2022-11-17 Thu 09:23 AM ![[moses_colorful_cross_section_of_a_human_head_inside_are_many_sm_0a1cbce7-2f2e-4b76-8689-d2d2e583e772.png]] From [[z.Attachments/Process of Psychotherapy Workbook 2022-2023.pdf|Process of Psychotherapy Workbook 2022-2023]]. I think it's fair to say that these are ordered roughly from low to high on the [[Spectrum of therapeutic directiveness]]. Eg, silence is a very non-authoritative intervention; reframing is quite high on authoritativeness. But the reason for this ordering is probably just that it takes more skill to be more directive and not fuck it up. FALL COUNSELING SKILLS ========================= Session I 1. Opening & closing a session 2. Genuine caring respectful tone (non-judgmental presence) 3. Attentive non-verbal skills 4. Appropriate use of silence 5. Mirroring (body, tone, & energy level) 6. Reflective comments on content (what) 7. Reflective comments on process (how & anything else going on in room not expressed yet) 8. Paraphrasing 9. Summarizing 10. Clarifying ========================= Session II 11. Accenting (highlighting a key word, phrase or image) 12. Prompt (tell me more about…) 13. Use of open-ended questions (absence of why or yes/no questions) 14. Acknowledging (naming aloud the speaker’s feelings) 15. Showing empathetic understanding verbally of the speaker’s thoughts, ideas, experience 16. Following/ Tracking the speaker WINTER COUNSELING SKILLS (In addition to fall) ========================= Session I 17. Commenting on or forming reflections based on body language and non-verbal language 18. Deepening, staying with, and returning to feelings 19. Paying attention to speaker’s responses 20. Noting themes & connections 21. Use of present-centered awareness (bringing speaker into here and now) 22. Use of Immediacy (using the immediate situation, to invite the speaker to look at what is going on between them) 23. Use of self, internal witnessing (becoming aware of my direct experience in the presence of the speaker) 24. Use of metaphor or image, symbol SPRING COUNSELING SKILLS (In addition to fall & winter) 25. Refocusing 26. Redirecting 27. Reframing 28. Noting discrepancies 29. Capacity to meet and hold strong affect 30. Recognizing and making use of transference and countertransference 31. Meeting a challenging moment (show ability to meet the unknown, to not know, to be corrected) 32. Showing confidence for the present level of skill --- **Process 1** - While the therapist’s work will vary from client to client, the primary healing factor is the therapeutic relationship. The therapeutic relationship is based on trust, a nonjudgmental atmosphere, as well as the embodiment of the therapeutic [[Rogers' core conditions of counseling]], and the use of fundamental powerful counseling tools. - Each quarter, students will be introduced to a set of counseling skills. Many of these skills will seem awkward and unnatural to implement at the beginning of your Active Listening sessions. However, like any new professional practice, it takes time and experience to feel comfortable and confident in their application. Students will practice in Active Listening—groups of two—one student plays the role of the “therapist” and the other student, or participant, plays the part of the “client.” **P1 Session I - skills below** 1. Opening & closing a Session - In Active Listening, the student establishes the container of Active Listening. The student needs to inform the speaker of the limits of the exercise. The student tells their partner that the activity is not therapy and is limited to thirty minutes. Additionally, the student informs the speaker that what they say will be held in confidence. The student may want to share that they are required to write a paper on the session with the focus on the student’s process as a listener. It is also essential to inform your partner that they are free to speak about whatever they choose and may stop at any time. The student might also want to inform the speaker that this exercise is a practice of counseling skills, and while this is not therapy, it may feel like it. - "What's here?" - "What's up right now?" - Just wait - "Thank you." - "Is this a good place to stop?" 2. Genuine, caring, and respectful tone (non-judgmental presence) - Students will practice the [[Rogers' core conditions of counseling]], as highlighted in the required reading. Please review the Core Conditions, and the guidelines for these Active Listening found in your Process of Psychotherapy Workbook. 3. Attentive non-verbal skills - What is the student listener communicating to their partner through body language and other non-verbal communication? What are facial expressions conveying; judgment, disbelief, concern, trust? The student must consider the tone of voice, mannerisms, and gestures; are they expressing interest, a presence of being? Remember, the therapist is always communicating, even when only listening. - It is important to note that the student also uses body language to communicate. Be aware that the use of eye contact, gestures, smiling, proxemics (distance between listener and speaker) and touch are always present. Remember that different cultures have different perceptions of appropriate proxemics and body language. 4. Proper use of silence - Note to student: Be aware of your reaction to silence in the Active Listening. How are these moments for you as the listener? Do you feel the need to rush in with a verbal response? Are you comfortable with no one speaking for a while? Remember, silence can be a significant time in the therapeutic field for reflection, and to process what is present in the Active Listening room. How do you utilize silence as a tool to deepen your partner’s process? - Not all silence is golden. Silence may be a concern if it is being used as a defense for what is not being said. However, it is important that the student does not push their partner to reveal or address that which they are not ready to bring into the container. Trust the process, honor your partner’s emotional defenses, honor the guards! It is also possible that silence may occur because the speaker is going too deeply into their material. This is where it is essential for the student to bring the speaker back into the room. - When to use silence - When their unconscious is on the go. Its about not interfering. They dive, they come back up with insight. Wait some more. Break silence when they want to connect. - When *you* (the counselor) need to process - When to break silence - When they want to connect - If they appear stuck — unconscious not on the go. Might say, "Do you need me to ask you a question?" 5. Mirroring (body, tone, & energy level) - The student’s role as listener develops the skill and ability to match internally and externally the speaker’s body language, and the energy level in such a way as to deepen the student’s empathy. Please keep in mind that the listener matches appropriate external energy and tone. It should also be noted that this is not to be confused with the self-object mirroring experience in Self Psychology. 6. Reflective comments on content (what) - A Reflective comment is what is being said. Reflective comments by the listener are essential. The student must listen to not only what is being said, but also the words expressed. This may lead to significant insight into the speaker’s internal process. 7. Reflective comments on process (how & anything else going on in room not expressed) - Reflecting comments are how content is conveyed. The listener may verbally reflect body language, facial expressions, voice, or other forms of non-verbal communication. Remember, what is said is only a small fraction of what is being expressed. 8. Paraphrasing - Paraphrasing provides feedback and can be used to communicate that the student is following what the speaker is saying. Paraphrasing uses the student’s ideas or images and can be a reflection of both content and process in a nonjudgmental way. 9. Summarization - Summarizing can help in keeping the student and their partner on the same track and is particularly helpful after a lengthy or complicated response from the speaker. Summaries can indicate that the speaker is being held and heard authentically by the student. Summarizing can also be used to put together themes, feelings, stories, and bring closure to an Active Listening session. - It's orienting. Bird's-eye view. 10. Clarification - Clarifications can be used to illuminate uncertainties, such as unclear or vague thoughts, feelings, or content. It can also be used if the listener wants to make sure they are following the speaker accurately. Clarifications also demonstrate to the speaker that they are being listened to with interest and attentiveness. **P1 Session II - skills below** 11. Accenting (highlighting a key word, phrase, or image) - Highlighting a keyword, phrase, or image that the speaker has expressed verbally to the listener. Accenting intends is to deepen the speaker’s process by drawing attention to the charged material. 12. Prompt (“Tell me more about...”) - A prompt usually begins with the words, “Tell me more about...” The intent is to highlight and deepen the current material being discussed with the speaker. 13. Use of open-ended questions (absence of *why* or yes/no questions) - Open-ended questions begin with what, would, could, how, and are helpful to elaborate a more in-depth response from your partner. This skill is used to facilitate and explore your partner’s content. It may also help the student to clarify and explore the speaker’s feelings and thoughts. Open-ended questions can be used very effectively with practice and necessary self-reflection. Avoid leading questions as they may contain an agenda with an embedded answer. This can be viewed as a detour. - At this point, refrain from using why questions, as they may cause the speaker to intellectualize, feel confronted, and become defensive. Avoid asking more than one question at a time. This is called stacking. Be cautious of asking too many questions, as the Active Listening session may feel like an interrogation. - Avoid yes/no questions at this point in your Active Listening work. Practice taking a yes/no question and rewording it as an open-ended question with the intent of becoming more adept at this critical skill. - Why not ask "why"? In Jungian terms, only the conscious brain does cause and effect. 14. Acknowledging (naming aloud the speaker’s feelings) - The listener names the speaker’s feelings and names what is in the room, i.e., fear, grief, anger, shame, happiness, love. If you move away from or are unable to acknowledge feelings, this is an indication of material for your therapy. 15. Showing empathetic understanding of the speaker thoughts, ideas, experience - How is empathy being communicated to the speaker? How does the student convey caring and understanding in a manner that is both genuine and respectful of the speaker’s feelings and content? 16. [Proactively] Following and tracking the speaker - The ability to monitor and track the speaker becomes apparent with the application of the skills listed above. However, the critical point to emphasize is, are you accurately following and tracking your partner? Or are you leading with new topics? Any other detours? Remember, the way you listen will influence the way your partner responds. It is essential that you regularly examine and track your process as you implement the Fall Counseling Skills. Ultimately, the question for the therapist is this: How do you listen? And perhaps a life-long question, which may vary from client to client: How should you listen? **Process 2** **P2 Session I – skills below** 17. Commenting on or forming reflections based on body language and non-verbal language - Empathic or active listening requires practice and goes far beyond merely listening to content. As discussed in the last quarter, much of what is communicated to you by your partner is non-verbal. As you move into Process II, are you beginning to use skills to interpret what is being said through body language? Notice your partner gestures, body movements, eye contact, voice, facial expressions, posture, and proxemics. How might you employ clinical skills to form reflections based on your observations? - Always be aware that different cultures have different norms and customs concerning non-verbal communication. Be sensitive to how these may differ from your own. Do not pathologize. Be mindful of your internal witness for judgments and biases. 18. Deepening, staying with, and returning to feelings - This skill is self-evident but can be a challenge. Once again, use your inner witness to reflect your internal process. Be aware of how you respond to your speaker’s material. Can you stay with difficult material, or do you find yourself moving away from intense feelings? Knowing when to deepen and when to hold back is an important skill in itself. - If the content is too extreme, this is usually an indication that a referral is needed. Conversely, this might also indicate material for your therapy. - It is important to note, that if you find yourself discussing content which you find goes beyond your comfort level, do not deepen, but rather move to another area or end the Active Listening session and make a referral to a licensed therapist. - "Let's stay here" / "Can we stay here?" 19. Noting themes and connections - This skill becomes possible if you work with a partner more than once. What appears to be recurring in the partner’s material? Are you, as the listener, able to connect fragments of the speaker’s dialogue that deepens understanding? - You may also recognize themes that return to past subject matter. Notice constant patterns. For example, when does the speaker change the subject or move away from challenging material? 20. Use of Present-Centered Awareness (bringing speaker into the here-and-now) ["now"] - Present-Centered Awareness asks the client to be fully cognizant of, and attentive to the experience occurring in the consultation room. The focus of this awareness may be directed inwardly toward the objective psyche, or it may be directed to the outer world. However, as life is experienced through the mechanisms of our humanness (the senses, thoughts, and emotions), Present-Centered awareness is usually directed at aspects of the experiencing self in the here-and-now. - Present-Centered Awareness has many names such as; bare attention (Goldstein, 1976), listening to oneself (Rogers, 1961), living in the moment (Perls, 1970), be here now (Ram Dass, 1972), and mindfulness, (Thich Nhat Hanh, 1992). - During Process II, you will experience Present-Centered Awareness as a result of what Daniel Siegel (2010), calls being mindful, that is, “being more conscientious and intentional in what we do... being aware of the present moment without grasping onto judgment—being mindful is a state of awareness that enables us to be flexible and receptive and have presence” (p. 1). 21. Use of Immediacy (using the immediate situation, to invite the speaker to look at what is ["us"] - What is going on at the present moment between the student and their partner? What is in the room at the moment? Immediacy occurs when the therapist talks openly about an Active Listening dynamic. It may be non-verbal communication, the speaker’s material, or the experience of each other. Immediacy in the here-and-now occurs on many levels: - What is happening within the process of the student? The student must know what is felt empathically, and to distinguish material that is activated in their speaker from their own. - What is the shared experience between the listener and the speaker? What is occurring between the listener and the speaker in the present moment? - What images are present and in the room from the objective psyche? - [The relationship between the therapist and client — bringing it between us. Telescopes it, catches it in net. Eg: "I'm afraid of my mother." "Are you afraid of me as well?"] **P2 Session II – skills below** 22. Use of self, internal witnessing (becoming aware of the direct experience in the presence of the speaker) - Become aware of the direct experience in the presence of the speaker and how to use this awareness to deepen the Active Listening experience using clinical skills. How might the activation of the student be employed in service of the speaker? 23. Use of metaphor or image, symbol - Use the speaker’s metaphors, images, and symbols in connection with their process. This may be accomplished using other skills such as accenting, prompting, reflections, and other skills. - While this may be helpful, it is not recommended to use images that may be occurring for the student at this point. This can lead to a detour. The student must only listen and practice clinical skills using the speaker’s images. **Process 3** **P3 Session I** 25. Refocusing - Help the speaker to stay focused on their process and the material discussed. Refocus the speaker if he or she moves away from their material and toward the exterior or other people. Refocusing may be accomplished by commenting on the speaker’s process, or by redirecting the Active Listening to previous relevant content. 26. Redirecting - Return to previous themes, topics, or discussions in current or past Active Listening. - What's the difference between refocusing and redirecting? - From class on 2023-05-07 Sun - Lot of overlap between the two - Perhaps refocusing is a 'smaller' move and redirecting is a 'bigger' move. 27. Reframing - This skill is used to change the conceptual perspective of a client. This skill is not a beginning therapy skill and is employed only when a client is unable to see beyond their present point of view. In other words, reframe allows the client to see the situation from a different angle. Reframing is a powerful change stratagem. It changes the client’s perceptions, and thus may then affect their actions and attitude. - Class 2023-05-07 Sun 10:29 AM - Can be a denying move, has a shadow side. So gotta be aware - When to use, when not? - When a client has self-image, self-esteem issues, can be useful - Stylistically, can be offered with more or less [[Spectrum of therapeutic directiveness|therapeutic directiveness]] - Children and teens can get stuck in the dominant narratives of their millieu. 28. Noting discrepancies - This sophisticated skill requires the student to bring attention to incongruence between verbal and non-verbal body language. This is usually noteworthy when the speaker says one thing verbally, but their non-verbal expression suggests (facial expression, body language) something entirely different. The student might also note inconsistencies or contradictions of ideas, purpose, or beliefs. - Class notes 2023-05-07 Sun 10:48 AM - Sometimes you can note it explicitly and the client will get it and see it with you, - And sometimes the person will meet it with their defenses. This might be a sign that they're not ready 29. Capacity to meet and hold strong affect - The ability to meet and hold strong affect is similar to the Winter Counseling Skill of deepening and staying with returning to feelings. The listener can witness, empathize, and stay with a speaker as they process sensitive material, and can name what is in the room. - Class 2023-05-07 Sun 11:18 AM - The process 3 skills are framed as "use with caution" / "not for beginners". Why does this one show up again here? - Maybe there's a [[Chesterton's fence]] thing: if you have the instinct to dodge, maybe that instinct was due some respect. 30. Recognizing and making use of transference and countertransference - Transference: What feelings or thoughts are being transferred on to the student Active Listening listener? What projections is the student receiving? - Countertransference: What are the student listener’s thoughts and feelings toward their partner? What are the student’s projections onto their partner? What unconscious emotional response is the student having to the speaker? These questions and your observations can be used to deepen the Active Listening encounter. - Class notes 2023-05-07 Sun 11:57 AM - Is it true? There are two orthogonal things: - To what degree is it "true"....does it really show up in the person. The hook, how big or small, in the person. How true or not - To what degree can I be aware of the projection here. [[All perceptions are projections]] - The more naive move is to treat these two as lying on a continuum — either x is more like a projection, or x is more like a feature of reality. As if it's a single zero-sum spectrum. 31. Meeting a challenging moment (show ability to meet the unknown, to not know, to be corrected) - The ability to meet and hold the unknown, to hold the unconscious moment without offering a detour. Put simply as the ability not to know. 32. Showing confidence for the present level of skill - The current level of skill development will be evaluated in classroom discussions, required papers, and in the final Observed In-Class Active Listening. **Detours and Tendencies** - Advising/Giving solutions - Directing/Leading - Consoling/Over-sympathizing - Judging/Criticizing - Interpreting/Analyzing - Moralizing/Preaching - Inappropriate Self-disclosure - Being defensive - Stereotyping - Praising/Agreeing - Interrogation - Warning/Promising - Withdrawing/Distracting - Humoring/Diverting