Building Therapeutic Relationships The Essence of Evidence-Based Counseling

1. Building Therapeutic RelationshipsThe Essence of Evidence-Based Counseling John Sommers-Flanagan Kindle Lewis Kimberly Parrow University of Montana

2. Where is the University of Montana?

3. Where are the Handouts? • Johnsommersflanagan.com • John.sf@mso.umt.edu • ACA App

4. The Counseling Relationship • One outcome of Vision 20/20 was the Consensus Definition of Counseling; this definition leads with the words: • “Counseling is a professional relationship. . .” (Kaplan, Tarvydas, & Gladding, 2014, p. 366). • Relationship is central to what we do

5. Ethics and “Scientific Treatments” • C.7.a. Scientific Basis for Treatment • When providing services, counselors use techniques/procedures/modalities that are grounded in theory and/or have an empirical or scientific foundation.

6. How Can We Be Relational and Scientific? • Rogers 1957 hypothesized that no techniques were needed, that diagnostic knowledge was “for the most part, a colossal waste of time” (1957, p. 102) • He famously said the relationship was necessary and sufficient

7. How Can We Be Relational and Scientific? • Later – Researchers said the relationship is facilitative • Recently (Norcross, 2011) put relational factors on par with “techniques or procedures” by referring to: Evidence-Based Relationships • Similar to, but not exactly common factors

8. Evidence-Based Relationship Factors • Congruence • Unconditional positive regard • Empathic understanding • Culture and Cultural Humility • WA1: Emotional bond • WA2: Goal consensus – Focus on strengths • WA3: Task collaboration • Rupture and repair • Countertransference (management) • Progress monitoring (feedback)

9. Nota Bene • Formerly, these relational factors were referred to as “non-specific” factors • They were viewed as difficult to measure • Today, they’re becoming more concrete • Illustrating how they manifest is our focus and goal!

10. 1 – Congruence The connection between  the inner and outer experience of the counselor AND the transparent expression of this experience to the student or client.  

11. Displaying Congruence • Informed consent process • Acknowledge reality/share referral information (teacher/principal example) • Self-disclosure • Honest feedback – “May I . . .” • Responding to questions (drugs; leave partner, etc.) • Authentic purpose statements

12. Ex: The Authentic Purpose Statement • Clients/students benefit from hearing why you’re in the room. Make it brief; tweak for each client. • Counselor Behavioral Examples: • “My goals are your goals. . .” • “I’d love to. . .” from TJ video • “I want to help you with. . .” • Counselor Behavioral Examples Activity: Write, share, share [3 min]

13. 2 – Unconditional Positive Regard (UPR) The counselor’s experiencing and expressing warmth and acceptance. • When clients/students feel accepted, they can safely explore insecurities and weaknesses.

14. Displaying UPR • Being on time • Non-directive listening • Asking clients what is important to them • Remembering client details • Using interactive summaries • Asking permission • Second session first question

15. Ex: Second Session First Question Role Play Demo Practice Time

16. 3 – Empathy Carl Rogers Defines Empathy As: • Sensing the client’s private world as if it were your own, but without ever losing the “as if” quality. • Sensing client’s emotions without getting too caught up in our own

17. Displaying Empathy • Paraphrasing/reflecting • Reflection of feeling and feeling validation • Walking within • Rogers often used empathic clarification “Do I have that right?”

18. 4 – Culture and Cultural Humility • Counselors are responsible for understanding when treatments require adaptation for diverse clients/students  • Cultural humility is an evidence-based orientation with three parts • An other-orientation instead of a self-orientation • Respect for others and their values/ways of being • An attitude that includes a lack of superiority

19. Ex: Cultural Humility • Broaching of cultural differences. • Acknowledging gaps in knowledge and asking about cultural values/orientation.

20. 5 – The Working Alliance (3 parts) WA1: The Emotional Bond • Mutual liking between counselor and client/student Methods: • Being a secure base (counterconditioning) • Being “happy” to see the student/client • Comfort, competence, and dependability • Reframing alliance: “Punched my last counselor”

21. The Emotional Bond Role Play Punched My Last Counselor Debrief 5 factors Practice

22. 6 – The Working Alliance WA2: Goal Consensus • Consensus and commitment to goals and means of reaching them. Methods • CBT: The problem list • SFBT: The goal list • Three wishes and miracle question • MI: What you like; what you like less

23. Goal Consensus Demo Video Luis: Collaboratively Gathering Goal Information

24. 7 – The Working Alliance WA3: Task Collaboration • Counselors engaging students/clients in process/activities that both parties believe are relevant and helpful. Methods: • Tasks should connect with mutual goals (Rationale!) • Process: Ask permission; describe task; ask for reactions; set a low (experimental) bar; debriefing • Could be PMR, problem-solving, etc.

25. Task Collaboration Demo Video John and Luis [Part II]

26. 8 – Rupture and Repair • Strains, impasses, resistance, and weakening of the therapeutic relationship. • Sooner or later, we all “fail” to get it right. • What are signs/types of rupture? • Withdrawal • Confrontation

27. Repair Strategies • Repeating the therapeutic rationale • Changing tasks or goals [Process?] • Clarifying misunderstandings at a surface level. • Exploring relational themes associated with the rupture [culture*] • Repair doesn’t happen instantly

28. Ex: Rupture and Repair Demo Video or Role Play John and Michelle

29. 9 – Countertransference Integrative Definition Counselor reactions based on unresolved conflicts, conscious or unconscious, and are triggered before, during, or after counseling sessions.

30. Managing Countertransference • Counselor is aware of the possibility • Counselor seeks supervision • Counselor gets counseling • Counselor owns it • What are your CT stories?

31. 10 – Progress Monitoring • Use the SRS • Check in for verbal feedback • Don’t be a love slob • What is the MOST important outcome of progress monitoring or client feedback?

32. Reflections and Discussion • What are your thoughts and reactions to the concept of EBRFs? • Any counseling research implications? • What would you like to remember from this presentation?

33. On Saturday • Join JSF for coffee, cookies, and a look at the newly published 3rd edition of Counseling and Psychotherapy Theories in Context and Practice • 1-2pm at the Wiley booth in the Exhibition Hall