So you wanna be a better counselor?: Part 5
Let’s get down to brass tacks. You’ve got the preconditions of a well defined field, clear feedback, and time. You know to avoid looking at gurus, but instead search for masters.
“Okay Jordan,” you say “these are all great ideas. But what do I do?”
Well you need track your outcomes, record your sessions, and deliberately practice microskills.
Track your outcomes.
Tracking your outcomes means handing each client a brief survey before every session. This is helpful because it allows you to find weak areas in your caseload.
Most people start with a survey like the OQ 45, the CORE, or the ORS/SRS surveys. My recommendation is to start with the ORS/SRS. They are brief and very user friendly. You can get all the ORS/SRS through online platforms like Fit-outcomes or Better outcomes. They cost a little bit of money (approx 150$ per year) but are worth it!
Personally I use the OQ -Analyst System mostly because they have copyright on the Outcome Questionnaire assessments. These are the assessments frequently used in research. So it feels, to me, a bit more advanced.
If you are super hesitant about price I recommend you start off with PsyPack, they have a free version you can test out. But don't let price me the only deciding factor. PsyPack offers a much wider range of assessments than the above resources. Also, while I've not used it myself, from what I've seen they're platform is actually more client friendly.
Watch your tape.
You should also start recording sessions. The easy way I do this, because so many of my clients are telehealth, is to use the record feature in zoom. That’s it.
When I was seeing people face to face I would use a GoPro. I like the wide angle lens the GoPro gives you, but feel free to use another camera if that fits you. Either way you’ll need a slew of batteries. You don’t want to have to worry about your camera going dead. And you’ll need a good microphone.
Some people I know use their computer or their phone to record. If you use your computer make sure you change the settings so it doesn’t go to sleep. The same goes for your phone. Also, if you use your phone, make sure you put it in airplane mode. You don’t want confidential videos of your client being saved to iCloud and you don’t want someone calling you and it stopping your video. Also, if you use your phone make sure you’ve got plenty of space. One time I used my phone and I ran out of space. So I deleted a bunch of stuff, and I still couldn’t record anything. I couldn't figure it out for a few days until I realized I had to clear out my “trash” folder. Keep that in mind. Your “trash/delete” folder may count towards your storage. Clear it out!
Finally, I keep all videos on an external hardrive that has a password. This helps me keep things confidential. You can just search “encrypted external hard drive” on amazon and almost anything that comes up with do. I use a WD My Passport. I think mine is like 2 terabytes. Honestly the size almost doesn’t matter since I delete the tapes every week.
How do I use these tools to be better?
People often ask, “Ok. So I started using the ORS/SRS. And I’m getting the survey results. How do I use this to be better?”
Let’s just keep it simple. You’re just starting out. You use the survey’s to identify client’s who are getting worse. Once you identify a client who’s getting worse you watch their tape. Usually when I watch a tape an obvious error jumps out at me. However, I don’t just go by my clinical intuition. I also ask clients, “I was reviewing your chart and it seems you’ve been feeling worse. I really want to make sure you’re getting the help you need. Do you have an idea about what might be missing?” because I want to know what the client thinks the obvious error is.
The most important thing is you pay close attention to whatever the client says. And validate the heck out of them for telling you. And then validate them again. And then at the end of the session validate them again. If you’re not laying it on thick, your not laying it on nearly enough.
Why so thick? Because you’re sending a signal. You’re demonstrating by your actions that their feedback is in invaluable. Way too often client’s won’t say what they think because they don’t want to hurt your feelings. Even if a client says “I don’t know. I just feel stuck.” Then you validate that, “wow, thanks for admitting that. On top of everything else, you also have to deal with not knowing. That alone is really hard when you’re in the middle of a big problem. Thanks for telling me. If anything else comes to mind, please let me know. In order for me to help you I need to deeply understand your experience.”
Engage in deliberate practice.
Once you have all this information you get a coach and make a plan to practice micro skills to address the obvious error.
This is the hardest part because most supervisors, coaches, and consultants haven't been trained in coaching, so they make one of two big mistakes.
The first mistake is they make everything theoretical. It’s like if you went to school to become a mechanic and instead of telling you want to do the mechanic just talked about how combustion engines worked. You wouldn’t really grown as a mechanic.
The second mistake most coaches do is they attempt to teach you a metaskill. They look at your data and say “okay, you need to build the relationship with your client. Let’s role play that.” Building a relationship is way to big. You’ve got to get much more nuanced. How do you do that? Well you work on a small goal and use skill criteria to meet that goal. Your coach might say “Okay, so you need to build the relationship. Let’s break that down. I see you ask a lot of questions. That can come off as interrogating to some clients. Let’s practice using more reflections. I’m going to give you some prompts and you offer a reflection. Your reflection should do to things. 1) Reflect the core emotional concern presented, 2) Use a tentative tone of voice.”
You practice that microskill, then layer in a second micro skill and a third, so on and so forth.
Is all this really necessary?
The obvious question is: is all this really necessary? I mean weekly surveys? Video recording? C'mon man. Do we really need all this stuff?
Yes. Because we're really bad a tracking what actually happens in our sessions.
Turns out it's normal for human memory to be faulty, and it's normal for humans to be unable to self monitor performance. In fact, the ability to accurately self monitor is actually an outcome of obtaining mastery. For instance, when Dr. Gary Klein interviewed highly experienced firefighters, he learned that they had better recall of what actually happened than novice fire fighters. The same is true of master chess players. It’s only expert chess players, not novice players, who can recreate a game from memory. This point really hit home for me what I was listening to Tim Ferris talking about his experiments in accelerated learning with his swim coach Terry Laughlin:
Tim: I’ve been practicing [the swimming techniques you taught me] for a while at that point. And, I was like, okay, I feel like my technique’s pretty good. And then, you see it on camera, and you just wanna cringe. And, that was also true when I was in Argentina, in 2004–2005, and ended up competing [in World Championships for Tango],…I thought I was — not hot shit, but I thought I was really on my road to being a fantastic dancer. And then, I remember, I went, and I bought a video camera… I bought this camera, took it to practice, had somebody record me dancing with this woman, and it was horrible. It just looked — what I was doing in my head, and what I was doing on the camera were so different, that they would have been — I mean, you would never have paired my video to what I would’ve described myself doing. And, that is what allowed me, though, that sort of harsh reality is what allowed me to really, really, really improve, after that point. … Terry Laughlin: Yes. Video, very important tool, very helpful tool, for anything movement oriented. There has never been a time that I have been videotaped, that I was satisfied with what I saw, to this day.
Photo by Preillumination SeTh on Unsplash
Because we can’t self monitor you’ve got to get objective feedback (via surveys and video tape), and a coach who can see things you can’t.
Other tips?
There aren’t many other tips I would offer except record everything! You never know when something important will happen, so just record everything and delete it later. For instance, I once had a session where a wife was talking about some really painful things. Her husband leaned his head back listened. After she was done talking I asked how he was doing and he suddenly just laid into her.
It totally took my by surprise.
But I had the tape.
So I watched the tape and he looked totally calm.
A few sessions later, the wife was saying something and I saw the husband lean back and I thought “He’s leaning back again. I’d better check in with him”. Turns out he was livid and his tell was leaning back in his chair and looking calm. I would have totally missed it if I didn’t have the tape. That’s it. That’s the big 3. If you want to become good at this, that's what you got to do. But it's a lot. In fact, I think it's too much to ask anyone to do on their own. Which is why we need certifications. But that's a topic for So you wanna be a better counselor Part 6.
TL;DR
We are bad at self monitoring. What we think we do is NOT what we actually do. Recording sessions is the solution.
Use a gopro and save your sessions to an external encrypted hardrive.
Record all your sessions. You never know what might be useful.
Use surveys to identify deteriorating clients.
Work with a coach who knows how to teach micro skills and use skill criteria.