When Micro is Not Micro

Kathryn G. Morrow Abilene Christian University MFTO 601.W5
Dr. Drew Jamieson March 20th, 2023

When Micro is Not Micro

The word micro comes from the Greek word Mikros, meaning small ("Micro-", 2023), but don’t let the name fool you! In the case of therapeutic micro skills, the meaning of the word is a bit of a contradiction, as the skills involved are anything but small. Properly executed skills such as attending, effective use of open and closed questions, fine tuned client observation skills, encouraging, paraphrasing, summarizing and reflecting all contribute to a healthy and positive therapeutic alliance, consequently having a positive correlation to positive client retention, and finally a positive client outcome, all parts of the therapeutic process. A positive client outcome is the goal of therapy, so these skills are monumentally important (Geldard & Geldard, 2012; Yoo et al., 2016).

A Very Important Collection

As therapists, it’s important to hold a collection of skills. From interpersonal skills such as warmth, genuineness and empathy to the therapeutic micro skills discussed in the next sections, the impact on the therapeutic relationship, not surprisingly, is resounding. In turn, this therapeutic relationship has a positive impact on client retention and a positive impact on client outcome. With regard to client retention and early termination, research shows this to be true regardless of the therapeutic modalities used in sessions, and the process of what is happening in session as opposed to the content of the session, is largely responsible for said retention (Yoo et al., 2016). This supports the importance of the relationship itself. Termination, however, is not necessarily negative. Termination refers to the cessation of a counseling session or sessions, which also happens when we reach the end of the allotted time in a single session or when a positive outcome for the client has been reached and the client no longer needs therapy (Geldard & Geldard, 2012). Early termination, on the other hand, has been shown to happen when there is a lack of therapeutic alliance, which is built using the aforementioned skills as well as those outlined below. Regardless of the way termination happens, therapists should prepare themselves for it at the beginning of therapy, because termination can cause a lot of emotions

(Geldard & Geldard, 2012). Knowing how to prepare oneself as well as how to prepare the client can help mitigate any negative emotions as well as prepare the therapist in the event of early termination; therefore, being familiar with standard operating procedures for single or multiple session termination as well as for early termination is essential.

Attending

One of the most important things a therapist can do is to be present with the client during the session. Being present, or attending, will allow the client to feel comfortable and at ease. The fluidity with which the therapist speaks to the client, known as prosody, as well as having empathy and positive regard for the client, can facilitate the therapist to have a richer understanding of the experiences of each party (Reading et.al., 2019 as cited in Katz et al., 2021). Being present with the client can be challenging. Every therapist will have outside responsibilities, including but not limited to a spouse, children, family and friends, another job etc., all of which could be a barrier to attending. For example, if a therapist has a six year old who has to come home from school due to a fever, the therapist might be preoccupied with the worry about the child. Likewise, if the therapist had a disagreement with her spouse earlier that day, she might not be as emotionally available for the client. To help prevent these types of worries, a therapist could consider various types of self care. For the sick child, perhaps the therapist is proactive and has a childcare helper on-call to assist when the therapist is mid session and she wants to attend to the client as well as to pick up the child from school. Having the help you need can work wonders for self-care (Miller, 2022). With respect to emotional availability, having a policy that states having a 15 minute wiggle room when needed could allow the therapist extra time to practice mindfulness and deep breathing prior to the session to allow her to get into the right headspace to attend to the client.
Open and Closed Questions

Open and closed ended questions, while both extremely valuable, serve two completely different purposes. Open ended questions are questions that allow the client to give a detailed

answer, while closed ended questions often elicit a one word answer, such as “yes” or “no”. Sometimes a detailed response is beneficial and can expand the therapist’s comprehension of the situation, and these types of questions will appear often in a therapy session, but other times a more factual answer is needed. For example, when questioning a client about an issue, a closed ended question might be “it sounds as though this isn't the first time this has happened. Is that accurate?”, to which the client could respond “yes” or “no”, while an open ended question might sound like “how do you feel when this happens?”, which allows the client many options as an answer (ACU Duncum Center Instructional Design, 2021).

Client Observation Skills

Client observation skills, put quite simply, means having a heightened awareness of the client’s behaviors, words, gestures and body language, which help the therapist determine how the client might be feeling and how to direct the session. This micro skill, like all the others, comes easier to some than others, but each of the micro skills is exactly that - a skill - and skills can be learned. The best way to master this skill is by continuing to practice, followed by evaluating results. Without effective client observation skills, the therapist could sacrifice the therapeutic alliance, which in turn could negate a positive outcome (Geldard & Geldard, 2012; Yoo et al., 2016).
Encouraging

When comparing praise to encouragement, praise can be likened to acceptance, while encouragement can be likened to inspiration. Acceptance, while important, leans towards acceptance or judgment of the person (you are good), while inspiration leans towards the actions of the person (you tried hard). According to Kuntze et al. (2009) encouragement can look like brief responses by the therapist to let the client know she is heard and that she is receiving attention. By providing brief responses as the client shares her story, she will be inspired to continue to share. On the other hand, hollow praise like “good job” ends up with little meaning (Newman, 2013). To avoid hollow praise, make sure encouragements are both minimal

to show understanding and specific to avoid generalizations that are likely to become unmeaningful white noise (Newman, 2013).
Reflecting, Paraphrasing and Summarizing

Although similar, reflecting, paraphrasing and summarizing do have some distinctions. When a client shares her situation, it is important to attend to the client and show understanding. When confirming understanding of a small portion of the session, it can be highly beneficial to repeat back the client’s thoughts in your own words. This is known as paraphrasing and can include your reflections on the feelings the client might be feeling. When a client is expressing how she feels about a situation, it might be difficult for her to find the right words, and she might become overwhelmed with her emotions, leaving her unable to express the actual emotion she is feeling. An example of this would be to say, “what I’m hearing is that you’re upset your mother spoke to you with that tone, and I’m sensing you might feel disrespected. Does that sound right?”. Not only does this help the client find the right words, but it also gives the client an opportunity to confirm or deny the feeling you’re sensing and suggesting with a closed-ended question. Summarizing, on the other hand, can include your own paraphrased version of the situation, or your client’s words, but is a more condensed version of the description the client gave. The ability to reflect in these ways is important to make the client feel heard and understood.

Conclusion

As shown above, the elements involved in the process of counseling such as interpersonal skills and therapeutic micro skills have a noticeable and proven impact on positive client outcome (Geldard & Geldard, 2012; Yoo et al., 2016). What’s more, as therapists practice these skills, they can better attune to their clients’ needs and fine tune these skills to enhance not only the clients’ experience, but their own experiences as well.

References

ACU Duncum Center Instructional Design (2021, October 25). Micro skills Video 2 [Video]. Youtube.https://www.youtube.com/watch?v=yhhrW6AAabA&list=PLT5kEvv0fUQL0Ot-5E wVkb23pFkfSJyno&t=15s

Geldard, K., & Geldard, D. (2012). Personal counseling skills: An integrative approach, revised edition. Springfield, IL: Charles C. Thomas. (ISBN 9780398088347) Parts I and II

Katz, E., McPartland, S., & Rines, J. (2021). Exploring micro-skills as the underpinnings of effective social work practice. Journal of Social Work Practice, 35(2), 177–190. https://doi.org/10.1080/02650533.2020.1737514

Kuntze, J., Molen, H. T., & Born, M. P. (2009). Increase in counselling communication skills after basic and advanced microskills training. British Journal of Educational Psychology, 79(1), 175–188. https://doi.org/10.1348/000709908X313758

Miller, A. E. (2022). Self-care as a competency benchmark: Creating a culture of shared responsibility. Training and Education in Professional Psychology, 16(4), 333–340. https://doi.org/10.1037/tep0000386

Newman, S., Ph.D. (2013, July 10). Praising Kids: "Good Job!" Doesn't Cut It Anymore, Part 1. Retrieved March 20, 2023, from https://www.psychologytoday.com/intl/blog/singletons/201307/praising-kids-good-job-doe sn-t-cut-it-anymore-part-1#:~:text=The%20Problem%20with%20Hollow%20Praise,event ually%20platitudes%20not%20even%20heard.

Yoo, H., Bartle-Haring, S., & Gangamma, R. (2016). Predicting premature termination with alliance at sessions 1 and 3: An exploratory study. Journal of Family Therapy, 38(1), 5. https://doi.org/10.1111/1467-6427.12031