Tag Archives: therapeutic alliance

Healing from multiple personalities

By Todd E. Pressman May 28, 2019

In April 1996, I began a course of psychotherapy with a woman named Angela. She came to the first session with vague feelings of anxiety and the need to “find a safe place.” This seemed usual enough for me after 20-some years in practice. Little did I know that our first meeting was the beginning of one of the most extraordinary therapeutic journeys I would ever encounter.

Although Angela had always suspected something was different about her, she did not realize that she had multiple personality disorder (now called dissociative identity disorder). She only knew that she was filled with fear much of the time and that there were large gaps in her memory.

Early in our work together, Angela had a dream of being in a bicycle repair shop — a wondrous place with huge escalators carrying bicycles here and there to be repaired. After watching many bicycles come in damaged and leave repaired, Angela asked the owner of the shop (me) if all bicycles could be repaired. In the dream, I answered “Yes.” When Angela showed me her own bicycle, which to her seemed hopelessly damaged, my response in the dream was, “There are no bicycles beyond repair.”

This was the message Angela needed to begin her therapeutic adventure. Through the course of her recovery, in which she integrated more than 70 personalities and opened up into one of the most spiritual people I have ever met, I deepened my own conviction that, truly, that are no “bicycles” beyond repair. In other words, there are no souls that cannot be healed and no injuries that cannot transform into a higher level of understanding and peace.

 

Angela’s story

The early part of our work together was simple and straightforward: Angela needed to know that there existed such a thing as “a love that didn’t hurt.” It was hard for her to trust that our therapeutic relationship could be the safe place she was looking for, that she could dare to start whispering family secrets without reprisal, that, together, we could be bigger and stronger than her fears.

Angela began her life as the victim of extreme abuses, as is true for most people with multiple personalities. From the time Angela was 4, her father, whom she trusted like any innocent child would, began sexually abusing her, while her mother stood by in passive compliance. When Angela resisted, her father threatened her, saying the devil would take her away if she did not agree to what he wanted to do and, in fact, if she did not enjoy it. At such a vulnerable age, Angela managed to do the impossible — she held in her screams and learned to say “thank you” and “I love you” in response to these abuses.

As these kinds of extreme torments continued, Angela forced her natural expression of self deeper and deeper down until, one day, she found a new solution: She would “project” herself into a certain picture that was hanging on the wall, a picture of a beautiful angel protecting a little girl and boy. Angela would make herself the little girl and her brother the little boy and bring the angel to life in her mind. She would do this so thoroughly that, for a time, she could live in that picture and escape her torture.

At a certain point in her therapy, Angela felt compelled to chronicle and perhaps publish her story. This served two purposes. First, she would be able to reach out to others — those with multiple personalities and those who simply needed to find their way through emotional struggle. She wanted to offer the help she was finding in her own recovery. Second, sharing her story would be a powerful way to take a stand against the thought that she needed to preserve the family secrets and stay victimized by them. That book, The Bicycle Repair Shop: A True Story of Recovery From Multiple Personality Disorder as Told by Patient and Therapist, became a reality.

In notes that Angela shared with me after the book was published, she provided the rarest of accounts of how the first moment of splitting off (dissociating) occurred:

 

One day, my father’s touches were worse than ever. His huge body pressing against mine was more than I could bear. … The pain grew greater until [the point of] what I thought was my last breath. I felt as if my arms were being yanked, pulling my body from its skin — my insides were separating from my outside to pull my body from the spot where I sat. My legs felt as if they were bolted to the ground. It was as though someone was trying to pull me from the other end out of my skin.

I was surprised to find myself standing in a picture that hung in my bedroom. A picture of a Guardian Angel watching over two children. Where was I? Who was it that was still with my father? I was not aware of what was going on. All I knew was that I was safe. The memory of what was happening before was successfully erased. That was how “four” was born, my first personality of many.

 

This remarkable description shows the adaptive function of multiple personalities: When one personality could no longer stand the circumstance of the moment, a new one would take over. This was the strategy Angela would use to grow her “family within” to help her navigate the abuses she was being exposed to.

 

Meeting Angela’s personalities

Through her therapy, Angela came to understand how each of these personalities was created to fulfill a specific role, protecting her from some unique threat that she could not handle by herself. In this way, she would simply stop “being” Angela and become someone who could better handle the situation.

First, there were “the little ones” — all children — including Four, Six, Schoolgirl and Crystal. Four was the first one I met, an absolutely adorable, sweet little girl who wanted nothing but to feel safe and loved. She was clearly terrified and felt solace only in my presence. When I would go away on vacation, for instance, her pain was so great that she could not tolerate it and would go “underground.”

Crystal, on the other hand, was immune to such pain. She was a beautiful little girl with curly blond hair and bright blue eyes (different in physical appearance than the others). Her strategy was to imagine that she was not, in fact, part of this family. She fully expected that she would be rescued by her “true” family any minute and taken away from the abuses.

Then there was Patrick. He was one of only two male personalities whom I met. In creating Patrick to be gay, Angela was imagining a model of a male who could be gentle, nurturing and safe.

The Boss was the other male personality, and his function was to “control” the children. In manner and even appearance (Angela’s face would change dramatically whenever the Boss showed up), he was like a classic Chicago mob boss. I must confess, I felt rather intimidated by him at the beginning. Later, however, I managed to convince him that I was an ally, someone who could help him find a better way to keep the children in place through understanding and meeting their needs. You can imagine his resistance, but in the end, we became a great team. (At one point, after we became “friends,” the Boss confessed to me in a hushed voice, “I’m working on getting rid of these.” He was referring to Angela’s breasts.) This was one of the rare occasions in which Angela’s external reality and the inner life of her creation did clash. Still, she was working on a “solution” that would enable her to keep her constructed world intact.

Eventually, three personalities came forth as those who would stand “out front”— those who would interact with the world — while the rest stayed inside to manage Angela’s inner experience. Angela, of course, was the primary personality, and she was the one who would take responsibility for handling the affairs of everyday life. Angie, on the other hand, was a party-loving, sexually profligate personality whose purpose was to have a good time and forget all troubles. She was especially skilled at “knowing what men wanted” and used these wiles to get men to do her bidding. At the other extreme was Angel, a spiritual personality who would remind the rest that they were safe and loved in God’s care. Angel would become a most important presence in Angela’s recovery because this spiritual aspect led the way to her final experiences of forgiveness.

At a later point in therapy, a personality was needed to “house” the others in a more neatly integrated whole. This was one of the few times in which I actually witnessed the creation of a new personality. The personality wanted to choose a name for itself that would bring it to life, so to speak, and it came up with Tang — a combination of Todd (my name) and Angela. This, she explained, was the result of my saying to the family, “I need you not to make any decisions without me because I am part of the family” — a necessary prevention against Angela trying to hurt herself or sabotage the therapy in some way.

Tang was a fascinating entity, representing the point at which Angela was 99% integrated. Angela described this sensation as if there were a body inside of her body that almost completely filled her up. There was just “1%” of space between them inside.

She also allowed the little ones at this point to create a magnificent collage. They knew they were about to “disappear” into the one personality that was Tang, and they wanted to be remembered this way. The collage showed what they felt inside: a single body with many faces, some happy, some sad, some shy and some covered with bugs who had been very afraid. Angela once told me that upon my calling Tang’s name, all the eyes of these faces opened up at the same time to look in response.

One by one the personalities came forth to express their need and tell their story. As Angela and I understood their core message, we were able to find a way to meet the need that was more adaptive. This required that Angela bravely face the fears that had been too horrible to withstand in childhood, trusting that it was safe to do so now. Borrowing my strength and trusting my words — that the people and circumstances of these memories could not stop her from standing up to them with my support — she did what she couldn’t dare do back then.

With a new and profound belief in her right to be free, she stood up to the abuses and said “Enough.” One personality even took on the name Shark to show her teeth and “devour” the fear that they represented. As Angela looked at her fears this way, always in manageable doses, she gave herself the message that she was no longer at their mercy, and one by one, the personalities that had been born to manage these fears would fulfill their purpose and integrate back into Angela.

 

Facing fears

With the right combination of safety and support, Angela was able to discover the great secret of all healing: When we face our fears, they lose their power over us. At worst, we find a problem that now can be managed. Often, the fear disappears completely because it can no longer scare us into running away from it. In this way, we find ourselves to be “bigger” than the fear, and so its illusion is exposed. It was but an imagination, given power by our refusal to look at it, with no actual ability to harm our true Self.

This was the freedom that gave Angela the  power to forgive her abusers (there was nothing left to forgive), integrate the personalities (they no longer had a function), and live in a world she now knew to be safe, manageable and, in the end, sometimes even fun.

In writing the book, Angela wanted others to hear the message that facing our fears is the key to freedom, that nothing can rob us of our ability to choose how we respond to life and to declare our right to be who we truly are. With this, we integrate the fractured parts of our own personality and find our own sense of wholeness, completion and fulfillment.

Throughout our work, Angela would repeat to me, “I want to be one of your success stories.” Many times, she felt the way was too difficult, but as I continued to hold a safe place for her, she developed the courage to face her fears one by one, dismantling the entire structure of her constructed “personality” and reclaiming her original innocence and wholeness.

In the end, she discovered that facing her fears made it possible to forgive, not in the sense of merely accepting those who had abused her, but in the much more profound sense of realizing that they, too, were in need of love, and that holding onto her anger and pain simply kept her a perpetual victim of their abuse. Only with this realization was she free to ask for the love she had once known as a little child of 4, and in asking, find that it was, in fact, still available in the world. With this, she was able to integrate that love and become whole again, to replace the path of disintegration into many fragments that she had chosen before. This integration of love, “a love that doesn’t hurt,” awakened a profound sense of spirituality within her. She is now, in fact, one of the most peaceful, loving and spiritual people I know.

 

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Todd E. Pressman has been a licensed psychologist for the past 32 years. He is the founder and director of Pressman and Associates at Logos Wellness in Voorhees, New Jersey. An author and speaker, he co-wrote The Bicycle Repair Shop: A True Story of Recovery From Multiple Personality Disorder as Told by Patient and Therapist with Angela Fisher, who, during the course of her recovery, felt the need to share her story so that it might be of help to “anyone who wants to get free.” Pressman’s forthcoming book, Deconstructing Anxiety: The Journey From Fear to Fulfillment, will be available in August. Contact him at toddpressman@comcast.net or through toddpressman.com.

 

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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.

Remembering Martin Buber and the I–Thou in counseling

By Matthew Martin and Eric W. Cowan May 8, 2019

Counseling research designed to measure therapeutic efficacy has increasingly focused on empirically validated methods and interventions. On the other hand, counselors have long understood the therapeutic relationship to be the most powerful meta-intervention for fostering client change and transformation. Carl Rogers’ No. 1 rule — that the counselor and client must be in psychological contact — is the precondition for all therapeutic movement. As counselors, we must “be someone with” rather than “do something to” the client.

However, the interpersonal process that occurs between counselor and client is difficult to quantify because it possesses intangible qualities that slip through the fingers of measurement and scientific scrutiny. The relationship between counselor and client seems to transcend any particular intervention strategy. The maxim “it is the relationship itself that heals” is an organizing principle to which most counselors subscribe and yet still sometimes forget. In the search for empirically validated methods, are we in danger of losing touch with what matters most in counseling?

Another consideration is the cultural shift that has altered how people communicate, with interpersonal contact becoming increasingly digitized, objectified and packaged in virtual platforms. Will the next generation of counselors still give primacy to the sense of “presence” in the therapeutic relationship that is the heart of counseling? From our perspective, it seems that a counselor’s enhanced capacity for meaningful interpersonal contact is more important than ever.

Philosopher Martin Buber detailed the qualities that characterize a real “encounter,” or I–Thou meeting, between two people. His ideas remain as relevant today as when they helped to shape the humanistic movement in psychology and counseling.

The I-Thou encounter

According to Buber, an interpersonal encounter contains wonderful potential that far exceeds two separate people in conversation. This potential becomes apparent when two people actively and authentically engage each other in the here and now and truly “show up” to one another. In this encounter, a new relational dimension that Buber termed “the between” becomes manifest. When this between dimension exists, the relationship becomes greater than the individual contributions of those involved. This type of meeting is what Buber described as an I–Thou relationship.

The I–Thou relationship is characterized by mutuality, directness, presentness, intensity and ineffability. Buber described the between as a bold leap into the experience of the other while simultaneously being transparent, present and accessible. He used the term “inclusion” to describe this heightened form of empathy. It is a far cry from the now-familiar scene of a group of friends sitting around a table at a restaurant, all gazing into their smartphones.

Buber saw the meeting between I and Thou as the most important aspect of human experience because it is in relationship that we become fully human. When one meets another as Thou, the uniqueness and separateness of the other is acknowledged without obscuring the relatedness or common humanness that is shared. Buber contrasted this I–Thou relationship with an I–It relationship, in which the other person is experienced as an object to be influenced or used — a means to an end. Regrettably, the I–It relationship requires little explanation for anyone living in a cultural frame of absent-mindedness and technological materialism.

The world of I–It can be coherent and ordered — even efficient — but it lacks the essential elements of human connection and wholeness that characterize the I–Thou encounter. The I–It attitude is increasingly depersonalizing and alienating as it becomes structuralized in human institutions. When an extreme I–It attitude becomes embedded in cultural patterns and human interactions, the result is greater objectification of others, exploitation of people and resources, and forms of prejudice that obscure the common humanity that unites us.

Although Buber saw the I–It as an essential pole of human existence, he thought humanity was losing its ability to orient toward the Thou. He emphasized the important balance required between the two poles if humanity was to survive the dangers inherent in the possibility of mutual destruction.

Counselors view the client–counselor relationship as the foundation of all therapeutic growth because it is fundamentally affirming of human connection, validation and participation. In our own small sphere of influence, we are a force for promoting a more compassionate and humanized world. Counselors should keep this in mind even as we strive toward greater technical organization and efficiency within a mental health “service delivery system” that is not entirely compatible with our broader aims.

To exist is to be in relation

Buber rightly understood that human development occurs in a relational context. Human beings are highly social creatures who need love and care from others to survive through infancy and beyond. An absence of these relational needs almost always leads to psychological injury.

Buber called this deep participation with, and acceptance of, another’s essential being “confirmation.” He believed that one’s innate capacity to confirm others, and to be confirmed in one’s own uniqueness by others, is the source of our humanity. The innate subjectivity that unfolds within every human being can begin to be actualized only when it is accurately mirrored in the eyes of another. Confirmation is at the heart of the I–Thou meeting, of human flourishing and of counseling.

Confirmation is similar to the concept of not imposing “conditions of worth” in the relationship. However, confirmation goes a step further by acknowledging the person’s potentialities — what one may become. For example, a child experiences the tension between growth and fear along each step of the developmental path. The parent can either accept the child’s reluctance in the moment or encourage the child to take the leap. At all ages, human thriving is found in these continual moments of confirmation of potentiality from person to person. As a client struggles with making the “growth choice” or the “fear choice,” the counselor invites the client to greater participation, yet expects to bump into the old fears that make such participation fraught for the client.

Unfortunately, we aren’t always as mindful and present as we’d like to be with others, and we ourselves have not been affirmed in the eyes of others as often as we would like. Even the best of us can fall into an I–It orientation with the world, failing to see the other person at all. Buber believed that these “missed meetings” were the ultimate failure of human relationships and resulted in us losing a part of ourselves.

We all desire to be confirmed in our uniqueness, but when we realize that confirmation is not going to happen, we seem to sacrifice true confirmation for mere approval in hopes of preserving our attachment to others. We cultivate the ability to “seem” a certain way to others to elicit approval, but such approval does nothing to nourish our “being.” A person would rather be confirmed in that which he or she is not than chance the possibility of not being accepted at all.

Unfortunately, this “seeming” mask tends to get stuck, and as one hides one’s being in fear, the possibility of an I–Thou relationship is lost. As Buber cautioned, “To yield to seeming is man’s essential cowardice, to resist it is his essential courage.” When the I of the I–Thou relationship is sacrificed for the It orientation of abstracted relation, authentic human growth and connection are lost, and the I begins to wither away.

Healing through meeting

How can we as counselors foster and model I–Thou relationships with our clients and help them avoid the temptation of “seeming” like someone they are not? Buber thought the answer could be found in a process of active imagination that he termed “inclusion.” In this process, the barriers and constrictions that prevent one from being fully present to an I–Thou encounter indicate where the work is to be done. In what ways must the client stay hidden from others and protect his or her own inner thoughts, feelings and fantasies?

In inclusion, one imagines what another person is feeling, thinking and experiencing while standing in relation to them as a Thou. Rogers’ concept of empathy and Buber’s concept of inclusion are similar (in fact, the two of them debated about it). However, inclusion places greater emphasis on the unique subjectivity of the person attempting to understand the other.

The attempt at understanding the subjective inner world of the person is not a one-way street because the counselor must account for his or her own influence upon the client as both participants come into psychological contact. The I–Thou is a relational event that is co-created; it does not fully reside in one participant or the other. The counselor’s ability to mine the riches of the present encounter and wonder “what is happening between us in the immediate moment” expresses Buber’s notion of inclusion.

We as counselors have the ability to confirm our clients through the process of inclusion, providing them with a relationship that can heal the wounds of their past missed meetings. We must stand in relation to our clients as an I to a Thou to successfully inspire them to move from a “seeming” stance to one of greater authentic participation and “being.”

Although empirical methods and interventions are critical in guiding our understanding of best practices, we must not forget that the single most predictive variable in whether counseling is effective is the client’s experience of the counseling relationship itself. Clients deserve to be seen as a Thou. As Buber once said, “In spite of all similarities, every living situation has, like a newborn child, a new face that has never been before and will never come again. It demands of you a reaction that cannot be prepared beforehand. It demands nothing of what is past. It demands presence, responsibility; it demands you.”

Every moment is an opportunity for “healing through meeting.”

 

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Matthew Martin is a graduate of James Madison University’s clinical mental health counseling master’s program. He is currently completing his residency in counseling at the university’s counseling center. Contact him at matthewmartin.rva@gmail.com.

Eric W. Cowan is a professor in the Department of Counseling and Graduate Psychology at James Madison University. He is the author of Ariadne’s Thread: Case Studies in the Therapeutic Relationship. Contact him at cowanwe@jmu.edu.

 

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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.

Counselor self-disclosure: Encouragement or impediment to client growth?

Written and compiled by Bethany Bray January 29, 2019

W. Bryce Hagedorn once counseled a client who was wrestling with intense feelings of shame regarding things he had done during the Vietnam War. The client, a veteran of the U.S. Marine Corps, felt responsible for the soldiers he had lost during combat. He never expressed any details connected to these painful and complicated memories, however, until Hagedorn used a pivotal therapeutic tool: self-disclosure.

Hagedorn is also a Marine Corps veteran who has served in combat. The disclosure of his military service “opened the door to share things that the client had never shared before, even with going to the Department of Veterans Affairs [for treatment] for years. Before he was able to share, he wanted to know if I would be judging him,” says Hagedorn, a licensed mental health counselor and director of the counselor education program at the University of Central Florida.

When used sparingly, professionally and appropriately, counselor self-disclosure can build trust, foster empathy and strengthen the therapeutic alliance between counselor and client. However, counselor self-disclosure also holds the potential to derail progress and take focus off of the client. It is a tool that should be used with care — and in small doses, according to the ethics professionals working at the American Counseling Association (see sidebar, below). Learning how, when or whether to use self-disclosure with clients is best achieved through training, experience and supervision.

Hagedorn notes that once a clinician self-discloses, the client may naturally be inclined to ask questions seeking additional personal information about the counselor. “If you’re going to self-disclose, know ahead of time where your bailout point is,” says Hagedorn, a member of ACA. “Once you open the self-disclosure door, where are you going to stop? When I worked with couples, they could see that I was wearing a wedding ring. I was often asked how long I had been married, if I had kids or if I ever struggled like [the clients were] struggling. Know where you’re going to stop answering questions.”

Hagedorn doesn’t believe that self-disclosure should be an automatic, out-of-the-gate technique for counselor practitioners. Rather, he advises, counselors should consider it a tool to keep in reserve, using it only when appropriate — and with clear intention.

“I’m in favor of less is more with self-disclosure,” Hagedorn says. “If you’re going to self-disclose, you have to do it with dignity and understand the reasons why a client is asking [for personal information from a counselor]. Explain to the client, ‘Even if I have walked down a similar path, it doesn’t mean I have walked down your path.”

 

The many aspects of self-disclosure

Counseling Today recently collected insights about counselor self-disclosure from American Counseling Association members of varied backgrounds and practice settings. Read their thoughts below.

We encourage readers to add their own thoughts to this discussion by posting comments at the bottom of this article.

 

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Kimberly Parrow is a doctoral student at the University of Montana. She is a licensed clinical professional counselor who specializes in working with clients to address grief and posttraumatic growth.

Client comments often spark the urge for self-disclosure. The feelings of connection in a professional counseling relationship tempt counselors to self-disclose, sometimes without warning. I think the consideration of providing personal details to clients occurs regularly [but] believe situations when such disclosures are appropriate are few. Appropriate self-disclosure is client-focused, validates the client’s experience and spurs further exploration. A constructive disclosure is brief, focused on meaning and light on story.

Professional counseling relationships require a harmony of the necessary theoretical and relational components. When the pull to disclose occurs, I take a moment and ask myself three things:

a) Is the disclosure grounded in theory?

b) Is there any other way to keep the locus of the experience within the client’s world?

c) How will the disclosure affect the therapeutic relationship?

For these reasons, I think it is important to keep in mind that the decision to disclose should not be made in the moment. An appropriate disclosure is the product of thoughtful planning.

I once had a young adult client recovering from a tragedy that killed several people and left him clinging to life. Our work began after several months of hospitalization and physical therapy. A number of sessions became focused on his feelings of dissociation regarding his own near-death experience. He would make statements such as, “I almost died, and it feels like I don’t care.” He explained the feeling was getting in the way of connecting with his family and friends. His support people couldn’t understand why he wasn’t more thankful to be alive, and neither could he. Feelings of isolation and confusion were becoming a sticking point in his recovery. He felt alone in a rare experience. However, he wasn’t and isn’t alone; I have had a near-death experience too.

My decision to disclose took several days. The disclosure would be tied to our treatment goals, but keeping the locus on the client was a challenge. A discussion of my experience might be too alluring and could pose a threat to our therapeutic relationship and focus. Eventually I decided on a very brief statement, [saying], “I almost died once too,” and waited for the subject to surface again. When it did, I shared my brief statement. It was simple and powerful. In that moment, he was able to trust that my validation of and explanation for his dissociation was real, because I had also lived it. As a result, our therapeutic bond deepened, and our trauma recovery work gained traction.

 

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Benjamin Hearn is a school-based counselor in Columbia, South Carolina.

Self-disclosure is something that we all do with our clients from the moment we begin interacting with them. Our clothes, offices and other nonverbal communications all disclose things about [us], either intentionally or unintentionally.

Our more common notion of self-disclosure, however, centers on information we share about ourselves verbally with our clients. One piece of information that I have found myself often considering whether to disclose is my identity as a gay male. I most often disclose this information when I have sufficient client rapport and a client voices an incorrect assumption about me, such as asking about my wife. At other times, I may use disclosure to model a healthy gay identity or to promote a sense of similarity between myself and a client.

This latter approach was particularly helpful with a teenage client who had recently come out as gay but did not know other gay people and conceptualized them using common stereotypes. In order to keep the focus on him while disclosing, I framed my disclosure with a question afterward, saying, “I’m not sure if you know this, but I’m also gay and wonder if you see me as fitting within these stereotypes?” This allowed my client to explore differences in gay identities, as well as modeling a secure identity. He noted that he was surprised at how casual I had been in my statement, after which I was able to assist him in exploring reasons that he was anxious about his own disclosure to others.

Regardless of the content being self-disclosed, counselors should consider the possible risks and benefits of disclosure prior to disclosure and how they will keep focus on the client afterward. This can be done by questioning how a client responds to the information or by ending the disclosure using an empathy statement such as, “I remember when my own child left for college. You feel like the house and your life is just emptier.” Though this statement contains a self-disclosure, it is framed in a way that acts as an empathy statement, which the client is then able to evaluate according to their own experience.

Overall, mindful and intentional self-disclosure can act as a powerful technique in the therapeutic relationship [that] can normalize client issues, model healthy behaviors and increase clients’ own self-exploration.

 

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John J. Murphy is a licensed psychologist and professor of psychology and counseling at the University of Central Arkansas. He is the author of the book Solution-Focused Counseling in Schools, published by ACA.

The decision to self-disclose, like any counseling decision, is based on my judgment of its potential to enhance clients’ goals. For me, self-disclosure is never planned but occurs spontaneously, just as it does in other relationships and conversations. Self-disclosure can help convey our humility, humanity and understanding. Research indicates that the most effective counselors are seen by clients as genuine, compassionate and accessible, and self-disclosure can help foster such perceptions.

The following examples of self-disclosure occurred in a psychoeducational group that I led for parents and guardians of children with behavioral difficulties:

  • We started the first meeting by stating that some parents describe parenting as one of the most joyful, gratifying and challenging experiences of their lives. I commented that parenting was much more draining and humbling than I ever expected, adding that “if I made as many mistakes on a job as I do as a parent, I’m pretty sure I’d be fired within a week.” They liked that metaphor and brought it up a few times in subsequent meetings.
  • I made the following comments in a meeting during which a parent stated how hard it was to change her parenting style: “Some of my parenting habits have been really hard to break. One that comes to mind is the use of those short ‘precision requests’ we discussed last week. Even though I teach it to parents, it’s hard for me to do it with my own kids. So, I have these times when I can almost see the words traveling from my mouth toward one of my kids, and I just want to reach out and pull them back before they get there. I’m not sure why I expect these words to work now when they haven’t worked the last 100 times. It’s frustrating and embarrassing.”

Both examples framed the experience of making and accepting mistakes — a valuable skill for any parent — as a shared, inevitable part of any major life journey, parenting or otherwise. While neither example was deeply personal or self-revealing, I hope that acknowledging my own parenting blunders and frustrations helped level the relationship and enhance my approachability.

Self-disclosure, like anything else we do as counselors, is only as useful as clients’ response to it. Obtaining regular client feedback on their experience of the alliance can also help detect a client’s response to self-disclosure and other aspects of our overall counseling style and approach.

 

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Catherine Beckett is an adjunct faculty member in the doctoral counseling program at Oregon State University. She also has a private practice in Portland, Oregon, specializing in grief counseling.

Like many other aspects of counseling, clients are going to have different experiences with different approaches. One question I always ask during the intake process is, “If you have had counseling in the past and it worked well, what was it about the therapist’s approach or style that was positive for you? Or, if it did not work well, were there aspects of the approach or style that contributed?”

Some clients say, “That therapist shared too much; I didn’t like it.” Whereas others may say, “That therapist wouldn’t even answer basic questions about him[self] or herself, and I found it hard to have a relationship with somebody I didn’t know at all.” So, within the bounds of what I believe is ethical and what I feel comfortable with, I will try to be respectful of a client’s preferences in the service of building a positive alliance.

The second principle I have found useful is the practice of requiring myself to have clarity about the purpose of a disclosure prior to making it. I suggest to clinicians whom I supervise that they be able to follow any disclosure with, “The reason I am sharing this is …” This serves two purposes. First, it holds counselors responsible for clarity around intention. Second, it makes the purpose or intention clear to the client, as opposed to — and guards against the possibility of — a disclosure coming across as chitchatty, or as the counselor making the session about him/her.

I also believe that counselors need to be very cautious about using disclosures to convince a client that we understand how she or he feels. Even if we have had an experience similar to what that client is going through, the reality is that we don’t know how she or he feels. We had our own experience, and the experience of our client may be quite different.

 

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John Sommers-Flanagan is a professor of counselor education at the University of Montana and the author of eight books, including Tough Kids, Cool Counseling, published by ACA.

My first thought about self-disclosure is that it’s a multidimensional, multipurpose and creative counselor response (or technique) that includes a fascinating dialectic. On one hand, self-disclosure should be intentional. If counselors aren’t aware that they’re using self-disclosure and why they’re using it, then they’re probably just chatting. On the other hand, self-disclosure should be a spontaneous interpersonal act.

Self-disclosure is an act that involves revealing oneself. As Carl Rogers would likely say, if your words aren’t honest and authentic, then your words aren’t therapeutic. From my perspective — which is mostly person-centered — the purest (but not only) purpose of self-disclosure is to deepen interpersonal connection. As multicultural experts have noted, self-disclosure can facilitate trust more effectively than a blank slate, because transparency helps clients know who you are and where you stand. What’s less often discussed is that it’s impossible to not self-disclose; we’re constantly disclosing who we are through our clothing, mannerisms, informed consent form, office accoutrements and questions.

I remember working with a 19-year-old white, cisgender, heterosexual male. He told me he was diagnosed as having reactive attachment disorder. After listening for 15 minutes, I was convinced that there was no possible way he could meet the diagnostic criteria for reactive attachment disorder. First, I used an Adlerian-inspired question/disclosure: “What if it turned out you didn’t really have reactive attachment disorder?”

You might not consider a question as self-disclosure, but every question you ask doesn’t simply inquire, it simultaneously reveals your interests.

Later, I disclosed directly, using immediacy: “As I sit and listen to all your positive relationships, it makes me think you don’t have reactive attachment disorder.” Despite my interpersonally clever use of an educational intervention embedded in a self-disclosure, my client didn’t budge, countering with, “That doesn’t make any sense, because I’m diagnosed with reactive attachment disorder.”

At that point, I wanted to use self-disclosure to share with him all the ways in which I was a smarter and better health care professional than whoever had originally misdiagnosed him. Fortunately, I experienced a flash of self-awareness. Instead of using disclosure to enhance my credibility, I spontaneously disclosed, “I’ve been talking way too much. I’m just going to put my hand over my mouth and listen to you for a while.”

As I put my hand over my mouth, my client smiled. The rest of the session was — in both our opinions — a rousing success.

 

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Zachary R. Taylor is a licensed professional counselor (LPC) and behavioral health director at a health center in Lexington, Virginia.

I specialize in working with patients who have chronic anxiety and panic, and I regularly disclose that I suffered from these disorders myself for more than 10 years.

The key is being specific about my experiences because many anxious patients feel no one understands what they are going through. Simply saying, “I too was anxious” often doesn’t connect. Instead, I choose specific stories about my many trips to the emergency room, my phobia of checking the mail, the clutching on to my Xanax and my sophisticated driving routes through town to avoid anxiety triggers.

When I share these things, it’s usually out of an effort to normalize their experience and get leverage because, if they know I’ve been there, they’re more likely to accept my help not only as a licensed counselor but also as a former anxiety sufferer who has used these same counseling principles to recover.

Second, I use self-disclosure to reinforce principles we are working on in counseling. For example, to this day, I still experience scary and sometimes tragic images that flash through my mind out of the blue. These used to send me into full-on anxiety spirals, during which I would go through all kinds of safety behaviors to reassure myself that I, and everyone I loved, was OK.

The only real difference between these images then and now is not that the images don’t come back anymore but that I learned how to do things many counselors know as cognitive defusion and psychological flexibility. This is the ability to recognize the imaginary quality of these images and learning how to have the courage to treat them as things I can safely ignore.

This example, in particular, is useful when patients believe every anxious thought, image or sensation and take them as something they need to either respond to or repress. It gives them a new vision that recovery doesn’t mean never having another anxious thought but learning to cope with them when they show up.

However, we must remember there’s a difference between showing patients our psychological scars versus our psychological wounds. There is a significantly greater risk in revealing hurts not yet healed. We must be judicious in self-disclosure, make it brief, always have a clear therapeutic purpose and have a reasonable expectation that the patient can manage the disclosure and that they never feel the need to care for us in the process.

 

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Richard S. Balkin is an LPC and the editor of the Journal of Counseling & Development. He is also a professor and doctoral program coordinator in the Department of Leadership and Counselor Education at the University of Mississippi.

In the second semester of my master’s program, my skills class was taught by a professor who followed a psychoanalytic orientation. She was clear that she would give feedback based on this orientation and that it was OK to reject her feedback as long as we supported any alternative with our understanding of theory. I do not recall any student rejecting her feedback. That being said, I do recall my first session with a client. When the client entered the room, I reached out to shake hands. When reviewing my initial session with the professor and class, I was asked [by the professor] why did I reach out to shake hands? When I indicated I thought that was the polite thing to do, I was told, “That’s about you, not the client.”

I remember being taken aback by this feedback, which seemed to me rather extreme. Not only did I listen to it at the time, but I was influenced by it for many years. Naturally, not shaking hands with the client easily extended to what I could possibly share with a client. If the initiation of a handshake was viewed as countertransference, I could only imagine what my professor would say if I were to self-disclose.

Of course, all of this was challenged in my first year working as a professional counselor, when I worked on a dual diagnosis unit with adolescents. Many members of the multidisciplinary treatment team were active in 12-step support programs, so self-disclosure as a means for teaching about addiction and working together was very natural. More importantly, the adolescents seemed to appreciate the candor and learn something from it.

No doubt, self-disclosure can be helpful, but it can also be self-serving for the counselor, contributing to an unhealthy dynamic in the counseling relationship. If the curative components of counseling truly are based on the counseling relationship, then counselors might do well to consider how self-disclosure will deepen the counseling relationship. In [the ACA-published book] Relationships in Counseling and the Counselor’s Life, my co-author, Jeffrey Kottler, and I mention ways that self-disclosure can be therapeutic, [including] communicating understanding and acceptance and promoting deeper reflection.

 

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Sidney Shaw is an LPC in Anchorage, Alaska, and a core faculty member in the School of Counseling at Walden University.

Researchers often describe two types of self-disclosure: immediate and nonimmediate self-disclosure. Immediate refers to process self-disclosures from the counselor about their own feelings or ways of experiencing the relationship with the client. Nonimmediate self-disclosure or counselor disclosure about their life, personal experiences or biographical information is often what counselors are referring to when they discuss self-disclosure. Immediate and nonimmediate self-disclosure both have potential to deepen the alliance and promote client wellness. That said, there can also be negative effects of indiscriminate self-disclosure. The litmus test of whether or not to engage in self-disclosure is to do so only when it will be therapeutic for the client.

In the spirit of self-disclosure, I’ll share an anecdote about nonimmediate self-disclosure from my own practice. Early in my counseling career, I worked with indigenous communities, and one of my first experiences was to co-facilitate groups on the topic of healthy families and communities. In preparing for the upcoming groups, my supervisor asked me, “Have you thought about what story you are going to share about yourself?” I replied that I had not considered it, and I could feel my anxiety rise as he mentioned it. As a recent counseling graduate, I was highly concerned about negative effects of self-disclosure — e.g., too much emphasis on me, communicating that how I dealt with a situation is how the client should deal with it, etc.

As my supervisor pointed out, and as supported by my subsequent experience and broader research findings on the topic, self-disclosure is frequently an important element of developing trust in working with indigenous clients. One of the groups that I co-facilitated was on the topic of male family relationships. With this in mind, I shared a brief story about my father, how we had been through a long period in which our relationship was conflictual and how we eventually worked to move toward a more harmonious relationship. Cultural context is an important factor to consider in terms of how and to what degree to engage in self-disclosure. Thoughtful and intentional self-disclosure can help counselors build alliances with individual clients and with communities outside of their own.

As counselors, we may initially intend to self-disclose in order to promote client well-being, but self-disclosure can subtly and unwittingly begin to creep toward serving our own needs. The question of whether or not our self-disclosure is therapeutic for the client is not one that counselors should answer in isolation. Ongoing consultation with skilled, wise and competent supervisors and peers is an essential element of helping counselors answer this question.

 

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Caitlyn M. Bennett is a licensed mental health counselor and an assistant professor at the University of North Texas.

One of my areas of clinical expertise is anxiety, especially in adolescents and young adults. Anxiety has a way of making people feel out of control, and oftentimes, clients have told me that they “feel crazy.” Because of this, I have found when processing and making sense of the physiological aspects of anxiety — i.e., racing heart, tightness of chest, etc. — with clients, it can be empowering and validating to self-disclose my personal physical expressions of anxiety.

Prior to this self-disclosure, I find that general psychoeducation about anxiety [and its effects on] the brain and body serves as a catalyst to making sense of anxiety as well as serving as a bit of a normalizing factor. This helps me to gauge whether clients feel connected and understand the physiological impacts of anxiety. For example, their experience of anxiety may not involve as much of the physical experiences. Thus, me expressing my personal physical experiences of anxiety would not be helpful for the client.

After exploring psychoeducation, I begin to encourage clients to share about their personal physical experience of anxiety. If clients have a hard time identifying where in their body they experience anxiety, this is where I introduce self-disclosure by sharing, “When I feel anxious, I may feel my anxiety in my chest or my shoulders tense up. What about for you?”

I have found that this softens and makes exploring anxiety safer and more relatable without taking away from the counseling space being for the client. It also creates an added layer of connectivity for the therapeutic relationship. I have found that some of the most powerful sessions have been when clients feel understood by me as their counselor and also realize that I am only human too.

In all aspects of self-disclosure, I reflect on rapport and encourage my students to do the same. For example, I don’t make it a point to self-disclose prior to establishing a working therapeutic relationship. Self-disclosing prior to creating this relationship may create misunderstanding of what counseling will or will not look like for the client.

It is also important for counselors to remember that self-disclosure can be such a powerful tool. In my personal process of integrating self-disclosure with a particular client, I reflect on the pros and cons of self-disclosure, the difference of impact in emotional (personal feelings) versus content (facts) self-disclosure, the development of the client and multicultural factors. When I have explored this with counselors-in-training, we often focus on using self-disclosure “for good and not for evil.” That is, will the self-disclosure I choose to use be helpful for my client and their process or only benefit myself?

 

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Carol ZA McGinnis is a licensed clinical mental health counselor and approved supervisor. She is a pastoral counselor and clinical director for the AWI Counseling Center at the Fairview United Methodist Church in Phoenix, Maryland, and an associate professor and clinical mental health track coordinator in the graduate counseling program at Messiah College.

As a person-centered [counselor], I rarely self-disclose and only after professional consultation and deep reflection on how that content may be of significant help to the client.

One client who had decided to drop out of high school and pursue her GED received a brief self-disclosure from me at our termination session. I considered the fact that I had dropped out of high school and earned my GED many years prior to completion of my Ph.D. sufficient to disclose. [In doing so, I] meant to encourage and challenge the client to stay the course.

Another client I can recall self-disclosing to was a Muslim adolescent whose parents had asked with concern about my religious orientation. After consultation with my site supervisor and fervent prayer, I decided to disclose my faith tradition along with reiteration of my work that would focus on the client’s beliefs and not my own. It was rewarding to receive a copy of the Koran at our termination session in appreciation from the client and his family.

I do, however, use emotional self-disclosure fairly frequently to validate and normalize client anger. Oftentimes, people who come to me for help with their anger feel shame, guilt or fear, and it has been helpful for them to hear that I am in alignment with them when they report an unfair or unjust event as the source of that emotional response. This disclosure does not include circumstances or stories from my life but instead remains strictly within the realm of emotion in the moment.

One client example of this type of disclosure involved a [client’s] vague memory of an unidentifiable doctor who had engaged in questionable behavior during a medical physical when she was a teenager. The client could not recall what had happened beyond [the doctor’s] request to have her strip naked and do jumping jacks, yet the anger she held toward him was fresh. When this client cursed through tears at this person in the counseling session, I disclosed my own feeling of anger toward this person because he had violated her trust and his professional mandate to act in an ethical manner. Efforts to report this professional were largely unsuccessful due to the client’s blocked memory, yet the client reported feeling affirmed and validated by our work that focused on mitigating that traumatic event.

 

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The ethics of self-disclosure

Practitioners who choose to self-disclose information about their personal lives in counseling sessions often walk a fine line between using it as a tool to connect with clients and diverting attention away from clients and on to themselves.

When used incorrectly, self-disclosure can take focus away from the therapeutic work and the needs of the client. When used appropriately, however, practitioner self-disclosure can build trust, strengthen the therapeutic relationship and help a counselor to express empathy.

So, how much self-disclosure is too much? Practitioners must always put the client first when using any intervention, including self-disclosure, says Joy Natwick, ethics specialist for the American Counseling Association. Counselors should carefully consider their client’s needs and presenting issues and whether the self-disclosure could trigger an issue with which the client struggles, such as excess worry or caretaking behavior, she says.

In addition, self-disclosure should never be used as a response to the counselor’s emotional needs or in situations in which self-disclosure would jeopardize the quality of care to the client, Natwick emphasizes.

Self-disclosure should be regarded as a tool to engage clients and help move them toward their treatment goals. If it would have any other outcome, it is unlikely to be the correct intervention to use, Natwick says.

For additional guidance, consult the following standards in the 2014 ACA Code of Ethics:

  • A.1.a. Primary responsibility
  • A.4.a. Avoiding harm
  • A.4.b. Personal values
  • A.6.b. Extending counseling boundaries
  • B.7. Case consultation
  • C.2.g. Impairment
  • C.6. Public responsibility
  • H.6. Social media
  • I.1.b. Ethical decision making

 

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Related resources from ACA

Books (counseling.org/publications/bookstore)

Counseling Today (ct.counseling.org)

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editorct@counseling.org

 

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

Volcanic adolescence

By Chris Warren-Dickins January 14, 2019

In the early days, Caroline, a 14-year-old girl, started each session with a chin thrust indignantly at her counselor. She wanted to be seen as a warrior, and she offered answers that were blunt as a sledgehammer.

And why should she drop her defenses? She had seen too many adults — teachers, social workers, friends of the family — try to engage with her at first, and then seemingly lose interest. In the end, she felt that she was just an inconvenience to everyone around her. Why should Caroline believe that this counselor would offer a different type of relationship?

With any new client comes the challenge of forming a therapeutic relationship, but when that new client is an adolescent, there are additional factors to consider. Aside from the legal issues of capacity and consent, I discuss 10 of those therapeutic factors below.

 

1) A holistic assessment: It is important to adopt a strengths-based approach to assessment of adolescents. In addition, it is worth reviewing that assessment more regularly than with an adult client because more things are likely to change with a growing adolescent. As Urie Bronfenbrenner pointed out, a young person’s development is the result of a complex system of relationships that constitute the child’s environment. Therefore, assessments of young clients will include their developmental needs, the extent to which caregivers are meeting their needs, and their family and environmental contexts, including the influence that their school and peers have on them. The assessment should also gauge the influence of technology in the young person’s life.

2) Emotional “distance” from problems: As an adolescent, Caroline needs her counselor to appreciate that she does not have the same “distance” as adults experience from their problems. Adolescents have little control over their lives. They have to stay in the same home or school, even if these things might be the source of their depression, anxiety or other presenting issue.

3) Grasp of emotional language: As a 14-year-old, Caroline still has not developed her emotional language, so volcanic eruptions of anger or shoulder shrugs of apparent indifference are her only means of expressing how she feels. We have to see past the shoulder shrugging, which can easily be interpreted as nonchalance, and open ourselves to the possibility that young clients want to express themselves but just don’t know how to yet.

Images are a useful starting point, even if it is just looking at a series of facial expressions to try and help these clients identify the emotions they are experiencing.

4) The dominance of transition: Transition features heavily in adolescents’ lives. Each year, they are at a different stage of educational development and, each year, they experience bodily changes. On top of all of this, their ideas about who they are and how they fit in with their peers and wider society are in a constant state of flux.

At this level of fluidity, a counselor can offer Caroline some sort of stability. One source of this stability can be the therapist’s professional boundaries. The counselor can also offer Caroline the benefit of his or her life experiences, providing a deeper context than Caroline’s young perspective. But the counselor’s older years and life experience do not provide complete insight, no matter what the client’s presenting issues is, so a person-centered approach is crucial. We, as counselors, do not know Caroline’s worldview until we explore it with her, and we have to be careful not to make too many assumptions.

5) Disruption tenfold: It is hard for adolescents to experience so much transition, but it is even harder to manage at the same time as dealing with mental or physical health challenges, a chaotic home life or a sudden major change experienced by the adolescent’s parents (e.g., job loss, divorce, bereavement).

Because of the volcanic eruptions of adolescence, there is a danger that adolescents will become scapegoats in these situations. Just because adolescents may shout the loudest does not mean they are the source of the problems. Often, parents bring their adolescents for therapy, and these adults are completely unwilling to consider that the need for change might also rest on their own shoulders, rather than expecting just the adolescent to change and the whole family dynamic to become settled.

6) Discrimination experienced by minority adolescents: If an adolescent client is a member of the LGBTQ community or is an ethnic minority, it is likely that they have endured some sort of discrimination. If adolescents have to make sense of this — in addition to the transitions they are experiencing in their bodies, at school and at home — it can be challenging to deal with.

Is it any wonder that we sometimes see volcanic behavior in adolescents in the form of outbursts and defiance, screamed at us in a burning rage? If we are to help these youngsters, we have to see past the behavior that spews out like lava. We must dare to imagine what unmet needs might be fueling this volcano.

To help us, we can consider Abraham Maslow’s hierarchy of needs, and we can assess to what extent our adolescent clients may be getting their basic physiological needs met. Perhaps they are hungry, or there is the constant threat of homelessness hanging over them. Or perhaps their basic safety needs aren’t being met because domestic violence is present in the home. We can continue working our way up Maslow’s hierarchy (love/belonging, esteem and, ultimately, self-actualization) to understand what unmet needs may be fueling what appears on the surface to be irrational and unacceptable behavior.

7) Trauma-informed care: If the adolescent has a history of trauma, it is especially important to see past his or her volcanic eruptions of anger. In a 2017 article in Counseling Today about young clients in foster care (“Fostering a brighter future”), Stephanie Eberts states that therapists need to “help these children heal” by acting as a “translator” of the child’s behavior: “This includes explaining what a child’s behavior means and what motivates it, and then equipping both the child and the parents … with tools to redirect the behavior and better cope with tough emotions.”

8) Testing (to discover and take reassurance from) the boundaries: Adolescents may test boundaries more than adult clients do. Modeling behavior is important, and this is where congruence comes into play. If young clients are constantly pushing the boundaries by turning up late to sessions or missing them entirely, you can communicate the resulting emotion you are experiencing as a result of their behavior.

I like to think of this like a sonar device: Young clients are checking to see if you are still emotionally there and whether they are also still present in the interaction. You can share this with young clients, showing that certain behavior has consequences. Then you can jointly look for a way to resolve the matter.

Psychotherapist Rozsika Parker wrote about parents’ relationships with their children, but the following statements could apply equally to counselors and their young clients. Young clients “need to learn that they have an impact, that it’s possible to hurt” an adult, but it is also possible to “make it up with them.” Parker encourages adults to “show joy, hate, love, satisfaction — the full range of emotions — that will help the child to know themselves.” Parker wrote that she “heard the same note of reproach in their wails when they teethed, as in the studied criticism of me they could launch as teenagers.”

9) The resistant adolescent: As with any resistant client, adolescents need to feel that they are choosing to be in the sessions. But what happens if they are given no choice? If a therapist is working with a young client and the client’s family, and the young client chooses to leave the session early, what should the approach be?

I have heard some therapists adopt the following approach: They tell young clients that they are free to return to the session at any time but that the session will continue with the other family members. I quite like this approach because it avoids sessions becoming hijacked and held hostage by young clients, which might be a parallel process to other times in which these young clients have held more power than they knew how to handle. For example, they might have been forced to adopt a parental role with a younger sibling, or even a neglectful parent, at an inappropriately young age.

10) Mindfulness and meditation: I have seen and heard some of the criticisms of mindfulness and meditation. I struggle with this because, when I was starting out in this profession, my mentors raved about mindfulness and meditation. I need to see where this debate goes, but in the meantime, I cannot help but believe that there might be some value in mindfulness and meditation in our work with young clients.

Everything we offer our clients involves a balancing act between thoughts, feelings and bodily sensations. Society is built to engage the thinking side of our awareness, and this casts a shadow over our feelings and bodily sensations. Yet all three are important sources of information. If we focus solely on our thoughts, we are arguably functioning at only a third of our capacity. Short and simple mindfulness or meditation exercises can help young clients tap all sources of information, while also giving them a moment of relief from the constant demands of life.

 

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Chris Warren-Dickins is a licensed professional counselor in Ridgewood, New Jersey. Contact him through his website at exploretransform.com.

 

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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.

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.

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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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