A self-identified transgender client has come to you for relationship advice.

The client

reports anxiety when approaching social situations and is unsure how to address the

anxious symptoms. Discuss how you will incorporate REPLAN to help the client. Be

specific. The client may be an adult or a minor, depending on your preferred population.

Tailor your response accordingly.

I would first work on building and maintaining a strong helper client relationship. Those

who are transgender have often experienced a lot of judgement from others throughout their

life, and may have issues being able to connect with and trust others. I would make sure the

client knows that they are in a safe space and that I do not judge them at all and that their

experience and feelings are completely valid.

Following this, I would implement the next step, which is enhancing efficacy and self-

esteem. We would first work on efficacy in social situations. I would implement stop and

reflect, and to do this I would give them a warm up activity. I would suggest they make a list of

10 things they cannot do socially but would like to be able to do in the future. I would then

have them rate how they perceive the difficulty of each task on a scale of 1-10. After this we

would begin to work on each task in ascending order, starting with the least difficult tasks and

working up to the most difficult.

I would then move on to the next part of REPLAN, which is practicing new behaviors. I

would first start off by facilitating a role-play of a stressful social situation with the client, and

take note of how they behave in this situation. I would also ask the client to take note of

moments during our role-playing session where the client felt the most anxious. Following the

session, I will have the client share the moments where they felt most anxious, and point out to

the client moments where I took note of anxious behaviors. This will help both the client and
myself to understand which parts of social interaction are most challenging for the client, and

from this we can move forward to addressing these.

After this I would move on to lowering and raising emotional arousal. The main issue

the client presents is a heightened amount of anxiety in social situations. I would use this step

to work with the client to lower emotional arousal. To do this I would work with the client on

relaxation training. I would work on deep muscle relaxation with the client and have them

practice this during moments of anxiety. I would also encourage the client to practice

meditation between sessions, which helps to relieve anxiety, along with heightening positive

emotions.

I would then move on to activating client expectations, hope, and motivation. I would

do motivational interviewing with the client to help improve their overall outlook and

motivation to change. I would also use embedded questions to foster a sense of hope for the

future so they can have a more positive outlook going forward with their treatment. Many

clients are in a bad place mentally when they walk through the door, and of course you cannot

solve that immediately. Clients may begin to feel hopeless when they are not making progress

as quickly as they would like, so it is important to provide gentle reminders that if they put in

the work to change, it will happen.

Based on your approach and use of techniques during the semester, describe your

counseling style. (Helpful Hint: It may be useful to compose a statement that you could use

for practicum/internship/employment applications!)

When working with someone, the most important part of being a counselor for me is to

be empathetic of the situation of any client, and to be non-judgmental toward the client. While I
may not see eye to eye with every client or completely understand their situation, I try my best to

be empathetic and make sure that they do not feel judged. I have been told while working at my

job that I present as a non-judgmental person, which I believe shows through in my counseling

videos. I anticipate that when I become a counselor I will be faced with people who have done

things that I would not align with morally. I have confidence in the future that when I work with

those individuals I will be able to make them feel like they are in a space that is safe and free of

judgment. I am also a firm believer in rehabilitation, and I believe someone’s past actions do not

always define them as a person. We are not our worst moments.

My counseling style is also direct and confrontational. I think starting off the semester it

may have been too direct and confrontational, but after my final video I would say I have now

found a good balance. This part of my counseling style is something I am proud of because there

have been times in my life where I was not confrontational enough, so it is very satisfying to see

that I have evolved into someone who is able to confront people when needed. This is especially

important to be able to do when working with my preferred population, which is the SUD

population. I believe my experience working with that population has greatly affected my

counseling style and pushed me into a more direct style of counseling than I would have had

without that experience.

Your client tells you that his family and friends have pressured him into seeking counseling

for substance abuse. The client appears unconcerned about his frequent use, and seems

annoyed at others for suggesting that he has a problem. Discuss your approach to SMART

goal setting with this client. Be specific. The client may be an adult or a minor, depending

on your preferred population. Tailor your response accordingly.

bound. Before attempting to set goals, I would make sure I have a firm understanding of the

client’s situation. Once I felt like I had a firm understanding, I would then start trying to set

SMART goals. Due to the client being resistant to change at the moment, goals would have to be

formulated more covertly by asking the client questions. When the client explains that he has

been having problems with his family and friends, I would ask, “So you would like to work

toward improving the relationships you have with family and friends?”. If the client responded

that this was something he would like to work toward, I would then work toward setting a

SMART goal pertaining to this.

Because the client’s substance use is the main thing causing the issues in his

relationships, I would set a goal with the client that he will not use substances around these

friends and family for one month. After that month, the client and I would reflect to see how his

relationships change during that time period. I will also check in each week with the client to see

how this is going. If the client is having trouble not using while around these friends and family,

that may open up the door to a larger conversation relating to how his substance use may be

problematic if he is unable to abstain in order to work toward mending his relationships.

I would also try to find out other ways in which the substance use may be negatively

impacting his life. For the sake of this example, let's say the client’s drug of choice is alcohol. He

may note that due to this he often must call off from work as he drank too much the night before

and has a hangover in the morning. I would respond to that by asking the question, “So your

drinking has negatively impacted your career and finances?”. If the client were to agree with this

statement, we could set another SMART goal in relation to it. The goal I would set with this

client would be to not drink on week nights for the next month. Following this month, me and
the client will reflect on how this change may have positively impacted his career and finances.

If the client is unable to achieve that goal, it could again serve as an opportunity to start having a

larger conversation about his substance use. If the client was able to successfully achieve this, we

could discuss making this a permanent change. This may be easier to convince the client of after

he has successfully completed the month, as he in that month would have been able to see for

himself the benefits of abstaining from alcohol has had on his career and finances.

Your client is mandated by the court to see you for anger management counseling. This

client has several legal offenses on record and appears unconcerned about consequences of

any kind. While in session, the client stares at you and keeps responses short, avoiding

lengthy exploration. Which techniques do you suggest for an effective therapeutic

outcome?

At the moment the client is being very resistant to change and does not want to be in

counseling, but must do so as he has been mandated. I would have to work toward building the

therapeutic relationship before any real progress could be made in session. I would build rapport

with the client a few different ways. One way I would do this would be through self-disclosure. I

may ask the client what his interests are. Let’s say the client loves to play video games. I would

then disclose to the client that I also enjoy playing video games, and we would spend some time

discussing that so the client can feel more connected to me as a person, instead of just seeing me

as someone he is forced to see every week.

I would also use more humor than I normally would while in session with this client at

first to build rapport. This would keep the session more lighthearted, and the sessions may even

become something the client begins to enjoy. Often these individuals hear they have to go to
counseling and think of a stereotypical depiction of a counselor and how a session may look like;

Inauthentic, forced, too formal, etc. Showing him that counseling can be a positive, enjoyable

experience will help him to be more consistent in showing up to sessions. This will also help the

client in becoming more receptive to the help I am trying to provide him with as his counselor.

I would also see if there are other ways I could help the client that are not just through

counseling. If the client was food insecure and I was at an agency that provided food boxes, I

would provide him with one of those. If the client complained of a medical condition that was

really negatively affecting him, I could set him up with a case manager who would be able to

help him get into a doctor as well as navigate the often-complicated American healthcare system.

The client seeing me as someone not only available to help with his mental health, but someone

who can help assist with other issues he is facing, will also be very beneficial in building the

therapeutic relationship.

Based on insight, reflection, and the performance on your tapes, what is the technique you

struggle with most? Give specific example(s), and describe how you will address this in

future practice.

The technique I struggled with the most was the use of attentive silence. This was the

case for pretty much all of my tapes. Silence in conversations is always something I struggled

with. It always feels awkward to me and I always feel like I need to come up with something to

say quickly. When I first read about the use of silence in a therapeutic setting, I was surprised to

see that this was a tool that people used. I was always under the assumption that I should not

allow there to be silence while in session, to keep the client from beginning to feel awkward or

anxious. However, looking back, I may have been more concerned about myself feeling
awkward and anxious. I can see how silence can be helpful for someone who has just disclosed

something very personal to their counselor. They may not want to continue the conversation as

normal right after disclosing something of that nature.

While filming my tapes I really struggled figuring out when using attentive silence would

be appropriate during the session. However, looking back on the tapes, I did notice moments

where I could have implemented silence but did not think to in the moment. For example, around

20:00 in my first video, my client was disclosing information about how he had been mistreated

by his father. Instead of using silence to leave some time to reflect, I immediately began talking

again, expressing my empathy. At this time this felt like the right thing to do, but looking back I

see how silence could have been a helpful tool. It can be hard to disclose those things, and at that

point I was virtually a stranger to the client, so a moment to just sit with that information out

there likely would have been beneficial for both of us.

I will continue to work on this throughout my journey into becoming a counselor.

Watching the tapes back was one of the most important things that helped me to realize I

struggled with implementing attentive silence into the session. Had I not looked back on tapes, I

likely would not have recognized that. Once I begin my practicum and internship I plan to record

sessions when clients are comfortable with this, and continue to look back on tapes and critique

myself. In my current job I will also try to use attentive silence. I think this will be very helpful,

as many of the clients I see disclose very personal information regarding their past trauma, as

this is heavily linked to addiction. Moving forward I will implement the use of silence when

appropriate and hopefully with time, this will come to me more naturally.