Survival—self-preservation and safety (both physical and psychological)Physical—nourishment, shelter, income, freedom from pain, rest, & replenishment of energyLove and sex—to be involved in a close personal way to another human beingStatus, success, and self-esteem—needs that motivate people to achieve in the eyes of othersMental health—to feel like a functional human being, to have congruencyFreedom—to feel autonomous and be able to make personal choicesChallenge—need for activity, future, opportunityCognitive clarity—drive to resolve conflicts in values, ideas, and commitments and to live with honor and integrity
Culture and value shape our beliefs around our needs.Life events and environmental stressors may be important in shaping needs, especially of clients who feel marginalized due to a variety of oppressions.
Contextual factors—time, place, current events, etc.Beliefs—may already contribute to the problem, impede the solution, or become the problemFeelings—emotional responses may exaggerate the problemBehavior—habits and routines, contribute to problemsInteractional and relational patterns—miscommunications, expectations, coping skillsLanguage patterns—narratives and stories that are constructed about self, others, the world
Process goals—establishing rapport, nonthreatening setting, unconditional positive regard, empathy
Treatment plan—describes client’s presenting issues, outcomes goals, a way to measure goals, intervention strategies, time-frame
Precontemplation—not aware of need for change or not ready to changeContemplation—aware of need for change and thinks about it (does not act)Preparation—decides to take action in near futureAction—ready for change and begun to take some actionMaintenance—maintains change for a period of at least 6 monthsRelapse and Recycling—does not successfully maintain change
Case Conceptualization and Goal Setting
and Goal Setting
Clients enter counseling when they experience issues and needs that they alone are unable to understand or to meet or when their particular coping strategies to meet needs or resolve issues no longer work
Survival Physical Love and sex Status, success, and self-esteem Mental health Freedom Challenge Cognitive clarity
Clients learn (or do not learn) what their needs are and how to get them met through their family of origin • Culture and values • Life events and environmental stressors
Presenting issues of clients do not always come quickly or easily Issues may present as sessions continue Initial questions: • What brought you here? • Why now? • How has this been affecting your daily functioning?
Important to remember that client issues are complex and multidimensional • Contextual factors • Beliefs • Feelings • Behavior • Interactional and relational patterns • Language patterns
Hear the issues of the client Help clients hear their needs and issues Help client formulate goals that will help meet needs Help clients recognize their progress
Process goals: related to the establishment of therapeutic conditions necessary for client change Outcome goals: directly related to clients’ changes and to be made as a result of the helping process
Flexibleprocess, always subject to modification and refinement Outcome goals are agreed upon between counselor and client Important to develop culturally sensitive goals Outcome goals form the basis of a treatment plan
Presenting Goal Intervention Measure Time-FrameProblemClient Reduce Teach client • Client’s 6 weeksexperiences symptoms of mindfulness Beck (individualhigh levels of anxiety and relaxation Anxiety sessions oncegeneralized techniques Inventory per week)anxiety and that can be (BAI) willmild anxiety practiced daily decreaseattacks at home (e.g., • Client will guided report less imagery, instances breath work) of anxiety attacks
Specifies in behavioral terms Choice of suitable and realistic what the client will do amount of new behavior differently as a result of • Client will experience no counseling more than one anxiety attack per month • Client will better manage symptoms of anxiety and will have fewer anxiety Client will better manage attacks anxiety and reduce Indicate the conditions under anxiety attacks by less which desired change will than one per month occur through weekly individual • Client will attend weekly counseling and a daily counseling sessions and mindfulness practice develop a brief, daily mindfulness practice
Use of future-oriented questions to assist in process • What would this problem look like if I were managing it better? • What would I be doing differently in my life? • What would I have that I don’t have now? • What would this opportunity look like if I developed it? • What would I accomplish? • What current behavioral patterns would be eliminated?
Goals can never be more specific than your (counselor and client) understanding of the problem Subgoals or action steps to achieve larger goal • May be arranged in hierarchical sequence
Are clients ready for change? Stages of change model 1. Precontemplation* 2. Contemplation 3. Preparation 4. Action 5. Maintenance 6. Relapse and Recycling*most clients who drop out ofcounseling early are inprecontemplation stage
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