Tag Archives: Offenders

Offenders

Bridging the divide between police and the public

By Kylen Farrell December 8, 2016

In a 2012 Counseling Today article titled “Counselors: Support local police by sharing your skills,” counselor educator Diana Hulse and retired police Capt. Peter J. McDermott advocated for counselors and counselor educators to serve their communities by training local police in interpersonal skills. They made the case that interpersonal skills are not inherent, but that they can be learned when taught according to counselor education best practices. They also emphasized the need to integrate interpersonal skills training in police academy curricula nationwide.

This past spring, Fairfield University’s Counselor Education Department and the Center for Applied Ethics sponsored a pilot interpersonal skills training program designed by Hulse for local police. As a current school counseling graduate student, I was invited to participate as an interpersonal skills coach. Through this experience, my eyes were opened to the immense potential for interpersonal skills training to change the culture of law enforcement and improve relations between police and the public.

The pilot program

Four sergeants and three officers from five police departments in the state of Connecticut participated in the pilot training program. After meeting the participants and speaking with them about their jobs, I came to realize that police work involves high-stakes interpersonal demands. I found myself contemplating the complexity of the interpersonal tasks that police personnel routinely carry out, including delivering death notifications and intervening in domestic violence situations.

I was astounded to hear that police personnel typically negotiate these challenges without first undergoing specific training courses for interpersonal skills. In response to this gap in police training, the pilot interpersonal skills training program designed by Hulse, chair of the Fairfield University Counselor Education Department, models the type of instruction that needs to be implemented into police academy curricula. A key objective of the pilot program is to help police-smallpolice personnel develop an awareness that using effective interpersonal skills can create and foster positive relationships within the communities in which they work.

Hulse and McDermott operated as lead instructors with help from 13 volunteers — a mix of faculty, licensed counselors, practicum supervisors, alumni and current students who served as skills coaches. The training was organized around three categories: setting the stage for effective interactions, gathering information and evidence, and summarizing and confirming information and evidence. Skills for these categories were taught and evaluated according to standard interpersonal skills instruction carried out by counselor educators. Verbal and nonverbal attending skills, door openers and minimal encouragers were covered first. Focusing, paraphrasing, reflecting feelings and confronting were reviewed next. Clarifying and summarizing were examined last.

Each training session commenced by introducing skills in a slideshow format. The significance of the skills and their utility in the field for police personnel were then discussed through lecture and rounds. Groups of two to three participants and one to two coaches broke off into separate rooms to practice the skills until the participants demonstrated them successfully. Finally, the coaches delivered verbal and written feedback to the participants. Between sessions, participants completed reflection forms on their learning and their ideas for future improvement.

At the program’s conclusion, participants were asked to complete an evaluation form about the training. In support of the original mission of Hulse and McDermott, participants unanimously agreed that interpersonal skills training would improve the curricula of police academies.

As one participant stated, “This training needs to be introduced ASAP. As the divide between the police and the public grows, we need to start developing the skills that will bridge this unfortunate gap. The skills learned in this class would produce a more well-rounded officer, who is able to interact with the public on a much higher level.”

Personal reflections

Leading up to this training, I was slightly intimidated by the thought of working with a group of police personnel, partially because of the stereotyped image of them being tough, stern individuals with guns strapped to them. My confidence wavered as I questioned whether I was qualified to coach these individuals, some of whom possessed up to 20 years of professional experience in their field. Furthermore, I wondered whether the participants would be open to learning skills that might seem “touchy-feely.”

My uncertainties were resolved quickly as I discovered that the participants were extremely open to learning material that was outside the norm for them. They continually expressed appreciation for the efforts of the instructors and coaches. This increased my confidence and helped me realize that over the course of my own training, I had developed many skills and insights that I could share with participants to improve the effectiveness of their interpersonal interactions.

At the start of each new session, I listened to the participants excitedly share stories about using their new skills on the job. Their execution of the skills demonstrated to me that interpersonal skills can, in fact, be taught, learned and applied to various fields. In addition to mastering specific skills, the participants reported being more aware of the perspectives of others, and more empathetic in general in their daily lives. These stories confirmed for me the positive impact the program had on these participants.

I learned valuable lessons while working with the participating police personnel that will enrich the remainder of my studies and my future career in counseling. In observing how eagerly the participants awaited feedback on their interpersonal skills, I was inspired to adopt greater openness toward the feedback that I receive as I prepare for my practicum and internship.

I also witnessed the effectiveness of learning in relationship with others. The participants shared that it was stimulating to interact with their fellow learners in such a dynamic way. Watching them grow closer as a group each session and gain appreciation for perspectives that were different from their own has encouraged me to focus on relationship building in groups as a future school counselor.

In light of the success of the pilot training program, I urge other counselors and counselor educators to support their local communities by offering interpersonal skills training to police personnel and departments. These programs not only would result in more effective interpersonal skills being practiced in the field of law enforcement, but also would increase the visibility of the counseling profession and enrich the academic experiences of counseling students. These results align directly with the mission of the American Counseling Association “to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession and using the profession and practice of counseling to promote and respect human dignity and diversity.”

My experience confirms the various benefits of providing interpersonal skills training to law enforcement personnel. Embarking on this journey offers counseling students and professionals the chance to work with a unique population, serve their communities, share their knowledge and practice their interpersonal skills and feedback delivery. I am grateful that I was presented with the opportunity to take part in this groundbreaking program during my studies, and I strongly encourage other counselors and counselor educators to sustain the effort to provide interpersonal skills training to police.

 

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To follow the latest news and developments in the initiatives of Diana Hulse and Peter J. McDermott, visit their website, talktrumpstechnology.com.

 

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Kylen Farrell is a graduate student in the school counseling program and a graduate assistant in the Counselor Education Department at Fairfield University. She is a member of the American Counseling Association and the American School Counselor Association, and is co-president of the Gamma Lambda Chi Chapter of Chi Sigma Iota. She recently received the Connecticut School Counselor Association Graduate Student of the Year Award and was inducted into Alpha Sigma Nu, the Jesuit honor society. She will be starting her school internship in the spring. Contact her at Kylen_farrell@sbcglobal.net.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for getting your article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Seeing people, not prisoners

By Kathleen Smith September 28, 2016

Upon being released from prison in the United States, the prospects for ex-offenders are grim. In some states, they might get $20 and a pair of clothes to wear out the door. If they’re lucky, they will receive a bus ticket back to the county where they were arrested. Almost immediately, they must secure or arrange for transportation, food and shelter in a world that might look very different from the one they were living in before their incarceration.

Rebuilding a life that is empowering and free of crime is anything but easy for ex-offenders. If your family lives in public housing, you can’t return home with them. If you have to check the box on employment applications saying that you’ve been charged with a felony, many people may hesitate to hire you. You might struggle to regain custody of your children, or you might be returning to a traumatic environment that is violent and unstable.

According to the National Institute of Justice, almost 80 percent of former offenders will be rearrested within five years of their release. Of these, an average of 30 percent will return to branding-images_prisonprison because of a parole violation. The Bureau of Justice Statistics reports that ex-offenders are also two to four times more likely than the general population to have a mental illness, which puts them at increased risk for substance use issues. The odds certainly aren’t in their favor.

When faced with the task of helping and empowering individuals who are exiting the criminal justice system, counselors confront a looming initial question: “Where do I begin?”

The answer to that question is as diverse as the counseling profession itself because many practitioners commit to tackling different facets of a client’s transition from incarceration to life on the outside. For instance, counselors facilitate career development. They connect ex-offenders with social supports and mentors who show that there is hope for a different life. Counselors provide invaluable trauma treatment to heal old and present wounds, and they train professionals within the penal system to empathize and start real conversations about change with those who are imprisoned or are preparing to transition out.

What these methods have in common is one of the unique qualities of the counseling profession: a person-centered approach that focuses on making space for a new narrative. Together, and from many angles, counselors are helping ex-offenders create new stories for themselves that don’t have to end with a clanging prison door.

Fostering career development

In 2012, a student in Mark Scholl’s career development class inspired him to consider a new kind of work. The student, a probation officer by day, created a career support group for ex-offenders and invited Scholl to co-facilitate. Scholl, a member of the American Counseling Association, used his expertise in career counseling to design skill-building activities for the group, and he found that he loved the work.

When Scholl moved two years later to join the Department of Counseling at Wake Forest University as an associate professor, he wanted to continue this work in the community of Winston-Salem, North Carolina. After consulting with friends, he found that the public library was the safest and most encouraging space to work with ex-offenders. “The library doesn’t have the politics of other settings, which distinguish between social workers and counselors and psychologists. It doesn’t have those turf issues because it’s just about serving people in the community,” he says.

The New Leaf Career Development Group has been running steadily ever since. Over a period of five weeks, Scholl guides a group of four to six ex-offenders through a series of workshops. Topics include job skills assessments, résumé writing, interviewing skills and job search strategies, all of which Scholl approaches with a postmodern slant. Activities also reflect many techniques found in solution-focused and narrative therapies.

“There’s a tendency on the part of the clients who’ve been released from prison to dwell on the past and to focus on their problem,” Scholl says. “Turning that around and focusing on positive alternative narratives is both therapeutic and empowering to the members.”

To engage these narratives, Scholl asks participants in the first session to create a metaphor for how they relate to their futures. He believes this technique provides therapeutic leverage because he and the other participants can encourage the individual group members to construct more adaptive metaphors throughout future sessions.

One group participant, whom Scholl calls “Sandy,” used the metaphor of being a runner in a baseball game. Sandy felt like she had been stranded at third base and frustrated that she couldn’t make it home. Scholl and the other group members helped Sandy open up her metaphor, suggesting that perhaps there was only a rain delay in the game or that she was “rehabbing” after an injury.

“We helped her emphasize her self-advocacy,” Scholl says. “She began to see her ability to choose her own direction and access resources.”

In their final graduation session, participants share their narratives about what they gained from the workshop and how they view the next chapter in their lives. Family members and friends are invited to respond with how hearing their loved ones’ stories has affected them.

Because many members of the group face additional challenges, such as homelessness or substance use, Scholl admits that success for group members is sometimes difficult to define. He and his colleagues at Wake Forest are currently conducting a qualitative study to evaluate the impact of the workshop on participants’ lives.

Individual successes do stand out, however. One member, whom Scholl refers to as “Carl,” completed the workshop series this past summer. Carl was an ex-offender who came to the workshop after looking for employment for an entire year without success. “He had difficulty remaining positive during mock interviews,” Scholl recalls. “We worked with him on emphasizing his strengths and how he could potentially contribute to a prospective work setting. During the last workshop, he announced that he had been hired as a forklift operator in a warehouse position. This, as you can imagine, was a very memorable success for the client and for our team.”

Reflecting on his experience with the career development group, Scholl says the possibility of empowerment motivates him to continue the work. “There’s a feeling of futility when you have to check a box on an application [saying you are an ex-offender]. It feels like a strike against you before the employer even meets you. So,” he says, “I really feel a strong inclination to do what I can to empower these folks.”

Mentoring ex-offenders

Before she began working with ex-offenders, ACA member Bethany Lanier’s inspiration came from television. “I loved Law and Order: SVU. I wanted to do that kind of work and figure out why people do what they do,” she says.

As a master’s student in clinical mental health counseling at Radford University in Virginia, Lanier worked with women who were up for release from prison, teaching them life skills and strategies for navigating their home environments. When she moved to Alabama to begin a doctoral program in counselor education at Auburn University, Lanier’s passion for that work didn’t end.

The numbers are daunting in the Alabama justice system. Facilities are operating at 190 percent of capacity, leaving little to no money (or energy) left to focus on combating recidivism. But rather than choosing to feel overwhelmed, Lanier, as a graduate assistant, began helping to develop a mentoring program for the local women’s prison and writing grants for funding. While doing research, which Lanier has since presented at an ACA Conference, she found evidence of the effectiveness of mentoring programs with the ex-offender population. She cites one program in particular, the Mentoring4Success initiative in Kansas, that effectively cut the state’s recidivism rate in half.

Inspired by other successes, Lanier continued working with her colleagues at Auburn to train mentors in Alabama. The mentors serve a number of functions for women exiting the correctional system, including teaching them how to navigate applications for the Supplemental Nutrition Assistance Program (also known as food stamps) or the Women Infants Children (WIC) program. Because many of the mentors are themselves ex-offenders, they also provide inspiring examples of success and needed social support.

“You have to have somebody that’s going to be supportive, somebody who’s going to answer all your questions and help you get where you need to go,” Lanier says. “It’s good for people to see somebody and say, ‘I don’t have to be like this, because she made it.’”

As a future counselor educator and a member of the International Association of Addictions and Offender Counselors (IAAOC), which is a division of ACA, Lanier has also given careful consideration to how to talk with students who are hesitant about working with ex-offenders. “Students say, ‘Oh, I don’t want to do that because it’s not safe’ or ‘It challenges my beliefs’ because we’re in the Deep South. But once people get out into the field, they realize you’re going to see these issues anywhere you go.”

For instance, Lanier explains, anyone working in a community mental health center or even in schools is likely to encounter the challenges and rewards of working with ex-offenders. For that reason, she believes counselor educators need to prepare students to think about the unique needs of this underserved population.

As for current counselors who would like to explore the power of mentorship in working with ex-offenders, Lanier encourages these helping professionals to consider the unique skills they can bring to the work, including active listening and empathetic understanding. “Don’t be afraid to take a risk,” she emphasizes.

Addressing trauma

In the literature, rates of posttraumatic stress disorder among incarcerated populations range anywhere from 4 percent to 21 percent, with women being disproportionately affected. Regardless, advocating for trauma work as a component in reentry preparation can be a tough sell. While focusing on basic needs such as housing and employment, ex-offenders may not have the money or the time to find effective therapy for trauma. Therefore, counselors have begun working with prisoners while they are still incarcerated to address their trauma and connect them to resources on the outside.

ACA member Tara Jungersen had already spent a significant portion of her career working with trauma and intimate partner violence before coming to Nova Southeastern University in 2009. But after arriving there, her colleague, Lenore Walker, introduced her to the Survivor Therapy Empowerment Program (STEP). A manualized treatment program, STEP uses principles of feminist therapy, survivor therapy and trauma theory to address common issues found in the incarcerated population. Its goal is to empower victims to become survivors.

“If somebody is stuck in a trauma cycle, if they are completely disconnected from experiencing emotion and safety in relationships, then they may lack the protective factors that can help them move forward in life,” Jungersen explains.

As the acronym suggests, the treatment program walks participants through 12 independent “steps” that help in dealing with trauma and its effects. Leaders teach relaxation skills, interpersonal skills and cognitive restructuring, and they also help participants examine their attachment patterns in relationships and grieve past relationships. The program is also focused on connecting women to resources on the outside to reduce recidivism.

“A person may be on a five-day hold, and they’ll be gone the next week. So we want to make sure that each step we teach can stand alone and that [participants] are able to find a qualified trauma therapist when they are released,” says Jungersen, who has led STEP groups herself and trained others to lead the groups. “We know that it’s challenging to find reduced-cost and pro bono services.”

Jungersen also notes that leaving prison can feel different for each person depending on the individual’s experience. For some women, jail provides structure and a departure from the chaos of their daily lives, which often can include drug addiction or physical and sexual abuse. But for others, the experience of incarceration itself is highly traumatic. For instance, a victim of sex trafficking may find herself in the same prison as her trafficker, or offenders may face abuse or neglect by correctional officers. Running a treatment program that promotes safety and stability can prove difficult if individuals are always on high alert and constantly feel exposed to danger, Jungersen says.

Despite the challenges, the STEP program has been employed successfully with both men and women in the United States and internationally. Jungersen acknowledges that when working with ex-offenders, measuring success requires different parameters than those used in traditional counseling settings. Qualitative data collected by Jungersen and her colleagues have indicated that STEP participants, who learn about their trauma symptoms and how these tie in with their substance abuse or other behaviors, are more open to seeking mental health treatment after their release as compared with their attitudes prior to participating in the program.

Regardless of whether counselors are doing trauma work specifically, Jungersen encourages them to consider the ways that trauma can affect ex-offenders and to avoid making generalizations about this population. “You’re going to have a wide distribution of cognitive functioning, a wide distribution of social skills and differences in individual trauma triggers,” she says. “Most ex-offender treatment is done in a group format. You’ve got to scan that entire group, recognize the nonverbals that indicate someone is getting triggered and adjust the conversation accordingly.”

Fostering motivation 

Melanie Iarussi was first introduced to motivational interviewing in her master’s program. She liked the method so much that she decided to become “trained as a trainer” so she could teach others how to elicit meaningful, change-oriented conversations. Now an assistant professor of counselor education at Auburn University, she has found an opportunity to provide training for probation and parole officers in the state of Alabama. By teaching the officers motivational interviewing techniques, Iarussi and others are introducing a different mindset to the people who work in corrections.

Motivational interviewing is an increasingly common technique encouraged by the National Institute of Corrections and other organizations. The technique’s focus on creating collaborative conversations and guiding people toward prosocial change is a drastic departure from many of the punitive, fear-based techniques the criminal justice system has traditionally employed. Because counselors have fairly limited interactions with ex-offenders, Iarussi and others see an opportunity to educate those who have the most access to this population — parole and probation officers.

“We know the prison system as it is does not work, and we know that taking a punitive approach is not effective in facilitating behavior change,” says Iarussi, a member of ACA and IAAOC. “By introducing MI [motivational interviewing], we’re trying to capitalize on what does work, and we’re bringing some counseling concepts to the conversation that can facilitate lasting change among people in the legal system.”

To teach and improve motivational interviewing skills, Iarussi asked her trainees among the probation and parole officers to record their conversations with their clients. In turn, she listened to the conversations and provided feedback. She says the officers who were able to make the shift to use the new skills noticed that they were having completely different conversations with their parolees.

“They were able to help their clients recognize that they do have choices over what they want to do. It’s not that they are trying to force them into something or back them into a corner, but they can present them with options,” she says. “You can have the conversation, but the choice is ultimately theirs.”

Iarussi acknowledges that empathy, a cornerstone of both counseling and motivational interviewing, is a challenging concept to teach. “Probation and parole officers have multiple roles. They’re not counselors,” she says. “Their primary job is to enforce the law. So … they have to make decisions about when it is appropriate to be empathetic and have these conversations, and when it is appropriate to enforce the law. And when it is maybe a combination of those two.”

One probation officer stands out in Iarussi’s mind because they both noticed a remarkable change in his work. In one training, Iarussi presented a video of a probation officer who wasn’t paying attention to the client. The officer was constantly interrupting and not giving the client the time he needed. Her trainee came to her later and said, “I was that person. I was that officer who treated people that way.”

Iarussi describes how the officer soon after began submitting tapes that featured longer, more in-depth conversations, whereas previously he had been meeting with his clients for only one or two minutes at a time. In the new tapes, he and his clients were discussing concerns and issues about parenting and work. The officer noticed the difference he was making. “He definitely felt the shift,” Iarussi says. “By changing his approach, he was making a significant impact in his clients’ lives.”

A unique perspective

Because each person who is incarcerated receives a range of services and interventions and faces a unique set of challenges, it is difficult to know what exactly keeps ex-offenders from returning to jail or prison. As research expands, however, professionals are gaining a clearer sense of what can decrease recidivism. Among the elements that have been identified as effective: assessing for risk, engaging individual motivators, using cognitive-behavioral strategies and providing ongoing support in the community. These are all strategies familiar to those in the counseling profession.

Whether it is using career counseling skills, trauma treatment or motivational techniques, counselors are taking their existing skills and intervening in the lives of people who are exiting the correctional system. They are also serving as advocates for systemic and legislative changes that give ex-offenders a better chance for success.

Above all, Iarussi and others believe counselors are in prime position to help their communities and the criminal justice system begin viewing ex-offenders as individuals rather than a series of daunting statistics. Counselors are trained to take off the lens of judgment and to empathize with experiences that might be far from their own. Both of these skills make the field uniquely suited to work with this population.

“What I experienced is that ex-offenders expect us to treat them like everyone else does,” Lanier says. “Sure, there is an extra layer of rapport building, because maybe they haven’t had anybody listen to them [before]. All they wanted was for me to hear them and understand they weren’t terrible people, but [rather] people who had made some bad decisions. As their counselors, we have to put our preconceived notions behind us and move forward.”

 

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Kathleen Smith is a licensed professional counselor and a doctoral candidate at George Washington University. She also works as a mental health journalist and is the author of The Fangirl Life: A Guide to All the Feels and Learning How to Deal, published earlier this year. Contact her at ak_smith@gwmail.gwu.edu.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

 

Sex offender therapy: A battle on multiple fronts

By Michael Hubbard March 31, 2014

OffenderWorking with individuals with sex offense convictions is a specialized area of counseling. There are also “specialties within the specialty” when factoring in the different venues for treatment, including programs in prison, in private practice (often with those on postprison supervision or probation) and in mental institutions. The individuals within this population are generally quite different, and the dynamics are made even more complex when considering whether the offenders are adult males, adult females (yes, there are female sex offenders) or juveniles. The research on each population varies considerably. There is a paucity of research on female sex offenders, and research is still somewhat lacking (although growing) on the ever-complex juvenile offenders.

Sex offender therapy is challenging regardless of the nature of the clients, and other factors also come into play. There exists the constant issue of resistance to treatment, particularly when treatment is a condition of probation or parole. Criminogenic thinking pervades the scene, and counselors must be on guard for the often subtle signs of that mind-set. For instance, individuals convicted of sex offenses can be highly manipulative, not only with their therapist but also with others in their therapy groups. Power plays, deflection, grooming and lying are a few examples of the criminal thinking that may be evident. Many offenders will also present with a virtual encyclopedia of thinking errors. Often topping the cognitive distortion list are victim stance (“This label is unfair”), minimization (“All I did was grope her”), justification (“We’d had sex before and she didn’t complain”) and entitlement.

In addition to the cognitive distortions and potential for criminogenic behavior, counselors may also have to contend with other factors such as addictions, co-occurring disorders and, of course, shame, guilt and incredibly demeaning self-talk. The ultimate goal of sex offender therapy is relapse prevention, based first upon accountability and assumption of responsibility for offensive behavior. But when all of these factors are thrown into the mix, the counselor is often faced with denial on several levels: denial of facts (“It wasn’t me”); denial of intent (“I was drunk”); denial of impact (“She didn’t seem to mind”); and denial of the need for treatment.

Research supports the best practice of sex offender therapy being conducted in groups whenever possible. The peer support, which includes challenging denial and other thinking errors, is invaluable in treatment and also lends itself to generally better outcomes. Part of the reason for this is that so many sex offenses are based in secrecy. Bringing offenses out into the open is generally conducive to discussion and to the cognitive elements that are so important to reducing recidivism.

Of course, group therapy adds still other elements for the therapist to consider, including properly populating groups (for example, matching risk factors, genders and ages) and building and maintaining effective group dynamics. Sex offenders don’t want to talk about their “stuff” in front of others. Consequently, providing a safe environment and building trust are staples of effective sex offender therapy groups.

While this represents a formidable enough battlefront on its own, sex offender therapists are faced with another perhaps even more challenging front — that of our society, including our lawmakers.

Society’s perception 

In this discipline, we understand that risk mitigation is a primary concern. After all, society demands and deserves protection, and we all share the goal of ensuring that there will be no more victims of sex offenses. In fact, that is a primary directive.

Yet our society is also responsible for erecting many of the barriers that stand in the way of the recovery that sex offender therapists and our clients strive to achieve. Understandably, victim advocacy is far more palatable than the thought of treating a population that most would prefer to exile. However, the sad fact is that punitive barriers such as limited jobs, housing restrictions and sex offender registration raise significant risk factors for recidivism. These barriers often negate the efforts of sex offender therapists and those clients who possess legitimate desires to recover and return as productive members of society. In fact, our society may be contributing to future victimization — just the opposite of our primary goal.

As we all know, hopelessness is like a vampire to therapy. As our restrictive policies and biases feed that hopelessness, treatment and recovery are undermined, and relapse can become more likely. The short of it is that society’s efforts are based on a significant amount of misinformation and myths about sex offenders, and politicians and law enforcement officials often respond to the public’s demand for protection with tougher and more restrictive laws. Those laws and policies, even when couched as seemingly more sensible restrictions on living locations (as though all sex offenders are child molesters), send a clear message of “not on our block, in our neighborhood or in our town.”

In the meantime, the question of “Who is a sex offender?” is often overlooked. When I describe a 19-year-old who had consensual sex with his 16-year-old girlfriend of two years, some people will respond, “Well, he’s not a sex offender in that case.” Yet I have worked with a number of individuals convicted in similar situations who are now registered as sex offenders for life and required to complete treatment. In fact, there were so many such cases in Oregon that the state finally passed what is referred to as the “Romeo and Juliet law.” Under this law and similar laws in some other states, there is generally no charge of engaging in unlawful sex even if the “victim” is underage and the “offender” is an adult, as long as the age difference is no more than three years and the sexual act was consensual. My point here is that there is no set “profile” for all individuals labeled as sex offenders, yet society and the media frequently attempt to paint one.

Common myths

This particular battle is not restricted entirely to public sentiment. In the state institution in which our program operates, the public’s general misconceptions about sex offenders are often shared by some staff members. And I should point out that those in our counseling community are not immune. Some of the common myths about sex offenders are as follows.

Most sex offenders are predators. Reality: The most common sex offender is opportunistic, has one victim and is known to the victim.

Most sex offenders are dirty old men, strangers and pedophiles who will grab children off playgrounds. Reality: First, pedophiles (those sexually attracted to children) are not necessarily child molesters, for most do not commit offenses regardless of their attraction. Most sex offenders and child molesters are relatives or otherwise known to the family; only 2-3 percent of such offenses are committed by strangers. An estimated half of all child molestations are committed by teenagers.   

Once a sex offender, always a sex offender (most sex offenders will reoffend). Reality: Study results vary considerably depending on the nature of the crime, whether the offender was previously incarcerated, whether the offender received treatment, what kind of support exists and the time after release and/or treatment completion. Yet contrary to popular belief, studies and statistics (including those from the Bureau of Justice) indicate that recidivism rates for sex offenders are lower than those for the general criminal population. A five-year study from the New York State Division of Criminal Justice Services noted a rate of recidivism ranging from 6 to 23 percent, depending on the offense (incest had the lowest recidivism rate, while molestation of boy victims had the highest recidivism rate). The Center for Sex Offender Management cites a recidivism rate of 12-24 percent but adds that many such offenses are underreported. 

Treatment for sex offenders does not work. Reality: This statement has been a source of debate for decades. The effectiveness of treatment depends on a number of factors, including the type of offender, the type of treatment and how much management, supervision and support the offender has. Although the risk of recidivism exists even in the best of cases, most offenders can and will lead productive and offense-free lives after treatment.

 Most sex offenders were sexually abused when they were children. Reality: Although sex offenders are more likely to have been sexually abused than nonoffenders, the vast majority of individuals who were sexually abused will not go on to commit sex crimes. A 2001 study by Jan Hindman and James Peters found that 67 percent of sex offenders initially reported sexual abuse in their history. Yet, when subjected to a polygraph, that figure dropped to 29 percent, suggesting that reports of sexual abuse were initially exaggerated to justify or rationalize their offenses.

I recall my former graduate school classmates, and even some of my professors, asking me, “How can you do that kind of work?” Most often the question came from those working with victims of sexual and physical abuse. Others in law enforcement and victim advocacy programs often repeated the question. The implication from some is that a counselor who treats the instigators of sexual abuse cannot also identify with the victims of such abuse. That argument could not be more fallacious.

Other obstacles

In our sex offender treatment program at a state hospital, a primarily forensic mental institution, our first challenge is getting patients with sex offenses into our program. We run an evidence-based program, principally using cognitive behavior therapy (CBT), that serves all risk levels and populations that have regular and diminished cognition with a variety of biopsychosocial diagnoses. Most of the patients in our program are in the hospital under a “guilty except for insanity” adjudication and under the jurisdiction of Oregon’s Psychiatric Security Review Board (PSRB). No matter why they are here, any patient with a history of a sexual offense or who engages in inappropriate sexual activity is referred to our sex offender treatment program.

When referred, a sex offender risk assessment is conducted to evaluate risk and appropriateness for sex offender therapy and to provide recommendations. Participating in sex offender treatment at the hospital is not mandatory, although the PSRB — concerned with risk mitigation — may consider nonparticipation a risk factor when contemplating the patient’s release to a less restrictive facility.

The patients often balk at the thought of living with the “sex offender” designation, fearful they will be subjected to harassment and other abuse. Their fear is warranted; many are labeled with terms such as chi mo (child molester), pedophile or predator and become targets for possible physical assault. Staff members are not immune to falling into the judgment trap, sometimes in the form of what we call the “ick factor.” Even if they try not to show it, the patients can read it. Many sex offender patients carry so much shame and guilt that any suggestion of judgment can keep them from engaging in treatment or create a setback. We use a considerable amount of motivational interviewing to facilitate patients’ decisions to engage in the treatment they sorely need to progress through this institution.

Because our team operates in a state institution, we face some challenges not seen as often in private practice or other counseling venues. Our patients have mental illness, with everything from schizophrenia spectrum disorders to various personality disorders. In addition, more than one-third of the members in the groups we facilitate have diminished cognition. This represents another barrier to effective treatment, especially when considering that CBT and adjunct approaches such as dialectical behavior therapy and acceptance and commitment therapy are the most foundational and evidence-based practices when working with sex offenders. Indeed, the dynamic risk factors between the populations vary considerably.

As stated before, therapists in this field often deal with criminogenic thinking. Although we may expect that with many clients on postprison supervision, it is easy to forget in this hospital, where we are working with those who have been diagnosed with some form of mental illness. But the guilty except for insanity plea and accompanying diagnoses do not preclude criminogenic thinking. We witness manipulation, victimization and other criminal activities all too frequently. Given all these factors, providing sex offender therapy in our program is sometimes like looking through a fractured lens and still trying to divine a clear image of each patient and how to work with that patient for engagement and progress.

How might this apply to you?

Those of us currently in this field, as well as those counselors who may one day work with sex offenders, must realize that our approach to treatment will be negatively affected should we hold on to the same misconceptions and biases that are so prevalent in society. We are already familiar with the more general bias toward mental illness. Consider how much more that can play out in a charged atmosphere of offenses with the prefix sex. If you are a counselor and saying to yourself, “I have no intention of working with sex offenders,” here’s news for you: Most counselors will work with sex offenders, although perhaps without even knowing it.

Consider that a U.S. Department of Justice report from 2005 said studies suggest that sexual assault is one of the most underreported crimes. That same report estimated that 60 percent of rapes go unreported. As a counselor, you may be just as likely to work with a client who has committed a sexual offense, even though the client comes to you for another unrelated reason, as you are to work with a client who eventually discloses that he or she was sexually molested. Given the underreporting of sexual crimes, it is not unthinkable that you may have a client who has offended and is coming to you due in part to the guilt that he or she is experiencing. Or you may have someone well into therapy for a different reason (for example, depression), only to finally have that client confess to sexual offending.

So, how should you prepare? As with any area in counseling, seek out information, research and guidance. There are a number of excellent resources in the field of sex offender therapy, including the Center for Sex Offender Management, the Association for the Treatment of Sexual Abusers (ATSA) and the New England Adolescent Research Institute. All provide forums for research and to improve the work we do, both in treatment and in support for recovery. ATSA has many organizations under its umbrella on a state level that offer workshops on sex offender therapy and related topics. It also hosts an annual conference with a plethora of research and presentations.

For those inclined to explore or promote advocacy, these organizations (as well as others) produce important educational information. Speaking of which, another misconception exists that if a therapist advocates for a recovery-minded approach in treating sex offenders, that person is precluded from advocating for victims. Some people even view us as “offender defenders.” But most of us have treated, and continue to treat, victims of sexual and other abuse. In doing so, we often treat individuals who are both victims and offenders.

Current research indicates that the most evidence-based therapy for sex offenders, with the best outcomes, is CBT. In addition, a person-centered approach has been demonstrated to be most effective. This is understandable given the shame and suspicion felt by many offenders. An interdisciplinary team that communicates well is another key factor for optimal treatment and supervision. When working with clients on postprison supervision in private practice, this team would include the therapist, the parole officer and other professionals such as polygraphers. In our hospital setting, the communication and cooperation between our sex offender treatment program personnel and the unit psychiatrists, psychologists, nurses and other staff such as treatment care plan specialists are essential to crafting and implementing treatment plans, considering and managing outings and other privileges, and working toward the patients’ recovery and eventual transition to other settings such as group homes.

Other programs, such as one begun in Canada called the Circle of Support and Accountability (COSA), have recognized the need to provide ongoing support and guidance as sex offenders leave treatment and attempt to make their way back into society as productive members. Studies involving the original COSA and those established in states such as Minnesota have demonstrated a significant reduction in recidivism — in some cases, in excess of 70 percent. In turn, this has had a positive fiscal impact by reducing prison time due to relapse and reconviction. Most important, that translates to fewer victims.

As stated earlier, group treatment is best practice in the field of sex offender treatment. Of course, many counselors in private practice may not have enough clients to establish a group. When there are enough members, setting up and running sex offender groups presents another level of challenge. First, groups should be set up with homogeneity in risk level, age and gender. In other words, low-risk clients should not be mixed with high-risk clients, genders should not be mixed and juveniles should not be included in groups with adults.

Once established, group dynamics become a focal point. Even though all group members will have committed some form of sex offense, some members will not be above judging others. For instance, a person convicted of raping an adult female may object to being in the same room with someone who molested a child, a relative or a male adult. Although society may not make distinctions between sex offenders, the offenders themselves sometimes have their own hierarchy.

Another challenge, yet to be sorted out by sufficient research, is treatment of offenders who are developmentally delayed. Some therapists have raised valid questions about using CBT with those who have diminished cognition. In addition, there are some risk factor differences between those with regular cognition and those with diminished cognition. Many treatment programs that handle both populations simply modify their regular program for clients who are developmentally delayed. Others have more distinct programs, with the one for developmentally delayed clients focused more on addressing emotional dysregulation and other dynamic risk factors.

Closing thoughts

Sex offender therapy is a controversial topic. No matter your involvement (or lack of involvement) in working with or advocating for the treatment of this population, you may still experience the battlefront I have outlined. The research and dissemination of findings will be limited as long as there is polarization around sex offender issues and as long as those perceived “sides” are not willing to listen to each other.

As counselors, we all know that listening, and especially reflective listening, involves a number of skills, not the least of which is seeing through the issues without allowing our own emotions to get involved. The public needs to receive an education on these issues. In addition, politicians, government agencies and policymakers must be urged to listen rather than simply striving to establish more “tough on offender” laws that sometimes make little sense and may, in fact, ultimately contribute to additional victims.

As counselors, however, we first focus on caring and applying our skills as best we can. We know that we cannot cure, but we can do our best to prevent future victims. In the process, it’s very likely that you will be faced with the task and frequent frustration of educating others who will not care. In fact, many will suggest that you simply throw away the key rather than provide treatment.

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Michael Hubbard is a mental health specialist with the sex offender treatment program at Oregon State Hospital in Salem, Ore. Contact him at Michael.Hubbard@state.or.us.

 

For related reading, see Hubbard’s July 2014 piece on denial: ct.counseling.org/2014/07/no-i-didnt-denial-revisited/

 

Letters to the editor: ct@counseling.org

 

Counselors: Support local police by sharing your skills

Diana Hulse and Peter J. McDermott September 1, 2012

Earlier this year, in an article for the FBI Law Enforcement Bulletin, we proposed that interpersonal skills training is fundamental to effective performance in all aspects of police work. We argued that although police officers receive expert training in tactical and legal skills, and that their mastery of these skills can be documented, it is unclear whether they are routinely taught interpersonal skills or how these skills are evaluated, if at all.

Actually, in preparing our article, we noticed that police officers rarely if ever receive basic interpersonal skills training, even though they are in dire need of developing these skills. Where can police officers find resources to assist them in the pursuit of these skills? One answer lies with counselor education programs and practicing counselors.

Counselor education programs provide curriculum and methods for teaching and evaluating foundational interpersonal skills. Counselor educators, practicing counselors and counseling interns can serve as coaches to teach, demonstrate, supervise and evaluate police recruits in the use of these skills. Counselors can also help veteran police officers to review, practice and upgrade performance in these skills.
There is no requirement for counselors to have specific knowledge of police work to help in this area. Rather, all that is needed is a willingness to share their skills. Police academy instructors are the ones who can then apply these skills to the training needs across the police academy curriculum.

Why police need to strengthen ‘talk’ skills

Police officers work with the public to create safe and crime-free communities. To be successful, they must display strong tactical and legal capabilities and also convey verbal and nonverbal interpersonal skills that communicate respect, diffuse conflicts, reduce violence, instill public partnership and demonstrate a professional demeanor.

The reality is that police engage on a daily basis in two activities: They talk to people and they touch people. The “touch” factor is represented by a concern for officer safety. Police are trained and evaluated in the handling of firearms, motor vehicle stops, self-defense, arrest and control, and responses to crimes in progress. “Talk” skills are essential to the execution of these tasks.
Talk skills are also necessary for police officers to create and maintain environments that encourage a tone of civility in their interactions with the public. It has been documented that the police and public have different expectations and attitudes that can raise tensions when the police and the public interact. These tensions can be further intensified today in an increasingly multicultural society in which a number of challenging issues and factors, including an uncertain economy, can lead to domestic or workplace violence, abuse, stealing, rage and bullying. Faced with these challenges, police officers must demonstrate a competence level with talk skills that is on par with their touch skills. Only by putting talk skills at the forefront of their training can police expect to contribute to their desire for a tone of civility, which is essential for maximizing a level of collaboration with the public that can lead to safe and crime-free communities.

Counselor educators, practicing counselors and counseling interns are an identifiable and critical resource to police in achieving a high level of training in interpersonal skills. Once basic interpersonal skills are in place, counselors can help police focus on other important skill sets, including how to give and receive feedback and how to succeed in leadership tasks.

Enhancing skills for giving and receiving feedback

Once police recruits complete classroom instruction, they enter what is called the officer field training program. This is where, under intensive supervision, police officers translate all learning experiences to date into acceptable performance in motor vehicle stops, criminal investigations, and domestic violence and conflict situations. In field training programs, officers receive mandatory feedback for a period of 10-14 weeks on their encounters with the public. This is analogous to the feedback process that counseling students engage in with site and university supervisors during their clinical training.

Here again, counselors can help supervising officers in field training programs learn effective ways of giving, receiving, clarifying and exchanging feedback, particularly if that feedback is corrective in nature. Many tools and approaches are available in the counseling literature, as well as in clinical supervision curricula, to help make the best use of supervision that leads to growth and competence as counselors. These same resources can be adapted for use in field officer training programs, allowing supervisors to enhance the professional development of police personnel, while helping officers to gain an appreciation of feedback and its link to their personal and professional development.

Enhancing skills for leadership tasks

Upon mastery of interpersonal skills and feedback skills, a natural progression is to focus on group facilitation skills. These skills are needed in a variety of situations common to police work, including debriefing meetings, block watch groups, and team or divisional commander tasks.

Here again, counselors possess the skills to provide training and supervision on a range of basic leadership competencies, including how to build interaction and gather information; how to draw members out, cut off extraneous conversation or shift the conversation to focus on the desired topic in a meeting; and how to use attention to the hereand now to address nonverbal behaviors that might negatively affect the work of the group.
Group work literature offers many models and ideas for counselors to use in helping police officers understand group dynamics and assemble a skill set that supports success in their leadership duties.

Sharing our skills: Who benefits?

With a solid grasp of basic interpersonal skills, police are in a better position to respond with competence and sensitivity to potentially volatile situations in their daily work. Additionally, as police gain mastery of interpersonal skills, feedback skills and skills for facilitating leadership tasks, they can model and transfer these skills to all members of the organization. A new generation of trained police personnel will emerge with proficiency both in human relations skills and tactical skills.

The timing is excellent for this type of collaboration between counselors and police. The medical profession is already addressing the need for physicians to learn how to communicate with patients and work as a team. Like doctors who listen carefully to their patients, police officers must listen to and understand the public to gather pertinent information, supplement their technical knowledge and build more civility and trust between themselves and the public they are sworn to serve.

By pursuing partnerships with police personnel, counselors will be fulfilling a call to share their skills with others in their communities. In addition, counselors will gain visibility for their expertise and contribute to the betterment of their communities.

Together, police officers and counselors will benefit through improved communication and increased understanding of what the other group does. In the end, communities will reap exponential benefits as a result of the collaboration between these two disciplines.

Contact your local police department today

You might believe that police organizations are insulated and difficult to reach as a counselor. We think such connections are possible, however. The key concepts to consider are creativity and opportunity.

Do you know a school resource officer in the local schools who might be willing to exchange ideas about training, or is there a training division within your local police department? You could take a copy of our 2012 FBI Law Enforcement Bulletin article, “Interpersonal Skills Training in Police Academy Curriculum,” and offer your assistance in providing skills training to young recruits or refresher sessions for veteran officers. We have written two other articles (one in print, the other in press) for the FBI Law Enforcement Bulletin that could serve as resources for your outreach efforts, and we are available to talk about our initiatives in the state of Connecticut.
The potential rewards for collaboration across the disciplines of counselor education and law enforcement are many. Such collaboration is a great way for counselors to share their important skills, helping police personnel to use improved interpersonal skills to achieve their mission of better communication with the public and safer, crime-free communities.

 

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 Diana Hulse is professor and chair of the Counselor Education Department at Fairfield University in Fairfield, Conn. Contact her at dhulse@fairfield.edu.

Peter J. McDermott is a retired captain from the West Hartford and Windsor, Conn., police departments and a retired instructor from the Connecticut Police Academy. Contact him at pete06422@yahoo.com.

Letters to the editor: ct@counseling.org

Working through ambivalence with adolescent substance abusers

Matthew Snyder & Lynn Zubernis April 1, 2012

As practicing counselors, we all have clients who are “easier” than others. The easy clients are motivated toward change, take action on established goals and internalize feedback readily. The other side of that coin is that we also have clients who are more difficult. They are not motivated toward change, do not perceive the need for change and are ambivalent toward counseling. We have all encountered the person who has experienced a heart attack but continues to smoke, or the person who keeps abusing alcohol despite DUIs, failed relationships and repeated hangovers. Why do some people change, while others continue to engage in self-destructive behaviors?

In many settings and with many populations, ambivalence is more the rule than the exception. Clients who are mandated for treatment by an administrator or judge, who are “forced” into counseling by concerned parents or loved ones, or who are simply “going through the motions” may exhibit high levels of ambivalence, and this can be a major impediment to positive change. So how, as counselors, do we best help these clients?

If we look at James Prochaska and Carlo DiClemente’s “stages of change” model, many of these ambivalent clients are in the precontemplation stage. In other words, they are not at the point in the change process in which they are able to make insightful conclusions. They do not see their behaviors as problematic, or if they do, they are most likely blaming an external entity or third party for their problems. When we have clients who are at an early stage of the change process, we want to help them begin to feel or think that they are ready, willing and able to make a positive change. To achieve this, clients must recognize that their current behavior is a concern, think that they will be better off if they change and believe they are able to change.

So, how do we get them from this initial defensive stance to a place in which they are internally goal driven and actively seeking solutions? William Miller and Stephen Rollnick (1991) and Thomas Bied, William Miller and J. Scott Tonigan (1993) established that certain critical conditions must be present for change to occur. These conditions include empathy, feedback regarding personal risk associated with current behaviors, emphasis on personal responsibility for change, clear goal options and the facilitation of client self-efficacy. Following this work, Robert Stephens and Roger Roffman (1996) found that brief treatments can be effective for substance use clients and can establish these critical conditions for change.

Building on these areas of critical research, which have been continued and expanded through the past two decades, this article will briefly discuss how to work effectively with ambivalent clients and provide some useful techniques and strategies for doing so. Because most of us work within the constraints of managed care, organizational constraints or merely the financial realities of the current economy, we will focus on brief treatments that empirical studies have demonstrated to be effective. The framework and interventions we present feature eclectic ideas from a variety of theoretical approaches to counseling, including humanistic, cognitive behavior, solution-focused and motivational interviewing paradigms.

Substance abuse is a serious problem among adolescents, who face significant stressors in competition for academic and job success, a lack of support from overstressed parents and school systems, and the challenges posed by formal operational thinking and rampant social comparison (including cyberbullying). It is widely accepted that both risk taking and resistance are developmentally appropriate parts of individuation. Thus, the approach outlined here can be particularly effective in helping teens and young adults to accomplish positive change.

The initial sessions

The first counseling session is always important. Ideally, it establishes rapport and sets the groundwork for client change. With ambivalent or unmotivated clients, the initial session is even more critical.

The goals of such a session are first to express empathy, then to develop discrepancies between what the clients want and the behaviors they are engaging in and, finally, to support the belief that clients can make positive change. Rapport is critical and hinges on the counselor’s expression of real interest in clients’ views. This means not being dismissive or making assumptions based on one’s own beliefs about what is “best” for clients.

We often tell our graduate students that counseling is not like putting together a barbecue grill — there are no printed instructions or one-size-fits-all approaches. Instead, a counselor has to listen, long enough and hard enough to “get it.” But how can counselors really know that we get it? When we do, clients’ behaviors and coping strategies will make sense — not in a general way perhaps, but in the context of their specific circumstances. Their behaviors may be kicking them in the backside, but somewhere, a reinforcement contingency is present that is keeping them dependent on this behavior. Oftentimes, clients also have a realistic fear of giving up the only coping strategy they have been able to find.

One important caveat is to avoid increasing the client’s resistance, which will result in the client tuning you out — and very little actual change. Try to steer clear of taking any kind of argumentative stance. This will help you avoid power struggles, including adolescents’ typically knee-jerk response to anything that sounds as if an adult is telling them what to do. Drawing from what humanistic psychology teaches us, the counselor should listen and reflect rather than judging or telling clients what to do. From a motivational perspective, it is important for all clients — but especially for adolescent clients — to make choices for themselves and to experience that choice as being internally motivated.

During the initial session(s), it is expected that adolescents will be ambivalent regarding change. Start from this premise and try not to expect otherwise. After the counselor accepts this and listens closely enough to understand the context of the client’s behavior, the next step is to develop discrepancies. These usually involve a client’s behaviors not matching his or her verbalized goals or affective expression. No matter how ingrained the coping behavior, even the most defended clients are aware on some level that there are costs to the behaviors they have adopted.

However, it is just as critical for the counselor to remember that clients likewise perceive benefits to their behavior. If the behavior is continuing, something is reinforcing it, and the perception of the client is that the reinforcements are currently outweighing the costs. As we often emphasize to our graduate students, every behavior has a reason — you just need to keep digging to figure out what that reason is. Beginning counselors commonly fear acknowledging the “positives” that clients associate with their addictive behavior, whether it be substance abuse, an eating disorder or self-harm. But the counselor gains credibility and the client feels as though the counselor “gets it” when both costs and benefits are discussed openly.

Having acknowledged the positives, we then want to examine the negative outcomes and make concrete comparisons between the two. We follow this with a systematic exploration of the feelings associated with these behaviors and outcomes. Change does not happen in an intellectual, rational vacuum. If the emotional costs of change are perceived as too high, clients will remain where they are — this makes perfect sense, because no one wants to incur emotional suffering.

The next step is to move forward to the future, examining how these behaviors affect the client’s long-range goals. The reinforcing impact of many coping behaviors such as substance abuse are limited to short-term pain reduction, and clients avoid awareness of long-term negative impact. It is human nature to prioritize stopping immediate pain over some future deferred benefit. Change will occur only if adolescents perceive a discrepancy between where they are and where they actually want to be, while also having the emotional regulation skills and substitute coping strategies to tolerate some discomfort in getting there. In other words, it makes sense to change only when the client (not the counselor) comes to believe that the good things about the problem behavior are outweighed by its adverse consequences.

A good way to get clients to express their ambivalence, as well as their awareness of some of the potential costs of their behavior, is through reflective listening. For example, a client who talks about feeling less anxious and more sociable when using marijuana but is also motivated to do well in school and concerned about the cognitive impact of use is expressing both positive and negative aspects of using. A typical reflective statement that points out one of these discrepancies would be “So, you are saying that you really enjoy the feeling of getting high, but at the same time you are afraid of losing brain cells.” If a client says, “Maybe I should start cutting down on my marijuana use a little bit before I lose my job or get suspended from school,” the counselor could follow with “So you see a connection between your drug use and problems you are having at school and work.” In making such a statement, the counselor is acknowledging and reinforcing the client’s insight, which naturally leads into more directive goal setting.

It may sound counterintuitive, but we want clients to become more distressed about their usage. People are motivated to change something when they’re in distress, so clients need to experience that distress. By first understanding and then challenging their defense mechanisms and pointing out the discrepancies, counselors can use this distress as a motivating factor toward change.

The early sessions should also be designed both to increase client motivation to address issues of concern and to empower clients for change by educating them about cognitive behavior approaches and the triggers to their substance abuse. It is important in these initial sessions for clients to start expressing motivational statements. These statements can be in the cognitive, affective or behavioral realms. For example, a client might say, “I guess maybe this is more serious than I thought” (cognitive recognition of the problem) or “I’m really worried about what’s happening to me” (affective expression). Motivational statements also include implied or stated intention to make changes, such as “I’ve got to do something!” or “I know I can do it if I put my mind to it.”

Later sessions

After the initial session(s), in which counselors have highlighted some discrepancies and clients have been able to verbalize some motivation statements, there are many techniques you can use to help clients progress toward goal setting and positive change.

Often, young adults who are abusing substances have a limited repertoire of alternative coping skills, so they are understandably reluctant to give up the ones they do have. Skill deficits should be explored and remedied, and new behaviors should be taught and practiced. This can be achieved through role-play, scripting or cognitive restructuring.

A functional analysis can also be very helpful at this point in the process. It will help clients explore and understand that there are antecedents and consequences that influence their usage patterns, and that their responses to these environmental contingencies are entirely understandable. Change the antecedents and consequences, and the behavior changes.

An understanding of the way in which their use is influenced by external factors, in combination with an emphasis on the client’s ability to change these, can be motivating and empowering. This approach also avoids pathologizing clients. Self-efficacy is an important component to later sessions. From this point, you can help clients come up with alternative behaviors and cognitions that will in turn alter their ultimate consequences.

Once clients have gained an understanding of how their behaviors are negatively affecting multiple aspects of their lives and have gained motivation toward change, the next step is goal setting.

Warning signals and how to navigate around them

Resistance is common when working with ambivalent clients. It should be expected but not ignored. Resistance might take the form of a client contesting some factual information or something the counselor has said. It might take the form of frequent interruptions to change the subject or be of the “yes, but …” variety. These should serve as red flags for the counselor, indications that you’re pushing too hard or trying to go too fast. Clients didn’t develop this coping strategy overnight, and it’s unrealistic to think they’ll discard it quickly either.

When you sense resistance, drop back and “roll with the resistance.” Repeat clients’ statements in a neutral, nonjudgmental tone, letting them know that you’re hearing them and that you realize what they’re saying is important. Express empathy with their statements, perhaps by reframing them toward the positive. Emphasize what clients are already doing that’s helping them move toward positive change. Shift focus away from obstacles that seem immovable to barriers that these clients have already been able to surpass.

Rather than arguing with clients, it can be helpful to try a paradoxical approach, siding with the problem instead of challenging it. Exaggerating what clients have said can sometimes help them to see the downsides of their coping strategies more clearly. For example, if a client has said that alcohol makes him or her more sociable, you can take that side by expanding the statement: “You can only talk to people and get to know them if you’re drinking, and it’s really helping you get to know people better and form some close relationships.”

Other motivational interviewing techniques are also useful in minimizing resistance. Asking open-ended questions (“What do you think about your alcohol use?” instead of “Do you know what drinking does to you?”), using reflective listening and validating the client’s worldview are all good approaches to use in helping the counselor to “get it” and helping the client to feel “gotten.”

Clients are more likely to attempt change and to persevere after relapse if the counselor has taken the time to get to know them and shared positive affirmations with them. Engaging in the helping process when dependent on a coping strategy that will be challenged takes a tremendous amount of courage. Reflecting that courage back to the client can be the starting point for real change.

“Knowledge Share” articles are adapted from sessions presented at past ACA Annual Conferences.

Matthew Snyder is an assistant professor and graduate coordinator in the Department of Counselor Education at West Chester University. Contact him at msnyder@wcupa.edu.

Lynn Zubernis is an assistant professor in the Department of Counselor Education at West Chester University.

Letters to the editor: ct@counseling.org