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week 9

Learning the art of heLping
Building Blocks and Techniques

S i x t h E d i t i o n

Mark E. Young
University of Central Florida

330 Hudson Street, NY, NY 10013

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Library of Congress Cataloging-in-Publication Data

Names: Young, Mark E., author.
Title: Learning the art of helping : building blocks and techniques / Mark E.
Young, University of Central Florida.
Description: Sixth edition. | Boston : Pearson, [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2016012245| ISBN 9780134165783 (alk. paper) | ISBN
0134165780 (alk. paper)
Subjects: LCSH: Counseling. | Psychotherapy.
Classification: LCC BF636.6 .Y68 2017 | DDC 158.3—dc23 LC record available
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To SKSJM

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ABOUT THE AUTHOR

Mark E. Young is Professor at the University of Central Florida. He received his bachelor’s
degree from Miami University, his master’s from Wright State University, and his doctorate
from Ohio University. He has trained helpers for more than 25 years and worked as a
therapist in community mental health, private practice, college counseling centers, and
corrections for more than 15 years. Since 2003 he has been affiliated with the Marriage
and Family Research Institute teaching relationship skills to low-income couples. His
professional writing has focused mainly on therapeutic methods and techniques, wellness,
and couples. If you have comments or suggestions on what you have read, please send
an e-mail to meyoung3000@gmail.com.

iv

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PREFACE

HOW IS THIS BOOK DIFFERENT FROM OTHER BOOKS
ABOUT HELPING SKILLS?
This book is unique in five ways. First, it is based on lessons learned through years of
practice and supervision. I have tried to infuse what I learned from my clients, my stu-
dents, and my teachers about the practical aspects of helping. For example, we will talk
about what a therapeutic office environment should look like and how to appropriately
terminate a client. My work with students has helped me understand the common prob-
lems in learning the art of helping and how to overcome them.

Second, the most important innovation of this book is that it involves you person-
ally in your learning. Throughout the book you are asked to “Stop and Reflect,” to con-
sider thorny issues and challenges that you will face. If you wish, you can journal using
Journal Starters or do outside homework to deepen your interaction with the material. In
addition, you will have the opportunity to practice on your own by watching videos of
helpers and clients and then identify the best helping responses. Every chapter contains
Application Exercises in which you can follow the steps of a particular technique and get
feedback on your answers.

Third, this book emphasizes that the relationship between helper and client is the
most powerful ingredient for success. The relationship (Vitamin R) potentiates all the basic
techniques that you will learn. If you and the client are on the same wavelength, progress
is possible. When the relationship fails, the helping process falters. In this book, I talk about
how to develop a therapeutic relationship and how to repair ruptures that threaten it.

Fourth, I have tried to incorporate the latest research on effective treatments. Stay-
ing close to the research can be called “evidence-based practice.” At the same time, we
must recognize that there is such a thing as clinical wisdom or “practice-based evidence.”
Not every method, technique, or client problem has been researched or even discovered.
Thus the helper-in-training needs to learn from his or her clients about what is working
for that specific person. I suggest that in every session, the helper should elicit feedback
from the client about the relationship and progress toward goals.

Finally, this is a book with an integrative perspective. That means that I have
drawn from the techniques of many different theories rather than presenting a purely
person-centered or cognitive behavioral approach. At first this may sound like chaos.
How can we possibly learn to arrange treatment by blending so many competing theo-
ries? In this text, we do not blend theories but instead take a common factors approach
to organizing the techniques using the REPLAN method. Common factors are those
therapeutic effects that underlie the various theories. REPLAN is an acronym that
describes each of the healing factors. R stands for establishing and maintaining a thera-
peutic Relationship, E is Enhancing efficacy and self-esteem, P means Practicing new
behaviors, L is Lowering and raising emotional arousal, A is Activating expectations,
hope, and motivation, and N is providing New learning experiences. Every theory
emphasizes one or more of these common factors and even advanced therapeutic
techniques tend to fall into one of these categories. We have found that categorizing the
techniques in this way provides a rational basis for deciding what kind of help the client

v

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vi Preface

needs. Is it important to raise self-esteem or practice new behaviors? This forms the skel-
eton of our treatment plan and is guided by the goals that are collaboratively formed
between helper and client. This approach can incorporate both time-honored methods
and cutting-edge techniques.

WHAT IS NEW IN THE SIXTH EDITION?

• The Sixth Edition of Learning the Art of Helping has additional coverage of cultural
issues. Throughout the book are new Culture Check sections that highlight issues of
culture in research and in personal experiences as they relate to helping skills.

• In addition, Chapter 12 focuses specifically on learning to help those who are cul-
turally different from you.

• For the first time, we have identified helping skills you should develop when you
work with children.

• We address the issue of gender differences and how they can challenge the helping
relationship.

• The book now includes two new self-assessment tools to help you evaluate recorded
sessions or transcripts. They are the Helper Competency Scale, which assesses the
basic skills, and the Depth Scale, which looks at the depth of helper responses.

• In addition to the end of chapter activities, such as homework, activities, exercises,
self-assessments, and journal starters, we now identify specific points of practice
where you can watch a video of the skill you are learning or complete written exer-
cises and receive feedback on your answers. You can now access these ancillary
materials at the same time you are reading about them.

ACKNOWLEDGMENTS
In my own journey, there have been many who have taught and inspired me to be a better
person and a better helper. I must acknowledge my teachers Rajinder Singh, J. Melvin Wit-
mer, Harry Dewire, and James Pinnell, my first supervisor, who took me as a raw recruit in
a mental health clinic, sacrificing his time and talent to teach me as an apprentice. We
shared a zeal and passion for the profession, and his wisdom infuses every chapter of this
book. I must also mention those who have encouraged me in my writing, Sam Gladding,
Gerald Corey, Jeffrey Kottler, Adam Blatner, James Framo, John Norcross, and Jerome
Frank. I appreciate the feedback from my colleagues at Ohio State University, Darcy and
Paul Granello, and Daniel Gutierrez at the University of North Carolina at Charlotte. Tracy
Hutchinson deserves special mention for reading every chapter and giving feedback at
every step. I also recognize the helpful comments of those who reviewed various drafts of
the manuscript including Hannah Acquaye and Shainna Ali. In addition, the following
reviewers supplied insightful feedback for updating this edition: Valerie G. Balog, University
of North Carolina at Charlotte; Daniel Bishop, Concordia University Chicago; Natalie Arce
Indelicato, University of North Florida; Kristin Perrone McGovern, Ball State University;
David A. Scott, Clemson University; and Heather Trepal, University of Texas at San Antonio.

I would like to thank my editor, Kevin Davis, who has believed in this book since
its first edition. Finally, I recognize the contribution of my wife, Jora, who remains my
most demanding critic and my staunchest supporter.

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BRIEF CONTENTS

Chapter 1 Helping as a Personal Journey 1

Chapter 2 The Therapeutic Relationship 31

Chapter 3 Invitational Skills 60

Chapter 4 Reflecting Skills: Paraphrasing 85

Chapter 5 Reflecting Skills: Reflecting Feelings 101

Chapter 6 Advanced Reflecting Skills: Reflecting Meaning and Summarizing 121

Chapter 7 Challenging Skills 147

Chapter 8 Assessment and Goal Setting 175

Chapter 9 Change Techniques, Part I 208

Chapter 10 Change Techniques, Part II 243

Chapter 11 Evaluation, Reflection, and Termination 276

Chapter 12 Skills for Helping Someone Who Is Different 297

Glossary 315
References 323
Index 349

vii

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CONTENTS

Chapter 1 HELPING AS A PERSONAL JOURNEY 1
The Demands of the Journey 1
Becoming a Reflective Practitioner 2

Using Reflection to Help You Overcome Challenging Helping
Situations and Enhance Your Learning 3
Using Reflection to Help Clients with Backgrounds Different
from Your Own 3
Using Reflection to Accommodate New Information about Yourself 4
Learning to Reflect through Exercises in This Book 6

What is Helping? 6
Psychological Helping 8
Interviewing 8
What Are Counseling and Psychotherapy? 10
Coaching 11

Challenges You Will Face in Learning the Art of Helping 11
The Challenge of Development 12
Taking Responsibility for Your Own Learning 12
Finding a Mentor 14
Finding the Perfect Technique 14
In Limbo 14
Accepting Feedback and Being Perfect 15
Following Ethical Guidelines 15
Individual Differences 17

Who Can Be an Effective Helper? 17
What Can You Bring to a Client? 19

The Nuts and Bolts of Helping 21
Learning Basic Skills and Common Therapeutic Factors 21
Therapeutic Building Blocks 22
Change Techniques 24
The Importance of the Building Blocks 24

The Stages of the Helping Process: A Road Map 24
Summary 26
Exercises 27

Group Exercises 27
Group Discussions 28

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Contents ix

Written Exercises 28
Self-Assessment 29
Homework 29
Journal Starters 30

Chapter 2 THE THERAPEUTIC RELATIONSHIP 31
The Importance of the Therapeutic Relationship in
Creating Change 33

What Is a Helping Relationship? Is a Professional Helping
Relationship the Same as a Friendship? 34
The Unique Characteristics of a Therapeutic Relationship 36
What Clients Want in a Helping Relationship 38

How Can a Helper Create a Therapeutic Relationship? 38
Relationship Enhancers 39

Other Factors That Help or Strain the Therapeutic Relationship 45
Facilitative Office Environment 45
Distractions 46
Appearing Credible and Taking a Nonhierarchical Stance 46
Therapeutic Faux Pas 47
Transference and Countertransference 50

Summary 56
Exercises 57

Group Exercises 57
Small Group Discussions 57
Homework 58
Journal Starters 59

Chapter 3 INVITATIONAL SKILLS 60
Listening to the Client’s Story 61
Nonverbal Communication between Helper and Client 64

Regulation 64
Intimacy 65
Persuasion 65

Nonverbal Skills in the Helping Relationship 65
Eye Contact 66
Body Position 66
Attentive Silence 67
Voice Tone 67

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Facial Expressions and Gestures 68
Physical Distance 68
Touching and Warmth 69

Opening Skills: How to Invite 71
Saying Hello: How to Start the First Session 72
How to Start the Next Session 72
Encouragers 73
Questions 74

Summary 79
Exercises 80

Group Exercises 80
Small Group Discussions 82
Written Exercises 83
Self-Assessment 84
Homework 84
Journal Starters 84

Chapter 4 REFLECTING SKILLS: PARAPHRASING 85
Reasons for Reflecting 86
Reflecting Content and Thoughts, Reflecting Feelings, and Reflecting
Meaning 86
The Skill of Paraphrasing: Reflecting Content and Thoughts 89

How to Paraphrase 89
Paraphrasing: What It Is and What It Isn’t 90
When to Paraphrase and the Nonjudgmental
Listening Cycle 91

Common Problems in Paraphrasing 94
Simply Reciting the Facts 94
Difficulty Listening to the Story because of “Noise” 94
Worrying about What to Say Next 95
Being Judgmental and Taking the Client’s Side 95
Being Judgmental of the Client 96
Turning a Paraphrase into a Question 96

Summary 97
Exercises 97

Group Exercises 97
Small Group Discussions 98
Written Exercises 99

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Contents xi

Self-Assessment 99
Homework 99
Journal Starters 100

Chapter 5 REFLECTING SKILLS: REFLECTING FEELINGS 101
The Importance of Understanding Emotions 101
The Skill of Reflecting Feelings 102

The Benefits of Reflecting Feelings 102
Why It Is Difficult to Reflect Feelings 103

How to Reflect Feelings 104
Step 1: Identifying the Feeling or Feelings 104
Step 2: Putting the Emotion into Words 104

Common Problems in Reflecting Feelings and Their
Antidotes 110

Asking the Client, “How Did You Feel?” or
“How Did That Make You Feel?” 112
Waiting Too Long to Reflect 112
Making Your Reflection a Question 112
Combining a Reflection and a Question: The Error of the
Compound Response 113
Focusing on Other People 113
Interrupting Too Soon and Letting the Client Talk Too
Long 114
Confusing the Words Feel and Think 115
Missing the Mark: Overshooting and Undershooting 115
Letting Your Reflecting Statements Go On Too Long 116

Summary 117
Exercises 117

Group Exercises 117
Written Exercises 119
Self-Assessment 120
Homework 120
Journal Starters 120

Chapter 6 ADVANCED REFLECTING SKILLS:
REFLECTING MEANING AND SUMMARIZING 121
Meaning, Uncovering the Next Layer 122

Why Reflect Meaning? 124
Challenging the Client to Go Deeper: The Inner Circle

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Strategy 126
Worldview: Meanings Are Personal 129

How to Uncover Meaning in the Story 130
Reflecting Meaning 130
Using Open Questions to Uncover Meaning 133

Summarizing 134
Focusing Summaries 135
Signal Summaries 135
Thematic Summaries 136
Planning Summaries 136

The Nonjudgmental Listening Cycle Ends with
Summarizing 137

What Happens after the Nonjudgmental Listening Cycle? 138
A Questioning Cycle Typically Found Early in Training 138

Summary 140
Exercises 141

Group Exercises 141
Small Group Discussions 142
Written Exercises 143
Self-Assessment 145
Homework 145
Journal Starters 146

Chapter 7 CHALLENGING SKILLS 147
When Should We Use the Challenging Skills? 149
Giving Feedback 150

Why Is Feedback Important? 150
How to Give Feedback 151

Confrontation 154
What Is a Discrepancy? 154
Why Should Discrepancies Be Confronted? 154
Cognitive Dissonance and Confrontation:
Why Confrontation Works 155
Types of Discrepancies and Some Examples 156
How to Confront 158
Steps to Confrontation 159
Common Problems in Confrontation and Their Antidotes 161
Final Cautions about Confrontation 162

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Contents xiii

Other Ways of Challenging 163
Relationship Immediacy 163
Teaching the Client Self-Confrontation 164
Challenging Irrational Beliefs 165
Humor as Challenge 166

Summary 167
Exercises 168

Group Exercises 168
Small Group Discussions 169
Written Exercises 170
Self-Assessment 170
Homework 174
Journal Starters 174

Chapter 8 ASSESSMENT AND GOAL SETTING 175
Why Assessment? 176

Assessment Is a Critical Part of Helping 177
Reasons to Spend Time in the Assessment Stage 178

Two Informal Methods of Assessment That Every
Helper Uses: Observation and Questioning 181

Observation 181
Questioning 183

Conducting an Intake Interview: What to Assess? 184
A. Affective Assessment 184
B. Behavioral Assessment 184
C. Cognitive Assessment 184
1. Developmental Issues 185
2. Family History 186
3. Cultural and Religious/Spiritual Background 186
4. Physical Challenges and Strengths 186

Categorizing Clients and Their Problems 188
Organizing the Flood of Information: Making a Diagnosis 188

Goal-Setting Skills 188
Where Do I Go from Here? Set Goals! 188
Why Must We Set Goals? 190
When to Set Goals 191

What Are the Characteristics of Constructive Goals? 192
Goals Should Be Simple and Specific 192

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xiv Contents

Goals Should Be Stated Positively 194
Goals Should Be Important to the Client 195
Goals Should Be Collaboration between Helper
and Client 195
Goals Should Be Realistic 196

Resources for Identifying and Clarifying Goals 197
The Technique of Using Questions to Identify a Goal 198

Questions That Help Make the Goal More Specific 198
Questions That Help Turn a Problem into a Goal 198
Questions to Determine a Goal’s Importance 199
Questions to Enhance Collaboration on Goal Setting 199
Questions That Help Confirm That the Goal Is Realistic 199

The Technique of Boiling Down the Problem 201
Summary 203
Exercises 204

Group Exercises 204
Small Group Discussions 205
Written Exercises 206
Self-Assessment 206
Homework 206
Journal Starters 207

Chapter 9 CHANGE TECHNIQUES, PART I 208
What Are Change Techniques? 209
REPLAN and the Common Therapeutic Factors 210

Understanding the Factors or Major Components
of the REPLAN Model 210
How the REPLAN System Helps You Plan Treatment 211
Using the Common Therapeutic Factors 212
Steps in Treatment Planning Using the REPLAN Model 212

Enhancing Efficacy and Self-Esteem 214
Sources of Low Self-Esteem 216
Silencing the Internal Critic: The Technique of Countering 218

Practicing New Behaviors 221
Role-Playing 223
Giving Homework Assignments as Practice 226

Lowering and Raising Emotional Arousal 230
Reducing Negative Emotions 230

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Contents xv

Reducing Anxiety and Stress 231
Raising Emotional Arousal and Facilitating Expression 234
Creating Positive Emotions 236

Summary 237
Exercises 238

Group Exercises 238
Small Group Discussions 240
Self-Assessment 241
Homework 241
Journal Starters 242

Chapter 10 CHANGE TECHNIQUES, PART II 243
Activating Client Expectations, Hope, and Motivation 244

The Demoralization Hypothesis 244
Motivation and Readiness 245
Increasing Expectations and Fostering Hope 246

Providing New Learning Experiences 256
Definitions of New Learning Experiences 256
What Client Problems Are Helped through New Learning? 257
Common Methods for Providing New Learning
Experiences 257

Summary 272
Exercises 272

Group Exercises 272
Small Group Discussions 274
Written Exercises 274
Self-Assessment 275
Homework 275
Journal Starters 275

Chapter 11 EVALUATION, REFLECTION, AND TERMINATION 276
Evaluating the Effectiveness of Helping 277
Basic Outcome Evaluation Methods 279

Use Progress Notes to Track Improvement on Goals 279
Use a Global Measure to Detect Overall Improvement 279
Consistently Assess the Client’s View of Progress and the
Therapeutic Relationship 280
Use a Specific Measure 281
Use Subjective Scaling and Self-Report to Measure

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xvi Contents

Improvement 281
Use Another Person to Monitor Change 282
Use Client Satisfaction Scales 282
Use Goal-Attainment Measures 282

Termination 283
How to Prevent Premature Termination 283
How to Tell Whether Termination Is Needed 285
How to Prepare a Client for Termination 286
Dealing with Loss at Termination 286
The Helper’s Reaction to Termination 287

How to Maintain Therapeutic Gains and Prevent Relapse
Following Termination 287

Follow-Up 288
Booster Sessions 288
Engaging Paraprofessionals 288
Self-Help Groups 288
Continue Self-Monitoring Activities 288
Role-Playing for Relapse Prevention 289
Letter Writing 289

Summary 289
Exercises 289

Group Exercises 289
Small Group Discussions 290
Written Exercises 290
Self-Assessment 291
Homework 291
Journal Starters 296

Chapter 12 SKILLS FOR HELPING SOMEONE WHO IS
DIFFERENT 297
Differences Make a Difference 297

Mismatch between Client and Helper 298
How Can You Become Culturally Competent? 298
What Is Culture, and What Should We Do about It? 299

Skills for Helping Someone Who Is Culturally Different 300
The Skill of Cultural Study and Cultural Immersion 300
A Tutorial Stance: The Skill of Understanding the Client’s
Culture by Listening 301

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Contents xvii

Tapping Cultural Support Systems 301
Achieving Credibility and Trust 301
Culturally Adapting Treatment: Tailoring Your Approach to the
Client 302
Acknowledging Differences by Broaching 303

Skills for Dealing with Gender Issues 303
Challenges Caused by Differences in Gender 303
Skills for Addressing Gender Issues 304
When the Difference Is Gender 305

Skills for Helping a Child 306
Identifying Helping Skills for Working with Children 307
Using Basic Skills as a Guideline for Working with
Children 311
The Case for Play Therapy 311

Summary 312
Exercises 312

Group Exercises 312
Small Group Discussions 312
Self-Assessment 313
Homework 313
Journal Starters 313

Glossary 315

References 323

Index 349

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1

The Demands of the Journey

Becoming a Reflective Practitioner
• Using Reflection to Help You Overcome

Challenging Helping Situations and
Enhance Your Learning

• Using Reflection to Help Clients with
Backgrounds Different from Your Own

• Using Reflection to Accommodate New
Information about Yourself

• Learning to Reflect through Exercises in
This Book

What Is Helping?
• Psychological Helping
• Interviewing
• What Are Counseling and

Psychotherapy?
• Coaching

Challenges You Will Face in Learning
the Art of Helping
• The Challenge of Development
• Taking Responsibility for Your Own

Learning
• Finding a Mentor
• Finding the Perfect Technique
• In Limbo
• Accepting Feedback and Being Perfect
• Following Ethical Guidelines
• Individual Differences

Who Can Be an Effective Helper?
• What Can You Bring to a Client?

The Nuts and Bolts of Helping
• Learning Basic Skills and Common

Therapeutic Factors
• Therapeutic Building Blocks
• Change Techniques
• The Importance of the Building Blocks

The Stages of the Helping Process:
A Road Map

Summary

Exercises
• Group Exercises
• Group Discussions
• Written Exercises
• Self-Assessment
• Homework
• Journal Starters

LEARNING OUTCOMES

By the end of this chapter, you will be able to:

1.1 Identify ways of reflecting that you can begin implementing to
deepen your learning of helping skills.

1.2 Recognize that there are personal challenges in learning helping
skills such as recognizing the time factor needed to master skills
and dealing with ethical dilemmas as you train with fellow learners.

1.3 Identify the therapeutic factors, the building blocks, and the
stages of the helping relationship.

THE DEMANDS OF THE JOURNEY

Learning to be a professional helper is a journey that takes years.
Besides gaining a basic fund of knowledge about people and
their strengths and challenges, one must be constantly learning

Helping as a Personal Journey

C H A P T E R 1

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2 Chapter 1 • Helping as a Personal Journey

and updating knowledge just as a physician needs to know about new treatments and
new diseases. But helping is also a personal, “interior” journey because you must be
committed to understanding yourself as well as your clients. In this book you will learn
the essential helping skills, but it is not enough to be skilled; at every turn, you face
self-doubt, personal prejudices, and feelings of attraction, repulsion, and frustration.
You will experience self-doubt when your clients encounter complex and unfamiliar
problems; you will experience attraction and repulsion because of your personal needs
and prejudices based on your cultural conditioning. Moreover, all helpers become
frustrated at times when clients fail to reach the goals we expect of them. These
reactions can be roadblocks on our journey if they interfere with the ability to form a
vibrant client/helper relationship or when we see the client as a reflection of ourselves
rather than as a unique human being. Irvin Yalom, in his book Love’s Executioner
(1989, pp. 94–95), describes his treatment of an obese woman who is depressed. From
the moment he meets her, he is disgusted by her body and realizes his reaction is
extreme. It makes him think about the rejection he received for being Jewish and white
during his childhood in segregated Washington, DC. He thinks that his repulsion is
perhaps a historical attempt to have someone to reject as he was rejected. It makes him
wonder why he cannot accept fatness even though he was able to easily counsel people
who were criminals when he worked in a prison. All of these reactions flood into his
mind before the client ever even opens her mouth. Becoming aware of our prejudiced
responses to others is part of the journey of the professional helper. This journey is
difficult because it requires that we simultaneously try to focus on the client while
keeping a close watch on our own tendencies to judge, to boost our egos, or to force
our viewpoint on others.

BECOMING A REFLECTIVE PRACTITIONER

Because of the challenges caused by our personal reactions and unique client character-
istics, we believe that helpers need a method of integrating new learning and coping with
moments of indecision and doubt. In this book, we teach one method of dealing with the
dilemma of understanding the client and monitoring the self. This is an approach called
the reflective practitioner. Being a reflective practitioner means that you make a com-
mitment to personal awareness of your automatic reactions and prejudices by taking time
to think back on these reactions and perhaps to record them in a journal or discuss them
with a supervisor or colleague. In other words, the reflective practitioner consciously
reviews what has happened and decides on a plan of action. Jeffrey Kottler (2010) con-
siders reflection to be not only a necessary characteristic of an effective helper but also a
form of training. Reflection trains one to be open to contemplation, to consider alterna-
tive plans of actio

week 9

Learning the art of heLping
Building Blocks and Techniques

S i x t h E d i t i o n

Mark E. Young
University of Central Florida

330 Hudson Street, NY, NY 10013

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Copyright © 2017, 2013, 2009 by Pearson Education, Inc. or its affiliates. All Rights Reserved.
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Library of Congress Cataloging-in-Publication Data

Names: Young, Mark E., author.
Title: Learning the art of helping : building blocks and techniques / Mark E.
Young, University of Central Florida.
Description: Sixth edition. | Boston : Pearson, [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2016012245| ISBN 9780134165783 (alk. paper) | ISBN
0134165780 (alk. paper)
Subjects: LCSH: Counseling. | Psychotherapy.
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To SKSJM

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ABOUT THE AUTHOR

Mark E. Young is Professor at the University of Central Florida. He received his bachelor’s
degree from Miami University, his master’s from Wright State University, and his doctorate
from Ohio University. He has trained helpers for more than 25 years and worked as a
therapist in community mental health, private practice, college counseling centers, and
corrections for more than 15 years. Since 2003 he has been affiliated with the Marriage
and Family Research Institute teaching relationship skills to low-income couples. His
professional writing has focused mainly on therapeutic methods and techniques, wellness,
and couples. If you have comments or suggestions on what you have read, please send
an e-mail to meyoung3000@gmail.com.

iv

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PREFACE

HOW IS THIS BOOK DIFFERENT FROM OTHER BOOKS
ABOUT HELPING SKILLS?
This book is unique in five ways. First, it is based on lessons learned through years of
practice and supervision. I have tried to infuse what I learned from my clients, my stu-
dents, and my teachers about the practical aspects of helping. For example, we will talk
about what a therapeutic office environment should look like and how to appropriately
terminate a client. My work with students has helped me understand the common prob-
lems in learning the art of helping and how to overcome them.

Second, the most important innovation of this book is that it involves you person-
ally in your learning. Throughout the book you are asked to “Stop and Reflect,” to con-
sider thorny issues and challenges that you will face. If you wish, you can journal using
Journal Starters or do outside homework to deepen your interaction with the material. In
addition, you will have the opportunity to practice on your own by watching videos of
helpers and clients and then identify the best helping responses. Every chapter contains
Application Exercises in which you can follow the steps of a particular technique and get
feedback on your answers.

Third, this book emphasizes that the relationship between helper and client is the
most powerful ingredient for success. The relationship (Vitamin R) potentiates all the basic
techniques that you will learn. If you and the client are on the same wavelength, progress
is possible. When the relationship fails, the helping process falters. In this book, I talk about
how to develop a therapeutic relationship and how to repair ruptures that threaten it.

Fourth, I have tried to incorporate the latest research on effective treatments. Stay-
ing close to the research can be called “evidence-based practice.” At the same time, we
must recognize that there is such a thing as clinical wisdom or “practice-based evidence.”
Not every method, technique, or client problem has been researched or even discovered.
Thus the helper-in-training needs to learn from his or her clients about what is working
for that specific person. I suggest that in every session, the helper should elicit feedback
from the client about the relationship and progress toward goals.

Finally, this is a book with an integrative perspective. That means that I have
drawn from the techniques of many different theories rather than presenting a purely
person-centered or cognitive behavioral approach. At first this may sound like chaos.
How can we possibly learn to arrange treatment by blending so many competing theo-
ries? In this text, we do not blend theories but instead take a common factors approach
to organizing the techniques using the REPLAN method. Common factors are those
therapeutic effects that underlie the various theories. REPLAN is an acronym that
describes each of the healing factors. R stands for establishing and maintaining a thera-
peutic Relationship, E is Enhancing efficacy and self-esteem, P means Practicing new
behaviors, L is Lowering and raising emotional arousal, A is Activating expectations,
hope, and motivation, and N is providing New learning experiences. Every theory
emphasizes one or more of these common factors and even advanced therapeutic
techniques tend to fall into one of these categories. We have found that categorizing the
techniques in this way provides a rational basis for deciding what kind of help the client

v

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vi Preface

needs. Is it important to raise self-esteem or practice new behaviors? This forms the skel-
eton of our treatment plan and is guided by the goals that are collaboratively formed
between helper and client. This approach can incorporate both time-honored methods
and cutting-edge techniques.

WHAT IS NEW IN THE SIXTH EDITION?

• The Sixth Edition of Learning the Art of Helping has additional coverage of cultural
issues. Throughout the book are new Culture Check sections that highlight issues of
culture in research and in personal experiences as they relate to helping skills.

• In addition, Chapter 12 focuses specifically on learning to help those who are cul-
turally different from you.

• For the first time, we have identified helping skills you should develop when you
work with children.

• We address the issue of gender differences and how they can challenge the helping
relationship.

• The book now includes two new self-assessment tools to help you evaluate recorded
sessions or transcripts. They are the Helper Competency Scale, which assesses the
basic skills, and the Depth Scale, which looks at the depth of helper responses.

• In addition to the end of chapter activities, such as homework, activities, exercises,
self-assessments, and journal starters, we now identify specific points of practice
where you can watch a video of the skill you are learning or complete written exer-
cises and receive feedback on your answers. You can now access these ancillary
materials at the same time you are reading about them.

ACKNOWLEDGMENTS
In my own journey, there have been many who have taught and inspired me to be a better
person and a better helper. I must acknowledge my teachers Rajinder Singh, J. Melvin Wit-
mer, Harry Dewire, and James Pinnell, my first supervisor, who took me as a raw recruit in
a mental health clinic, sacrificing his time and talent to teach me as an apprentice. We
shared a zeal and passion for the profession, and his wisdom infuses every chapter of this
book. I must also mention those who have encouraged me in my writing, Sam Gladding,
Gerald Corey, Jeffrey Kottler, Adam Blatner, James Framo, John Norcross, and Jerome
Frank. I appreciate the feedback from my colleagues at Ohio State University, Darcy and
Paul Granello, and Daniel Gutierrez at the University of North Carolina at Charlotte. Tracy
Hutchinson deserves special mention for reading every chapter and giving feedback at
every step. I also recognize the helpful comments of those who reviewed various drafts of
the manuscript including Hannah Acquaye and Shainna Ali. In addition, the following
reviewers supplied insightful feedback for updating this edition: Valerie G. Balog, University
of North Carolina at Charlotte; Daniel Bishop, Concordia University Chicago; Natalie Arce
Indelicato, University of North Florida; Kristin Perrone McGovern, Ball State University;
David A. Scott, Clemson University; and Heather Trepal, University of Texas at San Antonio.

I would like to thank my editor, Kevin Davis, who has believed in this book since
its first edition. Finally, I recognize the contribution of my wife, Jora, who remains my
most demanding critic and my staunchest supporter.

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BRIEF CONTENTS

Chapter 1 Helping as a Personal Journey 1

Chapter 2 The Therapeutic Relationship 31

Chapter 3 Invitational Skills 60

Chapter 4 Reflecting Skills: Paraphrasing 85

Chapter 5 Reflecting Skills: Reflecting Feelings 101

Chapter 6 Advanced Reflecting Skills: Reflecting Meaning and Summarizing 121

Chapter 7 Challenging Skills 147

Chapter 8 Assessment and Goal Setting 175

Chapter 9 Change Techniques, Part I 208

Chapter 10 Change Techniques, Part II 243

Chapter 11 Evaluation, Reflection, and Termination 276

Chapter 12 Skills for Helping Someone Who Is Different 297

Glossary 315
References 323
Index 349

vii

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CONTENTS

Chapter 1 HELPING AS A PERSONAL JOURNEY 1
The Demands of the Journey 1
Becoming a Reflective Practitioner 2

Using Reflection to Help You Overcome Challenging Helping
Situations and Enhance Your Learning 3
Using Reflection to Help Clients with Backgrounds Different
from Your Own 3
Using Reflection to Accommodate New Information about Yourself 4
Learning to Reflect through Exercises in This Book 6

What is Helping? 6
Psychological Helping 8
Interviewing 8
What Are Counseling and Psychotherapy? 10
Coaching 11

Challenges You Will Face in Learning the Art of Helping 11
The Challenge of Development 12
Taking Responsibility for Your Own Learning 12
Finding a Mentor 14
Finding the Perfect Technique 14
In Limbo 14
Accepting Feedback and Being Perfect 15
Following Ethical Guidelines 15
Individual Differences 17

Who Can Be an Effective Helper? 17
What Can You Bring to a Client? 19

The Nuts and Bolts of Helping 21
Learning Basic Skills and Common Therapeutic Factors 21
Therapeutic Building Blocks 22
Change Techniques 24
The Importance of the Building Blocks 24

The Stages of the Helping Process: A Road Map 24
Summary 26
Exercises 27

Group Exercises 27
Group Discussions 28

viii

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Contents ix

Written Exercises 28
Self-Assessment 29
Homework 29
Journal Starters 30

Chapter 2 THE THERAPEUTIC RELATIONSHIP 31
The Importance of the Therapeutic Relationship in
Creating Change 33

What Is a Helping Relationship? Is a Professional Helping
Relationship the Same as a Friendship? 34
The Unique Characteristics of a Therapeutic Relationship 36
What Clients Want in a Helping Relationship 38

How Can a Helper Create a Therapeutic Relationship? 38
Relationship Enhancers 39

Other Factors That Help or Strain the Therapeutic Relationship 45
Facilitative Office Environment 45
Distractions 46
Appearing Credible and Taking a Nonhierarchical Stance 46
Therapeutic Faux Pas 47
Transference and Countertransference 50

Summary 56
Exercises 57

Group Exercises 57
Small Group Discussions 57
Homework 58
Journal Starters 59

Chapter 3 INVITATIONAL SKILLS 60
Listening to the Client’s Story 61
Nonverbal Communication between Helper and Client 64

Regulation 64
Intimacy 65
Persuasion 65

Nonverbal Skills in the Helping Relationship 65
Eye Contact 66
Body Position 66
Attentive Silence 67
Voice Tone 67

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x Contents

Facial Expressions and Gestures 68
Physical Distance 68
Touching and Warmth 69

Opening Skills: How to Invite 71
Saying Hello: How to Start the First Session 72
How to Start the Next Session 72
Encouragers 73
Questions 74

Summary 79
Exercises 80

Group Exercises 80
Small Group Discussions 82
Written Exercises 83
Self-Assessment 84
Homework 84
Journal Starters 84

Chapter 4 REFLECTING SKILLS: PARAPHRASING 85
Reasons for Reflecting 86
Reflecting Content and Thoughts, Reflecting Feelings, and Reflecting
Meaning 86
The Skill of Paraphrasing: Reflecting Content and Thoughts 89

How to Paraphrase 89
Paraphrasing: What It Is and What It Isn’t 90
When to Paraphrase and the Nonjudgmental
Listening Cycle 91

Common Problems in Paraphrasing 94
Simply Reciting the Facts 94
Difficulty Listening to the Story because of “Noise” 94
Worrying about What to Say Next 95
Being Judgmental and Taking the Client’s Side 95
Being Judgmental of the Client 96
Turning a Paraphrase into a Question 96

Summary 97
Exercises 97

Group Exercises 97
Small Group Discussions 98
Written Exercises 99

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Contents xi

Self-Assessment 99
Homework 99
Journal Starters 100

Chapter 5 REFLECTING SKILLS: REFLECTING FEELINGS 101
The Importance of Understanding Emotions 101
The Skill of Reflecting Feelings 102

The Benefits of Reflecting Feelings 102
Why It Is Difficult to Reflect Feelings 103

How to Reflect Feelings 104
Step 1: Identifying the Feeling or Feelings 104
Step 2: Putting the Emotion into Words 104

Common Problems in Reflecting Feelings and Their
Antidotes 110

Asking the Client, “How Did You Feel?” or
“How Did That Make You Feel?” 112
Waiting Too Long to Reflect 112
Making Your Reflection a Question 112
Combining a Reflection and a Question: The Error of the
Compound Response 113
Focusing on Other People 113
Interrupting Too Soon and Letting the Client Talk Too
Long 114
Confusing the Words Feel and Think 115
Missing the Mark: Overshooting and Undershooting 115
Letting Your Reflecting Statements Go On Too Long 116

Summary 117
Exercises 117

Group Exercises 117
Written Exercises 119
Self-Assessment 120
Homework 120
Journal Starters 120

Chapter 6 ADVANCED REFLECTING SKILLS:
REFLECTING MEANING AND SUMMARIZING 121
Meaning, Uncovering the Next Layer 122

Why Reflect Meaning? 124
Challenging the Client to Go Deeper: The Inner Circle

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xii Contents

Strategy 126
Worldview: Meanings Are Personal 129

How to Uncover Meaning in the Story 130
Reflecting Meaning 130
Using Open Questions to Uncover Meaning 133

Summarizing 134
Focusing Summaries 135
Signal Summaries 135
Thematic Summaries 136
Planning Summaries 136

The Nonjudgmental Listening Cycle Ends with
Summarizing 137

What Happens after the Nonjudgmental Listening Cycle? 138
A Questioning Cycle Typically Found Early in Training 138

Summary 140
Exercises 141

Group Exercises 141
Small Group Discussions 142
Written Exercises 143
Self-Assessment 145
Homework 145
Journal Starters 146

Chapter 7 CHALLENGING SKILLS 147
When Should We Use the Challenging Skills? 149
Giving Feedback 150

Why Is Feedback Important? 150
How to Give Feedback 151

Confrontation 154
What Is a Discrepancy? 154
Why Should Discrepancies Be Confronted? 154
Cognitive Dissonance and Confrontation:
Why Confrontation Works 155
Types of Discrepancies and Some Examples 156
How to Confront 158
Steps to Confrontation 159
Common Problems in Confrontation and Their Antidotes 161
Final Cautions about Confrontation 162

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Contents xiii

Other Ways of Challenging 163
Relationship Immediacy 163
Teaching the Client Self-Confrontation 164
Challenging Irrational Beliefs 165
Humor as Challenge 166

Summary 167
Exercises 168

Group Exercises 168
Small Group Discussions 169
Written Exercises 170
Self-Assessment 170
Homework 174
Journal Starters 174

Chapter 8 ASSESSMENT AND GOAL SETTING 175
Why Assessment? 176

Assessment Is a Critical Part of Helping 177
Reasons to Spend Time in the Assessment Stage 178

Two Informal Methods of Assessment That Every
Helper Uses: Observation and Questioning 181

Observation 181
Questioning 183

Conducting an Intake Interview: What to Assess? 184
A. Affective Assessment 184
B. Behavioral Assessment 184
C. Cognitive Assessment 184
1. Developmental Issues 185
2. Family History 186
3. Cultural and Religious/Spiritual Background 186
4. Physical Challenges and Strengths 186

Categorizing Clients and Their Problems 188
Organizing the Flood of Information: Making a Diagnosis 188

Goal-Setting Skills 188
Where Do I Go from Here? Set Goals! 188
Why Must We Set Goals? 190
When to Set Goals 191

What Are the Characteristics of Constructive Goals? 192
Goals Should Be Simple and Specific 192

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xiv Contents

Goals Should Be Stated Positively 194
Goals Should Be Important to the Client 195
Goals Should Be Collaboration between Helper
and Client 195
Goals Should Be Realistic 196

Resources for Identifying and Clarifying Goals 197
The Technique of Using Questions to Identify a Goal 198

Questions That Help Make the Goal More Specific 198
Questions That Help Turn a Problem into a Goal 198
Questions to Determine a Goal’s Importance 199
Questions to Enhance Collaboration on Goal Setting 199
Questions That Help Confirm That the Goal Is Realistic 199

The Technique of Boiling Down the Problem 201
Summary 203
Exercises 204

Group Exercises 204
Small Group Discussions 205
Written Exercises 206
Self-Assessment 206
Homework 206
Journal Starters 207

Chapter 9 CHANGE TECHNIQUES, PART I 208
What Are Change Techniques? 209
REPLAN and the Common Therapeutic Factors 210

Understanding the Factors or Major Components
of the REPLAN Model 210
How the REPLAN System Helps You Plan Treatment 211
Using the Common Therapeutic Factors 212
Steps in Treatment Planning Using the REPLAN Model 212

Enhancing Efficacy and Self-Esteem 214
Sources of Low Self-Esteem 216
Silencing the Internal Critic: The Technique of Countering 218

Practicing New Behaviors 221
Role-Playing 223
Giving Homework Assignments as Practice 226

Lowering and Raising Emotional Arousal 230
Reducing Negative Emotions 230

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Contents xv

Reducing Anxiety and Stress 231
Raising Emotional Arousal and Facilitating Expression 234
Creating Positive Emotions 236

Summary 237
Exercises 238

Group Exercises 238
Small Group Discussions 240
Self-Assessment 241
Homework 241
Journal Starters 242

Chapter 10 CHANGE TECHNIQUES, PART II 243
Activating Client Expectations, Hope, and Motivation 244

The Demoralization Hypothesis 244
Motivation and Readiness 245
Increasing Expectations and Fostering Hope 246

Providing New Learning Experiences 256
Definitions of New Learning Experiences 256
What Client Problems Are Helped through New Learning? 257
Common Methods for Providing New Learning
Experiences 257

Summary 272
Exercises 272

Group Exercises 272
Small Group Discussions 274
Written Exercises 274
Self-Assessment 275
Homework 275
Journal Starters 275

Chapter 11 EVALUATION, REFLECTION, AND TERMINATION 276
Evaluating the Effectiveness of Helping 277
Basic Outcome Evaluation Methods 279

Use Progress Notes to Track Improvement on Goals 279
Use a Global Measure to Detect Overall Improvement 279
Consistently Assess the Client’s View of Progress and the
Therapeutic Relationship 280
Use a Specific Measure 281
Use Subjective Scaling and Self-Report to Measure

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xvi Contents

Improvement 281
Use Another Person to Monitor Change 282
Use Client Satisfaction Scales 282
Use Goal-Attainment Measures 282

Termination 283
How to Prevent Premature Termination 283
How to Tell Whether Termination Is Needed 285
How to Prepare a Client for Termination 286
Dealing with Loss at Termination 286
The Helper’s Reaction to Termination 287

How to Maintain Therapeutic Gains and Prevent Relapse
Following Termination 287

Follow-Up 288
Booster Sessions 288
Engaging Paraprofessionals 288
Self-Help Groups 288
Continue Self-Monitoring Activities 288
Role-Playing for Relapse Prevention 289
Letter Writing 289

Summary 289
Exercises 289

Group Exercises 289
Small Group Discussions 290
Written Exercises 290
Self-Assessment 291
Homework 291
Journal Starters 296

Chapter 12 SKILLS FOR HELPING SOMEONE WHO IS
DIFFERENT 297
Differences Make a Difference 297

Mismatch between Client and Helper 298
How Can You Become Culturally Competent? 298
What Is Culture, and What Should We Do about It? 299

Skills for Helping Someone Who Is Culturally Different 300
The Skill of Cultural Study and Cultural Immersion 300
A Tutorial Stance: The Skill of Understanding the Client’s
Culture by Listening 301

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Contents xvii

Tapping Cultural Support Systems 301
Achieving Credibility and Trust 301
Culturally Adapting Treatment: Tailoring Your Approach to the
Client 302
Acknowledging Differences by Broaching 303

Skills for Dealing with Gender Issues 303
Challenges Caused by Differences in Gender 303
Skills for Addressing Gender Issues 304
When the Difference Is Gender 305

Skills for Helping a Child 306
Identifying Helping Skills for Working with Children 307
Using Basic Skills as a Guideline for Working with
Children 311
The Case for Play Therapy 311

Summary 312
Exercises 312

Group Exercises 312
Small Group Discussions 312
Self-Assessment 313
Homework 313
Journal Starters 313

Glossary 315

References 323

Index 349

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1

The Demands of the Journey

Becoming a Reflective Practitioner
• Using Reflection to Help You Overcome

Challenging Helping Situations and
Enhance Your Learning

• Using Reflection to Help Clients with
Backgrounds Different from Your Own

• Using Reflection to Accommodate New
Information about Yourself

• Learning to Reflect through Exercises in
This Book

What Is Helping?
• Psychological Helping
• Interviewing
• What Are Counseling and

Psychotherapy?
• Coaching

Challenges You Will Face in Learning
the Art of Helping
• The Challenge of Development
• Taking Responsibility for Your Own

Learning
• Finding a Mentor
• Finding the Perfect Technique
• In Limbo
• Accepting Feedback and Being Perfect
• Following Ethical Guidelines
• Individual Differences

Who Can Be an Effective Helper?
• What Can You Bring to a Client?

The Nuts and Bolts of Helping
• Learning Basic Skills and Common

Therapeutic Factors
• Therapeutic Building Blocks
• Change Techniques
• The Importance of the Building Blocks

The Stages of the Helping Process:
A Road Map

Summary

Exercises
• Group Exercises
• Group Discussions
• Written Exercises
• Self-Assessment
• Homework
• Journal Starters

LEARNING OUTCOMES

By the end of this chapter, you will be able to:

1.1 Identify ways of reflecting that you can begin implementing to
deepen your learning of helping skills.

1.2 Recognize that there are personal challenges in learning helping
skills such as recognizing the time factor needed to master skills
and dealing with ethical dilemmas as you train with fellow learners.

1.3 Identify the therapeutic factors, the building blocks, and the
stages of the helping relationship.

THE DEMANDS OF THE JOURNEY

Learning to be a professional helper is a journey that takes years.
Besides gaining a basic fund of knowledge about people and
their strengths and challenges, one must be constantly learning

Helping as a Personal Journey

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2 Chapter 1 • Helping as a Personal Journey

and updating knowledge just as a physician needs to know about new treatments and
new diseases. But helping is also a personal, “interior” journey because you must be
committed to understanding yourself as well as your clients. In this book you will learn
the essential helping skills, but it is not enough to be skilled; at every turn, you face
self-doubt, personal prejudices, and feelings of attraction, repulsion, and frustration.
You will experience self-doubt when your clients encounter complex and unfamiliar
problems; you will experience attraction and repulsion because of your personal needs
and prejudices based on your cultural conditioning. Moreover, all helpers become
frustrated at times when clients fail to reach the goals we expect of them. These
reactions can be roadblocks on our journey if they interfere with the ability to form a
vibrant client/helper relationship or when we see the client as a reflection of ourselves
rather than as a unique human being. Irvin Yalom, in his book Love’s Executioner
(1989, pp. 94–95), describes his treatment of an obese woman who is depressed. From
the moment he meets her, he is disgusted by her body and realizes his reaction is
extreme. It makes him think about the rejection he received for being Jewish and white
during his childhood in segregated Washington, DC. He thinks that his repulsion is
perhaps a historical attempt to have someone to reject as he was rejected. It makes him
wonder why he cannot accept fatness even though he was able to easily counsel people
who were criminals when he worked in a prison. All of these reactions flood into his
mind before the client ever even opens her mouth. Becoming aware of our prejudiced
responses to others is part of the journey of the professional helper. This journey is
difficult because it requires that we simultaneously try to focus on the client while
keeping a close watch on our own tendencies to judge, to boost our egos, or to force
our viewpoint on others.

BECOMING A REFLECTIVE PRACTITIONER

Because of the challenges caused by our personal reactions and unique client character-
istics, we believe that helpers need a method of integrating new learning and coping with
moments of indecision and doubt. In this book, we teach one method of dealing with the
dilemma of understanding the client and monitoring the self. This is an approach called
the reflective practitioner. Being a reflective practitioner means that you make a com-
mitment to personal awareness of your automatic reactions and prejudices by taking time
to think back on these reactions and perhaps to record them in a journal or discuss them
with a supervisor or colleague. In other words, the reflective practitioner consciously
reviews what has happened and decides on a plan of action. Jeffrey Kottler (2010) con-
siders reflection to be not only a necessary characteristic of an effective helper but also a
form of training. Reflection trains one to be open to contemplation, to consider alterna-
tive plans of actio