INTEGRATING

ACTION
SKILLS

By
Mohammed Farhan
MSc Psychology S2
University College,TVM
 Integrating Action Skills

Rather than learning and practicing

single skills as we did in the
.

exploration and insight stages, we

combine the skills (open questions
and probes for action, information,
feedback, process advisement,direct
guidance and disclosure of strategies)
into a series of steps for four action
tasks.
 R Bc Br D
Relaxation Behavioural Behavioural Decision
Change Rehearsal Making
RELAXATION
 RELAXATION

• Relaxation is particularly important for clients who have problems with stress and anxiety. An extensive amount of data shows
that relaxing one's muscles reduces anxiety (Jacobson, 1929; Lang, Melamed, & Hart, 1970; Paul, 1969) and that it is useful to
teach clients to relax when they get anxious (Bernstein & Borkovec, 1973; Goldfried & Trier, 1974).

• When people are relaxed, they are more open and able to handle information, so relaxation is a good thing for helpers to teach
before trying to implement other behavioral interventions.

• Examples of markers for helpers to do relaxation are when clients have a fear of flying, are extremely anxious about taking
tests or speaking in public, have anxiety in social situations, or seem especially tense during the session. In contrast, helpers
should be cautious about offering to do relaxation with clients who are paranoid, fear losing control, or have delusions.
Essentially, the helper is first going to teach relaxation and then help the client figure out how to implement it outside of the
session.
STEPS

STEP 1: IDENTIFY AND DESCRIBE SPECIFIC SITUATIONS OF STRESS AND ANXIETY

Through exploration, clients often identify stress and anxiety as a major problem. Helpers can also observe when clients seem
particularly tense (e.g., they might speak rapidly, act fidgety, or panic). Helpers may then ask whether the client would like to
learn relaxation techniques to calm down in the immediate moment and to be able to calm themselves down outside of sessions in
times of stress. The explanation is that if a person is physiologically relaxed, this state is incompatible with anxiety, and relaxation
is a good coping strategy.

STEP 2: TEACH RELAXATION

Benson's (1975) extensive research has found two main components of effective relaxation: (a) the repetition of any word, sound,
prayer, thought, phrase, or muscular activity and (b) the passive return to repeating when other thoughts intrude. Following
Benson's suggestions (modified somewhat here), helpers can teach clients to relax by going through the following steps, using a
calm voice and speaking slowly:
1. "Get as comfortable as possible in your seat. Remove everything from your lap and put your feet firmly on the floor. Close your
eyes. Imagine sand being poured into your head and filling your body so that your whole body begins to feel heavy."
2. "Relax your body starting from your toes up through your head. Shrug your shoulders and release the tension. Now focus on
your breath. Breathe in... breathe out. As you breathe in,imagine taking in fresh, clean, restoring air. As you breathe out,
imagine getting rid of bad air."
3. "Pick a word (e.g., one, peace), sound (e.g., om), prayer (e.g., the Lord's Prayer), thought, or phrase (e.g., the river runs through
it).
Pick something that fits with your beliefs and feels comfortable to you. Repeat that phrase each time you breathe out."
4. "Let all your other thoughts go. When you find yourself thinking about something else, don't worry, just passively let it go and
return to repeating."
5. "Do this for 3 to 5 minutes and then sit quietly for a minute."

Another method is deep muscle relaxation (Jacobson, 1929), wherein the helper teaches the client to systematically concentrate
on one muscle at a time and tense it for 30 seconds and then relax. The helper goes systematically through the major muscle
groups of the body, perhaps starting at the feet and tensing and then relaxing opposing muscles (e.g., bend feet toward self,
bend feet away from self). Going through the whole body takes 20 to 30 minutes. After practicing relaxation systematically
several times, many people can begin to induce it when needed.
STEP 3: IMAGINE APPLYING RELAXATION IN A SPECIFIC SITUATION
If the relaxation was used because the client was anxious talking about something outside of the session, the helper can now help the
client Imagine the situation while staying relaxed (using a method similar to guided imagery or systematic desensitization). The
helper can ask the client to close her or his eyes and then gently lead her or him through the steps of the situation described in Step 1.

STEP 4: ASSIGN RELAXATION PRACTICE

If it seems useful, helpers can suggest that clients practice deep breathing, relaxation, or mindfulness 5 to 10 minutes, once or twice a
day (e.g., in morning before breakfast and in the late afternoon) in a quiet place with no distraction. A good explanation for practicing
is that the client will then be able to induce relaxation in new situations more quickly.

STEP 5: FOLLOW-UP
In subsequent sessions, helpers can ask about the client's experience practicing the relaxation. If the client was able to easily do the
exercise, the helper could encourage the client to continue practicing. They could also talk about and rehearse trying to implement
relaxation during difficult situations (e.g., flying, examinations).
If the client was not able to or chose not to do the relaxation exer- cises, the helper can nonjudgmentally ask about what was going on.
The helper and client can then work to modify the exercise or might choose to drop the idea of this exercise.
BEHAVIOURAL CHANGE
BEHAVIOURAL CHANGE

• During the exploration and insight stages, many clients identify specific behaviors that need to be changed. They might report
doing too much of some behaviors (e.g., eating too much, drinking too much alcohol or coffee, nail biting, playing too many
computer games), not enough of other behaviors (e.g., exercise, teeth brushing, keeping the apartment clean), and
inappropriate or unconstructive behaviors (e.g.. poor social skills, poor study skills, procrastination).

• The foci in earlier stages were on exploring the context more generally with brief mention of the specific problem, whereas in
the action stage our attention turns to a clearer, fuller description of the problem in and of itself. This model of behavior
change is ideal for problems that are intrapersonal and under the person's control (e.g., procrastination, exercise);
interpersonal problems (e.g., assertiveness) are more appropriate for behavioral rehearsal.
STEPS

STEP 1: CLARIFY THE SPECIFIC PROBLEM

In this step, we need to make sure that we understand the problem and that it is specific enough to work with behaviorally. It
is important to choose a specific, observable problem (e.g., studying more) rather than something nonbehavioral, vague, or
amorphous (e.g., feeling better). In addition, it is best to focus on one problem at a time because dealing with several
problems simultaneously can be confusing and diffuse change efforts. If the client has multiple problems, the helper could
work with the client to list all the problems, order them, and then choose the most important one, making sure that it is one
that using a behavioral approach.

STEP 2: EXPLORE THE IDEA OF ACTION FOR THIS PROBLEM

Rather than assume clients are eager to change, it is important to allow them to explore the idea of changing. Although
clients might be unhappy with the way things are, they are often scared by what things might be like if they change (e.g.,
it is better to live with the misery you know than to risk the unknown).
STEP 3: ASSESS PREVIOUS
CHANGE ATTEMPTS AND
RESOURCES
When the helper has established that
the client wants to change, she or he
can work with the client to assess what
attempts, if any, the client has already STEP 4: CLARIFY OR
STEP 5: GENERATE
made. RECONCEPTUALIZE THE
OPTIONS TOGETHER
Finding out about previous attempts
PROBLEM One of the biggest benefits for clients
can avoid encouraging actions that Now that the client has explored the of working with helpers is that they
have not worked in the past, indicate problem thoroughly, the helper might can come up with options together for
that the helper respects the client's ask the client how she or he now feels working on change.
change efforts, and lets the client about the original problem or goal.
know the helper is aware that the
client has been attempting to solve The client may well change the Through collaboration, two people (or
problems. problem description. example, rather even better, a group) can usually
than wanting to slow down her eating generate more ideas than can one
all the time, Chris decided he wanted person alone. The goal in this step is to
After all, clients have usually had to eat more slowly during Saturday generate as many ideas as possible to
lengthy experiences with their night dinners with her husband. enable clients to see that there are
problems and have undoubtedly tried, many alternatives.
and have many feelings about, various
alternatives. Instead of being the
experts. helpers thus act as
consultants, collaboratively working
with clients to determine what they
have tried and how these strategies
have worked
STEP 6: CHOOSE AN OPTION OR
OPTIONS STEP 7: DETERMINE REINFORCERS
Once a number of options have been generated, In this step, if reinforcers have not come up naturally, helpers work
the aim of the helper with clients to identify realistic reinforcers, things that they can use to
is to help the client think through the options and reward themselves for changing, given that change is more likely to
need to select ideas that are specific, realistic, happen with reinforcers. Importantly, reinforcers are individual, such
within visibility, and consistent with their values. that what works for one person (e.g., the helper) might not work for
another (e.g., the client).
It might be easiest to start by asking the client to
cross off any options that are totally bad (from
the list that the helper wrote).

Alternatively, helpers can ask the client to choose STEP 8: PROBLEM SOLVE ABOUT IMPLEMENTING
the three or four most likely options and then ACTIONS
work with the client to evaluate the good and bad Once the target behavior is identified, baseline information has been
aspects of cach of these options. gathered, realistic goals set, options generated and chosen, and rein-
forcers identified, the helper works with the client to figure out how
Helpers can also ask about clients' values to to implement the changes: how and when the client will try the new
determine whether any of the options violate behavior, what they expect will happen, and how they will cope with
these values. adversities that inevitably arise. Essentially, they work together to do
problem solving.
STEP 9: ASSIGN HOMEWORK
Helpers often assign homework so that the client can implement tasks that they have collaboratively developed in the session. For
example, after discussing study skills, a helper might make a contract with a client to study at least 30 minutes a night at his desk
(where he does nothing. else but study), after which he can reinforce himself by getting a soda and calling his girlfriend.
Helpers might also warn clients to "go slow" to prevent too much enthusiastic initial behavior that often results in not being able
to sustain the change. Many people enthusiastically say they will make an extreme change (e.g., exercise 3 hours a day) but then
get discour- aged when they discover how difficult it is to carry out this change. It is better to take too small a step than to
overestimate what one can do.

STEP 10: CHECK ON PROGRESS AND MODIFY ASSIGNMENTS

Problems almost always arise when clients try to implement actions outside sessions. Changing is often more difficult than
anticipated and unanticipated obstacles. On the basis of experiences clients have had trying out homework in the real world,
helpers can work with clients in subsequent sessions to modify homework assignments.
BEHAVIOURAL REHEARSAL
• Behavioral rehearsal is used to teach clients skills for responding in more adaptive ways to specific life situations (Goldfried
& Davison, 1994). Helpers teach clients new behaviors through role-playing how they could behave differently in specific
situations. Although behavioral rehearsal can be used for many concerns (e.g., rehearsing for a Job interview, practicing for a
public speech), It focus here on problems with assertiveness (i.e., standing up for oneself) because these are so prevalent.

• According to Alberti and Emmons (2001), the goal of assertiveness training is to teach clients to stand up for their rights
without infringing on the rights of others. The assumption here is that open and direct communication is most likely to lead
to good relationships
STEPS

STEP 1: ASSESS THE BEHAVIOR IN A SPECIFIC SITUATION

The helper asks the client to describe a specific example of when the lack of assertiveness occurred (e.g., a client did not tell a
roommate that she did not like her borrowing her clothes without asking, a client got angry and blew up at a colleague for not
doing his share of the work). It is best to ask the client to choose a specific example (e.g., the last time it happened) because
behavioral rehearsal works best with specific situations.

STEP 2: DETERMINE BEHAVIORAL GOALS

Helpers work with clients to determine specific, realistic goals for how they would like to behave differently (c.g.. make one
comment during class discussion, calmly teli son to take out the garbage, ask neighbor to turn down the music) given that
clients are more likely to make changes when they have clear, doable goals. To goals, helpers and clients can generate
different possible behaviors and determine which behaviors would feel comfortable to clients.
STEP 3: GENERATE AND EVALUATE POSSIBILITIES
Similar to the step in behavior change, the goal here is to generate various possible ways of dealing with the situation,
trying to help the client think creatively about options (e.g., what have others tried in the past, what might specific
situation. Once several options have been generated, the helper can work with the client to explore the feasibility and
desirability of the different options, hopefully leading the client to choose the best options.

STEP 4: PROVIDE A MODEL

Once the target behavior is determined, helpers can provide a model of how clients could implement the new behaviors by
playing the part of the client. For example, the helper could ask the client to be the instructor, and then the helper would
show how she would ask an instructor for an extension of a deadline because of a documented illness.
STEP 5: ROLE-PLAY AND PROVIDE FEEDBACK AND COACHING
Helpers then can ask clients to be themselves again, with the helper being the other person, and try the chosen behavior in a
role-play of the problematic situation. During the role-play, the helper again observes the client's behavior carefully and
provides honest positive feedback after the role-play ("You did a really good job of using eye contact and of stating your
needs"). Even if the positive feedback is about something minor, clients need to feel that they are doing something well and
mak- ing some progress. Helpers then can give corrective feedback about one or two specific things (it is important not to
overwhelm the client with too much feedback at one point).

STEPS 6 AND 7: ASSIGN HOMEWORK AND MODIFY ON THE BASIS OF EXPERIENCES

DECISION MAKING
• Clients often have major life decisions to make: which job to take, whether to go to graduate school, whether it is best to buy
a house or rent an apartment, or whether or not to get married to a specific person. In decision making, helpers work with
clients to help them articulate their options, explore their values, and evaluate the options according to their values
(Carkhuff, 1973; Hill, 1975).

• As they do with the other three behavioral tasks, clients reveal during the exploration and insight stages that they need to
make a decision about something (e.g.. choosing between graduate programs, deciding where to go on vacation, deciding
between two people for a dating partner choosing between three nursery schools for a child),

• Sometimes clients easily make the decision by exploring, and sometimes they are to make a decision after simply listing the
pros and cons of each possibility, but other times clients still feel blocked. At this point, the helper can ask if the client would
like to try an exercise to help make the decision.
STEPS

STEP 1: ARTICULATE THE OPTIONS

The helper first asks the client to describe and explore various options. This step often involves work on generating options
(similar to steps in behavior change and behavioral rehearsal). It sometimes takes a fair amount of exploration for all the
options to emerge, and clients some times add or modify options as they go through the steps so helpers may need to go back
and add to this list.

STEP 3: WEIGHT THE

RELATIVE IMPORTANCE OF
STEP 2: VALUES THE VALUES
CLARIFICATION The helper then asks the client to
Next, the helper asks the client to weight the importance of each value,
generate no more than 10 relevant desire, and need (1 not important, 10
values, desires, needs, or things that extremely important).
influence the choice and are relevant
to making the decision. Once again, Each weight is used only once so that
the client may need help in generating the client is forced to figure out
values because these are often not priorities, and it helps to suggest that
things we are aware of. the least important receives a
weighting of 1 and the most important
a weighting of 10, with some numbers
left unused if fewer than 10 values are
listed.
STEP 4 : RATE THE OPTIONS
The goal in this step is to evaluate all the options based on the values using a scale of -3 to +3 the helper asks the
client to rate the various options on each of the values and todiscuss the reasons for the ratings.

STEP 5: EVALUATE THE RESULTS AND REVISE THE WEIGHTINGS

The goal here is to look at the results and see how they fit for the client. A key is to pay attention to the client's reaction upon
learning the results. If the client is happy, the task is done. But if the client seems disappointed, this indicates that something is
wrong in the grid and we want to discover the problem. It might be necessary to modify the options or add more options, to
revise the values, or to change the rat- ings, all based on extensive exploration. It might also be helpful to use behavioral
rehearsal or a two-chair technique to the client think through the various options and obstacles.

STEP 6: FOLLOW-UP
It is for helpers to come back in subsequent sessions and check in with clients about their feelings.
REFERENCE

1. Hill,C.E.(2009).Helping Skills: Facilitating exploration,insight and

action.APA.Washington.D.C
THANK YOU
:)