Helping relationships, skill by skill

Which sequence of stages defines Egan's skilled helper model?

1. Relationship building, assessment, insight, and reorientation
   Relationship, assessment, insight, and reorientation are the four phases of Adlerian counseling, not Egan's stages.
2. Current scenario, preferred scenario, action strategies
   Egan's skilled helper model moves from the current scenario (the client's story and blind spots) to the preferred scenario (what the client wants) to action strategies (how to get there).
3. Engaging, focusing, evoking, and planning
   Engaging, focusing, evoking, and planning are the four processes of motivational interviewing (Miller and Rollnick), not the skilled helper model.

A school counseling program screens students for early signs of depression so it can intervene before problems worsen. Which level of prevention is this?

1. Secondary prevention
   Secondary prevention is early identification and intervention with people already showing early signs, which is what screening for emerging depression does.
2. Tertiary prevention
   Tertiary prevention works with people who already have an established disorder to limit impairment and relapse, a later point than early screening.
3. Primary prevention
   Primary prevention acts before any signs appear, for example through wellness lessons for all students; screening looks for problems that have already begun.

A client grieving a miscarriage asks her counselor whether she has ever lost a pregnancy. The counselor has. Which approach is MOST appropriate?

1. Decline and say disclosure is never appropriate
   Self-disclosure is not forbidden; a flat refusal to a direct, relevant question can feel cold and damage the relationship.
2. Share her own story in detail to build trust
   A detailed story feels warm but shifts the session to the counselor's loss and can leave the client caring for the counselor.
3. Describe how she coped so the client can copy it
   Offering her own coping as a model imposes the counselor's path on a grief process that is the client's own.
4. Disclose briefly and return the focus to her
   Self-disclosure helps when it is brief, relevant, and for the client's benefit, with the focus returned to the client right away.

A licensed counselor asks a respected colleague for advice on a difficult case. The colleague has no authority over her work and no responsibility for the client. What is this relationship?

1. Referral
   Referral transfers the client, or part of the care, to another provider; here the client stays with the counselor.
2. Supervision
   Supervision is evaluative and hierarchical, and the supervisor shares responsibility for the client's care, which this colleague does not.
3. Co-therapy
   Co-therapists both work directly with the client and share responsibility; the colleague never sees the client.
4. Consultation
   Consultation is a voluntary relationship in which a colleague advises but has no authority over the consultee's decisions and no responsibility for the client.

When the counselor leans forward, a client quietly moves her chair back to restore a greater distance. Which dimension of nonverbal communication does this involve?

1. Proxemics
   Proxemics is the use of personal space and interpersonal distance; moving her chair back restores the distance she is comfortable with.
2. Paralanguage
   Paralanguage is how something is said: tone, pitch, pace, and pauses. Nothing vocal happens here.
3. Kinesics
   Kinesics covers gestures, posture, and facial expressions; the counselor's lean is a body movement, but the client's response concerns space between them.
4. Chronemics
   Chronemics concerns the use of time, such as punctuality or response delay, not physical distance.

A counselor who once left a violent relationship finds herself urging a client to leave her partner immediately and feels angry when the client chooses to stay. Which countertransference pattern is MOST evident?

1. Projective identification
   Projective identification describes a client inducing disowned feelings in the counselor; this counselor's urgency comes from her own past.
2. Overidentification
   Overidentification is countertransference in which the counselor sees her own history in the client and pushes her own solution, here leaving immediately.
3. Burnout
   Burnout is exhaustion, cynicism, and reduced effectiveness built up over time, not a pull toward one client tied to the counselor's history.
4. Transference
   Transference is the client's feelings toward the counselor drawn from earlier relationships; the reaction described is the counselor's.

A client says, "My boss criticized me in front of the whole team, and I just wanted to disappear." Which response is at level 3 (interchangeable) on Carkhuff's empathy scale?

1. "You felt humiliated being criticized in front of everyone, and maybe you're questioning this job."
   Adding that he may be questioning the job goes beyond what he said, which makes it additive (above level 3), not interchangeable.
2. "That sounds like a bad day; tomorrow will be better."
   Calling it a bad day that will pass minimizes and reassures, losing the intensity of the feeling: a subtractive response below level 3.
3. "You felt humiliated being criticized in front of everyone."
   Reflecting 'humiliated' and 'criticized in front of everyone' captures the client's feeling and content accurately, adding nothing and leaving nothing out: level 3.
4. "You should report your boss to human resources."
   Advising him to report his boss skips the feeling entirely, a subtractive response on Carkhuff's scale.

A client says, "Everything is just falling apart." The counselor responds, "I'm not sure I follow. Do you mean at work, at home, or both?" Which skill is the counselor using?

1. Clarifying
   Clarifying asks the client to make a vague statement more specific so the counselor understands it accurately.
2. Paraphrasing
   Paraphrasing restates the client's message in the counselor's words; this counselor asks for more detail instead of restating.
3. Interpreting
   Interpreting offers a new frame of reference; asking whether he means work or home adds no hypothesis of the counselor's own.
4. Summarizing
   Summarizing pulls together several statements or themes, usually at a transition or the end of a session, not one vague remark.

Bordin's model of the working alliance consists of which three components?

1. Trust, rapport, and respect
   Trust, rapport, and respect are general relationship qualities, not Bordin's three named components.
2. Empathy, warmth, and genuineness
   Empathy, warmth, and genuineness resemble Rogers' core conditions, which describe the counselor's attitudes, not the shared alliance between both people.
3. Goals, tasks, and bond
   Bordin defined the working alliance as agreement on goals, agreement on the tasks that reach them, and the emotional bond between counselor and client.
4. Goals, techniques, and termination
   Goals is right, but techniques and termination replace tasks and bond; termination is a phase of counseling, not an alliance component.

A client says, "Everyone at work is against me." The counselor asks him to describe one specific recent situation, who was involved, and what was said. Which facilitative condition, described by Carkhuff, is the counselor promoting?

1. Immediacy
   Immediacy addresses what is happening between counselor and client right now; asking about a work event is not about the relationship.
2. Concreteness
   Concreteness, or specificity, moves the client from vague generalities to specific events, people, and words, which makes the problem workable.
3. Confrontation
   Confrontation points out discrepancies in what the client says or does; asking for one specific example is not a challenge.
4. Genuineness
   Genuineness is the counselor's congruence and authenticity, a quality of the counselor rather than a request for specifics.

A client says his long hours finally make sense when he pictures his kids in college. The counselor replies, 'Providing for them gives your work its purpose.' Which skill is this?

1. Reflection of feeling
   A reflection of feeling names an emotion, such as exhaustion or pride; this response names a value, not a feeling.
2. Interpretation
   Interpretation adds the counselor's own frame; this response stays with the purpose the client himself just described.
3. Reflection of meaning
   Reflecting meaning names the value or purpose beneath the client's words, here that providing for his children gives his work its purpose.

Beyond the three core counselor conditions, which of the following is also one of Rogers' six necessary and sufficient conditions for change?

1. The client has a clearly defined, measurable counseling goal
   Measurable goals belong to behavioral and solution-focused planning; Rogers' person-centered approach does not require them.
2. The client is incongruent, vulnerable, or anxious
   Rogers' six conditions include psychological contact, a client in a state of incongruence, the counselor's three core conditions, and the client perceiving them.
3. The counselor models effective problem-solving
   Modeling problem-solving is a cognitive-behavioral or social learning technique, not one of Rogers' conditions.

A client says, 'I know I should cut back on drinking, and I've been thinking about it, but I'm not ready to set a date.' According to Prochaska and DiClemente, which stage of change is this?

1. Contemplation
   Contemplation means seeing the problem and seriously weighing change without committing, marked by ambivalence like 'not ready to set a date.'
2. Precontemplation
   In precontemplation the person does not see a problem or has no intention to change; this client says she should cut back.
3. Preparation
   Preparation involves intending to act soon and making a plan, such as setting a date, which she says she is not ready to do.

The American Association of Suicidology's mnemonic IS PATH WARM is used to recall what?

1. Demographic risk factors for suicide
   Demographic factors such as age and sex are long-term risk factors; the mnemonic lists acute warning signs that call for prompt assessment.
2. Steps of a collaborative safety plan
   Safety-plan steps (warning signs, coping strategies, contacts, professionals, means safety) follow the Stanley-Brown format, not this mnemonic.
3. Warning signs of imminent suicide risk
   IS PATH WARM lists warning signs of near-term risk: ideation, substance use, purposelessness, anxiety, feeling trapped, hopelessness, withdrawal, anger, recklessness, and mood change.

Which single factor most strongly predicts future suicidal behavior?

1. A previous suicide attempt
   A prior suicide attempt is the single strongest known predictor of future attempts and deaths, so risk assessment always asks about it.
2. Exposure to a friend's suicide
   Exposure to a friend's suicide raises risk, especially in adolescents, but as a predictor it is far weaker than one's own past attempt.
3. A diagnosis of generalized anxiety
   Anxiety disorders raise risk modestly, mostly together with depression or substance use, and do not outweigh a prior attempt.

A client says, "I studied for weeks and still failed my licensing exam." Which counselor response best shows accurate empathy?

1. "I'm so sorry, that must feel absolutely awful for you."
   Saying 'I'm so sorry' is sympathy: it centers the counselor's reaction and guesses at an intensity the client did not express.
2. "Lots of people don't pass it on the first try."
   Pointing out that lots of people fail the first time is normalizing reassurance that moves past the feeling before it has been heard.
3. "What study methods did you use to prepare?"
   A question about methods moves to problem solving and skips the feeling entirely.
4. "You're discouraged that your work didn't pay off."
   Accurate empathy names the client's feeling and its context from the client's frame: discouragement that weeks of work did not pay off.