Chapter 5: Skills in the Work Phase

Work Phase ModelPhases in a single session

Preliminary Phase (Sessional): Within the preliminary stage the workers attempt to sensitize themselves

before a session begins. This involves putting the client’s feelings they may be feeling into words.

Beginning Phase (Sessional): Within the beginning phase, the workers man goal is to find out what their

client may be troubled with or working on at the given moment. Middle Phase (Sessional):

The middle phase can also be defined as the work phase. Within this stage it is important that the workers use empathy to ensure that the clients will share with them the entire and affective part of their messages.

Work Phase ModelPhases in a single session

Endings and Transitions (Sessional): In the endings and transitions of single sessions it is idea to present the

important dynamic and require the workers attention. Transitions need to be made to next sessions and future actions.

Work Phase ModelSessional Tuning-In Skills

Tuning in to the client's sense of urgency: These types of interactions between client and worker can be very indirect

because of the client’s lack of consciousness awareness or concerns. Tuning in to the workers own feelings:

It is very important that the workers tune into their own feelings especially when receiving negative feedback. The workers feelings can either help or hinder the work with a client.

Tuning in to the meanings of the client’s struggle: When patterns start to emerge when working with a client, it is important

that the worker step back and try to understand the client’s struggle in a different way.

Work Phase ModelSessional Tuning-In Skills

Tuning in and the workers realities of time and stress: Allowing time to prepare for sessions is often prevented by large caseloads of

the speed in which events actually happen. Tuning in to the workers own life experience:

Overtime, workers capacity tends to expand with use. After time with engaging in the clients, workers are able to start seeing growth.

Chapter 6: Endings and Transitions

Difficulties

The therapeutic relationship is an important relationship, and we as a society tend to struggle with closure of such a relationship.

We often deny feelings instead of dealing with them, and society hasn’t taught us how to deal with ending of a close relationship.

Ending the worker-client relationship can be a trigger for deep feelings, which is why it is important to know how to handle this process as a worker.

Affects of termination

“In a study of 12 clients those who had positive termination experiences reported a strong therapeutic relationship and positive outcomes of therapy. They terminated mainly for logistical or financial reasons; their termination, post-termination plans, and feelings about termination were discussed in advance with their therapist, as was their growth in therapy, leading to mostly positive effects of the termination”.

“In contrast, those who had problematic terminations reported a mixed therapeutic relationship and mixed outcomes of therapy. They usually terminated abruptly because of a therapeutic rupture, and thus termination was rarely planned and discussed in advance, rendering it a negative experience”.

Knox, S., Adrians, N., Everson, E., Hess, S., Hill, C., & Crook-Lyon, R. (2011). Client's perspective on therapy termination. Psychotherapy Research, 21(2). Retrieved February 12, 2017.

Stages

Denial-The worker and client often start in this stage after they are aware that an end is coming to the sessions. The worker or client don’t want to deal with feelings

associated with the termination of the therapeutic relationship.

As a worker, it is important to manage personal feelings so that the worker can help the client manage their feelings as well.

Indirect/Direct Anger- Following denial, the next stage would be indirect or direct cues of anger. As a worker, it is important to respond to these cues

even if they are indirect.

Stages

Mourning- The client often jumps to this stage next, which is sadness. Empathizing with the feelings of the client and

expressing the worker’s feelings will be important during this stage.

Trying It on for Size- This is the stage where the client is able to do things more independently and starts to have positive feelings of the process they have experienced.

Farewell-Party Syndrome- This stage is the “celebration” of the relationship. Feedback of both positive and negative feelings is important during this stage.

Skills

During the ending stage of the therapeutic relationship, the client either takes initiative or is asked to reflect upon their relationship and think about what they have learned.

The worker should encourage the client to identify that there might be future work. The work is not necessarily done, and the client will have learned how to handle more situations.

Suggesting new support systems and new experiences for the client is essential during the ending stage.

Types of Endings(Some reasons why the therapeutic

relationship comes to a halt) The worker gets terminated The death of a client Working with a dying client A client commits suicide End of life decisions (Assisted-suicide)

These types of endings can end in guilt, and can be traumatic for the worker. As a worker, it is crucial to take care of oneself, because when the worker is self-aware, the client receives better services.

Types of Endings(Some reasons why the therapeutic

relationship comes to a halt) Therapy is often considered to go on for to long. The timing of the therapy is also very important. The practitioner can usually determine how long the client needs therapy The practitioner always tries to discourage leaving therapy at certain times. There are certain times termination should be brought up. Client’s can sometimes no longer pay for therapy. How to work through the process of termination, uncovering the sometimes

painful or angry responses both patient and therapist can experience. Terry, K. A. (1988). Ending therapy: The meaning of termination.

New York University Press Ending therapy: The meaning of termination. Retrieved February 12, 2017.

The 4 Must Do’s of Ending Therapy

https://www.youtube.com/watch?v=4NxMtG4Jp98

Morton, Kati. (2014) The 4 MUST Do’s of ENDING THERAPY! Mental Health Videos with Kati Morton. United States: YouTube.

Citations

Knox, S., Adrians, N., Everson, E., Hess, S., Hill, C., & Crook-Lyon, R. (2011). Client's perspective on therapy termination. Psychotherapy Research, 21(2). Retrieved February 12, 2017.

Morton, Kati. (2014) The 4 MUST Do’s of ENDING THERAPY! Mental Health Videos with Kati Morton. United States: YouTube.

Shulman, L. (2016). The skills of helping individuals, families, groups, and communities. Boston, MA: Cengage Learning.

Terry, K. A. (1988). Ending therapy: The meaning of termination. New York University Press Ending therapy: The meaning of termination. Retrieved February 12, 2017.