Communication is vital in any relationship. Understanding can be created and perhaps any hurt can be healed provided people can be kept in communication with each other. Therefore communication and problem solving are key areas to be considered when dealing with couples counselling.

The counsellor’s aim here should be twofold:

1. To help clients acquire skills and practice in communication and developing and maintaining affinity and rapport.
2. To help clients acquire skills and practice in dealing with conflict situations that are getting out of hand.

Research has shown that openly expressed anger is not a factor in the deterioration of relationships. Instead it is contempt, belligerence, and defensiveness that bring about the deterioration. Where feelings and opinions are not openly and clearly expressed things go downhill.

Where there is a clear expression of feelings and opinions, even if this is done in anger, there can be a de-escalation of negativity (Gottman, et al, 1998). Furthermore, active listening is not necessarily an element in conflict resolution. Not surprisingly, couples find it difficult to paraphrase,  summarise and validate their spouses feelings in the heat of an argument. Active listening and the associated skills may be of most use in preventing conflict and maintaining understanding and affinity; a more specialised approach may need to be taken with conflict itself.

If a healthy expression of emotion can clear the air and lead to resolution of problems, then it would be of benefit to coach the couple, as needed, towards assertion and the open communication of feelings and needs. Then as they progress into their relationship they have at least been given them a reference point, something they can look back on. And they can always see the counsellor again for a refresher course in these skills.

Having interacted with the clients by now on a number of occasions the counsellor will be in a position to assess their need for some coaching in relation to their speaking, listening and conflict resolution skills. What sort of listeners are they? In interviews with them, a counsellor could ask one to paraphrase what the other has been saying, then repeat this exercise with their partner. Has one of them drifted off? Have they put their own interpretation onto what they heard their partner say?

It might pay to look into how the listening style of each person developed. Were they listened to in childhood? How has this affected them in the present? Are they talking a lot to compensate for not being listened to when they were younger? In general is there a pattern in their communication, and is there anything that is either dysfunctional or that has the potential for future conflict?

What sort of arguments have there been between them, how did they begin and if they were resolved, how was this done? Are they bringing anything with them of note in these areas from their family of origin?

Click here to read a communication drill that can be used to enhance communication skills with couples.

Tweet This Post Digg This Post Share on Facebook

Focusing enables a counsellor to direct client’s conversational flow into certain areas. It is a microskill that is relevant to all stages of a counselling interview. This skill however should be used sparingly.

Example: After noticing that a client has mentioned very little about his family, the counsellor, (believing the family is relevant) directs the conversation toward the client’s family.

Ivey and Ivey (2003) have identified seven areas a counsellor can focus on in the counselling session to bring about broader perspectives and potential solutions.

The first is Individual focus, where the counsellor begins the counselling session by focusing totally on the personal aspects of the client; the demographics, history, and the reasons why counselling is sought, from the client. The counsellor will often use the client’s name, to help bring about total focus on that client. For example, “Joan, tell me a little about yourself”. “Joan, are you the oldest daughter in the family?”

The second is; Main theme or problems focus. Attention is given to the reason why the client sought counselling.

Other focus, as no problem is truly isolated, the client will often speak of friends’, colleagues, extended family members and other individuals that are somehow connected with the reason for the client seeking counselling.

Family focus, concerns siblings, parents, children. Flexibility is required in the definition of “Family”, as it can have different meanings to different people, i.e. traditional, single parent, nuclear and/or can include extended family members, or very close friends who are given family titles such as Aunt or Uncle.

Mutuality focus is concerned with how the client reacts to the counsellor, because this could be an indication of how the client develops in relation to other people. It attempts to put the counsellor and client on an equal level, with the counsellor asking: “How can we work together?” “How would you like me to help with this situation at this point?”

Interviewer focus is where the counsellor may disclose information about themselves.

Finally, Cultural/environmental/context focus. The counsellor will understand how a client is influenced by the community/ies in which they grew up, but this can be extended to other issues such as gender, race, ethnicity, religion, socio-economic status to gain a greater understanding of the person the client is today.

Tweet This Post Digg This Post Share on Facebook

Communication has several key aspects which are all the more pertinent to people whose lives are entwined with each other and who need to maintain high levels of understanding.

First of all, when speaking there are certain principles that come into play.

1. Words have different meanings to different people and what we intend to say is not always what comes across.
2. Messages are often ‘coded’ so that the true intent is something that is inferred rather than spoken openly.
3. People do not always get to the point and may altogether omit or avoid what they really want to say.
4. The complexity of one’s inner world is not always easy to express. Emotions, thoughts, reactions and so on are not always easy to put into words.

As a listener, there are two specific phenomena to keep in mind.

1. People may be distracted from what is being said and consequently may not fully comprehend nor remember what was said.
2. People can easily distort what they hear, through their different interpretations of words and through other emotional and psychological factors.

Listening is a vital aspect of communication all on its own. It is said that on average 70 per cent of our waking hours are spent in communication with others. Of that time, 45 per cent is spent listening. Tests show that most people only recall half of what heard even when they thought they were listening carefully. Eight hours after a conversation, only 25 per cent of what was said is remembered (Bolton, 2003). 

We can see the causes of so many arguments and disagreements in these aspects of communication and their associated phenomena. It may be worthwhile as a counselling exercise to have clients go through these points and relate examples of how minor disagreements have occurred due to these aspects of communication not being in place. A counsellor should make sure in doing this that the cause of the disagreement is successfully isolated to the satisfaction and relief of both parties.

A key part of listening is attending, giving a person one’s whole attention. Sometimes this is referred to as “listening with your whole body”. It includes eye contact and facing the person who is speaking. It involves ceasing what one is doing (where possible) so that one can focus on the speaker, and it also needs that  there be no or minimal distraction or that distractions are catered for as much as possible.

Body posture should be open and receptive, as should facial expressions. It may not always be possible, but one could encourage clients to devote some time in each day when they give each other their undivided attention. This is especially necessary when something needs to be clarified or when tensions may be mounting up.

Note in all of this the potential for barriers to communication to arise when children are present, as they can be major distractions. Again, there is benefit in raising these issues so that the couple may be more prepared for what lies ahead.

Below are two client resources which can be used to assist couples in improving their communication skills: 

Client Resource #1 - Attending Drill

Have the couple sit facing each other in reasonably straight backed chairs. Tell them they are not allowed to talk, look away, or make gestures at each other, only that they should sit and maintain eye contact and ‘be there’ until they are told to stop.

One or both of them may go through varying degrees of discomfort doing this. The solution is to keep doing the exercise. It is not unusual for dormant emotions to be stirred by this exercise. In that sense it has a cathartic value, provided one continues with it. In time everything will settle down and the intrinsic discomfort will have disappeared.

Once there is a genuine ability to attend, a person’s other communication skills will improve considerably. This is an excellent exercise for a couple. It can lead to them being much more stable and confident in being able to communicate to each other.

Client Resource #2 - Listening Drill

Once people have better attending skills, they can build up their ability to listen and interact with others. A counsellor can begin to address any communication deficiencies they observe in their clients by having them practice drills of this kind.

1. Have Person A take up an attentive listening position.
2. Have Person B talk about something they are interested in or concerned about.

A listens, uses minimal encouragers (“Go on”, “Yes…?” etc) and open questions (“How do you feel about that?”… etc). When B has finished, A thinks over what was said, how it was said, body posture and facial expressions and thinks about how they feel about what was said.

Person A sums up what was said by Person B “I gather that… happened and that you are…” or something along those lines. Ask B how this felt.

Turn this around a few times. Let each of them practice listening to the other with good attending skills, then have them paraphrase what was said. The clients should keep in mind that attentive listening is a key. When this is done well, the rest of the skills should fall into place naturally.

If the person who is listening and paraphrasing is sounding a little formal, it may help to coach them towards simply clarifying what was said, with statements like “Did I hear you correctly” and “Is there anything more to that?” They may find that once the other person has fully conveyed what they want to say, it is easier to acknowledge them.

And an acknowledgement is mainly letting the other person know that they have been heard and understood, there is not really any need to elaborate on that. 

Tweet This Post Digg This Post Share on Facebook

A counsellor can encourage a client to continue to talk, open up more freely and explore issues in greater depth by providing accurate responses through encouraging, paraphrasing and summarising. Responding in this way informs the client that the counsellor has accurately heard what they have been saying. Encouragers, paraphrases and summaries are basic to helping a client feel understood.

Encouragers, also known as intentional listening, involve fully attending to the client, thus allowing them to explore their feelings and thoughts more completely. Paraphrasing and summarising are more active ways of communicating to the client that they have been listened to. Summarising is particularly useful to help clients organise their thinking.

The diagram below shows how encouragers, paraphrases and summaries are on different points of a continuum, each building on more of the information provided by the client to accurately assess issues and events.

Encouragers - Encouragers are a variety of verbal and non-verbal ways of prompting clients to continue talking.

Types of encouragers include:

1. Non-verbal minimal responses such as a nod of the head or positive facial expressions
2. Verbal minimal responses such as “Uh-huh” and “I hear what you’re saying”
3. Brief invitations to continue such as “Tell me more”

Encouragers simply encourage the client to keep talking.  For a counsellor to have more influence on the direction of client progress they would need to make use of other techniques.

Paraphrases - To paraphrase, the counsellor chooses the most important details of what the client has just said and reflects them back to the client. Paraphrases can be just a few words or one or two brief sentences.

Paraphrasing is not a matter of simply repeating or parroting what the client has stated. Rather it is capturing the essence of what the client is saying, through rephrasing. When the counsellor has captured what the client is saying, often the client will say, “That’s right” or offer some other form of confirmation.

Example: I have just broken up with Jason.  The way he was treating me was just too much to bear.  Every time I tried to touch on the subject with him he would just clam up.  I feel so much better now.

Paraphrase: You feel much better after breaking up with Jason. 

Summaries - Summaries are brief statements of longer excerpts from the counselling session.  In summarising, the counsellor attends to verbal and non-verbal comments from the client over a period of time, and then pulls together key parts of the extended communication, restating them for the client as accurately as possible.

A check-out, phrased at the end of the summary, is an important component of the statement, enabling a check of the accuracy of the counsellor’s response. Summaries are similar to paraphrasing, except they are used less frequently and encompass more information.

Tweet This Post Digg This Post Share on Facebook

In this post, we look at how Motivational Enhancement Therapy can be applied to a practical situation. More specifically, we’ll discuss how counsellors can utilise this model to assist clients suffering from eating disorders.

To start, consider the Four Fundamental Principles (Lacey & Lister, unpublished) outlined below:

1. The client’s drive towards thinness is ego-syntonic - it is in harmony with their goals.
2. Symptom choice is driven by desperation - clients often feel there are no other options.
3. Change is difficult and true empathy is difficult - reading evocative personal accounts of the disorder can help counsellors “get” this illness.
4. There are reasons underpinning resistance to treatment - the counsellor is trying to change something the client regards as the solution.

Given the above principles, it is imperative that the counsellor provides validation and aims for collaboration with their client. This is achieved by acknowledging the difficulty of making changes to behaviour and by asking questions that demonstrate a knowledge and understanding of eating disorders.

In building a collaborative therapeutic relationship, the client is able to be involved in the decision making process and treatment planning. In doing this, it is always important to respect the person’s individuality - while it is reassuring to feel understood it can be offensive to be stereotyped, therefore the counsellor needs to avoid comments such as: “all anorexics feel like this”, or “Like other bulimics, I bet you…”. 

Instead the counsellor should choose comments such as: “Everyone is different”, and “I don’t know what it’s like for you but some of my clients have said…”

In motivational enhancement, any arguments for change should come from the client, not the counsellor. The natural expected outcome of a counsellor making an argument for change is that an ambivalent client will argue against it.

A client becomes more committed to what they hear themselves saying, so if the counsellor causes a client to argue against the need for change, they are being moved in the wrong direction.

For example, when asking “On a scale of 0 to 10, how important is it for you to change your eating behaviour?” the follow-up question would be “Why are you at a 5 and not 0?” The answer to this is the reason for change. Asking the more obvious question “Why are you a 5 and not a 10?” is not motivational because the answer to this question provides reasons against change.

Expressing Empathy - This initial step seeks to understand the person’s feelings and perspectives without judging, criticising or blaming. The counsellor simply accepts the person’s ambivalence about change as a normal part of human experience, i.e. reluctance to give up a problem behaviour is to be expected.

Developing Discrepancy - Change is motivated by the size of the discrepancy between where a person is and where they want to be. The bigger the discrepancy, the stronger the motivation is for change.

This approach often utilises the “Colombo approach” where the counsellor plays detective, investigating a mystery where the clues don’t add up and engaging the client in the process to help solve the mystery. This process encourages the person to recognise reasons for change. A number of strategies can be useful at this stage:

1. Future projection: exploring how the eating disorder interferes with the client’s future goals.
2. Looking back: exploring the strengths from the client’s life prior to the onset of the eating disorder.
3. Explore extremes: loosening the client’s attachment to their eating disorder by exploring their worst fears, e.g. “What are the worst things that could happen to you if you keep behaving the way you have been?”
4. Respectful information provision on the negative consequences of the eating disorder.
5. Juxtaposition of the person’s statements, eg. “Your aim is to have a fit healthy body, yet you frequently skip meals and haven’t had a period for months. I’m not sure how these go together?”
6. Externalise the disorder: this is a process of separating out the illness from the person and can be done through talking to or writing letters directly to the eating disorder.

Rolling With Resistance - There are four types of resistance:

1. Arguing: the person contests the accuracy, expertise or integrity of the counsellor.
2. Interrupting: the person interrupts the counsellor in a defensive manner.
3. Denying: the person expresses unwillingness to recognise problems, cooperate or accept responsibility.
4. Ignoring: the person shows signs of ignoring or not following what the counsellor is saying. 

In motivational enhancement, arguments are considered counterproductive because defending breeds defensiveness. Client resistance is viewed as a signal to change strategy because direct persuasion is not considered an effective means for resolving resistance.

Arguments are not rejected but reframed, so that new perspectives are suggested rather than imposed on the person.

Supporting Self-Efficacy: This step involves supporting the person’s belief in their ability to succeed in changing behaviour. The counsellor encourages the person to remember any achievements they may have had in the past.

They also assist the person to develop an internal locus of control by encouraging personal responsibility for change, rather than attributing change to external factors outside their control (an external locus of control).

Another important step towards increasing a client’s self-efficacy is to introduce doubt about the beliefs that keep them stuck. The counsellor should first validate these beliefs by showing they understand that change is difficult and that such beliefs hold an adaptive function for them, i.e. it protects the person from confronting change too quickly before they are ready.

Source: www.counsellingacademy.com.au

Tweet This Post Digg This Post Share on Facebook