Essential Principles of Therapeutic Practice

Posted on Aug 2, 2025 in Psychology and Sociology

Carl Rogers’ Core Conditions of Therapy

Unconditional Positive Regard: The client needs to feel accepted, loved, and prized. This involves accepting and valuing the client without judgment.
Genuineness: The therapist needs to be congruent and their authentic self in the therapeutic relationship.
Accurate Empathy: Deeply understand the client’s experience when offering empathy, sensing their world as if it were your own, without judgment.

Nonverbal Communication in Therapy

Three key categorizations of nonverbal behavior:

Paralinguistics: Refers to “how you speak,” including vocalizations, silent pauses, speech errors, and tone.
Proxemics: The use of personal and social space, such as the size of the room, seating arrangement, and distance between the helper and client.
Kinesics: Pertains to body motion, including gestures, posture, and facial expressions.

Limits to Confidentiality in Therapy

Three primary limits to confidentiality:

Harm to Others: Clear and imminent risk of serious harm to others or vulnerable populations, including a child under the age of 18 at risk.
Harm to Self: The client states they have been sexually abused by a regulated health professional or is going to hurt themselves with a plan.
Legal Requirements: A subpoena from a court to release records.

Understanding Transference and Countertransference

Transference

Transference is the client’s projection of feelings and fantasies, which are reactions to significant others in the client’s past, onto the helper or therapist.

Example: A client’s father was very strict and demanded punctuality. The therapist reminds the client of an upcoming appointment and mentions a previously missed appointment. The client has a strong reaction and becomes angry at the therapist, transferring unresolved feelings from their father to the therapist.

Countertransference

Countertransference is a therapist’s unconscious emotional response to a patient, often triggered by the patient’s characteristics or behaviors that remind the therapist of someone or something from their own life.

Example: A therapist, who had a difficult relationship with their own mother, finds themselves becoming overly nurturing and protective towards a client who is struggling with maternal abandonment issues.

Six Influencing Responses in Therapy

Helper Questions:: Examples: “How did you feel when that happened?” “What’s been the most challenging part of this experience for you?”
Helper Information Giving:: Examples: “Based on what you’ve shared, I think it might be helpful to know about the different types of therapy approaches that could support you.” OR “I want to share some information about the resources available in our community for people struggling with addiction.”
Helper Self-Disclosure:: Example: “As someone who has experienced loss, I can understand how difficult it must be for you to navigate this challenging time.”
Helper Immediacy:: Example: “I can sense your vulnerability as you share this with me, and I’m glad you feel comfortable enough with me to let me in on some of it. I think that might help ease some of the burden you are carrying.”
Helper Interpretation:: Example: “You’ve described feeling overwhelmed by your responsibilities. Perhaps this is a possible sign that you’re shouldering too much responsibility or that you need to develop more effective coping strategies. What do you think?”
Helper Confrontation:: Example: “You’ve stated that you want to make changes in your life, but I’ve noticed that you don’t seem to be taking concrete steps towards making those changes happen. Can we examine what might be holding you back?”

Effective Counseling Goal Characteristics

Five characteristics of well-constructed counseling goals:

Salutary, Not Remedial: Goals should represent the presence of something positive, rather than the absence of something negative.
New and Different: Treatment goals should be behaviors that the client has generally not engaged in before.
Process-Oriented, Not Static: Process-oriented goals reflect the continuity or maintenance of preferred outcomes, rather than a once-and-for-all achievement.
Realistic and Achievable: Treatment goals should be realistic and achievable and are within the client’s control.
Specific and Comprehensible: When goals are specific, that leads to clarity.

Client Assessment Categories in Therapy

Ten out of eleven categories for assessing clients:

Explaining the Purpose of Assessment: Presenting the rationale for the assessment interview to the client.
Identifying the Range of Concerns: Using leads to help the client identify all relevant primary and secondary issues to get the big picture.
Prioritization and Selection of Issues: Using leads to help the client prioritize issues and select the initial area of focus.
Identification of Present Behaviors: Using leads to help the client identify the six components of current behaviors: affective, somatic, behavioral, cognitive, contextual, and relational.
Identification of Antecedents: Using leads to help the client identify categories of antecedents and their effect on the current issue.
Identification of Consequences: Using leads to help the client identify categories of consequences and their influence on the current issue.
Identification of Secondary Gains: Using leads to help the client identify underlying controlling variables that serve as payoffs to maintain the issue.
Identification of Previous Solutions: Using leads to help the client identify previous solutions or attempts to solve the issue and their subsequent effect on the issue.
Identification of Client Individual and Environmental Strengths and Coping Skills: Using leads to help the client identify past and present coping or adaptive behavior and how such skills might be used in working with the present issue.
Identification of the Client’s Perceptions of the Concern: Using leads to help the client describe their understanding of the concern.

Suicide Risk Assessment Stages

Identify Risk Factors: Ask about recent changes in behavior, mood, or circumstances. Inquire about previous suicidal thoughts or attempts. Assess for mental health conditions and substance abuse. Consider demographic factors such as young males (16-24) or middle-aged males experiencing loss.
Assess Suicidal Ideation and Plan: Directly ask: “Have you thought about hurting yourself in any way?” If ideation is present, explore details. Assess intent. Ask: “How would you go about hurting yourself?” “Do you intend to carry out your plan?” Assess for impulsivity or reckless behavior.
Identify Protective Factors: Ask for reasons for living, significant relationships, and future goals. Assess coping skills, support systems, and problem-solving abilities.
Develop Safety Plan: Work with the client to ensure safety. Identify coping skills, support systems, and emergency resources. Ask questions like: “Do you have somebody close to talk to if you feel this way?” “Who else could you talk to?” “What would you do if you can’t talk to [person X]?”