Section 3: Specialist Counselling Communication Skills

People come to counselling because they are experiencing an issue they want to resolve. At times, their own patterns of thought and behaviour can make this more difficult, and it is the counsellor’s job to help the client identify when this is happening. Challenging is a skill that counsellors use to facilitate change in clients by highlighting discrepancies, distortions, or ‘blind spots’ in clients’ communication or behaviour. These may indicate “unresolved, contradictory or suppressed feelings” (Cormier, Nurius & Osborn, 2013, p. 100). Pointing them out to the client offers an opportunity for change in thinking, feeling, or behaviour.

It is appropriate to use challenging when you become aware of discrepancies or mismatches that may have some bearing on the client’s current difficulties. You may notice discrepancies in verbal and non-verbal communication. For example, a client may smile while talking about how angry she is. You could point out this discrepancy which may help the client become aware of her underlying emotions. Other discrepancies may be evident in a client’s verbal communication and his or her actual behaviour. For example, a client may express an intention to do something but then fail to follow through.

Other forms of challenging involve ‘reality testing’ situations where you might challenge a client’s perception by offering a more balanced view. Nelson-Jones (2014) suggests these may include but are not limited to:

• Challenging possible distortion of reality: Clients may make statements that are inconsistent with their reality, such as “They are all out to get me” or “I have no friends.”
• Challenging insufficiently acknowledging strengths: Some clients may need to be reminded of their strengths to obtain a more balanced picture of themselves.
• Challenging not acknowledging choice: Sometimes, clients will make an inaccurate statement about having no choice in a situation.

Steps in the Challenging Process

Challenging is usually appropriate in the latter stages of the counselling interview process after establishing a good rapport and counselling relationship with your client. The challenging process involves the following steps (adapted from Ivey et al., 2014, p. 236):

1. Use core microskills to listen, observe, and take note of client conflict, mixed messages, and discrepancies in verbal and nonverbal behaviour.
2. Start with an accurate reflection of the client’s previous message. You can do this by utilising the core microskills discussed in the previous section of this module. This demonstrates that the counsellor has understood the client and acknowledged his or her viewpoint. By taking these steps, the client is more likely to be open to the content of the challenge.
3. Focus on the ‘incongruity as the problem’ rather than the person – focusing on specific examples using core microskills:
   • Responding: Summarise and clarify internal and external discrepancies by feeding them back to the client, usually through summarising.
   • Noting and reflecting: helps clients to come to their own conclusions. By reflecting back what the client has said, you can allow them to come to their own conclusions about discrepancies.
   • Observe and evaluate: how the client responds and whether the confrontation leads to client movement or change. If the client does not respond to the challenge, try another skill.

Important Considerations

It is important, however, to point out that there is the potential for adverse impacts on the client as a result of challenging. At times challenging can be hurtful or counterproductive, such as when it prompts defensiveness. Challenging should only be used (Cormier et al., 2013; Nelson-Jones, 2014):

• Intentionally: Only when you have a good understanding of what you are trying to achieve by pointing out the discrepancy and when you have reasonable grounds for believing that challenging will be a useful and appropriate technique given the situation. Challenges should be given at times when they are likely to be used by and useful to the client. This includes giving the client time to react to and discuss the challenge.
• Sparingly: Take care with the strength and frequency of challenges. It is important to ensure that the counselling environment remains a safe, supportive, and therapeutic space.
• Only once you have established a strong and supportive counsellor-client relationship: Ensure that rapport and trust have been established before challenging a client.

When deciding whether and how to challenge a client, and while challenging, you also need to:

• Be aware of an individual’s cultural beliefs and other factors that could impact the appropriateness of the challenge.
• Consider the client’s potential reactions to being challenged, including how they could interpret the challenge (remembering that a client’s interpretation may be quite different from what the counsellor intends).
• Be aware of the limits of challenging. While the client may gain new insight, for example, the challenge itself may not bring a resolution to the client’s presenting issue.
• Allow the client to decide whether the message in the challenge is helpful and needs to be explored further.
• Keep in mind the circumstances when it is definitely inappropriate to use challenging techniques. These include highly emotive situations, such as when a client is in crisis or when they are experiencing significant stress or trauma.

Let’s look at an example of how challenging can be used by a counsellor to help a client reflect on a discrepancy in their behaviour.

Case Study

Allan, a counsellor with a special interest in career development, has had four counselling sessions with Christos, a young man who left school two years ago and is currently working casually as a labourer.

In earlier sessions, Christos told Allan that he had been “a bit wild” at school and freely admitted to Allan that he hadn’t really put much effort in. He revealed that the school guidance officer had told him that he would “never amount to anything” and that this was something that had always stuck in his mind.

Allan has developed a good working relationship with Christos, and they have explored various options for him, including becoming a paramedic, which Christos has expressed a keen interest in. Although Christos has done quite a bit of research into what is involved in becoming a paramedic, he has reported in his last two sessions that he has not actually completed the application process.

Allan has identified a repetitive pattern of behaviour that Christos engages in – not following through with his goals. He feels that pointing this out in a supportive way may encourage Christos to do things differently this time. He decides to use a well-timed challenge.

Allan: Christos, you’ve said that you really want to become a paramedic, and you’ve told me all about the reality television programs you watch that involve emergency medicine. It says to me that, on one hand, there’s a real interest there. You’re also telling me, though, that you haven’t got around to filling in your application forms for the course yet, and the deadline is on Monday.

Allan adopts a questioning and concerned stance using appropriate verbal and non-verbal communication in order to show Christos that he is listening and open to his response.

In the case study, Allan has taken care to highlight the incongruence in Christos’ stated aims and his behaviour rather than pointing out a personal failing. Allan’s use of challenging here may result in various responses from Christos. Christos may come up with a list of reasons why he didn’t fill in the application form or even tell Allan that he has changed his mind about the course and didn’t want to tell Allan because he thought he might be disappointed in him.

Regardless of Christos’ response, by highlighting the problematic behaviour, they can address the unhelpful behavioural pattern that Christos is engaging in or explore any underlying issues. Now let’s look at an ineffective use of the challenging technique.

If Allan were to use this type of ineffective approach, Christos is likely to feel shamed (particularly given what his school guidance officer said to him as a teenager) and pressured by this challenge. He will likely respond by saying, "Well, I didn’t want to become a paramedic anyway!”

Challenging

This short but effective video explores how clients can get in touch with the difficult feelings they’re reluctant to face by sensitively challenging them.

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Focusing is a skill that can be used to identify a client’s major problem area and determine what should be attended to first by directing the client’s conversational flow (Ivey et al., 2014). Focusing skills are used to direct attention to specific dimensions and areas of the client’s life and experiences. There are three main types of focusing skills. They are:

• Focusing clients on themselves: Assist clients to focus on themselves by encouraging them to send “I” messages. When clients do not use “I” messages, they distance themselves from their feelings, thoughts, and actions, thus, reducing their accountability and ownership.
• Focused exploration: Ask clients to prioritise areas for exploration.
• Focused responding: Choose a part of the client’s statements to focus upon.

As an example of how focusing can be important within counselling, consider a client who is currently living interstate for work, and has mentioned very little about his family despite the counsellor having a hunch that his family is relevant to the client’s main concerns. The counsellor may direct the conversation toward the client’s family by making statements about the family (e.g., “I imagine it can be very challenging for you and your family, living apart for this period …”) or directly asking the client to talk more about them (e.g., “How does your family feel about you living so far away?”).

Consider the following example of a counsellor focusing on a particular part of the client’s issue and how this can help the work of counselling progress:

Case Study

Scott is attending counselling for help with problems he is having in his relationship with his wife.

Excerpt from the counselling conversation.

Counsellor: Has it always been like this? Was there a time when you did talk to each other?

Scott: When we first married, we talked about everything … had no secrets. It was really comfortable and easy. Now things seem so hard. It seems like we hardly talk to each other at all.

Counsellor: Can you remember when things changed?

Scott: We just drifted into it, I suppose… [Scott looks down, flushes and shifts in his seat].

Counsellor: Was there something in particular that changed things?

Scott: Well, yes, there was, I guess. I had an affair a couple of years ago.

The counsellor has picked up on Scott’s non-verbal communication (looking down, flushing, and shifting in his seat) and decides it might be helpful to focus on this area of Scott’s story using a probing question (i.e., focused responding). Reading E has further detailed examples of how focusing may be used in counselling sessions.

Ivey, Ivey, and Zalaquett (2014) identify several areas you may wish to focus on with your client.

Areas of focus:

• The individual client: This dimension focuses on the client rather than their story. Some counsellors may forget to focus on the client and instead begin unnecessarily prying into the client’s life.
• The client’s feelings: It can be helpful to understand the client’s experience of what they are feeling, either currently or in retrospect, regarding a past memory.
• A theme, concern, issue, or problem: This involves focusing on the reason why the client came to counselling or another issue that has been raised.
• Significant others (partner/spouse/family/friends): Often, clients come to counselling for help with interpersonal problems. Thus, counselling often focuses on “issues of conflict, incongruity, and discrepancies between the individual and family and friends” (p. 214).
• The context: Families and family structures, friends and communities, norms, values, beliefs, and roles impact all of us. Exploring these aspects of environmental and cultural context can help both counsellor and client develop their understanding of the client’s experience. It is particularly important to understand how environments we might not be familiar with impact our clients, but remember that everyone’s context differs (including yours!). It is not only clients with different cultural backgrounds from your own for whom this is important.
• The mutual ‘we’ and the ‘here and now’: It is sometimes useful to focus on the relationship between the counsellor and client, including the client’s reactions to the counsellor and their experience of the current moment in the counselling room.
• The counsellor: In times when self-disclosure is useful, the focus can be on the counsellor. Please note: self-disclosure should be used very sparingly and only when there is a specific counselling reason for the self-disclosure.

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Clients who seek help from a counsellor are often distressed and in emotional pain. Their thoughts and feelings may be coloured by particular ways of viewing or thinking about events and circumstances. Through reframing, counsellors provide other possible perspectives. It is critical that this does not deny the client’s view or impose the counsellor’s perspective, which can happen when reframing is not done appropriately. Instead, reframing should come after hearing about and demonstrating an understanding of the client’s position. The counsellor can then tentatively offer an alternative way of thinking about something, and the client can choose to adopt this ‘reframed’ perspective if they think it would be helpful to them (Geldard & Geldard, 2009).

The Process of Reframing

The aim of reframing is to assist clients in seeing a situation or issue from a different perspective. To do so effectively, however, counsellors need to prepare. As with challenging, reframing relies on a strong and safe client-counsellor relationship to be effective; requires counsellors to use high-level core microskills throughout; and should only ever be done supportively, intentionally, and for the client’s benefit. Reframing involves:

1. Listening to the client’s interpretation of a situation, event, or problem; attending and demonstrating understanding and empathy.
2. Noticing what the client is highlighting or emphasising, as well as information they may be overlooking or minimising.
3. Identifying another perspective which still encompasses what the client has said, but provides a different view. This may involve making use of what has been overlooked or under-emphasised or suggesting an alternative explanation for an event where the cause is not definitive.
4. Tentatively presenting this alternative or inviting the client to explore different interpretations.

Counsellors may use reframing in a variety of ways, including to help clients:

• Consider alternative explanations for an event, such as when Alison (in the extract) considered her poor academic performance as an indicator of low intelligence when it may have been due to her not using effective study techniques and time-management strategies.
• Create a distinction between their self-concept and the problem they are experiencing. This is a core feature of narrative approaches – the person is not the problem – the problem is the problem. This also occurs within cognitive approaches, when labelling thoughts (e.g., “I can’t believe I did that – I’m such an idiot!”) are challenged.
• View a mistake as a learning opportunity. For example, when a client tells their counsellor that they feel awful about upsetting a friend, the counsellor can reflect the feeling and then help the client see what they can learn from the situation. The client might leave the session with a set of strategies and communication skills they can use in future to minimise the chances of the event recurring.
• See problems or things that are stress-inducing as challenges to be overcome. A client anxious about submitting a job application might change their view to see writing and sending the email as a challenge to overcome to achieve their goal of finding new work.
• See other possible motives or reasons behind someone else’s behaviour. For example, a client upset that a friend did not acknowledge them in the street may not have considered the possibility that their friend did not see them.

Factors to Consider When Reframing

Reframing is a challenging skill to master and can be invalidating and unhelpful if not used appropriately. The counsellor may attempt reframing too soon, having not invested enough time and effort into understanding the client and their take on the situation; the reframe may be experienced as denying the client’s perspective or minimising their distress, or the reframe may be offered in a situation in which it is not appropriate. For example:

Like all specialist skills, you should use reframing cautiously and appropriately. Remember that gentleness and sensitivity are critical when reframing. In addition, this technique should only be employed when you have a detailed understanding of the client within their broader context, as well as the particular issue or situation being discussed. It is generally used in the ‘working’ stages of the counselling process.

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Now that you have an understanding of what the specialist counselling skills are – and how and when it is appropriate to use them - let’s look at some specific situations where these and the core microskills might be particularly useful.

Clients with Limited Self-Awareness

Often clients who come to counselling have limited awareness or understanding of their own thoughts, emotions and behaviours. For example, some clients:

• Distance themselves from their thoughts or emotions by speaking in abstract or general terms rather than expressing themselves directly.
• Demonstrate inconsistencies in their behaviours and in what they say they want.
• Have distortions in their thoughts, such as “I need to do something perfectly, or there is no point doing it at all”, or “I’m a failure. I never do anything right”.
• Fail to see other opportunities or courses of action.

Such clients may have difficulty embracing the counselling process because they often underestimate their ability to make positive changes in their own lives. Sometimes clients are ‘stuck’ in a particular pattern of behaviour, and even though they work through strategies to change those behaviours within counselling sessions, they may not implement these strategies in their life outside the counselling environment.

These are situations where you might utilise the skill of well-timed challenging. For example, when dealing with a client who has thought distortions (e.g., “I need to do something perfectly or there is no point doing it at all” or “I’m a failure, I never do anything right”), the counsellor may ask “Where is the evidence for that?” or may challenge the client’s existing perceptions by offering new perceptions or ways of viewing problematic situations.

Clients Who Are Unsure of Where to Begin

Sometimes clients will come into counselling not knowing the main concern that they would like to focus on. They may mention numerous concerns, and it will be unclear which one takes precedence. When clients have a number of concerns, the best thing to do is to summarise and acknowledge them all and then ask the client to pick one to focus on.

Alternatively, some clients may spend the majority of the first session focusing on small issues because they are too uncomfortable to talk about what is really bothering them. Here, it is important to develop rapport and help the client feel understood. Demonstrating your understanding of their concerns may help them to feel free to talk about the more important ones.

Clients Who Lack Commitment

A lack of commitment can also be a challenging problem in the counselling process. A lack of motivation and commitment can be common in involuntary clients (for example, someone who has been referred to drug counselling as part of a criminal sentence or a husband who has been forced by his wife to attend couple’s counselling in order to preserve their marriage). Some typical characteristics of the uncommitted client include those that may:

• forget appointments
• show indifference to the counsellor and the counselling process
• not actively participate in the counselling process
• not take responsibility for their own problems.

Generally, counsellors are motivated to help their clients. As such, it can be a source of dismay and frustration for a counsellor when their efforts are met with disengagement or resistance. When this persists, counsellors may find themselves feeling defensive, rejected and even angry. While this is an understandable reaction, it is important for the counsellor to clearly identify the reasons for this reaction and develop strategies for dealing with it. Reframing may be a good tactic to re-model the way the client perceives the counselling relationship. Alternatively, a timely challenge may shift the person’s attitude toward the counselling process.

Cultural Differences

Despite a counsellor’s best efforts, it is possible that positive therapeutic change does not occur. This is sometimes due to the counsellor utilising skills that are not appropriate based on the client’s personal or cultural values. As with all counselling skills, it is important for the counsellor to consider how the skill will be taken in the context of a client’s cultural beliefs. For example, challenging or giving feedback may not be appropriate for some clients. Using these sorts of skills with culturally diverse clients may be damaging to the therapeutic relationship. Thus, you must take care when choosing the specialist skill you wish to use to elicit client change.

In addition to considering the match between the client and the skills and techniques you will use, you must also be aware of your own values and beliefs. These values and beliefs can have an impact on the work you do with a client, which can, in turn, affect their development and growth. It is important that counsellors work from the point of view of the client and in the context of the client’s values and cultural beliefs. In the following section, you will learn more about evaluating your own values and beliefs (self-reflection) and ensuring your practice acknowledges and respects the client’s individual context (person-centred practice).

Challenges and Rewards of a culturally-informed approach to mental health

Dr. Jessica Dere explains how culture makes a difference when thinking about mental health and mental illness. She explains how across mental health research, clinical care and teaching, there are profound rewards to be had by truly understanding individuals in context.

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Responding to Cultural Differences

Despite a counsellor’s best efforts, it is possible that positive therapeutic change does not occur. This is sometimes due to the counsellor utilising skills that are not appropriate based on the client’s personal or cultural values. As with all counselling skills, it is important for the counsellor to consider how the skill will be taken in the context of a client’s cultural beliefs. For example, challenging or giving feedback may not be appropriate for some clients. Using these sorts of skills with culturally diverse clients may be damaging to the therapeutic relationship. Thus, you must take care when choosing the specialist skill you wish to use to elicit client change.

In addition to considering the match between the client and the skills and techniques you will use, you must also be aware of your own values and beliefs. These values and beliefs can have an impact on the work you do with a client, which can, in turn, affect their development and growth. It is important that counsellors work from the point of view of the client and in the context of the client’s values and cultural beliefs. You will learn more about evaluating your own values and beliefs (self-reflection) and ensuring your practice acknowledges and respects the client’s individual context (person-centred practice) in the next section of this module.

Don't Put People in Boxes

This video sets out to prove that we have a lot more in common than we think and we should keep that in mind when we encounter anyone who might seem different than we are. 

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Check your understanding of the content so far!

In this section of the module, you were introduced to specialist communication skills, including challenging, focusing, and reframing skills. You learned about how to use these skills, as well as the anticipated impact these skills will have on the client, your relationship with the client, and their development and growth. You also learned that it is important to carefully consider the use of specialist skills as they can be inappropriate in certain situations and with certain groups.

• Cormier, S., Nurius, P. S., & Osborn, C. J. (2013). Interviewing and change strategies for helpers (7th ed.). Belmont, CA: Brooks/Cole.
• Egan, G. (2014). The Skilled Helper: A problem-management and opportunity-development approach to helping. (10th ed.). Belmont, CA: Brooks/Cole, Centage Learning.
• Geldard, D. and Geldard, K. (2009). Basic Personal Counselling: A training manual for counsellors. (6th ed.). Frenchs Forest, Australia: Pearson Prentice Hall.
• Ivey, A. E., Ivey, M. B.,& Zalaquett, C. P. (2014). Intentional interviewing and counseling: Facilitating client development in a multicultural society (8th ed.). Belmont, CA: Brooks/Cole.
• McLeod, J., & McLeod, J. (2011). Counselling skills: A practical guide for counsellors and helping professionals (2nd ed.). Maidenhead, UK: McGraw Hill.
• Nelson-Jones, R. (2014). Practical counselling and helping skills (6th ed.). London, UK: Sage.