THE AHA MOMENT: HELPING CLIENTS DEVELOP INSIGHT INTO PROBLEMS James F. Whittenberg, PhD, LPC-S, CSC Eunice Lerma, PhD, LPC-S, CSC
THE HELPING SKILLS MODEL Exploration Client-centered theory Insight Cognitive and Psychoanalytic theories Action Behavioral theory
SKILLS OF THE INSIGHT STAGE Foster awareness Challenging thoughts Challenging discrepancies Facilitate insight Probing for insight Disclosures of insight Interpretation Working on the therapeutic relationship Immediacy
CHALLENGING THOUGHTS Irrational beliefs Love, Perfect, Fair, Awful, Control, Worry, Avoid, Support, Solve, Past, Upset Dysfunctional interpretations Concluding, Generalizing, Catastrophizing, Minimizing, Blaming, B/W Thinking Questions for challenging thoughts What are you telling yourself now? What is the worst thing that could happen? What would be so horrible about that? You say you can t stand it. Would you fall apart? It might be unpleasant, but is it a catastrophe?
CHALLENGING DISCREPANCIES Between statements You say there s no problem, yet you re annoyed. Between words and actions You say you want to get good grades, but you spend most of your time partying. Between behaviors You re smiling, but your teeth are clenched. Between feelings You feel angry at your sister, but you also feel pleased that everyone will see the person she really is.
CHALLENGING DISCREPANCIES Between values and behaviors You say you believe in respecting others choices, then you try to convince them that they re wrong. Between one s perception of self and experience You say that no one likes you, but earlier you described a time when someone asked you to lunch. Between one s ideal and real self You say you want to achieve, but you also say that you can t be successful. Between the helper s and client s opinions You say you re not working hard, but I see you are.
CLIENT STATEMENT #1 Client: My family is really important to me. They mean more to me than anyone else in the world. I think about them a lot. I go home about once a year, and I call them every month or so when I m running out of money.
HELPER RESPONSES #1 Helper: You say your family is important to you, but you don t call them. Helper: You told me your family is important to you, but you seem to talk to them only when you want money.
CLIENT STATEMENT #2 Client: I really want to go to graduate school, but I have lots of things going on right now, and I just want time for myself to travel and play. I don t think I want to study as much as I know I would have to in graduate school, but I do want to be able to get a good job as a psychologist so that I can do therapy with kids.
HELPER RESPONSES #2 Helper: You want the things that come from having a graduate degree, but you aren t sure you want to do what it takes to get the degree. Helper: You say you want to get a graduate degree, but your voice doesn t sound very enthusiastic as you talk.
CLIENT STATEMENT #3 Client: My parents are very religious. They tell me I have to go to church every Sunday as long as I am living at home. I know I have to do it to please them, but I feel so confused about the whole topic, I don t know what I believe, and nothing makes sense. I feel like I m going through the motions. I feel guilty even talking about this though, because they would be so upset that I don t agree with everything they say.
HELPER RESPONSES #3 Helper: You want to please your parents, but you also really want to figure out for yourself what you believe. Helper: You feel guilty that you might believe something that your parents don t, but perhaps you feel angry that they don t allow you to have your own feelings.
PROBING FOR INSIGHT Initial open questions for insight What thoughts do you have? What do you make of your feelings? Aspects of the issue that don t fit What makes you blow up? Why doesn t he deserve respect? How to ask open questions I wonder if you could think about why you do that? I wonder if your feelings are connected to that event?
Making connections INTERPRETATION Could your anger at your husband be connected to your grief over your mother s death? I wonder if your fear of intimacy originates from your father abandoning you as a child? Perhaps you have difficulty concentrating because you re worried about your parents declining health. Pointing out themes or patterns I wonder if it is difficult for you to keep a job because you fear of success? Could it be that your difficulty coping with your friend s suicide is because you feel guilty or even responsible for her death?
INTERPRETATION Explore defenses, resistance, or transference Perhaps I remind you of when your father would raise his voice. I wonder if you learned to avoid interaction as a child to protect yourself from abandonment? I wonder if talking about romantic relationships is hard for you because of your anger about your parents divorce? Offering new frameworks of understanding I wonder if you cling to people because you often felt abandoned as a child. Perhaps you want her to distrust you so you can get mad and leave. Is it possible you avoid confrontation because you were bullied as a child?
DISCLOSURES OF INSIGHT Deeper levels of self understanding I remember feeling I wasn t sure I made the right decision after leaving my ex. It was scary because my parents always made my decisions. Could that be true for you? When I was in a similar situation, I found my feelings about my breakup interfered with my studies. I wonder if that is true for you? Noting parallels I don t go out alone either, because it makes me feel like no one loves me. Perhaps that is true for you? I felt that way one time, and I realized later I had to choose a partner specifically because he was different from my father. Does that fit for you?
DISCLOSURES OF INSIGHT Your behaviors in similar situations When my father died, I didn t know what I was feeling, so I relied on others to tell me what I should be feeling. As a result, I lost myself. I wonder if that is happening to you? Most people think about changing careers at one time or another. I had these thoughts during my first teaching job after graduating from college. I was trying to figure out what I wanted in life. I wonder if that could be true for you now? Reflecting on feelings from the past I still feel like a child around my parents because I lose my adult identity. Perhaps that is the case for you? When I was a teenager, I was afraid that I would disappoint my parents if I didn t succeed. I wonder if that might be going on for you?
CLIENT STATEMENT #1 Client: I m not doing very well in school right now. I m sure it s my study skills. I just can t concentrate. I keep gazing out my window instead of getting my assignments done. I try to make myself stay at my desk more and more, but I seem to be getting less done. I broke up with my boyfriend so I could have more time to study, but it just doesn t seem to be working. Open question for insight Interpretation Disclosure of insight
HELPER RESPONSES #1 Open Question for Insight Helper: What do you think is going on? Interpretation Helper: Maybe a fear of commitment keeps you form committing yourself to your schoolwork or a relationship. Disclosure of Insight Helper: When I was in a similar situation, I found my feelings about the breakup interfered with my schoolwork. I wonder if that is true for you?
CLIENT STATEMENT #2 Client: I m about ready to graduate and I need to decide what to do next. I m getting a lot of pressure from my parents, but I can t figure out what I want to do. I keep having this dream where I fail a math class. I can never seem to get to class, and when I do get there, I don t understand any of the work. I never get to the tests on time. Math has always been hard for me, but I got an A in my last math class. Why am I having this dream? Open question for insight Interpretation Disclosure of insight
HELPER RESPONSES #2 Open Question for Insight Helper: What do you think causes your anxiety about the future? Interpretation Helper: I wonder if your anxiety is related to your fear of failing? Disclosure of Insight Helper: When I was your age, I found that I was afraid that I would disappoint my parents if I didn t succeed. I wonder if that might be going on for you?
CLIENT STATEMENT #3 Client: I really love my boyfriend and I want to get married, I really do. But, you know, recently I have not wanted to see him much. Every time we re together, I find myself criticizing him. You know, he does stupid things sometimes that just irritate me. I can just imagine him drinking beer and belching in front of my father. You know, my parents still haven t met him, I don t know why, but I haven t wanted to take him home. Open question for insight Interpretation Disclosure of insight
HELPER RESPONSES #3 Open Question for Insight Helper: What thoughts do you have about why you don t want to take your boyfriend to meet your parents? Interpretation Helper: Maybe your fear about taking your boyfriend to meet your parents is because you re unsure about your feelings for him. Disclosure of Insight Helper: I felt that way one time, and I realized later I had chose a boyfriend specifically because he was so different from my father. Could that be true for you?
IMMEDIACY The therapeutic relationship overall We ve worked through initial discomfort and we re getting along well now. A specific event in session I m surprised you appreciate our sessions. I wasn t sure how you felt. Personal reactions to the client I feel hurt because you reject everything I say. Challenging issues in the relationship I feel frustrated that you avoid answering my questions.
IMMEDIACY Inquiries about the therapeutic relationship I wonder what reactions you had to the session today? How did you feel just now when I complimented you? What would you need from me as a therapist right now? Stating your reactions to the client I have been feeling a little disconnected from you today. I wonder how you have been feeling? I am so impressed that you have shared such deep feelings. I feel so moved by what you have said. What are your thoughts? I am proud of you for sharing such intimate thoughts. I wonder how you really feeling about the situation?
Making the covert more overt IMMEDIACY You are late again today. I wonder if anything is going on in terms of your feelings about being here? You keep looking at your watch. I wonder if you re eager to leave? You seemed angry when I said that. I wonder what s going on inside? Drawing parallels You mentioned that no one seems to understand you. I wonder if you might be saying that I don t understand you? You are talking about withdrawing from your friends lately. I wonder if that is happening here in session? You ve said that you get upset when criticized and just now you avoided the topic of procrastination. I wonder if you are worried I will criticize you?
IMMEDIACY Confronting maladaptive behaviors I feel that you are blunt and rude. I wonder if others may agree? Encourage honesty about feelings with others Are you aware that you are so negative? I wonder if others see it as well?. Making covert communication more direct You say that no one can help you. Do you think I can help you? When the client blames the therapist I am feeling attacked. Can we look at both sides of this issue? Be aware of client transference
CLIENT STATEMENT #1 Client: You know, I thought about what you said last time, and I got really angry. I don t think you know what you re talking about when you suggest that I go to see my old boyfriend when I go into town to give a presentation. He hasn t even tried to contact me in 10 years, and I m supposed to be focused on my work and giving a presentation? I couldn t possibly concentrate if I knew I had to spend time going to see him and started worrying about what he would say.
HELPER RESPONSES #1 Helper: I m sorry I suggested that you contact your old boyfriend. It obviously was hurtful to you. Maybe we could spend some time talking about what was going on between us, given that I don t usually tell you what to do. Helper: I feel concerned that you are blaming me when my memory is that you were the one to suggest that you go see him.
CLIENT STATEMENT #2 Client: You sure haven t been very helpful today. You don t give me any good advice. I don t know why I bother coming here. It s a waste of time.
HELPER RESPONSES #2 Helper: I also am feeling frustrated that we don t seem to be getting anywhere. Helper: I feel upset right now because I put a lot of time and energy into our relationship and yet it doesn t seem to be enough for you. Helper: I also feel that we have wasted some time. What can we do to make our sessions a little better?
CLIENT STATEMENT #3 Client: (silent for 5 minutes)
HELPER RESPONSES #3 Helper: You seem angry at me. Can you talk about what is going on? Helper: I am worried about you right now because you seem so distant. Helper: I feel like I am not being a very good therapist right now because you are being so silent. Helper: I feel hurt that you can t open up to me.
REFERENCES Hill, C. E. (2009) Helping Skills: Facilitating, Exploration, Insight, and Action (3rd ed.). Washington DC: American Psychological Association. ISBN: 978-1-4338-0451-9