Write a paper on how to use four helping skills that you learned in class that you find interesting and research how to use them when dealing with a difficult client or diagnosis that you find difficult. Chapter 18 of the book integrates all the information provided in class and can be used as part of your references for your paper. Remember to also use at least four peer review articles for your references.
Ex. Using self-disclosures (one out of four skills) with reluctant clients (difficult client or diagnosis)
Hill, C. (2020) Helping Skills. Facilitating Exploration, Insight, and Action. 5th Edition. Publisher: American Psychological Association
Print ISBN: 9781433831379, 1433831376
Putting It All Together: Working
With Clients in the Three-Stage
Model
Helping Skills: Chapter 18
Session Management
• Each helper has a different style
• Each client has different needs & reactions
• Each clinical setting has different policies & procedures
There is no “right” way to implement the helping model!
Intakes
• Gather information about:
• Client demographics
• Presenting concerns
• Background information/psychosocial history
• Health & medical history
• Risk factors
• Expectations for therapy
(Whiston, 2005)
Intakes
• Helper will be more directive given that they are gathering
information
• Helper still needs to be using attending & exploration skills
• At the end of the intake, helpers ask clients if they want to commit to
becoming involved in the helping process
• If clients are uncertain, helpers might suggest they meet for 3-6 sessions &
then re-evaluate
Work Between Sessions
• Listen to audio recordings and watch video recordings of sessions
• Write process notes to facilitate the recall of the salient issues that
were covered during the session
• Look for underlying themes & recurring patterns across all the
problems the client discusses
Work Between Sessions
• Educate yourself about theories & research to obtain a framework
with which to understand client dynamics
• Read about the client’s culture and the client’s issue
• Consult with supervisors
Process Notes
• Manifest content: what the client talked about
• Underlying content: unspoken meanings in what the client said
• Defenses & barriers to change: how the client avoids anxiety
• Client distortions: ways in which clients respond to you as they have
to other significant persons in their lives (i.e., transference)
• Countertransference: ways in which your emotional, attitudinal, &
behavioral responses may have been stimulated by the process
• Personal assessment: your evaluation of your interventions; what you
would do differently and why
Subsequent Sessions
• Beginning the session
• Develop a focus for sessions
• The working phase of helping
• Ending sessions
Beginning the Session
• Helpers might sit quietly & wait for clients to talk about what is on
their minds (although, they might need to educate clients that they
are expected to bring in material to begin the session)
• Helpers might summarize what took place in the former session, start
by asking how the client felt about the previous session, or simply ask
what the client would like to talk about during the session
Develop a Focus for Sessions
• Clear focus typically involves a specific incident or behavior
• Focus should not be too vague or too diffuse
• Ask what is troubling clients now
• If it is not possible to get the client to focus, the lack of focus in itself
becomes the important issue for the session that the helper needs to
talk about with the client
Develop a Focus for Sessions
• Helpers must respect the client’s decisions about the focus of the
sessions
• Use a combination of skills to help clients focus
• Although the focus stays on the problem, helpers also facilitate client
exploration of how the concern is affected by & influences other parts
of the client’s past, present, & future life
• Keep the focus on the client
The Working Phase of Helping
• Respond to issues that clients bring up in each session
• Cycle through exploration, insight, & action with many problems to help
the client begin to be able to do this process independently
• There are many phases of the work, depending on the individual client
• During longer term therapy, in addition to working on clients’ presenting
problems, there is also often a focus on the therapeutic relationship using
immediacy skills
Ending Sessions
• Helpers need to begin & end sessions on time to set clear boundaries
• Can say something to end the session like, “Our time is up for today”
• Might reinforce clients for what they have accomplished in the
session & encourage them to think about carrying these changes over
to their lives outside of therapy
Termination
• Separation & termination is inevitable
• It is time to end after helpers & clients have accomplished as much as
they can within the confines of their contracted relationship
• One goal of therapy: prepare clients to leave therapy & become selfreliant
When to Terminate
• Sometimes imposed by external time limits
• Open-ended, long-term therapy: helpers & clients ideally together
decide when they are ready to end
• Sometimes clients directly tell helpers they are ready to terminate
• Other times, helpers have to suggest to clients that they think they
are ready to terminate
• Crucial for helpers to have discussions with clients about what they
are getting out of treatment & how they feel about continuing
• Clients can return to work with helpers at another time
How to Terminate
• Be clear in the beginning about length of treatment
• Spend considerable time in planning & preparation
• Challenging for both helpers & clients
• Termination often brings up issues of loss for helpers & clients
• Some clients may experience intense sadness but struggle with how
to thank the helper & show appreciation
• Some clients may be disappointed about still having unresolved
problems
• Some clients quit prematurely to avoid thinking about termination
How to Terminate
• Looking Back
• Review what clients have learned & how they have changed
• Clients can provide feedback
• Most & least helpful aspects of therapy process
• Looking Ahead
• Discuss future plans
• Consider need for additional therapy
• Review ongoing goals
• Saying Goodbye
• Share feelings about ending & say farewells
Share Your Thoughts
What will it feel like to stop working with a client?
Referrals/Transfers
• Clients might need a referral for an area of expertise the helper does
not have (e.g., eating disorder, substance abuse)
• Clients might need referrals for medication, long-term therapy,
assessment of learning disabilities, financial assistance, housing
information, spiritual guidance, legal advice, etc.
• Transfer: helpers facilitate the process of switching to someone else
for treatment
Helper needs to explain the reason for the referral or transfer to the
client
Dealing with Difficult Clients and Clinical
Situations
• Reluctant or resistant clients
• Clients who are angry
• Clients with suicidal ideation
• Sexual attraction
Reluctant or Resistant Clients
• Most clients have at least some reluctance to change
• Some possible roots of reluctance: lack of trust, fear of falling apart, shame,
fear of change, lack of motivation to change (Egan, 1994; Young, 2001)
• Resistance is more active than reluctance
• Resistant clients often present as not needing the help & feeling misused
• Might try to manipulate the helper
• Clients who come to therapy because they are forced to do so are often
resistant
Reluctant or Resistant Clients
• Helpers often become confused, panicked, angry, guilty, or depressed
(Egan, 1994)
• Become aware of your self-defeating attitudes & assumptions to
reduce their influence on the therapy process
• Helpers need to find creative ways to deal with reluctance &
resistance
Clients Who Are Angry
• Stressful when clients are angry at you & express it in a direct and
hostile way
• Client anger often disrupts the therapy process
• Respond to anger as you would respond to any other emotion by
encouraging clients to talk openly about it
• Listen nonjudgmentally & nondefensively
• If clients are justified, helpers can apologize & alter their
inappropriate or unhelpful behaviors
• Try to understand the client’s anger
• Consult with supervisors
Clients With Suicidal Ideation
• Actively & directly assess seriousness of suicide risk
• Ex: “Do you have a plan and/or means for attempting suicide?”
• Clients might need to be hospitalized
• Some clients might instead develop a written behavioral contract
• In some cases it may be useful to notify the client’s family, close
friends, or significant others
• Helpers can provide numbers of crisis hotlines & assist clients in
identifying support systems
Clients With Suicidal Ideation
• By talking about suicidal feelings, clients can bring their worst fears
into the open & feel like someone listens and understands them
• Clients often appreciate that helpers take their problems seriously
• Mobilizing other resources is crucial
• Seek supervision & therapy after dealing with the aftermath of a
client’s suicide
Sexual Attraction
• Helper feels sexually attracted to client
• ~87% of surveyed helpers reported that they have been sexually attracted to
a client at some point in their careers
• Feeling attracted is not unethical, but acting on the attraction can harm
clients & is thus unethical
• Supervisor can assist you in working through these feelings
• Client feels sexually attracted to helper
• Helper needs to strike a balance between allowing clients to express their
feelings & not actively encouraging the attraction
• Of course, any sexual contact in or outside of session is unethical
• Consult with a supervisor
• Self-reflect
Share Your Thoughts
How can you remain empathic while dealing with
difficult clinical situations?
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