CHAPTER 7

1. CHAPTER 7 Counseling and People Who Stutter

2. Ways of conceptualizing counseling . . . All clinicians should also train themselves in the subtle skills that enable them to sense the hidden feelings of their clients. These are not to be found in textbooks or classrooms. They must be mastered in the situations of intimate human encounter. Some of my students and clients have felt that I had an uncanny ability to read their thoughts—and at times I have indeed experienced something akin to

3. Ways of conceptualizing counseling (continued). . . clairvoyance—but only after I had observed and identified closely with the person long enough. . . . It is the result of very careful observation, uninhibited inference making, and the calculation of probabilities. It comes through empathy. (pp. 107–108) Charles Van Riper (1979) A career in speech pathology

4. At a certain point in this self-generated event, the client experiences an Aha! He says, “Now I understand how I am,” or “Yes, that’s how I feel,” or “Now I know what I need to do, how I need to act to get what I want in this situation.” He is his own teacher. (p. 125) Joseph Zinker (1977) The Creative Process in Gestalt Therapy

5. Some basic issues • Working under the surface of “doing emotions”! • Are we the ones to do it? • For support & understanding—not mental illness • A normal reaction to a difficult problem (Luterman, 2001) • How to counsel? • Counseling = The Relationship • A focus on the clinician

6. Basic concepts • Understanding is the key • Helplessness and getting “unstuck” • Negative emotions are a normal reaction to a serious communication problem • Young clinician & older client • Ellis (1977) irrational ideas • Separate feelings from nonproductive behavior • Egan (2007)—the goal is on a continuum between telling the client what to do and leaving him to his own devices → Action

7. Basic concepts (continued) • It’s not about talking or thinking, it’s about taking action • Because I trusted him, he trusts himself more; because I cared for him, he is now more capable of caring for himself; because I invited him to challenge himself and because I took the risk of challenging him, he is now better able to challenge himself. Because of the way I related to him, he now relates better both to himself and to others. Because I respected his inner resources, he is now more likely to tap these resources. (Egan, 1990, p. 59)

8. Counseling is NOT • Making people feel better • Fixing the problem/rescuing people • Information giving • Counseling techniques

9. Counseling can be • Taking action • Working with emotions (they just are) • Expected emotions ? • Nonverbal behavior • Empathy (not sympathy) • Probing and challenging • Rewriting the story

10. Egan’s goals Goals: • Enabling clients to manage their problems in order to live more effectively (in spite of emotions or circumstances) • Helping clients to develop unused or underused opportunities However: * It is messy * Wisdom necessary to get unstuck; learning must be sifted through experience to acquire wisdom

11. Egan’s model – Stage I The current story • Understand the client’s current map • Impact of stuttering on their lives • Blind spots and missed opportunities • Choose the right problems to identify • Develop pathways for accomplishing goals • Take action toward goals

12. Egan – Stage II • Determine the preferred story • Imagine what a better story would look & sound like • What are realistic & achievable goals? • Determine courage and persistence; create a supportive environment with timely challenges.

13. Egan – Stage III • Taking action • Brainstorm & experiment with possible actions • Deconstruct the past/structure the future • Sharpen the knife, practice, use talents (unique outcomes from the past) • Develop support for the journey, work through problems, support from others

14. The clinicians choices • The clinician’s philosophy • Directive or nondirective • Cognitive restructuring in some form

15. Philosophical approaches • Behavioral—structured rewards & steps • Humanistic—emphatic listening & unconditional support for client’s self-actualization • Existential—anxiety due to dealing with our existence, facing death, responsibility, loneliness . . . • Cognitive—thinking about our thinking, listen to the “quality” words informing us about cognitive state, (in)appropriate thinking creating reality, changing the language may change the situation.

16. PostModern approaches • Rather than experts dispensing the “truth,” there are many “realities” • Reality is created by context of one’s life • Not “what is the truth” but “how is reality constructed?” • People create their story based on society, culture, gender, age, . . . • People can alter their situation by altering their story and becoming liberated from their situation

17. Personal construct theory • Kelly, G. A. (1955). ThePsychology of Personal Constructs. New York: Norton • Kelly, G. A. (1963). A theory of personality. New York: Norton

18. Personal construct theory (continued) • People as scientists—experimenting & creating hypotheses • Develop personal construct to predict events • Corollaries that operationalize the system • A Range of convenience for a set of events • Experience gained actively rather than passively • A Choice that provides greater meaning

19. Emotions within PCT • Threat is defined as “an awareness of an imminent and comprehensive change in core structure” • Fear is defined as “the awareness of imminent incidental change in one’s core structures” • Anxiety is an awareness that the events a person is experiencing are beyond the range of convenience of the construct system. • Guilt occurs when a person acts in a way that is contradictory to his or her core role structure. • Hostility occurs when the person is persistent in trying to validate a social prediction in the face of repeated invalidation of that prediction.

20. Therapeutic change • Change requires the creation of alternative constructs (a reconstructing) • Difficult because it means letting go of accepted and safe views • Clinician assists client in experimenting with alternative views (constructions) • The speaker learns to problem solve

21. The therapeutic alliance and the client • Clients can change if they choose to do so. • Clients have more resources for managing problems in living than we assume. • The psychological fragility of clients is overrated both by themselves and others. • Maladaptive attitudes and behaviors of clients can be significantly altered, no matter how severe or chronic. • Effective challenge can provide in the client a self-annoyance that can lead to a decision to change.

22. The therapeutic alliance andtherapeutic discourse • A sensitivity to the language & the Tx alliance • Assist vs. help • The asymmetrical interaction of RRE interaction (Leahy, 2004) and the framing of the participants’ social and speaking roles (p. 45) • An “institutional pattern” of discourse conceptualizes and promotes the client as an “error-maker”

23. The therapeutic alliance andtherapeutic discourse (continued) The asymmetrical interaction of RRE interaction (Leahy, 2004) and the framing of the participants’ social and speaking roles (p. 45) (Continued) An asymmetrical relationship; the clinician in the authoritative role of the expert and the client in the subordinate role Increase the symmetry with socio-relational framing Follow the conversational lead of the client and summarize the speaker’s contribution

24. The therapeutic alliance and the clinician Luterman (2001) • The clinician is not likely to be entirely self-actualized. • The competent counselor does “. . . need to be a caring individual who does not impose beliefs on others, who maintains a constant awareness of self, and who does not hide behind the artificiality of being a professional (Luterman, p. 190). • Good clinicians recognize their limitations.

25. The therapeutic alliance and the clinician (continued) Egan (1990) • How did you decide to be a helper? • Why do you want to be a helper? • With what emotions are you comfortable? • What emotions—in yourself or others—give you trouble? • What are your expectations of clients?

26. The therapeutic alliance and the clinician (continued) Egan (1990) How will you deal with your clients’ feelings toward you? How will you handle your feelings toward your clients? To what degree can you be flexible, accepting, and gentle?