Tag Archives: resistant clients

The beauty of client and supervisee resistance

By Michelle Backlund and Veronica Johnson August 8, 2018

In the counseling profession, resistance is essentially considered a four-letter word. Actually, many counselors probably feel more comfortable using a four-letter word than they do talking about a client’s or supervisee’s resistance. There are good reasons for this aversion.

Traditionally, resistance shown by clients or during supervision was considered a type of pathology. It was akin to victim blaming. As a profession, we have come to understand that resistance to change or to feedback is often a normal reaction to anxiety, stress, evaluation, trauma or even the learning process. Counselors have substituted many names, including ambivalence and self-protection, in place of resistance to avoid pathologizing normal behavior. As counselors and supervisors, we must choose our words wisely, understanding that every word has unspoken meaning.

History is full of negative references to resistance. Most of these denote the effect of some form of rejection — an idea is discarded, a form of government is found offensive, love has bloomed unrequited in someone’s heart, advice is unwanted, and on and on. However, resistance also has a beautiful aspect: the formation of diamonds as they respond to the pressure of the earth, muscles gaining tone and strength under the resistance of weight, the violinist’s fingers sturdily pressing the strings of her instrument as she then presses her bow to produce the sound.

Taking it a step further, here is an object lesson: I (Michelle Backlund) was visiting with a colleague who previously taught ballroom dance for 30 years, and he recognized how physical resistance could create connection, spontaneity and fun within a dance partnership. I was sharing with this colleague the many negative effects of resistance on relationships.

He asked me, “Did you know that resistance is really a great tool to make relationships strong?”

I said, “How?”

He said, “Put your hand up, with your palm facing me.”

I did, and he placed his hand against mine, then gently pressed. I automatically pressed back. He showed me how the pressure in the form of resistance connected our hands and held us together. The resistance allowed him to move his hand from place to place; it allowed me to feel that movement and follow him. Then he said, “With no resistance, there is no connection — you cannot move together.”

This simple object lesson created a paradigm shift for me as a counselor and as a supervisor. I began wondering how to harness client and supervisee resistance to create stronger, more collaborative, nonpathologizing relationships. This is the beauty of resistance.

Most humans use resistance to assure their physical and emotional safety. The reality is that the world can be truly threatening, and resistance is a means of reducing that threat. Whether we are discussing resistance as it relates to a client who has taken the risk to attend counseling or a supervisee who understands that supervisors serve as gatekeepers to the counseling profession, their anxiety and protection of identity should be regarded as normal reactions to a perceived threat.

An obvious question then arises: How do we recognize resistance that is showing up in our counseling or supervision sessions? You might laugh at this question, feeling that you know all too well how to recognize resistance. Resistance can be difficult to identify, however, especially for new counselors and new supervisors. Responding to the many threatening experiences that humans face from childhood through adulthood, people may unknowingly develop very artful and socially acceptable methods of manifesting their resistance. Of course, some methods are less artful.

Recognizing forms of resistance

Some forms of resistance are easier to detect than others. My interest in this subject came from my experiences as a counselor and as a supervisor. I noticed that sometimes I would come out of a session feeling what I called “yucky,” but I didn’t really know why. Things seemed fine, but for some obscure reason, I did not feel good about the session.

Then I came across some old literature about how resistance manifests in supervision, written by Cheryl Glickauf-Hughes, that changed my world. First, I started saying things like, “I do that to my supervisor,” and “I feel like that.” Then, when I was counseling or supervising others, I suddenly heard what I had not been able to hear previously: resistance. In my new exuberance, however, I quickly picked up on an attitude from other professionals of “We don’t use that word.”

The conclusion I finally reached after an extensive literature review on the different linguistic substitutes for the word resistance is that no word stands alone without using resistance to help define it. To me, this says that turning away from use of the word resistance is not really feasible. However, it is feasible to harness the constructive power of resistance by using it to create relationship. But to use this tool, we need to be able to identify resistance in its various forms.

Game playing

Game playing may be used as a form of resistance either consciously or unconsciously. Either way, it is deployed as an attempt to maintain control. I think of it as a type of shell game in which attention is drawn elsewhere to get the player (i.e., the counselor or supervisor) to lose his or her place. Esteemed social worker Alfred Kadushin wrote about game playing; what follows in this section is a synthesis of some of his ideas combined with some of my own.

One game-playing technique is flattery, which is used to deflect counselors or supervisors either from confrontation or their evaluative agenda. Flatterers are the clients or supervisees who can talk for 20 minutes about the counselor’s or supervisor’s outfit, the office décor or even the “game” the other night, secretly hoping that the counselor will run out of time to address some important aspect of the prior session or the supervisor will run out of time to look at their session recording.

Other types of game playing may include:

  • Redefining the relationship, in which the client or supervisee creates ambiguity.
  • Self-disclosure, in which the client or supervisee talks about himself or herself through telling stories. Clients might do this by skipping from one story to another, giving no time for reflection or comment. Supervisees might use storytelling about self or clients, engaging the supervisor so there is no time for skill correction.
  • Trying to reduce the counselor’s or supervisor’s power, in which clients or supervisees attempt to show that they are more intelligent than the counselor or supervisor.
  • Working to control the situation with the direct use of questions that can steer conversation away from the client’s or supervisee’s areas of anxiety.
  • Focusing on failure and seeking reassurance.
  • Allowing helplessness to feed into dependency by working to implement every single word that the counselor or supervisor shares in session.
  • Practicing self-protection by externalizing blame for their lack of growth on the counselor or supervisor.

It is important to remember that playing games is designed to create safety and protect the self.

One simple way to work with game playing is role induction. Clients and supervisees have constructed coping strategies (resistance) that have served them well. Typically, these strategies have evolved in an organic way and are outside of the client’s or supervisee’s awareness. We can help these individuals understand that counseling or supervision can be stressful and that clients or supervisees may develop certain behaviors as a way of dealing with their anxiety or stress. In normalizing this process, it becomes less threatening.

You could provide your clients or supervisees with a list of behaviors, thoughts and feelings that they might experience during your work together, then invite them to freely point out these behaviors, thoughts and feelings to you as they notice them. This broaching process becomes a step toward creating a collaborative relationship. As they point out their own resistance, you can be appropriately curious about it and then thank them for bringing it to your attention. Often, clients and supervisees will not call attention to their own resistance. However, as they grow more aware of it, they may choose to lay these behaviors down in an effort to use their time more wisely.

Developmental causes of resistance

Another way to look at resistance is through a developmental lens. It has been proposed that manifestations of resistance can have roots in the unsuccessful completion of Erik Erikson’s developmental stages. What would we listen for if we used this framework in our counseling or supervision sessions?

Trust versus mistrust: When clients or supervisees have not fully learned to trust others, the anxiety produced in an ambiguous setting such as counseling or supervision may create enormous tension. In many instances, those who have not successfully navigated this stage have experienced parents, guardians or other authority figures as harsh, critical or unaccepting of them. Often, they expect to be rejected by their counselor or supervisor.

This lack of trust can be recognized by clients’ or supervisees’ maintenance of distance in the relationship; they may seem closed, guarded, defensive and extremely self-sufficient. Identifying these traits is essential to using this information to strengthen the relationship and create collaboration. Glickauf-Hughes suggests that when working with those who are distrustful, taking a person-centered, nondirective approach can help them to feel safe and may provide a corrective experience. Consider letting them know that you can tell they are a bit guarded; ask them whether they have been hurt in the past and whether they are concerned that you might also hurt them.

Autonomy versus shame and doubt: Clients or supervisees who struggle with issues surrounding the need for autonomy can be confusing for counselors and supervisors. Erikson warned that controlling others helps those without a sense of autonomy to feel in control of their own lives.

Often, those who struggle with autonomy cannot quite put a name to what they want, but they can clearly identify what they do not want. They often vacillate between seeking direction and then dismissing the very information they sought. An exchange with someone who struggles with autonomy might sound something like this:

Counselor: “Mary, I hear you saying that this situation is irritating you.”

Mary: “I’m not irritated, I’m frustrated.” 

To protect their personal freedom, these individuals may mince words or say things like “yes, but …” — anything not to accept influence from others.

Glickauf-Hughes and Linda Campbell suggested three ideas for working with those who struggle with autonomy: Socratic questioning, homework, and healing stories or puzzles. These strategies put power directly into the hands of clients or supervisees, allowing them to arrive at the answers they seek without things being laid out for them explicitly. Interestingly, this is helpful even when resistance is not present. Most people enjoy finding their own answers; it increases their self-efficacy and helps them to feel autonomous. This is exactly why it works so well for those with issues of autonomy.

Those who have not successfully navigated the aspect of shame versus doubt are particularly sensitive to any confrontation or feedback, even when it is done with extreme care and sensitivity. Issues of shame originate within relationships and indicate to the individuals being shamed that, somehow, they themselves are unworthy or defective. Unfortunately, shame can be so internalized that it becomes self-activated and no longer attached to an interpersonal event. This may present as clients or supervisees being so hard on themselves that it preempts any possible feedback from others.

This ultra-vulnerable type of person is, in some ways, reminiscent of a sensitive child. This makes sand tray therapy or sand tray supervision an excellent tool for working with clients or supervisees who have internalized shame. For those who believe intrinsically that they are somehow unworthy or defective, the sand tray is a wonderful avenue for them to look at issues and dynamics in a nonthreatening way. The figures become a buffer between these individuals and the counselor or supervisor, protecting the ego from further damage. This is less threatening for supervisees because they can work out the dynamics they are witnessing with their clients. Sand tray therapy or sand tray supervision can also create self-awareness. When incorporated with Carl Rogers’ core conditions, this can cause confidence to grow and doubts to recede among clients and supervisees.

The use of positive reframes can also be used to reduce anxiety and increase receptivity to change. Mark A. Masters suggests that positive reframes should be designed to emphasize the client’s or supervisee’s experience of personal power and self-esteem. The use of positive reframes is most useful when three different components are present.

First, the reframe empowers clients and supervisees by improving their self-reliance and motivation. Second, most behaviors can be asserted in a positive connotation. This can increase clients’ and supervisees’ sense of safety within the counseling or supervisory relationship, thereby promoting reflectivity and growth. Finally, the positive reframe is most useful when it models more effective ways of dealing with the person’s thoughts, feelings and behaviors. When all three of these components are applied together, they can create a powerful alliance that furthers clinical development. Glickauf-Hughes emphasizes that when reframing, the counselor’s or supervisor’s word choice needs to be mild and should evoke curiosity in the client or supervisee.

Identity versus role confusion: What about the client or supervisee whose fundamental issues with others involves the developmental stage of identity versus role confusion? This fragile sense of self can come into play as clients and supervisees strive to find their confidence or shift their already-fragile identity. In this case, learning from the counselor or supervisor would mean merging with him or her, so clients and supervisees in this developmental stage steadfastly hold to their current identity. Signs of this resistance can come through expressions of contempt (such as eye rolling and other demeaning behaviors and statements), often appearing argumentative or expressing directly or indirectly that all other modes of being (for the client) or all other theories (for the supervisee), other than their own, are without value.

Metaphors can provide a means to use what a person already knows and relate it to even more complicated information in a way that transfers the learner’s original understanding to the new situation. The use of metaphors, or the process of transferring information from the known to the unknown, can enhance the learning process and create an atmosphere in which resistance improves emotional connection. For those who feel their identity threatened, the use of metaphors, jokes or Socratic questioning can help them find their own answers. This maintains their identity and prevents them from rejecting the information.

Externalizing issues can also reduce stress in the client or supervisee, again allowing both learning and a better relationship. For example, let’s say your client with a talent for writing music has a goal to develop relationship skills to create a more satisfying social life. Relating the client’s goal to something with which the client is familiar may transfer his or her understanding of one skill to another. In this case, you might first create a theme for the type of song or type of social life the client wants. Let’s imagine it will be a ballad because the client is looking for an intimate relationship. Next, a basic melody is plotted out (what type of person is the client looking for?). Then the lyrics are sketched in (does the client believe this type of person already exists in the client’s current social circle?). Add some harmonies (how can the client enlarge his or her social group?). Once the basic song is set, the addition of instrumentation, percussion and orchestration develops the song into a masterpiece, with all of the different pieces adding to the complexity and beauty of the finished product (how might the client expand the types of activities that he or she enjoys — sports, theater, reading, dancing, outdoor recreation and so on?).

Metaphors, in the form of stories or drawing activities, allow clients and supervisees to depict themes, issues and relationships in their lives or their clients’ lives. At the same time, the use of metaphors leaves the identity or newly emerging identity of the client or supervisee intact.

Motivational interviewing

Motivational interviewing can broaden our view of resistance in a way that can be applied to the supervisory relationship. William R. Miller and Stephen Rollnick, the primary developers of motivational interviewing, explore using resistance to increase connection. Rolling with resistance — which simply means being curious about it — can strengthen relationships and depathologize resistance as normal. Supervisors can easily detect resistance in supervision and can choose to employ some basic motivational interviewing responses to join with the supervisee and open the door to exploration.

Developing the discrepancy: Imagine a supervisee who presents as needing assistance and guidance in working with a difficult client, but when provided with that guidance, responds with, “I don’t think that will work because I already tried ________” or “I don’t think the client will respond well to that because of ________.” 

Developing the discrepancy involves acknowledging what the supervisee wants and then also acknowledging the difficulty the supervisee has in accepting this help or guidance when it is offered. The supervisor’s response might be along these lines: “This sounds like a really challenging client. I hear that you really want help moving forward with the client, and I notice that it’s hard to hear some of the suggestions that I have.”

The specific use of and instead of but in this example is important. And creates the possibility that the supervisee can exist in both worlds — one of wanting help and another of rejecting it. Embracing the ambivalence that a supervisee might feel in supervision can open the possibility for the supervisee to explore what it feels like to be needing connection and resisting it at the same time. And it’s also possible that the supervisee’s client feels the same way — an example of parallel process.

Agreeing with a twist: Being a supervisee is hard work. The courage it takes to present clinical work that is mediocre and the vulnerability required to sit with a supervisor and watch the “magic” unfold can be unnerving. “Agreeing with a twist” refers to reflecting on the risk that a supervisee takes when sharing difficult sessions with a supervisor (especially when the supervisee is not yet in a place to be vulnerable and courageous) and then providing a reframe that opens discussion.

Imagine a supervisee who seems to select sessions or cases to discuss in supervision that aren’t of substance or that don’t allow many opportunities for constructive feedback. This behavior could indicate that the supervisee is protecting his or her already-fragile ego from potentially critical or damaging feedback. Addressing this in supervision is tricky. Agreeing with a twist might sound something like, “It can be so hard to watch sessions that you don’t think are great. I remember what that felt like when I was in training. What are some of your concerns about showing me your not-so-great sessions?”

This example is a three-part equation:

1) Acknowledging and validating the supervisee’s experience.

2) Offering a simple self-disclosure that deepens the reflection.

3) Asking an open-ended question that gets at the heart of what is happening, apart from the actual case the supervisee has brought to discuss.

This method of “caring confrontation” serves to invite the supervisee to share his or her fears of negative evaluation. It also allows the supervisor to assuage those fears and build the kind of relationship in which a supervisee can share “not so great” work without sacrificing a piece of his or her ego.

Using OARS as a basic model for resistance-free supervision: At its core, motivational interviewing is person-centered. Simple strategies for supporting, inviting and engaging supervisees early in the supervisory relationship are often overlooked. OARS is an acronym that can serve as a reminder to supervisors (and counselors) that the basic skills of open-ended questions, affirmation (support, appreciation and understanding), reflective listening and summarizing are absolutely essential and can foster connection, openness and curiosity in both supervisees and supervisors (and clients and counselors).

 

Conclusion

The usefulness of any tool involves its accessibility and effectiveness. The beautiful aspect of resistance as a tool is that it is consistently present in some form. It is always available to strengthen the counseling or supervisory relationship. Try using the tools we have suggested in this article and working to identify strategies that can reframe resistance in positive, collaborative and nonpathologizing ways. Resistance provides opportunities to connect, engage, be curious and, ultimately, foster the kind of counseling and supervisory relationships that create growth and change.

 

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Special thanks to Ray Backlund, coordinator of the New Mexico State University dance program, who holds a doctorate in counselor education and supervision, for sharing his connection between ballroom dance and positive uses of resistance with supervisees.

 

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Michelle Backlund is an assistant professor and clinical director of the master’s program in the Counseling and Educational Psychology Department at New Mexico State University. Identifying positive uses of resistance to enhance all types of relationships is a major part of her research agenda. Contact her at micback@nmsu.edu.

Veronica Johnson is an associate professor and chair of the Department of Counselor Education at the University of Montana. Her research interests are intimate relationship development and maintenance, forgiveness in intimate relationships and clinical supervision. Contact her at veronica.johnson@mso.umt.edu.

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 having an 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.

When help isn’t helpful: Overfunctioning for clients

By Kathleen Smith March 19, 2018

“Erin” came to counseling with all the signs of depression. She was unhappy with her career, her health and her family. Her mother was distressed, her father was distant and her disabled brother was sick.

Erin spent a lot of energy calming and directing her family, and she complained about how little her family supported her in return. She increasingly relied on sugar to calm herself down, and she struggled to end this dependence.

Erin’s anxiety was high, and as a newbie counselor, I struggled to operate outside of it. She cried through many of our meetings, and she grew increasingly critical of our work together.

She said she wanted to stop focusing on her family dynamics, so I switched topics.

She wanted to focus more on her eating habits, so I focused on that.

Then she said I wasn’t giving her enough tools, so I gave her more tools.

I dreaded meeting with her every week, knowing that she’d find some reason to be unhappy with me. I’ll admit that I was relieved when she decided to switch to a different counselor.

It would be very easy for me to look back on my work with Erin and label her as a difficult or resistant client — someone who simply wasn’t ready to change. But now I know better.

You see, I’m a student of Bowen family systems theory. One of the big ideas in Bowen theory is that relationships are reciprocal. Each person plays a part, and these parts are complementary. When you look at the individual and not the relationship, then you miss seeing this reciprocity. The therapeutic relationship is no exception.

Murray Bowen wrote, “When the therapist allows himself to become a ‘healer’ or ‘repairman,’ the family goes into dysfunction to wait for the therapist to accomplish his work.”

Erin was looking for someone to take responsibility for her problems, and I quickly dove in and volunteered as a way to calm down the room and avoid her anger. Looking back, I think about how our relationship might have been different if I hadn’t begun to overfunction for Erin and had refrained from “teaching” her how to fix her depression. I decided that Erin wasn’t willing to change, and I never stopped to think about how my actions were supporting her ambivalence and helplessness.

Have you ever heard an interview with a successful person who grew up in an intense family situation? These individuals always have at least one variable in common. Someone took an interest in them. Often, it was a teacher, a coach, a grandparent or a clergyperson. Someone was curious about their capabilities, and they thrived from this interest.

I truly believe that the opposite of anxiety is curiosity. If I can stay curious about counseling clients who are challenging, they will often do better. When I jump in and try to fix, I am communicating to those clients that they aren’t capable of solving a problem — that their thinking isn’t useful and that they should borrow mine instead. In such instances, I am more concerned with calming everything down than letting clients take responsibility for themselves.

I am very fortunate to have a curious counseling mentor who does not prop up my own incapacity to direct my life. Even though we have been meeting for years, I could probably count the number of times she has made a suggestion to me on one hand. I can see how by simply asking good questions and helping me develop my thinking, she has allowed me to take responsibility for my own functioning.

My job as a counselor is to help people see the reciprocity in their relationships. Like when a client wonders why his mother is financially irresponsible when he’s spent years bailing her out of debt. Or when someone wonders why her partner doesn’t share more when she’s constantly asking him to manage her own distress. When we focus on the other person in a relationship, we’re missing 50 percent of the picture. In fact, we’re missing the 50 percent that we can actually control. By focusing on Erin and what I thought was her “fault,” I missed seeing my part in our relationship.

When anxiety is high in the counseling room, it’s incredibly difficult to shift the focus back on yourself. Difficult, but not impossible. So when a person is distressed, instead of fixing or reassuring, I try to relax my posture, take some deep breaths and access my best thinking. I try to pay attention to when I’m slipping into my default mode of overfunctioning. When a person asks me how I think they’re doing, I challenge them to trust their own ability to evaluate themselves. I try to do this for any relationship, whether it’s with a counseling client or with a friend.

I think I’m getting a little bit better each day with noticing the reciprocity in my relationships. By seeing my part, I’m taking responsibility for myself and allowing others to do the same. In exchange, these relationships bring so much more joy into my life. If I can stay focused on myself around my most anxious clients, then, often, they end up being some of the most rewarding ones I see.

It’s funny how when we treat people as though they can take responsibility for themselves, they are likely to rise to the occasion. I hope that Erin found a counselor who saw her as the capable young woman she was.

 

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Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Read more of her writing at kathleensmith.net.

 

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Related reading by Kathleen Smith, from the CT archives: Facing the fear of incompetence

Self-doubt often nags at the minds of counselors, but the practice of vulnerability might offer both a powerful antidote against unrealistic expectations and a prescription for forming stronger connections with clients. https://wp.me/p2BxKN-4EK

 

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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.

 

Counseling ‘unlikeable’ clients

By Laurie Meyers August 25, 2016

It’s not a politically correct statement, but, sometimes, clients are tough to like. Yes, counselors are supposed to remain professional at all times and practice unconditional positive regard. But they are also human, and fending off creeping feelings of “dislike” can be a challenge, especially when clients espouse racist, misogynistic or homophobic beliefs; have abrasive personalities; or simply remind counselors of someone in their own lives whom they find difficult to be around. So the question becomes, how do counselors handle that reality?

Tamara Suttle is a licensed professional counselor (LPC) in Castle Rock, Colorado, with more than 30 years of experience in mental health. She also runs a business in which she provides supervision, consultation, private practice coaching and counseling for other therapists. In her Branding-Images_Difficultopinion, most counselor education programs and the counseling profession itself don’t do enough to prepare future clinicians for those instances when they will experience negative feelings toward a client. In truth, she says, it’s a bit of a taboo topic.

“If your professors don’t talk about these things and our clinical supervisors don’t talk about these things and our colleagues and our friends and our bosses and our professional associations don’t talk about these things, then we learn pretty quickly that we aren’t supposed to talk about these things or even experience these things,” says Suttle, a member of the American Counseling Association.

But in reality, all counselors experience discomfort with and dislike of a client at some point in their careers, says Keith Myers, an LPC and ACA member in the Atlanta metro area. “If someone tells you that it does not [happen], they’re not being honest with themselves,” he says. “We are counselors who also happen to be human beings.”

Digging deeper

The key is being able to set aside and even learn from those negative feelings when they pop up, Suttle says. To do that, counselors need to discern what is truly at the root of those feelings.

Lauren Ostrowski, an LPC at a group private practice who also works at a community mental health agency in Pottstown, Pennsylvania, agrees. “To me, what is far more common [than fully disliking a client] is working with clients who do things or have traits that I don’t like,” says Ostrowski, a member of ACA. “Even if I feel like I have a client I don’t like at all, I make it a point to figure out what it is they are doing or saying that I don’t like. Then I figure out whether the problem is really me — [making] a value judgment perhaps — or whether they are doing something in session that also affects their everyday life that they are motivated to change.”

Suttle acknowledges that after reflecting on her negative feelings toward a client, she sometimes discovers that the problem actually resides with her. She is reacting with dislike because the client triggers personal issues she has struggled with herself, such as having been raised to be a people pleaser.

“I’m sure many therapists can relate to having a certain type of client that they simply prefer not to work with,” Suttle says. “For me, that has historically been a client who is so focused on people pleasing and [is so] passive or passive-aggressive that she is often unable or unwilling to own her truth and … tell the truth.”

“After years of struggling with this type of client and [having] lots of opportunities to reflect on my struggles, I now recognize my discomfort as being much more about me and my own people-pleasing tendencies than those of my clients,” she continues. “It’s one of those issues that I must continually be cognizant of and work on in order to work with clients.”

Likewise, Myers says that his feelings of dislike or discomfort with a client are often about him. “Most times … it’s [dislike] about an interpersonal issue or a client reminding me of someone I know or knew,” he says. “I think, for me, it comes down to countertransference and how a client may stir up my own unconscious — or, at times, conscious — parts of me.”

Myers and Suttle both stress the importance of counselors practicing self-reflection to identify personal issues that can creep into counseling.

When Suttle works with other counselors who are struggling to like one of their clients, she looks for what she calls “signature issues” in the counselors’ backgrounds. She does this by helping them to construct genograms. The purpose is to identify how a counselor’s family members interacted in relationships going back several generations, such as Suttle’s long line of people pleasers.

Together, Suttle and the counselor search for behavior patterns related to family relationships. For instance, passivity might be a pattern in the counselor’s family. Suttle also asks about how conflict was handled in the counselor’s home growing up. As an example, a counselor whose father punched walls when he was angry might not be comfortable with conflict. This could engender a negative reaction to clients who push back, are stubborn or struggle to control their anger, Suttle notes.

Identifying the personal issues and biases that contribute to a counselor’s dislike of a client is an important step, but that alone will not solve the problem, say Myers and Suttle. Both stress the importance of counselors receiving supervision and even engaging in individual therapy when their personal issues trigger feelings of dislike toward a client.

“Supervision and consultation play a huge role in processing the material and my own internal responses that occur within my counseling relationship with clients,” Myers says. “Having someone who comes alongside me in my process of helping others and is willing to see me through a different lens … who is often challenging me and exploring my conscious and my unconscious feelings. … [That] is so important to me keeping those ‘dislikes’ [about a client] in check.”

“Another thing I do is participate in individual therapy,” Myers says. “Sometimes if a client is rubbing me the wrong way or I feel irritated or agitated with a client, my therapist provides me with a safe space to be able to process those things.”

In addition, Ostrowski urges counselors to seek more informal supervision when struggling with negative feelings toward a client. “This doesn’t have to be the official [type of] supervision with a contract and consultation agreement, etc.,” she says. “While I think that kind of supervision is important, here I’m talking more about a trusted co-worker or another clinician where you can just have a discussion about exactly what you are reacting to, how you reacted in session and what you are going to do moving forward.”

Suttle has a consulting group that she meets with regularly, and she urges other practitioners to participate in similar groups to help them deal with problematic feelings toward clients.

Setting aside personal beliefs

In accordance with the ACA Code of Ethics, counselors know that they must not force their own beliefs on clients, but what happens when a client espouses beliefs that are hateful, personally hurtful or just uncomfortable to the counselor?

“Sometimes working with clients who have different values can be challenging,” Ostrowski says. “In that case, I really try to learn more about the client’s worldview and, in some cases, ask about how looking at a situation in a certain way may affect them or their family. Often, they are already aware of these things and will say that they understand that it causes certain trouble with extended family dynamics or may be part of why they don’t have a relationship with someone important to them. There can be some very fruitful discussions about how important their beliefs are to them compared to what it is that they want in life and whether there is some sort of balance that they see.”

When Myers, a past co-chair of the ACA Ethics Committee, is working with a client who has strong prejudices or biases against certain groups and is making judgmental or harsh comments in session, he tries to tie it back into the therapeutic process.

“I normally use this time to explore these comments so that I can gain further insight into the client’s background, values, beliefs [and] family-of-origin issues,” he explains. “This is usually an opportunity to hold the tension while exploring deeper with the client. And if we believe it’s important to be fully accepting and nonjudgmental with all clients, then it’s important for us to accept those who are different from us and who hold very different values and opinions, even when they are being judgmental.”

Although Ostrowski often manages to make therapeutic use of a client’s biases or prejudices, she acknowledges that it isn’t always easy, recounting the story of one of her recent cases as an example. “A few days after the tragic shootings in the Orlando nightclub [at Pulse in Florida on June 12], I had a client discussing his beliefs on the whole idea with me. Let’s just say that [the client’s beliefs and Ostrowski’s beliefs] were about as far opposite as one can get, and on top of that, he had a lot of the facts incorrect. I did mention that I had heard different facts on the news, but he disagreed,” she says. “I stopped trying to point out things that were different from what I had heard, and I allowed him to discuss how all of this had affected him, restating what he was saying and asking for more information.”

Ostrowski says the situation served as a good reminder for her to closely monitor her reactions when faced with a client’s prejudicial statements and biases. “I will say that for the rest of the session after the topic was brought up, I was checking every statement or question I used before I said it to see whether it was to benefit me or my client,” she notes.

It is important for counselors to know themselves well so they can better guard against their personal beliefs and biases slipping into the counseling session, Ostrowski says. However, that doesn’t mean that counselors have to give up their personal beliefs.

“We can keep our worldview [as counselors] and simultaneously learn more about the world as our clients see it,” she explains. “For that matter, it’s not even about hiding our beliefs, but more about disclosing only those that would further the conversation we are having with our clients about what they believe and leading them in the direction of their therapeutic goals.”

Regardless, hearing a client spout hateful or misinformed comments in session can still take a toll on counselors, Myers and Ostrowski say, and that is one reason why they think counselor self-care is crucial in these situations. Myers take breaks to walk in nature after client sessions that may have been upsetting because the activity helps him clear his head. Ostrowski, meanwhile, has found that staying grounded helps her and can be particularly useful while in session.

“[Staying grounded] may decrease the feeling of being emotionally flooded or overwhelmed,” she explains. “[It] can be as simple as taking the time to notice your feet on the floor or your hips in the chair. The possibilities are endless. Each and every one of us can find some way that we can move or notice the location of our body in the room or the chair in a way that is not distracting to a client. It takes only a matter of seconds and can change the trajectory of the session because of having an increased ability to stay present with the client in that moment.”

‘Liking’ versus ‘accepting’

Other clients can be difficult to like not so much because of their beliefs but because they possess abrasive personalities.

Christine Moll, an LPC who practices in the Buffalo, New York, area, points out that no one ever said that counselors have to like every client they come in contact with. She cites the writings of Carl Rogers — one of the founders of the client-centered approach — to support her statement.

“He called for empathy,” Moll explains. “Nowhere did he say like, but [rather] embracing the person with concern or care, wanting the best for that person.”

Moll, an ACA member who is also a past president of the Association for Adult Development and Aging, says she has definitely encountered clients whom she didn’t like, but she always tries to put her personal feelings in perspective. “I have worked with clients that I have found difficult, arrogant, elitist or biased,” she says. “But I am not in their lives. I don’t need to share a fence with them. I think to myself that if I [have to put my reactions] aside, it’s just for 50 minutes, and I tell myself, ‘It’s not about you.’”

Regardless of how a counselor feels about a client, the goal should always be to help that client find and attain a good quality of life, says Moll, who is also a counselor educator at Canisius College. “I try to use what I’ve not liked about a person and figure out how to reframe it,” she notes.

For instance, clients might come to counseling complaining that no one likes them and they don’t know why. Moll explains, “I might point out a [client’s] passion for life that other people might see as a chip on the shoulder and say, ‘I see your energy and your passion for life, and if you feel threatened and put up against a wall, you are going to fight back. That’s great. That’s a gift. But can you see how that can lead people to see you negatively?’”

Ostrowski suggests exploring whether a client’s difficult personality is connected to the reason that person is seeking counseling. “For example,” she says, “if clients come across very gruff and unpleasant, it could be that they have emotions that they don’t understand or they struggle to have effective conversations, thereby leading them to react in ways that are perceived as unpleasant because of self-protection strategies.”

Moll also tries to identify positive aspects in even the most unpleasant client. “I was raised with the idea that everyone’s got something [good] about them,” she says. “If I find a glimmer or find a good quality, I praise it.”

Myers comes back to the importance of always putting the client first in the counseling relationship. “I will say, yes, it is harder to work with a client that I don’t like, at least at first. But then I remind myself that I must accept each client where they are in their lives and that I don’t have to like them necessarily to fully accept them, support them and offer them respect.”

 

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To contact the counselors interviewed for this article, email:

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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.

 

 

Recognizing and managing deception in the therapeutic relationship

By Gregory K. Moffatt June 27, 2016

I had been working with “Alex,” an 8-year-old boy diagnosed with attention-deficit/hyperactivity disorder, for longer than six months. His hyperactivity had become a major problem at school, and much of our clinical focus had been on managing behavior in the school environment. Each week, Mrs. T, his mother, who drove almost three hours to bring Alex to see me, confirmed that Branding-Images_fingers-crossedhis behavior was improving. Then, one cold December afternoon, she appeared for our appointment without Alex.

“I’m sorry,” she said, “but I haven’t been honest with you. Alex’s behaviors haven’t improved at home or at school. I’ve lied about it all along, and I don’t know why. We are withdrawing from therapy, but I wanted to tell you to your face.”

Mrs. T was embarrassed. She apologized profusely, thanked me and then left. I never saw her or Alex again.

I was devastated. I had been in the field for more than 20 years and had never had anyone be so overtly dishonest with me. Mrs. T had paid me a lot of money and invested a substantial amount of time driving Alex to and from therapy. I couldn’t understand why she hadn’t simply told me the truth all along.

From this experience, I learned the valuable lesson that I can’t always take a client at his or her word. But how can we know when clients are not being truthful? What clients are most likely to deceive? How can we identify and manage deception? The answers aren’t simple ones.

Problems with research

Before I address the questions at hand, some caveats about the research on deception are necessary. The research on indicators of lying is so full of conflicting ideas that little sense can be made of it all. Even some of the best studies have serious problems.

For example, some studies have argued that agents from the former U.S. Customs Service are no better at detecting lies than the average person. But many of these laboratory studies have subjects lie about little things such as “I have the ace of spades in my pocket” when in fact they don’t. These are called “low-stakes lies.” Nobody goes to jail for lying about having a playing card in his or her pocket. But when it comes to high-stakes lies — lies that are meaningful — Customs agents are much better at detecting lies than most of us.

In fact, it is easy for people to lie about little things. Most of us do it regularly in daily life.

“Do you like my sweater?”

“Um, yeah …”

These little white lies are meaningless in the big picture of life. But the physiological response to lying about big things (“No, sir, there are no illegal drugs in my bag”) is much harder to suppress. These are lies that most of us don’t tell.

Among the beliefs that have been held in the past are that liars fidget more, don’t make eye contact and stutter more frequently. Although sometimes these things are true, sometimes they aren’t. These oversimplifications were based on problematic research methodology. Today we know much more about deception. But before we look at what people who tell lies do, let’s look at who lies and why they tell the lies they tell.

Who lies?  

All of us lie. We just lie about different things. Unless we are pathological liars, we regularly evaluate the cost or benefit of telling the truth, which often involves determining the likelihood of delaying or avoiding a certain cost or increasing a particular benefit by using deception.

For example, if someone made a meal for you and asked if you liked it, you might lie to protect the person’s feelings if you didn’t really enjoy it. The cost of the truth — hurt feelings — is much higher than the cost of a little white lie. The cost of a child telling me (a counselor) the truth about his or her abuse is shame, embarrassment and humiliation. The lie often feels much safer to the child.

For that reason, over several decades of experience working with children who have been sexually and physically abused, I have found that almost all children attempt to deceive me at some level in the initial interview. My question of whether anyone has ever touched them in a way that hurt them or made them feel uncomfortable is nearly always met with a “no” response, even when I already know that the child has been sexually or physically abused. They don’t trust me enough to tell me that secret yet.

By recognizing those clients who might be motivated to lie because of what the truth might cost them, we can, as counselors, better predict the likelihood that a lie is being told.

Why it matters

Nearly all of our clients will lie to us at some point. Lying can take several forms. A person can lie by saying something that isn’t true (called falsification) or by denying something that is true (called concealment).

Lies can be blatant. Former President Bill Clinton displayed this form of deception when he told the media, “I did not have a relationship with that woman.” But many lies are not so blatant. Clients might deflect as a form of lying. Again, in the case of the former president, he drew a lot of attention for his statement, “It depends on what the meaning of the word is is.” This is a common method a person who is lying might attempt to use to save his or her reputation (cost) by parsing terms. The person rationalizes that his or her response wasn’t really a lie by deflecting and answering a different question.

Clients might also lie by diminishing their behavior: “Well, I didn’t really hit my husband. I lost my balance and my hand might have touched his face.”

All these forms of lying might be seen in nearly any counseling context — marriage counseling, alcohol and drug counseling, anger management, working with court-ordered clients and so on. The accuracy of the information we get from our clients matters to us as therapists because we structure our interventions and treatment plans and measure progress based on what our clients tell us. When they deceive us, as Mrs. T did to me, at the very least we waste therapeutic resources. But we might also miss important pieces of information that are critical to a client’s survival. For example, a client who is attempting to manage suicidal ideation might end up succeeding at suicide if we miss the intensity and frequency of the individual’s ideation due to deception.

All of us can expect our clients to deceive us at some point. I was taught early in my education that “the problem is never the problem.” My professors and clinical supervisors were trying to demonstrate the importance of rapport and trust in a therapeutic relationship. Part of that is expecting that, sometimes, the stated presenting problem isn’t really why the client came in. Clients have to learn that they can trust us before they will tell us what they really want to talk about.

Therefore, early on in the relationship, I am always listening for hints that there might be more to the story than I am being told. I have found that, oftentimes, my teachers were correct.

High-risk populations

Several client populations are at particularly high risk for lying, including incarcerated individuals, children in foster care, clients who are addicted, people involved in sexual assaults and clients who are suicidal.

Prisoners and juvenile detention: Kenneth Bianchi, also known in the 1970s as the Hillside Strangler, came very close to successfully duping several of the country’s most renowned experts on multiple personality disorder (as it was known then) by faking the disorder while supposedly under hypnosis.

These professionals made a critical mistake. They naïvely believed that Bianchi wouldn’t — and, more importantly, couldn’t — fool them. These experts had extensive experience working with clients who were motivated to tell the truth, but a person accused of serial crime is highly motivated to lie.

Any client or patient familiar with the “system” is at risk for manipulating it. One of the lead psychologists in the Bianchi case later served as a clinical director in a prison. He acknowledged that the experience of working with prisoners confirmed that he had been naïve in the Bianchi case.

Most therapists have the luxury of believing their clients will tell the truth, or at least near truths, much of the time. But when working with those who are incarcerated — either those in the juvenile justice system or adults in the prison system — one must verify all information by a second source because the motivation to lie is so high. We have done this with alcohol and drug treatment patients for years.

“I didn’t smoke anything this week.”

“OK, I believe you. Please pee in the cup.”

“But I haven’t smoked anything …”

“Fine. Please pee in the cup.”

Clients who are addicted could be telling the truth, but the information must be verified. Manipulating people for one’s own gain is inherent in the prison system, where inmates have very little power and must always look out for themselves. Nobody trusts anybody. Inside the prison block or juvenile hall, deception is an everyday part of life, giving people motive to lie and providing ample opportunity to practice. In other words, telling the truth doesn’t outweigh the benefits of the lie — more privileges, freedom or exoneration.

Accusations of sexual abuse: Generally, young children do not falsely accuse others of sexual or physical abuse. They have too much to lose. As noted earlier, the opposite is far more likely. I’ve seen hundreds of children who have been physically or sexually abused by caregivers, and most of these children still want to go home. They want the abuse to stop, but they don’t want to be elsewhere, even if it means returning to the homes of their abusers. Therefore, they are not motivated to make up abuse allegations but rather motivated to lie that it did not occur (concealment).

The exception to this general rule involves teenagers who know how to manipulate their parents or guardians with threats of intervention by child protective services and children who have been exposed to the “system” (see the preceding section on prisoners and juvenile detention.) Sadly, I’ve seen several cases in which adolescent children in foster care accused a foster parent of sexual misconduct or abuse simply to exact revenge on the foster parent for a perceived grievance. These teens knew how to work the system.

Sometimes, parents also have a motivation to lie about abuse. I have worked with dozens of parents who were divorcing. In some of these cases, one of the spouses has either accused the estranged spouse of abuse or proposed a “concern” about potential abuse simply to improve his or her own position in the custody hearing. People know that the mere accusation of abuse can have an effect on a judge’s decision for custody. In these cases, the benefit of the lie may outweigh the benefit of the truth.

Rape allegations: Unfortunately, I have been in the position several times of having to evaluate the truthfulness of a victim and her alleged rapist. This is a very sensitive process because a mistake in either direction has tragic consequences. If I wrongly suppose an accused rapist is telling the truth, I have provided data that might let him avoid charges. Even more serious, I have contributed to one of a victim’s greatest fears — that she won’t be believed. On the other hand, if I errantly believe an accuser, an innocent man may go to prison and be labeled a sexual offender for the rest of his life.

Generally, the accuser is least motivated to lie, but both parties can possess motives to lie. The accused, obviously, is motivated to lie to avoid prosecution. But in false allegations of rape, the accuser is motivated also. In two of my cases, it was discovered that the accusers had engaged in consensual sex and then, fearing pregnancy or disease, realized their indiscretion would eventually come to light. A false accusation of rape provided the accusers with the benefit of being “victims” rather than facing the cost to their reputations of promiscuous sexual liaisons. Please note, however, that the data is quite clear. Most victims of rape never even call the police. Therefore, the accused is far more likely than the accuser to lie.

Suicide risk: Perhaps the most common instance in which clinicians will encounter deception is with suicidal risk assessment. Early in my career, I was working with a 19-year-old woman who was exhibiting suicidal tendencies. We had been working together for several weeks, and our rapport was strong. In one session, she verbally consented to a safety contract, agreeing to contact me before the next session if she felt suicidal. She left my office, and within two hours, I received a call from her mother saying that my client had taken an overdose of medication.

Fortunately, she survived, but there was no doubt that I had missed something and that my client had lied to me. It was my responsibility to take into account all risk factors, and I had failed. Part of my suicide risk assessment now involves evaluating what stressors a client might have after leaving my office, even if I believe the client is telling me the truth. Clients have to convince me that they are not simply saying what they think I want to hear.

Detecting lies

So, how can we detect lying? This is a process with many variables, but here are some of the basics.

1) The first issue is for the counselor to ask himself or herself if the client has a motive to lie. Is the cost of the truth potentially higher than the cost of the lie? If so, be on guard. How much trust has been built in the therapeutic relationship? When little trust has been established (such as early in the relationship), this increases the cost of the truth to our clients.

2) When telling a lie, people often provide unnecessary detail, and their stories are often presented verbatim over several tellings. When someone is simply describing an event, the gist of the event is what matters, and sometimes small details vary because they are comparably unimportant. Someone who is lying, however, feels the need to “prove” that his or her story is genuine by providing minute, memorized detail that doesn’t change much from one telling to another.

3) The story of a person who is lying won’t match the known facts. In a complicated story, cross-referencing facts can often lead to an untruthful person’s downfall because there are simply too many details to keep in working memory while the lie is being constructed. Lying requires an immense amount of mental energy.

4) People who are lying may not look you in the eye, but they may be just as likely to stare if they are trying to concentrate on being believable. Staring is an example of a “countermeasure.” As described in a 2014 article for FBI Law Enforcement Bulletin by Brian D. Fitch, these are behaviors construed in an attempt to prevent the hearer from recognizing the lie. The person may believe that “people who lie don’t look you in the eye,” so he or she attempts to counterbalance that by staring. When telling the truth, a client is more natural in either situation, looking off into space at times and making occasional eye contact in the same way.

5) When people lie, they often ramble on and on. When I’m interrogating a suspect in a legal situation, I sit quietly and let the person talk. The person telling the truth will tell the story and then wait for instructions or a response from me. Uncomfortable with silence, the person telling a lie will continue to talk, adding flowery language and detail to the story.

6) People who are telling lies are more physically stiff, use fewer hand motions, are more negative and use fewer first-person pronouns, according to a 1997 article by Mark Frank and Paul Ekman in the Journal of Personality and Social Psychology.

7) People who are telling lies often exhibit microexpressions. As described in a 2011 FBI Law Enforcement Bulletin article by David Matsumoto, Hyi Sung Hwang, Lisa Skinner and Mark Frank, these are behaviors that communicate a feeling such as contempt or disgust. Microexpressions that communicate an emotion inconsistent with the words being spoken are important clues. For example, a client who should be feeling relief at the telling of a story but is instead exhibiting contempt should be considered potentially untruthful.

Four steps to managing deception

The first step in managing deception with clients is recognizing that deception has occurred. The second step is determining what form the deception has taken (blatant, deflecting, diminishing, falsification or concealment).

Third, the counselor must decide if the deception must be confronted. Early in a therapeutic relationship, I sometimes can tell that I’m not getting the whole story, but my client needs to trust me more deeply before confiding certain secrets. In these cases, I don’t confront the deception. Once trust has been established, however, or in cases in which I am confident that confrontation is the proper therapeutic tool, I address the deception head-on.

Finally, the counselor must evaluate the therapeutic relationship and decide why the client didn’t trust the counselor with the truth. In the case of Mrs. T, I suspect that her deception was more for her than for me. She wanted so desperately for her son to be “normal” that it was more costly to admit that he wasn’t normal than to admit that nothing was working. She trusted me but couldn’t face the fact of her disappointment in her son.

Conclusion

At some point, we have to trust our clients. Mrs. T betrayed my trust in her, and this came at the expense of her son. But looking back, she gave me hints that she wasn’t being honest.

Therapy went too easily. She confirmed that things were better each week almost before I asked. Her confirmation that things were going well were inconsistent with some of the behaviors I saw in therapy and in the child’s sand trays — so much so that at one point, I consulted with a colleague on these inconsistencies.

But Mrs. T provided multiple energetic and animated stories to prove to me that therapy was working. She was anxious and nervous when I asked about her son’s progress at school and often jumped ahead in the conversation at a pause or lull in our discussions. In hindsight, the most notable clue was that she looked me straight in the eye, almost staring at me, each week as she lied to me.

I still don’t know why Mrs. T was motivated to lie to me, but perhaps the most important lesson I learned from her is that clients will, indeed, deceive me if I’m not careful. In her case, I never even bothered to consider the possibility of deception. It was a mistake I haven’t made again.

 

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Gregory K. Moffatt, a licensed professional counselor, runs a private practice in which he specializes in working with children who have experienced physical or sexual abuse. He is also a professor of counseling and human services at Point University in Georgia and serves as a risk assessment and psychological consultant for businesses, schools and law enforcement agencies. Contact him at Greg.Moffatt@point.edu.

Letters to the editor: ct@counseling.org

Scaling client walls

By Laurie Meyers December 22, 2015

Every practitioner has been confronted by them — clients who show up for counseling (at least physically) but demonstrate little interest in actually being there, or clients who come in week after week but seemingly fail to make any progress. In some scenarios, these clients rarely speak. Or they talk about making changes but don’t take action. Or they talk about everything under the sun except what’s actually bothering them. You try to gently guide them; they drag their heels. What’s a Branding-Images_Client-Wallscounselor to do when faced with a client who is resistant?

Start by realizing that it isn’t useful to label a client as resistant, says W. Bryce Hagedorn, an addictions counselor in Orlando, Florida. The resistance, he says, comes from the client-counselor relationship — in particular, how a counselor approaches change.

“A big assumption that counselors make — particularly the longer they are in the field — is that they know what is best for clients,” says Hagedorn, a member of the American Counseling Association. “I don’t know that they would admit it, but the longer you are in the profession, the better you get, so you think you know how to achieve change. And we start to impose on clients.”

“We are trying to be agents for change, and we assume that [clients] are ready, willing and able,” he adds. “We design action-oriented change when they are
not ready.”

Hagedorn says it can be especially easy to fall into the trap of trying to impose change when working with clients who have substance abuse issues. Counselors often assume that people with substance abuse issues are in denial and thus need a “push,” Hagedorn says. On top of that, practitioners may feel the pressure of having a limited amount of time that insurance will pay for the client to complete treatment, he says.

“We need to get people [in treatment] from point A to point B, but when we push people toward B, people push back,” he explains. “It’s only natural. People don’t like change.”

Change is a process

Hagedorn, the former editor of the Journal of Addictions & Offender Counseling, says that earlier in his career, he was unquestionably guilty of pushing clients, often without quite realizing it. He was working with people struggling with substance and process addictions, both of which are often comorbid with other mental health issues.

“Just because clients are agreeing with you doesn’t mean they are going there with you,” he says. “There were plenty of times in the beginning [of his career] where, although the clients would agree with my ideas, they never tried them. I would design all of these activities and homework, but they just wouldn’t do them.”

Hagedorn eventually realized that although he was employing a more subtle form of pushing, he was still trying to move clients faster than they wanted to go. He reframed his approach by using the stages of change model developed by James Prochaska and Carlo DiClemente. The model focuses on specific strategies that are helpful to clients at each particular stage of change: precontemplation, contemplation, preparation, action, maintenance and termination.

“I was always using CBT [cognitive behavior therapy], and it’s really designed for people who are in the preparation or action stage [of change],” Hagedorn reflects. He eventually realized his activities weren’t working because the clients he was seeing were still contemplating change rather than preparing to take action or engaged in action toward change.

Hagedorn describes the thought process of clients who are in the contemplation stage as follows: “Since I am thinking about change, change is happening.” And that is valid to a certain degree, he says.

“For them just to come in [to counseling] each week, that can be a huge change for them,” he says. “We [counselors] tend not to honor that. If we can help them recognize what the next step would be, whether or not they are going to take it, that is significant.” Counselors must realize that ambivalence about change and relapse to past behaviors are normal and expected parts of all change processes, not just those related to addiction, Hagedorn says.

To encourage clients in their efforts at change without imposing his own ideas on them, Hagedorn started using motivational interviewing, a technique that incorporates principles from the stages of change model. Motivational interviewing also uses reflective listening, which demonstrates empathy and helps diffuse resistance, Hagedorn says.

As an example, with a female client considering leaving an abusive husband, Hagedorn says he might start with a statement such as “Tell me about what happened during the last altercation.” He then listens for specific details to reflect back and summarize so that the client will know he is listening.

“I’m listening both for words that use explicit feelings and for underlying meaning,” he elaborates. “She may say, ‘I just don’t know if I can do this anymore.’ So I can either say, ‘You don’t know if you can stay, or you don’t know what’s going to happen?’”

This approach communicates empathy while also eliciting information, Hagedorn says. He adds that the mistake many well-meaning counselors make is to instead listen to their “righting reflex” — the reflexive need to make everything “right” for clients.

“When someone comes in and talks about hurt, my righting reflex goes off — ‘I need to make this stop,’” he says. “That is not good because I am going to make a plan, and I start firing off questions: ‘What have you tried? Have you tried this? Why don’t you try that?’ I’m drilling her, and I freak her out. So she starts saying, ‘Well, it’s not always so bad …’”

Instead, Hagedorn likes to use the OARS method, which stands for open questions, affirmation, reflective listening and summary reflections. He says this technique often helps him implement change talk in clients.

“As they’re talking about what’s going on, I’m listening for them to say something that reflects that things aren’t all that they’re cracked up to be,” he explains. “Like [with the client in an abusive marriage], ‘Although I can predict the cycles [of violence], I realize my kids are seeing things that I don’t want them to see.’”

Hagedorn can then pick up on that observation and continue to strategically reflect. “I’m really hearing that there are two sides,” he might say. “On the one hand, you say there is predictability and stability, but on the other hand, you don’t want the kids to see what’s happening. Tell me more about that.”

Hagedorn also emphasizes the importance of counselors not taking any perceived resistance from clients personally. “When they push back, for me it’s a sign that I’m moving too quickly, not that I am doing something wrong,” he says. “I appreciate that as a sign of where we are in the therapy.”

To move past the point of taking resistance personally, Hagedorn said, he had to redefine what successful therapy looks like, and that often requires a great deal of patience. “People can get in a holding pattern. We all have things that we’ve been thinking about for years and haven’t done,” he points out.

Practitioners naturally prefer the action stage, and that can lead to frustration when clients are seemingly “stuck” in the contemplation stage. But as Hagedorn, an associate professor and coordinator in the Department of Child, Family and Community Sciences at the University of Central Florida, reminds his students, the stages of change model teaches that 80 percent of clients are in either the precontemplation or contemplation stage.

Hagedorn considers it a win if he can help clients move forward a stage or move them toward putting together a plan. If a client isn’t yet ready to transition to the next stage but has a good enough experience in counseling with Hagedorn that he or she is willing to come back when there is impetus to make a change, he also considers that a success.

Having said that, Hagedorn acknowledges that he doesn’t simply allow clients to circle around and around a problem with little apparent motivation to move forward. “I set treatment and session goals,” Hagedorn says. “I want to be moving toward something. If there have been a few weeks of no movement, maybe we need to reevaluate goals. Or maybe this stage of counseling is over.”

In such cases, Hagedorn might ask clients if they want to reduce the number of sessions or work on something else. If it becomes evident that certain clients really just want to complain, Hagedorn lets them know that he will still be there when they decide that it’s time to move past what is impeding them.

Solutions for students

ACA member John J. Murphy is an expert at working with a client population that is frequently perceived as resistant: high school students. Like Hagedorn, however, he doesn’t believe such labeling is useful.

“It blames the client for the impasse,” says Murphy, the author of Solution-Focused Counseling in Schools, published by ACA. “It kind of sets up an adversarial environment that I don’t think is really compatible with the way we know good counseling works.”

Calling clients resistant “kind of takes us [counselors] off the hook,” he continues. “It takes away our responsibility for finding a way to connect. They [clients] come to us in all sizes and shapes. Our talent is to tailor our approach to the person sitting across from us.”

Although he rejects the word resistant, Murphy, a former school psychologist who continues to work with students, teachers, parents and administrators, does think that school-age clients pose a unique challenge. “Students and young people rarely refer themselves for services, and that has major implications for how we approach them from the very start,” he explains. “We can’t approach them the same way [we would] someone who enters counseling in a voluntary way.”

Counselors working with young people should be aware that these clients are often in counseling at someone else’s request, Murphy says, and he advises acknowledging this with clients from the start. When applicable, Murphy tells clients that he knows it wasn’t necessarily their idea to be in counseling and understands that it’s not always pleasant to be a part of something when it’s not their choice. “No wonder you don’t like being here,” he might say to the client. “I don’t like doing things that someone who has control over me tells me to do when I don’t want to do them.”

Once Murphy validates school-age clients, he asks about their issues indirectly by inviting them to tell him why they think they were referred for counseling. “I will ask, ‘Do you know why you were asked to see me? Whose idea was it for you to come here? What do you think needs to change to get these people off your back?’” he says.

Murphy firmly believes such queries are helpful. He says the questions serve not only to put him squarely in the student’s corner but also allow him to learn more about the student’s perception of the situation and what he or she wants to get out of the sessions — even if it is just to get out of counseling altogether.

A student is generally referred to the school counselor’s office for behavioral or mental health counseling for one of two reasons: a specific event or ongoing, cumulative problems, says Murphy, a professor of psychology and counseling at the University of Central Arkansas. The event or crisis may take the form of a suicide attempt, a school suspension or getting into trouble with the law. Ongoing problems might include persistent conflict between the student and his or her parents, chronic lateness at school, refusal to do assigned work, disruptive behavior in class or harassment of other students. Other times, the problem may be more subtle, such as a formerly solid student whose academic performance starts to decline in one subject, then another and another, seemingly without explanation.

When faced with a student who seems disinterested in school or at home, it can be tempting to label him or her as apathetic, Murphy says. “That’s just a totalizing description,” he cautions. “It makes it seem like apathy runs from the tips of their toes to their head, and that’s not the way it works. Everyone is motivated by something. Our job [as counselors] is to find something that gives this person a heartbeat and energy.”

Murphy recounts working with a 17-year-old who was referred for counseling because of behavior issues that included not completing assignments. His grades put him at risk of not finishing high school. The school authorities and teachers said the student didn’t care about anything, but when Murphy asked him what he enjoyed doing in his spare time, he quickly learned that the young man had a passion for writing rap songs.

“I learn that this guy spends most of his evenings writing,” Murphy exclaims. “If you said that [a student spends all of his time writing] and they [the teachers] didn’t know anything else, they’d probably think that was great.” Many counselors or teachers might dismiss the student’s passion and talent after learning that the writing primarily involved rap songs, Murphy says, but that would demonstrate a lack of resourcefulness in connecting with a young person.

Murphy went on to ask the student if he had ever spoken with someone who recorded rap music. The young man said he knew someone who occasionally recorded for himself, but not professionally. Murphy then asked the student whether he would be interested in having his rap music recorded if he were to meet someone in the industry.

“He said, ‘Yes! Definitely!’ So now he’s energized,” Murphy continues. “[But] how does this become school related?”

Murphy asked the student if having a high school diploma might help him achieve his dream of getting his rap music recorded. The young man said he thought it would because people automatically assume that individuals who have graduated from high school are smarter. “Now, all of a sudden, school becomes a means to an end [for the young man],” Murphy says.

Murphy kept the focus narrow: You want to get your high school degree. What is one small step that you could take in school tomorrow that would move you toward your goal?

The techniques Murphy used are representative of solution-focused counseling, which he describes as a method of helping people change by building on their strengths and resources. These strengths and resources include elements such as special talents, interests, values, social and family support, heroes and influential people, and even a client’s own ideas about his or her problem and possible solutions. “I want to find out what they think might help turn things around,” Murphy emphasizes.

He also likes to focus on resiliency. “Everyone has overcome lots of things in their lives, [but] when we have a problem, it’s easy to forget that,” he asserts. “One of the core techniques [for developing resiliency] is building on the exceptions — a time when a problem could have occurred but did not.”

For example, with a student having problems with tardiness, Murphy would ask about a time when he or she wasn’t late. “What did you do differently? Who was around? What will it take for that to happen again?” he says.

The student might provide an answer as simple as her mother waking her up instead of her father. Often, Murphy says, he has no way of knowing if the answer the student identified truly made the difference in the outcome, but he’ll suggest that the student try it again to see if it resolves the problem.

“Solution-focused counseling changes a young person’s focus from, ‘How can I be more like other people’ to ‘How can I be more like myself during my better times?’” Murphy says. “I think it’s really important … when a young person realizes, ‘I already know what I need to do to be better. I just need to figure out how to do it more often or in different circumstances.’”

For instance, a student might recognize that he or she is a very good listener with friends but not with his or her parents, Murphy says. Based on the parents’ experience, they think their child isn’t a good listener at all, and that can become part of the young person’s self-perceived identity. But if the student can realize that he or she already possesses the skills needed to solve the problem, that is a huge step, Murphy says.

“It’s not going to be easy [to make that change],” he says, “but that is completely different than [thinking], ‘There is something missing in me. I am deficient.’”

Making a difference with mandated clients

Kerin Groves, a licensed professional counselor (LPC) with a private practice in Denton, Texas, counsels individuals who are typically very reluctant participants — mandated clients.

Most of her clients are referred through the court system for charges related to substance abuse or at the behest of child protective services. Groves evaluates these clients and, when needed, provides substance abuse or mental health treatment. But with many of the people she sees, her primary challenge is getting them to embrace counseling as a place where they can set and meet goals, which range from avoiding additional entanglements with the law to getting a child or spouse back to simply fulfilling their probation requirements.

Groves’ clients are often angry and defensive, and she has found that the best way to start is by acknowledging that fact and simply listening to what they have to say. These clients typically believe that no one is interested in their side of the story, Groves says, because they claim that all authority figures — from the police and judges to their lawyers, probation officers and child protective services — refuse to hear them out.

“So if they come into my office and I just say, ‘Tell me your version of what’s going on,’ they may talk for an hour and a half to tell me their perspective,” she says. “Even if it’s not based in reality, it’s something that’s almost magical. They will say, ‘You are the first person who has listened to me.’”

“That doesn’t mean I approve,” Groves continues, “but I’ve built up credit with them, let them know, ‘I understand the position you are in.’”

She says this is something that is important with all of her clients, but particularly with those who tend to be the most defensive and ashamed — mothers who have been referred to counseling by child protective services.

“In our culture, we see parenting as a very private matter,” observes Groves, a member of ACA. “Clients take it very personally. There is typically a lot of anger and denial — ‘The caseworker is picking on me.’ … [Being neglectful of or abusing your children is] hard to admit personally, and socially, it’s also taboo.”

It’s not unusual for parents mandated to counseling to claim that it’s no one’s business how they raise their children, she says. “I help them to recognize that they do have certain rights and privileges as parents and that authority figures only get involved when basic standards have been violated, such as the child has not been coming to school, is poorly groomed or can’t sleep because of all the chaos [from fighting or other disturbances] in the house,” Groves says. “There are standards as a society that we have set: We want [our children] to be clean, we want them to be well-fed. When you come up against those standards, then and only then will authority figures step in.”

However, in addition to helping parents understand the reality of their situation, Groves strives to build cooperation. The shame and embarrassment attached to child protection cases tend to work well as motivating factors because, generally, she says, the clients authentically want to change the situations they are in.

“I’ll say, ‘What I hear is that you really want to get your kids back because if you didn’t care, you wouldn’t have shown up for counseling. So let’s talk about what you need to do. What do you think you need to do?’ It’s different than me saying, ‘You need to do this, you need to do that,’” Groves emphasizes. “Most people, if they’re given a chance to relax and see that I’m not technically a part of the system — I’m not the judge or caseworker but someone who has been brought in to help them [the client] — they will come up with, ‘Well, I guess I need to get my boyfriend straightened out’ or ‘I need to stop drinking.’

“[I’ll say], ‘That’s great. I hope your boyfriend gets straightened out, but he’s not here right now. Let’s talk about what you can do.’”

Groves’ goal is to help her clients understand that they are the ones who need to take specific steps to change their circumstances. “If there is drug or alcohol abuse, they need to get treatment,” she says. “If there is a guy who is being abusive to the kids or abusive to the mom in front of the kids, the mom has to make some tough choices.”

Although her clients are often reluctant to come to counseling, it is typically fairly easy to get them to set goals, Groves says. “Most people will agree with, ‘I want to get authority figures out of my life’ [or] ‘I want to get caseworkers off my back.’ Those goals are not incompatible with counseling,” says Groves, who uses a combination of reality therapy, narrative therapy and motivational interviewing with her clients.

In addition, setting even basic goals can sometimes lead to big changes, Groves points out. “I have a client right now who was a very successful drug dealer who made a lot of money at a young age,” she says. “That worked out well for a while, but then he got caught distributing and is on probation.”

“When he [first] came in [to mandated counseling], he was pretty ticked off about it. He had been making $30K a month, and now he was just making minimum wage,” Groves recounts. “I had to spend a lot of time letting him vent about how unfair it was and just had to help him get to the point that this is where he is now. He has now come to the point that he says it’s nice to not have to look over his shoulder all the time. Because if you’re successful [at dealing drugs], someone else wants to take over or the police are looking for you.”

The man had already been on probation for three years before coming to Groves, so he had spent a good deal of time under scrutiny, getting clean and learning to toe the line, she says. During that time, he had started thinking about what was next in his life and was considering going to college.

“I think he had already been in preparation mode and had already decided that [going to school was] what he would choose because he didn’t want someone else to choose for him,” she says. “So we talked about ‘What are your skills? What are your strengths?’ He went back to college to study business because he recognized he was good at business. We turned that toward legal pursuits, and I think he’s going to be a great businessman.”

Groves also asked the client where he envisioned himself in 10-20 years. In thinking about his answer, the client said he had come to realize that if he hadn’t been caught selling drugs when he was, he likely wouldn’t be around because he would either be dead or in prison.

Groves acknowledges that some mandated clients never embrace the need for change. But she has worked with many others who upon being given tools to help them solve their problems were amazed at the difference it could make.

“I can’t tell you how many people have told me, ‘When I got into trouble, it was the worst day and the best day of my life, because I would never have changed if it weren’t for that,’” Groves says.

She doesn’t attribute those changes entirely to counseling, but she firmly believes that the mere act of giving a person a place to be heard and to regain some agency is powerful.

Creative cooperation

Clients have many reasons to be hesitant in therapy, particularly in the beginning, says private practitioner Suzanne Degges-White, an LPC. Feelings of anxiety, a lack of rapport with the counselor and a sense of shame for even needing counseling can all inhibit clients from opening up, she explains.

Because the therapeutic relationship is so crucial to the counseling process, a counselor cannot go forward without gaining the trust of the client, says Degges-White, a past president of the Association for Adult Development and Aging, a division of ACA. “Being asked to disclose and address topics that may be considered private can be anxiety provoking — scary, unsettling, too intimate for many of us,” she notes.

“Clients who choose to begin counseling are seldom intentionally resistant in such a way that they won’t work on an issue, [but] sometimes they need to know the support is in place if the topic gets too scary or shaky or anxiety provoking,” she says. “By finding a way to open up the relationship, you are going to be able to grow the comfort of the client and help the client feel that you and the process are trustworthy.”

“In straight talk therapy, there is so much ‘quiet’ in the room sometimes, with so much weight felt by the client to say what they ‘should’ be saying or to discuss issues they might not be ready to discuss or even that they don’t have the words to discuss,” Degges-White notes. “Sometimes providing a new method of communication and emotional expression can be exactly what is needed to get over the hurdle that has appeared in a session or a course of treatment.”

From her experience, injecting a dose of creativity into counseling often provides a mode of communication that feels less threatening to clients. For instance, asking clients to recreate their world in a sand tray may help them to more accurately evoke and articulate feelings than they could do with words, she says. Hiding a tiny figure under the sand with a larger figure standing on the mound can represent those things that the client is afraid to or not yet willing to say, she adds.

For example, Degges-White once had a female client in her 40s, and in the first sand tray world she created, she picked a tiny rabbit to represent herself, while her husband was represented by a tiger on a mountain. The client was dealing with being abused and feeling trapped.

“We did five different trays [over the course of the woman’s counseling]. In the end tray, she was an elephant — someone who moved slowly but was powerful and could pull trees down. Her husband was still a tiger, but not on a mountain, and she could handle him,” Degges-White recounts.

The woman was searching for the strength to know that she could live on her own if she wanted to, and she started to take steps toward independence, such as getting her own bank account. Although she was still not ready to leave the marriage because of her children, she had a need to feel like an individual. Once that happened, the client felt stronger and more assured. She and Degges-White went over the process of establishing a safety plan if needed, and the client was even able to have some needed discussions with her husband. The sand tray process had helped the woman overcome her lack of belief that she could, and should, express herself, and it also provided her with a different way of seeing herself, Degges-White says.

Other approaches can also be effective in overcoming clients’ hesitancy and unlocking their concerns, says Degges-White, who has found bibliotherapy to be particularly helpful. “It can be a wonderful way for clients to see their story in action without having to own it quite so personally,” she says. “Counselors can assign readings and movies for a client to read or watch and then ask them to journal afterward in order to process difficult feelings.”

Degges-White gives clients questions to answer when journaling or asks them to react to specific characters or events. For example, “What did it feel like for you when character X did that? Have you ever had a time when you wanted to do what character Y did? What did you think about the scene where the big event happened? What are some times in your life when you’ve had those same feelings?”

Degges-White, also a professor and chair of the Department of Counseling, Adult and Higher Education at Northern Illinois University, cautions that not all clients will be open to creative expression and suggests motivational interviewing as an alternative. But whatever approach a counselor takes, she thinks that normalizing the anxiety and reluctance a client may feel is extremely important.

Degges-White also believes it is useful for counselors to own their therapeutic limitations in the face of missing information. For example, she might tell a client, “It may be more challenging and it might take more time to reach the goals you’ve shared with me if we aren’t able to address all the aspects of the issue that have you stuck.”

At the same time, she says, it is important to let clients know that the counselor will accept them wherever they are in the process. She suggests saying something like, “However, I’m definitely glad you’re here, and I know that it took courage to show up today. So let’s begin where you feel comfortable beginning.”

 

 

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To contact the individuals interviewed for this article, email:

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org