Creating a Working Alliance: Generic Interpersonal Skills and Concepts

Creating a Working Alliance: Generic Interpersonal Skills and Concepts by Bryan Hiebert, Ph.D. Division of Applied Psychology University of Calgary (2005-09-01) Hiebert, B. (2005). Creating a working alliance: Generic interpersonal skills and conflicts. Calgary, AB: University of Calgary. Reproduced with permission. Creating A Working Alliance: Generic Skills and Concepts i

Table of Contents Introduction 1 A Note on Terminology 1 Interpersonal Process and the Working Alliance 2 Generic Skills 2 An Aside on Communication Skills 3 Skill Taxonomy 3 Skills for Enhancing Meaningfulness 5 Skills for Engaging People Sample Sentences for Exploring Affect Sample Sentences for Exploring Cognition 7 9 10 Skills for Clarifying and Providing Feedback 12 Basic Attending Skills 15 Additional Skills for Working with Groups Skills for Promoting Involvement and Inclusion 16 16 Counselling Goals 17 Relationship Building 18 Problem Solving or Decision Making 18 Skill Training 18 Personal Coping 18 Self-Management 18 Summary 18 Counselling Process 19 Personal Definition 21 Creating A Working Alliance: Generic Skills and Concepts ii

Introduction A basic theme running through this document is that clients typically seek the help of a professional to learn something. They might want to learn new skills, new ways to think about a problem, how to change some interfering attitudes, or feel differently than they currently feel. Clients might want to learn skills like: how to get a job, identify a career path, control anger, prepare for a job interview, be more assertive, or get along better with a spouse, boss, children. Some clients want to change their thinking patterns, so they are more self-confident, less critical of others, more positive about their jobs or their lives, or more motivated. Other clients want to change the way they feel, so that they are less depressed, less stressed, more happy and satisfied with their jobs or their life in general, or more optimistic about their future prospects. Some clients are other professionals seeking assistance in order to deal more effectively with their own clients. For example, a teacher may seek help from a school psychologist, hoping to learn more effective ways to deal with problem students or challenge gifted students. Other clients are organizations, seeking new ideas for how to deal more effectively with their employees. In each of these cases clients learning is central the client comes to counselling expecting some change, and that change represents learning on the client s part. A Note on Terminology In this course the terms professional and client have special meanings. When the term professional is used, it refers to school psychologists, counsellors, or other professionals in a variety of differing roles that involve working with other people, including, counsellor, school psychologist, project officer, case manager, career advisor, trainer, community development agent, job developer, etc. The term client is used to refer to the person, people, or organization that the professional is working with. Thus, the diads can include: counsellor-client, school psychologist-teacher, job developer-potential employer, project officer-service provider, school psychologist-social worker or police liaison officer, case manager-other professional, trainer-worker, etc. In each of these cases, there likely will be differing goals and purposes of the interactions. However, an underlying shared characteristic in all of the above cases is that a strong working alliance will help both parties achieve their respective goals. That working alliance can be fostered through the skills covered in this course. For the sake of brevity, the term session is used to refer to a meeting between a professional and a client. Used in the context of the special meanings described above, the meeting could be a counselling session, a case conference, a meeting between a project officer and the manager of a community agency, a conference between a school psychologist and a classroom teacher, a meeting between a school psychologist and the implementation team working with a selected student, or meeting between a job developer and a potential employer. The specific goals in each of these cases may differ, but the skills involved in creating a working alliance will be very similar regardless of the context. If clients seek the help of a professional to learn something, it follows that a large part of what happens in the process is educational in nature. Although some of what people learn happens accidentally, it probably is not the case that clients seek the help of a professional searching for accidental learning. Clients likely seek the help of a professional expecting the professional to Creating A Working Alliance: Generic Skills and Concepts 1

assume an instructional role. Sometimes clients can identify specifically what they hope to learn in the process and can articulate those goals quite clearly. However, even in these cases, if the clients were able to teach themselves how to produce the types of changes they want to make, they probably would not be seeking the assistance of a professional. Therefore, the instructional role in the process falls to the professional. It is important to state explicitly, however, that this instructional role is not intended to depict the stereotypic autocratic teacher who rules a class with an iron fist, making sure everyone remains on task. It is closer to the experiential teacher who adopts a style that promotes learner involvement, demonstrates flexibility, and tailors his or her teaching manner and learning outcomes to the needs, wishes, and learning styles of the students. The goals and outcomes, and indeed the process followed, always need to be learner (=client) driven. The educational approach in working with others is collaborative, with client fully involved in the process. The process should be client-centered, i.e., centered around the client concerns and made explicit to the client, with full client involvement in all aspects of the process. This is somewhat different from the typical Rogerian notion of client-centered counselling, which refers to a process where reflecting and paraphrasing predominates the counselling interaction. Instead, client centered in this document quite literally refers to a focus that emanates from client concerns and where the process of addressing those concerns is openly negotiated with clients. In instructional terms this means that professional and client negotiate together the learning goals (i.e., the outcomes) and the curriculum (i.e., the interventions, or how the outcomes will be attempted to be achieved). In this way, professional and client are partners in the instructional enterprise and the outcomes, the processes, and the specific skills or approaches, are determined together. Interpersonal Process and the Working Alliance The psychological construct of the working alliance provides a theoretical anchor for many of the above observations and affords a means for explaining why some collaborations are more successful than others. Working alliance is an organizational construct in this course because the liaison principles involved in a working alliance apply to all of the professional client dyads mentioned earlier. It is generally accepted (cf. Gelso & Carter, 1994; Manera & Patton, 1994; Horvath & Symonds, 1991) that a strong working alliance develops when there is: agreement on the goals towards which counsellor and clients are working, agreement on the tasks that need to be accomplished in order for those goals to be realized, and mutual respect and trust between counsellor and client. A strong working alliance encourages self-exploration and the disclosure of relevant information and helps people feel ready to risk trying new approaches for dealing with a problem situation. One of the key assumptions, that seems to be born out in practice, is that establishing mutually agreeable goals will help all parties develop a greater sense of ownership over both process and outcome, and foster a sense of accomplishment in achieving the end goals. Generic Skills Generic skills are the basic tools that professionals use to communicate with clients. These skills are known as generic because they are applicable and appropriate across a wide range of Creating A Working Alliance: Generic Skills and Concepts 2

interactions. As such, it is important that professionals are competent in the use of a wide range of skills. It is important also that professionals know which skills to use in different client situations, are able to use those skills in a purposeful manner, and that they are able to selfmonitor their use of the generic skills to make sure they (the professionals) are doing what they want to in the session and that the effects are in line with the goals. Therefore, in training generic counselling skills, it is important to develop facility on three levels: 1. performance of a basic repertoire of generic skills 2. using the skills purposefully, not randomly, i.e., professionals doing what they want, when they want to, and selecting their skills in terms of the intended effects on the client 3. self-monitor skill use so that professionals can be their own observers, giving themselves feedback on how they are doing An Aside on Communication Skills It is important to emphasize that many of the skills used in developing a working alliance also have a corresponding use in every day communication, to the extent that the goals of the interactions are similar. Thus the skills that professionals use to establish rapport and build trust also serve to establish trusting and meaningful relationships in every day interactions. The skills professionals use to gather information and promote open exploration also help to generate information in everyday interactions. Of course, there often are no specific goals attached to everyday interpersonal interactions, but neverthe-less, the generic skills serve similar purposes in all interpersonal interactions, both formal and informal. Skill Taxonomy In discussing and training generic skills it is helpful to have a way of clustering the skills into meaningful categories. The most useful means to do this is by developing a skill taxonomy. The purpose of any skill taxonomy is to provide a system to help promote meaningful communication, i.e., to develop, if you like, a common language that permits people to talk about what they are doing. The skill definitions in any taxonomy are somewhat arbitrary. The purpose of the skill definitions is not to provide the ultimate answer regarding how a skill should be defined, but simply to ensure that when people use a particular skill name they have some assurance that other people attach a similar meaning to that skill name as they do. The taxonomy in this course uses a functional base, i.e., skills are grouped together and defined in terms of the probably effect they have on a client. This approach has an advantage of providing a functional link between the actions of the counsellor and the reactions of the client. The approach used in this course does not relate to any particular theoretical viewpoint, but it does have two important stipulations attached to it: views the counsellor s role as a systematic and purposeful endeavour (as opposed to a random, or reactive, or playing-it-by-ear endeavour) believes that client learning (as opposed to intra-psychic factors) is centrally important in producing client change. Creating A Working Alliance: Generic Skills and Concepts 3

Thus, creating a working alliance, needs to be seen as the responsibility, primarily, of the professional, who should undertake this task in a purposeful and systematic fashion, developing the climate and skills needed for the client to be able to enter into a working alliance with the counsellor. The client is an expert on the experience he or she brings to the interaction. The professional needs to be the expert on managing the process of exploring and clarifying, and in the end, developing a strong working alliance. Applying the skills and knowledge from this course to any particular theory will be easiest for counsellors who wish to be systematic and purposeful in their interactions with clients, and who view their own actions as making a large contribution to the outcomes resulting from their interactions with clients. From the educational literature, three necessary conditions have been identified that facilitate client learning: the interaction must be meaningful, the learner must be engaged in the process (practicing what is being learned), and there must be some mechanism for providing feedback (feedback on the practice). Therefore, the functional taxonomy used in this course contains three categories, each one corresponding to one of these three conditions that facilitate learning. An additional category is provided for skills that do not neatly fit into the above three categories, but are important for successful interpersonal interactions. These can be thought of as the basic attending skills which are useful to demonstrate that both parties (the professional and the client) engaged in the process. Each of the resulting four categories contains a number of generic skills. The resulting taxonomy is depicted in Figure 1. 1. Skills for enhancing meaningfulness overviewing reviewing goal setting summarizing transitions information giving 2. Skills for engaging people questioning probing prompting demonstrating 3. Skills for clarifying and providing feedback reflecting descriptive praise corrective feedback 4. Skills for attending paraphrasing nonverbal skills Figure 1. A Taxonomy of Generic Skills Creating A Working Alliance: Generic Skills and Concepts 4

Skills for Enhancing Meaningfulness This group of skills, sometimes referred to as structuring skills, are used to provide an organized and meaningful focus to a session. Generally speaking, when people know what to expect and can identify where they are in the process, it helps to create a more meaningful interaction. Enhancing meaningfulness can be fostered through skills which: help consolidate information, clarify what has gone on in a session, create a common mental set which helps put the client in a frame of mind that will be more receptive to what occurs in the session, help to keep the professional and client on the same wave length, and create emphasis in a session. These are elaborated below. Summarizing. The primary purpose of summarizing is to structure the session by identifying patterns or themes across many client messages and/or interpersonal exchanges. This helps the client and professional recall and organize the different events that take place during the session. The summary might come at the end of the session, as a recap of the salient themes that were covered, or it may come several times within the session, as a way of getting closure on one part of a topic, or activity before moving on to the next part of the session. Summaries can be of a menu or agenda variety, which is simply a recapping of the events that have happened. For example, We spent some time discussion your past work history and what you found most attractive about the various jobs you have had, and then laid out a course of action for us to work on together in future sessions. A summary also can be used to highlight the main theme that has been running through a particular part of a session. This type of summary is the professional s attempt to highlight the bottom line theme that has predominated a particular part of the session. As such it usually encapsulates the main meaning or feeling that the client has expressed. For example, The underlying theme running through what you said is that while you want a decent salary, the money is not nearly as important as the sense of fulfillment you get from your work. Overviewing. Overviewing is used to convey to the client a clear sense of what might reasonably be expected to occur during a session, or during the next portion of a session, and why that is important. Overviewing makes explicit the intended agenda and rationale underlying the proposed agenda. Thus, overviewing helps to create a sense of joint purpose for professional and client. It often is possible for the professional to make tentative suggestions to the client by means of overviewing. These suggestions may be altered or dismissed by the client. At other times, the professional might ask the client to provide his/her own overview. The important thing is that both professional and client know what they are trying to do, why they are trying to do it, and how they will try to do it. An example of an overview at the beginning of a session might be: Today we are going to practice the skills used at the beginning of a job interview. Practicing these skills here will help you be more comfortable in a real interview and help create a good impression on the interviewer. An example of an overview in the middle of a counselling session might be: Now I d like to focus on the aspects of your last job that you really liked so I can get a more clear idea of what factors you re looking for in a job. Sometimes, professionals follow an overview with a closed question to make sure that the client is comfortable with the proposed agenda, e.g., Today I d like to focus on what you do in situations that precipitate a hassle at work in order to understand what other factors might be operating there. Is that OK with you? or Today I d just like to spend about 20 minutes outlining a new on-the-job training program we have and see if you might be interested in using that program to hire some people from our job finding club. Is that OK with you? Creating A Working Alliance: Generic Skills and Concepts 5

Reviewing. Reviews are similar to summaries, except that they recap what has been done on previous sessions. They quite often will be combined with an overview as a way of introducing a session. Stating goals or objectives. This skill helps the professional clarify a purpose of the session by telling clients what they should be able to do at the end of the session that they could not do before the session started. The focus may be on acquiring information, practicing particular skills, or exploring different aspects of the problem so as to arrive at a consensus between professional and client about the best strategy to use on attempting to rectify a situation. For example, After today s session you will be able to use the career files in the waiting room of the office to find relevant information on any career you chose, or By the end of today s session I should have a clear understanding of all the relevant aspects of your situation and we will have decided together on a plan for rectifying the situation. Set induction. Set induction provides a common experience in the here-and-now that professional and client can build on in the session. It is perhaps more common for counsellorclient interactions, or other settings where client learning is the primary goal. It might involve visualizing a particular situation the client has experienced in the past so that information about that situation will be more fresh in the client s mind, or viewing a video tape, or reading a newspaper clipping. Set induction helps clients focus meaningfully on specific elements of the process that is about to follow. For example, a counsellor working with a client who is anxious in job interviews, and who wants to explore the nature of that experience with the client, might begin with a set induction such as: Imagine you have a job interview this afternoon. It is in the morning now and you are getting ready for the interview. You are in your bedroom getting ready. Imagine the scene vividly in your mind. What are you wearing..., how are you feeling..., where is the tension in your body..., what thoughts are running through your mind... OK, stop imagining that now, let your attention drift back to this room, and let s talk about the anxiety you feel in anticipation of your job interview. Skills for transitions. Transitions are ways to signal a change of topic within a session. Sometimes a professional changes direction or focus in a session and the client, not realizing that there has been a change in focus, is left wondering how the new information relates to what was being discussed before. Making the change explicit helps to reduce this sort of confusion. Sometimes a transition can be a simple statement such as, Changing topics now,..., or I d like to change the focus somewhat now and look at how you have approached that task in the past. Other times, the professional can use the combination of a summary and an overview to get closure on one part of a counselling session and then move on to another, We ve looked at how you prepare yourself mentally for a job interview, now I d like to get an idea of your behaviour in job interview situations so I can see what sorts of interviewing skills you have and see if there are others that might be helpful to you. Regardless of which type of transition is used, if professional and client are going to stay on the same wave length, it is important that changes in focus within a session are made explicit. That is the function of transitions Information giving. Sometimes professionals need to provide factual information to clients, about such things as: agency mandate, explanations about a particular intervention plan, job market information, etc. When doing so, it usually is important to block the information into small chunks that are succinct and clear. The usual guideline is to try to keep factual information under 2 minutes, so as to avoid overtaxing client s attention spans. Creating A Working Alliance: Generic Skills and Concepts 6

Verbal markers of importance. This skill helps to highlight the most important or crucial elements of the counselling session. This can be accomplished using a word or phrase to verbally underline the crucial message. For example, The most important thing to remember when making first impressions in an interview is to smile when you walk into the interview room, introduce yourself, and shake the interviewers hand. Other sorts of lead-ins that can serve as Verbal Markers of Importance are: the essential element in the process is..., The bottom line here is..., The key aspect of all this is..., etc. Physical structuring of the situation. The physical arrangements in a professional s office can facilitate or impede interaction with a client. To promote open communication, most professionals place their desks against a wall so that it is not a physical barrier between them and the client. Sometimes when a session involves writing and recording, professionals sit across the corner of a table from the client so that both people can easily see what is being written down. Having chairs that are the same height is important in creating the atmosphere of equals interacting with equals. Paying attention to these sorts of physical factors can make sure that they do not interfere with the meaningfulness of a session. Skills for Engaging People Skills in this group are used to initiate and maintain client involvement or engagement in the process. They help gather information, direct an interaction, or promote client practice in cognitive, affective, or behavioural domains. Sometimes clients (and professionals) need to examine a problem from a different perspective, practice thinking of things in a somewhat different way, explore relevant information, or examine the reasons for particular events, or behaviours, or feelings. At other times, clients may need to practice behaviours: trying out a new skill like retrieving information from a library or role playing to practice new behaviours like interviewing skills. Skills for client engagement are used by professionals to help them make decisions about which future directions might be the most productive, which problem areas need elaboration, where further exploration would be useful, what aspects of the client s problem require more clarification, or what sorts of behaviour practice would help the client skill learning. Further, when professionals identify areas needing further elaboration, exploration, or clarification, then the same skills are used to get the elaboration or guide the further exploration. Skills for client engagement are used when professionals work with clients to get a more clear picture of potential shared goals, future directions, and the sorts of strategies would help accomplish those goals. Questioning techniques. Questioning techniques are used to promote cognitive practice (thinking), gather information, or to get confirmation. It is useful to distinguish between two basic categories of questions, open questions and closed questions. Open questions are contrasted with closed questions in that open questions cannot be given a yes or no answer, (e.g., What was the feedback on the course evaluation you conducted in your last session? or How are you going about finding names to add to our job bank? or What are some of the jobs you ve had in the past? ). Open questions are used to obtain open-ended information in an unbiased fashion, or to promote client thinking about various aspects of a situation, such as looking for relationships between events, possible ramifications, alternative courses of action, etc. The purpose of open questions is to obtain more information in a fairly open manner, not leading the client in any particular direction by giving hints of the response you Creating A Working Alliance: Generic Skills and Concepts 7

anticipate, but leaving the nature of the information obtained pretty much up to the client. Closed questions are used to obtain confirmation about something. They can be distinguished from open questions, in that closed questions can be answered with a yes or no answer (e.g., Did you complete the course evaluation in the last session your conducted? or Are you actually contacting potential employers and asking if you can add them to our job bank? or Can you tell me more about the kind of jobs you ve had in the past? ). Keeping in mind the attempt to provide a functional link between professional and client behaviour, it is useful to make the discrimination between open and closed questions on the basis of how the question could be answered, rather than how the person actually did answer the question. Therefore, a professional might ask Can you tell me more about that? and the client might respond with four or five sentences of explanation. However, if you examine the question, it still is a closed question because it could have been answered yes or no. (Also, typically, when the client s answer is examined, it most often boils down to a yes or no, except that it took several sentences to say it rather than just one word.) Usually, closed questions begin with words like Can, Did, Will, Are, etc. Closed questions are not inappropriate, however they serve a different purpose than do open questions. The main purpose of closed questions is to solicit confirmation. Thus, questions like Did you complete the home practice we discussed last time we met? or Have you contacted the three employers and arranged for an interview? or Have you completed your month-end summary of placement statistics? are appropriate ways of getting confirmation on whether commitments have been carried out. However, if the intent of the question Can you tell me more about that? is to actually get some more information, it probably would be better to ask What are some other aspects of the situation that affect you? or use the probe Tell me more about that please. (Of course, if the intent is to confirm the client s capability of providing more information, then the question Can you tell me more about that? would be appropriate.) The goal in developing questioning skills is to make sure there is a match between the form of the question and the intended client response. Declarative probes. Declarative probes are functionally equivalent to open questions, except that they adopt a non-interrogative sentence form, hence the name declarative. Some authors refer to these skills as polite commands. They are requests for information like: Tell me more about that please, or Elaborate a bit, or Give me some more background information, or Describe for me some of the jobs you ve had in the past. Declarative probes can be used intermixed with open questions to provide variety in the professional s soliciting. Declarative probes have an additional advantage over open questions when dealing with very nonverbal clients. It is harder to shrug and say Nothing or I dunno in response to a declarative probe, e.g., What did you do in school today?... Nothing much. versus Describe the sorts of things you did in school today. Sentence beginnings that make good declarative probes include such words as: describe, tell me, elaborate, explain, expand, provide, etc. Professionals who feel that declarative probes sound a bit harsh or demanding sometimes preference their probes with Please to make the request more polite, so the form becomes Please describe, or Please explain, or Expand on that please. Others rely on their tone of voice or facial expression to make sure the declarative probe is not too demanding. Creating A Working Alliance: Generic Skills and Concepts 8

When open questions and declarative probes are used to solicit client affective or cognitive responses, it is important to make explicit the nature of the response being requested. Sometimes people use the verbs think and feel almost interchangeably. People are frequently heard to say I feel the price of gasoline is too high or I think I m in a good mood. This sort of imprecision makes it difficult to distinguish affective experiences from cognitive experiences and makes it hard to examine client beliefs and feelings, especially in counselling situations. Therefore, it is important for professionals to be aware of which client domain they are wanting to explore and to communicate that clearly to clients. If a professional wishes to get a client to identify and describe some of the feelings associated being unemployed or having an unsuccessful job interview, then it is important to cue client feelings in the request. Some professionals find it helpful to have a set of sentence stems to use as a guide for exploring feelings. The following list will serve as a starting point to help students compose their own set of sample questions. For variety sake the examples are phrased as both open questions and declarative probes. Open Questions How did you feel when that happened? How do you feel about him/her? How do you feel about that situation? What s that like for you? What sorts of feelings do you have in that situation? How do you feel about that? How did you experience that? Your voice is really shaky, how do you feel about that now? Sample Sentences for Exploring Affect Declarative Probes Tell me how you felt when that happened. Tell me how you feel about him/her. List/identify the feelings you have in that situation, please. Describe what that s like for you. Give me some examples of the sorts of feelings you have in that situation. Describe how you feel about that. Explain what that experience is like for you. Your voice is really shaky; describe how you feel about that now. Sometimes the agenda, especially in counselling situations, focuses more on exploring the meaning attached to situations the client is involved in, or the reasons for clients feeling like they do. These are cognitive (thinking) considerations and it is important to cue the client that a cognitive response is being requested. It is important also to remember that cognitive reports can focus on process (a description of the thoughts that a person was having in a situation) or they can focus on structure (a description of the schemata, or beliefs, or values that a person connects with a situation). Again, many professionals find it helpful to have a set of sentence stems to use as a guide for cueing client cognitive activity (thinking). The following list will serve as a starting point to help students compose their own set of sample questions. For variety sake the examples are phrased as both open questions and declarative probes. Creating A Working Alliance: Generic Skills and Concepts 9

Sample Sentences for Exploring Cognition Open Questions What do you think about that? What effect did that have on you afterwards? What did that mean for you? What s your understanding about that? What was it about the situation that you really liked (disliked)? What elements do those things have in common? Why was that an important thing for you? What did you see your role as being? How does that compare to...? Declarative Probes Tell me what you think about that. Describe the effect that had on you afterwards. Explain what that meant for you. Tell me more about the meaning that had for you. List the things about the situation that you really liked (disliked). Identify what sorts of elements those things have in common. Explain why that was important for you. Describe what you saw your role as being. Tell me how that compares to... Tell me more about how that compares to... Elaborate on how that compares to... Prompting and leading. Sometimes, it is useful to restrict the range of responses when exploring various aspects of a situation or ask a question in a way that helps a client come to a particular conclusion. In such cases, it may be useful to pose a question in a way that presents a set of alternatives, e.g., Is it A or B or C?, or phrase a question in a way that gives a hint of an answer, e.g., Given your past experience as a group facilitator, how do you think you might go about getting these three people to work together? Caution needs to be exercised when using these skills in the context of creating a working alliance, because they can lead to the perception of being manipulated and they do not allow for an open exploration of common goals and purposes. Calling for a demonstration. Often when professionals want information on client behaviours, they ask clients to describe what they would do in a situation (which is a cognitive response). Frequently, it is better to get the client to actually demonstrate the behaviours. For example, instead of asking clients to describe their interviewing skills, professionals might do a simulation where they play an interviewer and the client responds as he or she would in a real interview. If the professional was trying to determine a client s ability to track down job leads, it might be useful to have newspapers and yellow pages handy and ask the client to demonstrate how to go about identifying potential job leads. On a different theme, if a case manager wants to determine how an agency supervisor provides feedback to front-line workers, it might be useful to ask the supervisor to provide a sample performance appraisal and then give the feedback to an imaginary worker. It is important when using this skill not to be confrontive. The goal is not to get clients to prove they can do something, but to give the professional first hand information about the client s skill levels. Calling for a demonstration also is used in skill training interventions to get clients to practice new skills. For example, after a trainer has described and demonstrated how to enter an interview room, and introduce himself or herself to the interviewer, the client should then practice the behaviour sequence. If the goal is client skill acquisition, it is important not to just talk about the skill, but to have the client actually practice the skill with the professional. Calling for a demonstration is used to accomplish this. Whenever new behaviours are being taught it is important to not stop at just explaining the behaviour and giving examples of how a behaviour Creating A Working Alliance: Generic Skills and Concepts 10

could be used, it is important for clients also to practice the behaviour themselves. One appropriate way to get clients to engage in that behaviour practice is simply to ask the person to show you, or to try it. For example, Now that I ve described the sort of posture that denotes assertiveness, and demonstrated it for you, I want you to try it yourself, right now, here with me. Essentially, calling for a demonstration says You do it to the client. Describing inconsistency. Sometimes clients send confusing messages to professionals--not because they are trying to deliberately confuse the professional, but because they are somewhat confused. Often this confusion comes out in an inconsistency. The inconsistency could be between: what the client said now and what was said previously, what the client said and what was actually done, what the client is feeling (or more accurately, the description of the feelings) and how the client is behaving. If such inconsistencies arise only periodically, it is probably best to just ignore them, after all no one is perfectly consistent all the time. However, if the inconsistencies occur repeatedly, or occur in a key area, it probably is important to address them. A useful way to address the inconsistency is to simply describe it and wait for the client to clarify the situation. This skill used to do this is describing inconsistency. Sometimes this skill is called confrontation, however, that term is not used here because the goal is not to confront, but to resolve the inconsistency, i.e., to get clarification on how the client has resolved the situation in his or her thinking. A useful algorithm to follow in describing inconsistency is the following: 1) I notice that - Use an I statement 2) on the one hand you are saying and on the other hand you are doing. - Describe the inconsistency 3) Pause - Give the person time to absorb your description and then respond to it. If the person does not respond, then follow up with an open question or a declarative probe, e.g., Tell me how you reconcile that or How does it seem to you? It is important to note that the goal in describing Inconsistency is not to call the client on the carpet for being inconsistent, but to understand how the client feels and thinks about the inconsistency, i.e., how the client justifies or resolves the situation, so that the professional and client can make more predictable plans in the future. Describing an inconsistency and inviting the client to respond is a more gentle way of addressing concerns than confronting them head on, therefore the phrase describing inconsistency is used rather than confrontation. Maintaining focus in client responses and professional requests. When a client responds to the professional s request for cognitive, affective, or behavioural information, the professional needs to think about the degree to which the actual client response matches the domain that the professional intended the client to address. Therefore, if a professional wants to find out how a client feels when his work is criticized by his boss and asks How do you react when your boss criticizes your work? The client might respond by saying Oh, I just think about what a jerk the boss is for being so demanding. In this case the client has not responded with a statement about his feelings, i.e., there is not a match between the domain being requested and the nature of the client response. In this case the professional might follow-up with a more explicit declarative probe like: OK, that s what s going on in your head, but I d like you to describe what sorts of feelings you experience when the boss criticizes your work. Common areas of mismatch occur across the cognitive and feeling domains, where professionals ask clients to describe feelings and they get a cognitive response or a reason for the feeling existing. If frequent mismatches occur, then the professional might use describing Creating A Working Alliance: Generic Skills and Concepts 11

inconsistency to get clarification in order to fully understand a client s problem. In order to address client change in a comprehensive way, it is important to address all relevant parameters of the problem, and to make sure that the nature of the client responses are addressing all the aspects of the problem that the professional knows to be relevant. Summary. The purpose of engaging skills is to obtain information and promote client practice on an affective, cognitive, or behavioural level. Open questions, closed questions, and declarative pprobes can all be used to do either, so long as professionals make sure they explicitly cue the desired client response mode. Calling for a demonstration is used primarily for exploring client behavioural responses. One additional note is important before leaving the description of these skills. Sometimes when people are asked a lot of questions, or when a lot of probing has been going on, they begin to feel somewhat defensive. One way to minimize this effect is to own your information deficit and/or your need for information clarifications. We do this by using I statements, e.g., I d like you to tell me about the kind of work you have done in the past. This is especially important when you are expressing your own perceptions or emotions. I feel angry when you do that is likely to result in a different reaction than You make me angry when you do that. It will likely be more facilitative to use a phrase like I don t enjoy it when you break our agreement rather than People don t enjoy it when you break your agreements or Nobody enjoys it when you break your agreement. Avoid being judgmental. Use I don t like it when you behave that way rather than You re really stupid to behave that way, or Only a clod would behave like that. Skills for Clarifying and Providing Feedback These skills, sometimes called reacting skills, provide clients with information about what they are saying or doing, or feeling. Some of these skills also have the multiple functions of helping to build relationships, establish rapport, or clarify various aspects of a situation. Reflecting meaning. Reflecting meaning lets clients know you are doing more than just hearing the words they are saying, but that you also are understanding the message they are trying to send. To reflect meaning, ask yourself the question, What did the client mean by the remark he or she just made?, then say the answer to that question back to the person, e.g., Having a lot of variety in your work life is important to you. Reflecting meaning is a way to avoid misunderstandings between professionals and clients for it helps to make sure that the professional s perception of what is being said is the same as the client s. Reflecting meaning provides more information to clients than paraphrasing, for it adds to the interaction the professional s perceptions and inferences about the meanings underlying the words. For this reason, if the professional is on the same wave-length as the client, reflecting meaning usually helps to speed up the exploration process. Because reflecting meaning stems from the professional s inferences about what is being said, there is always a chance that the professional s perception is not accurate. Therefore, it is important to be somewhat tentative in framing meaning reflects. Phrases such as It seems like..., It sounds to me like..., It appears as though... are useful ways to provide this degree of tentativeness, while still sharing the professional s perceptions. Reflecting affect (or feeling). Reflecting feeling lets clients know you understand how they feel about the situations you are discussing. To reflect affect, ask yourself the question, What is the client feeling right now while they are talking?, or How was the client feeling in the situation being described? and say the answer to that question back to the person, e.g., Creating A Working Alliance: Generic Skills and Concepts 12

You re feeling sort of unsettled now. Reflecting feeling also provides more feedback to clients than paraphrasing for it adds to the interaction the professional s perceptions and inferences about the client s feelings. For this reason, if the professional is on the same wave-length as the client, reflecting feeling usually helps to speed up the exploration process, but in a way that is different from reflecting meaning. Reflecting affect also is a good way to develop empathy with clients and show them you understand how they feel. Because reflecting affect also stems from the professional s inferences about what is being said (like reflecting meaning), there is always a chance that the professional s perception is not accurate. Therefore, it is also important to be somewhat tentative in framing affect reflects. Phrases like It seems like you were feeling.., It sounds like you feel..., It appears as though... I sense that... are useful ways to provide this degree of tentativeness, while still sharing the professional s perceptions.. Reflecting feeling also is a good way to defuse negative affect and help clients be more accepting of their negative feelings, i.e., to convey the impression to the client that it is OK to be angry, upset, happy, etc. When using reflecting affect to defuse anger, avoid over-reacting to what the client says, or offering apologies or excuses for what you did. Do not pose alternatives for the client. Simply reflect the anger back You seem really mad about. Avoid saying, I understand how you feel. Instead, demonstrate that you understand by reflecting back the emotion that you perceive: You seem upset about. One further note about reflecting. All client statements always contain an element of affect and an element of meaning. Some professionals find it easier to spot the affective part of a client s statement, while other professionals find it easier to spot the meaning part of a client s statement. Therefore it is important for professionals to practice both sorts of reflects, so that they will be able to provide feedback to clients on as wide a range of client experience as possible. Moreover, it is important also when professionals solicit client feelings that they are careful to use affect reflects when reacting to the client answers. This helps to maintain focus in the session. Likewise, when open questions and declarative probes are used to get clients to think about different aspects of a situation or to examine the meaning or values attached to a situation, professionals should be careful to react using meaning reflects. The point here is that maintaining consistency between the domain of the questions/probes and reflects helps to keep a session focused and prevent it from skipping around and creating confusion. It is the professional s job to manage the process and make sure it stays on track. Sometimes without realizing it professionals train clients to ignore the substance of their questions by providing a response that is not on the same domain as the solicits being used. The important thing to remember is that reflects pertaining to cognitive activity need to be meaning reflects, while reflects pertaining to affective/feeling states need to be affect reflects. I think I m feeling... refers to cognitive activity. A reflect like You re feeling sad because it seems to you like you can t to do anything right and now you ve been fired also prompts cognitive activity. If the goal is to get a more clear idea of client feelings, then it usually is best not to include reasons for the affect in the reflect. Such statements often prompt clients of think about whether the reason for the feeling is accurate, rather than trying to get more clarity on the nature of the emotions they are experiencing. This is not very useful in trying to get the client s feelings more clearly defined. Most often it is preferable to stay with descriptions of the feeling themselves and not digress into the reasons for the feelings--clarify the feelings first, then explore the contributing reasons after. Creating A Working Alliance: Generic Skills and Concepts 13

Descriptive praise. Descriptive praise is used to give clients precise, non-evaluative feedback on their performance when they have been successful. This skill goes beyond just saying Good work, to describe what it is about the work that made it good, e.g., That time your voice was clear, you were looking in my eyes, and your posture was erect and confident. That was exactly what you were aiming for. The purpose of descriptive praise is to indicate specifically and descriptively, without value judgments, what the person has done, and let the learner/client judge the goodness or badness of the behaviour. Astute students will notice that descriptive praise would be an appropriate skill to use when client responses stay in the same domain as the professional solicits. Statements such as You re really able to get in touch with your feelings, or That s very insightful, or You re really doing a good job of linking events together and spotting the underlying themes in what we re discussing usually help clients remain even more focused on the agenda for the session. Informational feedback. Informational feedback is the same sort of skill as descriptive praise, except that it is used when client performance has missed the mark. It simply describes the client s behaviour and leaves the client to place a value judgment on the performance, e.g., That time your voice was loud and clear but you were looking at the floor most of the time you were talking. When using informational feedback, professionals should take care not to sound punitive, the goal in informational feedback is to point out the mistakes so that a learner can avoid the pitfalls the next time. However, often is it more facilitative in dealing with client performances that miss the mark to use corrective feedback instead. Corrective feedback. Corrective feedback most often is used in combination with informational feedback to correct client performances that miss the target. It involves describing the client performance and suggesting how to improve on it in the next practice round, e.g., That time your voice was clear but you were looking at the floor most of the time you were talking. I want you to try it again and this time look straight into my eyes as you talk. A further note on feedback. In interactions where some sort of learning outcome is a goal, it is important to remember that some types of feedback are more facilitative than others. Generally speaking, feedback enhances learning to the maximum when it is: immediate, descriptive, specific, and positive. Focusing on a client s success experiences and providing specific and descriptive feedback as soon as possible, usually enhances the learning process. Summary. If professionals wish to maximize client learning from the practice they do, it is important to provide them with feedback on their practice. The basic purpose of reacting skills is to provide that sort of client practice. Reacting skills serve numerous functions. Reflecting meaning and reflecting affect lets clients know professionals are listening and provides a mirror to help clarify client affective states and the meanings they attach to events in their lives. These reacting skills also have the multiple functions of providing feedback to clients; clarifying the intentions, values, and beliefs about situations; clarifying client feelings in situations; and helping to build relationships and establish rapport. Descriptive praise, informational feedback, and corrective feedback provide a mirror on how skill practice is proceeding and help to sustain motivation and speed up the learning process. Creating A Working Alliance: Generic Skills and Concepts 14