Write your own dialogue in which a helper addresses a client’s issue with a change technique of your choice from the REPLAN model.? Clearly state

Learning the art of heLping Building Blocks and Techniques

S i x t h E d i t i o n

Mark E. Young University of Central Florida

330 Hudson Street, NY, NY 10013

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Copyright © 2017, 2013, 2009 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Printed in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms and the appropriate contacts within the Pearson Education Global Rights & Permissions department, please visit www.pearsoned.com/permissions/.

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Library of Congress Cataloging-in-Publication Data

Names: Young, Mark E., author. Title: Learning the art of helping : building blocks and techniques / Mark E. Young, University of Central Florida. Description: Sixth edition. | Boston : Pearson, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016012245| ISBN 9780134165783 (alk. paper) | ISBN 0134165780 (alk. paper) Subjects: LCSH: Counseling. | Psychotherapy. Classification: LCC BF636.6 .Y68 2017 | DDC 158.3—dc23 LC record available at https://lccn.loc.gov/2016012245

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To SKSJM

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ABOUT THE AUTHOR

Mark E. Young is Professor at the University of Central Florida. He received his bachelor’s degree from Miami University, his master’s from Wright State University, and his doctorate from Ohio University. He has trained helpers for more than 25 years and worked as a therapist in community mental health, private practice, college counseling centers, and corrections for more than 15 years. Since 2003 he has been affiliated with the Marriage and Family Research Institute teaching relationship skills to low-income couples. His professional writing has focused mainly on therapeutic methods and techniques, wellness, and couples. If you have comments or suggestions on what you have read, please send an e-mail to [email protected]

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PREFACE

HOW IS THIS BOOK DIFFERENT FROM OTHER BOOKS ABOUT HELPING SKILLS? This book is unique in five ways. First, it is based on lessons learned through years of practice and supervision. I have tried to infuse what I learned from my clients, my stu- dents, and my teachers about the practical aspects of helping. For example, we will talk about what a therapeutic office environment should look like and how to appropriately terminate a client. My work with students has helped me understand the common prob- lems in learning the art of helping and how to overcome them.

Second, the most important innovation of this book is that it involves you person- ally in your learning. Throughout the book you are asked to “Stop and Reflect,” to con- sider thorny issues and challenges that you will face. If you wish, you can journal using Journal Starters or do outside homework to deepen your interaction with the material. In addition, you will have the opportunity to practice on your own by watching videos of helpers and clients and then identify the best helping responses. Every chapter contains Application Exercises in which you can follow the steps of a particular technique and get feedback on your answers.

Third, this book emphasizes that the relationship between helper and client is the most powerful ingredient for success. The relationship (Vitamin R) potentiates all the basic techniques that you will learn. If you and the client are on the same wavelength, progress is possible. When the relationship fails, the helping process falters. In this book, I talk about how to develop a therapeutic relationship and how to repair ruptures that threaten it.

Fourth, I have tried to incorporate the latest research on effective treatments. Stay- ing close to the research can be called “evidence-based practice.” At the same time, we must recognize that there is such a thing as clinical wisdom or “practice-based evidence.” Not every method, technique, or client problem has been researched or even discovered. Thus the helper-in-training needs to learn from his or her clients about what is working for that specific person. I suggest that in every session, the helper should elicit feedback from the client about the relationship and progress toward goals.

Finally, this is a book with an integrative perspective. That means that I have drawn from the techniques of many different theories rather than presenting a purely person-centered or cognitive behavioral approach. At first this may sound like chaos. How can we possibly learn to arrange treatment by blending so many competing theo- ries? In this text, we do not blend theories but instead take a common factors approach to organizing the techniques using the REPLAN method. Common factors are those therapeutic effects that underlie the various theories. REPLAN is an acronym that describes each of the healing factors. R stands for establishing and maintaining a thera- peutic Relationship, E is Enhancing efficacy and self-esteem, P means Practicing new behaviors, L is Lowering and raising emotional arousal, A is Activating expectations, hope, and motivation, and N is providing New learning experiences. Every theory emphasizes one or more of these common factors and even advanced therapeutic techniques tend to fall into one of these categories. We have found that categorizing the techniques in this way provides a rational basis for deciding what kind of help the client

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vi Preface

needs. Is it important to raise self-esteem or practice new behaviors? This forms the skel- eton of our treatment plan and is guided by the goals that are collaboratively formed between helper and client. This approach can incorporate both time-honored methods and cutting-edge techniques.

WHAT IS NEW IN THE SIXTH EDITION?

• The Sixth Edition of Learning the Art of Helping has additional coverage of cultural issues. Throughout the book are new Culture Check sections that highlight issues of culture in research and in personal experiences as they relate to helping skills.

• In addition, Chapter 12 focuses specifically on learning to help those who are cul- turally different from you.

• For the first time, we have identified helping skills you should develop when you work with children.

• We address the issue of gender differences and how they can challenge the helping relationship.

• The book now includes two new self-assessment tools to help you evaluate recorded sessions or transcripts. They are the Helper Competency Scale, which assesses the basic skills, and the Depth Scale, which looks at the depth of helper responses.

• In addition to the end of chapter activities, such as homework, activities, exercises, self-assessments, and journal starters, we now identify specific points of practice where you can watch a video of the skill you are learning or complete written exer- cises and receive feedback on your answers. You can now access these ancillary materials at the same time you are reading about them.

ACKNOWLEDGMENTS In my own journey, there have been many who have taught and inspired me to be a better person and a better helper. I must acknowledge my teachers Rajinder Singh, J. Melvin Wit- mer, Harry Dewire, and James Pinnell, my first supervisor, who took me as a raw recruit in a mental health clinic, sacrificing his time and talent to teach me as an apprentice. We shared a zeal and passion for the profession, and his wisdom infuses every chapter of this book. I must also mention those who have encouraged me in my writing, Sam Gladding, Gerald Corey, Jeffrey Kottler, Adam Blatner, James Framo, John Norcross, and Jerome Frank. I appreciate the feedback from my colleagues at Ohio State University, Darcy and Paul Granello, and Daniel Gutierrez at the University of North Carolina at Charlotte. Tracy Hutchinson deserves special mention for reading every chapter and giving feedback at every step. I also recognize the helpful comments of those who reviewed various drafts of the manuscript including Hannah Acquaye and Shainna Ali. In addition, the following reviewers supplied insightful feedback for updating this edition: Valerie G. Balog, University of North Carolina at Charlotte; Daniel Bishop, Concordia University Chicago; Natalie Arce Indelicato, University of North Florida; Kristin Perrone McGovern, Ball State University; David A. Scott, Clemson University; and Heather Trepal, University of Texas at San Antonio.

I would like to thank my editor, Kevin Davis, who has believed in this book since its first edition. Finally, I recognize the contribution of my wife, Jora, who remains my most demanding critic and my staunchest supporter.

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BRIEF CONTENTS

Chapter 1 Helping as a Personal Journey 1

Chapter 2 The Therapeutic Relationship 31

Chapter 3 Invitational Skills 60

Chapter 4 Reflecting Skills: Paraphrasing 85

Chapter 5 Reflecting Skills: Reflecting Feelings 101

Chapter 6 Advanced Reflecting Skills: Reflecting Meaning and Summarizing 121

Chapter 7 Challenging Skills 147

Chapter 8 Assessment and Goal Setting 175

Chapter 9 Change Techniques, Part I 208

Chapter 10 Change Techniques, Part II 243

Chapter 11 Evaluation, Reflection, and Termination 276

Chapter 12 Skills for Helping Someone Who Is Different 297

Glossary 315 References 323 Index 349

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CONTENTS

Chapter 1 HELPING AS A PERSONAL JOURNEY 1 The Demands of the Journey 1 Becoming a Reflective Practitioner 2

Using Reflection to Help You Overcome Challenging Helping Situations and Enhance Your Learning 3 Using Reflection to Help Clients with Backgrounds Different from Your Own 3 Using Reflection to Accommodate New Information about Yourself 4 Learning to Reflect through Exercises in This Book 6

What is Helping? 6 Psychological Helping 8 Interviewing 8 What Are Counseling and Psychotherapy? 10 Coaching 11

Challenges You Will Face in Learning the Art of Helping 11 The Challenge of Development 12 Taking Responsibility for Your Own Learning 12 Finding a Mentor 14 Finding the Perfect Technique 14 In Limbo 14 Accepting Feedback and Being Perfect 15 Following Ethical Guidelines 15 Individual Differences 17

Who Can Be an Effective Helper? 17 What Can You Bring to a Client? 19

The Nuts and Bolts of Helping 21 Learning Basic Skills and Common Therapeutic Factors 21 Therapeutic Building Blocks 22 Change Techniques 24 The Importance of the Building Blocks 24

The Stages of the Helping Process: A Road Map 24 Summary 26 Exercises 27

Group Exercises 27 Group Discussions 28

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Contents ix

Written Exercises 28 Self-Assessment 29 Homework 29 Journal Starters 30

Chapter 2 THE THERAPEUTIC RELATIONSHIP 31 The Importance of the Therapeutic Relationship in Creating Change 33

What Is a Helping Relationship? Is a Professional Helping Relationship the Same as a Friendship? 34 The Unique Characteristics of a Therapeutic Relationship 36 What Clients Want in a Helping Relationship 38

How Can a Helper Create a Therapeutic Relationship? 38 Relationship Enhancers 39

Other Factors That Help or Strain the Therapeutic Relationship 45 Facilitative Office Environment 45 Distractions 46 Appearing Credible and Taking a Nonhierarchical Stance 46 Therapeutic Faux Pas 47 Transference and Countertransference 50

Summary 56 Exercises 57

Group Exercises 57 Small Group Discussions 57 Homework 58 Journal Starters 59

Chapter 3 INVITATIONAL SKILLS 60 Listening to the Client’s Story 61 Nonverbal Communication between Helper and Client 64

Regulation 64 Intimacy 65 Persuasion 65

Nonverbal Skills in the Helping Relationship 65 Eye Contact 66 Body Position 66 Attentive Silence 67 Voice Tone 67

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Facial Expressions and Gestures 68 Physical Distance 68 Touching and Warmth 69

Opening Skills: How to Invite 71 Saying Hello: How to Start the First Session 72 How to Start the Next Session 72 Encouragers 73 Questions 74

Summary 79 Exercises 80

Group Exercises 80 Small Group Discussions 82 Written Exercises 83 Self-Assessment 84 Homework 84 Journal Starters 84

Chapter 4 REFLECTING SKILLS: PARAPHRASING 85 Reasons for Reflecting 86 Reflecting Content and Thoughts, Reflecting Feelings, and Reflecting Meaning 86 The Skill of Paraphrasing: Reflecting Content and Thoughts 89

How to Paraphrase 89 Paraphrasing: What It Is and What It Isn’t 90 When to Paraphrase and the Nonjudgmental Listening Cycle 91

Common Problems in Paraphrasing 94 Simply Reciting the Facts 94 Difficulty Listening to the Story because of “Noise” 94 Worrying about What to Say Next 95 Being Judgmental and Taking the Client’s Side 95 Being Judgmental of the Client 96 Turning a Paraphrase into a Question 96

Summary 97 Exercises 97

Group Exercises 97 Small Group Discussions 98 Written Exercises 99

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Self-Assessment 99 Homework 99 Journal Starters 100

Chapter 5 REFLECTING SKILLS: REFLECTING FEELINGS 101 The Importance of Understanding Emotions 101 The Skill of Reflecting Feelings 102

The Benefits of Reflecting Feelings 102 Why It Is Difficult to Reflect Feelings 103

How to Reflect Feelings 104 Step 1: Identifying the Feeling or Feelings 104 Step 2: Putting the Emotion into Words 104

Common Problems in Reflecting Feelings and Their Antidotes 110

Asking the Client, “How Did You Feel?” or “How Did That Make You Feel?” 112 Waiting Too Long to Reflect 112 Making Your Reflection a Question 112 Combining a Reflection and a Question: The Error of the Compound Response 113 Focusing on Other People 113 Interrupting Too Soon and Letting the Client Talk Too Long 114 Confusing the Words Feel and Think 115 Missing the Mark: Overshooting and Undershooting 115 Letting Your Reflecting Statements Go On Too Long 116

Summary 117 Exercises 117

Group Exercises 117 Written Exercises 119 Self-Assessment 120 Homework 120 Journal Starters 120

Chapter 6 ADVANCED REFLECTING SKILLS: REFLECTING MEANING AND SUMMARIZING 121 Meaning, Uncovering the Next Layer 122

Why Reflect Meaning? 124 Challenging the Client to Go Deeper: The Inner Circle

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Strategy 126 Worldview: Meanings Are Personal 129

How to Uncover Meaning in the Story 130 Reflecting Meaning 130 Using Open Questions to Uncover Meaning 133

Summarizing 134 Focusing Summaries 135 Signal Summaries 135 Thematic Summaries 136 Planning Summaries 136

The Nonjudgmental Listening Cycle Ends with Summarizing 137

What Happens after the Nonjudgmental Listening Cycle? 138 A Questioning Cycle Typically Found Early in Training 138

Summary 140 Exercises 141

Group Exercises 141 Small Group Discussions 142 Written Exercises 143 Self-Assessment 145 Homework 145 Journal Starters 146

Chapter 7 CHALLENGING SKILLS 147 When Should We Use the Challenging Skills? 149 Giving Feedback 150

Why Is Feedback Important? 150 How to Give Feedback 151

Confrontation 154 What Is a Discrepancy? 154 Why Should Discrepancies Be Confronted? 154 Cognitive Dissonance and Confrontation: Why Confrontation Works 155 Types of Discrepancies and Some Examples 156 How to Confront 158 Steps to Confrontation 159 Common Problems in Confrontation and Their Antidotes 161 Final Cautions about Confrontation 162

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Other Ways of Challenging 163 Relationship Immediacy 163 Teaching the Client Self-Confrontation 164 Challenging Irrational Beliefs 165 Humor as Challenge 166

Summary 167 Exercises 168

Group Exercises 168 Small Group Discussions 169 Written Exercises 170 Self-Assessment 170 Homework 174 Journal Starters 174

Chapter 8 ASSESSMENT AND GOAL SETTING 175 Why Assessment? 176

Assessment Is a Critical Part of Helping 177 Reasons to Spend Time in the Assessment Stage 178

Two Informal Methods of Assessment That Every Helper Uses: Observation and Questioning 181

Observation 181 Questioning 183

Conducting an Intake Interview: What to Assess? 184 A. Affective Assessment 184 B. Behavioral Assessment 184 C. Cognitive Assessment 184 1. Developmental Issues 185 2. Family History 186 3. Cultural and Religious/Spiritual Background 186 4. Physical Challenges and Strengths 186

Categorizing Clients and Their Problems 188 Organizing the Flood of Information: Making a Diagnosis 188

Goal-Setting Skills 188 Where Do I Go from Here? Set Goals! 188 Why Must We Set Goals? 190 When to Set Goals 191

What Are the Characteristics of Constructive Goals? 192 Goals Should Be Simple and Specific 192

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Goals Should Be Stated Positively 194 Goals Should Be Important to the Client 195 Goals Should Be Collaboration between Helper and Client 195 Goals Should Be Realistic 196

Resources for Identifying and Clarifying Goals 197 The Technique of Using Questions to Identify a Goal 198

Questions That Help Make the Goal More Specific 198 Questions That Help Turn a Problem into a Goal 198 Questions to Determine a Goal’s Importance 199 Questions to Enhance Collaboration on Goal Setting 199 Questions That Help Confirm That the Goal Is Realistic 199

The Technique of Boiling Down the Problem 201 Summary 203 Exercises 204

Group Exercises 204 Small Group Discussions 205 Written Exercises 206 Self-Assessment 206 Homework 206 Journal Starters 207

Chapter 9 CHANGE TECHNIQUES, PART I 208 What Are Change Techniques? 209 REPLAN and the Common Therapeutic Factors 210

Understanding the Factors or Major Components of the REPLAN Model 210 How the REPLAN System Helps You Plan Treatment 211 Using the Common Therapeutic Factors 212 Steps in Treatment Planning Using the REPLAN Model 212

Enhancing Efficacy and Self-Esteem 214 Sources of Low Self-Esteem 216 Silencing the Internal Critic: The Technique of Countering 218

Practicing New Behaviors 221 Role-Playing 223 Giving Homework Assignments as Practice 226

Lowering and Raising Emotional Arousal 230 Reducing Negative Emotions 230

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Reducing Anxiety and Stress 231 Raising Emotional Arousal and Facilitating Expression 234 Creating Positive Emotions 236

Summary 237 Exercises 238

Group Exercises 238 Small Group Discussions 240 Self-Assessment 241 Homework 241 Journal Starters 242

Chapter 10 CHANGE TECHNIQUES, PART II 243 Activating Client Expectations, Hope, and Motivation 244

The Demoralization Hypothesis 244 Motivation and Readiness 245 Increasing Expectations and Fostering Hope 246

Providing New Learning Experiences 256 Definitions of New Learning Experiences 256 What Client Problems Are Helped through New Learning? 257 Common Methods for Providing New Learning Experiences 257

Summary 272 Exercises 272

Group Exercises 272 Small Group Discussions 274 Written Exercises 274 Self-Assessment 275 Homework 275 Journal Starters 275

Chapter 11 EVALUATION, REFLECTION, AND TERMINATION 276 Evaluating the Effectiveness of Helping 277 Basic Outcome Evaluation Methods 279

Use Progress Notes to Track Improvement on Goals 279 Use a Global Measure to Detect Overall Improvement 279 Consistently Assess the Client’s View of Progress and the Therapeutic Relationship 280 Use a Specific Measure 281 Use Subjective Scaling and Self-Report to Measure

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Improvement 281 Use Another Person to Monitor Change 282 Use Client Satisfaction Scales 282 Use Goal-Attainment Measures 282

Termination 283 How to Prevent Premature Termination 283 How to Tell Whether Termination Is Needed 285 How to Prepare a Client for Termination 286 Dealing with Loss at Termination 286 The Helper’s Reaction to Termination 287

How to Maintain Therapeutic Gains and Prevent Relapse Following Termination 287

Follow-Up 288 Booster Sessions 288 Engaging Paraprofessionals 288 Self-Help Groups 288 Continue Self-Monitoring Activities 288 Role-Playing for Relapse Prevention 289 Letter Writing 289

Summary 289 Exercises 289

Group Exercises 289 Small Group Discussions 290 Written Exercises 290 Self-Assessment 291 Homework 291 Journal Starters 296

Chapter 12 SKILLS FOR HELPING SOMEONE WHO IS DIFFERENT 297 Differences Make a Difference 297

Mismatch between Client and Helper 298 How Can You Become Culturally Competent? 298 What Is Culture, and What Should We Do about It? 299

Skills for Helping Someone Who Is Culturally Different 300 The Skill of Cultural Study and Cultural Immersion 300 A Tutorial Stance: The Skill of Understanding the Client’s Culture by Listening 301

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Tapping Cultural Support Systems 301 Achieving Credibility and Trust 301 Culturally Adapting Treatment: Tailoring Your Approach to the Client 302 Acknowledging Differences by Broaching 303

Skills for Dealing with Gender Issues 303 Challenges Caused by Differences in Gender 303 Skills for Addressing Gender Issues 304 When the Difference Is Gender 305

Skills for Helping a Child 306 Identifying Helping Skills for Working with Children 307 Using Basic Skills as a Guideline for Working with Children 311 The Case for Play Therapy 311

Summary 312 Exercises 312

Group Exercises 312 Small Group Discussions 312 Self-Assessment 313 Homework 313 Journal Starters 313

Glossary 315

References 323

Index 349

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1

The Demands of the Journey

Becoming a Reflective Practitioner • Using Reflection to Help You Overcome

Challenging Helping Situations and Enhance Your Learning

• Using Reflection to Help Clients with Backgrounds Different from Your Own

• Using Reflection to Accommodate New Information about Yourself

• Learning to Reflect through Exercises in This Book

What Is Helping? • Psychological Helping • Interviewing • What Are Counseling and

Psychotherapy? • Coaching

Challenges You Will Face in Learning the Art of Helping • The Challenge of Development • Taking Responsibility for Your Own

Learning • Finding a Mentor • Finding the Perfect Technique • In Limbo • Accepting Feedback and Being Perfect • Following Ethical Guidelines • Individual Differences

Who Can Be an Effective Helper? • What Can You Bring to a Client?

The Nuts and Bolts of Helping • Learning Basic Skills and Common

Therapeutic Factors • Therapeutic Building Blocks • Change Techniques • The Importance of the Building Blocks

The Stages of the Helping Process: A Road Map

Summary

Exercises • Group Exercises • Group Discussions • Written Exercises • Self-Assessment • Homework • Journal Starters

LEARNING OUTCOMES

By the end of this chapter, you will be able to:

1.1 Identify ways of reflecting that you can begin implementing to deepen your learning of helping skills.

1.2 Recognize that there are personal challenges in learning helping skills such as recognizing the time factor needed to master skills and dealing with ethical dilemmas as you train with fellow learners.

1.3 Identify the therapeutic factors, the building blocks, and the stages of the helping relationship.

THE DEMANDS OF THE JOURNEY

Learning to be a professional helper is a journey that takes years. Besides gaining a basic fund of knowledge about people and their strengths and challenges, one must be constantly learning

Helping as a Personal Journey

C H A P T E R 1

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2 Chapter 1 • Helping as a Personal Journey

and updating knowledge just as a physician needs to know about new treatments and new diseases. But helping is also a personal, “interior” journey because you must be committed to understanding yourself as well as your clients. In this book you will learn the essential helping skills, but it is not enough to be skilled; at every turn, you face self-doubt, personal prejudices, and feelings of attraction, repulsion, and frustration. You will experience self-doubt when your clients encounter complex and unfamiliar problems; you will experience attraction and repulsion because of your personal needs and prejudices based on your cultural conditioning. Moreover, all helpers become frustrated at times when clients fail to reach the goals we expect of them. These reactions can be roadblocks on our journey if they interfere with the ability to form a vibrant client/helper relationship or when we see the client as a reflection of ourselves rather than as a unique human being. Irvin Yalom, in his book Love’s Executioner (1989, pp. 94–95), describes his treatment of an obese woman who is depressed. From the moment he meets her, he is disgusted by her body and realizes his reaction is extreme. It makes him think about the rejection he received for being Jewish and white during his childhood in segregated Washington, DC. He thinks that his repulsion is perhaps a historical attempt to have someone to reject as he was rejected. It makes him wonder why he cannot accept fatness even though he was able to easily counsel people who were criminals when he worked in a prison. All of these reactions flood into his mind before the client ever even opens her mouth. Becoming aware of our prejudiced responses to others is part of the journey of the professional helper. This journey is difficult because it requires that we simultaneously try to focus on the client while keeping a close watch on our own tendencies to judge, to boost our egos, or to force our viewpoint on others.

BECOMING A REFLECTIVE PRACTITIONER

Because of the challenges caused by our personal reactions and unique client character- istics, we believe that helpers need a method of integrating new learning and coping with moments of indecision and doubt. In this book, we teach one method of dealing with the dilemma of understanding the client and monitoring the self. This is an approach called the reflective practitioner. Being a reflective practitioner means that y

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