Welcome back, Nathan

"I hear you saying you can feel isolated by your parents when your parents treat you different than your siblings. Describe to me how that isolation makes you feel."

Source: Lecture — Counseling Skills Syllabus (08-14), Dr. Liam

Source: Lecture — Counseling Skills Syllabus (08-14), Dr. Liam

"Don't focus on the story, focus on what's being not said... peel go deeper, peel the onion. Once you get those feelings just dig in, dig in, in those feelings."

Source: Role-Play — Divorce Case (08-14), ~11:39

Source: Role-Play — Divorce Case (08-14)

"Three emotions that I heard you say were anger, disrespected, and rejected. Could you prioritize those for me in order of one being the one you felt the most and three, the least?"

Source: Role-Play — Divorce Case (08-14)

"If he's angry, was he threatened? Was he hateful? Was he maddened? Was he violated? Was he furious?... Watch the inflections of his voice, his body language."

Source: Role-Play — Divorce Case (08-14)

"Don't let him off the hook... he's pivoting, right?... You're pivoting away from what's really going on."

Source: Role-Play — Divorce Case (08-14), debrief

"If you were looking at it yourself from thirty thousand feet, right?... What do you think the underlying issue is now that you've been through this whole episode?"

Source: Role-Play — Divorce Case (08-14), debrief

"I'm focusing too much on the story when I'm not listening to the things that are not said... I got stuck."

Source: Role-Play — Divorce Case (08-14), debrief

Source: Lecture — Client-Led Counseling and Counselor Self-Awareness (08-15), Dr. Lim

Source: Lecture — Client-Led Counseling and Counselor Self-Awareness (08-15), Dr. Lim

• Don't solve the client's problem — goal is exploration, not a fix.
• Dig into history — look for earlier instances of the same feeling.
• Find parallels across the client's life.
• Don't let the client run the session — chaotic stories can be avoidance.
• Don't chase the rabbit — stay anchored to the core feeling.
• Be present — notice your own reactions rather than getting pulled in.
• Read the energy — the session starts the moment the client walks in.

Source: Lecture — Counseling Skills Syllabus (08-14), Dr. Liam

A large bank of sentence-starters for reflective listening, so you're not reaching for the same 2-3 phrases every session.

Source: Clinical Skills Workbook (Mee-Gaik Lim, Ph.D., LPC-S, LMFT-S; Brandi Aguirre, MA; Bethany Colegrove, BA) — official WBU program document. Full 30+ stem list in the Skills Worksheets tab.

The program's standard sentence-openers for open-ended, positively-stated questions.

Source: Clinical Skills Workbook, Foundations/Introduction section.

Use this before submitting the Week 7 Counseling Case recording or any Blackboard video presentation.

• Asked open-ended questions (with examples)
• Questions were positively stated (with examples)
• Process identified: themes, patterns, dynamics, family-of-origin patterns
• Client/counselor interaction target: 70% client / 30% counselor. "It is highly suggested that a client should participate in 70% of the work during a session. The counselor should not 'chase' the client." — official confirmation of entries 7 and 12 above.
• Is the session client-focused or other-focused?
• Theory identification — what theoretical questions/interventions were actually implemented?
• Questions that have the client take responsibility for their own behavior/actions
• What is the counselor doing to promote emotional growth and accountability?
• Level of questioning: beginner, intermediate, or advanced
• Suggestions for counselor improvement and growth

Source: Clinical Skills Workbook, Exploration section ("Video Evaluation" + "Tips In Session").

Lens: CBT — problems rooted in childhood but reinforced by present thinking; internal dialogue drives behavior; present-focused (what/how over why); structured sessions with homework.

Presenting concern: Julie (35, unmarried) doesn't trust men, tracing it to her alcoholic, unavailable father. Recognizes the belief is self-defeating but is invested in it — prefers to place responsibility on her father rather than examine her own part.

Long-term goals → objectives → sample therapeutic questions:

1. Recognize thought patterns and evaluate their validity — "Elaborate on ways that can keep you a record of your thoughts." "Tell me about at least one man you have been able to trust who wasn't a romantic partner."
2. Understand how thoughts affect mood/behavior/physical condition — "Paint for me a picture of how you think you would feel and behave if you were able to trust a man."
3. Resolve assumptions through behavioral activation — "Help me to understand how you can come to be trusting of a man."
4. Strengthen coping skills — "Describe for me a situation in which you have successfully used problem-solving techniques."

Lens: Reality Therapy — people are responsible for their choices; motivated by 5 basic needs (survival, love/belonging, power, freedom, fun); present-focused; behavior is chosen as a response to unsatisfying relationships.

Presenting concern: Jack describes a childhood pulled between a controlling father and an over-protective mother; after his parents' divorce at 16 he drifted into permissive relationships and drug use. Fears he's nothing more than the cold, careless image others see, and wants to be vulnerable but can't let himself.

Long-term goals → objectives → sample therapeutic questions:

1. Establish a satisfying relationship with at least one significant person — "Illustrate what a successful relationship would look like to you."
2. Explore alternative behaviors for dealing with frustration — "List healthy behaviors that can be used to help you deal with stress and frustration."
3. Strengthen ability to evaluate and meet his own basic needs — "Clarify how you have satisfied your basic need for power and achievement."
4. Take responsibility for effective choices — "Paint me a picture of what an effective choice would look like when you are faced with a future unsatisfying relationship."

Both cases from the program's official Clinical Skills Workbook — good templates for the shape a real write-up should take: lens → goals → objectives → operationalizing questions.

Read to client: "Over the last 2 weeks, how often have you been bothered by any of the following problems?" Score each: 0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.

1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed — or the opposite, being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way

Functional impairment question (ask after scoring): "If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?" (Not difficult at all / Somewhat difficult / Very difficult / Extremely difficult)

Scoring bands: 0-4 minimal · 5-9 mild · 10-14 moderate · 15-19 moderately severe · 20-27 severe.

Item 9 asks about thoughts of self-harm/death — any response above 0 requires direct follow-up risk assessment regardless of total score.

When to use: Intake, periodic re-check during treatment (every few weeks) to track progress. Sourcing: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, with an educational grant from Pfizer Inc. Pfizer has stated no permission is required to reproduce, translate, display, or distribute the PHQ-9.

Read to client: "Over the last 2 weeks, how often have you been bothered by the following problems?" Same 0-3 scale as PHQ-9.

1. Feeling nervous, anxious, or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it's hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen

Scoring bands: 0-4 minimal · 5-9 mild · 10-14 moderate · 15-21 severe.

When to use: Intake and periodic tracking; also a reasonable general-purpose screen since anxiety symptoms co-occur with many other presentations. Sourcing: Same authorship/permission terms as the PHQ-9 (Spitzer, Williams, Kroenke, Löwe; Pfizer-funded, free to reproduce).

Read to client: "In the past month, how much were you bothered by:" Score each 0 = Not at all, 1 = A little bit, 2 = Moderately, 3 = Quite a bit, 4 = Extremely.

1. Repeated, disturbing, and unwanted memories of the stressful experience?
2. Repeated, disturbing dreams of the stressful experience?
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
4. Feeling very upset when something reminded you of the stressful experience?
5. Having strong physical reactions when something reminded you of the stressful experience (e.g., heart pounding, trouble breathing, sweating)?
6. Avoiding memories, thoughts, or feelings related to the stressful experience?
7. Avoiding external reminders of the stressful experience (people, places, conversations, activities, objects, or situations)?
8. Trouble remembering important parts of the stressful experience?
9. Having strong negative beliefs about yourself, other people, or the world (e.g., "I am bad," "no one can be trusted," "the world is completely dangerous")?
10. Blaming yourself or someone else for the stressful experience or what happened after it?
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?
12. Loss of interest in activities that you used to enjoy?
13. Feeling distant or cut off from other people?
14. Trouble experiencing positive feelings (e.g., unable to feel happiness or have loving feelings for people close to you)?
15. Irritable behavior, angry outbursts, or acting aggressively?
16. Taking too many risks or doing things that could cause you harm?
17. Being "superalert" or watchful or on guard?
18. Feeling jumpy or easily startled?
19. Having difficulty concentrating?
20. Trouble falling or staying asleep?

Cutoff: ~31-33 commonly used as a provisional PTSD diagnosis threshold, but this varies by setting — follow your site's standard, not a fixed number treated as absolute.

When to use: With any client reporting trauma history, especially combat vets and clients with significant street/survival trauma. Best paired with a clinical interview, not scored in isolation. Sourcing: Developed by the National Center for PTSD, U.S. Department of Veterans Affairs — a U.S. government work, public domain, free to use without permission.

Items 1-8 scored 0-4; items 9-10 scored 0/2/4 only.

1. How often do you have a drink containing alcohol? (Never / Monthly or less / 2-4 times a month / 2-3 times a week / 4+ times a week)
2. How many drinks containing alcohol do you have on a typical day when you are drinking? (1-2 / 3-4 / 5-6 / 7-9 / 10 or more)
3. How often do you have six or more drinks on one occasion? (Never / Less than monthly / Monthly / Weekly / Daily or almost daily)
4. How often during the last year have you found that you were not able to stop drinking once you had started?
5. How often during the last year have you failed to do what was normally expected of you because of drinking?
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
9. Have you or someone else been injured as a result of your drinking? (No / Yes, but not in the last year / Yes, during the last year)
10. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down? (Same scale as item 9)

Scoring bands: 0-7 low risk · 8-15 hazardous · 16-19 harmful · 20+ possible dependence.

When to use: Any intake, especially where alcohol use isn't the presenting concern but may be a contributing factor — it's easy to underscreen when substance use isn't the stated reason for the visit. Sourcing: Developed by the World Health Organization (Babor, Higgins-Biddle, Saunders, Monteiro) — freely published by WHO for clinical and public health use.

Non-alcohol substances, typically referring to the past 12 months. Yes/No format.

1. Have you used drugs other than those required for medical reasons?
2. Do you abuse more than one drug at a time?
3. Are you always able to stop using drugs when you want to? (scored in reverse — "No" counts as a problem indicator)
4. Have you had "blackouts" or "flashbacks" as a result of drug use?
5. Do you ever feel bad or guilty about your drug use?
6. Does your spouse (or parents) ever complain about your involvement with drugs?
7. Have you neglected your family because of your use of drugs?
8. Have you engaged in illegal activities in order to obtain drugs?
9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
10. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding)?

Scoring bands: 0 no problem · 1-2 low · 3-5 moderate · 6-8 substantial · 9-10 severe.

When to use: Alongside AUDIT for a fuller substance use picture — don't assume alcohol screening alone covers it. Sourcing: Developed by Harvey A. Skinner, Ph.D. (1982), Addiction Research Foundation of Ontario — widely reproduced in clinical/training settings; some formal commercial uses may require permission from the copyright holder, so confirm your site's policy if this is going into an official chart rather than a training reference.

Vet/street register available — reframes the same content in a grittier, more direct voice ("wiring doing exactly what wiring does," "a bad twenty minutes in a much longer deployment"). Ask to see it in full when prepping a handout.

Real resources: SAMHSA National Helpline (1-800-662-4357, 24/7 free & confidential) · "What Is Substance Abuse Treatment?" — booklet for families (SAMHSA) · SAMHSA KAP Brochures & Serials library

Vet/street register available — same techniques, reframed as "your alarm isn't broken, it's just outdated."

Real resources: NIMH — Anxiety Disorders overview · NIMH Brochures & Fact Sheets library

Real resources: VA National Center for PTSD — PTSD Basics · "What is PTSD?" printable patient handout (VA) · VA — PTSD Treatment Basics

Real resources: VA National Center for PTSD — Moral Injury (clinician reference) · VA MIRECC — Moral Injury information for Veterans

Real resources: "Fact Sheet for Survivors of Loss" (SAMHSA, printable PDF) · Hospice Foundation of America — Trauma and Loss

Real resources: VA AIMS — Anger & Irritability Management Skills guidebook (printable PDF) · VA My HealtheVet — "Don't Let Anger Get in Your Way"

Real resources: "Change Your Habits to Sleep Better" (VA Whole Health, printable PDF) · CBT-i Coach app (VA) · Sleep Hygiene Handout (Therapist Aid)

A Buddhist teaching story: when something painful happens, that's the first arrow — unavoidable. The suffering we add on top (the story we tell ourselves, the catastrophizing, the "this means I'm broken") is the second arrow — optional. We can't always stop the first arrow, but we have some control over the second.

Use: Good for clients who spiral from a real setback into global self-judgment. Helps separate "the thing that happened" from "the meaning I added."

(ACT metaphor.) You're driving a bus. Your thoughts and feelings — fear, doubt, the anxious voice — are passengers who get on and off, sometimes shouting at you from the back. You don't have to kick them off or obey them to keep driving toward where you want to go.

Use: Useful when a client believes they need to eliminate anxious thoughts before they can act. Reframes the goal from "get rid of the thought" to "act with the thought present."

Feelings are weather passing through — intense, real, but not permanent and not a verdict on who you are. The climate (the person's underlying stability) doesn't change because of one storm.

Use: Grounding language during acute anxiety or panic; also useful psychoeducation for clients who fear a bad mood/panic attack means something is fundamentally wrong.

Depression is often described as carrying a backpack full of rocks uphill — every step costs more energy than it should, so of course things that used to be easy now feel exhausting. This isn't laziness; it's carrying extra weight other people don't see.

Use: Combats the "why can't I just do it" self-blame. Also useful for psychoeducation with family members who don't understand the fatigue.

You can't will weeds out of a garden by hating them — you have to tend the soil, water the flowers, and pull weeds patiently over time. Recovery/mood work is gradual tending, not a single act of willpower.

Use: Good for clients who feel discouraged that "nothing's working yet" early in treatment.

An elder tells a child that two wolves fight inside every person — one is fear, anger, and old habits; the other is hope, discipline, and connection. Which one wins? "The one you feed."

Use: Frames recovery as an ongoing daily choice rather than a one-time fix — useful for relapse-prevention conversations. Caution: can land as oversimplified/moralizing with some clients — read the room, and don't use it as a substitute for discussing craving mechanics.

A baby elephant tied to a stake learns it can't break free; as an adult, strong enough to snap the rope easily, it still doesn't try — the old belief still holds. Old coping patterns (including substance use) can persist as "this is just who I am" long after the person actually has more capacity to change than they believe.

Use: Good for challenging identity-level beliefs ("I'm just an addict, this is who I am") without being confrontational.

Common recovery-community phrase: however bad things feel, there can always be a lower point, and there's also always a floor to stand on and start climbing. Not a story so much as a reframing line — useful in relapse conversations to counter shame-driven hopelessness ("I already failed, why try again").

Use: Pairs well with normalizing relapse as part of many people's recovery process rather than a moral failure — check this framing against your site's relapse-prevention model.

Imagine a window with too-high (fight/flight, flooded) above it and too-low (shutdown, numb) below it — and in the middle, the window where a person can think, feel, and respond flexibly. Trauma narrows that window; the work is widening it back out, one tolerable stretch at a time, not forcing someone into it.

Use: Great as spoken psychoeducation before teaching grounding skills — gives the client a shared vocabulary for "I'm outside my window right now."

You can't stop a wave from coming, but you can learn to dive under it, ride it, or swim to shore before it hits — versus standing rigid and getting knocked down. Applied to flashbacks/triggers: the goal isn't to stop them from ever coming, it's building skill in how to move through them.

Use: Pairs with grounding/breathing skills as the "why we're practicing this" framing.

A farmer's horse runs away — neighbors say "bad luck." It returns with wild horses — "good luck." His son breaks a leg taming one — "bad luck." The army passes through conscripting young men and skips the son because of his broken leg — "good luck." The farmer just says "maybe" each time. A story about resisting premature certainty about whether an event is "good" or "bad" before its full effect plays out.

Use: Useful with clients stuck catastrophizing a recent setback, or conversely those pressuring themselves to feel grateful/positive too fast. Also just a good rapport-building story — low-stakes, not diagnosis-specific.

Old grunt phrase — when something is miserable and you can't change it (weather, orders, the situation), you don't fight the misery, you just... embrace the suck and keep moving. It's not toxic positivity — it's the opposite. It doesn't pretend the thing doesn't suck. It just refuses to let the suck be a reason to stop.

Use: Radical acceptance, ACT-style willingness, distress tolerance — without the therapy-speak. Lands well with clients who roll their eyes at "just accept your feelings."

Combat medics and ER docs are famous for cracking jokes over the worst scenes imaginable — not because they don't care, but because if they let the full weight land in the moment, they can't do the job. The joke is a pressure valve, not proof they're heartless. The catch: if the valve never gets released later — if the joke is the only place the weight ever goes — it backs up. That's what we're doing in here: giving the weight somewhere else to go besides just the joke.

Use: Great for clients who use humor constantly and seem allergic to "getting serious" — validates the humor as legitimate while opening a door to more.

There's the quiet of a place that's safe, and the quiet of a place where something's about to happen — and after enough time downrange, a lot of guys can't tell the difference anymore, so their body treats every quiet room like the second kind. That's not broken, that's a nervous system that learned its lesson too well in a place where the lesson mattered. The work now is teaching it there are two kinds again.

Use: Hypervigilance psychoeducation for combat vets — reframes constant alertness as adaptive-but-outdated rather than a personal defect.

On a long ruck march, the weight on your back doesn't lighten because you're exhausted — it stays exactly as heavy whether you're fresh or running on empty. The only thing that changes is whether you keep the pace or fall out. Recovery, grief, whatever you're carrying — it's not going to get lighter because you're tired of carrying it. But you get to decide if you fall out or keep the pace.

Use: Perseverance/motivation framing that respects the difficulty instead of minimizing it — no "just push through," more "the weight's real, keep the pace anyway."

Dark joke that circulates in every unit: you can survive the worst day of your life and still have to fill out a form about it before you're allowed to eat. The bureaucracy doesn't care what you went through, it just wants the box checked. It's absurd and everyone knows it's absurd — and somehow laughing about the absurdity is what gets people through the DMV of trauma (the VA claims process, the paperwork, the waiting rooms) without losing their minds.

Use: Good for venting sessions about the VA system, disability claims, institutional frustration — validates the absurdity instead of just saying "I understand that's frustrating."

A sniper can lie in the same position for eighteen hours waiting for one right moment — not because they enjoy it, but because they understand that acting too early wastes the whole setup. Some situations in life are like that: the discomfort of waiting isn't a sign something's wrong, it's the price of doing it right instead of blowing your position for temporary relief.

Use: Distress tolerance / impulse control — useful for clients about to make an impulsive decision (relapse, blowing up a relationship, quitting a job) out of impatience with discomfort.

Old joke among people who've cycled through jail, shelters, and the street: sometimes the only guaranteed hot meal and a bed is inside, which says less about the person and everything about how thin the safety net is outside. It's dark because it's true, not because anyone thinks it's funny that it's true. Naming the joke out loud without flinching is often the fastest way to earn trust with a client who expects to be judged for having lived it.

Use: Opening line for engaging clients with incarceration/homelessness history — signals you've heard this before and won't recoil, without you having to claim experience you don't have.

On the street, the person who sleeps too deep is the person who gets robbed, or worse. Staying half-alert isn't paranoia out there, it's just Tuesday. The problem is the body doesn't always get the memo when the person finally gets somewhere safe — it keeps running the old program because the old program kept them alive. We're not turning off a broken alarm. We're teaching a working alarm that the building it's in changed.

Use: Same hypervigilance framing as "Two Kinds of Quiet" above, adapted for street rather than combat context — use whichever matches the client's actual history.

Somebody who's survived on the street for years has usually run a whole informal economy in their head — who owes who, what's tradeable, where the next meal comes from, who's safe and who's not, updated in real time with no margin for error. That's not "no skills." That's project management, risk assessment, and negotiation under conditions that would break most people with a college degree. The skill isn't gone when the circumstances change — it just needs a new job to do.

Use: Strengths-based reframe for clients who see their survival history as shameful or as proof they "can't function" — useful heading into job-readiness or self-worth conversations.

A dog that's been kicked by every hand that ever reached for it eventually bites the next hand too — even a hand that means well — because waiting to find out which kind of hand it is has gotten a lot of dogs killed. That's not a character flaw, that's a dog that learned exactly what it was taught. Rebuilding trust with a person who's been failed by every system that was supposed to help them works the same way — the biting (or the walking out, or the no-shows) isn't about you, it's about every hand before you.

Use: Explains ambivalence/testing behavior toward the counselor or toward services generally — useful for clients who miss appointments, push back hard, or seem to be testing whether you'll bail on them.

Gallows-humor line some street-connected folks use on the worst nights — finding the one absurd technicality to laugh about (it's not raining, the cop was at least polite, the shelter had seconds) when the actual situation is genuinely bad. It's not denial — everyone in on the joke knows exactly how bad it is. It's proof the person hasn't lost the part of themselves that can still find something, anything, worth a laugh. That part is worth protecting and building on.

Use: Good example to point back to when working on behavioral activation or hope-building — "you already do this, you already find the one good thing on a bad night, let's use that skill on purpose."

Pull from here when a client — or you, prepping — is stuck on "I don't know how to say what I'm feeling."

absorbed · abusive · accepting · accommodating · accomplished · adaptable · adversarial · aggressive · agreeable · alert · altruistic · analytical · angry · annoyed · antagonistic · anxious · approved of · arrogant · ashamed · authentic · balanced · beautiful · belligerent · bereft · bitter · bored · brave · bullied · calm · chaotic · cheerful · cold · commanding · compassionate · competitive · complaining · conceited · condemned · confident · conflicted · confused · conservative · content · controlled · controlling · cooperative · courageous · cowardly · creative · critical · cruel · curious · defeated · deluded · demanding · dependent · depressed · desperate · destitute · destructive · detached · dignified · disconnected · discouraged · disgusted · dominated · dominating · eccentric · ecstatic · egocentric · egotistical · empathic · empowered · envious · erratic · excited · expressive · extroverted · fair · faithful · fearful · frightened · frustrated · glad · good · grateful · greedy · grieving · guilty · happy · harmonizing · hatred · helpful · helpless · hesitant · hopeless · idealistic · ignorant · impatient · important · impoverished · impulsive · indifferent · individualistic · inert · insecure · insensitive · inspired · in service · interested · intolerant · introspective · invulnerable · irresponsible · irritated · isolated · jealous · joyful · judged · judgmental · lazy · likable · lively · lonely · lost · loved · loving · mad · manipulated · manipulative · mediating · miserable · mistrusting · moody · moral · negative · noble · obsessed · open · panicked · paranoid · passionate · passive · peaceful · perfectionist · pitiful · pleased · poor · possessive · powerful · practical · preoccupied · procrastinating · proud · punished · punishing · purposeful · rage · reactionary · reclusive · rejected · rejoicing · repressed · resentful · resigned · resistant · responsible · ridiculous · righteous · ruthless · sad · sadistic · secretive · selfish · self-accepting · self-condemning · self-defeating · self-destructive · self-hatred · self-obsessed · self-pity · self-sabotaging · sensitive · serene · shamed · shut-down · shy · sorry · stable · stimulated · stricken · strung-out · stubborn · superior · tantrums · timid · tolerant · unconcerned · understanding · unforgiving · unhappy · unresponsive · untrusting · vain · vengeance · vicious · victimized · violent · visionary · well-meaning · wise · withdrawn · worthy