TPC-Journal-V3-Issue3

145 The Professional Counselor \Volume 3, Issue 3 Step 1: Assessment During the assessment phase of the model, person-centered (Rogers, 1961) and motivational interviewing skills (Miller & Rollnick, 1991) are used to create an environment where clients feel safe to discuss their is- sues. The assessment phase of the model should provide clients ample opportunity to discuss their concerns in an atmosphere that fosters therapeutic alliance. Anecdotal evidence suggests clients often discuss their emotions, thoughts, behaviors and physiological reactions related to presenting issues without excessive counselor question- ing. By utilizing empathy, positive regard, summarization, and open-ended questions; and by clarifying discrep- ancies and listening for change-words (i.e., words that indicate a client’s needs, desires, abilities and commitment to change), a counselor creates an environment that enhances therapeutic alliance. The following case scenario is described to show how the different components of the TFM are conducted. Sabine is a 30-year-old female, who was born in Quebec, Canada, and moved to the United States when she was 8 years old. She is a college graduate and has worked for the past eight years in a bank where she is now the branch manager. After witnessing a car accident two months ago, she reports experiencing increasing anxiety when driving, which is now compromising other areas of her life. She reports feeling isolated from friends and family, and for the first time in her professional career, she called in sick to avoid driving to work. After further reflection of content and summarizing, it appears that she is feeling helpless and having thoughts of being “out- of-control” and unable to manage her anxiety. She is scared that she will not be able to drive to see her family, or continue to drive to work. She reports that her anxiety is now causing her to stay at home most of the day and not visit with friends or attend church. Her main anxiety symptoms include rapid pulse, shallow breathing, difficulty with swallowing, and feeling faint. Sabine described herself as a shy child who was always able to overcome her fears. She reports no substance use except for a few glasses of wine with friends on the weekend, and she takes no medication. From Sabine’s presenting concerns, the assessment phase of the model can be completed. To ensure Sabine’s presenting concerns were fully heard, the model is shown to Sabine, and she is asked what else needs to be added to ensure that her concerns are represented. This process serves two important purposes. First, Sabine sees how the four quadrants are interrelated, a cognitive behavioral technique that serves to teach the client how thoughts, feelings, behaviors and physiology interact. Second, presenting the information in this way helps to establish a good working relationship and treatment fit. It makes Sabine aware that the counselor wants to fully understand her primary concerns. Step 2: Goal Setting With the initial assessment complete, Sabine is asked to imagine resolution of her issues in the near future and to describe what she would be feeling, thinking, and doing, and how this might affect her physiological reactions. The following script is one way to begin facilitating the goals step of the process: Sabine, it is helpful for me as a counselor to understand your life goals and values so we can work to- gether to determine an effective treatment plan. So, keeping the different areas in mind that we discussed earlier, let us assume that three months from now you are feeling much better. What words best describe how you would be feeling in three months? Thus, if Sabine were to say, “I’d be feeling more self-confident,” the counselor would respond, “When you are feeling self-confident, what kind of thoughts will you have about yourself?” It can be helpful with some clients to give examples of “thoughts about self” to increase their awareness and help them challenge unproductive self-beliefs. For instance, the counselor could say, “If I were feeling more self- confident, I might be saying to myself ‘I can do it,’ or ‘I can accomplish my goals.’” Such counselor self-disclo- sure can make it easier for clients to identify positive affirmations. To determine desired behaviors and physiolog- ical responses, the counselor asks, “When you are feeling confident and thinking ‘I can handle this,’ what will you be doing differently and how might this affect your physiological symptoms?”