Dissociation is a serious condition resulting from PTSD. When triggers of past trauma arise, the mind tries to shut the body down through dissociation. Sometimes it is through a flashback, or a disconnect from reality. These situations while in public or driving can cause injury to the person. So it is important to understand what triggers it and how to ground oneself when dissociation occurs.
Please also review AIHCP’s numerous mental health certifications which include grief counseling, crisis intervention, spiritual and Christian spiritual counseling, stress management and anger management programs. The programs are online and independent study and open to qualified professionals seeking a four year certification.
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
“ENCOURAGERS, PARAPHRASING AND SUMMARISING”. Counseling Connection. Access here
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
Attending skills and attending the client are the initial phases of patient interaction with a counselor. It involves how well the counselor attends the client through listening, observing and feedback skills. These basic skills set the table for productive counseling.
Attending to the client involves listening and observing skills that lead to better feedback. Please also review AIHCP’s Grief Counseling Certification as well as its Christian Counseling Certification
The fundamental foundation in conversation and communication is listening. When others try to interrupt or speak over each other, the purpose of communication is crippled. Listening is a key communication skill that helps one understand the other half of the conversation. It allows one to learn about the other person and be able to make productive comments to the process of the conversation. When listening fails, communication fails. No wonder then, counselors, whether clinical or pastoral, whether in grief, spiritual or general counseling fields need to develop this skill in counseling.
When working with someone, whether in basic clinical interviewing where information is collected, or in counseling itself, where one hopes to help someone find healing or progress in life, listening is a key ingredient. When counselors fail to listen properly, the counseling process itself fails. Clients sense when their issues are addressed or if the counselor cares about what they are telling them. Hence, listening and giving good feedback is key not only for providing help but also creating a relationship between counselor and client. A counselor who listens is not only better able to help the client but is also better able to give the client a sense of meaning. Through listening, the client feels someone cares about his/her problem and is willing to listen and offer productive advice and guidance in the process.
The Counselor and Client Relationship
The counselor and client relationship is key. When the counselor makes him/herself available to the client, he/she invites the client into a professional and therapeutic relationship. Through this communication, a team evolves that works together for the benefit of the client. In essence it becomes an alliance (Egan, 2019, p. 67). Any good alliance is built upon good communication and listening. The counselor builds the relationship first via listening. Through listening, communication begins, through communication, trust emerges, and through trust, a relationship that can heal begins.
The Art of Attending
Attending a client involves both listening and also observing. When attending to a client, the counselor reduces talk time and provides clients with the timeframe to speak (Ivey, 2018, p. 75). Conducive to this is how a counselor attends to the client from four physical aspects. These attending aspects include visual contact, vocal qualities, verbal tracking and body/facial expressions (Ivey, 2018, p. 75). In regards to eye contact, when someone looks away, it denotes for many, a sign of disrespect or lack of interest. Hence good visual contact involves eye contact. This does not necessarily mean awkward staring, but it does denote eye contact during conversation. This promotes the sense that one is genuinely interested in the story of the client and promotes the process of counseling itself. Vocal qualities also play a key role in the attending art. Tones and speech rate can be interpreted by the client as positive or negative based on the counselor’s speech. A counselor who seems upset via a tone, can quickly scare away a client or embarrass a client from further discussion. A calm and sensitive tone is essential to provide security to the client while his/her story is being told. While listening it is also essential to track the conversation. It is important to keep the client tied to the initiated topic (Ivey, 2018, p. 75). Good listening helps keep the conversation in a good and purposeful direction. Finally, one’s body language and facial expressions can play a key role in attending. An awkward or angry face, or turning away from a person can have the same negative effects as the tone of one’s voice. Egan recommends facing the person squarely, adopting an open posture and sometimes leaning forward as needed during the conversation (2018, p. 101). Instead of folding one’s arms, or shifting and moving, one can create a safe sense of being for the client during the narrative. Bear in mind also cultural aspects. Some individuals may be from a different and diverse culture that utilizes different ways of expressing certain emotions. This can lead to different postures or emotional ways of expression. It is important to be aware of other cultures and their views and to also be aware of oneself and how one’s own appearance, race, faith or culture can affect the client one is attending and trying to help.
Dialogue and Listening
Empathetic listening is an important skill that lets the client know his/her story matters
A good conversation involves taking turns during it. It involves connecting and mutually influencing each other (Egan, 2018, p. 100). It not only a monologue but a shared story that each party invests in. Good listening skills help the counselor make the most of the narrative but some types of listening miss the point. Egan points out that partial listening is one type of listening that counselors need to avoid. When counselors only partially listen, they only skim the surface. They pick up parts of the conversation and miss others. When questioned by the client, their response is less complete and can cause problems with the client (2018, p. 107). Another poor listening skill, according to Egan, is an audio-recording style of listening, where the counselor simply parrots what the client has expressed. In this case, the paraphrase adds no insight or questioning but merely repeats. Sometimes, repeating something has power and can be utilized but if paraphrasing is utilized in parrot form consistently, then it only mirrors and gives no true insight. Counselors need to listen to the client’s experiences, thoughts, behaviors and feelings and better respond to those things with insight (Egan, 2018, p. 108). This insight should not be judgmental, but should be slowly integrated into the responses. The response then should not merely always paraphrase or repeat, but the listening should produce a paraphrase that not only restates but also probes deeper, but without judgment or necessarily value based accusations. The key is to help the client find the answer because ultimately the client is in the driver seat. Finally, Egan points out that another form of bad listening involves rehearsing. Many novice counselors are looking for the perfect answer or solution, or even the proper response. During this, counselors can become dominated during listening as to what their response will be instead of what the client is discussing (2018, p. 107). Effective helpers do not stop listening to derive a solution but continue to listen instead of preparing what they will say next.
Other Distortions in Listening
Egan points out a few other ways distortions to listening that can occur even to counselors who are fully paying attention. Egan states that it near impossible to listen to someone in a completely unbiased way but counselors need to try their very best to filter these assumptions (2018, p. 125). A counselor who is a white male may use filters from his own life that could distort cultural differences from a black female. This bias could side track both parties. Hence it is critical to remove types of subconscious bias when listening to the narrative of a person from a different race, culture, or faith. In addition, during listening, it is important to avoid evaluative listening. Egan defines evaluative listening as judgmental listening. It involves seeing statements as good or bad, or right or wrong or acceptable or unacceptable (2018, p. 126). Clients need to be first understood before productive change is introduced. Another type of distortion involves stereotyping a client based on diagnosis. This type of listening involves labeling the individual. While diagnosis is important, when focusing solely on diagnosis of the individual, the counselor puts the client in a box. Egan states the counselor can be correct in diagnosis but still lose the person (2018, p. 127). Finally, it is important for counselors not to fall victim to sympathetic listening, where they become solely captivated and emotional about the client’s situation while missing the objective facts. Sometimes too much sympathy can limit effective helping (Egan, 2018, p. 127).
Importance of Empathy and Finding Missing Cues
Counselors can discover various insights into a client through various physical cues
Empathy is crucial in human relationships. An empathetic person is able to understand the other person emotionally and feel what it may be like to experience certain things. Empathetic listening allows the counselor to take a sincere and honest interest in the client but still remain objective. Carl Rogers, author of the Humanistic Approach in counseling, emphasized the importance of acute empathy and the utilization of it throughout the discussion. Empathetic listening according to Ivey can be subtractive, basic or additive. When subtractive, the counselor gives less back in response and the response is sometimes distortive and hence ineffective. When the empathy is basic, it is an accurate feedback. One needs to avoid completely audio-repeating but it sufficient to help the client. Additive empathy is the best because it reframes but also may include past statements or include additional information to produce positive change (Ivey, 2018. p. 67). Again, these rephrases, summaries or reflections are not meant to be commands but are used to guide. They are not meant to impose judgment or value either, but awaken the client to other views or self actualizations.
Counselors have a wide variety of ways to respond through their listening and observing skills, some may include generalizing or summarizing, paraphrasing or reflecting on various issues. Regardless, they need to be at least additive or basic in empathy. Summarizing is a broad basic account of the dialogue. Paraphrasing is more acute but it can be basic or additive. Reflective is very additive in nature but connects the dialogue to self and offers insight and questions on the statement.
Empathetic listening is key in helping clients and is the basis for a client-based therapy (Egan, 2018, p. 67). Through empathetic listening, one can become more attune to verbal and non-verbal cues that can reveal issues surrounding the story. Counselors should watch for tone of voice in responses, facial expressions or body movements during the conversation. How a client speaks or responds to a question can be a key clue (Egan, 2018, p.116). Ivey recommends mirroring sometimes the client. When movements do not clearly match and shifts and jerks within the client appear, then this could be a sign of an issue (2018. p. 99).
As noted, counselors need to watch for changes in tone of speech or physical movements. Good observing skills, in addition to good listening can help counselors discover other missing pieces of the puzzle. In regards to some verbal behaviors, Ivey emphasizes that counselors should carefully watch “I” statements or “other” statements. Are these statements positive or negative regarding “I” or “other” (2018, p. 93). Ivey also recommends looking for words such as “can” and “can’t”. Some clients as well are more concrete in their speech, while others are more abstract. During listening and observation, a counselor needs to identify this. Abstract clients are excellent at self analysis and reflecting on an issue, but may struggle with concrete issues. More concrete clients may be able to provide specifics, but be less able to see the point of views of others. Both types have their strengths, but it is important for a counselor to identify which type of speech one is listening and observing (Ivey, 2018, p. 91). During interviewing or counseling, a counselor may be able to find cues to the issue through various discrepancies throughout the clients story. Ivey points out that contradictions may occur between statements, or between words and actions, or regarding goals. It is important for the counselor to identify these discrepancies and in a non-confrontational way expose them to the client (Ivey, 2018, p. 99).
In listening empathetically and avoiding bad and distortions of listening , one can better hear the client’s experiences, thoughts, behaviors and feelings and not miss various cues of other issues.
Conclusion
Proper attending of the client is key for good counseling. Please also review AIHCP’s Grief Counseling Certification
Attending a client involves good listening and observing with feedback that reflects this. Counselors need to develop good listening skills for the betterment of their clients. Listening forms the foundation for any relationship and it is important to avoid bad listening habits. Counselors can better attend their clients through a patient-centered model that is empathetic and humanistic. Neuro-science studies portray that when clients are properly listened to and given feedback that show thought and reflection corresponding with listening, then certain parts of the brain light up in positive ways (Ivey, 2018, p. 77). Listening plays a key role in making a positive effect on one’s client. It lets the client realize someone actually is listening and cares and is providing feedback to produce positive change.
If you would like to learn more about helping other people or would like to become certified in Grief Counseling or Christian Counseling, then please review AIHCP’s certifications in these fields. The programs are open to both clinical and non-clinical counselors who would like to earn a certification in these fields and add to their existing practice. The Grief Counseling and Christian Counseling programs are online and independent study and lead to a four year certification.
References and Additional Resources
Egan, G & Reese, R. (2018). “The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (11th)”. Cengage.
Ivey, A. et, al. (2018). “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society (9th)” Cengage.
Sutton, J. (2021). “Defining the Counseling Process and Its Stages”. Positive Psychology. Access here
Stress and stressors erode a person’s ability to cope with life, whether in the workplace, school, home, or with family or friends. Stressors ignite within the human person a stress response to face danger. The Sympathetic Nervous System within the body prepares the body from a physiological standpoint to physically withstand the danger or stressors by fueling the body cortisol and adrenalines to overcome the situation. If the human body or any organism for that matter is overcame by the stressor, then weakness and possible disease and shock can occur. Only when the body or organism is able to overcome the stressor is it able to again return to normal functioning.
When a stressor overtakes a person or organism, then the person is no longer able to cope. The Sense of Coherence when exhibited illustrates an individual who can overcome a stressor
In most stress research, disease and weakening of the organism via poor health is viewed through the lens of pathogenesis and the reasons why individuals become sick, ill or die. Obviously stress can play a key role in that. With chronic influxes of cortisol, the blood pressure, constriction of vessels, and higher tension on the heart can have life altering affects on the body. However, there is another angle to explore in regards to the body’s over health and its reaction to stress. Aaron Antonovsky (1923-1994) reviewed how health and disease are not dichotomy of two states but a continuous variable based on health and coping. This includes various holistic approaches as well as diet, exercise and life views that help individuals maintain health. Antonovksy’s famous concept of salutogenesis looks and focuses more so on the factors and practices that promote health instead of what destroys health. Stemming from the Greek “salus” meaning health and “genesis” meaning origin, salutogenesis looks to maintain health by healthy practices and healthy origins itself.
In regards to stress and loss, this has great implications. Many individuals under stress or loss are unable to maintain physical, mental and emotional health and can fall prey to the stressor. As noted the stress kills and an inability to better cope with stress in a healthy way can be detrimental long term to one’s health. Hence Atonovksy looks the concept of coherence as gold mark of individuals who maintain a stronger mental and emotional health in responding to loss or a stressor. These types of individuals are far better equipped to cope with stress in the forms of loss, death, job loss, problems, crisis, or any bump in the road. The resiliency of those who display coherence is stronger than those who do not.
Sense of Coherence
So what is coherence? The Sense of Coherence forms a theoretical framework for how a person responds to stress and plays a key role in one’s ability to respond to it. In Atonovsky’s work, “Unraveling the Mystery of Health, Antonovsky lists the key elements of the Sense of Coherence. He states,
“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.”
Within this, one can see three key elements to coherence. First the person has comprehension of the situation. The person has an understanding of what is occurring and the person is able to predict and understand the outcomes. This understanding lays the foundation for the individual to better able to cope. One can imagine when this foundation ceases to exist. When something so so shocking, so traumatic and so meaningless occurs it shocks the system of a person. It gives the person no rationale or direction to resolve the issue. This is why it is so common in traumatic loss or witnessing senseless destruction that PTSD often occurs and the individual is unable to properly process the event.
The second element is manageability. If a person has the experience and tools to properly cope with the stressor, then the individual has a better chance to overcome it. Having control in the chaos is so important. Antonovsky in his work, “Health, Stress and Coping” coined the term generalized resistant resources to illustrate resources and tools an individual has to overcome stress and loss. If these resources were not available, no matter the Sense of Coherence, a person would fall to the stressor or loss due to lack of these resources. When lacking, the term generalized resistant deficit was employed. A good example of this would be applicable to a person who lost his or her home in a fire. An individual with little income or support systems lacks any resources to face the stressor, while a wealthy individuals with resources, insurance, funds and good friends will more than likely survive the stress and loss.
Finally, Antonovsky pointed to the importance of everything in life has meaning and purpose. The good and the bad occur, but there is an overall sense of understanding and purpose. Individuals who are not anchored by a world view, whether spiritual or practical, can sometimes float in life and lose purpose and guidance when bad things occur. Having a sense of meaning helps individuals anchor one self in loss and stress and find orientation and purpose.
Hence, comprehensibility of the stress, loss or moment, manageability of the stress, loss or moment and meaningfulness of the stress, loss or moment, are critical to a Sense of Coherence and the ability of the person or organism to maintain health and resilience against stress or loss. In times of crisis, pandemic, or war at the social level or at times of personal distress or severe trauma on the person, individuals who display a Sense of Coherence are better equipped to excel and survive during bad times.
Conclusion
Salutogenesis sees health as more than an absence of disease. Please also review AIHCP’s Stress Management Program
A person or organism that is able to adjust and react due to experience, manageability and understanding of a given crisis, loss or stressor has a greater ability to respond in a healthy fashion. A healthy emotional and mental mindset can better prepare a person for crisis and loss. This does not mean a person will not feel the effects of a loss, but it does point to the probability of healthier and normal outcomes or resiliency. Antonovksy’s ideas and theories are important for a better understanding of stress management as well as grief and loss trajectories.
Within Stress Management, his ideals point to how one can better handle stressful situations and find resiliency. In grief counseling, it can help grief counselors better predict grief and loss trajectories of individuals and who may be more likely for a complicated grief reaction.
Please also review AIHCP’s Stress Management Consulting Certification as well as AIHCP’s Grief Counseling Certification and see if they meet your academic and professional goals. The programs are online and independent study and open to qualified professionals seeking a four year certification.
Hege Forbech Vinje, Eva Langeland, and Torill Bull. (2016). “Aaron Antonovsky’s Development of Salutogenesis, 1979 to 1994″. The Handbook of Salutogenesis [Internet]. National Library of Medicine. Access here
Monica Eriksson and Bengt Lindström. (2006). “Antonovsky’s sense of coherence scale and the relation with health: a systematic review”. J Epidemiol Community Health. 2006 May; 60(5): 376–381. National Library of Medicine. Access here
Writing about our feelings is an important way to express in a positive and healthy way. Within CBT it has numerous effects in helping the person reframe and identify troublesome emotions and behaviors. It allows one to express but also cognitively review and respond to the self.
Instead of maladaptive coping, journaling helps the individual express without hurting oneself with damaging practices that lead to worst grief responses. It grants the person privacy in expression but also grants the person control. The person controls what is written as long within the confines of where the person writes, the person is able to safely release the pain in a positive way.
Please also review AIHCP’s Grief Counseling Certification and see if it matches your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Grief Counseling.
Neurotransmitters play a big role in our mental health from a physiological view. They are important chemicals without our brain and body that balance various moods. Serotonin for example when balanced regulated mood disorders such as depression. Proper balance and understanding of these transmitters play a key role in mental health. Sometimes it is diet, other times it may require medication to find balance, but most licensed mental health care professionals can help individuals find the mental help they need if an imbalance occurs.
Please also review AIHCP’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. AIHCP also offers a variety of other mental health certifications for other professionals as well.
Counselors can fall into pitfalls with clients and encounter ethical dilemmas often without knowing it. They can sometimes be placed between two conflicting sources as well. It is important to identify potential pitfalls and understand proper responses to avoid later ethical issues or possible termination by employer or suspension of licensure.
Counselors need to be aware of various pitfalls that can endanger their position and career. Please also review AIHCP’s various mental health certifications
The video below highlights and illustrates different types of scenarios and certain preventive measures to protect one’s career. Please also review AIHCP’s various Mental Health Certifications for Human Service Professionals. The certifications can serve both licensed and unlicensed professionals in advancing their careers.
Ethics in counseling has standards that counselors in the human service field must adhere to in regards to conduct with clients, other counselors, employers, students and other peers. They are essential to ensure quality and standards within the field of counseling. Various organizations such as the American Counseling Association offer lists of standards that the profession adheres to in regards to conduct.
This video below reviews in more depth counseling standards and ethics. Please also review AIHCP’s Certifications for counselors including Grief Counseling, Christian Counseling, Crisis Intervention, Anger Management and Stress Management.
Whether operating as a pastoral counselor, licensed counselor or a close friend and confidant in the grief process for a bereaved person, certain biases and perceptions from both the griever and grief helper can hamper the healing process or cloud assessment entirely. In past blogs, we have talked about grief myths, grief bullies and both the griever and the grief helper’s own biases. In this blog, we will put all together as one core unit in how these issues can culminate in preventing healing and also hamper one’s ability to help the grieving.
Helping others through grief is naturally composed of both healthy and unhealthy perceptions, biases and sometimes myths about loss itself.
Grief Myths
Grief myths exist in society and can attach to a particular griever, grief helper, or grief bully. They prevent true healing because they mislead about the true nature of normal grieving itself. They help form bias within the individuals toward a particular grieving process. In Junietta McCall’s text, “Bereavement Counseling: Pastoral Care for Complicated Grieving” there are various problematic implications that occur due to bad perceptions. Among them, McCall lists the denial of the necessity of grief work, the fact grief should always be simple, that any type of extended grief is due to immaturity or pathology, that grieving is feeling sorry for oneself or seeking attention and finally that grieving and any outward manifestation displays weakness in character or lack of faith (2012. p. 182-184). When individuals believe grieving is not normal, or that is an attention seeking process, then these myths become problems that infect the person’s bias in both helper and griever.
Personal Bias
Grief bullies are particular guilty of personal bias. They set timelines for grief and assert rules for expression of grief. Most are harboring their own interior issues and cannot grieve properly themselves. These individuals will assert that individuals are seeking attention, or weak in character. Some may grow with a bias that “real men do not cry” or that it is simply time to “get over it”, Others who are less bullies but more observers may dismiss other’s grief due to their own bias and simply state “the person never talks about it, so I leave it be” or “I avoid this person because it will turn into a sad and uncomfortable conversation every time” or “I would rather say nothing instead of bringing up the pain” or “She needs to simply have more faith” (McCall, 2012, p. 179-182).
From this comes a series of problems grievers face in their own perception of their loss. They may question the amount or lack emotion displayed. They may question if they have grieved or felt bad long enough or not enough. Common exclamations such as “I should be over this by now” or “It is time to move on” or “I feel obligated to cry more” are all nagging pains within the person as the person encounters the grieving process over time. Some may feel a religious obligation to feel happy that the person is in a better place and any crying is selfish or may question other emotions of anger or guilt. Others may feel ashamed they are angry with God or have not shown enough faith that the person is in a better place.
Others may feel conflicted based upon relationships with deceased or the nature of the loss itself. They may feel guilty for not maybe noticing an illness soon enough, or not paying enough attention to someone who passed away and feel it is partly their own fault. The person may feel guilt for not visiting enough or appreciating the person enough. This perception as well other perceptions can create future issues in the grief trajectory and how a person heals. The only way these issues and emotions can be properly diagnosed is through talking and identifying them.
The Pastoral Counselor, Licensed Counselor or Grief Helpers Bias
Many times, even those who work as primary help of the bereaved enter into conversations with their own bias. While grief and loss are objective realities, everyone has particular unique and subjective experience in their reactions to grief. This incorporates a history of grieving that has good and bad things. Some things may also be neutral and worked for oneself while one grieved but may not work for others. This is not to say sharing experience and coping ideas are bad but it has to be done when invited. Comparing grief and offering solutions that may have worked for one’s personal self may not work for others. One should not be upset if one’s particular advice does not lead one to healing but understand that a grief helper is there to listen and sojourn with the bereaved and the griever’s own particular loss in the griever’s own particular way. Biases of past experience hence can be helpful or detrimental based on a case by case basis.
Yet, biases inherently are part of the care and healing process and when used correctly can supply large doses of wisdom and knowledge to healing. The care process, according to McCall, involves both the griever’s bias and the helper’s bias. This leads to two sets of perceptions, thoughts, feelings and beliefs (2012, p. 175). In healthy outcomes, this feedback loop meets the needs of the given grieving situation and promotes healthy healing.
Grief helpers can play key roles in helping identify issues that relate to griever’s bias, beliefs or perceptions due to grief myths or personal complications within the grieving process. McCall lists numerous ways pastors, counselors or friends can help the bereaved through difficult times. McCall lists the critical importance of making careful observations, building healthy relationships, furthering necessary treatment and promoting professional and healthy behaviors (2012, p. 186).
Careful observations push the intuitive abilities of a helper to notate issues that may be arising during the grieving process. This involves not only note taking but also looking for non verbal clues as well as understanding the person’s past history to better identify issues that may be affecting the current grief process. Three key consultation questions arise. First, what is the counselor paying attention to and what could he/she be missing or taking for granted? Second, is something unsettling oneself or making oneself uncomfortable about a particular griever and what is it about? And finally, is the counselor helping the person or getting in the way? (McCall, 2012, p,. 196).
Beyond observations emerges the importance of building a healthy and professional relationship with the bereaved. One that is helpful and not leading to co-dependence but one that is promoting a healing process where the bereaved will be able to again move forward in life. This involves identifying with the person and forming an understanding of their pain. It involves empathy, listening, communication and helping the person form connections from past, present and future (McCall, 2012, p. 189-192).
The third key according to McCall is integrating treatment based upon perceptions. These treatments are unique for each individual griever and may depend on the griever and the nature of the loss. Treatments can range based on the person but it involves good note taking and documentation of challenges and issues that appear during the grief trajectory. These notes and documents help the grief counselor make better assessments and plans of action. Maybe a particular griever needs a particular therapy best performed by a specialist in it, or maybe the griever needs to be seen by a licensed counselor instead of merely a pastoral counselor. Maybe CBT is a better resource than a Humanistic approach, or psychodynamic approach? Maybe this individual would benefit from journaling, or instead of journaling, other forms of artistic expression?
Finally, a review of oneself is critical. It illustrates how one is reacting to the griever and how effective one is being in terms of helping the individual in his/her progress in grieving. In analyzing oneself, one is better able to see how one has been successful and not with this particular griever and what things may need adjusted or even if one needs to step back and allow another with more experience or expertise to resume the role in the care plan.
Conclusion
The grief process is about human beings. The griever and helper are on a mutual journey upon the grief trajectory. Perceptions, bias and process are all part of it. Some individuals have unhealthy bias and myths about grief and their perceptions are detrimental while others have healthy perceptions which aid in healing. The dyad process of two individuals and their past, perceptions and ideas all constitute part of the care model and ultimate healthy grieving outcomes.
The care model of helping others through grief is between the bereaved and helper. Please also review AIHCP’s Grief Counseling Certification
Please also review AIHCP’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 in Grief Counseling.
Reference
McCall, J. (2012). “Bereavement Counseling: Pastoral Care for Complicated Grieving”. Routledge.
