Helping Skills in Practice: A Three-Stage Model
For individuals in the U.S. & U.S. territories
In Helping Skills in Practice: A Three-Stage Model, Dr. Clara E. Hill demonstrates her three-stage model of helping clients. This three-stage approach involves exploration, insight, and action. The exploration stage is based on client-centered theory, and aims to help clients explore their thoughts and feelings. The insight stage, which is based on psychodynamic theory, involves helping clients understand the reasons for their thoughts and feelings. The action stage, based on behavioral theory, centers on helping clients make desired changes in their lives. This model emphasizes a number of themes, including empathy, collaboration with the client throughout therapy, cultural considerations, and a focus on what the individual client needs.
In this DVD, Dr. Hill demonstrates each stage of the model with a woman who has concerns about eating and weight.
The helping skills model is a three-stage model. The first stage, exploration, involves helping the client examine his or her thoughts and feelings. The second stage, insight, helps clients understand the reasons for these thoughts and feelings. The third stage, action, involves the client making changes. The model builds on itself, such that exploration builds the foundation for insight, which sets the stage for action.
There are some overall themes across stages. The first is the importance of the helper being empathic and nonjudgmental—of actively listening to clients without judging them. Relatedly, it is important for the helper to collaborate with the client throughout the whole model—the helper doesn't have the answer but rather works together with the client to help the client figure things out.
In addition, we need to focus on cultural considerations—culture plays a major role in our worldviews and we need to understand what forces help to shape clients. Finally, we need to focus on the individual client and what this particular person needs. We cannot make global statements about what will work for everyone—rather we need to see what works for the individual client.
In the exploration stage, a major goal is to build a relationship with the client. We want to accept the client so that the client can begin to accept him or herself. We do that through having an attitude of truly trying to understand the client, being empathic, compassionate, and nonjudgmental. We believe that clients are self-healing: We need to provide a facilitative environment and that will help them get unblocked and able to recognize and use their feelings.
There are three major goals in the exploration stage:
- attending, observing, and listening to the client
- helping clients explore their thoughts
- helping clients explore their feelings
The goal in the insight stage is to help clients understand their problems at a deeper level. Insight means seeing things in a new way, gaining a new perspective, or making connections. Insight is important because we seem as human beings to need to make sense out of our world and because insight guides behavior—we choose what to do based on our understanding of the issues.
Many clients naturally move to this stage from exploration; others need a little gentle support from the helper. Helpers facilitate clients in gaining insight because insights that clients come to are generally better and more long-lasting than interpretations that someone lays on them. To help clients attain insight, helpers use probes for insight, challenges, interpretations, and disclosures of insight, and immediacy statements.
Once clients have some understanding of their problems, they often turn to thinking about what they would like to do differently in their lives. However, even though clients might be ready and motivated to seek action, they often lack the specific skills to take action. Behavioral theory provides guidance about how to help clients learn these skills.
Rather than telling clients what to do though, the action stage focuses on helping clients decide if they want to make changes in their lives. If, after considering the pros and cons about changing, clients decide that indeed they want to change, helpers work with clients to decide what changes to make, how to go about making those changes, and how to modify action plans when the inevitable obstacles come up. It is important here that helpers not be invested in trying to make clients change, but instead work with clients to figure out what they want to do.
To help clients with action, helpers use probes for action, information, process advisement, direct guidance, and disclosures of strategies. But more importantly in this stage, helpers put these skills together in working on one of four types of action: relaxation, behavior change, behavioral rehearsal, and decision making. Which one of these the client and therapist choose to focus on depends on the client and what he or she is motivated to work on at the time.
Clara E. Hill received her PhD in counseling psychology from Southern Illinois University in 1974, and has been in the Department of Psychology at the University of Maryland since then. Her current areas of interest are the identification and training of counseling skills, process and outcome studies of psychotherapy, working with dreams, and qualitative research. She is a licensed psychologist in the state of Maryland.
She was the editor of the Journal of Counseling Psychology (1993–1999), is currently the North American editor of Psychotherapy Research, and is a past president of both the North American and International Society for Psychotherapy Research.
She has written seven books: Therapist Techniques and client outcomes; Eight cases of brief psychotherapy (1989), Working with dreams in psychotherapy (1996), and Helping Skills: Facilitating exploration, insight, and action (American Psychological Association [APA], 1999), Helping Skills: The empirical foundation (APA, 2001), Dreamwork in therapy: Facilitating exploration, insight and action (APA, 2003), Helping Skills: Facilitating, exploration, insight, and action, 2nd Edition (APA, 2004), and Insight in Psychotherapy (with L. G. Castonguay, APA, 2006), and over 200 journal articles and book chapters.
She was awarded the Leona Tyler Award from Division 17 (Society of Counseling Psychology) of APA in 2001, the Distinguished Psychologist Award from Division 29 (Psychotherapy) of APA in 2003, and The Lifetime Achievement Award from the Section on Counseling and Psychotherapy Process and Outcome Research of Division 17 of APA in 2005.
- Hill, C. E. (1989). Therapist techniques and client outcomes: Eight cases of brief psychotherapy. Thousand Oaks, CA: Sage.
- Hill, C. E., Sim, W., Spangler, P., Stahl, J., Sullivan, C., & Teyber, E. (2008). Therapist immediacy in brief psychotherapy therapy: Case study II. Psychotherapy: Theory, Research, Practice, Training, 45, 298–315.
- Kasper, L., Hill, C. E., & Kivlighan, D. (2008). Therapist immediacy in brief psychotherapy therapy: Case study I. Psychotherapy: Theory, Research, Practice, Training, 45, 281–287.
- Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford.
- Teyber, E. (2006). Interpersonal process in psychotherapy: An integrative approach (5th ed.). Belmont, CA: Thomson: Brooks/Cole.
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