Psychoanalytically oriented interviewers usually refrain from self disclosure because talking about their own real feelings muddies the transference. When pressed by clients for a congruent or genuine response, psychoanalytic oriented interviewers usually take shelter behind the professional relationship. For example: Client: “I like being with you so much that I wish we could get together outside therapy. I wish we could go out to lunch and do the kinds of things that friends do.” Interviewer: “I want you to know how important it is for us to maintain our professional relationship. Even if I wanted to have a friendship with you, I wouldn’t, because to do so could have a negative effect on our work together.” The psychoanalytic response is much cooler and more distant than the person centered or feminist response in similar situations. Although person centered and feminist interviewers maintain professional client therapist boundaries, they might be more warm and open: Client: “I like being with you so much that I wish we could get together outside therapy. I wish we could go out to lunch and do the kinds of things that friends do.” Interviewer: “Yeah, I can really relate to that because I enjoy our time together too. And in some ways, spending time together outside therapy would be nice for me too. But counseling is a special kind of relationship. Each of us has a role, or a job to do, and if we added in other roles, like being friends, it could get in the way of the work you’re doing here. Does that make sense to you?” Whether positive or negative, take your clients’ reactions to you with a grain of salt.
Feminist Response, Feminist Interviewers
September 29th, 2009 — Uncategorized
Normal Haemodynamic Response, Recovery Normal Left Ventricular Function Persistent
September 29th, 2009 — Uncategorized
The second Canadian Guideline proposal is to use a riskstrati?cation tool which analyses the risk of subsequent cardiac events and the risk of disease progression, as directed by the presence and severity of the individual’s risk markers. The third Canadian Guideline proposal is to merge the Duke Treadmill score, CCS class score and the Table 2.1. Characteristics of low and high risk CR
A low risk individual would have all of A high risk individual would have the following: only one of the following: Normal haemodynamic response to Decreased left ventricular function
Action Response Questions, Repeated Questions
September 29th, 2009 — Uncategorized
However, we generally avoid boundary violations because they may lead to more frequent inappropriate impulses and eventual ethical violations .
Guidelines in Using Questions
Both clients and interviewers sometimes have strong reactions to questions. To optimize your use of questions, keep in mind the following ?ve guidelines: Prepare your clients for questions.
Do not use questions as your predominant listening or action response.
Make your questions relevant to client concerns.
Use questions to elicit concrete behavioral examples.
Approach sensitive areas cautiously.
Prepare Your Clients for Questions
A simple technique that reduces negative fallout from questioning is to forewarn and prepare your client for intensive questioning. This often helps clients feel less defensive and more cooperative. You can forewarn clients by saying: “I need some speci?c information from you. So, for a while, I’ll be asking you some questions to help me get that information. Some of the questions may seem odd or may not make much sense to you, but I promise, there’s a reason behind my questions.” Do Not Use Questions as Your Predominant Listening or Action Response Questions should always be used in combination with other listening responses, especially nondirective listening responses. Be sure to follow your client’s response to your query, at least occasionally, with a listening response: Interviewer: “What happened when you ?rst stepped onto the subway?” Client: “When I stepped inside the train, I felt my heart begin to pound. I thought I was going to die. I just held onto the metal post as hard as I could because I was afraid I would fall over and be humiliated. Then I got off the train at my stop and I’ve never been back on the subway again.” Interviewer: “So that was a pretty frightening experience for you. You were doing about everything you could to stay in control. Was anyone with you when you went through this panicky experience?” Unless a variety of sensitive listening responses are used in combination with repeated questions, clients are likely to feel bombarded or interrogated .
Interpretive Response, Interpretive Feeling re
September 29th, 2009 — Uncategorized
Basic Attending, Listening, and Action Skills 73The reason an interpretive feeling re?ection is considered a directive, interviewercentered response is worth further discussion. You may be wondering why such a response is labeled interpretive if it is based on the client’s report of personal experience.
First, as Egan suggests, the interpretive feeling re?ection is based on emotional material “buried” or “hidden” from the client . When interviewers bring this material to a client’s awareness, they are engaging in a directive activity. Second, an interpretive feeling re?ection, or Egan’s “advanced empathy,” assumes that unconscious or out of awareness processes are in?uencing the client’s functioning. In making such an assumption, the interviewer is imposing a theoretical construct on the client. Essentially, because an interpretation’s goal is to bring unconscious material into consciousness, it is a directive technique . However, as George and Cristiani suggest, even nondirective feeling re?ections can produce this effect: “The classic client centered technique, re?ection of feeling, can be viewed as an interpretation” .
Interpretive feeling re?ections are powerful techniques that can promote therapeutic breakthroughs. They may also stimulate client defensiveness. As psychoanalytically oriented clinicians emphasize, when it comes to effective interpretations, timing is extremely important . That’s why, in the preceding example, the interviewer initially uses a nondirective feeling re?ection and then, only after that re?ection has been af?rmed, moves to a more probing and interpretive response. Interpretive feeling re?ections require a good relationship and previous knowledge of the client as a foundation for effectiveness. In addition, as with nondirective feeling re?ections, interpretive feeling re?ections should be worded tentatively.
Other Times, Cation Response
September 29th, 2009 — Uncategorized
The third form of clari?cation is the most basic. It’s used when you don’t quite hear what a client said and you need to recheck.
- “I’m sorry, I didn’t quite hear that. Could you repeat what you said?”
- “I couldn’t make out what you said. Did you say you’d be going home after the session?”
There are times during interviews when you do not understand what clients are saying. There are also times when your clients are not sure what they are saying or why they are saying it. Of course, the worst possible scenario is when neither of you has any sense of the meaning or purpose of what’s being said. Sometimes, the appropriate response is to wait, as Luborsky suggests, for understanding to come. However, other times, 66 Listening and Relationship Developmentit is necessary to clarify precisely what clients are talking about. There are also times when clients need to clarify something you’ve said.
Brammer provides two general guidelines for clarifying. First, admit your confusion over what the client has said. Second, “try a restatement or ask for clari?cation, repetition, or illustration” . Asking for a speci?c example can be especially useful because it encourages clients to be concrete and speci?c rather than abstract and vague.
From the interviewer’s perspective, there are two main factors to consider when deciding whether to use clari?cation. First, if the information appears trivial and unrelated to therapeutic issues, it is best to simply wait for the client to move on to a more productive area. It can be a waste of time to clarify minor details that are only remotely related to interview goals. For example, suppose a client says, “My stepdaughter’s grandfather on my wife’s side of the family usually has little or no contact with my parents.” This presents an excellent opportunity for the interviewer to listen quietly. To attempt a clari?cation response might result in a lengthy entanglement with distant family relationships.
Tumors, Response
September 1st, 2009 — Uncategorized
It concerns a man with a fulminating cancer of the lymph nodes who convinced his doctor to treat him with a drug called Krebiozen; the man had a miraculous recovery with disappearance of his many large tumors. He did well until he heard news reports of the ineffectiveness of Krebiozen, whereupon he regressed to the same desperate state in which he had been before.
Impressed with his response to the treatment, the doctor told him he would give him injections of a more powerful Krebiozen, but this time used only sterile water. Once more the patient responded dramatically and his tumors melted away. When the American Medical Association officially announced the decision that Krebiozen was of no value, his tumors returned and he died soon after.
It is clear from this case history that a placebo works on the body not the imagination. In this instance it stimulated a vigorous response in the immune system that was able to destroy the tumors.
Based on the impression that most of the pain syndromes I see are due to TMS, I have to conclude that beneficial results from most of the treatments to be described are the work of theHealing Back Pain placebo factor.