The Skilled Helper

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The Skilled Helper

• Gerard Egan

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Rational Problem Solving

• Initial Awareness
• Urgency
• Search for remedies
• Estimation of costs
• Deliberation
• Rational decision
• Rational emotive decision
• Yankelovich (1992)

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Overall aims of counselling as a skilled helper
Egan, 2002

• Provide a quiet confidential environment
• Enable the client to talk openly about themselves
  without being judged
• Help the client gain greater awareness of
  themselves and their situation
• Focus on ways to help them manage their problems
  and develop opportunities

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The Three Stage Model

• Stage one The problem situation as it is.
• Stage two The clients preferred scenario.
• Stage three Action programs.

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Stage I Current Scenario What's going on?

• 1. Goal Help clients fully understand their
  current situation
• a) Helping clients tell their story
• b) Identifying blind spots in the clients
  perception
• c) Focusing on strengths rather than weaknesses
• 2. In psychology this is essentially the
  diagnostic interview however, we will can help
  clients give better information and understand
  their own situation better when we apply
  counselling skills

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A. Step A Helping the client tell his/her
story

• 1. Goal Help clients be specific about their
  experience and actions so they understand their
  story more fully
• 2. Key micro-skills
• a) Basic Empathy validate clients feelings
  create setting where client feels safe sharing
  feelings
• b) Probes ask questions that guide the client to
  examine their feelings, experiences, behaviours
• c) Summaries help keep clients on target and
  moving forward in telling their story

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Step B Identifying blind spots

• Goals Help the client see inconsistencies in the
  story identify roadblocks to success
• 2. Key microskills
• a) Basic Empathy Summaries reflect to the
  client what you heard so client can consider the
  situation from a different perspective
• b) Probes Challenges ask focused questions
  that encourage the client to examine the
  situation (and their own role) more critically

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Step C Leveraging / Picking Issues to
Address

• Goals Help clients decide which issues to work
  on, based on need, readiness, resources
• 2. Key microskills
• a) Summaries present the clients entire
  situation so they can judge which area they want
  to address and whether they are ready
• b) Probes Ask clients about resources (internal
  and external) that may be available to help
• c) Problem-solving Teach clients the process of
  problem-solving so they can be more proactive

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Stage I Case Example

• Scenario A year 11 adolescent to her school
  counsellor My class doesn't like me, and right
  now I dont like them! Why do they have to be so
  mean? They make fun of mewell, they make fun of
  the way I talk. Ive been going to speech therapy
  and I know Im doing a lot better. I wish theyd
  stop making fun of me.
• What do you say next?!?

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Responses that dont help

• Probes that keep us at the information level of
  rather than moving toward solutions
• (1) What types of things do they say?
• (2) How long as this been going on?
• (3) Who is teasing you ?

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Responses that dont help cont

• Responses that ignore the clients feelings or
  rely on persuasion rather than empathy
• (1) Im sure they dont mean anything by it
• (2) Just ignore them

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Rule 1 RememberIf a client expresses a
feeling, respond to it!

• a) At first, this may seem awkward, but you will
  rapidly find that validating the clients
  feelings encourages her to provide more
  information
• b) How do we respond to that feeling? Use a Basic
  Empathy Response!
• c) After we validate the feeling, we can move on
  to other responses to gather more information,
  provide information, challenge blind spots, etc

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Basic Empathy Responses

• Using the formula
• (1) You feel angry / hurt because theyre making
  fun of you over something you cant help.
• (2) You feel upset because they wont accept you
  as you are.
• Using my own words
• (1) It bugs you that they wont accept you as you
  are
• (2) Youre mad that theyre teasing you about
  your speech rather than getting to know you

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Other Helpful Responses

• Probes that may help the child identify blind
  spots in her perspective
• (1) How have you responded when they tease you?
• (2) What have you done to try to solve the
  problem?
• b) Summary / Probe aimed at problem-solving
• (1) It sounds like youve been teased by other
  kids about your speech, and youve tried to
  explain to them that theres nothing you can do
  about it.

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Stage II Preferred Scenario

• Goal Help clients identify what they want for
  their future and what they are willing to do in
  order to achieve that future
• a) Identifying possibilities for the future
• b) Setting the agenda for change
• c) Making a commitment to the process
• 2. This is the stage most often overlooked by
  helping professional we need to help clients
  think about where they want to GO before we help
  them get there

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Step A Identifying Possible Futures

• Goal Help clients identify possible outcomes for
  the future that they may not have considered (in
  other words, what do you want?)
• 2. New Microskills and Characteristics that
  Support Stage II
• a) Future-oriented probes Focuses client on
  preferred outcomes (rather than actions)
• b) Brainstorming Helps clients identify
  possibilities they have not previously considered
• c) Creativity Not a skill, but a characteristic
  that can be encouraged through microskills

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Advanced Skill Future-Oriented Probes

• Goals
• a) Help clients focus on the preferred scenario
  and think about what they want
• b) Help clients take ownership for making changes
  in their lives that are aimed at a goal
• c) Help clients focus on outcomes not process
• d) Help clients regain hope for a future they
  desire rather than focusing only on the problem
  they are currently facing

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Examples

• a) What would this situation look like if you
  were managing it better?
• b) What changes in your present lifestyle make
  sense?
• c) What would you be doing differently with the
  people in your life?
• d) What behaviour patterns would be in place that
  are not currently in place?
• e) What current behaviour patterns would be
  changed?
• f) What would you have that you dont have now?
• g) What would this opportunity look like if you
  developed it?

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Advanced Skill Brainstorming

• Goal Help clients open up new possibilities
• 2. Rules for Brainstorming
• a) Suspend judgment help clients suspend theirs
• b) Come up with as many possibilities as possible
• c) Do not criticize any suggestions just record
  them
• d) Encourage quantity, worry about quality later
• e) Use one idea as a takeoff point for another
• f) Help clients let go and develop wild
  possibilities
• g) When you run out of ideas, put the list aside
  and come back to it later to try some more

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Creativity Helps Clients (and Clinicians) Solve
Problems

• Some characteristics of creative people
• a) Optimism / confidence / hope
• b) Acceptance of ambiguity and uncertainty
• c) Tolerance of complexity
• d) Willingness to take risks
• e) Divergent thinking (there is always another
  option)

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Characteristics that may hinder progress

• Fear,
• Fixed habits,
• dependence on authority,
• perfectionism,
• difficulty taking risks

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Step A help clients discover possibilities for
a better future cont

• Step A. Summary
• Develop a sense of hope
• Look at possibilities
• Brainstorming possibilities for future
• If you know what u want then you can see problems
  and solutions clearer.

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Step B Set Agenda for Change

• Goal Select outcomes the client might work
  toward (turn possibilities into goals) (in other
  words, what do you really want?)
• 2. Key Microskill Summaries help clients review
  the options they brainstormed and set their goals
  for the future
• 3. A warningMaintain the focus on outcomeswere
  not yet talking about what they can do were
  still talking about they want for their lives

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Step B. Help clients craft problem-management
goals cont

• Sort through possibilities and prioritise them.
• Goals need to be
• Specific
• Measurable
• Achievable
• Realistic
• Time frame

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Good intentions to Specific Goals.

• Help clients move from good intentions through
  broad aims to specific goals
• a) Good intentions I need to do something about
  my speech
• b) Broad aims Adds content to what the client
  wants to work on. I want to be able to
  communicate better.
• c) Specific goals States exactly what the goal
  looks like. I want to be able to give clear
  presentations.

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Step C Making a Commitment

• Goals Help clients set goals that dont cost
  more than they are worth (in other words, what
  are you willing to pay for what you want?)
• 2. Key Microskills
• a) Basic Empathy Response Help clients clearly
  hear and understand the goals they are
  considering
• b) Probes May need to help client identify
  resources to help them achieve the desired
  outcomes
• c) Challenges May need to help client be very
  realistic about what they are willing to do

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Evaluating Goals and Commitments

• Questions to ask clients about goals
• (1) What is your state of readiness for change in
  this area at this time?
• (2) To what degree are you choosing this goal
  freely? / Whats pushing you to choose this goal?
• (3) To what degree are you choosing this goal
  from among a number of possibilities?
• (4) How highly do you rate the appeal of this
  goal? / In what ways does the goal not appeal to
  you?
• (5) In what ways can the goal be reformulated to
  make it more appealing?

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Questions on client commitment

• What is my state of readiness for change in this
  area at this time?
• How badly do I want what I say I want?
• How hard am I willing to work?
• To what degree am I choosing this goal freely?
• How highly do I rate the personal appeal of this
  goal?

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• The goal is to ensure that the client is
  committing himself freely, willingly and with an
  understanding of the true costs of the commitment
  

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Stage II Example

• Yr 11 student is still being teased about her
  speech. She has expressed her frustration, we
  have validated her feelings, and she has
  recognized that she hasnt done enough to try to
  solve the situation in a constructive way.
• How can we help this client move toward a future
  she wants?

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Responses that dont help

• Moving too quickly toward action strategies
  solves the problem the way we would want it
  solved, not the way the client wants it solved.
• a) Have you tried?
• b) You should just tell them!
• c) The best way to handle this is to!
• d) Just tell your teacher!
• e) Lets bring one of them to speech so theyll
  understand what youre going through!

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Focusing on the Future

• Future-oriented probes help the client think
  about what she wants
• (1) What would like to see happen in this
  situation in the future?
• (2) What would the situation look like if it were
  less problematic?
• (3) What do you wish they would do instead?
• (4) (Note that none of these focus yet on what
  the client should do to solve the problem)

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Opening up Possibilities.

• Brainstorming helps clients think about futures
  havent considered
• (1) List all possible desirable futures you can
  think of
• (2) Dont be afraid to be wild and creative

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Examples

• (1) Theyd stop teasing her
• (2) Theyd be her friend
• (3) Theyd be nicer to her overall
• (4) Theyd start trying to help her fit in
• (5) Shed stop worrying about being teased
• (6) Shed know what to say to people when they
  tease her

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Selecting the Desired Outcome

• Turn Possible Futures into Specific Goals
• (1) Review the possible futures identified in the
  brainstorm activity
• (2) Make sure each goal is stated specifically

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Examples

• (1) I want to know what to say to people when
  they tease me
• (2) I want to be able to talk to my classmates
  without being teased about my speech.
• (3) I want to be able to meet people without
  worrying about what theyre thinking about my
  speech

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Stage II and action

• Work of Step A. developing possibilities may be
  enough to identify needs and wants and a few
  possible goals, then move into action.
• For other clients Step B. is a trigger for
  action. They see the future in a different way.
• For some clients the search for incentives and
  commitments is the trigger for action- a what's
  in it for me will move them into action.

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Are they ready?

• a) Is she ready to let go of her anxiety about
  speech?
• b) Is she willing to acknowledge her speaking
  difficulty openly and freely ?
• c) Is she able to try different responses when
  people tease her to see what works?
• d) Can she pursue this goal even if is hard to
  do?
• (1) What roadblocks does she anticipate?
• (2) Is she willing to take risks to overcome
  these roadblocks?

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Stage III Action Strategies What do I have to
do to get what I need or Want?

• Goal Help clients identify actions that will
  help them achieve the preferred outcome
• a) Making a list of possible actions
• b) Determining which actions provide the best fit
• c) Formalizing a plan for achieving those goals

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Step A Identify Possible Actions (Finally we can
talk about what to do)

• 1. Goal Help clients identify different possible
  courses of action to achieve the outcome selected
  in Stage II
• 2. Key microskills
• a) Brainstorming To open up new possibilities
• b) Probing To help clients focus on resources
  that may help them achieve their goals

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Step A. Help clients review possible strategies
to achieve goals.

• If task is difficult, Driscoll offers the
  following
• Alternatives are best sought cooperatively, by
  inviting our clients to puzzle through with us
  what is or is not a more practical way to do
  things. But we must be willing to introduce the
  more practical alternatives ourselves, for
  clients are often unable to do so on their own.
  Clients who could see for themselves the more
  effective alternatives would be well on their way
  to using them. That clients do not act more
  expediently already is in itself a good
  indication that they do not know how to do so
  (1984, p. 167).

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Develop a framework

• Develop a framework for stimulating clients
  thinking about strategies.
• Individuals what individuals can help?
• Models and exemplars who is currently doing what
  client wants?
• Communities What community of people are there
  that can help?
• Places Are there places that can help?
• Things What things exist that can help?
• Organizations Are organisations available to
  help?
• Programs are there ready-made programs for
  people in clients position?

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Social Support

• Social support is a key element in change.
• Social support has been examined as a predictor
  of the course of mental illness. In about 75 of
  studies with clinically depressed patients,
  social-support factors increased the initial
  success of treatment and helped patients maintain
  their treatment gains. Similarly, studies of
  people with schizophrenia or alcoholism revealed
  that higher levels of social support are
  correlated with fewer relapses, less frequent
  hospitalizations, and success and maintenance of
  treatment gains (see Behavioral Science Step
  Force of the National Advisory Mental Health
  council, 1996, p.628)

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Explore support networks

• To explore support networks, at action arrow use
  questions such as
• Who might help you do this?
• Whos going to challenge you when you want to
  give up?
• With whom can you share these kinds of concern?
• Whos going to pat you on the back when you
  accomplish your goals?

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Linking strategies to action

• Step A. should stimulate action on the part of
  the client.
• Many clients, once they begin to see what they
  can do to get what they want, begin acting
  immediately.
• They dont need a formal plan.

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Step B Selecting the Best Fit

• Goal Help clients select actions that will move
  them toward their goal
• Guidelines Keep goals realistic, specific,
  consistent with clients values, etc
• New microskill Balance Sheet Helps clients
  evaluate the strategies they are considering

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Criteria

• Criteria for selecting goal-accomplishing
  strategies similar to step B.
• Specific specific enough to drive behaviour.
• Substantive challenge the clients resources and
  when implemented achieve the goal.
• Realistic can be carried out with the resources
  the client has, are under the clients control and
  are unencumbered by obstacles.
• Keeping with the clients values not counsellors.

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Step B. Help clients choose strategies that best
fit their resources cont

• Strategy Sampling
• Sample possibilities.
• Balance Sheet method (costs/benefit exercise)
• Not to be used with every client
• Tailor to needs of client.
• Use relevant parts as probes eg how will this
  decision affect you? Significant others?

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Advanced skill Balance Sheet Method

• a) What are the benefits of choosing this
  strategy? For me? For others?
• (1) To what degree are these benefits acceptable?
• (2) In what ways are these benefits unacceptable?
• b) What are the costs of choosing this strategy?
  For me? For others?
• (1) To what degree are these costs acceptable?
• (2) In what ways are these costs unacceptable?

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Step C Making a Plan

• Goal Help clients develop a specific plan for
  putting selected strategies into place
• 2. How plans help
• a) Without a plan, clients may remain stuck due
  to a lack of direction they may try different
  things but it will not be focused or
  goal-directed
• b) Plans help clients anticipate obstacles,
  consider solutions, incorporate resources
• c) Plans help clients move toward action

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Step C. Helping clients make plans.

• After id and choosing strategies to accomplish
  goals, clients need to organise these into a
  plan.
• A plan is a clear step- by- step action program
  of accomplishing a goal or a set of goals.
• Counsellors help clients develop a plan and the
  sequence of actions i.e. What should I do first,
  second and third etc? that will get them what
  they want, their goals.
• A plan can emerge whilst discussing possible and
  best-fit strategies.

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Step C. Helping clients make plans cont

• Shaping the plan three simple questions
• What are the concrete things that need to be done
  to accomplish the goal or sub-goal?
• In what sequence should these be done? What
  should be done first, second, and third?
• What is the time frame? What should be done
  today, What tomorrow, what next month?

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Step C. Helping clients make plans cont

• Humanizing the technology of constructive change.
• Planning is often not as neat as described in
  textbooks.
• Most clients too impatient to work with planning
  outlined.
• May set realistic goals, but no discipline to
  develop reasonable plans.
• Cannot be too pedantic, mechanistic or awkward in
  your attempts to help clients engage in these
  steps run the risk of alienating clients.

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Step C. Helping clients make plans cont

• Principles to guide constructive change process
• Build a planning mentality into the helping
  process from the start.
• Adapt the constructive-change process to the
  style of the client.
• Devise a plan for the client and then work with
  the client on tailoring it to his or her needs.

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Stage III Example

• Our year 11 client has decided that her first
  goal is to learn how to respond when people tease
  her. This will require her to be more open about
  her speaking difficulties and to be willing to
  try different responding techniques until she
  finds one that will work.
• How can we help her plan her actions?

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Brainstorm

• Brainstorm a list of all possible actions she
  might take to help her become more open about her
  speaking difficulties
• a) Begin to talk to people about speech
• b) Invite friends to speech therapy
• c) Invite non-friends to speech therapy
• d) Exaggerate her speaking difficulties
• e) Give a class presentation
• f) Find other people who have speech difficulties

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Evaluate Costs and Benefits

• a) Telling others about speech
• (1) Cost Possible embarrassment Benefit
  Desensitization, education of others
• (2) Worth it? YES (if she works up to handling
  the embarrassment)
• b) Try different responses to teasing (Specific
  responses still need to be selected)
• (1) Cost Might make a mistake, make it worse
  Benefit May help to reduce teasing
• (2) Worth it? YES, depending upon the response

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Make a Plan

• Action 1 Invite best friend to therapy
• (1) Select a friend, role-play the request
• b) Action 2 Develop responses to teasing
• (1) Brainstorm responses and role-play
• (2) Try them with easy partner evaluate
  success
• (3) Use them in real-world situation
• c) Action 3 Plan classroom presentation
• (1) Prepare content in therapy room role-play

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Action!

• Goal Helping the client achieve the goals set in
  Stage III that are focused on the future defined
  in Stage II that solves the problem identified in
  Stage I
• 2. Using counselling strategies will help clients
  become more successful at achieving action
• a) Identifying facilitating and restraining
  factors
• b) Adjusting action plans to overcome roadblocks
• c) Evaluating and enhancing motivation

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Moving from Planning to Action!

• Goal To achieve their desired outcome, clients
  must have a clear strategy in mind (their plan)
  and they must be able to adapt it to the specific
  situations they face (flexibility).

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Key skills and resources

• 1. Self-contracts agreement specifying
  goal-directed feelings, behaviours, and thoughts
• 2. Self-help groups strength in numbers, in
  being with those who are working on similar goals
• 3. Feedback helps the client stay on track

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Thoughts about Action!

• 1. If the client is engaging in action, we have
  done a good job of matching needs to goals to
  plans.
• 2. If not, we need to consider other strategies
  for supporting action
• a) Overcome procrastination
• b) Reinforce incentives / rewards for action
• c) Develop backup-plans
• d) Move toward independence

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Overcoming Roadblocks To Action

• 1. There are many possible roadblocks
• a) Inertia Without effort, things stay the same
• b) Entropy Without tending, plans disintegrate

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Overcoming Roadblocks To Action cont

• Try not to blame difficulty just on motivation
• a) Low motivation may just be a sign of
  reluctance
• (1) Are the goals still consistent with the
  clients desires?
• (2) Is the cost of accomplish the goals too
  great?
• (3) Is the task harder than the client expected?
• b) Low motivation is a sign that the we should
  revisit the helping model and check our plan.

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Action Example

• Our Yr 11 client has selected her plan
• a) Invite friend to therapy
• b) Practice responses to teasing and try them
• c) Prepare classroom presentation

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Action Example cont

• The next step is to help her monitor her progress
  and ensure that she is moving in the right
  direction.
• How do we do it?

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Action Example cont

• Some strategies for ensuring action
• a) Encourage her to make a self-contract
  specifying the timeline for taking action
• b) If she is having difficulty, encourage her to
  identify roadblocks and brainstorm solutions
• c) Review the incentives for taking action if
  they are not sufficient, increase the reward
• d) Incorporate hierarchies aimed at the goals so
  she can take small steps in the right direction

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Case Summary.

• By using counselling skills within the context of
  the helping model, we helped the client
• A. Identify and understand the current situation,
  including blind spots in her perception
• B. Evaluate desired outcomes and select the ones
  she wants and is willing to work for
• C. Develop a specific plan for achieving her
  desired outcomes and preparing for success
• D. Continually monitor her progress and make
  adjustments in her plan as necessary

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Summary

• Counselling is not a separate aspect of therapy
  it is simply the way we interact with clients
  (all clients on all issues)
• Microskills for attending, listening, responding
  can become incorporated into all aspects of our
  interaction (both professional and social)

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Summary cont

• Clinicians and clients should always know where
  they are in the process of change
• The helping model can help everybody keep track
  so they are always moving forward

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Questions ?