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Over the last couple of months, I have been busy sharpening the tools in my counselling toolkit. Due to the pandemic, there has been a high demand for mental health services, leading me to take a new role doing virtual counselling for clients across Canada.
Although I had to take a step back from regular writing, I’ve been getting the opportunity to help many people, gaining valuable lessons along the way.
Thus far, throughout my career in addiction and mental health, I’ve enjoyed collecting and sharpening new counselling tools, learning that having multiple tools at one’s disposal is critical. As they say, when your only tool is a hammer, every problem looks like a nail.
In my experience, effective counseling requires using the right tool, at the right time, in the right way. This does not mean you need to have every single tool in existence. It’s more effective to be a master of a few different tools than to have a rudimentary understanding of many.
My counselling toolkit can be divided into three different sections:
- Building a foundation (person-centered approach)
- Holding space for emotions (humanistic approach)
- Reframing thoughts (cognitive-behavioral approach)
Sticking with the construction metaphor, a person’s thoughts, emotions, and actions are the wood, support beams, and concrete. They are the primary raw materials in counselling.
But before you start building, you need a foundation.
Start with a Foundation
You may be hired to renovate a room, construct an addition, or perhaps just knock down a kitchen wall. Either way, you can’t make assumptions unless you ask your client. This is the foundation of a person-centered approach.
Making assumptions without first asking the client what they want is like a friend asking your opinion on a paint colour, and you tell them how to remodel their home.
You won’t be very helpful if you start making assumptions.
“But what if my friend’s home is falling apart?” you may ask.
If you think someone requires more than they are asking for, there is a time and place to introduce the subject. Perhaps deep down, they realize they need a lot more help but are not ready to address these other areas right now. If they need to paint a room to brighten their day before taking on the rest of their renovations, simply help them choose the paint colour.
Meeting a person where they are at is the foundation of an effective counselling relationship. Like the foundation of a home, the concrete needs to set before you can start building on it.
The Open-ended Question
Laying the foundation to a strong counselling relationship by meeting someone where they are at does not require fancy tools, but it can be easily overlooked.
When someone presents a set of problems, it might be tempting to try to address what we perceive to be the most important issue first.
Rather than starting with an assumed priority, I like to get a sense of what is going on, then directly ask an open-ended question like the following: “what would you like to get out of our work together?”
This is the core of solution-focused counselling and single-session counselling. There is often a misunderstanding that counselling has to be a long and drawn-out process that explores every aspect of someone’s past. This might be helpful in certain situations, but it is not necessarily what everyone needs during a session.
Another open-ended question might include the following: “By the end of this session, what would tell you this has been a helpful conversation?” or “If you get what you want out of this conversation, what would it allow you to do tonight or tomorrow?”
By starting with the end in mind, I can quickly determine what kind of conversation this is going to be. In my experience, counselling conversations generally fall somewhere on a spectrum between two broad categories: 1) conversations for support and 2) conversations for advice.
Conversations for support generally involve persons simply looking for someone who will listen with compassion, facilitate a sense of connection, and offer validation that they are doing the best they can. Clients often express this as “just wanting to know I’m not crazy” or “I just need to vent.”
Let’s take a closer look at the best tools for these types of conversations.
When determining the primary goal is to support a client who simply needs a compassionate ear, I immediately switch to my set of connection tools for holding space. These tools are the essence of a humanistic counselling approach.
Many clients, especially those in crisis, just want to feel heard. They have often felt dismissed or not understood by friends, family, colleagues, or other professionals. This leads to a sense of isolation or perhaps even shame.
The best way to hold space is to simply listen.
I originally learned about holding space from Heather Plett in this article:
It means that we are willing to walk alongside another person in whatever journey they’re on without judging them, making them feel inadequate, trying to fix them, or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.
To continue with the construction metaphor, it’s like adding strong supportive beams in a building. They are non-imposing and usually invisible, but their strength allows a structure to hold space, keeping the occupants inside safe.
In counselling terms, this means compassionately being with another person with complete acceptance, allowing them to feel held by your presence, and safe to express whatever they need to.
Let’s consider a few other tools that can help hold space more effectively.
Reflective listening means showing the other person you understand rather than simply saying, “I understand.”
How do you do this?
Although we can never really understand exactly what another person is going through, we can do our best to show we get it, on some level. We may not have been through the same experiences, but we all feel the same emotions from time to time and can connect with another person’s experiences through this shared humanity.
Even if your understanding is imperfect, just showing you are trying to understand can be enough. This is the core of empathy.
Reflecting back what you understand the other person is saying demonstrates this empathy.
It can be as simple as saying, “wow… you’ve been through a lot recently.” or it could be a brief summary of everything they’ve shared. The key is that it comes from a place of genuine compassion.
Here is an example of a more complicated form of reflective listening whereby you prompt the person to continue by saying the statements you believe they may say next:
Person: “I’m here because I find it difficult to control my drinking.”
You: “…and you’re looking to gain back some control.”
Person: “yeah… I miss the way things were with my family before I started drinking.”
You: “… spending quality time with the ones that matter.”
Person: “That’s right…”
Reflective listening is the primary tool I use to hold space. It allows the other person to feel safe and understood.
Although reflective listening is a tool, holding space goes beyond one’s words. It is an attitude and way of being with the other person. There is no need to change anything or fix anything in these moments. Just simply being with the other person during these difficult moments is often all they need.
If a client is ready to start developing new coping skills, I take out a different set of tools to work with their underlying unhelpful thoughts. This is the foundation of a cognitive-behavioural approach.
At the core of self-destructive actions, there are often unhelpful thoughts. For example, a person struggling with an addiction is not simply chemically hooked to a substance. Although there may be physical dependence, it often goes much deeper.
Past traumas or chronically unmet needs can result in distorted perceptions of oneself and the world. For example, this is common for people who grew up with emotionally unattuned parents struggling with mental health or addiction issues. Growing up in this environment can lead to distorted beliefs and habits that were adaptive in this early environment but become maladaptive in adulthood.
Common distorted self-perceptions include thoughts such as the following:
- I am not enough
- I will be a burden if I ask for help
- I’m bad/ broken/ hopeless
- I’m undeserving
- I’m unlovable
- I’m worthless
Continuing with the construction metaphor, these thoughts are equivalent to a distorted wall, throwing off the alignment of a room. This would require reframing some of the walls, but the walls need to be deconstructed before reframing can be done.
In conunselling terms, this means getting to the root of unhelpful core beliefs.
Identifying Core Beliefs
Deconstructing one’s thought processes to identify core beliefs should be done carefully. Like knocking down a wall, getting too reckless with the hammer could indirectly affect other areas of the house.
I generally ask what thoughts are going through their head during a challenging moment. For example, if someone is anxious every time they walk into work, I may ask them to imagine they are in that situation and share what might be going through their head at that moment.
If they are struggling to think of something or they begin to notice discomfort in their body, I will ask them to describe this discomfort in detail. Where is it located in the body? What does it feel like? I then ask if this discomfort had a voice, what would it say?
Responses might often include, “You’re going to mess up.” I would then go further, asking if this were true, what it would mean about you as a person. A response might include, “I’m going to lose my job.” Since this does not directly answer the question, I might ask what this would mean about them as a person. A common response might include, “I am not enough.”
Unhelpful core beliefs are distorted ideas about oneself, often extending into many areas of one’s life. For example, the core belief of not being enough often extends beyond isolated events such as worries about one’s work performance. It can affect one’s level of self-worth in all relationships, leading to frequent feelings of fear and unhelpful behaviors such as avoidance or overcompensation.
Unlike reframing a room in a house, reframing core beliefs does not merely require knocking down the old one and constructing a new one. Since core beliefs have often been around so long, they tend to pop back up frequently.
There is no process of unlearning in psychology. There is only new learning. You can’t just knock down the wall and burn the lumber. You have to use the same lumber to reconstruct the new wall.
In counselling terms, reframing these beliefs often requires putting them into a new context. For example, rather than unconsciously going through life with “I’m not enough,” we can identify where it may have come from and how to let go of it when it returns.
In this particular example, a person may share a highly invalidating upbringing with parents who frequently criticized them for not being good enough. Bringing this core belief to light and tracing its origin gives it a new context. It can then be held as an unhelpful thought that has been learned from one’s past experiences.
Gaining this perspective allows a person to step back from these unhelpful thoughts and reframe their meaning.
This is a fancy-sounding concept in Acceptance and Commitment Therapy (ACT), referring to one’s ability to step back from one’s thoughts.
When we are fused with unhelpful thoughts, they become heavy and weigh us down. We identify with the self-critical thought rather than noticing it’s just a thought and letting it go.
A popular metaphor in ACT includes the leaves on a stream visualization. It consists of imagining you are sitting beside a stream with leaves floating down it. Bringing your attention to your physical sensations, you step out of overthinking and into the present moment. If a thought comes in, place it on a leaf and watch it float by. If you would like to try this exercise, you can find a guided version of it on YouTube here.
The goal of this exercise is not to merely float into a dreamlike bliss where you stop identifying with every thought, going through life in a state of idyllic apathy. The goal is to practice stepping back from unhelpful thoughts, allowing you to focus on things you value.
For example, when “I’m not good enough” shows up, it can be used as a reminder that you care about a particular situation, such as doing quality work. You can then thank your mind for the reminder that you value your job and that you will not get hooked by this unhelpful thought right now.
Although you are working with the same lumber, you now have the blueprint. Having a broader perspective on the situation allows you to respond in ways that are more self-compassionate, increasing the chances you will act effectively.
This is another major tool I tend to use in reframing.
If people talked to their friends how they often talk to themselves, they wouldn’t have many friends for long.
People often beat themselves up with phrases such as, “I’m bad, I’m stupid, I’m crazy….” This lack of self-kindness cuts a person off from common humanity, making them feel uniquely defective and isolated. It then reinforces unhelpful worries and behaviours, decreasing the odds of effectively handling difficult situations.
After identifying and reframing core beliefs, I find it helpful to bring up the concept of self-compassion.
I often introduce self-compassion by asking how a person would talk to someone they care about going through the same situation. I then have them confirm this is the most helpful way to engage with someone and that harshly criticizing this person would be counterproductive.
I would then draw attention to the interpersonal process we’ve been engaged in over the session. If I were to constantly criticize them through the session, would this improve their chances of changing? They often immediately resonate with how unhelpful this would be.
After getting their full agreement on these examples, I suggest the same applies to how they talk to themselves. I then inquire into their thoughts after noticing this tendency and ask if it would be possible to pretend they are talking to a friend, next time they notice a lack of self-compassion.
When designing a room, the space can look very different, depending on your perspective. Perhaps we’ve become more familiar with this idea, given the increased use of videoconferencing from home. From the frame of a carefully placed webcam, a space can look clean and organized, but it can look very different from another perspective.
For me, perspective-taking has been a powerful reframing tool. I find it to be most beneficial among persons who are caught up in their view of a situation, unable to empathize, or have rigid beliefs about someone else’s intentions.
For example, if someone rigidly projects specific intentions onto their partner’s actions, perspective-taking can help determine a more accurate interpretation of events. This is particularly helpful if these unhelpful interpretations include concerns about one’s adequacy. In this way, perspective-taking can be a multi-purpose reframing tool that can also initiate cognitive diffusion.
This kind of reframing should be done carefully since you can unintentionally break the foundation. For example, asking how the other person views the situation can be interpreted as invalidating and appear as if you are supporting the other person’s behaviour.
When using perspective-taking, it is helpful to have a solid foundation of trust and approach it carefully, inviting the person to see the situation from behind the other person’s eyes. If approached with a spirit of curiosity and openness, it can lead to significant insights.
My goal in this article has been to reflect on my counselling toolkit. Hopefully, this has also been beneficial for you.
If you are a fellow practitioner, perhaps it has offered some ideas for your toolkit. If you are someone who is looking for support, perhaps it has debunked some myths about counselling and provided a few insights.
When sharing my role with others, people often ask, “what do you tell people?” As you can see in this article, the answer is always, “it depends.”
Asking me what I tell people is equivalent to asking a home builder what tool they use. It depends on what needs to be done at that moment.
But unlike construction, counselling can often be most productive when doing less. I heard a great quote recently by Judson Brewer in his new book, Unwinding Anxiety. He says, “don’t just do something… sit there.”
People who value compassion often feel compelled to rush in with their shiny well-stocked toolbox and try to fix things. I have to remember this every time I begin a conversation.
Although I used a repair-oriented metaphor throughout, the metaphor has its limits. Counselling is not about “fixing” people.
Taking a “fixing” orientation assumes people are broken and puts them into a passive role within the dynamic. This disempowers them in two ways. Implying they are broken can reinforce unhelpful self-critical thoughts. Also, placing someone in a passive role takes away a core ingredient of motivation; it takes away their sense of autonomy, self-efficacy, and sense of incremental mastery.
I’ve written about this collaborative approach to counselling in my article on how to do motivational interviewing here.
While exploring my counselling toolkit, I also realized there are way too many tools to fit within one article. If you are interested in taking a more detailed look inside my ACT toolkit, check out my article on how to improve psychological flexibility, here.
Great podcast – loved the bantering – eases the listening and learning!