Empi Q4: Counseling Behaviors for Physical ● Ability to remain tolerant / objective during irrational,

controversial & provocative attitudes and behaviors

Therapists ● We try to maintain our firmness
● Clients become irritated with the pain and become
OUTLINE
demanding so we have to be tactful and creative in
I. Topic 1 dealing with them
A. Subtopic A ○ Some clients think that everybody should be
B. Subtopic B serving them because of the pain lol
II. Topic 2 ○ Practice a better way in dealing with them
○ “Hanapin natin yung kiliti ng client para win-win”
LECTURE | RECORDING | BOOK | IMPORTANT | MNEMONICS
3) FLEXIBILITY
● Necessary in interpreting the value system of the culture
COUNSELING in order to permit the relaxation of certain demands
● Important that we are aware of what is acceptable and
● Art, science and all around valuable skill not acceptable in one’s culture (e.g. Muslim clients, etc.)
● Professional relationship between the counselor & client ○ Check with themif exercise or treatment is okay
○ Counselor – provides a learning situation with them
○ Client – knows himself in a way that is satisfying to ● Flexible enough to adjust to it
himself and beneficial to others
4) EMPATHY
Traits Needed ● Tolerance of client’s making mistakes
● Using his/her own judgments
● Developing an individual sense of values
● Traits needed to become more efficient & marketable in ● Ability to put ourselves in their shoes & accept whoever
terms of being more sought after in your practice they are
● Highly selected traits to highlight the importance of ● Giving them support without making them feel that they
counseling in PT can manipulate you
1. Sensitivity ● Inability to show a degree of empathy affects how we
2. Objectivity deal with them (welfare, warmth & support)
3. Flexibility ○ They might not come back to you anymore
4. Empathy ● Make them feel that even if they’re going through
5. Relative absence of serious emotional problems something, you’re there to teach them how to cope with it

1) SENSITIVITY
● Being able to receive focus on the contents that is not
just in words
● Contents of client’s communication
● Moods / conflicts that underlie content
● Awareness of one’s feelings / attitudes
○ Ex. Maybe the pain is exacerbated by stressful
situations or personal problems or intense anxiety
○ If they feel safe with you, they would eventually feel
that their pain is nababawasan and it also would be
easier for them to follow instructions
● Be aware of your feelings & attitudes toward the client as
well
○ Do you still have patience for the pt?
● Lack of empathy interferes with interest in client’s welfare
→ somehow affects our ability to give warmth and
2) OBJECTIVITY
support
● Endure attitudes, impulses and actions at variance with ● At this point in time, they are experiencing the pain and it
accepted norms of patients would really be a big help if they can feel your warmth,
 tenderness, empathy, and support
○ Without making them feel like they can manipulate
you
○ We have certain boundaries to take care of
● If there’s no warmth/support, they will not come back to
you
● Feeling portion plays a big role also
5) RELATIVE ABSENCE OF SERIOUS EMOTIONAL PROBLEMS
● We may have these attitudes that we need to be aware of
and deal with
● Tendency to be domineering, proud and authoritative
○ By nature, maybe you are the type to be
domineering or authoritative that can turn off some
clients
○ “Wag niyo po kasing gaganitohin, dapat ganito.
Dapat sumunod kayo para mabawasan yung pain.
Wag po matigas yung ulo.”
○ Nice to be domineering at the right time and place
○ We need to focus on our clients and their needs
● Tendency toward passivity and submissiveness
○ If we’re passive, it can tell the client na oks lang to
change sched all the time
○ You can be manipulated and taken advantage of
○ Remain firm in how we relate with them to deliver
the message that there are time I can be
submissive but not all the time
● Detachment
○ “Pasyente lang kita, makinig ka sa akin”
○ No human touch; absence of human factor
○ Lessens your marketability as a physical therapist
○ Makes your patient feel like “wow he’s just here to
fix me, parang robot lang ako. I can’t even talk to
him as a person”
○ Patient-orientedness is very important!
● Need to use client for gratification of impulses
○ Ex. Strong need to be accepted by the opposite sex
○ Ex. Client keeps talking to you so you assume they
like you, dummy. So you try to get in touch with the
client even outside your therapy sessions
○ This is going beyond the professional relationship
between the PT and the client
○ Need to be aware of our needs and make sure that
it is not a factor that motivates us to help and relate
with the client
● Neurotic attitude towards money
○ A normal human desire
○ However, we need to ask ourselves, are we
allowing the need for money affect how we perform
■ How to deal with clients who come from
different social classes
○ Check yourself, fool! Do you deal with them
differently, just coz they’re poor or just coz they’re
rich?
SCENARIO:
The client is a married female patient who has recovered from
major surgery. However, she has shown reluctance to leave the
hospital and resume her normal daily activities.
1. PT: Could you tell me what is making it difficult for you to
return to your home?
Client: Well, it’s difficult to know where to start. I guess
things just got to be too much for me. I seem to be tense all
the time.
a. (Turn to the side and start checking your phone, saying
to the client) Excuse me but I must text somebody.
b. (Lean back with arms folded and look at the ceiling as
you gather your thoughts while she is talking)
c. (Look at the client and, with your eyes, encourage
her to continue talking)
d. Call up a friend while talking to the client
2. PT: Could you tell me about it?
Client: I was afraid to go outside the house. Just thinking
about going out into the yard made me tense. I just could not
do it.
a. (Maintain eye contact and smile or nod as the client
talks)
○ Lessens anxiety & makes them feel that they are
important
b. (Gaze thoughtfully out of the window while you listen to
the client)
c. (While listening to the client, check your watch often to
ensure the physical activity is well paced and does not
run overtime)
d. Call up a friend while talking to the client
3. PT: uhmm-hmm
Client: It’s not that I don’t want to go out. I do. But when I try
to leave the house, I feel anxious and can’t do it
a. (In your uneasiness, avoid the client’s anxious gaze)
○ Seems like you’re detached and uncomfortable to
what your patient is saying
b. (Maintain varied, culturally appropriate, natural eye
contact to show your interest)
c. (Move closer to the client, and look at her with intense
interest).
○ Makes the pt uncomfortable
d. None of the above
4. PT: You try to go out, but you can’t
Client: Yes. I want to be able to go to work again and visit
people, but just can’t do it
a. (Sit in a relaxed, comfortable but professional
manner.)
b. (Lean across the desk, listening thoughtfully rolling your
pencil around)
c. (Sit back, relax, and put your feet on the table)
d. None of the above
5. Client: It is so much worse when I try to go out. I get tense
and can’t do it and then I get very depressed about it
a. (in a nervous voice) Tell me how it all started
b. (In a warm, expressive voice) Tell me how it all
started
○ The mere fact that you are listening, it has a
cathartic effect that they feel like they’re human
being → lessening the pain
 c. (Hearing a ringing phone and sounding distracted) Tell
me how it all started Responses Description
d. None of the above
● Not being non-directive
6. Client: I fainted in the bank about 4 years ago, and when I ● Usually acceptance
came to, a lot of people were standing over me ● Encourages client to take full
a. But that was 4 years ago. It should not bother you now responsibility for the contents of the
b. Have you tried going back to the bank every day until 1. SILENCE conversation
your confidence is re-established? ● Just because you’re silent it does not
c. You must have felt quite embarrassed when that mean that you are not interested
happened. ● You can project that you are interested
d. None of the above by using non-verbal behaviors

A & B invalidates the patient’s feelings ● Non-judgmental openness to whatever

is said by client
7. Client: Yes. And I found it difficult the next time. In fact, I left ● Acknowledgement that what has been
before I had deposited my money. There were so many 2. ACCEPTANCE said is understood
people. ● Gives tentative approval, security and
a. There were so many people. credibility
● “Yes, I understand what you’re saying”
○ It tells the patient that you are paying attention
○ Example of restatement
● Verbatim repetition of what client said
b. Which bank was it?
● Gives client accurate feedback
c. What did your husband think?
regarding what s/he has said
d. None of the above
● Hears his/her own statement, giving
3. RESTATEMENT
him/her opportunity to clarify/reiterate
8. Client: Yes. All the people bothered me. Then I began to get
● Telling them that you are listening
upset in other places where there were lots of people
● Used when you are monitoring the
a. Excuse me for a moment. What exactly were you doing
activity of the client
in the bank?
b. Could you tell me more about that?
● Making things transparent, more
○ Probing for more information
intelligible to both the therapist and the
○ Makes it seem like you’re listening & interested
client
c. (Interrupt her after she has said: “all the people
4. CLARIFICATION ● Ask questions that may need their
bothered me.”) How many people were there?
explanation
d. All of the above
● Used as reflecting, can mirror the
feelings and attitudes of the client
9. Client: Well, it soon became unbearable for me to go into
stores or to get my hair cut – to do all the things I should do
● Review, recapitulation of the main
a. What happened at the hairdresser?
ideas and feelings expressed by the
b. How do you buy new clothes?
client
c. All the usual things became unbearable
● May have clients that are performing
○ Explaining the behavior of the pt
the exercise but are verbally active and
d. All of the above
5. SUMMARY keeps repeating their stories
● You might want to cut through it to
10. Client: Yes, when I go out, my stomach gets upset. I get
move on to the next topic by
headaches, my throat dries and I can’t breathe
summarizing what they said
a. How do you think this relates to what happened in
● Cut through the meaningless verbiage
the bank?
and propose a bird’s eye view
b. Well, I fainted in public once, too, and it took me some
time to get over it.
● Meant to give hope, courage,
○ PT-centered
self-confidence
c. There is no reason for your to feel that way. I don’t think
● Used to reinforce the idea / feelings
other people feel that way
expressed by the client
d. All of the above
6. REASSURANCE ● More meaningful if given immediately
after the statement
● Especially if what they did is very good
Kinds of Responses
→ more meaningful when done
immediately after
● Fall into a continuum from less intense (silence) to more
intense (rejection) response
 ○ Sometimes clients may misinterpret the way we
● An understanding of the twist of phrase
touch them
or colloquial expression
5. Paralinguistics (subvocals, vocalism)
● Client needs to see clearly the
○ Is it said with sincerity or sarcasm?
implications of his statement
7. INTERPRETATION 6. Eye contact
● May not be used at this point
○ When they can’t look at you straight, there is a
● Makes you understand what pt means
message there that you may want to check
when they say something unclear
7. Appearance
● “What do you mean by unbearable?”
○ Some are overly dressed
○ Long sleeves to cover something vs showing some
● Offering suggestions that may stimulate
skin
and motivate client to further action
8. Posturing, Body Language
towards a goal
○ How one position themselves
● We don’t tell what to do but make it
8. SUPPOSITION ○ Some are in the belief that if you are standing there
clear that you’re only making a
needs to be poise
suggestion
■ Standing with poise exudes confidence
● For our own protection → if it fails we
■ E,g, a candidate standing without pays tells us
might get blamed
about what kind of person they are
9. Distancing, proxemics
● Giving a descriptive statement in
○ Safe space
response to a question or as an
○ Di naman close pero lalapit sayo dfq
explanation of a behavior or tendency
○ Depends on the relationship between you and the
9. FACILITATION ● Should be matter-of-fact, non-nagging,
person
impersonal and logical
○ Different from when a friend comes to whisper
● Facilitate their understanding of the
something
situation
10. Artifacts
● Consists of probing questions, the ○ E.g. wearing of so many bracelets → implies
curious interrogation and even the something about the person
10. INTERPELLATION cross-questioning
● We don’t use frequently because it can
have a strong impact on the clients Offering Support: Techniques

● Rebuff of the client’s ideas and is used

rarely Active Building rapport
11. REJECTION
● We don’t use frequently because it can Listening
have a strong impact on the clients
Asking ● Open ended questions
Questions ● General leads
Non-verbal Behaviors
Facilitating ● Repeating and paraphrasing what the
● More reflective what is inside the client instead of verbal Reflections client has said
messages
Clarifying Enduring that the client’s concerns or
1. Ambulation problems are understood
○ How the client carries himself
Summarizing Recapping what has transpired so far in the
○ Some people seem like they’re carrying the whole session
world on their shoulders
■ Sinasayad yung paa
○ Others are so bubbly and friendly amidst all the
concerns they have
2. Tics
○ If not organically based, it is good indicator of
psychological state
○ Indicative of stress or anxiety
3. Gestures
○ Habit-forming for some people
○ Ex. kuyakoy
○ Delivers how sensitive the topic is for them
4. Touching, haptics
○ We have to be careful