Counseling and Helping Relationships
What this domain covers
Counseling and Helping Relationships tests the therapeutic alliance, core counseling skills, major theoretical orientations, and the arc of treatment from intake through termination.
Core rules
- Rogers' person-centered conditions: two persons in psychological contact, client incongruence, counselor congruence, unconditional positive regard, empathic understanding, and the client's perception of the last two.
- Bordin's working alliance: goals, tasks, and bond. Alliance is the strongest transtheoretical predictor of outcome.
- Microskills (Ivey): attending behavior, open and closed questions, paraphrase, reflection of feeling, summarization, confrontation, immediacy, and appropriate self-disclosure.
- Orientation markers: psychodynamic - transference, countertransference, resistance, defense mechanisms; cognitive-behavioral - Beck's cognitive triad and automatic thoughts, Ellis's ABCDE; motivational interviewing - OARS (open questions, affirmations, reflections, summaries) and the stages of change.
- Treatment arc: informed consent and intake, assessment, goal setting, intervention, evaluation, termination, and referral when needed.
Worked example
A client says everything is fine while her eyes fill and she grips the arm of the chair. Reasoning: the discrepancy between content and affect is the clinical data. A reflection of feeling - noting that she is telling you it is fine while something in her face says otherwise - tests the observation, stays with her experience, and invites exploration without interpreting or advising. A premature question about why she is crying shifts the work to the counselor's curiosity and can close the client down.
Traps
Advising before understanding; stacking multiple questions; labeling a reflection of content as a reflection of feeling; interpreting through a preferred theory before assessing; neglecting to discuss termination, gains, and relapse prevention at the end.