Tuesday, September 25, 2007

Counselling Skills: It Ain’t Necessarily So

Entry for 23 September 2007:

In the mid-1970’s, together with fellow UCLA grad students Chris Barker & Nancy Pistrang (and others), I embarked on a research program to examine the assumptions of the helping skills training programs that were widespread at the time. We had been trained by our advisor, Jerry Goodman (who had studied with Carl Rogers at the University of Chicago) in a client-centered/person-centered approach to therapy that encouraged (with varying degrees of directness or subtlety) empathic reflection, silence, and self-disclosure, that discouraged the overuse of questions and interruption, and that was skeptical of the value of interpretations and advice-giving. While there was a small research literature bearing on the effectiveness of each of these response modes, no one had ever asked clients what they thought about actual therapist responses in their own sessions.

This was exactly what we proposed to do, using a new research application of Norman Kagan’s Interpersonal Process Recall method, in which we played videotapes of sessions back for clients right afterwards. True to our training, we believed that clients would generally report that empathic reflections to be the most effective therapist response.

However, we were disabused of this notion in our initial one-session analogue study, when our very first research participant told us, in no uncertain terms, that he hated his helper/counsellor's reflections, explaining to us that they reminded him of a previous unsuccessful therapy. It was clear to us that he had acquired a kind of “allergy” to not-particularly-deep, mechanical-sounding (“wooden”) reflections of content. Our conclusion: There is nothing as bad as a bad reflection! (This phenomenon of the interpersonal allergy to a particular kind of helping response is something that I have seen repeatedly over the years, but have never seen documented in the literature. It would be really interesting to do research on it.)

And so it went: we found something like that for each of the response modes we were investigating: Some were very helpful; many were slightly or somewhat helpful, and a few were hindering. We also found that, on average, clients found interpretation most the helpful, and questions the least helpful. (Questions were often viewed as "help neutral" -- for the therapist rather than for the client.) But as I said, there were exceptions in every case: They hated interpretations when they were incorrect or implicitly critical of them, and they loved questions when these were open-ended, focused on unpacking implicit emotional experience, and occurred with a good working alliance.

In other words, all the generalities we had been taught about therapist response modes (also known as types of therapist response, speech acts, or “skills”) were wrong! Instead, we learned, the helpfulness of therapist responses is highly contextual and strongly influenced by specific content, verbal and nonverbal manner (which in turn reveals the therapist’s attitude toward the client), and timing. It took me 15 years to work this all out systematically, but eventually I developed a method for unpacking all these factors: Comprehensive Process Analysis (Elliott et al., 1994).

Now I have returned, full circle, to my person-centred roots and to the question of counselor response modes. The students on the diploma course come to us, most of them, having had a counselling skills course in which they have been taught, just as my friends Nancy and Chris and I had been, many generalizations about different counselor responses. In particular, they have been taught use reflections and silence, and to avoid questions (and also advisements and interpretations). But, to quote from Gershwin’s famous American musical, Porgy and Bess, “It ain’t necessarily so.”

Last week the Monday Parttime Diploma Counselling course began with a weeklong intensive, culminating in a day of skills training and their first supervision group. And so it came to be that many of the students I worked with in counselling skills sessions or supervision left in a state of confusion, after having been informed that most of what they had learned on their counselling skills courses was wrong. For some the confusion was unsettling, but for others it was liberating. For my part, I came away from the experience with a fuller understanding of why my colleagues de-emphasize skill training in the diploma course: to get away from the simplistic approach to helping skills that many of our students have been exposed to on counselling skills courses.

I have been saying for almost a year that our students need more specific skills training, but that’s not the kind of skills training I meant at all! I would say rather, that what students need from skills training is an opportunity to try out different kinds of helping response in order to discover for themselves what works and what doesn’t work: which questions open things up and which ones close them down; which reflections deepen exploration, and which ones fall flat; and so on. In other hands, they need to learn how to learn from their clients!

1 comment:

counselor said...

I am an online counsellor at http://www.counsellingsolution.com The topic of this blog is something that I reflect on almost every day. I aim to balance the humanistic and post-humanistic schools of thought in an online setting. I do find it helpful to fall back on the “not knowing” method that the narrative and social construction discources use in questioning (learning from clients). With clients asking me for “expert” views I find the post-humanistic use of deconstructive and reconstructive questioning useful (with positive regard). Questions that externalize the “problem” in clients own words. This is a rather “tricky” undertaking when “expert” advice is asked for, but it does facilitate wanted change.

What are the concerns of a humanistic view on post-humanistic skills (if any)? “Post” used here meaning alongside humanism and not something there after.