What a therapist isn’t

When training as a therapist, it helps to remember that:

• You are not a sage
It is unwise to try to be wise. You are not there to give your clients words of wisdom.

In working with the client you can help them feel safe enough to explore and reflect in ways that put them in touch with their own wisdom.

• You are not an expert on the client
You are not expected to know the answers to the client’s problems, or know what would be best for them. There’s only one expert on the client in the room, and it’s not you.

In working with the client you can help them feel safe enough to explore and reflect in ways that help them come to an awareness of how they feel and what they need.

• You are not an advisor
Giving advice is not normally a counselling skill (except, perhaps, in more directive approaches such as those sometimes used in rehab). In general, though, you are not there to tell the client what to do.

In working with the client they can develop a sense of being genuinely understood and valued, so that they can start value their own judgement enough to trust that they know themselves what is best for them.

• You are not a clairvoyant
You cannot know how things will turn out in the future. If you say “I’m sure it will turn out all right” or “He’s never going to change” you are predicting the future, and may not be helping the client in the here-and-now.

Active listening

Active listening means using a set of skills that encourage the person you are listening to to talk, to help them feel heard and understood. It is called “active” because you intentionally do things to help them feel able to talk, and because you engage with all your attention on what the speaker is saying, how they are acting, and how they are feeling.

Some active listening skills are:

  • Using minimal encouragers – small signals or words that let the speaker know you are listening and understanding – words like “uh-huh”, “yes”, “no”, “mmm”, and little actions like nodding that show you are engaged in listening.
  • Using open body language – helping make the speaker feel comfortable and safe with you.
  • Repeating back some of the speaker’s words, or a phrase, to help prompt them to say more.
  • Paraphrasing – putting what the speaker says into your own words.
  • Summarising – putting in a nutshell, in a sentence or two, what the speaker has been talking about over an extended period.
  • Mirroring the speaker – adopting aspects of their body language, voice tone and language to develop rapport and help them feel more at ease.
  • Reflecting – picking up on the speaker’s feeling or mood and feeding your perceptions back to them.
  • Using silence – so that the speaker has a respectful space to stay with their feelings and to work up to what they want to say.
  • Questioning skills – when and how to use questions to help the speaker to open up and tell you more.

In the context of interpersonal and counselling skills, active listening involves a focus on feelings – helping the speaker get in touch with their own feelings, and being aware of what feelings are around for you in the process. This can help the focus move from the surface issue, to underlying issues.

In listening actively, you are not trying to solve the speaker’s problems, nor to have “words of wisdom” to give them. Rather you are helping them get in touch with, and work through, the feelings that are at the root of what is going on for them, and in doing so enable them to work out for themselves what they may want to do about it. Only the speaker can really be sure what’s best for them.

Safety

Safety in the helping relationship refers to:

  • Emotional safety
  • Physical safety

Emotional safety

Creating a sense of emotional safety for the person being helped involves:

  • building trust: through the use of rapport skills
  • manifesting the core conditions: a sense of congruent acceptance from a helper who hears and understands them
  • a commitment to confidentiality
  • setting clear boundaries so the person knows where they stand. For instance there are limits to confidentiality which might come from:
    • legal requirements to disclose eg. a court order for client notes
    • safety considerations: serious risk of harm to themselves or others
    • supervision: the need for the helper to get professional support
    • contractual requirements: related to the organization in which the helper is working
  • creating an environment where the person fees secure, eg a warm, comfortable setting, not in danger of being overlooked or overheard

Physical Safety
Physical safety relates to aspects such as:

  • avoiding physical risks, like slippery surfaces, hot surfaces, sharp objects, electrical supplies
  • providing adequate fire exit routes
  • meeting other Health and Safety requirements, especially in an organisational setting

Helper safety

Helper safety is an issue too. As well as the above aspects of physical safety, in some contexts the helper might have to safeguard against the possibility of harm from the person they are helping. Such safeguards might involve:

  • contracting with a person with a history of physical aggression that they will not direct their aggression towards the helper
  • sitting nearest the door
  • carrying a personal alarm
  • making sure someone else is in the building or the room
  • choosing not to work with that person
  • Ensuring emotional safety for the helper might involve support from a person in a supervisory role or other organizational backup, and making sure that the workload for the person in the helping role was appropriate to maintaining their health and well-being.

The Metamodel – a safety net for trainees

In essence, the Metamodel is a simple way of deciding what to say next with the client. It was developed in the 1970s by Richard Bandler and John Grinder, the founders of NLP (Neuro Linguistic Programming).

Bandler and Grinder studied the techniques of famous therapists, such as Fritz Perls and Virginia Satir, and came up with a formula for deciding what to explore next with the client, simply based on linguistics – generalised aspects of meaning and grammar. Novices sometimes find it useful to fall back on (or at least to know that they can fall back on it, if they get stuck).

Bandler and Grinder’s insight is based on the fact that our issues tend to distort our perceptions and judgements in various ways, and that this can be spotted in the way we use language.

Missing possibilities

At the time this model was developed, Chomsky’s Transformational Grammar was in vogue, and a great deal was made of linking it to that theory, but in practice the idea is really quite simple.

When we look at the grammar of a sentence, we can see that there is a certain structure (for example, Subject-Verb-Object as in “My boss bullies me”). If you know that certain sentence parts (such as the object of the verb) are possible, but missing, then it may be that the reason is that the person speaking is being vague, or omitting bits and pieces, either consciously or unconsciously, and this might be a sign that something is being overlooked.

    Client: my boss bullies a lot.
    Counsellor: Who does he bully?

As well as simple omissions such as missing a subject or object, the therapist can look for things like passive sentence structure (“I was shouted at”); missing out details like when, what, and where; and using high level concept-words like “communication”, that abstract events from time and omit the participants:

    Client: I feel uncomfortable at work.
    Counsellor: So when, at work, do you feel uncomfortable?

    Client: I get criticised a lot
    Counsellor: Uh huh, and who is it that criticises you?

    Client: The problem with this family is that there’s no communication.
    Counsellor: Right … so who’s failing to communicate with who?

Distortions and generalisations

The therapist can also look for certain general language patterns that suggest a distortion or a generalisation:

  • All or nothing thinking – where the client uses words like “always”, “never”.

      Client: Nobody ever helps me at work
      Counsellor: Nobody? Was there ever a time at work when someone did help?

  • Mind reading – where the client talks about what others think or feel.

      Client: They think I’m stupid.
      Counsellor: Do you have any evidence that they think that about you?

  • Possibility and obligation – using words like must, should, can’t, can, will and won’t.

      Client: I couldn’t do that.
      Counsellor: What would happen if you did?

  • Cause and effect – assuming one thing must follow from another.

      Client: I couldn’t see anything wrong with the way I did it. But there must have been, for him to reject it.
      Counsellor: Must there?

      Client: I know he doesn’t like me because he frowns when he speaks to me.
      Counsellor: And can you think of any other reason why he might frown?

  • Presuppositions – building assumptions into what you say.

      Client: If my friends realised what a kind, caring guy he is, they wouldn’t be so down on him.
      Counsellor: So what is it that you know about him that leads you to see him as kind and caring?

Of course this model in itself is not enough to enable you to work powerfully as a therapist, but as a novice it’s a useful tool if you are unsure what to explore or where to focus next.

How does counselling differ from other types of helping?

Some characteristics of counselling that differentiate it from other types of helping:

  • A contracted activity. Counselling involves an explicit agreement between the counsellor and the client. This means that the client must consent to counselling and will be aware that the relationship is a counselling one.

  • A psychological therapy. Whereas a helper can focus on practical solutions and support, such as helping a friend move house, counselling is always concerned with addressing psychological or emotional needs and problems.

  • Clearly defined boundaries. Counselling places clearly agreed limits on the scope of the activity, including time and space boundaries (where, when and for how long it takes place), as well as agreed limits of confidentiality.
  • Based on psychological theory. All types of counselling are based on psychological theories, although different approaches may employ different psychological models, or may make use of them in different ways.

  • Based on listening & talking. Unlike medical treatments, counselling is a talking therapy, although sometimes this may be combined with other activities (eg. a play therapist might also use sand and toys to help a child give expression to emotional issues).

  • Appropriately trained. Professional counsellors are formally trained in skills and theory so that they can practice safely and to an acceptable standard.

  • A joint endeavour. It requires the co-operation and engagement of the client in the process. With some other forms of helping, the helped person may be passive, or even unaware of the helping process.

  • Abides by a code of ethics and practice. Counsellors work to a set of ethical standards, such as the BACP Ethical Framework. People using helping skills in other roles may be bound by ethical codes, but those will relate to the responsibilities of that role (eg. teaching, nursing).

  • Uses the relationship. The relationship developed between the counsellor and client is part of the process. For example, the experience of being in relationship with a counsellor who listens and responds acceptingly and empathically may help a client to grow in self-esteem and to learn to trust their own judgement. Brief therapy methods sometimes stress this less.

  • Avoids mixing of roles. Counsellors don’t normally have contact with clients except in their role as counsellor. This is to avoid a conflict of interests, although sometimes meeting in other contexts is unavoidable, e.g. in a small community. Someone may practice counselling skills to help friends or family, but it is unsafe and unethical to be in a counselling relationship with someone you are already close to.

  • Avoids giving advice or guidance. The role of the counsellor is facilitative rather than directive, to encourage client empowerment and autonomy, and to help clients develop their own insight, clarity and self-understanding. (An exception to this is more directive forms of therapy such as may be used in the early stages of rehab.)