As mentioned above, among the calls received by the Hotline in connection with emergencies, there are those that contain an explicit or hidden request for psychological assistance. The mode of operation of the Hot Line does not always imply the possibility of in-depth processing of these requests due to objective circumstances (the Hot Line employs specialists who do not have a psychological education; in the first hours of the Hot Line, when the main request is informational, a very large amount of number of hits). However, in any case, the identification and recognition of such requests is the responsibility of the Hot Line employee, and working with them is the responsibility of a psychologist.
Persons experiencing acute grief, loss.
Persons experiencing fear and anxiety for the physical or emotional state of the injured relative/relative.
Persons who have received information that their relatives/relatives are listed as missing or have conflicting and insufficient information about the fate of their loved ones.
Persons who have received information that their relatives/relatives located in the emergency zone cannot be provided with immediate assistance.
Persons with relatives who have lost their relative/relative or who are not yet aware of the death of their relative/relative.
Persons who have experienced psychological trauma as a result of their presence at the scene of an emergency at the time of its occurrence (among them may be those who received light physical injury, as well as witnesses and eyewitnesses of the incident).
Persons experiencing strong Negative consequences Emergency situations, expressed in the appearance of pronounced phobic and depressive reactions, panic attacks and other psycho-emotional problems.
Persons experiencing the loss of property, forced relocation, relocation, significant deterioration in living conditions in the absence of information about resources and opportunities to overcome vital problems.
Counseling clients in emergency situations.
If a person who has recently experienced an extreme situation contacts the emergency psychological help line, the following approaches can be recommended to the consultant in working with such a subscriber:
Encourage the client to talk about their feelings.
Don't expect a man to handle trauma better than a woman.
Remind the client that their feelings are normal. Give information about normal reactions to a stressful situation.
Do not try to assure the client that everything will be fine - this is impossible.
Don't try to force your explanations on the client as to why things happened.
Try to convince the client that it doesn't matter why he got into this situation, what matters is that he got out of it (transition from the category of "victim" to the category of "hero").
Don't tell the client that you know what he's going through.
Be prepared not to speak at all. It may be sufficient to simply "be with the client".
Don't be afraid to ask how the person deals with trauma. But don't ask questions about the details of the injury. If the client talks about it, listen to him. The best thing you can do in this situation is to follow the client.
Subscribers experiencing the negative consequences of emergencies, manifested in the occurrence or exacerbation of psychological problems, should be advised to seek further face-to-face consultation with a specialist.
Example
In connection with the explosion in the subway car, which occurred as a result of a terrorist act, a woman who was in the next car at the time of the explosion called at the main line. She asked for help to overcome her fear of her upcoming subway ride tomorrow. The woman said that she had to pass through the station at which the explosion occurred almost daily and now she is considering possible options for using land transport. But it will make it very difficult for her. The subscriber complained that the thought of the need to travel by metro seized her with fear that she could not control, although she did not reject reasonable arguments that it makes no sense to expect a repetition of the explosion. The woman asked the Hotline specialist to recommend to her what she could do to reduce her fear. Since the subscriber was aware of the irrationality of her own fear reaction and well understood the reason for its occurrence, the Hot Line specialist discussed with her the features of the manifestation of her fear reaction in connection with the general patterns of manifestation of such reactions, which have both positive and negative influence of the fact of having the ability to experience fear. He also gave practical recommendations aimed at creating several options for her plan of action in case fear arises at the time of a trip to the subway, so that the subscriber could be aware of her own freedom to choose a predetermined practical method and thus feel that she can influence the situation of occurrence fear, control it. Also, the Hotline specialist recommended that the woman seek an in-person consultation if her problem persists for a long time. If the subscriber felt fear at the time of the call, the Hotline specialist would have to choose a different strategy, as well as if the subscriber was already experiencing a psychological or psychiatric problem, exacerbated by the emergency.
Witnesses, third-party observers, people who are not directly related to the emergency, but who learned about it from the media, may also experience experiences similar to those of the direct participants in the events and need psychological help. In working with them, it is advisable to use the same methods and approaches.
Subscribers who witnessed the events of an emergency, or who received minor injuries and returned home after receiving outpatient care, as a rule, indicate a direct request for psychological help themselves if they feel the need for it. Sometimes their relatives may call with such a request. If it is not possible to provide psychological help such subscribers in a face-to-face meeting, you need to provide assistance by phone. If possible, you should first determine the severity of the negative emotional state of the subscriber. Any expression is the best reaction from such subscribers. In some cases, it is enough just to listen to him, but sometimes it is necessary to discuss with him his current emotional experiences and what he can do with them now and in the future to alleviate his condition. In some cases, such a subscriber should be referred for face-to-face consultation and such an opportunity should be arranged for him.
Example
A young woman called the hotline, which was opened in connection with an explosion at the airport as a result of a terrorist attack. She asked to listen to her and said that she was in an overwhelmed emotional state. The woman said that at the time of the explosion, her 7-month-old son and elderly mother were separated from her and she, without seeing them, assumed that they had died, based on the fact that she left them to wait in the exact place where the explosion occurred. By a happy coincidence, the elderly woman, tired of standing, stepped aside with her child to sit down, and this happened just before the explosion. During that time, while the young woman, having heard the explosion, returned to the place where she left her loved ones, she experienced a strong emotional shock. She found her mother and son alive and well, but the effects of the emotional upheaval appeared after she and her family returned home. The young woman needed to communicate with the Hot Line specialist, since she could not calm down on her own.
The Hotline specialist listened to the young woman, the story of her experiences and feelings in connection with what had happened, asking questions as the subscriber described the circumstances of the situation. Since the subscriber behaved expressively and fully stated everything that she felt and experienced, then at the end of communication with the Hot Line specialist, she managed to come to thoughts and feelings leading to an understanding of the situation. Her emotional state became more balanced.
Techniques psychological counseling
Asking questions
Obtaining information about the client and encouraging him to introspection is impossible without skillful questioning.
As you know, questions are usually divided into closed and open questions. Closed questions are used to obtain specific information and usually require a one or two word answer, affirmative or negative ("yes", "no"). For example: "How old are you?", "Can we meet in a week at the same time?", "How many times have you had fits of anger?" etc.
Open-ended questions are not so much about learning about the lives of clients as they are about discussing feelings. Benjamin (1987) notes:
"Open questions widen and deepen contact; closed questions limit it. The former open the doors wide to good relationships, the latter usually leave them closed."
Examples of open questions: "Where would you like to start today?", "How do you feel now?", "What made you sad?" etc.
Open-ended questions provide an opportunity to share your concerns with the consultant. They give the client responsibility for the conversation and encourage him to explore his attitudes, feelings, thoughts, values, behavior, i.e. his inner world.
Ivey (1971) highlights the main points of counseling when open-ended questions are used:
- The beginning of the consultation meeting ("Where would you like to start today?", "What happened during the week that we did not see each other?").
- Encouraging the client to continue or complete what was said ("How did you feel when this happened?", "What else would you like to say about it?", "Can you add anything to what you said?").
- Encouraging the client to illustrate their problems with examples so that the counselor can better understand them ("Can you explain any particular situation?")
- Focusing the client's attention on feelings ("What do you feel when you tell me?", "What did you feel when all this happened to you?").
We should not forget that not all clients like open-ended questions; for some, they increase the sense of threat and increase anxiety. This does not mean that such questions should be avoided, but they should be carefully formulated and asked at the right time when there is a chance of getting an answer.
Counseling uses both closed and open questions, but the importance of surveys should not be overestimated in general. Benjamin (1987) points out:
"I am very skeptical about using questions in a conversation and I feel like I'm asking too many questions, often meaningless ones. We ask questions that upset the client, interrupt him, and questions that he may not be able to answer. Sometimes we even we ask questions knowingly not wanting to receive answers, and as a result we do not listen to answers.
Although questioning is an important technique in counseling, however, paradoxically, I dare say that excessive questioning should be avoided in counseling. Any question must be justified - asking it, you need to know for what purpose it is asked. This is a very difficult problem for the novice consultant, who often worries too much about what else to ask the client, and forgets that, first of all, the client must be listened to. If interrogation is turned into the main technique of counseling, then counseling will turn into interrogation or investigation. In such a situation, the client will leave the consultant's office with the feeling that he was not so much understood and called to emotional participation in the counseling contact as interrogated.
Too much questioning in counseling creates many problems (George and Cristiani, 1990):
- turns the conversation into an exchange of questions and answers, and the client begins to constantly wait for the consultant to ask about something else;
- forces the consultant to take full responsibility for the course of counseling and the topics of the problems discussed;
- moves the conversation from emotionally colored topics to a discussion of the facts of life;
- "destroys" the mobile nature of the conversation.
For these reasons, budding consultants are generally discouraged from asking clients questions, except at the very beginning of counseling.
There are a few other rules to keep in mind when asking questions to clients:
- Questions "Who, what?" most often focused on facts, i.e. questions of this type increase the likelihood of factual answers.
- Questions "How?" more focused on a person, his behavior, inner world.
- Questions "Why?" often provoke defensive reactions of clients, so they should be avoided in counseling. Asking a question of this type, most often you can hear answers based on rationalization, intellectualization, since it is not always easy to explain the real reasons for one’s behavior (and “why” questions are primarily directed at them), due to many rather contradictory factors.
- It is necessary to avoid posing several questions at the same time (sometimes other questions are included in one question). For example, "How do you understand your problem? Have you ever thought about your problems before?", "Why do you drink and fight with your wife?" In both cases, it may not be clear to the client which of the questions to answer, because the answers to each part of the double question may be completely different.
- The same question should not be asked in different formulations. It becomes unclear to the client which of the options to answer. Such behavior of the consultant when asking questions indicates his anxiety. The consultant should "voice" only the final versions of the question.
- You can’t ask a question ahead of the client’s answer. For example, the question "Is everything going well?" most often encourages the client to give an affirmative answer. In this case, it is better to ask an open question: "How are things at home?" In such situations, clients often take the opportunity to give a vague answer, such as: "Not bad." The consultant needs to clarify the answer with another question of this type: "What does "not bad" mean to you?" This is very important, since we often put quite different content into the same concepts.
Encouragement and soothing
These techniques are very important for creating and strengthening the consultative contact. You can cheer up the client with a short phrase indicating agreement and/or understanding. Such a phrase encourages the client to continue the story. For example: "Go on", "Yes, I understand", "Okay", "So", etc. A fairly common positive reaction is "Yeah," "Mmm." Translated into the language of speech, these particles would mean: "Go on, I am with you, I am listening to you attentively." Encouragement expresses support - the basis of a consultative contact. A supportive atmosphere in which the client feels free to explore the anxiety-provoking aspects of the self is especially recommended in client-centered counseling.
Another important component of client support is reassurance, which, together with encouragement, allows the client to believe in himself and take risks by changing some aspects of the self, trying out new ways of behaving. It is too short phrases counselors agreeing: "Very good", "Don't worry about it", "You did the right thing", "Everyone feels the same way from time to time", "You're right", "It won't be easy", "I don't I am sure, but I think that you can try", "I know it will be difficult, but you not only can, but you must do it", etc.
However, when talking about calming the client, we must not forget that, like any technique, this method can be used correctly and incorrectly. Common mistake"soothing" is that the consultant offers himself as a "prop" to the restless client. This limits the ability of the client to solve their problems on their own. Personal growth is always associated with a sense of uncertainty and a certain dose of tension and anxiety. Also, if sedation is used excessively and too frequently, i.e. begins to dominate in counseling, it creates a dependence of the client on the consultant. In this case, the client ceases to be independent, does not seek his own answers, but completely relies on the consultant's approval, i.e. does nothing without the consent of the consultant. The counselor should also not forget that if he overuses the phrase “everything will be fine” common in our everyday vocabulary, considering it to be calming, the client will begin to feel a lack of empathy.
Reflection of Content: Paraphrasing and Summarizing
To reflect the content of the client's confessions, it is necessary to paraphrase his statements or summarize several statements. The client is thus convinced that he is carefully listened to and understood. The reflection of the content also helps the client to better understand himself, to understand his thoughts, ideas, attitudes. According to Hill (1980), this is the most widely used counseling technique regardless of the counselor's theoretical orientation.
Paraphrasing is most appropriate early in counseling because it encourages the client to discuss their concerns more openly. However, on the other hand, it does not deepen the conversation enough, Ivey (1971) identifies three main purposes of paraphrasing:
- show the client that the consultant is very attentive and tries to understand him;
- crystallize the client's thought by repeating his words in a compressed form;
- check the correctness of understanding the client's thoughts.
There are three simple rules to remember when paraphrasing:
- Paraphrasing the main idea of the client.
- You can not distort or replace the meaning of the client's statement, as well as add something from yourself.
- "Parrot" must be avoided, i.e. verbatim repetition of the client's statement, it is desirable to express the client's thoughts in your own words.
A well-paraphrased thought of the client becomes shorter, clearer, more specific, and this helps the client to understand what he wanted to say.
Paraphrasing examples:
Consultant: You have an internal struggle for further self-determination in life, and it is difficult for you to decide which of the two paths is more correct today.
Client: This year, misfortunes follow one after another. My wife was sick, and then that accident that overflowed the cup, and now this operation of my son ... It seems to me that the troubles will never end.
Consultant: It seems that the problems will never end and you ask yourself if this will always be the case.
A generalization expresses the main idea of several unrelated statements or a long and intricate statement. Summarizing helps the client to organize his thoughts, remember what was said, encourages consideration of significant topics and promotes adherence to the sequence of counseling. If the paraphrase covers the client's statements just made, then the whole stage of the conversation or even the entire conversation is subject to generalization, Ivey (1971) indicates situations in which generalization is most often used:
- when the counselor wants to structure the beginning of the conversation in order to integrate it with previous conversations;
- when the client speaks very long and confusingly;
- when one topic of conversation has already been exhausted and a transition to the next topic or to the next stage of the conversation is planned;
- in an effort to give some direction to the conversation;
- at the end of the meeting, in an effort to emphasize the essential points of the conversation and give a task for a period of time until the next meeting.
Reflection of feelings
Emotions, feelings in counseling and psychotherapy, according to Bugental (1987), are like blood in surgery: they are inevitable and perform a cleansing function, stimulate healing. Feelings are very important in the process of counseling, but they are not an end in themselves, although it is strong feelings that help achieve goals: fear, pain, anxiety, pity, hope, etc.
Cognition and reflection of the client's feelings seems to be one of the most important counseling techniques. These processes are more than technology, they are an indispensable component of the relationship between two people. The reflection of feelings is closely related to the paraphrasing of the thoughts expressed by the client - the only difference is that in the latter case, attention is focused on the content, and when reflecting feelings, on what is hidden behind the content. Wishing to reflect the feelings of the client, the consultant listens carefully to his confessions, paraphrases individual statements, but also focuses on the feelings expressed by the client in confessions.
It is important to pay attention to the balance of facts and feelings in a counseling conversation. Often, succumbing to the passion of questioning, the consultant begins to ignore the feelings of the client.
For example:
client: My husband and I have been friends since childhood and got married after graduation. I thought what a wonderful married life would be! But everything turned out to be completely different ...
Consultant: How many years have you been married?
In this case, it seems that the consultant is more interested in the formal fact of the duration of the marriage, and not in how the client experiences her married life. Continuing the conversation could obviously be more productive, let the consultant continue the confession, or, catching an extended pause, ask him the question: "What does" completely wrong "mean to you?"
There is a rule in counseling that when asking about feelings, the client will often tell facts from life, but when we ask only about life events, there is practically no chance of hearing anything about feelings. This rule clearly indicates the priority of questions about feelings and the essential role of reflecting feelings in counseling. This is a necessary condition for maintaining the counseling contact in client-oriented therapy.
Reflecting the feelings of the client, the consultant focuses on the subjective aspects of his confessions, trying to help the client understand his feelings and (or) experience them more fully, more intensely, deeper. Reflection of feelings means that the consultant is like a mirror in which the client can see the meaning and meaning of their feelings. Reflection of feelings contributes to the emergence of interpersonal, emotional contact, because it shows the client that the consultant is trying to know his inner world. Effective reflection of feelings helps the client to better understand their often conflicting feelings and thereby facilitates the resolution of internal conflicts.
For example:
client: It is difficult not only to talk about it, but even to think about it. For a long time I have not had any relationship with men, and now I do not know how to treat the opportunity that has arisen.
Consultant: It's sad to see how you are afraid and avoid what you say you would like.
client: Without a doubt. I don't know if it suits me. He seems very sweet and has everything I would like. I dont know...
Consultant: Your senses are now in turmoil. You can't decide if you really want this man.
client: Yes. And it always happens when I think about it. If someone takes care of me and is good to everyone, I run away from him, when someone does not want me, I want him. What a porridge! Will I ever change position?
Consultant: You feel confused, wondering if you should always try to run away when someone cares about you.
The desire to reflect feelings involves recognizing them. To do this, it is necessary to pay attention not only to the content of the client's story, but also to his emotional tone, posture, facial expression. It is also important to remember that feelings can lurk not only in what is said, but also in what is not told, so the consultant must be sensitive to various hints, silences, pauses.
Reflecting feelings, one should take into account all the emotional reactions of the client - positive, negative and ambivalent; directed at oneself, other people and the consultant. To accurately reflect feelings, it is important to use many concepts that define a variety of sensory nuances.
In counseling, it is important not only to reflect feelings, but also to generalize them. It allows you to determine the emotional tone of the conversation, to synthesize the emotional aspects of the client's experience. Very often in a conversation we come across conflicting, and sometimes polar feelings in relation to situations or objects of love that are significant for the client. Here, the generalization of feelings is very valuable in order to show the client the real unity of opposites in the emotional sphere.
Speaking about feelings in counseling, we can formulate several general principles that cover not only the reflection of the client's feelings, but also the expression of feelings by the consultant:
- The consultant is obliged to identify as fully and accurately as possible the feelings of both his own and clients.
- It is not necessary to reflect or comment on every feeling of the client - every action of the counselor must be appropriate in the context of the counseling process.
- Be sure to pay attention to feelings when they:
- cause problems in counseling or
- can support the client, help him.
In the first case, fear, anxiety, anger, hostility are especially prominent. For example, a client's anger may be blocking normal communication, so this feeling ("You seem rather angry today") should be brought to their attention so that the discussion can help remove the barrier to maintaining counseling contact. Such a discussion also makes sense for the client, as it helps him to accept the normality of his negative feelings, as well as to reduce their intensity. It is also important to help the client express negative feelings because it is easier for the client to control openly expressed feelings. In the second case, we provide the client with emotional support. For example, if a client who finds it difficult to leave work early shows up for a consultation meeting on time, this should be noted: "It's good that you were able to come on time!" Or when a client with prolonged depression says that she was able to get out of bed, clean her room, and cook dinner for herself, we, understanding the significance of the event, should rejoice with her at the successful “progress” in overcoming depression.
- The consultant must also express own feelings arising in a counseling situation. Their occurrence is a kind of resonance to the experiences of clients. As S. Rogers says, "what is most personal is most general." By listening to the feelings that arise in the course of counseling as a reaction to the behavior of the client, the counselor can gain a lot of valuable information about him. Expression of feelings helps to maintain deep emotional contact, in which the client better understands how other people react to his behavior. However, the counselor should only express feelings related to the topic of the conversation. Sometimes the client himself wants to know about the counselor's feelings. And on a very frequently asked question: "I would like to know how you feel with me?" - no need to rush to answer. It is better to answer such a question with the question: "Why are you asking me about this?", "What do you think about this?". In counseling, the client's feelings are always more important than the consultant's.
- Sometimes it is necessary to help clients control their feelings, especially when they are too intense. This applies to both positive and negative feelings.
Pauses of silence
Most people feel embarrassed when the conversation ends and there is silence. It seems to be endless. In the same way, a novice consultant feels uncomfortable when there is a pause of silence in a conversation, because it seems to him that he constantly has to do something. However, the ability to remain silent and use silence for therapeutic purposes is one of the most important skills in counseling. Although silence in counseling sometimes means a breakdown in counseling contact, it can nevertheless be deeply meaningful. As everyone in everyday life knows, good friends do not have to talk all the time, and lovers spend a lot of time in silence, which only testifies to the depth of their relationship. For a counselor who has learned to be sensitive to different meanings of silence, to silence in general, and who has learned to consciously create and use pauses in counseling, silence becomes especially therapeutically valuable, because it:
- increases the emotional understanding of the consultant and the client;
- provides the client with the opportunity to "immerse himself" in himself and study his feelings, attitudes, values, behavior;
- allows the client to understand that the responsibility for the conversation lies on his shoulders.
Although the range of meanings of silence in counseling is quite wide, a distinction is usually made between "meaningful" and "meaningless" silence (Gelso and Fretz, 1992). In the latter case, the client's anxiety increases, he cannot sit still, he begins to get nervous.
What are the essential implications of silence in counseling?
- Pauses of silence, especially at the beginning of the conversation, can express the client's anxiety, poor health, confusion due to the very fact of counseling.
- Silence does not always mean the absence of real activity. During pauses of silence, the client can search the right words to continue his story, weigh what was discussed before, try to evaluate the guesses that arose during the conversation. The consultant also needs pauses of silence to reflect on the past part of the conversation and formulate important questions. Periodic pauses of silence make the conversation purposeful, since at this time the essential points of the conversation are mentally revealed, the main conclusions are summarized. Pauses of silence help not to miss important questions.
- Silence may mean that both the client and the counselor are hoping for a continuation of the conversation from each other.
- A pause of silence, especially if it is subjectively unpleasant for both the client and the consultant, may mean that both participants in the conversation and the whole conversation are at an impasse and there is a search for a way out of this situation, a search for a new direction for the conversation.
- Silence in some cases expresses the client's resistance to the counseling process. Then it has a manipulative meaning in relation to the consultant. Here the client is playing the game: "I can sit like a rock and see if he (the consultant) can move me."
- Sometimes pauses of silence occur when the conversation proceeds on a superficial level and discussion of the most important and significant issues is avoided. however, increase the client's anxiety.
- Silence sometimes implies a deep generalization without words, it is then more meaningful and eloquent than words.
The incomparable therapeutic value of silence is illustrated by Rogers (1951) with an example from his practice:
"I recently completed counseling for the strangest case I've ever seen (...). Joan was one of my first clients when I started weekly counseling at the local high school. To the school counselor, the girl said: "I'm so shy I can't even speak about your difficulties. Could you do it yourself?" So, before meeting Joan, the consultant told me that the girl's biggest problem is the lack of friends. The consultant also added that Joan is very lonely.
When I first saw the girl, she hardly talked about her problem and only mentioned her parents, whom she seemed to love. Our conversation was interrupted by very long pauses. The next four conversations would fit word for word on a small piece of paper. In mid-November, Joan said that "things are going pretty well." And nothing more. However, the consultant said that teachers notice an unusually friendly smile on Joan's face when they meet in the hallway. She hardly ever smiled before. The consultant herself rarely saw Joan and could not say anything about her contacts with other students. In December, a conversation took place during which Joan spoke freely. At other meetings, she only remained silent, squatting down, and seemed thoughtful, sometimes looking with a smile. An even greater silence reigned over the next two and a half months. After that, I found out that Joan was chosen as the "girl of the month" in her school. Selection criteria have always been sportiness and popularity. At the same time, I received a message: "I think I no longer need to visit you." Yes, of course, she does not need to, but why? What happened during those hours of silence? So my faith in the client's capabilities was tested. I'm glad I didn't doubt it."
This case shows that the consultant must allow the client to be in a consultative contact as he wants, and therefore, to remain silent.
Provision of information
The goals of counseling are also achieved by providing the client with information: the consultant expresses his opinion, answers the client's questions and informs him about various aspects of the problems discussed. The information is usually related to the counseling process, the behavior of the counselor, or the conditions of the counseling (place and time of meetings, payment, etc.).
Providing information in counseling is sometimes very important, as clients often ask a counselor a variety of questions. Particularly significant are the questions behind which lies the anxiety of clients about their future, health, for example: "Will we be able to have children?", "Is cancer inherited?". Customer puzzlement is significant not in itself, but in the context of its occurrence. Such questions should be taken seriously and the answers to them should be carefully considered. In no case should you turn questions into a joke and answer incoherently or even evade the answer. After all, personal problems of clients with accompanying anxieties and fears are hidden behind the questions. It is desirable to be competent and avoid simplifications so as not to lose the trust of customers and not increase their anxiety.
In providing information, the counselor should not forget that clients sometimes ask in order to avoid discussing their problems and exploring the self. In reality, however, it is not difficult to distinguish between questions that indicate a client's concern and an attempt to manipulate the counselor by questioning.
Interpretation
Almost everything leaves an imprint on the "image of personality." There is nothing meaningless and random even in the slightest movement of a person. The personality constantly expresses itself in words, tone of voice, gestures, posture, and it depends on the competence of the consultant whether he can "read" complex psychological writings. Each client is not an open book, but an unknown country where everything is new and difficult to understand at first. The technique of interpretation helps the consultant navigate in this unknown country - perhaps the most difficult method of counseling.
It is very important in counseling to bring out more than what is contained in the client's superficial narrative. The external content, of course, is also significant, but the disclosure of the latent content hidden behind the client's words is more significant. For this, narrative interpretation is used. Interpretive statements of the consultant give a certain meaning to the expectations, feelings, behavior of the client, because they help to establish causal relationships between behavior and experiences. The content of the client's story and experience is transformed in the context of the explanatory system used by the consultant. This transformation helps the client to see themselves and their life difficulties in a new perspective and in a new way. A. Adler said that a correct understanding of what is happening underlies adequate behavior. Well-known maxim of Socrates - "knowledge is action".
The essence of the proposed interpretation largely depends on the theoretical position of the consultant. In client-centered therapy, direct interpretations are avoided, not wanting to relieve the client of responsibility for the counseling process. Representatives of the psychoanalytic direction adhere to a completely opposite view of interpretation. Here, interpretive techniques are central, because in psychoanalysis almost everything is interpreted - transference, resistance, dreams, free association, silence, etc. Thus, psychoanalysts seek to more deeply reveal the psychodynamic meaning of the client's problems. In "Gestalt therapy" the client himself is encouraged to interpret his behavior, i.e. remains solely responsible for the explanation.
Hill (1986) identifies five types of interpretation:
- Establishing links between supposedly separate statements, issues, or events. For example, to a client who talks about fear public speaking, low self-esteem and difficulties in relationships with other people, the consultant points to the relationship of problems and the influence of inadequate expectations and claims of the client on their occurrence.
- Emphasizing any features of the behavior or feelings of the client. A client, for example, constantly refuses to work, although he expresses a desire to work. The counselor might say to him, "You seem to be excited about the opportunity, but when faced with the inevitable difficulties, you run away."
- Interpretation of methods of psychological defense, reactions of resistance and transference. In the above example, an interpretation is possible: "From our conversation, running away is a way for you to deal with the fear of failure." Thus, psychological protection (escape) from anxiety (fear of failure) is interpreted here. Transference interpretation is a basic technique in psychoanalytic treatment. They try to show the client that his past relationship (usually with his father or mother) interferes with the correct perception of the feelings and behavior of the consultant.
- Linking current events, thoughts and experiences with the past. In other words, the consultant helps the client to see the connection of current problems and conflicts with previous psychotraumas.
- Giving the client another opportunity to understand their feelings, behavior, or problems.
For example:
client: He does nothing at home, but all the time he goes to drink with friends. I am doomed to take care of the children and do everything around the house.
Consultant: It seems that in this way he saves you in a peculiar way from making a decision about your current and future life.
Practically in all listed types of interpretations the moment of explanation is obvious, i.e. The essence of interpretation is to make the incomprehensible understandable. Let us give as an example an explanation to the client of the concept of "agoraphobia" (Storr A., 1980):
“It follows from your story that the world has become dangerous for you since childhood, when your mother was afraid to let you go alone from home. Such a fear for a three-year-old child is not surprising, but over the years, self-confidence and risk appetite increase. The only abnormality of your fear is its duration."
This interpretation does not remove the neurotic symptom, but reduces anxiety by turning the symptom from an incomprehensible obstacle into a clearly established problem that can be solved.
Interpretation should take into account the stage of the consultative process. This technique is of little use at the beginning of counseling, when it is expected to build a trusting relationship with clients, but later it is very useful for uncovering the psychodynamics of problems.
The effectiveness of interpretation largely depends on its depth and timing. A good interpretation, as a rule, is not too deep. It should link to what the client already knows. The effectiveness of the interpretation is also determined by the timeliness, the willingness of the client to accept it. No matter how wise and accurate the interpretation is, if it is presented at the wrong time, the effect will be zero, since the client will not be able to understand the consultant's explanations.
The effectiveness of interpretation also depends on the personality of the client. According to S. Spiegel and S. Hill (1989), clients with a high level of self-esteem and education are more sensitive to interpretations and even in case of disagreement take them into account.
The consultant must be able to understand the reactions of clients to the essence of interpretations. The emotional indifference of the client should make the consultant think about the conformity of the interpretation with reality. However, if the client reacted with hostility and immediately dismissed the interpretation as implausible, there is reason to believe that the interpretation has touched the root of the problem.
Despite the importance of interpretation, it should not be abused; when there are too many interpretations in the counseling process, the client becomes defensive and resists the counseling. We must not forget that a consultant, like any person, can make mistakes, i.e. his interpretations are inaccurate or not true at all. Therefore, it is inappropriate to formulate interpretative statements in an authoritarian, categorically instructive tone. It is easier for the client to accept interpretations formulated as assumptions when he is allowed to reject them. It is best to begin interpretative statements with the words "I suppose", "probably", "why not try to look like this", etc. The hypothetical nature of the interpretations does not detract from their value, if they are accurate and acceptable to the client.
Confrontation
Every counselor has to confront clients from time to time for therapeutic purposes. Egan (1986) defines confrontation as any response by the counselor that is contrary to the behavior of the client. Most often, the confrontation is directed at the client's dual behavior: evasions, "games", cunning, apologies, "splurge", i.e. to everything that prevents the client from seeing and solving their pressing problems. By confrontation, they try to show the client the methods of psychological protection used in an effort to adapt to life situations, but which oppress, limit the formation of the personality. The focus of the confrontation is usually the client's interpersonal communication style, which is reflected in the consultative contact. The consultant draws attention to the techniques by which the client tries to avoid discussing important topics in counseling, distorts the topicality of his life situations, etc.
George and Cristiani (1990) identify three main instances of confrontation in counseling:
- Confrontation in order to draw the attention of the client to contradictions in his behavior, thoughts, feelings, or between thoughts and feelings, intentions and behavior, etc. In this case, we can talk about two stages of confrontation. The first one states a certain aspect of the client's behavior. On the second - the contradiction is most often represented by the words "but", "however". In contrast to the interpretation, confrontation directly points to the causes and sources of contradictions. With this type of confrontation, they try to help the client see the contradiction itself, which he did not notice before, did not want or could not notice.
For example:
Client: I was looking forward to today's meeting, because I have a lot to tell.
Consultant: Yes, but you were fifteen minutes late and have been sitting with your arms crossed for some time now.
A few more examples of conflicting statements from customers:
"I'm depressed and lonely, but it's not all that bad."
"I think that people should make their own decisions, but I constantly shower my children with advice on how to live."
"I think that I have excess weight but others say I look pretty good."
"I would like to listen to others, but for some reason I always speak more than anyone."
- Confrontation to help see the situation for what it really is, contrary to the client's idea of it in the context of his needs. For example, a client complains: "My husband got a long-term job because he doesn't like me." The real situation is that the husband changed his job at the request of his wife after long quarrels, because he did not earn much at his previous job. Now the husband earns enough, but is rarely at home. In this case, the consultant must show the client that the problem is not love relationships, and in the financial situation of the family, the need for the husband to earn more, although because of this he is often forced to be away. The client does not appreciate her husband's efforts to achieve great prosperity for the family and interprets the situation in a way that is convenient for herself.
- A confrontation to draw the attention of the client to his avoidance of discussing some problems. For example, a consultant expresses surprise to a client: “We have already met twice, but you don’t say anything about sex life, although during the first meeting you identified it as your most important problem. Whenever we approach the main topic, you step aside. I wondering what that could mean."
Confrontation is a complex technique that requires sophistication and experience from the consultant. It is often perceived as an accusation, therefore, it is applicable only with sufficient mutual trust, when the client feels that the consultant understands and cares about him. For correct use It is important to know and understand the limitations of confrontation techniques. Kennedy (1977) identifies several main cases:
- Confrontation should not be used to punish a client for inappropriate behavior. It is not a means for the counselor to express hostility.
- Confrontation is not intended to destroy the psychological defense mechanisms of clients. Its purpose is to help clients recognize the ways in which they protect themselves from the realization of reality. Finding and destroying psychological defense mechanisms is, unfortunately, one of the most common confrontational techniques in sensitivity training groups, from where this technique is borrowed. The style of psychological defense says a lot about the personality of the client, and understanding is more important here, not destruction, which annoys the client and causes his resistance. Before using the confrontation technique, it is important to understand the client's defense mechanisms and ask yourself:
- how deeply rooted and how long do these mechanisms last?
- What personal motives are hidden behind psychological protection?
- To what extent are protective mechanisms necessary for a person to successfully adapt to everyday life?
- what would happen without psychological defense mechanisms?
- Confrontation should not be used to meet the needs or self-expression of the counselor. Counseling is not a situation where the counselor has to demonstrate his wisdom and strength for the purpose of self-aggrandizement. The task of the consultant is not to defeat the client, but to understand him and provide assistance. Incorrect use of the confrontation technique often indicates that in the process of counseling, the specialist solves personal problems.
The use of confrontation in counseling must be justified by certain simple rules (Egan, 1986):
- it is necessary to carefully characterize the content of the client's inappropriate behavior and its context, but it is not worth saying everything at the same time; it should not be forgotten that this is not about presenting the analysis of the case to colleagues;
- it is necessary to explain in detail to the client and his relatives the consequences of conflicting behavior, including in the process of counseling;
- it is necessary to help the client find ways to overcome his problems.
Complementing the above rules, I would like to emphasize that the confrontation with the client should in no case be aggressive and categorical. It is advisable to use more often the phrases: “I think”, “please try to explain”, “if I am not mistaken”, which express certain doubts of the consultant and soften the tone of confrontation.
As a separate version of the confrontation, the interruption of the client's narrative deserves attention. While allowing the client to speak freely, the counselor must not forget that not all information is equally important, that some topics or questions should be deepened. A client interruption is possible when it "jumps" to other problems without exhausting the previous ones. If the client has changed the subject, the counselor may intervene with the remark, "I noticed that you changed the subject. Did you do it on purpose?" However, interrupting the narrative frequently is risky. When we do not allow the client to tell the way he wants, we usually do not achieve what we want. Most clients tend to succumb to the counselor's guidance, so constant interruption breeds addiction and it is then difficult to count on frankness.
Counselor Feelings and Self-Disclosure
Counseling always requires not only experience, insight, but also emotional involvement in the process. However, it is very important that emotional involvement be appropriate and serve the interests of the client, not the counselor. The desire to better understand the client's problems should not be accompanied by a loss of objectivity. As Storr (1980) says, "empathy without objectivity is as little value as objectivity without empathy." Jung (1958) writes:
“If a doctor wants to show someone the way or accompany a person even on an insignificant part of his path, he must know the soul of this person. Feelings cannot be combined with an assessment. It makes no difference whether the assessment is expressed or kept to oneself. it is impossible to agree with the patient without any objections - this also retracts, like condemnation. Sympathy is manifested only with impartial objectivity. "
The consultant, through the expression of his feelings, is revealed to the client. Opening up in the broadest sense means showing your emotional attitude to events and people. For many years, the prevailing view in counseling and psychotherapy was that the counselor should resist the temptation to reveal his identity to the client. This is generally not recommended for two reasons. First, when the client knows too much about the consultant, he fantasizes much less about him, and the consultant loses an important source of information about the client. For example, some clients want to know if he (she) is married or not. Instead of answering this question, the counselor should ask whether it matters to the client whether the counselor is married or not. The second reason why it is not recommended to open up to clients is that being open involves sharing your problems with clients, which is anti-therapeutic. Reticence is especially relevant at the beginning of counseling, when the client feels anxious and does not trust either himself or the consultant. The counselor's frankness can increase the client's anxiety and distrust of the counselor. Telling about himself to the client, the consultant most often simply achieves that the client understands and "accepts" him better. However, the consultant faces the opposite task - to understand the client. Of course, there is some truth in these arguments. Nevertheless, representatives of the existential-humanistic orientation interpret the frankness of the consultant as an important aspect of modern counseling and psychotherapy, which helps to develop a sincere relationship between the consultant and the client. Descending from the high pedestal of anonymity, the consultant empowers clients to reveal significant events and increases mutual trust. The frankness of clients often depends on reciprocity, i.e. on the degree of emotional participation of a specialist in counseling.
Jourard (1971) writes:
"We find a positive correlation when we study mutual frankness in communication."
In other words, frankness begets frankness. Consultant self-disclosure can be twofold. First of all, the counselor can express his immediate reactions to the client or to the counseling situation, limiting himself to the “here and now” principle. I am sad and anxious that you constantly stumble and engage in self-deprecation," etc. Another option for the consultant's frankness is a story about his life experience, demonstrating its similarity with the client's situation. For example:
client: I have difficulties with my father. He is getting old and very lonely. Comes and sits all day. I feel that I should keep him occupied, I abandon all household chores, I do not pay enough attention to children. I would like to help my father, but the further, the more difficult it is for me to succeed.
Consultant: I think I can understand how angry and at the same time guilty you feel. My wife's mother is a widow and also very lonely. She does not always come at a convenient time and sits for hours. It's hard for me to look pleased, and I feel guilty about being so selfish.
Sometimes a consultant's positive and negative frankness is also distinguished (Gelso and Fretz, 1992). In the first case, the client expresses support and approval. For example: "I also feel that our relationship is developing perfectly, and you have noticeably succeeded." In the second case, there is a confrontation with the client. For example: "You say that everything is fine, however, if someone reacted in this way to my appearance, I would be extremely angry." When revealing, the consultant in any case should be sincere, spontaneous and emotional. When talking about your experience, it is better to rely on the current life situation, and not talk about the past, not related to the problem of counseling. Talking about your experiences should not divert attention from the client.
It is not easy to distinguish a consultant's reasonable frankness from unreasonable one. First of all, one should not abuse frankness. You don't have to share every feeling, memory, or fantasy that you've experienced. Often the narrative of the events of one's past is more like a pseudo-disclosure. The consultant must always be aware of the purpose for which he speaks about himself - wanting to help the client or satisfying his desires.
In self-disclosure, the time factor is very important - it is necessary to catch the appropriate moment and not delay the revelation, so that the client remains in the center of attention and the consultant's experiences are not brought to the fore. The self-disclosure technique is used only when there is good contact with clients, usually in the later stages of counseling.
Structuring counseling
This procedure runs through the entire counseling process. Structuring means organizing the consultant's relationship with the client, highlighting the individual stages of counseling and evaluating their results, as well as providing the client with information about the counseling process. Having completed one stage, together with the client we discuss the results and formulate conclusions. It is necessary to make sure that the assessments of the results of this stage by the consultant and the client coincide.
Structuring occurs throughout the consultation. Work with the client is carried out according to the principle "step by step". Each new stage starts with an assessment of what has been achieved. This contributes to the desire of the client to actively cooperate with the consultant, and also creates the opportunity, in case of failure at a separate stage, to return to him again. Thus, the essence of structuring is the participation of the client in planning the counseling process.
Based on materials (Kochyunas R. - Basics of psychological counseling)
I very rarely conduct consultations by correspondence. But occasionally there are such spontaneous consultations that were not planned, but simply turned out, because the client dropped in to ask a couple of questions, and I had a good creative mood, some free time and a desire to understand better .... and away we go…. I will post a couple of such consultations here with the permission of the people with whom I worked, so that it is clearer, but how it generally happens.
I want to make a reservation right away that this is not the whole consultation, but only part of it. The work itself required much more time, which was spent on collecting information, trying to work through other techniques, as well as discussing and checking the result after. I cut all this and post here only the main part.
Consultation:
T: What are you afraid of happening now?
K: I have a feeling that at 34 I'm like a newborn, and this can be seen from the outside
don't know where to go
those. real experience, knowledge - there is a lot
but still dumb
well, some kind of dissatisfaction with yourself
I can't make out
I can not yet
T: ok. how do you feel when you're not old enough?
Or you don't look good enough...
K: self-prejudice, disrespect
T: What's the feeling?
where in the body?
or not in the body?
what does it look like?
how do you feel about it?
K: something behind, behind the back of the head
as if holding by the collar
small
“don’t climb”, you are still small
“why are you climbing there”, etc.
what is this technique? I need to dig myself
T: imagine someone who treats you like that on an empty chair
and then tell him that you are not small, you are an adult
and keep saying that you are an adult, you are thirty something
you might want to yell at him
try
K: yes, today I had a similar situation, but I couldn’t bend the dude under me
T: yeah dude it's nothing to do with it
do the exercise
it's something from the past
K: I understand
T: something stuck
need to release it
sometimes you want to scream, beat, kick, etc.
K: strange, I don't want to offend him
T: what do you want?
K: there is only one desire - to say HOW TO understand
T: say
K: but just to say, confidently and calmly
so that he understands that I'm not joking
T: you can even ask why he treats you like that
And another question: who is holding you back?
turn around and look
K: I don't see
feel the hand
T: Whose hand is this?
what do you feel about her?
K: I want to get rid of
let go
T: so turn around and tell her: "I'm already an adult, go to hell"
TO: _
T: Loud and confident
and repeat until something changes
K: ok, got it
oh, apparently still clean and clean
I'm going to study
T: so you didn't?
just understood?
when are you going to do it?
i want you to do it now
K: damn
hand said
T: and?
K: let go, does not hold
but i feel it
T: and you can also do the following: step aside and look at the one who was held by this hand. what does he look like?
K: little frightened
.. hooks .. me
T: and now watching from the side, start making it more
make him older
and see what happens
K: I got a picture
that it was my mother who was holding me, preventing me from approaching adults who somehow frightened me
T: tell your mother that you can no longer keep
K: I fight off my mother so that she would let me go, I want to run up and hit adults
K: ..sausage..
T: knock them
you can beat them if you want
physically
until you release all the aggression
and tell your mother that you can no longer keep that you are an adult
she will understand
K: all
I protected her from my father drunk, and she protected me so that he would not hit
I had it often
both in childhood and later in adolescence
T: clear. What now?
what are the feelings?
what image?
K: calm, I have this often now
I realize, and immediately calmness
T: good. But think about how you will interact with people?
something has changed?
K: confidence
T: ok
Tell me, has that guy grown up?
K: and freedom
yes, grown up
there was a father and his friends, all drunk, and their mother drove them out of the house
everything is drawn, hmm
T: if this guy has grown up to your age, then it would be nice to accept him, become one with him
K: yes, I did
T: great, well done