The Skilled Helper model-stages, focus of each stage and three elements for each

o 1. Current Picture
The Story
New Perspectives
Leverage
o 2. Preferred Picture (outcomes)
Possibilities
Brainstorming
Divergent thinking
Future oriented probes
Change Agenda
Problem management goals
o Client has needed resources, under clients control, and external circumstances dont prevent accomplishment
Commitment
o 3. The way forward (activities)
Possible Strategies
Framework
o Social support
Individuals
Role Models/ Exemplars
Communities
Physical supports
Organizations
Programs
o Knowledge and skills needed
o Link strategies to action
Prompt & fade techniques
Ask-provide-ask technique
Best Fit Strategies
Clients values
Strategy sampling
Balance-sheet method
o Benefits / costs
Plan
Formal vs. Informal
Concrete things, sequence, time frame
Being real
Work with clients to tailor a plan
Contingency plan
o The action arrow
Under all stages
Client to manage problem without helper
The Helping Dialogue-essential communication skills-definitions for each
o Therapeutic dialogue
Turn taking
Connecting
Mutual influencing
Co-creating outcomes
o Essential communication skills:
Tuning in
Active listening
Your body language (SOLE(A)R)
o Face the client SQUARELY
o Adopt an OPEN posture
o LEAN forward
o Maintain EYE contact or AIM body toward client
o Be RELAXED
Respond with empathetic highlights
Feelings and Content
o Be sensitive to internal and external context when naming an emotion
Check Understanding
Probing
Statements
Requests
Questions
o Closed/Open
o Causality
o Relationship
o Difference
o Behavioral Effect
o Hypothetical/Future oriented
Summarizing
Focusing scattered thoughts
Bringing discussion to a close
Prompting client to explore a theme
Challenging
Core focus & foundation of counseling according to Egans Framework
o Therapeutic Dialogue
Turn taking
do no harm, become competent and committed,
Connecting
make it clear you are for the client, assume the clients
Mutual influencing
goodwill, do not rush to judgement, keep clients agenda in
Co-creating outcomes
focus

Obstacles to change
Passive helpers
Client inertia
Client passivity
Disabling self-talk
Learned helplessness
Disorganization
Vicious cycles
Choosing not to changes
Entropy
o Challenging and Immediacy
Self-limiting beliefs and assumptions
Challenging self-limiting internal behavior
Challenging ways of managing and expressing emotions
Challenging dysfunctional external behavior
Challenging clients imperfect understanding of the world in which they live
Challenging discrepancies
o Challenging unused and underused strengths and resources
o Challenging the predictable dishonesties of everyday life
o Challenging inadequate participation in the helping process
How nurses challenge clients directly
o Sharing advanced empathetic highlights
o Information sharing
o Helper self-disclosure
o Immediacy: discussing the helper client relationship
Relationship-focused
Event-focused
o Suggestions and recommendations
o Confrontation
o Encouragement
Strategies for dealing with patients in crisis
Purpose and benefits of communication models
o Problem oriented
Aim to correct negative outcomes
Reinforce limitations
Create indebtedness
o Help-giving models (empowerment)
Strengths-based
Proactive
Emphasize mastery & optimization
o Empowerment behavior
Pre-helping
Positive attributions
Client responsibility
Client strengths
Proactive
Help-giving
Active listening
Honest and sincere
Warm caring and builds a trusting relationship
Proactively offers help
Partnerships
Post-helping
Accepts and supports client decisions
Permits client reciprocity
Maintains confidentiality
Minimizes client indebtedness
o Swanson
Knowing
Being with
Doing for
Enabling
Maintaining belief
The shadow side of helping
o All those things that adversely affect the helping relationship, process, and outcomes in substantive ways but that are not identified and
explored by helper or client in their sessions or even by the profession itself in some open or public way.
Conflict management
o A dispute, disagreement, or difference of opinion related to a situation [e.g., patient care] involving more than one individual and requiring some
decision or action
o Normalize conflict
Proactive and reactive
Build integrated conflict management systems
o Stress as a transaction
o Stress as a response
o Stress as a stimulus
o Triggers of stress
Primary appraisal
Secondary Appraisal
Joharis window
o

N4050 Study Guide for November Quiz 2015

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Goals of helping

o Personalization
o Dichotomous thinking
o Catastrophizing
o Selective abstraction
o Arbitrary inference
o Mind reading
o Magnification/minimization
o Perfectionism
o Externalization of self-worth
Stages of Behavioral change

o
Blind spots
o Consider clients degree of awareness about self-limiting thinking, emotional expression, & behaviors
o Degrees of awareness
Simple unawareness
Self-deception
Choosing to stay in the dark
Knowing, but not caring
Leverage
o Clients usually seek guidance because they want to change something in their lives but they may not be sure what this change constitutes or
even what issues to focus on. Guidance workers help them identify and work on problems, issues, concerns, or opportunities that will make a
difference (Egan). Guidance workers help clients focus on important issues and to prioritize the order in which they are to be dealt with. In
situations where clients are grappling with many issues at once, the guidance worker helps clients search for some leverage; by tackling one
particular problem which will also contribute to resolving some of the other problems faced by the client, e.g. taking a up a course will have a
knock-on effect on other issues e.g. higher qualification, better job prospects, higher pay etc.
Anger-definition, triggers , needs and approaches
o An experiential state composed of emotional, physiological, and cognitive processes frequently experienced simultaneously
o Hot thoughts
o TBI
o Alexithymia inability to put feelings into words
o Substance abuse
o BATHE model
Background
Affect
Trouble
Handling
Empathy

Psychotic thinking
o Prodromal
o Acutely psychotic
o Stable
o Insight/No insight
o Comorbidities
o Changes in:
Thinking patterns
Unusual false beliefs
Perception
Feeding and mood
Behavior
Cognition
o Approaches we tend to use with our client population
Solution focused therapy
Motivational interviewing
Cognitive behavioral therapy

Review all PPP and required readings in Egan The Skilled Helper

Good luck with studying!

o
Managing anger
Take a time outcount to 10
Once you are calm express your anger
Exercise provide an outlet for emotions
Think before you speak
Identify possible solutions
Stick with I statements
Dont hold a grudge
Humor
Relaxation techniques
Seek help self awareness
Stinkin thinkin
o Overgeneralization