to as the five stages of cultural identity, Cross identified how diverse populations recognize themselves and respond to confrontation.  Focusing on the stage of a particular client hence can be very beneficial.  The first stage involves the conformity stage.  The individual may be unaware of racial identity and merely conforms to societal expectations.  The second stage involves dissonance where the individual realizes that something does not match or fit.  This can lead to self-appreciation or self doubt.  The third stage results in resistance or emersion.  An individual may become more angry at the injustice or immerse oneself more in one’s own culture.  The fourth phase involves introspection where the individual sees oneself as an individual and part of the cultural group.  The final phase of integrative awareness is the full sense of caring for oneself and one’s cultural heritage.  This leads to appreciation and action but more so due to pride and awareness (Ivey, 2018, p. 245).   Through identification of these phases or stages, counselors can help clients better utilize the client’s heritage and culture to empower the client in various interventions.

Empathetic Confrontation

Empathetic Confrontation looks to help someone understand negative behaviors in a nonjudgmental and empathetic way

A counselor, like a coach, uses a variety of encouragement and challenging strategies to help a client find change.  Within the Problem Management Model, a client is shown the present, perceived view and ways to find the new view.  This involves identifying internal as well as external conflicts.  Sometimes, clients may become stuck in a way of thinking. They lack intentionality to change or lack creativity (Ivey, 2018, p. 229).  Within this state, the client becomes immobile, experiences blocks, cannot achieve goals, lacks motivation and has reached an impasse (Ivey, 2018, p. 229).   In these, cases, like a coach, the counselor needs to help the client face these issues and move forward.   This involves a type of confrontation but this confrontation is not meant to imply aggression or hostile or argumentative behavior but is an engagement for change. According to Ivey, Carl Rogers pushed for the ideal of Empathetic Confrontation, which espouses a gentle listening to the client and then encouraging the client to examine oneself more fully (2018, p. 2029).   Summaries are an excellent way to help confront a client with empathy.  In this way, the counselor can present a two-part summary which states both positions with the connecting phrase “but on the other hand” (Ivey, 2018, p. 229-230).  This presents both views of feelings and allows the client to digest the statement and see any discrepancies or issues of conflict within his/her logic.

 

Carl Rogers points out that even when presented in these terms, sometimes, the client may feel attacked or confronted. In these cases, he suggests to also hold tight to nonjudgmental attitudes, keeping one’s own beliefs to the side.  Rogers emphasized that individuals with issues who come to counseling do not need judged or evaluated but guided (Ivey, 2018, p. 230).   Within any issue, the counselor confronts but also supports.  This involves first a relationship that must exist.  Without a relationship of trust, the client will not accept any advice from a sterile stranger who he/she may merely see as a paid listener.  When confronting, it is essential when summarizing to state the client’s point of view first, before comparing the opposing view.  In addition, the client must remain in charge of outcomes.  The counselor when confronting is not telling the client what to do but offering suggestions (Ivey, 2018, p. 232).  In conclusion, the counselor must listen and observe for mixed messages and then respond with empathy in a summary that clarifies any internal or external issues.  This should resolve with actions towards resolution of the issue (Ivey, 2018, p. 235).

Egan points out that are multiple ways to challenge and confront clients to life enhancing actions.  Egan differentiates between goals but also strong intention and commitments to a course of action.  The importance of understanding the value of action intentions is key in helping a client carry out a particular again (2019, p, 234-235).    Implementing these instructions, with strong phrases such as “I strongly intend to do x when y occurs” can help clients find tools necessary to incorporate the necessary change (Egan, 2019, p. 235).  Sometimes, a self contract to do a certain thing can be a powerful tool in helping clients galvanize towards change (Egan, 2019, p. 239).

Egan also points out that counselors need to help their clients overcome procrastination.   Egan lists numerous excuses that can include competing daily agendas or short term pains (2019, p. 236).  It is important to guide one’s client between conscious deliberation and procrastination that prevents true change.

Egan reminds counselors to also help clients identify unused resources that can help facilitate change.  Replace “I can’t” with “I can” phrases by helping the client discover unused talents and resources to help one overcome negative thoughts of failure. (Egan, 2019, p.237).

When aiding clients with life enhancing actions, it is important to provide sometimes confirmatory feedback as well as corrective feedback.  Obviously, confirmatory feedback acknowledges progress, but corrective feedback looks to help clients who wandered off from the course of action (Egan, 2019, p. 244).   The spirit of empathy and nonjudgment are again essential in how this is accomplished.  In many ways, it is confronting but in a non hostile way.  Counselors can help clients stay on track through multiple ways via checklists, identification of possible obstacles and helping them identify damaging attitudes.  Such attitudes can be due to a passivity not to take responsibility, a learned helplessness, disabling self talk, or disorganization (Egan, 2019, p. 245-248).  Egan also warns that while helping clients, be aware of entropy and how initial change can gradually break down.  Egan lists false hopes and the natural decay curve as two things that can occur in clients (2019, p.249-250).  Within each, clients may have too high of expectations, or consider mistakes to destroy the entire process.  Give clients the power to make mistakes throughout the process.

Sometimes, as noted, some clients are more resistant to confrontation and change.  Some may become visibly upset if confronted with a discrepancy in life.  Different clients respond to different challenges in different ways.  The Client Change Scale or CCS is a way to measure a client’s reaction to empathetic confrontation (Ivey, 2018, p. 237).  Level 1 involves denial of the issue. Within this level, the story is distorted and the client will look to blame others unfairly.  Level 2 consists of bargaining and partial acceptance of the story.  In this reality, the story is finally changing in a more true direction.  Level 3 involves acceptance of the reality.  The truth is recognized and the story is finally complete.  Level 4 incorporates new solutions to make the story better and finally Level 5 refers to transcendence and the incorporation of the new story into the client’s life (Ivey, 2018, p. 246).  The CCS helps the counselor track each session and see if progress or regression occurs from one session to the next in regards to change.

Egan points out that many individuals are reluctant to change due to variety of issues including fear of intensity of it, lack of trust in the process, extreme shame, loss of hope, or even the cost of the change itself (2019, p. 253-255).  In dealing with these things, counselors need to be realistic and flexible and look to push the client beyond resistance by examining incentives of change (Egan, 2019, 259).  In some cases, when change is identified and the need for it accepted, clients may need time in adjusting or implementing it.  Egan points out that change can exist on two levels.  He refers to these types of changes as first order changes and second order changes.  First order change is operational and a short term solution, while second order change is more strategic and long term.  Egan compares the two with first and second as being compared in these ways.  First order utilizes adjustments to the current situation, while second is systematic, first monitors, while second creates new, first creates temporary, while second creates to endure.  First changes look sometimes to deal with the symptoms while second attacks the causes (Egan, 2019, p. 308).

In some clients, the situation to change may not permit a new paradigm but may requires coping skills.  For instance, a stressed employee may be forced to keep a stressful job but may need to tinker with it due to the financial a loss of finding a new job would incur with a more lasting change, while a battered spouse would require a permanent change and would not be able to cope with the existing abuse.

An interesting model is the GROW model.  John Whitmore, creator of the model utilized the acronym to produce change and to assess one’s willingness to change.  G represents goal or what one wishes to accomplish. R stands for reality and where the client currently exists.  O stands for options and what one can possibly do.  Finally W stands for will, or what one is willing to do.

This model as well the Problem Management Model are ways to help move the sessions and help identify issues and assess how to empathetically confront and challenge individuals to productive change.

Conclusion

How a counselor attends to a client also involves sometimes more than listening but also focusing on particular aspects of the client’s life.  This involves the other aspects of the clients life and in many cases includes cultural and social issues that affect the client.  This can be merely family but also take upon the broader cultural aspect of a person.  Someone of European descent may react quite differently than someone of Asian descent to the same issue.  Hence focusing in on these issues is an essential attending skill.  It is also important to understand where one cultural exists within oneself.  The Cross model can help counselors better gauge one’s cultural awareness and how that plays in one’s particular situation.

Please also review AIHCP’s Grief Counseling Certification as well its Christian Counseling Program.

In addition, this blog discussed the importance of Empathetic Confrontation.  Carl Rogers understood the importance of helping individuals identify problems that were internal or external but he also understood that is was critical to approach confrontation with nonjudgment and empathy.  Employing a two part summary with “on the other hand” can help expose issues and offer good solutions but different individuals react to confrontation to change differently.  The Client Change Scale is an excellent way to gauge and monitor a client’s willingness to change.  Through Empathetic Confrontation, the counselor looks to challenge past themes or schemas of a client’s life and help them find new ways to correct negative behaviors.

Please also review AIHCP’s many mental health certification programs.  AIHCP offers a Grief Counseling Certification, as well as a Christian Counseling Certification. In addition, AIHCP offers programs in Crisis Intervention, Healthcare Life Coaching, Stress Management and Anger Management Consulting.  The programs are online and independent study and open to qualified professionals seeking a four year certification.

 

 

Reference

Ivey, A. et, al. “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society” (9th Ed( (2018). Cengage.

Additional Resources

Williams, M. (2018). “Ethnic and Racial Identity and the Therapeutic Alliance”.  Psychology Today.  Access here

Sutton, J. (2022). “How to Assess and Improve Readiness for Change”, PositivePsychology.com.  Access here

“Focusing” (2016). Good Therapy.  Access here

“The Technique of Confrontation in Counseling” (2022). Optimist Minds. Access here

 

 

Challenging and Encouraging Clients in Counseling

Posted on by Dominick Flarey

To help transform a person to change, attending, listening and responding are key, but the skilled counselor needs to be able to help instigate change or water the seeds of the healing process within a client.  Whether loss and grief, or merely more daily stressors or emotional issues that are holding the client back from living life productively, the counselor needs to know how to coach the client and help the client find that preferred outcome.  This involves not only identifying the goals and actively pushing towards them but also motivating and challenging them.  Like a coach who is able to abstract the best out of their players on the field, a counselor needs to be able to encourage and challenge his/her clients to produce meaningful change.  Some clients respond better, others may be still facing inner turmoil and self esteem issues.  Some clients may be more resilient naturally, while others may need more prodding and gentle and empathetic guidance.  Each client is unique and different but the general ideas within this short blog complement the previous blogs on attending the client and responding to the client.

Challenging and encouraging a client to change is much like a coach trying to get the best of a player on the field

 

Some clients may have zero motivation to be challenged.  They may possess some world view or bias that prevents this change.  Some may be forced to attend counseling and feel no need to change.  This can occur with state mandated counseling or clients forced to attend because of family or spouses.  Some clients may feel motivated simply because of guilt and look to foster a positive change.  Some may simply have an interest in the counseling process and wish to see what happens.  In the best case, one will find a client who understands the critical importance of counseling and the changes that need made.  Regardless of the clients motivation level, it is the purpose of the counselor to help bring the best out of the client. This can be easier said then done.

 

 

 

The Counselor as Coach?

Life coaching in itself is a newer field within the Human Service Field.  It is not clinical or requiring of various licensing but it does promote the idea of healthy change and life styles.  It involves a professional who is trained to motivate, direct and help clients meet end goals.  This involves both encouraging and challenging the client.  Whether it is a weight goal, training goal, dieting goal, or health and life style change, life coaches are inherently trained to help produce change through motivation, encouragement and challenging of their clients.  Counselors, whether pastoral or clinical, working in grief counseling or other mental counseling disciplines, through empathetic listening and responding, should have a vested interest in helping their clients meet change, but some may lack the skills to help motivate the client to change.  As counselors, the client is directed and given options, but is never commanded or forced to change, instead, the client is invited to change through an array of options.  Many times, clients need motivated and encouraged and even challenged to push forward through these options. Many times they may fall and need help getting up.  Again, like a coach in sports, it is the counselor’s profession to not only direct, but also to help the client emotionally and mentally push towards that direction.

Challenging for New Behaviors

According to Egan, it is important to challenge clients to change.  He states,

“Help clients, challenge themselves to change ways of thinking, expressing emotions, and acting them mired in problem situations and prevent them from identifying and developing opportunities…become partners with your clients in helping them challenge themselves to find opportunities in their problems, to discover unused strengths and resources, both internal and external, and to commit themselves to the actions needed to make opportunity development happen (2019, p. 190).

In challenging, Egan emphasizes the importance of the counselor and client relationship which is based on trust and partnership.  A counselor, in the eyes of the client, needs to earn the right to challenge.  Once this is established, the counselor needs to ensure that challenges are presented tentatively but not apologetically, with a balance between not being too harsh but not also too passive.  In addition, counselors need to ensure the challenges are clear and specific.  Challenges also should not make demands or be forceful in nature but provide a structural system of choices.  As the term challenge indicates, it is never easy, so help clients utilize unused strengths to help meet the challenges and the ability to build on successful challenges to meet new ones (2019, p. 220-225).  As Egan points out, the counselor should be a “catalyst for a better future (2019, p. 190)”.

Many times, a counselor has to identify what is preventing the person from being able to face a challenge in life

In challenging clients, many times, they have many inherent issues that are already hampering them with the problem and maybe life in general.  To help clients become more resilient and able to create new behaviors, counselors sometimes need to identify blocks and issues within the client.  Egan lists a variety of target areas that negatively affect a client’s ability to respond to challenges and delay productive and healthy change.  Through attending, listening and responding, a counselor is able to identify certain issues that may restrict the ability of a client to respond effectively to challenges.

The first issue Egan lists are what he refers to as self defeating mindsets that include “assumptions, attitudes, beliefs, values, bias, convictions, inclinations, norms, points of view, perceptions of self and the world, preconceptions and prejudices (2019, p. 190-191)”.   Albert Ellis looked at facing irrational beliefs head on with interventions that would challenge irrational mindsets.  According to Ellis, many individuals have flawed misconceptions on life.  Egan lists a few of these ideals.

  • I must only be liked and loved in life
  • I must always be in control in life
  • I must always have my things done my way or no way
  • I should never have any problems
  • I am a victim and not responsible for any of my issues
  • I will avoid things that are difficult
  • I believe my past dictates what I do in the future
  • I do not need happiness in anything or anyone else

(Egan, 2019, p.191)

Ellis considered these mindsets as impediments to change because when something did happen that was bad, the person would tend to “catastrophize” it and become unable to adjust to the problem or even be remotely open to challenges to face it.  In addition to these mindsets, Egan points out that some individuals embrace in four fallacies that hamper change, as according to Sternberg.  Among those listed by Sternberg were egocentrism and taking into account only one’s own interests, omniscience and thinking one knows everything about the issue, omnipotence and feeling one can do whatever one desires and invulnerability and one will never face true consequences (2019, p.192).  Obviously these four fallacies are undesirable characteristics and whether naive or part of a greater personality disorder, they are issues that can prevent true change in the client.

In addition to mindsets, some individuals may have self defeating emotions and feelings that prevent them from achieving goals.  They may possess low self esteem or poor self image.  They may have fears that prevent them doing greater things.  Others may possess various dysfunctional behaviors that are external in nature.  In essence, the person cannot get out of their own way in life.  Their behavior, unknown to them sometimes, continues to create the issues they are trying to escape. Others may possess discrepancies in what they feel and think in regards to what they say and do and how they view themselves versus how they are truly viewed by others. Other times, individuals can be hampered in making true change or answering challenges because of unused strengths or resources (Egan, 2019, p. 194-197).

Other “Blind Spots” within the client preventing and hampering change can include various levels of unawareness.  This can include being blind to one’s own talents and strengths seen by others but not perceived by the self.   Some individuals may be unaware due to self deception itself, or choosing ignorance.  Some individuals will avoid issues and problems because they simply would rather not know because the truth may be too terrifying.  In helping clients challenge themselves to new behaviors, counselors can open clients to new areas of awareness with simple self questions.

  • What problem am I avoiding?
  • What opportunities am I ignoring?
  • What am I overlooking?
  • What do I refuse to see?
  • How am I being dishonest with myself?

(Egan, 2019, p. 204)

As the counselor, but also a coach, it is important to help clients identify these issues and understand why they are unable to move forward.

Helping Clients Identify These Issues and Healthy Challenging

Carl Rogers promoted a empathetic approach. In helping others face hard realities, a fact based empathetic approach is key.  Showing patience and empathy and carefully presenting the issue with assertiveness but compassion is key in helping the client awaken to certain issues.  Of course, timing, tone, and words all play a key role in helping the client become acceptive.  The counselor cannot come across as afraid to address issues but not confrontational.  Sometimes, certain words, may offset a client or labels, and the counselor will need to navigate why and how to discuss the issue.  Also within this process, the counselor cannot simply give a set of directions but present options.  Finally, again, the counselor needs to present the new awareness and challenge to the client without judgment but in a way that creates self awareness and pushes forward change.

Counselors help motivate clients to change through empathy and supplying the client with appropriate level challenges and options to meet

When discovering hindering blind spots and issues, the counselor needs to become a detective in some respects before he/she can truly become a coach.  What is the client truly trying to say, or hinting at, or half saying (Egan, 2019, p.206)?  Counselors need to help clients understand their implicit thoughts and words and make them become more explicit.  In doing so, counselors can help clients understand themes in their stories, make connections with what may be missing and share educated hunches in feedback (Egan, 2019, p. 207-210).  Counselors can through their hunches, help clients see the bigger picture, dig deeper in the story, draw conclusions, open up more, see overlooked aspects, or even own their own story (Egan, 2019, p. 210-211).

 

 

Of course how these opinions and disclosures are presented to the client are critical.  They are part of the art of counseling and also the product of good coaching. A good coach is able to present a deficiency in a player’s form or approach and help turn into change and better performance.  This however involves not tearing down the player, but building the player up and giving the player the tools necessary to improve.  As an teacher and encourager, a coach is able to transform the problem and help the player have success on the field.  Likewise, an counselor needs to be able to coach his/her client through approaching a weakness and being able to challenge the person to overcome it and make it a strength in the field of life.  Strength Based Therapies as proposed by Pattoni, (2012) help clients label their strengths and identify them and utilize them in variety of goal setting environments. The process looks to expand hope but also create autonomy in facing issues.

When providing factful information and options to a client, a counselor needs to remain empathetic and tactful in delivering the news.  Some news can be shocking to a client and the client may need time or understanding in the process (Egan, 2019, p. 213).  Hence Egan recommends sometimes sharing one’s disclosures and challenges, but he recommends it to be used with caution.  He recommends being sure to use it sparingly, appropriately and culturally aware.  Timing can be key.  One does not wish to have one’s own disclosure to become a distraction (2019, p.215).

As a counselor and coach, how one gives suggestions and recommendations for better improvements are critical.  Inspired first with empathy and secondly aware of internal issues of the client, a counselor needs to approach and challenge the client without confronting but at the same time presenting clear and factual options to promote change.  These challenges are not easy, so like a good coach, a counselor needs to find ways to provide encouragement during the change process.  Counselors should invite clients to challenge themselves and help them identify specific challenges that will make the best changes.  Like a sports coach, while identifying any issue, the counselor needs to encourage and identify strengths to overcome a particular challenge.  Furthermore, the challenge needs to be evaluated as not to be too intense to be self-demeaning to the client.  Sometimes, success is built upon.  So when identifying challenges, the counselor needs to present them in a fashion that leads to success (Egan, 2019, p. 220).

As a counselor-coach, a counselor identifies changes that are essential and helps the client identify change.  Some clients are more resistant to change.  In another blog, we discuss the Client Change Scale which lists the levels of difficulty for a client to accept change or implement it based on their stage.  It is the counselor’s job to help the client see the necessity of change and help the client find it through encouragement and help.  Some changes will be first order, or deal with the current situation, or others may be second order and more long term or permanent.  This depends on the nature of the issue and the needs of the client.  The counselor like a coach, helps the client implement goals, strategies and plans to implement the change.   The counselor helps the client see his/her possible self, delve into creativity,  and think differently (Egan, 2019, p. 315-318).  In essence, the counselor helps the client see a better future, set goals to attain it and help them put it into action (Egan, 2019, p. 314).

 

Conclusion

Counselors are like coaches.  They need to challenge their clients by identifying weaknesses and help clients overcome them with appropriate challenges.  This involves active attending and responding to the client and understanding the inner challenges the client faces.  The counselor then is able to better become a catalyst of change in the clients life with setting appropriate challenges to make the client a better person in the field of life.

Please also review AIHCP’s multiple counseling certifications in Grief Counseling, Christian Counseling, Life Coaching, Anger Management, Stress Management and Crisis Intervention Counseling

Please also review AIHCP’s Grief Counseling Certification, as well as its Christian Counseling Certification.  Other mental health certifications for both pastoral and clinical counselors, or those engaged in the Human Service Fields, include Stress Management, Life Coaching, Anger Management, and Crisis Intervention. The programs are online and self study and open to qualified professionals seeking a four year certification in any of these fields.

 

 

 

 

 

 

 

Reference

Egan, G. & Reese. R. (2019).”The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed). Cengage

Additional Resources

Sutton, J. (2022). “Motivation in Counseling: 9 Steps to Engage Your Clients”. Positive Psychology.  Access here

Sutton, J. (2022). “How to Perform Strengths-Based Therapy and Counseling”. Positive Psychology. Access here

“The Skill of Challenge in Counselling”(2019). Counseling Tutor. Access here

Voitilainen, L. et, al. (2018). “Empathy, Challenge, and Psychophysiological Activation in Therapist–Client Interaction”. Front Psychol. 2018; 9: 530. National Library of Medicine. Access here

 

Responding Skills in Counseling

Posted on by Dominick Flarey

In the previous blog, we discussed listening skills and observing skills of the client.  Good listening and observation set the stage for proper responses.  In this blog, we will shortly review core concepts in turning listening into positive and productive  counselor responses that help the client through the counseling process.  Attending skills are essential in any type of counseling, especially grief counseling.  When these basic skills are absent, the client can feel neglected or misunderstood.  Good grief counselors, whether licensed clinical counselors or non-clinical counselors, are able to incorporate these skills to enhance the therapeutic nature of counseling and keep the client as an active and on going participant in his/her mental health.  Bear in mind, good responses are not necessarily saying the most profound or theory correct statement, but the particular response that is best for the particular stage of counseling and needed comment.  Sometimes the responses may be short or longer, statements or questions, informative or probing, but they all have a particular reason and are the tools of the trade in discovering issues and helping clients find better outcomes.

Identifying Emotions in Counseling

Grief Counselors need to identify emotions when preparing a response or prompt to help the client’s story proceed smoothly

In the last blog, we spoke about the vital importance of observation and how a grief counselor needs to identify verbal but as well as non-verbal cues in a client that can illustrate a particular issue or feeling.  In formulating therapeutic responses, grief counselors and other counselors need to identify the particular emotion of an attending client.  This involves identifying the words associated with the emotion, implicit and unspoken emotions, and any non-verbal cues of the emotion expressed (Ivey, 2018, p., 170).   Based from the core universal feelings across cultures, a counselor should watch for sad, mad, glad and scared (Ivey, 2018. p., 171).   These are root words for all emotions and a grief counselor can build from these words to more complex emotions.

It is crucial to employ empathetic responses.  Like the previous blog, which emphasized empathetic listening, again, the word empathy appears in counseling.  The grave importance of empathy allows the counselor to become involved in the client’s state of being in a true and understanding way that helps the counselor produce productive and positive change.  Empathetic responses help the client feel understood and not judged, or admonished.  Hence, responses to emotions need to be empathetic and caring in nature.   Egan reports three important types of empathy in responding from the work of Arthur Clark.  He first lists subjective empathy, which puts the counselor literally in the client’s life and helps the counselor understand the emotional state of the client.  Second, he lists the term objective empathy which ties to the studies of the counselor and the counselor’s own personal experience in counseling.  Tying these together is a third type of empathy referred to as interpersonal empathy, which ties together the client’s feelings and the way the counselor is able to communicate it as well as any needed information (Egan, 2019, p. 132-133).

Interpersonal empathy involves the ability to perceive the issues, the know how to state it and the assertiveness when to input it (Egan, 2019, p. 134-137).  Grief Counselors need to perceive the emotion on display, the ability to articulate it and the assertiveness to sometimes address it when uncomfortable.  It is important to report what is said back with empathetic accuracy (Egan, 2019., p. 137).  Ivey also emphasizes the importance of accuracy in naming particular emotions.  He points out that counselors should use the words to describe the emotion by the client and also attempt to articulate the emotion with name and when only seen non-verbally as close as possible to what the client is experiencing (2018, p. 171).  Egan continues that is important when naming emotions to remain sensitive when naming them, as well as to not over-emphasize or under emphasize them.  He also encourages counselors to be aware of cultural sensitivities as well when naming particular emotions (2019, p. 139-142).

 

Prompts in Counseling

Some clients may speak openly about issues of loss, trauma or everyday issues.  They are a flood of information.  Other clients may be more shy, untrusting, or quiet in how they detail their issues.  Obviously, building trust is key within the therapeutic relationship and plays a large role in receiving vital information during the listening phases. However, sometimes it takes various prompts, nudges, or encouragements to help a client discuss difficult issues.  The art of counseling involves keeping a steady dialogue and flow between client and counselor and this falls upon the counselor’s shoulders to ensure this productive process.  According to Egan, probes are extremely beneficial in helping clients engage more fully, especially with more reluctant clients, in identifying experiences, feelings and behaviors.  They further help clients open to other areas of discussion and engage in conversation with more clarity and specifics.  They can also help clients remain on target and on important issues (2019, p. 177).

There are a variety of ways to help a client continue the story through prompts such as paraphrasing, summarizing, or open ended questioning

Some encouragers can be as simple as “uh huh” or a simple phrase of understanding which serves as a bridge for the client to continue speaking (Ivey, 2018, p. 148).  Sometimes, as simple, as saying “I see” or “okay” or “please continue” are strong enough phrases to encourage the client to continue the story. Sometimes the counselor can merely restate the emotion in a particular tone expressed by a client which further facilitates further discussion.  These simple prods can break silence and encourage the client to continue with the story.  Others can be simple non verbal movements, as a nod of the head, a particular look or leaning forward (Egan, 2019, p.161).  Prompts, probes or nudges can also take the form in longer responses.  Counselors can make statements, requests, or ask particular types of questions to better understand the story and also to properly push it forward.

Questions in particular have high value in counseling.  They help the counselor not only understand and clarify points, but they also show the client a sincere interest on the part of the counselor and sometimes can push the client to delve deeper into an issue and find more self discovery.  Questioning, however, for the pure purpose of questioning can be counter-productive and make the client feel they are being interrogated, so questions need to be utilized sparingly and effectively (Egan, 2019, p. 163).   Ivey points out that there are types of questions that are open and closed (2018, p. 124).  Both have their purpose and time but need to be utilized properly in order for the question to be effective.   Open ended questions, as a rule, should be utilized most.  These types of questions do not end with a simple response of “yes” or “no” by the client but look to abstract more information and input from the client.  According to Ivey, most open questions begin with the words “how”, “what”, “where”, “when” or “could” (2018, p. 124). Close ended questions look for a particular concise answer and have value but usually are used when the counselor is looking for a particular answer while the counselor is primarily talking during the session.   Another great question is the “what else question”.  This question looks for any additive elements to the story or if the counselor is missing anything (Ivey, 2018, p. 125).  Remember, if the counselor does not understand something, then questions or statement looking for greater clarity are better than pretending to understand.

Another important prompt involves paraphrasing.  Paraphrasing is a useful tool utilized in responses by counselors to help keep the conversation going or to help the client hear reflectively what the client has stated.  Sometimes the mere power of hearing something back has immense value.  When a counselor paraphrases, the counselor usually states the emotion in a sentence and then concludes with a “because” phrase.  For instance, a counselor may paraphrase to a depressed client by stating, “you are depressed because you no longer feel any energy”.  This paraphrase can illicit additional information or continue the conversation, much in the same fashion as a simple nod, or phrase.  Ivey points out that paraphrasing is not repetition but also adding some of the counselor’s own words (2018,p. 148).  It is important to note that when paraphrasing, if something is worded incorrectly, the counselor should apologize and ask for deeper clarification.  Sometimes, hearing certain things back can trigger an individual, or if worded differently, and the client is not ready to hear the interpretation, the client may respond quickly, or begin to close up.  Cultural issues can sometimes play a key in this.

Finally, Summaries are a critical promoting tool in responding to a client. Summaries are more detailed paraphrases that adds more depth to the conversation.  They are usually utilized to begin an interview to help bridge the previous meeting, or to conclude a meeting, but they have other purposes as well during the session (Ivey, 2018, p. 148).  Egan points out that sometimes a more detailed summary can help during a session when the discussion is not going anywhere.  They can also be utilized to help the client see a new perspective (2019, p. 178-179).   A counselor utilizing a summary for purposes of illustrating a new perspective can state “I’d like to get the bigger picture… or “I’d like to put a few things together” (Egan, 2019, p. 179).   According to Egan, it is also important to help clients create summaries.  The counselor can ask the client to put together the major points or concerns of the issue and to articulate them Egan, 2019, p. 180).

Carl Rogers saw the importance of these ways to respond.  In this Basic Listening Sequence BLS, he saw the skills of the counselor in how he/she responds to be most crucial.  The utilization of open/closed questions, encouraging, reflecting feelings, paraphrasing and summarizing were all critical elements in the empathetic relationship and understanding the story (Ivey, 2019,p.194).

Pitfalls to Avoid When Responding

Responses while helpful can also be detrimental when not properly utilized by the counselor during a session.  A counselor needs to avoid certain responses that derail the process or make the client uncomfortable.  Not responding or asking too many questions are two extremes to avoid.  Not responding can remove merit from a statement or display disinterest to the conversation.  While sometimes silence can be powerful, not saying anything or responding is usually non productive to the counseling session (Egan, 2019.p. 155).  It is also a dis-service merely to respond for the sole purpose of it.  Counselors should avoid parroting or repeating without context  Parroting dismisses any empathetic response (Egan, 2019, P. 156)

Counselors need to avoid distracting questions when working with clients

In addition to not responding, some counselors misuse questioning.  They can either over utilize it and make the session appear as an interrogation, or ask distracting questions that inflame rather than heal.  For instance, instead of responding with empathy, some counselors can ask inflaming and distracting questions that upset the client.  Instead of focusing on the client’s feelings, the question looks at how the client may have responded. “Did you confront him” or ” Did you do anything at all” or “Are you positive you cannot resolve this” (Egan, 2019., p. 155).  These questions again distract from the story and the emotion and can cause irritation in the client as he/she focuses on a personal injustice or slight.

Cliches are another responses that should be avoided.  In grief counseling,  cliches are counter-productive.  In general counseling, they are also counter-productive.  Cliches can minimize the conversation and cheapen it.  They attempt to replace understanding and empathy with a more generic and impersonal response (Egan, 2019, p. 155).  Clients can hear cliches from the next door neighbor, they do not need to hear them from trained professionals that are their to help assist them in resolving issues.

Another pitfall is how counselors advise clients.  In the counselor-client model, most people expect advise from a counselor.  Other cultures may demand it.  However, in counseling, the counselor does not exist to advice a course of action, but presents a host of options for the client to choose. The client is in control and the counseling relationship is one of teamwork and collaboration.  When the client is told what to do, then the counseling relationship strips the client of self discovery and self healing.  The client is not looking for a family member to give un-wanted advice, but a set of options.  Instead of saying what to do, instead utilize “if I was in your situation, here are a few options that I might look into” (Egan, 2019, 156).

Interpretations based on theories and models are also tempting responses that have a time and place but usually not in responses.  A counselor may have a wealth of knowledge to share, but when interpretations and labeling of an client’s state of mind overtake empathetic responses, then the process of counseling can become derailed.  Instead of giving a moralistic interpretation based on past study, respond to the client’s feelings (Egan, 2019. p. 155).

Counselors need to be also honest in their responses to a client.  Pretending to respond with ingenuine “Uh huh” or “Ok” can lead to later issues when the counselor is expected to remember or understand something previously stated by the client.  Hence if, one loses sight, or track of a story, it is far better not to pretend to understand but to ask for clarification.  This is not only polite and professional but it also shows genuine interest and also pushes the client to better explain the issue which alone may be beneficial (Egan, 2019, p. 157).

Finally, a counselor’s response should not be sympathetic and agreeing for the sake of being so.  Empathy is far different than sympathy.  Many times sympathy can drown logic and allow one to lose focus on the facts.  An empathetic counselor while caring remains grounded.  The counselor response is not overtly sympathetic or judgmental but one that addresses emotion and the issue in a caring way.  The client is looking for help beyond a shoulder to cry on (Egan, 2019, p. 157).

Conclusion

A grief counselor’s response to a client is key in helping the client tell the story.  The response is tied to good observation of the client’s emotions.   Good responses are helpful in transitioning the story, moving it forward, but also in in proper feedback about the story.  Empathy is the guiding force in responding.  Grief Counselors can utilize nudges or prompts with verbal and non-verbal responses. Some verbal responses can be one word or a phrase, while some may include paraphrasing or summaries.  Good counselors utilize responses like an artist and interweave them throughout the counseling process.

Please review AIHCP’s multiple mental health certifications including Grief Counseling and Christian Counseling

Please also review AIHCP’s numerous mental health certifications that involve counseling skills.  AIHCP offers a Grief Counseling Certification, as well as a Christian Counseling Certification.  Other topics include crisis counseling, stress management and anger management.  All of the programs are online and independent study and open to qualified professionals seeking a four year certification.

 

 

 

 

 

 

References

Egan, G & Reese. R. (2019). “The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping” (11th Ed). Cengage

Ivey, A. et, al. (2019). “Intentional Interviewing and Counseling: Facilitating Client Development6 in a Multicultural Society” (9th Ed.) Cengage

 

 

 

 

Additional Resources

Bennett, T. “Empathic responding (or active listening) in counseling: A basic, yet essential response for counselors to master in their practice”. Thriveworks.  Access here

Sutton, J. (2022). “Communication Skills in Counseling & Therapy: 17 Techniques”. Positive Psychology. Access here

“ENCOURAGERS, PARAPHRASING AND SUMMARISING”. Counseling Connection.  Access here

“What Are The Benefits Of Paraphrasing In Counseling”. Processing Therapy.  Access here

 

 

 

The Problem Management Helping Model in Grief and Counseling

Posted on by Dominick Flarey

Helping individuals from one point of need to the final point of self resilience and healing is the process of counseling itself, however, many times counselors helping others with grief, issues of loss, or problems in life become loss in the process.  Maintaining a sense of direction when helping is key.  While there is a partnership in the counseling relationship, the counselor still nonetheless is the guider within the partnership.  The counselor directs the process and guides it to its eventual end point.   Whatever counseling philosophy or model one incorporates, it is still essential to have a template of how to help resolve a particular issue.  Problem Management is a key arrow and guiding modality to help counselors and clients stay on track and have a sense of direction.  It is essentially the compass or navigation control in the counseling session.  Good counselors understand its use and properly utilize it during counseling.  In this short blog, we will review its essential nature in counseling and how to properly incorporate it with a client.

We will also note how Problem Management lays the foundation and structure for a counseling session and compare it to the 5 Stage Model of Carl Rogers.

Counselors help clients identify problems, offer solutions, and incorporate goals and ways to achieve them

 

Problem Management: Four Questions

When a client attends counseling, he/she is looking for guidance in a particular struggle.  Whether it is more complex trauma or loss, or instead a simpler issue revolving around a decision to find a job or not, clients are seeking guidance.  While the clients ultimately determine the outcome, they seek guidance with options and how to accomplish a given thing.  Counselors can help guide clients through Problem Management and its four questions.  The process involves the current picture, preferred picture, a way forward and action itself.

First, the counselor will ask questions about the current problem and current picture..  According to Egan, one should ask a client, what his/her issues or concerns pertain to (2019, p. 45)?   Within this first stage of helping the client, the counselor can help the client discover and identify the issue.  The first task involves the story itself.  What is the primary problem and main concerns (Egan, 2019, p. 48)?  When discussing the story, the counselor should help the client possibly see new perspectives to the problem and what may be really going on beyond the client’s initial story.  Finally, the counselor should be able to direct the client to the right story and what  he/she should be working on.  This process leads to first listening, but then helping the client identify beyond his/her perceptions and find the right story and the keys surrounding it (Egan, 2019, p. 48).  For example, a person who is obese may discuss multiple issues revolving around self image and poor diet/health.  Discussing the primary problem and identifying perceptions of self image and directing the person to the core of the problem is important.  Leading the client to the right story and issue sometimes takes time, but is essential.

After helping the client identify the right issue at hand, the counselor needs to help the client look beyond the current picture and propose a preferred picture.  The primary question should include what does a better picture look like? Within this phase, according to Egan, the counselor helps the client determine problem managing outcomes and set goals (2019, p. 48).   What are the possibilities for a better outcome entail?  What goals and outcomes are truly the most critical and important?  Finally, what is the client willing to do to achieve these outcomes (2019, p.48). Ultimately, these better outcomes and preferred pictures involve effort.  In this phase, again the example of the obese client will see a preferred picture of weight loss, better health and higher self esteem.

Following the preferred picture, the counselor looks to guide the client forward.  The counseling sessions look to help the person move forward with a plan.  The client and counselor should brain storm with possible ideas and strategies to resolve a particular issue.  The counselor will help narrow down the best fit strategies for the particular client and then help the client organize a way to accomplish these goals (Egan, 2019, P. 48).  In the case and example of the obese client, the counselor will discuss diet and exercise strategies and then see which particular strategies fit best with the client’s work and life schedule.  The counselor will then help coordinate first steps and possible times to put things into action.

These three phases of identifying problems, seeking better outcomes and making plans all lead to a call to action.  How well will this call to action being implemented depends on many subjective factors within the client.

Clients and Change

Human beings, despite perfect plans, usually fail to accomplish goals the first time. This requires patient and flexibility by the counselor to help facilitate lasting change and resiliency within the client

Counselors can only direct, they cannot force a client to change.  Hence it is important to help facilitate change but not to expect perfection.  Change takes time.  Some clients may be more resilient to let downs, or more focused in accomplishing a task.   It is important to expect a back and forth wavering between stages.  Clients when they finally become aware of a problem enter into various phases to push forward in change.  According to Egan, individuals looking for change after initial awareness of a problem, will still waver, until the awareness leads to a heightened level (2019, p. 56). This leads to preliminary actions and a search for remedies.  Within this, individuals estimate costs and weigh those costs of a change.  They soon turn to more rational decision that is not only rational but tied to emotional change.  This leads to serious action.  However, these actions still require maintenance and the reality that relapse can occur (Egan, 2019, p.57-58).

It is the counselors job to help nurture positive change and guide clients through pitfalls.  Those facing addiction issues, or in our example, one facing weight loss challenges, will wish to change but may sometimes not be emotionally tied to the rational decision enough to take the serious action.  Others may do well for a few months and not be able to maintain what is demanded, or worst, yet relapse into addiction, or fall off their diet.  Counselors are there to help guide in those cases and foster resilience.  This may involve returning to the Problem Management model at an earlier stage to again find grounding and direction.

This is why counselors must ever remain flexible in their approach.  Somethings may work for one client but not another.  Counselors need to constantly “mine” various approaches or counseling philosophies that will help a particular client (Egan, 2019, p. 58).   The counselor then organizes what works best, evaluates it and incorporates it into the various phases of the Problem Management Model (2019, p, 58-59)

Pitfalls to Avoid in Problem Management

When helping clients identify issues, outcomes and plans of action, there are some pitfalls that counselors need to avoid.  Counselors need to avoid a lack of plan in their work.  Some helpers go session by session without a uniform plan set into play.  Others on the contrary attempt to implement to many plans at once.  While there are many good models, not all models fit for a particular person, so each model and stage of helping, needs to be tailored to the individual client.  Avoiding rigidness and being flexible in approach is key with an understanding that one can go back and forth between stages.  It is also important to include the client in the process.  Since counseling is a partnership, then it is essential to share the helping models with the client.  This is an element of psycho-educational healing.  A client who is part of the process understands the points of reference and can better track oneself in the healing and change process (Egan, 2019, p. 60-61).  Finally, while important as it is to utilize flexibility, a good counselor can recognize lack of progress on part of the client and when to help the client push forward (Egan, 2019, p52).

Hence the process while simple in theory is more difficult when people become involved.  People are complex and no one person is the same.  This leads to the need of flexibility, testing and feedback, and trying other things within the parameters of the Problem Management model.  Some clients may process the issue quicker, others may take longer.  Some my engage in a certain stage a different way than another, while others will regress or progress.   This is why counseling while a science is also an art.  The individual talents of a counselor go well beyond the models and theories but also helping others implement what needs to be done through a variety of skills that involve evaluation and guidance.

Problem Management and Carl Roger’s 5 Stage Model

The great Humanist counselor, Carl Rogers, understood the importance of structure in helping clients find direction.  At the source, he also made his care patient based and utilized empathy to help individuals find healing.  In previous blogs, we discuss the Humanistic Approach.

In regards to Carl Rogers, the Problem Management Model shares many similarities with the 5 Stage Model.  Carl Rogers listed 5 important stages within any counseling relationship that are essential in directing an individual towards healing.  The first stage involves an empathetic relationship.  Within this first stage, the counselor looks to build rapport with the client through empathy, trust building and establishing a goals and direction (Ivey, 2018, p. 194).  This stage is so critical because many counselor/client relationships end because of a disconnect.  Whether due to insensitivity or indifference that is purposeful or perceived, the relationship is never able to grow.  The client does not feel the counselor cares or truly invests in the problem.  Furthermore, in our previous blogs, it can be due to multicultural issues that are perceived by the client.  The client may feel a young woman may not understand himself, an older man, or a black woman, feeling a white middle class counselor will not understand her issues of social injustice.

Rogers second stage includes understanding the story. Stage two is labeled Story and Strengths and focuses on the story itself.  Collecting data, drawing out the story and establishing early goals are essential (Ivey, 2018, p., 194).  Of course this stage demands good attending of the client.  It involves active listening and good responding skills that emphasize reflecting feelings, paraphrasing and summarizing as needed to have a full understanding of the story.  It involves empathetic understanding of the client and identifying strengths and weaknesses, truth and discrepancies, and helping to build up with the client.

Stage three involves in identifying and establishing goals that best fit the needs of the client.  It is a collaborative effort where as a team, the counselor and client identify the best goals and options (Ivey, 2019, p. 194).  This stage is very similar to the Problem Management Model, where after feelings are identified, then the client is asked beyond the current picture, what is the preferred picture?  Hence, the similarities show a concrete plan in helping the client from one point to another and helping the counseling sessions move forward with purpose and direction.

Rogers’ stage four continues align with the Problem Management Model in continuing to identify the preferred picture.  Within this stage, the Restory stage, the client is asked to identify alternative goals, confront issues and rewrite the narrative (Ivey, 2018, p. 194).  It is the completion of the preferred picture and implementation of a plan.

Finally, the final stage, looks at action and how to achieve it and also deal with set backs (Ivey, 2018, p. 194).  Hence one can see the similarities but also see a common art and science that should guide a counselor in helping individuals through problems.  There is a common theme and way to do things.  There is a general current that one should allow counseling sessions to flow.  The flow may be different at certain times, but the general direction is essential.

 

 

Conclusion

It is essential to have a plan.  Counseling is structured while also flexible.  It has a purpose and a plan to reach a goal.  The flexibility is how to reach that goal not the goal itself.  Problem Management helps the counseling relationship stay structured in regards to the issue.  It helps identify the issue, state the better outcome and help give the tools and plans to accomplish it.  Counselors need to work their clients to the desired change but while doing so understand the nature of change within the human person and the need to keep trying when results do not appear.  The counselor not only guides the client to facilitate positive change but also helps the client get up when the client falls.

Please also review AIHCP’s numerous mental health programs, including its Grief Counseling and Christian Counseling Certification Programs

 

Please also review AIHCP’s Grief Counseling Certification as well as its Christian Counseling Program.  AIHCP also offers Spiritual Counseling, Stress Management, Crisis Intervention and Anger Management programs to help train professionals in facilitating positive changes in clients.  Utilization of a Problem Management paradigm is essential in all of these models.  AIHCP’s programs are all independent study and online.

Reference

Egan, G & Reese, R. (2019). “The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed.) Cengage.

Additional Resources

“Problem-Solving Models: What They Are and How To Use Them”. (2023). Indeed Editorial Staff. Indeed.  Access here

Cuncic, A. (2024). “What Is Problem-Solving Therapy?”. Very Well Mind.  Access here

Antonatos, L. (2023). “Problem-Solving Therapy: How It Works & What to Expect”. Choosing Therapy.  Access here