Download personally inviting with oneself, being personally inviting

GLOSSARY
Absolute efficacy: One of two types of evidential counseling outcome research. Refers to
the overall effectiveness of counseling and psychotherapy in general.
Adjustment disorders: A class of disorders appearing in the DSM-IV-TR system which have in
common clinically significant emotional or behavioral symptoms that occur in
response to an identifiable psychosocial or environmental stressor.
Age, gender, SES, and cultural differences in making diagnoses: Information about common
demographic differences associated with specific mental disorders provided in the
DSM-IV-TR when such information is known.
Analyzer:
The natural helper style in which the individual likes to explore, probe,
and offer a critical analysis of a situation.
Areas of dysfunction approach: One of four approaches to intuitive-logical clinical.
thinking at Step 2 of the inverted pyramid method of case conceptualization.
Using this approach, the counselor looks for life roles and themes. Clinical
thinking using this approach organizes client issues by common denominators
according to problematic themes of every day life.
Associated features: Clinical features that are not part of the diagnostic criteria for a particular
mental disorder, but may frequently occur in association with the disorder.
Attitudes of helper: Specific personality characteristics that have been theoretically or
empirically shown to be critical to the effective helping relationship. Include
being empathic, genuine, accepting, open-minded, cognitively complex, adjusted
psychologically, able to build a relationship, and competent. One of the eight core
areas of knowledge and skills
Accountability: The increased emphasis by health care organizations and others to have
clinicians show that what they are doing is working. Some say accountability has
become more important than one’s theoretical orientation when working with
clients.
Acceptance:
The ability to regard clients unconditionally, despite differences in cultural
heritage, values, or beliefs. One of the eight critical attitudes of the helper.
Advice-giving: The most potentially harmful of three problem-focused, commonly used,
skills in which the clinician offers expert opinion in hopes client will follow
suggestions. Also see offering alternatives and information giving.
Advanced empathic responses: After becoming proficient at conversational empathic
responses, clinicians are encouraged to make these kinds of responses which often
bring about deeper levels of understanding for the client. They include the use of
analogies, metaphors, visual images, and the pointing out of contrasting feelings.
Affirmations: Genuine and caring responses on the part of the clinician that says to the
client that he or she likes a behavior or statement the client has expressed. A
commonly used skill.
Appearance and behavior: This part of the mental status exam reports the client’s
observable appearance and behaviors during the clinical interview. Often includes
manner of dress, hygiene, body posture, tics, significant nonverbals (eye contact,
wringing of hands, swaying), and manner of speech (e.g., stuttering, tone).
Assessment techniques: Formal and informal assessment instruments helpful in
information gathering.
Axis I:
Axis II:
Using the DSM-IV-TR classification system, all clinical disorders and other
conditions that may be a focus of clinical attention with the exception of
personality disorders and mental retardation are recorded on Axis I.
Using the DSM-IV-TR classification system, personality disorders and mental
retardation are recorded on Axis II.
Axis III:
Using the DSM-IV-TR classification system, general medical conditions are
recorded on Axis III.
Axis IV:
Using the DSM-IV-TR classification system, psychosocial and environmental
problems are recorded on Axis IV.
Axis V:
Using the DSM-IV-TR classification system, the Global Assessment of
Functioning, or GAF, score is recorded on Axis V.
Behaviorally stated treatment approach: Preparing the treatment plan in such a manner
that it is clear what will take place during the working stage of the counseling
relationship.
Breach of confidentiality: A critical ethical and legal issue that addresses the importance
of the confidential nature of the helping relationship and that confidentiality
should only be broken under extreme circumstances such as when there is a “duty
to warn.” See Tarasoff case.
Buckley Amendment (FERPA): Also known as the Family Rights and Privacy Act of
1974, this law affirms the right of all individuals to have access to their
educational records.
Business-related activities: The management of the professional counseling office, such
as documentation of contacts, billing, and interacting with third-payers.
Case conceptualization [Definition 1]: The process that allows the clinician to
understand, through his or her unique theoretical perspective, a client's presenting
problems and subsequently apply appropriate counseling skills and treatment
strategies. One of the eight core areas of knowledge and skills. [Definition 2]: A
clinical thought process that provides a
framework to assess, appraise, and make sense of client needs. Involves three
elements: assessing client behaviors, thoughts, feelings, and physiology; using
this assessment to determine patterns and themes among the client’s concerns;
and then, as a function of the clinician’s theoretical orientation, using the patterns
or themes to make clinical judgments about etiology and sustaining factors
associated with the client’s concerns.
Case management: The overall process involved in maintaining the optimal functioning
of clients. Includes: documentation; consultation, supervision, and collaboration;
communicating with stakeholders; business-related activities; and caseload
management. One of the eight core areas of knowledge and skills.
Case notes: A record, prepared by the clinician, of how counseling proceeds. A key part
of the client’s record, providing a clinical reference for professional use and a
mechanism or showing accountability. Also referred to as “progress notes.”
Case reports: Reports used to summarize client sessions. Such reports are often the
reflection of information gathered during a structured interview or during daily
client contacts.
Caseload management: Directing ones time and schedule, and tracking and following up
ones caseload; carefully monitoring each client’s experience of the counseling
relationship, treatment compliance, and progress; and ensuring that ones caseload
remains manageable in terms of size, number of weekly client contacts,
complexity, challenge, and psycho-emotional demand.
Challenger
The natural helper style in which the individual likes to push and confront
a client into viewing the world differently.
Clinical consultation: Occurs when the therapist seeks out another mental health
professional in order to discuss a client’s needs, explore treatment options, or gain
a better understanding of the dynamics of the counselor-client relationship.
Clinical disorders: All childhood and adult mental disorders contained in the DSM-IV-TR with
the exception of personality disorders and mental retardation.
Clinical skills: The attitudes and techniques used by professional counselors. They
include the eight attitudes of the helper, foundational skills, information
gathering skills, and commonly used skills.
Clinical supervision: An intensive, interpersonally focused relationship in which one
person is designated to facilitate the development of therapeutic competence in
one or more other persons (Loganbill, Hardy, & Delworth, 1982).
Clinical tools: The skills needed for managing the counseling process. They include
diagnosis, case conceptualization, treatment planning, and case
management.
Closed question delimiting affect: A type of information gathering technique that uses
questions to force the client to pick between feeling choices assumed by
the clinician.
Closed question delimiting content: A type of information gathering technique that uses
questions to focus on a particular topic or point of view and forces the client to
pick between choices given.
Closure stage: Stage 5 of the helping relationship, with its primary goal being to
summarize, review, and make the transition out of counseling as smooth as
possible. See Tables. 2.1-2.3 to review how core areas of knowledge and skills are
applied at this stage.
Clinical targets approach: One of four approaches to intuitive-logical clinical.
thinking at Step 2 of the inverted pyramid method of case conceptualization.
Using this approach, the counselor looks at thoughts, feelings, behaviors, and
physiology. Clinical thinking using this approach divides client presentations into
four domains: irrational thoughts, distressing moods, dysfunctional and
maladaptive actions, and problematic physical aspects.
Codes of ethics: Documents that guide the ethical practice of mental health professionals.
See Appendix A for websites of codes of ethics.
Cognitive complexity: A broad range of cognitive skills related to the manner in which
one makes sense of the world. The ability to think systemically and understand
multiple perspectives. One of the eight critical attitudes.
Cognition:
The part of the mental status exam that assesses the client’s orientation
to time, place, and person; short- and long-term memory; knowledge base and
intellectual functioning; and insight and judgment.
Collaboration: When the clinician communicates that he or she values the client’s
feedback and wants want to come to a mutually agreed upon decision about the
next phase in treatment. Most useful at transitional points in the helping
relationship.
Common outpatient disorders: The Mood Disorders (depressive and bipolar disorders)
and Anxiety Disorders follow four red flag chapters in the DSM text and are
considered common outpatient disorders.
Competence: A thirst for knowledge. Willing to examine new ways of working with clients.
Being aware of appropriate techniques. One of the eight critical attitudes. Also,
one of the ethical “hot spots” highlighted in many professional ethical codes (see
Table 3.1).
Communication with stakeholders: Interactions with interested parties who are not mental
health professionals, such as the client’s family and friends, courts, schools,
employers, and social services.
Confidentiality: An ethical “hot spot” that states clients have the right to privacy in their
communication with clinicians. Contrast with privileged communication. See
Tarasoff. See Table 3.1.
Confidentiality of records: The critical ethical and legal issue that address the importance
of confidentiality records, the probable right of parents to their children’s records
as well as clients to their own records. See Buckley Amendment.
Confinement against one’s will: The critical ethical and legal issue that addresses the fact
that an individual cannot be hospitalized against his or her will unless he or she is
in danger of harming self or another. See Donaldson v. O’Connor.
Conflicts of interest: An ethical “hot spot” that suggests that dual relationships can often
be problematic in the helping relationship and should be avoided. See Table 3.1.
Confrontation: The commonly used skill in which the clinician first builds a trusting
relationship then gently encourages the client to change. Based on the clinician
recognizing one of four client discrepancies: values and behavior, feelings and
behavior, idealized self and real self, and expressed feelings and underlying. Five
types: You/but statements, asking client to justify the discrepancy, reframing,
irony or satire, and higher level empathy.
Conjoint treatment: Occurs when the client is engaged in more than one mode of
treatment. Common examples include individual counseling plus a support group,
group counseling, or group psychotherapy; individual counseling plus family or
couples counseling; and individual or group therapy plus specialized assistance
such as stress management training or career counseling.
Content self-disclosure: A type of self-disclosure in which the clinician reveals
information about himself or herself. Also see process self-disclosure. A
commonly used skill.
Contents of a client record: Materials comprising a client record vary according to type of
professional counseling setting, differences in state and local requirements, and
needs and guidelines of the specific agency in which one is employed. Typical
contents include: initial contact information, diagnosis and treatment planning
notes, progress notes, and termination materials.
Consultation, supervision, and collaboration: Use of clinical supervision, clinical
consultation, medical consult, referral, co-therapists, conjoint treatment, and other
professional relationships when assisting clients.
Conversational empathic responses: The infusion of one’s natural personality style into
the response while maintaining the critical components of an empathic
response: reflection of feelings and content.
Core areas of knowledge and skills: Eight areas, identified by the authors, which professional
counselors should master. Include: ethical, professional, and cross-cultural issues;
helper attitudes; techniques; diagnosis; case conceptualization; treatment
planning; case management; and theory.
Corey’s model of ethical decision-making: A seven step ethical decision-making model.
Includes: identifying the problem; identifying the potential issues involved;
reviewing the relevant ethical guidelines; obtaining consultation; considering
possible and probable courses of action; enumerating the consequences of various
decisions; and deciding on the best course of action.
Co-therapy: Occurs when two (or more) clinicians work directly together. Common
examples include group, couples, or family therapy conducted by a pair of
therapists.
Countertransference: Classic definition: “The positive or negative wishes, fantasies, and
feelings that the counselor unconsciously directs or transfers to the client,
stemming from his or her own unresolved conflicts” (Gladding, 2001). Modernday definition: When a client’s behavior touches a clinician’s “sore spot,” that
clinician may respond in ways that can have a deleterious affect on the client. A
common concern of beginning counselors.
Courts and criminal justice mandates: One important exception to confidentiality, courts
in the United States typically may demand information or clinician
communication about a client’s background, current functioning, compliance with
treatment, clinician’s assessment, or other professional data.
Criterion-referenced approach: A categorical system of diagnosis, stemming from the
traditional medical-scientific method of organizing, naming, and communicating
information as objectively as possible, which requires matching client
presentations to sets of observation criteria.
Critical ethical and legal issues: Those ethical concerns that have significantly impacted
the work of the clinician and are often found to be associated with important legal
issues. Include: breach of confidentiality, confidentiality of records, privileged
communication, confinement against one’s will, and the importance of
malpractice insurance.
Cross-cultural issues: The acknowledgement that counseling is not working for many
clients of color and that clinicians need to be vigilant about having an ever
increasing awareness of their own assumptions, values, and biases; an
understanding of the worldview of the culturally different client; and the ability to
apply adequate intervention strategies when working with culturally different
clients
Cross-cultural myths: Eight myths/attitudes that some clinicians hold that deleteriously
affects their work with minority clients. Include: melting pot myth, differing
expectations about counseling, not understanding impact of social forces,
ethnocentric worldview, ignorance of own racist attitudes and prejudices, not
understanding cultural differences in expression of symptomatology, not realizing
bias in assessment and research instruments, and being unaware of institutional
racism.
Culturally appropriate reactions: From a diagnostic standpoint, culturally appropriate
reactions to life events usually are not diagnosable as mental disorders, even when
they cause distress or dysfunction in the client’s life.
Decision-making model: A model that suggests a process for helping to resolve difficult
ethical dilemmas. One such model, suggested by Corey, et al. (2003) has seven
steps. See Corey’s model of ethical decision-making.
Descriptive-diagnosis approach: One of four approach to intuitive-logical clinical.
thinking at Step 2 of the inverted pyramid method of case conceptualization.
Using this approach, the counselor looks for mental disorders. Clinical thinking
using this approach leads toward inferences and treatment planning based on the
diagnoses or disorders identified.
Destructive attitudes: Attitudes that can have a deleterious effect on the helping
relationship, such as being critical, disapproving, disbelieving, scolding,
threatening, discounting, ridiculing, punishing, sexist, prejudice, and rejecting.
Determining treatment: The second aspect of treatment planning. Includes
decision-making about: who will be the service provider, what treatment formats
will be employed, what therapeutic approach will be used, which specific
interventions will be employed, and what the duration of the counseling
relationship will be.
Developmental models: Models that address ethical dilemmas and suggest that clinicians
at lower developmental levels are dualistic and likely to adhere rigidly to ethical
code while clinicians at higher levels are apt to use such codes in a deeply
reflective decision-making process.
Diagnosis:
How the professional counselor comes to understand and categorize client issues,
usually using DSM-IV-TR, in case conceptualization and treatment planning. One
of the eight core areas of knowledge and skills.
Differential diagnoses: Competing diagnoses the clinician should consider before settling on a
particular mental disorder diagnosis. These are listed in the DSM text for every
disorder to help to clinician avoid overlooking other possible mental disorders the
client might be experiencing.
Direct question: A type of information gathering technique that uses a question to focus
on specific content in an effort to obtain information quickly.
Disorders organized by shared similarity: Seven DSM chapters organized into classes of
disorders by shared similarity of symptoms, also referred to as shared
phenomenology of features. These include: Somatoform, Factitious, Dissociative,
Sexual and Gender Identity, Eating, Sleep, and Impulse Control disorders.
Documentation: Record-keeping, note-taking, monitoring, and notations of all client
information, including pre-interview and intake materials, case notes, termination
materials, and storage of records.
Documenting the attainment of goals: The third aspect of treatment planning. Provides
the clinician with a tool to substantiate the work being done and confirm the
efficacy of one’s work. Includes showing what goals were set, what interventions
were used, what milestones were reached along the way, and whether the goals
were ultimately reached. Besides demonstrating that client needs are met, also
provides support for third-party payments and safeguards in the case of liability
challenges.
Donaldson v. O’Connor: The Supreme Court decision that unanimously upheld lower court
decisions stating that a hospital could not hold a patient against his will if he was
not in danger of harming himself or others. Led to deinstitutionalization of state
hospitals.
DSM-IV-TR: The Diagnostic and Statistical Manual-IV-TR (DSM-IV-TR), published by
American Psychiatric Association, is the primary classification system of mental
health diagnoses in use today and contains about 300 separate diagnoses.
DSM-IV-TR Diagnosis: Description of a client’s mental health concerns using a classification
system of mental disorders that is based on sets of criteria made up of observable
features.
Dual relationships: An ethical “hot spot” that states clinicians should avoid not having
other relationships outside the professional arena with clients. See Table 3.1.
Duty to warn: The legal assumption that a clinician must make all efforts to prevent a
client from danger to another or to self.
Emotional state: Part of the mental status exam that assesses the client’s affect and mood.
Affect is the client’s current, prevailing feeling state (e.g., happy, sad, joyful,
angry, depressed, etc.), and may also be reported as constricted or full,
appropriate or inappropriate to content, labile, flat, blunted, exaggerated, and so
forth. Mood represents the long-term, underlying emotional well-being of the
client.
Empathy:
The ability to have deep understanding toward a client. May be more important as
a function of the stage of the counseling relationship. Classic definition developed
by Carl Rogers. Robert Carkhuff created a scale to measure empathy. Three kinds
of responses: formula, conversational, advanced. Both a critical attitude and an
important skill for effective counseling. A foundational skill.
Employment checks and background investigations: Clinicians may receive requests to
communicate about clients and former clients with employers or potential
employers, and generally may do so with the client’s written authorization.
Encouragement: When the clinician tells the client he or she has faith that the client can
achieve a certain goal or be successful in trying out a new behavior. A commonly
used skill.
Establishing how change will be measured: Included in a completed treatment plan, this
is a specification of the methods to be used to assess client progress. Change may
be assessed by a combination of subjective and objective measures such as: client
records and self-report, in-session observation, clinical rating and clinical
estimate, pre-post comparisons, and achievement of milestones or short-term
gains.
Ethical “hot spots”: Ethical issues that have been particularly focused upon over the recent years
and addressed in varying professional codes of ethics. Include: confidentiality,
competence, dual relationships and conflicts of interest, inappropriate fee
assessment, informed consent, misrepresentation of credentials, and sexual
relationships with clients. See Table 3.1.
Ethical, professional, and cross-cultural issues: Those ethical, professional, and cross-cultural
issues that are critical to the helping relationship and affect how the clinician
works with his or her client. One of the eight core areas of knowledge and skill.
Ethics:
Generally describes the collectively agreed upon “correct” behaviors
within the context of a professional group.
Existential model of cross-cultural counseling: As suggested by Speight, Myers, Cox, and
Highlen (1991), in trying to understand clients, clinicians should be aware of their
uniqueness (Eigenwelt), their common experiences held in groups and cultures
(Mitwelt), and their shared universal experiences (Umwelt).
Evidence-based treatment: Selection of treatment mode and specific interventions on the
basis of efficacy research regarding the most effective approaches associated with
various client needs.
Eysenck:
Known for flawed research on counseling that showed little results. His
research spurred new research that showed effectiveness of counseling.
Family Rights and Privacy Act (FERPA): See Buckley Amendment.
Formal assessment techniques: Tests that are valid, reliable, practical, cross-culturally
fair, and specific to the issue at hand. Often used to assist in information
gathering.
Freedom of Information Act: This law assures the right of individuals to access their
federal records. Most states have similar laws that assure access to state records.
Formula empathic responses: Important in the learning of empathic responses, it involves
using the following formula when first making empathic responses: “You feel
place feeling word here because (or “and”) place content here.
Functional, normal, and ordered behavior: From a diagnostic standpoint, most human
behavior is functional, normal, and ordered, rather than dysfunctional, abnormal,
or disordered. Such behaviors do not cause significant distress or impairment
beyond normal expectations.
Gelso and Carter: See “relationship building.”
General medical conditions: Physical and medical problems, especially those that might
be associated with a client’s mental health concerns. These are recorded on Axis
III.
Genuineness: The willingness to be authentic, real, open, and periodically self-disclosing
within the helping relationship. One of the eight critical attitudes.
Genogram:
An informal assessment tool that examines the family's functioning over
a number of generations. Often includes such items as dates of birth and death,
names, major relationships, scapegoats, identified patient, mental illness,
disabilities, cultural or ethnic issues, physical diseases, affairs, abortions, and
stillbirths
Glasser, William: Founder of reality therapy and spoke to the importance of the
relationship in counseling.
Global Assessment of Functioning: The GAF Scale ranges from 1 – 100, is used by the
clinician to estimate the client’s overall functioning in everyday life, and is
recorded on Axis V of the DSM-IV-TR system.
Goal setting and treatment planning stage: Stage 3 of the helping relationship, with its
primary goal being to specify expected outcomes of the counseling process. See
Tables. 2.1-2.3 to review how core areas of knowledge and skills are applied at
this stage.
Hackney and Cormier: Presented eight characteristics of effective helping: self-awareness
and understanding, good psychological health, sensitivity, open-mindedness,
objectivity, competence, trustworthiness, and interpersonal attractiveness.
Health Insurance Portability and Accountability Act (HIPAA): Ensures the privacy of
client records and the sharing of such information. In general, HIPAA restricts the
amount of information that can be shared without client consent and allows clients
to have access to their records, except for process notes used in counseling.
Health maintenance organization (HMO): A managed health care organization.
Inadvertent modeling. The unplanned adoption of behaviors exhibited by the clinician on
the part of the client. Also see intentional modeling. A commonly used skill.
Imposter syndrome: The feeling that although we have gained expertise in a particular
area, we still feel as if we are “faking it” or not worthy of what we have
accomplished. A common concern of beginning counselors.
Inappropriate fee assessment: An ethical “hotspot” that suggests clinicians need to be
vigilant about how they charge for services. See Table 3.1. See Table 3.1.
Informal assessment instruments: Instruments that allow a client a wide-range of
responses and often used in information gathering. A few examples include:
clinician made ratings scales, sentence completions, client diaries, client
autobiographies, observation of clients, interviewing others about clients, the use
of drawings, and genograms.
Information gathering: The skills used to gather information from clients. Includes the use
of questions, conducting a structured interview, and assessment techniques.
Information giving. One of three problem-focused skills, commonly used skills, in which
the clinician offers “objective” information of which the client is truly unaware in
an effort to help the client reach his or her goals. More potentially harmful than
offering alternatives but less than advice giving. Also see offering alternatives and
advice giving.
Informed consent: The client’s verbal or written permission to participate in the helping
interview. Generally given after the client has received a professional disclosure
statement. Also considered an ethical “hot spot” (see Table 3.1).
Initial contact information: Generally includes data obtained prior to the first interview as
well as intake materials. Typically included are such items as information on
record, intake data, psychological testing results, and the intake summary.
Intake summary: A report written by the clinician that provides a detailed snapshot of all
the basic information gathered from the client’s initial contact. Typically includes
identifying information, presenting concerns, background history, problem and
counseling history, mental status exam, and goals for counseling and course of
counseling to date.
Intentional modeling: The planned viewing and subsequent practice then adoption of
desired behaviors by clients. Also see inadvertent modeling. A commonly used
skill.
Inter-chapter organization: The DSM-IV-TR’s inter-chapter organization is designed to
assist the clinician in making an appropriate diagnosis. The text begins with
childhood disorders, follows with four “red flag” classes of disorders and two
most common disorders (mood and anxiety disorders), next presents a series of
phenomenologically similar classes of disorders, then presents adjustment
disorders, follows with Axis II personality disorders, and finally presents other
conditions.
Intrapsychic approach: One of four approaches to intuitive-logical clinical.
thinking at Step 2 of the inverted pyramid method of case conceptualization.
Using this approach, the counselor looks for intrapersonal life themes. Clinical
thinking using this approach divides client issues by common denominators
according to the intrapsychic roles they play.
Inverted pyramid method: A step-by-step approach to case conceptualization that gives
students and beginning clinicians a specific plan to identify and understand client
concerns. Involves four steps: problem identification; thematic grouping;
formation of theoretical inferences; and formation of deeper theoretical
inferences.
Joining:
See “relationship building.”
Jaffee v. Redmond: The 1996 Supreme Court ruling that held the right of a licensed
social worker to keep her case records confidential. Likely to apply to all licensed
clinicians.
Kitchener’s moral model: Describes the role of five moral principles in the making of
ethical decisions. Include autonomy, beneficence, nonmaleficence, justice, and
fidelity.
Lambert and Cattani-Thompson: Conducted research that showed effectiveness of
counseling.
Lambert and Ogles: Conducted research that showed effectiveness of
counseling.
Listener:
The natural helper style in which the individual likes to understand
another‘s point of view by listening and showing empathy.
Listening:
A foundational skill that helps build the relationship and tells the client the
clinician is wanting to learn more about him or her. Good listeners don’t interrupt,
show interest, don’t jump to conclusions, and have good non-verbals.
Malpractice insurance: A critical ethical and legal issues which suggests that all clinicians
need to purchase insurance to protect them from potential lawsuits.
Managed care: Includes HMOs, PPOs and other organizations that are designed to help
contain health care costs and provide evidence of accountability from
providers.
Matching problem with intervention strategy: An important professional issue, that
addresses the research that suggests that adherence to one theoretical orientation
may be less important than matching the client’s problem with an intervention
strategy that has been shown to be effective.
Mental disorder: A clinically significant pattern that occurs in an individual and is
associated with present distress, impairment in one or more important areas of
functioning , or significantly increased risk of distress or dysfunction (APA,
1994).
Mental retardation: This mental disorder is presented in the DSM-IV-TR’s first chapter,
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.
Criteria include significantly subaverage measured intellectual functioning,
deficits in everyday adaptive functioning, and onset before age 18. Mental
retardation is recorded on Axis II of the system.
Mental status exam: An assessment of the client’s appearance and behavior, emotional
state, thought components, and cognitive functioning. Used to assist the clinician
in making a diagnosis and in treatment planning.
Minuchin, Salvadore: Well-known family therapist who stressed the importance of
“joining” with clients. Similar to the concept of relationship building.
Misrepresentation of credentials: The “ethical hotspot” that speaks to the issue of the
importance of claiming only those credentials for which one has legitimately
achieved. See Table 3.1.
Modeling:
The demonstration of a behavior which a client views and later exhibits.
Modeling can be inadvertent or intentional. A commonly used skill.
Moral models: Ethical decision-making models that stress the role of moral principles
when faced with difficult ethical dilemmas. See Kitchener’s moral model and
Rest’s moral model.
Morality:
Generally concerned with how an individual conducts oneself and is often
the reflection of values of a group, such as an individual’s family, religious sect,
culture, or nationality.
Multi-axial diagnostic system of the DSM-IV-TR: A system of five “axes,” or
mechanisms for gathering and recording data, currently in use by the mental
health profession.
Narrowed inferences: Step 4 of the inverted pyramid method of case conceptualization.
Requires applying the same theoretical orientation used in Step 3 of the method to
identify still-deeper, more encompassing, or more central, causal themes, when
they are present. At Step 4, these themes are distilled or narrowed further into
existential, fundamental, or underlying questions of life and death (suicidal and
homicidal thoughts and meaning of life issues), deep-rooted shame or rage,
extreme loss of identity, fragile personality structures, or other deep concerns.
Natural helping: The informal style of the untrained lay helper. Natural helpers
rely on intuition, familiarity, natural responsiveness, and personal
opinions. Four different styles: listener, analyzer, problem solver,
and challenger.
Non-diagnosable client presentations: Functional, normal, and ordered behavior, or
expected and culturally appropriate reactions to life events and developmental
challenges.
Non-verbal behaviors: The often unconscious behaviors exhibited during communication.
As much as eight percent of communicate. Varies across culture. Includes:
attire, eye contact, body positioning, facial expressions, personal space,
touch, voice intonations and tone. A foundational skill.
Offering alternatives: The least potentially harmful of three problem-focused, commonly
used, skills in which a number of options toward working on identified problems
are given. Also see information-giving and advice-giving.
Open-mindedness: Freedom from fixed preconceptions and an attitude of open
receptivity to what the client is expressing. One of the eight critical attitudes.
Open question: A type of information gathering technique in which a question is used to
allow the client to respond in a myriad of ways.
Other conditions that may be a focus of treatment: Problem areas that are not considered
mental disorders appear together in the DSM-IV-TR under this heading.
This section lists various issues, problems, areas of growth and development, and
other counseling themes and topics that may be a focus of treatment, but are not
causing enough clinically significant symptoms or distress to warrant a mental
disorder diagnosis.
Paraphrasing: Repeating back to the client, in condensed form, what you heard the client
say. An important skill prior to being empathic. A foundational skill.
Pause time:
The amount of silence between responses. Varies as a function of culture. Some
suggest allowing for 30 seconds of pause time.
Personality disorders: These disorders are presented in the DSM-IV-TRs’ last chapter of
mental disorders. Personality disorders are characterized by “an enduring pattern
of inner experience and behavior that deviates markedly from the expectations of
the individual’s culture” (APA, 1994; p. 633). Three clusters of personality
disorders are included: Odd-Eccentric (Paranoid, Schizoid, and Schizotypal),
Dramatic-Emotional (Antisocial, Borderline, Histrionic, and Narcissistic), and
Anxious-Fearful (Avoidant, Dependent, and Obsessive-Compulsive).
Parents and legal guardians: As a general rule, in the United States the parent or legal
guardian of a minor under age 18 has “ownership” of the client’s confidentiality.
Post-interview stage: Stage 6 of the helping relationship, with its primary goal being to
maintain appropriate availability. See Tables. 2.1-2.3 to review how core areas of
knowledge and skills are applied at this stage.
Pre-interview stage: ”Stage 0” of the helping relationship, with its primary goal being to
prepare for an optimal first professional encounter with the client. See Tables.
2.1-2.3 to review how core areas of knowledge and skills are applied at this stage.
Privileged communication: The critical ethical and legal issue that asserts the right to
confidentiality of a conversation conducted with someone that state or federal law
identifies as a person with whom conversations may be privileged; that is, legally
kept confidential. Generally given to licensed clinicians. See Jaffee v. Redmond.
Contrast with confidentiality.
Problem identification: Step 1 of the inverted pyramid method of case conceptualization.
Requires using wide latitude to identify and list the client’s presenting concerns,
associated concerns, and relevant aspects of the person’s functioning. More
specifically, involves exploring the presenting problem, additional areas of
concern, parental and family relationships, experiences and reactions during
sessions, health-related issues, as well as formal psychological assessment.
Problem identification stage: Stage 2 of the helping relationship, with its primary goal
being to identify, describe, and understand the client’s concerns. See Tables. 2.12.3 to review how core areas of knowledge and skills are applied at this stage.
Problem solver: The natural helper style in which the individual likes to define the
problem, set goals, and take action to reach a solution.
Problem-focused skills: One of three types of commonly used skills in which the
clinician either offers alternatives, provides information, or gives advice. See
offering alternatives, information-giving, or advice giving.
Process self-disclosure: When the clinician expresses how he or she feels about the client
in the moment. Also see content self-disclosure. A commonly used skill.
Professional counseling: The term used to describe the highly trained clinician who
deliberately applies a broad range of critical skills in a systematic fashion
within the counseling relationship.
Professional disclosure statement: A verbal or written statement given near the beginning
of the helping relationship that describes a number of counseling related issues such as the
helper’s theoretical orientation, credentials held, the purpose of the interview, relevant agency
rules, limits to confidentiality, legal issues, and fees for service.
Progress notes: A record, prepared by the clinician, of how counseling proceeds. A key
part of the client’s record, providing a clinical reference for professional use and
a mechanism or showing accountability. Also referred to as “case notes.”
Professional provider organization (PPO): A managed health care organization.
Psychiatric consultation: Either discussing a case directly with a psychiatrist, usually to
explore diagnoses or pharmacological interventions, or referring a client to a
psychiatrist for diagnostic or medical evaluation.
Psychological adjustment: The willingness to undertake activities, such as counseling, in
order to assure that the clinician is well-balanced and able to work effectively
with clients. One of the eight critical attitudes.
Psychosocial and environmental problems: Problems the client is experiencing with his
or her primary support group, social environment, educational situation,
occupational situation, housing, economics, access to health care services, the
legal system, and similar issues, especially those that might be associated with
the client’s mental health concerns. These are recorded on Axis IV.
Psychotropic medications: Medications used in the treatment of mental health problems.
Purkey and Schmidt: Identified four characteristics of the effective helper: being
personally inviting with oneself, being personally inviting with others, being
professionally inviting with oneself, and being professionally inviting with others.
Questions:
One of the information gathering skills, questions come in a variety of
forms, including: direct questions, closed questions delimiting affect,
closed questions delimiting content, open questions, tentative questions,
and why questions.
Rapport and trust building: Stage 1 of the helping relationship that begins with the
actual interview. The primary goal is to gather initial information about the client
and establish a trusting, facilitative, therapeutic alliance. See Tables. 2.1-2.3 to
review how core areas of knowledge and skills are applied at this stage.
Recording procedures: Provided in the DSM-IV-TR text for each mental disorder, these
are instructions for documenting subtypes and specifiers as well as for writing out
the numerical code associated with the diagnosis.
Red flag chapters: Four red flag classes of disorders appear early in the diagnostic system
text and should be immediately ruled out by the clinician. These include:
delirium, dementia, amnestic disorders and other severe cognitive disturbances;
general medical conditions; substance use disorders; and schizophrenia and other
psychotic disorders.
Relationship building: The manner in which clinicians brings themselves into the
counseling relationship and relate with the client. Gelso and Carter state that this
working alliance exist throughout the stages of the counseling relationship,
regardless of whether it is explicitly acknowledged by the counselor and the
client. One of the eight critical attitudes.
Relative efficacy: One of two types of evidential counseling outcome research. Refers to
the comparative study of the effectiveness of different theoretical approaches, for
example psychoanalytic versus behavior treatment, to help understand which
approaches are best for which client needs.
Resistance:
“Any behavior that moves a client away from areas of discomfort or
conflict and prevents the client from developing.” (Gladding, 2001). A
common concern of beginning counselors.
Resolving ethical dilemmas: Three methods suggested for resolving difficult ethical
concerns: decision-making models, moral models, and developmental models.
Rest’s moral model: Suggests following a critical decision-making path that includes:
making an interpretation about the situation, gauging and selecting the moral
principles that underlie the decision to be made (e.g., a person should not murder),
and acting on the basis of the selected moral principle(s).
Rogers, Carl: Defined empathy, genuineness, and unconditional positive regard as core
conditions to the counseling relationship. Stressed the importance of the
relationship in the counseling process.
Selecting achievable goals: The first aspect of treatment planning. Involves determining
specific objectives for change from among the presenting concerns, associated
concerns, etiological factors, and/or sustaining factors which are causing the client
distress or dysfunction. Involves the following considerations: selecting the
problems, urgency and dysfunction, case conceptualization, client motivation, real
world influences, and setting behaviorally measurable goals.
Self-disclosure: When the clinician reveals parts of himself or herself in an effort to
strengthen the counseling relationship, help client feel comfortable with selfdisclosure, and/or offer a new way of being in relationships. Two types: content
self-disclosure and process self-disclosure. A commonly used skill.
Sexton:
Researcher who found that "counseling outcome research findings are so
compelling that the debate regarding whether counseling is effective is no
longer a major issue."
Sexual relationships with clients: The ethical “hot spot” that states clinicians must not
have sexual relationships with clients. See Table 3.1.
Silence:
An important foundational skill that gives the client and the clinician time
to reflect on what has been said. Also, see “pause time.”
SOAP:
A common template for writing case notes, including the following
information: Subjective Client Report, Clinician Observations, Current
Assessment, and Current Plan.
Speight, Myers, Cox, and Highlen: See existential model of cross-cultural counseling.
Stages of the counseling relationship: The natural unfolding progression of the helping
relationship. Core areas of knowledge and skills should be applied to them in a
systematic fashion (See Tables 2.1–2.3). The stages include: The Pre-Interview;
Rapport and Trust-Building; Problem Identification; Goal-Setting; Work;
Closure; and The Post-Relationship.
Storing of records: Safeguarding of client files and materials during and after a course of
professional counseling. Must be done in a secure and confidential manner in
compliance with ethical and legal guidelines.
Structured interviews: An information gathering technique that gives the clinician a
mechanism to gather information in a consistent and expeditious manner. An
important precursor to developing treatment plans. Questions are often used to
facilitate this process. Often includes: demographic information, reason for
referral or contact, family of origin background, current family background,
cross-cultural issues, educational and vocational background, medical/psychiatric
history, substance abuse history, legal issues and history, and mental status.
Tarasoff case: The landmark case that set a precedent for the responsibility that clinicians
have regarding confidentiality and acting to prevent a client from harming self for
others. See “duty to warn.”
Techniques:
The type of helping skills that have been shown to be effective in assisting the
client through the stages of the helping relationship. Includes foundational skills,
information gathering skills, and commonly used skills. One of the eight core
areas of knowledge and skills.
Tentative question: A type of information gathering technique in which a question is
asked in a manner that invites the client to tell the clinician if he or she is on target
with the response made. Empathic responses can be made into tentative questions
or other kinds of questions can be asked in a tentative fashion.
Termination summary: A part of the client record associated with the Closure Stage of
the helping relationship. Describes the overall progress made in implementing the
treatment plan and achieving stated goals for change. Typically includes four
components: Reason for Termination, Treatment Plan Compliance, Progress
Summary, and Post-Termination After-Plan.
Thematic groupings: Step 2 of the inverted pyramid method of case conceptualization.
Requires organizing all identified client problem and symptoms into intuitivelogical groupings or constellations. Four types of intuitive-logical judgment may
be applied: descriptive-diagnosis, clinical targets, areas of dysfunction, or
intrapsychic.
Theoretical inferences: Step 3 of the inverted pyramid method of case conceptualization.
Requires attempting to tentatively match client themes developed in previous
steps of the process to areas of difficulty according to the counselor’s theoretical
orientation. At this step, previously identified symptom constellations are refined
to reflect inferences about deeper aspects or causal roots of the client’s
difficulties.
Theoretical orientation: System of understanding human functioning and dysfunction
applied by the clinician to his or her understanding of client needs. Commonly
used traditional theoretical orientations include: behavioral, brief solutionfocused, cognitive, cognitive-behavioral, humanistic, and psychodynamic. Others
include existential, feminist psychology of women, reality, and gestalt. Theories
often are combined to form eclectic or integrative orientations.
Theory:
The template for conceptualizing client problems. Theories are heuristic,
based one’s view of human nature, and typically take into account the effects of
biology, genetics, and environment. One of the eight core areas of knowledge and
skills.
Thought components: The part of the mental status exam that looks at the content and the
process of thinking. Content includes delusions, distortions of body image,
hallucinations, obsessions, suicidal or homicidal ideation, and so forth. Process
includes circumstantially, coherence, flight of ideas, logical thinking, intact as
opposed to loose associations, organization, and tangentiality.
Time management: Being on time, keeping appointments, meeting deadlines, staying as
expected during assigned office hours; and being present, timely, and
conscientious regarding all clinical duties, including individual, group, and other
counseling assignments, as well as intake duty, on call and emergency staffing,
phoneline responsibilities and similar tasks; and being present, timely, and active
in all clinically related activities, such as attending supervision, consultation
meetings, case staffings, and other meetings. Such work habits take on special
meaning and importance in the context of providing professional counseling
services.
Treatment planning [Definition 1]: The process used to address identified client concerns, and is
based on one’s conceptualization of client problems and on the diagnosis. One of
the eight core areas of knowledge and skills.
Treatment planning [Definition 2]: The process of plotting out the counseling process by
delineating the path from the client’s presenting concerns and underlying
difficulties to alleviation of these concerns. Treatment planning stems from the
clinician’s conceptualization of client needs and includes three aspects: selecting
achievable goals, determining treatment modes, and documenting attainment of
goals.
White knight syndrome: The feeling that we need to rescue others. A common concern of
beginning counselors.
Why question: A type of information gathering technique in which a “Why” question is asked
with the intent to have the client delve deeply into self. However, clients often
feel defensive with why questions and they should generally be avoided.
Work stage:
Stage 4 of the helping relationship, with its primary goal being to facilitate
progress toward specified treatment goals. See Tables. 2.1-2.3 to review how core
areas of knowledge and skills are applied at this stage.
Working alliance: See “relationship building.”