Test Bank for Counseling Strategies and Interventions for Professional Helpers, 9th Edition

Chapter 2 The Helping Relationship CHAPTER OUTLINE The Importance of the Relationship to Clients Accurate Empathy The Brain Connection and Empathy Empathy and Mindfulness Cultural and Relational Empathy Shame and the Empathy Bond Positive Regard Positive Regard and the Acceptance Therapies Motivational Interviewing Acceptance and Commitment Therapy Dialectical Behaviour Therapy Congruence/Genuineness Steps in Congruence: Awareness and Discernment Self-Disclosure Sharing and Feedback Statements Positive Feedback Statements: Encouragement and Strengths Perspective A Climate of Safety Summary KEY WORDS Accurate empathy Communicative attunement Congruence Core conditions Counter-transference Cultural empathy Empathic mirroring Empathic rapport Genuineness Mindfulness Mirror neurons Person-centered approach Positive feedback statements Positive regard Relational empathy Self-disclosure Shame Therapeutic relationship Transference CHAPTER OVERVIEW Although the helping relationship has some marked differences from other interpersonal relationships, it does serve as a model that the client can use to improve the quality of relationships outside the counseling room. From the view of your clients, the helping relationship is described as a special place outside the usual context of family, friends, and work where they can express themselves freely to a respectful and supportive person (Lilliengren & Werbart, 2005). Clearly, the helping relationship cannot succeed without the presence of accurate empathy or understanding of the client’s world. When you assume that you understand, but you do not, you and your client detour from a constructive and helpful course and risk the dangers of false conclusions and failure. In a similar manner, if you do not value your client or if you do not consider the client’s problems and concerns to be real, you are denying the most reliable information about your client’s perceptions. Lacking this information, you cannot help your client develop in more constructive directions. Finally, and underlying both accurate empathy and positive regard, the degree to which you can be honestly and consistently yourself, knowing yourself, and sharing yourself with your client in congruent ways will establish the ultimate parameters of the helping relationship. A recent study of clients in counseling described the critical incidents that, from the client’s perspective, helped to forge a strong helping relationship (Bedi, Davis, & Williams, 2005). These were described by clients as specific things the helper said or did. They included the following: Active Listening—the counselor remembered what I said. Self-Disclosure—the counselor recalled an experience similar to my own. Encouragement—the counselor focused on what I was doing well. Validation of Feelings—the counselor understood my fears and my frustration over situations. Bedi and colleagues (2005) concluded several things about the helping relationship from the client’s perspective. First, clients see the strength of the helping relationship as related to things the helper does rather than things the client does. Second, as helpers we may overlook behaviors and comments that seem simple or benign to us but have tremendous impact on clients for establishing a positive therapeutic relationship. Although the behaviors presented in this chapter can be learned and incorporated into your style and repertoire, there is a dimension yet to be acknowledged. The integral human element of the helping relationship cannot exist by mechanical manipulation of certain behaviors at given moments. Your relationship with each client contains its own uniqueness and spontaneity that cannot, without the loss of both genuineness and sincerity, be systematically controlled prior to its occurrence. Your spontaneity, however, will increase rather than decrease once you have become comfortable with a variety of counseling techniques. While you are learning counseling responses, this ease may not be quite as apparent because you will need to overlearn them. However, once the responses suggested in this book have become second nature to you, your spontaneity as a helper will begin to emerge. You will be on your way to becoming the helper you hope to be. ACTIVITIES 1. Respond to the following three client situations with a self-disclosing response. Make sure that you reveal something about yourself. It might help you to start your statements with “I”. Also, try to make your statements similar in content and depth to the client messages and situations. Example The client is having a hard time stating specific reasons for seeking helping. Your self-disclosing statement: “I’m reluctant at times to share something that is personal about myself with someone I don’t know; I know it takes time to get started.” A. The client is feeling like a failure because nothing seems to be going well. Your self-disclosure: B. The client is hinting that he or she has some concerns about sexual performance but does not seem to know how to introduce this concern in the session. Your self-disclosure: C. The client has started to become aware of feelings of anger for the first time and is questioning whether such feelings are legitimate or whether something is wrong with him or her. Your self-disclosure: REFLECTIVE QUESTIONS 1. How do you approach a new relationship? What conditions do you require to be met before you open yourself to a closer relationship? 2. What were the “unwritten rules” in your family and in your culture about interactions with non-family members? How might these rules affect the kind of relationship you are able to offer clients? 3. If you were a client, what conditions would you look for in your helper? 4. Under what conditions do you feel safe? Open and disclosive? Trusting? Does this vary with persons of different ages, gender, values, and ethnic origins? 5. How have your own childhood experiences influenced your relationships with others as an adult? In exploring this for yourself, can you see potential connections between the childhood experiences of your clients and the way they may relate to you and to others? TEST ITEMS Chapter 2 MULTIPLE CHOICE: Choose the alternative that best completes the statement or answers the question. 1. The primary focus of person-centered therapy is __________. a. examination of behavior patterns that are causing difficulty in the client’s life b. selection of specific intervention strategies that are tailored to the client’s needs c. promotion of a therapeutic alliance characterized by empathy, unconditional positive regard, and congruence d. exploration of the intrapsychic experience of the client 2. The individual credited with the genesis of the person-centered approach is a. Norcross. b. Skinner. c. Freud. d. Rogers. 3. The concept of core conditions in the therapeutic process refers to a. the therapeutic relationship. b. theoretical approach. c. treatment type. d. intervention strategies. 4. Which of the following is LEAST likely to be true about clients who feel cut off from themselves and their experiences and are seeking a sense of wholeness? a. They missed out on caring communication and healthy attachment to a caregiver in early life. b. They have developed narratives (or stories) and conclusions about themselves that are both organized and flexible. c. They have not achieved enough brain integration to regulate emotions effectively. d. They have had their experiences and expressions of self denied or judged. 5. When helpers’ unresolved issues get projected onto clients this is referred to as a. transference. b. projection. c. countertransference. d. projective identification. 6. The communication of accurate empathy promotes all EXCEPT which of the following? a. decreased client exploration b. decreased premature client termination c. increased client sense of safety d. increased client sense of being understood 7. The demonstration of empathic understanding requires the following of the helper: a. empathic rapport and permeable internal boundaries. b. empathic rapport and communicative attunement. c. disconnection from oneself in order to take on the client’s feelings. d. imagining the feelings one would experience in the same or similar experience. 8. Understanding the client’s perspectives alone is not sufficient. The helper must also a. express verbally the helper’s sense of understanding of the client. b. mirror the client’s feelings without agreeing, disagreeing, reassuring, or denying. c. reflect on the immediate process in the helping session. d. engage in all of the above. 9. Which of the following statements does NOT accurately depict helper empathy? a. It sounds as though it has been really unsettling for you to change schools as a result of your parents’ divorce. b. You seem really hurt and confused about the break-up with your girlfriend. c. I’m so sorry to hear about the loss of your grandmother. d. I imagine that it was pretty difficult to break this news to your family. 10. Which of the following statements about client hidden shame is FALSE? a. Hidden shame is unacknowledged, repressed, or defended against. b. Hidden shame is associated with addiction, aggression, obsessions, narcissism, and depression. c. Hidden shame is due to excessive parental empathic attunement. d. Hidden shame tends to lead to self-loathing and/or unprovoked attacks on others. 11. Which of the following does NOT apply to the quality of positive regard? a. It also may be referred to as nonpossessive warmth. b. It contributes to a long-term working relationship. c. Neurobiological research has associated the insular cortex with the processing of information related to positive regard. d. It is reflected in lack of disagreement with the client. 12. All of the following are considered acceptance therapies EXCEPT: a. Acceptance and Commitment Therapy b. Cognitive Behavioral Therapy c. Dialectical Behavior Therapy d. Motivational Interviewing 13. The condition of being honest, transparent, open, and real with the client is known as a. positive regard. b. congruence or genuineness. c. accurate empathy. d. cultural and relational empathy. 14. It is important for helpers to offer congruent or genuine responses to the client in order to a. model the process of claiming one’s truths and speaking about them. b. foster authenticity and mutuality in the helping relationship. c. address persistent thoughts or feelings that may block the helper’s full acceptance of the client. d. provide an environment in which all of the above will occur. 15. Research has suggested that helpers are perceived more positively when they engage in __________ selfdisclosure. a. high levels of b. moderate levels of c. low levels of d. no 16. Generally, the most productive use of helper disclosure occurs when the focus is on a. the helper’s own issues and facts about the helper’s role. b. the helper’s own issues and reactions to the client. c. facts about the helper’s role and the helper’s reactions to the helping relationship. d. the helper’s reactions to the client and to the helping relationship. Helper sharing and feedback is most helpful to the client when it is constructed a. as an indirect and conditional statement acknowledging helper tentativeness. b. in the past tense with a focus on the ‘there’ and ‘then’. c. in the present tense with a focus on the ‘here’ and ‘now’. d. in the future tense with a focus on the ‘where’ and ‘when’. 17. 18. Which of the following is NOT accurate with respect to feedback statements? a. Feedback statements should focus on personality traits rather than behaviors b. c. d. According to Hepworth and colleagues (2010), tapes of helping sessions reveal limited helper responses highlighting client strengths and successes. Feedback statements should be constructed using the personal pronoun “I” to communicate acknowledgment and ownership. If the client responds defensively or with denial, this is a clue that the feedback was premature. 19. Identify the most probable sequence of helping experiences with a new client who has a history of discrimination, oppression, or betrayal. a. client guardedness, testing of helper, sense of safety, sense of trust, disclosure by client b. disclosure by client, sense of safety, sense of trust, client guardedness, testing of helper c. testing of helper, sense of trust, client guardedness, disclosure by client, sense of safety d. sense of safety, sense of trust, disclosure by client, client guardedness, testing of helper 20. In a study conducted by Bedi and colleagues (2005), clients highlighted the contribution of active listening, self-disclosure, encouragement, and validation of feelings to the establishment of a strong helping relationship. These client perceptions underscored the importance of __________ in the helping session. a. what the client says and does b. what the helper says and does c. what the client and helper say d. what the client and helper do ESSAY QUESTIONS: Please formulate your responses using complete sentences and paragraph format. (Instructors may opt for an open book response format.) 1. Imagine that you have identified a person-centered counseling approach as part of your counseling practice. Prepare a brief outline that you might include in your business brochure that would help potential clients understand the basic elements of this approach. 2. Compare and contrast the concepts of sympathy and accurate empathy. Include definitions of the two constructs, common and differentiating elements, and suggestions as to how counselors can hone their ability to attain and convey empathic understanding. 3. Discuss your understanding of the connection between mirror neurons and empathy. Where are mirror neurons located? With what part of the brain do they interact? How do they contribute to the experience of empathy? 4. Discuss the relevance of cultural and relational empathy to the helping relationship. How is the attainment of cultural and relational empathy facilitated? How does the absence of cultural and relational empathy detract from the helping process? 5. Explain how the three acceptance therapies described in this chapter promote the development of the therapeutic relationship and client change. 6. Define Rogers’s concept of congruence. How does congruence serve to enhance the helping relationship? In what manner might it detract from the helping relationship? How could you apply the steps of awareness and discernment to ensure that congruence is employed therapeutically? 7. Identify potential causes and impact of, and approaches to addressing client shame in a helping relationship. 8. Consider the different forms of helper self-disclosure. Which types of self-disclosing statements are most likely to contribute to the productivity of a helping session? What level of self-disclosure is optimal? When is helper self-disclosure contraindicated? 9. Imagine that a client that you have seen for five sessions repeatedly asks you about your personal life, including questions about your leisure time activities and composition of your family. What might you be hypothesizing about the client’s tendency to turn the focus of conversation to you as the helper? How might you respond to the client’s queries? 10. What are some considerations when offering positive feedback statements? Include suggestions about the message structure, benefits relative to negative feedback statements, and appropriate timing and focus. Prepare five examples of positive feedback statements that you might offer to hypothetical clients. Provide a brief statement of the client background and presenting issue for each feedback statement (e.g., high school senior from a middle-class family of parents and three siblings who wishes to strengthen her assertiveness skills). RECOMMENDED READINGS Bein, A. W. (2008). The Zen of helping. Hoboken, NJ: John Wiley & Sons. Brammer, L. M., & MacDonald, G. (2003). The helping relationship (8th ed.). Boston: Allyn & Bacon. Breggin, P., Breggin, G., & Bemak, F. (Eds.). (2002). Dimensions of empathic therapy. New York: Springer. Chi-Ying Chung, R., & Bemak, F. (2002). The relationship of culture and empathy in cross-cultural counseling. Journal of Counseling and Development, 80, 154–159. Clark, A.J. (2007). Empathy in counseling and psychotherapy. NY: Erlbaum. Cowan, E. W., Presbury, J., & Echterling, L. (2013, Feb- ruary). The paradox of empathy: When empathy hurts. Counseling Today, 56–61. Hepworth, D. H., Rooney, R. H., Rooney, G. D., & Strom-Gottfried, K. (2013). Direct social work practice (9th ed.). Belmont, CA: Brooks/Cole, Cengage. Johnson, D. W. (2014). Reaching out: Interpersonal effectiveness and self-actualization (11th ed.). Upper Saddle River, NJ: Pearson Education. Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press. Pedersen, P., Crethar, H., & Carlson, J. (2008). Inclusive cultural empathy. Washington D.C.: American Psychological Association. Siegel, D. (2010). The mindful therapist. New York, NY: Norton. Zur, O., Williams, M., Lehavot, K., & Knapp, S. (2009). Therapist self-disclosure and transparency in the Internet age. Professional Psychology, 40, 22-30. Handout Masters Helper Self-Disclosure DILEMMA The client is faced with a painful, isolating experience such as: failure to accomplish a desired goal loss of employment serious illness of self or loved one loss of a loved one to illness or accident termination of a friendship parental separation or divorce dissolution of partnership (e.g., intimate relationship) Note that painful experiences invariably incur a sense of loss. HOW TO ADDRESS THE DILEMMA Will the client feel unburdened and relieved to know that someone else has shared a similar experience? or Will the client feel upstaged or that his/her experience has been diminished by another’s disclosure? or Will the client feel that the helper has endured far greater pain and loss, thus leading to a sense of selfishness on the part of the client and guilt about further burdening the helper? Since this is difficult to predict, consider a tentative and fairly general sharing statement. “I am trying to imagine just how painful this must be for you. When I found myself in a similar situation, I also found it extremely difficult to negotiate all the painful thoughts and feelings.” This type of statement makes the client aware that you have also endured difficult circumstances without taking the focus off the client by elaborating on the details. The statement validates the client’s psychological distress and offers some normalization of the client’s responses without detracting from the uniqueness of the client’s experience. Handout Masters Goals of Helper Self-Disclosure When a Client is Overwhelmed by Distress • lessening of the client’s feelings of isolation • continuing to acknowledge the uniqueness of the experience • validating the client’s psychological state (shock, denial, distress, anger, grief) • normalizing only to the extent that the client is relieved by the similarity of his/her experience to those who have gone before • gently alluding to the universality of challenging life experiences rather than comparing to an n = 1 (helper’s) experience STRATEGIES TO AVOID • suggesting that the client’s path of healing and recovery will be similar to that of the helper “I’ve been there too. It’ll be rough, but you’ll get through it.” • prescribing procedures for healing “This was really helpful for me. You might want to try it.” • imposing a timeline for healing “I was over it in about a year; you should be too.” STRATEGIES THAT CLIENTS MAY BE OPEN TO • responding to client questions with normative examples based on professional experiences and understanding about the particular concern “Yes, it does happen that after losing a loved one, a person may report having seen and talked to the deceased person. It doesn’t mean that you are going crazy.” “It is very common for children to hope that their parents will get back together, even if one or both parents have entered into new relationships.” Chapter 2 1) c 2) d 3) a 4) b 5) c 6) a 7) b 8) d 9) c 10) c 11) d 12) b 13) b 14) d 15) b 16) d 17) c 18) a 19) a 20) b