COMPETENCIES OF A TRANSFORMATIVE COUNSELOR

1. Establishing Rapport

Therapeutic rapport is an essential part of a healthy therapist-client relationship, leaving the client feeling safe and respectedso
that therapy can be successful. Therapeutic rapport refers to the empathic (caring) and shared understanding of issues between
a therapist and a client. It implies a team approach to management of these issues in contrast to an adversarial approach. With
good therapeutic rapport, a client feels his therapist "has his back" in a way the allows him to face
difficult-to-face problems. Likewise, the therapist in a setting with good therapeutic rapport feels
respected in a way which allows her to speak clearly and freely.

2. Basic Attending Skills

Attending: Attending is the ability to be physically present for the client. It means giving them your undivided attention and
making appropriate eye contact, mirroring body language, and nodding. These attending behaviors show your client that you
care. In fact, according to Kevin J. Drab, approximately 80% of communication takes place non-verbally.

According to Egan (1975, 2009) and Guindon (2011), these basic attending skills can be easily recalled by the acronym SOLER

 Sitting across the counselee

 Open posture during the counseling session

 Leaning at times toward the counselee

 Eye contact, but not necessary staring at the counselee

 Relaxed or the ability to be composed and confident during the session

3. Observational Skills

NOTE: Use the Mental Status Examination

 Physical Appearance

 Personal Space

 Voice

 Facial Expression

 Body Language

 Sudden change in behavior

4. Basic Responding Skills

a. Use of Minimal Encouragers

 Listening/Observing: Listening is one of the most valuable counseling skills in the therapeutic relationship. It can be used in two
ways:

Active listening: Active listening occurs when you are listening with all of your senses. According to the Perinatal Mental Health
Project , active listening involves listening with your body, heart, ears, eyes, and mouth.

Verbal listening: This is a form of showing you are listening through the words that you use. These verbal cues are used to show
attention and to encourage more exploration from the client. This can be as simple as ‘yes’, or ‘go on’. It can also be in the form
of paraphrasing or repeating a word of emotion that the client has just said.

b. Asking Questions

Questions are helpful in the therapeutic environment because they allow you to learn more about your client. The type of
questions that you ask will set the tone of the session and the entire counseling process. Questions occur in two forms.

 Closed: A closed question is the practice of asking a question that can be answered as a ‘yes’ or ‘no’. Closed questions
should generally be avoided in the counseling relationship, as they do not encourage deeper exploration.

Closed questions have the following characteristics:

 They give you facts.

 They are easy to answer.

 They are quick to answer.

 They keep control of the conversation with the questioner.

For example:
1. Is that your coat?

2. Are you living alone?

3. Do you enjoy your job?

 Open: An open question is necessary to gather information. An open question is one that cannot be answered with a
simple ‘yes’ or ‘no’ and it requires reflection or exploration on the client’s end. Every open question should be intentional and
therapeutic. According to Susan Mills of the Nielsen Norman Group , the best open ended questions begin with ‘how’ and
‘what’.

An open question is likely to receive a long answer.

Open Questions
Open questions are those that cannot be answered in a few words, they encourage the client to speak and offer an opportunity
for the counsellor to gather information about the client and their concerns.

Open questions have the following characteristics:

 They ask the respondent to think and reflect.

 They will give you opinions and feelings.

 They hand control of the conversation to the respondent.

Typically open questions begin with: what, why, how or could.

For example:

1. What has brought you here today?

2. Why do you think that?
3. How did you come to consider this?
4. Could you tell me what brings you here today?
 How? Most often enables talk about feelings and/or process.
What? Most often lead to facts and information.
When? Most often brings out the timing of the problem, including what preceded and followed it.
Where? Most often enables discussion about the environment and situations.
Why? Most often brings out reasons.

It should be noted that care must be taken by the counsellor when asking “why” questions. Why questions can provoke feelings
of defensiveness in clients and may encourage clients to feel as though they need to justify themselves in some way.

c. Restatement and Paraphrasing

Restating/Paraphrasing: Restating and Paraphrasing can build a stronger client therapist relationship. Paraphrasing a client’s
statement allows you to better understand what a client has just said and to gain further clarity, if you have gotten it wrong.
Paraphrasing is when you restate what the speaker said. Often different words are used and the listener may be using this to
draw attention to a particular concern or aspect. Sometimes paraphrasing is used to clarify.

d. Reflection of feelings

Feelings reflections: Reflections allow clients to hear the feelings they have just expressed. Sometimes you have to look for the
descriptive feeling in a client’s statement. It can also be helpful to look at a client’s nonverbal feeling cues.

e. Summarization

Summarizing is focusing on the main points of a presentation or conversation in order to highlight them. At the same time you
are giving the “gist”, you are checking to see if you are accurate.

Mental Status Examination

The Mental Status Exam is analogous to the physical exam: it is a series of observations and examinations at one point in time.
Focused questions and observations can reveal "normal" or pathological findings. Although our observations occur in the
context of an interview and may therefore be ordered differently for each patient, the report of our findings is ordered and
"paints a picture" of a patient's appearance, thinking, emotion and cognition. The data from the Mental Status Exam, combined
with personal and family histories and Psychiatric Review of Systems, forms the data base from which psychiatric diagnoses are
formed.

Mental Status Examination

A synopsis of the four MSE sections is presented below. In following pages, there are elaborations of each section, with sample
descriptors.

1. General Observations 3. Emotion

1. Appearance 1. Mood

2. Speech 2. Affect

3. Behavior 4. Cognition

1. Cooperativeness 1. Orientation/Attention

2. Thinking 2. Memory

1. Thought Process 3. Insight

2. Thought Content 4. Judgment

3. Perceptions
General Observations

Appearance

 Hygiene: clean, body odor, shaven, grooming

 Dress: clean, dirty, neat, ragged, climate appropriate — anything unusual?
 Jewelry: rings, earrings — anything unusual?
 Makeup: lipstick, nail polish, eye makeup — anything unusual?
 Other: prominent scars, tattoos

Speech

 General: accent, clarity, stuttering, lisp

 Rate: fast (push of speech) or slow
 Latency (pauses between questions and answers): increased or decreased
 Volume: whispered, soft, normal, loud
 Intonations: decreased (monotone), normal

Behavior

 General: increased activity (restlessness, agitation), decreased activity

 Eye Contact: decreased, normal, excessive, intrusive
 Mannerisms, stereotypies, posturing

Cooperativeness

 Cooperative, friendly, reluctant, hostile

Thinking

Thought Processes

 Tight, logical, goal directed, loosened, circumstantial, tangential, flight of ideas, word salad

Thought Content

 Future oriented, suicidal ideation, homicidal ideation, fears, ruminative ideas

Perceptions

 Hallucinations (auditory, visual, olfactory)

 Delusions (paranoid, grandiose, bizarre)

Emotion

Mood

 (Patient describes in own words and rates on a scale 1-10)

Affect

 Type: depressed/sad, anxious, euphoric, angry

 Range: full range, labile, restricted, blunted/flattened
 Appropriateness to content and congruence with stated mood

Cognition

Memory

 Immediate recall, three and five minute delayed recall of three unrelated words

Orientation/Attention

 Day, date, month, year, place, president; Serial 7's (or 3's), WORLD — DLROW, digit span

Insight/Judgment

 Good, limited or poor (based on actions, awareness of illness, plans for the future)