What Therapists Say and Why They Say It

Effective Therapeutic Responses and Techniques

Bill McHenry, Jim McHenry

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000074703
• Edition: 3
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

What Therapists Say and Why They Say It, Third Edition, is one of the most practical and flexible textbooks available to counseling students. The new edition includes more than one hundred techniques and more than a thousand specific therapeutic responses that elucidate not just why but also how to practice good therapy.

Transcripts show students how to integrate and develop content during sessions, and practice exercises help learners develop, discuss, combine, and customize various approaches to working with clients. Specific additions have been added to address the use of technology in therapy, as well as basic core competencies expected for all therapists. "Stop and Reflect" sections have been introduced to chapters, along with guidance on the level of skill associated with each individual technique.

Designed specifically for use as a main textbook, What Therapists Say and Why They Say It is also arranged to help students make clear connections between the skills they learn in pre-practicum, practicum, and internship with other courses in the curriculum—especially theeight core Council for Accreditation of Counseling and Related Educational Programs (CACREP) areas.

Chapter 1

Welcome

So you’re going to be a therapist. Welcome! Congratulations on joining a group of professionals who work every day helping people deal more effectively with many of the issues they face in their daily lives. Therapists play an ever-increasing role in our society, and in that role they help clients work through a variety of concerns; some are positive, such as assisting someone in making a choice among several attractive alternatives, and some are negative, such as working with substance abuse or the death of a loved one.

Chances are you’ve chosen this career because you’ve been told that you’re a “good listener.” It’s likely you were one of those people in high school or in your dorm to whom others poured out their troubles. Experiences like that have probably already taught you one of therapy’s larger lessons. Being able to unload a burden to a listening ear can be a real help to a person experiencing genuine pain in her life. And even though the techniques we have articulated in this book help with this process, techniques alone will never outweigh or stand in for the process of really listening to the client. Technicians can fake they are hearing the client; true therapists need not fake, but simply listen with warmth, accuracy, and presence.

However, as you were listening in this friendship role, you may have been simultaneously processing several of your own reactions. While feeling very honored that another human being was demonstrating such real trust in you by sharing very personal and deeply meaningful emotions, you may have also felt a growing anxiety within yourself, possibly bordering on panic, because you simply didn’t have a clear idea of just what you should say or just how you should react. You may have felt that you were in “over your head.” Maybe one of the reasons you appeared to be such a good listener then was that you simply had no idea how to respond to this person’s pain. That feeling probably taught you another very basic fact about therapy: a therapy session, whether conducted in an office or outdoors sitting on opposite ends of a log, is not a simple conversation.

While being a good listener may be an important and necessary prequel to many forms of therapy, listening, in and of itself, is usually not sufficient to help the person change behavior. In many theories and in most counseling cases, deep listening/empathizing/hearing the client is merely the first step in the process.

So what else do you need? That’s a great question—an important question. However, as with many of the great and important questions scientists—including behavioral scientists—deal with, the answer is not easy to come by. In actuality, the answer depends on whom you talk to. Consider the many theories extant on how to hit a baseball, how to kick a field goal, how to win an election, or how to treat a patient. Then recognize that many of these “accepted” theories actually contradict one another. Medicine offers us clear examples of such contradictions. An extreme example is a branch of medical practice that relies on poisons and toxins to attempt to cure patients—not a mainstream therapy. Another example is Christian Scientists’ almost exclusive dependence on prayer to heal patients—again, certainly not mainstream. Similarly, therapy literature is filled with many suggestions regarding how the therapy process should occur. Some suggestions may actually appear to be contradictory. For example, Adlerian therapists are taught to ask clients to recall early recollections (from before the age of eight). Solution-focused brief therapists (SFBT), on the other hand, focus attention almost exclusively on the present and future, avoiding as much as possible any efforts the client makes to discuss his childhood. Of significant interest, however, is that many active therapists would agree that Alderian and SFBT counselors are actually working from a very similar frame of reference with regard to key and core issues such as encouragement and positive reframes.

Therefore, in the final analysis there actually is no final analysis. Instead, we have a number of hypotheses, theories, suppositions, and the like, suggesting that there is more than one way to effectively and efficiently provide professional therapeutic services. This brings us to the matter at hand.

Purpose of the Book

Our goal with this book is to help both therapists and therapists-in-training as they develop, expand, and refine both their skills and their understanding of the practice of therapy. As such, we wrote the book as a direct response to students who pose the basic question: “Can you give me an example of what that might sound like?” While those students understand the words used in the literature, they continually push their professors to provide concrete examples. Their questions are specific:

“How do you get a client to focus on the here and now?”

“How do you define a problem?”

“How does confrontation work—exactly?”

This book has been designed to be straightforward and to the point. It presents over one hundred different skills, techniques, and ways of conducting the therapy interview. Yet the coverage, of course, is not comprehensive. Therapy is an ever-growing and dynamic field.

What Is Not Here

The dynamics of personal therapy involve two or more unique human beings interacting in the moment. In this shifting and dynamic landscape, no exact, rigid “lesson plan” is possible. Therefore, some cautionary observations are warranted regarding several important therapy components that you will not find covered in these pages. Indeed, we firmly believe you will not find them in any book.

Perhaps most important, you will not find your own sense of authenticity. While you may read over and review each skill, really incorporating those skills and techniques into YOUR unique and personal style of counseling may be rather difficult. Such acquisition will be determined partly by your own comfort level and partly on your own working theory of how therapy works. Being authentic in the moment requires a certain degree of trust in the techniques and skills you are using. If you lack that trust, both the client and the therapy process may suffer.

What you make of the material contained herein will also be shaped by your own values, beliefs, and worldview. If, for example, you hold tight to the notion that a therapist should not provide any direction at all for the client—that the client should find her own way of life—you may not connect well with the skills used in the Directive technique.

As you wrestle with attaining greater skill in therapy, understand that you will make mistakes. Perfectionism is as unattainable in this field as in any other. Doctors attend their patients’ funerals. World-class chefs burn the soup. Great hitters in baseball fail to hit more than two-thirds of the time. You get the point. No one has ever conducted a perfect therapy session, period. Practice and feedback will make you a better therapist, but you will not be perfect. You will benefit from experiences such as audio- and videotaped sessions, role plays, and both live and post hoc supervision. However redundant as it sounds, perfection is not possible. We have chosen to hammer this point home because many beginning counselors try to perfect the process and score exceptionally high on their “taped sessions.” I (Bill) once had a student who received a 99 on a taped session say to several of her classmates, “I was nearly perfect in the session—look at this score.” I had to burst her bubble a bit with the information that the scale of 100 was based on PRE-PRACTICUM technique usage—not perfection of a session. This was a very good learning experience. She got the lesson. We suspect you will too. Freud never had a perfect session, neither did Jung or Rogers or Kim Berg. Don’t sweat it that you won’t either.

Of course, and maybe most important, clients vary. Some enter therapy genuinely committed and determined to change (about one-half of the clients you might meet in marriage therapy, for example); others are just as firmly resistant (think about therapy conducted with clients who are incarcerated or the resistant half, and sometimes both, of the clients you might meet in marriage therapy, for example). Each and every client enters with a different personality, demeanor, worldview, and attitude, which are added to and merged with a dozen or a thousand-dozen or so other personal characteristics.

Obviously, working with a truly unique individual (different from any other person on the earth) requires the full attention of the attending therapist. And, significantly, when this unique human being is immersed in the therapeutic process, an in-the-moment process, the relationship itself becomes a dynamic, shifting, and changing landscape for both the therapist and the client as they proceed by fits and starts through the thickets toward greater client insight. Therapy is definitely not rigid. Therapy is a co-developed and co-constructed process—not a test or product. Consequently, progress rests on the quality of the interaction and, for that matter, the relationship that occurs between the therapist and the client(s), and that interaction is shaped, for better or worse, by therapeutic decisions (direction or lack of same, tone, etc.) made by the skilled therapist. One size does not fit all.

Implementation of some of the skills in this book requires great care on the part of the therapist. “First, do no harm” must be more than a just a slogan for the therapist. For example, harm can result if the therapist tries to Externalize the Problem, causing the client to focus blame and responsibility for the problem inappropriately (and counterproductively) on another person or other people. Using the Spitting in the Client’s Soup technique before the therapist has developed adequate rapport with the client is another example. In the latter situation, the therapist may not only hurt the therapeutic relationship but may also leave the client wondering if all therapists are so cruel and mean-spirited.

What Is Here

• 106 therapy skills/techniques
• 1,395 therapist responses
• 2 partial fictional transcripts utilizing the skills presented in the two chapters that focus on many of the basic listening skills
• 1 full transcript utilizing the skills described in the book
• 9 sets of practice exercises
• 9 sets of stop and reflect prompts
• 10 examples of intertwined interventions
• 31 annotated references for further skill and theory development

So, take a look. The material includes basic therapy skills such as Open Question, Closed Question, Minimal Encourager, Reflection of Meaning, Reflection of Feeling, Paraphrase, Empathy, and Immediacy. Beyond these basic skills is a multitude of others that you might also consider adding to your personal therapy practice. No matter which skills seem to work best for you, provide the greatest comfort level for you, or best fit your philosophy of human behavior, you should push yourself to continue to grow in your clinical skills. So, if you’re a .300 hitter this year, why not try to move it up to .310 or .320 next year. The material in this book can be practiced and honed, improved and improved upon through your entire career as a therapist. You can visit and revisit skills as you work with new clients, and you may find that you are continuing to develop new and clearer ways of seeing and hearing people.

Layout of the Book

For each skill presented in this book we provide the therapy approach the skill is most closely aligned with (individual, family, group, cognitive-behavioral, etc.). We include a brief definition of the skill along with a statement that gives you a sense of how to incorporate it. Finally, we provide examples of each skill. These examples were created by us from our work as counselors and counselor educators and from our observations, supervision, and consultation with other therapists.

Without a doubt, there are many ways to utilize these skills. The examples offered in this text were written from the authors’ perspectives, although an attempt was made to utilize different types of “therapist voices” in the examples. It should be clearly noted that each therapist will find his own way to integrate the philosophy and technique associated with each skill. For example, one therapist may be very direct and to the point in asking the client for information, while another may “blow on the embers” of a piece of the client’s story to uncover the same information.

We arranged the skills in chapters that reflect natural groupings gleaned from both historical and current therapy texts. We reviewed individual, group, play, couples, and family therapy and included as many different skills as possible. We also consulted various theoretical models for this book.

Chapters are not isolated by clear boundaries. In fact, several skills could be, and were, c...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgments
• 1 Welcome
• 2 Pragmatic Therapy
• 3 The Reflecting Pool
• 4 The Questioning Tree
• 5 The Framework
• 6 Looking for Clear Skies
• 7 Chasing Down Mirages
• 8 The Supply Line
• 9 Therapist’s Actions
• 10 Pure Imagination
• 11 Waves in Motion
• 12 Abandoned Mine Shaft
• 13 Comprehensive Transcript
• 14 Intertwined Interventions
• 15 Practice Exercises
• Annotated References
• Index