Use your The Skilled Helper text to read the following:
Chapter 8, “The Action Arrow: Right From the Beginning Help Clients Turn Talk Into Life-Enhancing Action,” pages 231–268.
The following articles will be helpful as you consider different perspectives of identity and how they might inform your work with clients. These will be especially helpful to you as you work through upcoming discussions and assignments.
Use the Capella library to read the following:
Iwamoto, D. K., Negi, N. J., Partiali, R. N., & Creswell, J. W. (2013). The racial and ethnic identity formation process of second-generation Asian Indian Americans: A phenomenological study. Journal of Multicultural Counseling and Development, 41(4), 224–239.
Tynes, B. M., Umaña-Taylor, A. J., Rose, C. A., Lin, J., & Anderson, C. J. (2012). Online racial discrimination and the protective function of ethnic identity and self-esteem for African American adolescents. Developmental Psychology, 48(2), 343–355.
Torres, V., Martinez, S., Wallace, L. D., Medrano, C. I., Robledo, A. L., & Hernandez, E. (2012). The connections between Latino ethnic identity and adult experiences. Adult Education Quarterly, 62(1), 3–18.
We all have a cultural identity that is constantly being reshaped and redefined. Theorists say we construct these self-concepts and identities ourselves—yet, self-identification occurs within the context of various social and cultural forces. It is crucial for those in the human services field to develop a keen understanding of this dynamic relationship between self-concept and the social-cultural context in which it is shaped.
Click Introduction to Cultural Identity to view a presentation to find where you are in the process.
This activity will help you achieve the following learning components:
Examine the problem management process for working with clients.
Analyze identity models to inform communication and collaboration with clients.
[u05d1] Unit 5 Discussion 1
Applying Identity Models
Research an article that features an identity model that aligns with your own identity. Using the article, do the following:
Summarize the identity model you selected.
Evaluate how you relate to the identity model based on your own experiences.
Explain how your own identity might come into play when working with a client group.
Cite your article using current APA style and formatting.
INTRODUCTION TO CULTURAL IDENTITY
Introduction to Cultural Identity
What defines Cultural Identity for each one of us varies on our background. In other words, what are the specific influences on an individual that helps one identify with a particular culture.
There are many broad influences, like the cultural values, beliefs, and norms in which we are living. The dominant language spoken will help others identify with a particular culture. Our nationality and world view is all dependent on family influences.
What race were we raised in? What were our ancestor’s life experiences? What are the genetics that go into making us who we are? The geography in which we are living will also help create a culture that we identify with.
Acculturation is something that we are able to develop over time and feel like we fit in, or belong to a particular group; whether it’s a racial group, ethnic group, or nationality.
Family rules, which are often unspoken, help determine how we view ourselves in light of the greater culture that we are living.
Our religious upbringing also has influences on our particular Cultural Identity.
Individual influences vary greatly. The ethnic group, your socioeconomic statis, your gender, your political beliefs, your sexual orientation, your ableism—or your ability to function like the rest of the culture—your spirituality, and even age are all individual influences on your cultural development.
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this is just the reading for the assingment do no have to read every thing Licensed under a Creative Commons Attribution 3.0 Li
Find Ways of Helping Clients Move to Life-Enhancing Action LO 8.2 There are many ways to help clients not only move to action but also, more generally, to develop the bias toward action described in Chapter 3. Two kinds of client action are important. First, the behaviors related to the client’s participation in the helping process itself. To what degree is the client an active participant? Second, the behaviors related to problem-management and opportunity-development outcomes. To what degree does the client pursue life-enhancing outcomes in his or her daily life? Obviously both are important. But in some ways it is possible for a client to be a “good participant,” say, in exploring problem situations and setting goals without doing whatever is necessary to pursue and accomplish these goals. What follows is a number of ways you can help clients pursue and achieve life-enhancing outcomes. Help Clients Discover the Value of Action Intentions In the research literature these are called “implementation” intentions because they are often associated with implementing plans to achieve goals. Mere commitment to goals and plans to achieve them is not enough. Commitment must be accompanied or followed by commitment to the courses of action needed to accomplish these goals. Gollwitzer and associates (Achtziger, Gollwitzer, & Sheeran, 2008; Bayer & Gollwitzer, 2007; Gollwitzer, 1999; Gollwitzer & Sheeran, 2006; Oettingen & Gollwitzer, 2010; Webb & Sheeran, 2006) have researched a simple way to help clients cope with the common problems associated with translating goals into action—failing to get started, becoming distracted, reverting to bad habits, and so forth. Even strong commitment to goals is not enough. Equally strong commitment to specific actions to accomplish goals is required. Good intentions, Gollwitzer and associates point out, do not deserve their poor reputation. Strong intentions—“I strongly intend to study for an hour every weekday before dinner”—are “reliably observed to be realized more often than weak intentions” (p. 493)….Implementation intentions are subordinate to goal intentions and specify the when, where, and how of responses leading to goal attainment. They have the structure of “When situation x arises, I will perform response y!” and thus link anticipated opportunities with goal-directed responses. (p. 494) Consider the case of Gwendolyn, an aide in a nursing home who is reviewing the way she attends to the needs of difficult or abusive patients. Gwendolyn says to herself, “When Enid [a patient] becomes abusive, I will not respond immediately. I’ll tell myself that it’s her illness that’s talking. Then I’ll respond with patience and kindness.” Her ongoing goal is to control her anger and other negative responses to patients. However, Gwendolyn keeps pursuing this goal by continually refreshing her strong implementation intentions. Because Enid has been a particularly difficult patient, Gwendolyn needs to refresh her intentions frequently. However, her initial strong intention to substitute anger and impatience with kindness and equanimity means that in most cases her responses are more or less automatic. The environmental cue—patient anger, abuse, lack of consideration, and whatever—triggers the appropriate response in Gwendolyn. In a way, poor patient behavior provides cues or opportunities for her responses. You can help clients enunciate to themselves strong specific intentions that will help them almost automatically move into goal-accomplishing action. For instance, the person trying to manage his or her weight gets the menu in the restaurant and automatically looks for the right kind and amount of food. “I’ll have the vegetarian entrée, thank you.” The research being done on implementation intentions has great pragmatic value with respect to translating goals into accomplishments. Commitment intentions can take place anywhere in the helping process, even right at the beginning. Toward the end of the first counseling session that was going nowhere, one client—in response to my (GE) saying, “I’m not sure where we’re going here so I’m not sure what I can do to help”—paused and then said, “It’s not you, it’s me. I’m not prepared for what we’re doing. I’d like to think about what I need to talk about, what I fear, what I’m afraid to learn about myself. Then I’d like to come back next week and start over. I want to be ready. Is that OK?” And he did return ready to work. Help Clients Overcome Procrastination At the other end of the spectrum are clients who keep putting action off. The gap between knowing and doing (Kegan & Lahey, 2010; Pfeffer & Sutton, 2000) has been with us from time immemorial and will probably remain with us till the earth disappears. “Competing agendas” can stand in the way of change. We have too many things to do and tend to do the things we want to do instead of the things we should do. This is a form of procrastination. Kegan and Lahey take this concept further. They talk about how clients’ “hidden commitments” stand in the way of change. For instance, a principal thinks that she should get out of her office and into classrooms more often, but she never finds the time. What hidden commitments might keep her from changing her behavior? Well, she might be afraid of what she will find in any given classroom. But what hidden commitment stands in the way? The school has a “comfortable” faculty culture that she might disrupt. Or she might be afraid of going into math and science classroom because math and science are not her forte. She may be shown up. What’s her hidden commitment? Authority figures should stay on the pedestal. This is important for order in the institution. We all have hidden commitments that keep us from changing. So do our clients. We need to challenge ours and help clients become aware of and challenge theirs. There are many other reasons for procrastination (Ferrari, 2010; Ferrari, Johnson, & McCowan, 1995; Pychyl, 2010). Each person has his or her set of factors that create what Kegan and Lahey call their personal “immunity to change.” Many clients procrastinate because they focus on the short-term pain of moving into action even when they can clearly see the long-term benefits of doing so. Take the case of Eula. Eula, disappointed with her relationship with her father in the family business, decided that she wanted to start her own. She thought that she could capitalize on the business skills she had picked up in school and in the family business. Her goal, then, was to establish a small software firm that created products for the familybusiness market. But a year went by and she still did not have any products ready for market. A counselor helped her see two things. First, her activities—researching the field, learning more about family dynamics, going to information technology seminars, getting involved for short periods with professionals such as accountants and lawyers who did a great deal of business with family-owned firms, drawing up and redrafting business plans, and creating a brochure—were helpful, but they did not produce products. The counselor helped Eula see that at some level of her being she was afraid of starting a new business. She had a lot of half-finished products. Over preparation and half-finished products were signs of that fear. So she plowed ahead, finished a product, and brought it to market on the Internet. To her surprise, it was successful. Not a roaring success, but it meant that the cork was out of the bottle. Once she got one product to market, she had little problem developing and marketing others. Eula certainly was not lazy. She was very active. She did all sorts of useful things. But she let herself become a victim of what Andreou (2007) calls “second-order” procrastination. Second-order procrastination is procrastinating on implementing a solution to procrastination itself. Eula avoided getting around to accomplishing the most critical actions—creating and marketing products. The opposite of procrastination is a sense of urgency that leads to timely problem-managing action. Kotter (2008) suggests that change, and this applies to personal change, does not start, continue, or “stick” without a sense of urgency. But he distinguishes between true and false urgency. The former means doing the right things in a timely way. False urgency refers to activity, even intense activity, which goes nowhere. It looks like urgency but isn’t the real thing. Partnoy (2012) suggests that not all forms of procrastination are bad. Delaying decisions and actions gives clients time to think more carefully about possible unintended consequences of acting, especially the consequences of acting too quickly. So Partnoy suggests that there is good procrastination and bad—but perhaps this is something that most of us already know. Help Clients Identify Unused Resources That Can Facilitate Action We need to find ways of helping clients substitute “I can’t” with “I can” and “I can” with “I will.” One way is help them identify unused resources that facilitate action. Nora found it extremely depressing to go to her weekly dialysis sessions. She knew that without them she would die, but she wondered whether it was worth living if she had to depend on a machine. The counselor helped her see that she was making life more difficult for herself by letting herself think such discouraging thoughts. He helped her learn how to think thoughts that would broaden her vision of the world instead of narrowing it down to herself, her discomfort, and the machine. Nora was a religious person and found in the Bible a rich source of positive thinking. She initiated a new routine: The day before she visited the clinic, she began to prepare herself psychologically by reading from the Bible. Then, as she traveled to the clinic and underwent treatment, she meditated slowly on what she had read. In this case, the client substituted positive thinking, an underused resource, for poor-me thinking. Brainstorming resources that can counter obstacles to action can be very helpful for some clients. Helping clients brainstorm facilitating forces raises the probability that they will act in their own interests. In our view one of the most underused action-focused resources in counseling is insight. When a client says something like “For the first time I really understand how counterproductive my sarcastic humor is,” we fail him or her if we do not help him change his style. Insights that remain just that, insights, are lost opportunities. Or consider this case: A manager I (GE) was coaching came to me after attending a lecture I gave on leadership. He said, “It hit me like a ton of bricks when you said that one of the main reasons discussions of leadership are so muddled is the failure to distinguish between headship and leadership. Headship is positional. Leadership is about results beyond the ordinary. Many heads are not leaders at all.” He went on to say, “I realized in an instant that I have been trying to use organizational politics to climb the ladder, to get better and better positions. How cheap! How phony! Leadership is about company-enhancing innovation. Boy, do I have to change my approach. I’m good at innovation but I haven’t done much about it.” We went on to discuss much more concretely what he was going to do. He concluded, “If I exercise leadership, then the positions will come.” In this case the helper provided the insight but the client turned the insight into an action. One of the best things you can do is to help clients turn useful insights into action. Help Clients Find Incentives and Rewards for Action Clients avoid engaging in action programs when the incentives and the rewards for not engaging in the program outweigh the incentives and the rewards for doing so (Pink, 2009). The counselor in this case thinks that he is justified in taking a tough confrontational approach to helping. Miguel, a police officer on trial for use of excessive force with a young offender, had a number of sessions with a counselor from an HMO that handled police health insurance. During the sessions, the counselor learned that although this was the first time Miguel had run afoul of the law, it was in no way the first expression of a brutal streak within him. He was a bully on the beat and a despot at home, and had run-ins with strangers when he visited bars with his friends. During the trial, witnesses recalled instances of these behaviors. Up to the time of his arrest, he had gotten away with all of this, even though his friends had often warned him to be more cautious. His badge had become a license to do whatever he wanted. His arrest and now the trial shocked him. Before, he had seen himself as invulnerable; now, he felt very vulnerable. The thought of being an ex-cop in prison understandably horrified him. He was found guilty, was suspended from the force for several months, and received probation on the condition that he continues to see the counselor. Beginning with his arrest, Miguel had modified his aggressive behavior a great deal, even at home. Of course, fear of the consequences of his aggressive behavior was a strong incentive to change. The next time, the courts would show no sympathy. The counselor took a tough approach to this tough cop. He confronted Miguel for “remaining an adolescent” and for “hiding behind his badge.” He called the power Miguel exercised over others “cheap power.” He challenged the “decent person” to “come out from behind the screen.” He told Miguel point-blank that the fear he was experiencing was probably not enough to keep him out of trouble in the future. After probation, the fear would fade and Miguel could easily fall back into his old ways. Even worse, fear was a “weak man’s” crutch. On a more positive note, the counselor saw in Miguel’s expressions of vulnerability the possibility of a much more decent human being, one “hiding” under the tough exterior. The real incentives, he suggested, came from the “decent guy” buried inside. He had Miguel paint a picture of a “tough but decent” cop, family man, and friend. He had Miguel come up with “experiments in decency”—at home, on the beat, with his buddies—to get first-hand experience of the rewards associated with decency. The counselor was not trying to change Miguel’s personality. Indeed, he did not believe in personality transformations. But he pushed him hard to find and bring to the surface a different, more constructive set of incentives to guide his dealings with people. The new incentives had to drive out the old. This counselor’s approach seems to run up against a lot that has been said about responsible helping. What is your view? If you were Miguel’s counselor, what approach would you take? The incentives and rewards that help a client get going on a program of constructive change in the first place may not be the ones that keep the client going. The counselor asked him to visit the children’s ward. Dwight was both shaken by the experience and amazed at the courage of many of the kids. He was especially struck by one teenager who was undergoing chemotherapy. “He seems so positive about everything,” Dwight said. The counselor told him that the boy was tempted to give up, too. Dwight and the boy saw each other frequently. Dwight put up with the pain. The boy hung in there. Three months later, the boy died. Dwight’s response, besides grief, was, “I can’t give up now; that would really be letting him down. I’ve got to keep my part of the bargain.” Dwight’s partnership with the teenager proved to be an excellent incentive. It helped him renew his resolve. Although the counselor joined with Dwight in celebrating his newfound commitment, he also worked with Dwight to find “backup” incentives for those times when current incentives seem to lose their power. Constructive-change activities that are not rewarded tend over time to lose their vigor, decrease, and even disappear. This process is called extinction. It was happening with Luigi. Luigi, a middle-aged man, had been in and out of mental hospitals a number of times. He discovered that one of the best ways of staying out was to use some of his excess energy helping others. He had not returned to the hospital once during the three years he worked at a soup kitchen. However, finding himself becoming more and more manic over the past six months and fearing that he would be sent back to the hospital, he sought the help of a counselor. Luigi’s discussions with the counselor led to some interesting findings. He discovered that, whereas in the beginning he had worked at the soup kitchen because he wanted to, he was now working there because he thought he should. He felt guilty about leaving and also thought that doing so would lead to a relapse. In sum, he had not lost his interest in helping others, but his current work was no longer interesting or challenging. As a result of his sessions with the counselor, Luigi began to work for a group that provided housing for the homeless and the elderly. He poured his energy into his new work and his manic episodes subsided. The lesson here is that incentives cannot be put in place and then be taken for granted. They need tending. Help Clients Develop Action-Focused Self-Contracts Self-contracts—that is, contracts that clients make with themselves—can also help clients commit themselves to new courses of action. Although contracts are promises clients make to themselves to behave in certain ways and to attain certain goals, they are also ways of making goals more focused. It is not only the expressed or implied promise that helps but also the explicitness of the commitment. Consider the following example, in which one of Dora’s sons disappears without a trace. About a month after one of Dora’s two young sons disappeared, she began to grow listless and depressed. She was separated from her husband at the time the boy disappeared. By the time she saw a counselor a few months later, a pattern of depressed behavior was quite pronounced. Although her conversations with the counselor helped ease her feelings of guilt—for instance, she stopped engaging in self-blaming rituals—she remained listless. She shunned relatives and friends, kept to herself at work, and even distanced herself emotionally from her other son. She resisted developing images of a better future, because the only better future she would allow herself to imagine was one in which her son had returned. Some strong challenging from Dora’s sister-in-law, who visited her from time to time, helped jar her loose from her preoccupation with her own misery. “You’re trying to solve one hurt, the loss of Bobby, by hurting Timmy and hurting yourself. I can’t imagine in a thousand years that this is what Bobby would want!” her sister-in-law screamed at her one night. Afterward, Dora and the counselor discussed a “recommitment” to Timmy, to herself, to the extended family, and to their home. Through a series of contracts, she began to reintroduce patterns of behavior that had been characteristic of her before the tragedy. For instance, she contracted to opening her life up to relatives and friends once more, creating a much more positive atmosphere at home, encouraging Timmy to have his friends over, and so forth. Contracts worked for Dora because, as she said to the counselor, “I’m a person of my word.” When Dora first began implementing these goals, she felt she was just going through the motions. However, what she was really doing was acting herself into a new mode of thinking. Contracts helped Dora in both her initial commitment to a goal and her movement to action. In counseling, contracts are not legal documents but human instruments to be used if they are helpful. They often provide both the structure and the incentives some clients need. Even self-contracts have a shadow side. There is no such thing as a perfect contract. Most people don’t think through the consequences of all the provisions of a contract, whether it is marriage, employment, or self-contracts designed to enhance a client’s commitment to goals. And even people of goodwill unknowingly add covert codicils to contracts they make with themselves and others— “I’ll pursue this goal—until it begins to hurt” or “I won’t be abusive—unless she pushes me to the wall.” The codicils are buried deep in the decision-making process and only gradually make their way to the surface. Earlier we discussed self-contracts as a way of helping clients commit themselves to what they want—that is, their goals. Self-contracts are also useful in helping them both initiate and sustain problem-managing action and the work involved in developing opportunities. Self-contracts and agreements with others focus clients’ energies. Sherman and her associates (2008) point out the obstacles to getting family, spouses, partners, and friends to provide support for veterans with PTSD. Family members shy away for a number of reasons: no one has enlisted their help, they live too far away, they have unchallenged beliefs such as “what goes on behind closed doors is not to be discussed,” they are reluctant to make an effort to understand the veteran, and they fear being exposed to upsetting information. Spouses and partners have misgivings about engaging in formal programs, feel hopeless about the veteran’s ability to improve, become resigned to being lifelong caregivers, and feel that most of their attention should be given to their children. Perhaps the main problem with social support is that it does not happen automatically. Involved parties—client, helper, and others— have to make it happen. In some sense of the terms relevant parties need to be enrolled. Karlan (2008) demonstrates the power of commitment contracts. His website (www.stickK.com) allows people to set a goal, determine the stakes for not pursuing the goal, choose a referee to determine if progress is being made, and get supporters’ help in staying on target. Public commitment works. If you share your change agenda “with the world,” it is easier to move forward and harder to give up. Transparency helps. The StickK system tends to work because it provides incentives that work with most people. The principles Karlan outlines—goal setting, putting stakes at risk, an objective referee, and transparency can, with some adaptation, be used in therapy. In the following case, several parties had to commit themselves to the provisions of a commitment contract. A boy in the seventh grade was causing a great deal of disturbance by his outbursts in class, which included verbal jousting with his friends and profanity. The apparent purpose of the disruptions was to position himself among his friends. He seemed to want to cultivate a reputation for being unafraid of the teachers and the principal. The punishments handed down by them were dwarfed by what he saw as the admiration of his friends. After the teacher discussed the situation with the school counselor, the counselor called a meeting of all the stakeholders—the boy, his parents, the teacher, and the principal. The counselor offered a simple contract. When the boy disrupted the class, he would spend the next day working by himself under the direction of a teacher’s aide. This would take him away from his friends. The day after, he would return to the classroom. There would be no further punishment. Concurrently, the counselor would work with him on what “leadership” behavior in the classroom might look like. The first month, the boy spent a fair number of days with the teacher’s aide. The second month, however, he missed only 2 days, and the third month only 1. The truth is that he really wanted to be in school with his classmates. That’s where the action was. And so he paid the price of self-control to get what he wanted. He also began to discover more constructive forms of leadership behavior. For instance, on occasion he challenged what the teacher was saying about a particular topic. Sometimes this led to a very lively classroom debate. Even the teacher thought that the boy’s behavior was responsible and added value. The counselor had suspected that the boy found socializing with his classmates rewarding. But now he had to pay for the privilege of socializing. Reasonable behavior in the classroom was not too high a price. This was more than just a self-contract. Other stakeholders were involved. Getting others involved increases the likelihood that progress toward the goal will be made. The more you know about the power of incentives, the more clients will benefit. Help Clients Find and Utilize Action-Focused Social Support As we will see, planning includes helping clients identify the resources, both internal and environmental, they need to pursue goals. One of the most important resources is social support (Barker & Pistrang, 2002; Seeman, 1996; Taylor, 2007; Taylor and associates, 2004), though, surprisingly enough, research to verify the usefulness of social support is skimpy (Cruza-Guet and associates, 2008; Hogan, Linden, & Najarian, 2002; Roehrle & Strouse, 2008), highlighting once more the not infrequent necessity of common sense to outpace “science.” Lakey (2010) contends that despite the need for an understanding of social support on the part of helpers, the helping professions “still lack sufficient understanding of social support processes to create effective, new interventions” (p. 177). The starting point for understanding social support is the client and his or her relationship with the support provider. The kind and quality of the relationship has, perhaps, the most influence when it comes to social support (Lakey, 2010). So-called objectively supportive people or actions are actually so only if they are perceived to be so by the client. How people provide support is also critical in the eyes of the recipient. Sometimes “supportive” people, especially those with “good intentions,” wonder why they are being shunned by those they are trying to support. Yet most practitioners see social support as a key element in problem-managing change. Social support has … been examined as a predictor of the course of mental illness. In about 75% of studies with clinically depressed patients, social-support factors increased the initial success of treatment and helped patients maintain their treatment gains. Similarly, studies of people with schizophrenia or alcoholism revealed that higher levels of social support are correlated with fewer relapses, less frequent hospitalizations, and success and maintenance of treatment gains. (Basic Behavioral Science Task Force of the National Advisory Mental Health Council, 1996, p. 628) While helpers themselves can provide a great deal of support, still, if clients are to pursue goals “out there” in their real lives, their main support should also be out there. Unfortunately, such support may not always be easy to find (Putnam, 2000). In North American society, the supply of “social capital”—both informal social connectedness and formal civic engagement—has fallen. We belong to fewer organizations that conduct meetings, know our neighbors less, meet with friends less frequently, and even socialize with our families less often. Yet this is the environment in which clients must do the work of constructive change. In a study on weight loss and maintaining the loss (Wing & Jeffery, 1999), clients who enlisted the help of friends were much more successful than clients who took the solo path. This is called “social facilitation” and is quite different from dependence. Social facilitation is energizing, whereas dependence is often limiting and depressing. Therefore a culture of social isolation does not bode well for clients. Of course, all of this reinforces what we already know through common sense. Who among us has not been helped through difficult times by family and friends? When it comes to social support, there are two categories of clients. First, there are those who lead an impoverished social life. The objective with this group is to help them find social resources, to get back into community in some productive way. But what about clients who do have people they can turn to? Well, as Putnam points out, even when clients, at least on paper, have a social system, they may not use it very effectively. This provides counselors with a different challenge—that is, helping clients tap into those human resources in a way that helps them manage problem situations more effectively. Consider this example. Casey, a bachelor whose job involved frequent travel literally around the world, fell ill. He had many friends, but they were spread around the world. Because he was neither married nor in a marriage-like relationship, he had no primary caregiver in his life. He received excellent medical care, but his psyche fared poorly. Once out of the hospital, he recuperated slowly, mainly because he was not getting the social support he needed. In desperation, he had a few sessions with a counselor, sessions that proved to be quite helpful. The counselor challenged him to “ask for help” from his local friends. He had underplayed his illness with them because he didn’t want to be a “burden.” He discovered that his friends were more than ready to help. But because their time was limited, he, with some hesitancy, “grafted” onto his rather sparse hometown social network some very caring people from the local church. He was fearful that he would be deluged with piety, but instead he found people like himself. Moreover, they were, in the main, socially intelligent. They knew how much or how little care to give. In fact, most of the time their care was simply an exercise of friendship. Casey was likeable. What about those who are less likeable? The National Advisory Mental Health Council study just mentioned showed that people who are highly distressed and therefore most in need of social support may be the least likely to receive it because their expressions of distress drive away potential supporters. Who among us has not avoided at one time or another a distressed friend or colleague? Therefore distressed clients can be helped to learn how to modulate their expressions of distress. Who wants to help whiners? On the other hand, potential supporters can learn how to deal with distressed friends and colleagues, even when these friends and colleagues let themselves become whiners. Help Clients Find People Willing to Challenge Them to Act In Chapter 7 we discussed how counselors can invite clients to challenge themselves in constructive ways. But therapists can also help clients look for these “invitations” on their own in their day-to-day lives. Review Chapter 7 which deals with invitations to self-challenge. Support without challenge can be hollow just as challenge without support can be abrasive. Ideally, the people in the lives of clients can provide a judicious mixture of encouragement and challenge. Harry, a man in his early 50s, was suddenly stricken with a disease that called for immediate and drastic surgery. He came through the operation quite well, even getting out of the hospital in record time. For the first few weeks he seemed, within reason, to be his old self. However, he had problems with the drugs he had to take following the operation. He became quite sick and took on many of the mannerisms of a chronic invalid. Even after the right mix of drugs was found, he persisted in invalid-like behavior. Whereas right after the operation he had “walked tall,” he now began to shuffle. He also talked constantly about his symptoms and generally used his “state” to excuse himself from normal activities. At first Harry’s friends were in a quandary. They realized the seriousness of the operation and tried to put themselves in his place. They provided all sorts of support. But gradually they realized that he was adopting a style that would alienate others and keep him out of the mainstream of life. Support and encouragement were essential, but not enough. They used a variety of ways (some included a bit of dark humor) to invite Harry to challenge himself to stay on the road to recovery. They mocked his “invalid” movements, engaged in serious one-to-one talks, turned a deaf ear to his discussion of symptoms, and routinely including him in their plans. Harry did not always react graciously to his friends’ challenges, but in his better moments he admitted that he was fortunate to have such friends. He died three years later, but because of the challenges of his friends, he lived quite a full life until the end. Counselors can support clients in their search for people willing to provide a judicious mixture of encouragement and challenge. Use Feedback as a Way of Helping Clients Move to Life-Enhancing Action Feedback was identified in Chapter 1 as one of the key ingredients of successful therapy (Lambert, 2010a). Feedback on progress toward problem-managing outcomes at the beginning of each therapy session and on the quality and value of the interactions during therapy at the end of each session is a principal contributor to client action throughout the helping process. If therapy is ultimately defined by life-enhancing outcomes, then two-way feedback within the session is crucial. Feedback helps both client and therapist engage in course correction. Dorner’s (1998) research found that successful project managers reviewed their progress, looked for unanticipated and unintended consequences, and corrected course often. The same could be said of clients and their helpers. Feedback from significant others in clients’ everyday lives also goes far in helping them start acting on their own behalf and persevere even when the going gets rough. Gilbert (1978, p. 175), in his book on human competence, claimed that “improved information has more potential than anything else I can think of for creating more competence in the day-to-day management of performance.” Feedback is certainly one way of providing both encouragement and challenge. If clients are to be successful in implementing their action plans, they need adequate information about how well they are performing. If goals and the path to these goals are clear, clients will know whether they are making progress or not. But sometimes clients need a more objective view of their progress. The purpose of feedback is not to pass judgment on clients’ performance but rather to provide information, guidance, support, and challenge to help them move forward. There are two kinds of feedback. Confirmatory feedback Through confirmatory feedback, significant others—such as helpers, relatives, friends, and colleagues—let clients know that they are on course; that is, moving successfully through the steps of an action program toward a goal. Corrective feedback Through corrective feedback, significant others let clients know that they have wandered off course and specify what they need to do to get back on. Corrective feedback, whether from helpers or people in the client’s everyday life, should incorporate the following principles: Help clients to give feedback to themselves. Give feedback in the spirit of caring. Remember that mistakes are opportunities for growth. Use a mix of both confirmatory and corrective feedback. Be concrete, specific, brief, and to the point. Focus on the client’s behaviors rather than on more elusive personality characteristics. Help clients see whether their behavior is helping or hindering their movement toward problem management of opportunity development. Help clients explore the impact and implications of the behavior. Avoid negative language arising from impatience (“Gee, that was a stupid thing to do!”). Provide feedback in moderate doses. Overwhelming the client defeats the purpose of the entire exercise. Engage the client in dialogue. Invite the client not only to comment on the feedback but also to expand on it. Lectures do not usually help. Help the client discover alternative ways of doing things. If necessary, make suggestions. Help clients explore the upside of changing and the downside of not changing. The spirit of these “rules” should also govern confirmatory feedback. Very often people give very detailed corrective feedback and then just say “nice job” when a person does something well. All feedback provides an opportunity for learning. Consider the following statement from a father talking to his son, who stood up for the rights of a friend who was being bullied by some of his high school classmates: Paul, I’m proud of you. You stood your ground even when they turned on you. They were mean. You weren’t. You gave your opinion calmly, but forcefully. You didn’t apologize for what you were saying. You were ready to take the consequences. It’s easier now that a couple of them have apologized to you, but at the time you didn’t know they would. You were honest to yourself. And now the best of them appreciate it. It made me think of myself. I’m not sure that I would have stood my ground the way you did (he pauses), but I’m more likely to do so now. Although not as brief, this is much more powerful than “I’m proud of you, son.” Being specific about behavior together with pointing out the impact of the behavior turns positive feedback into an action-focused learning experience. Of course, one of the main problems with feedback is finding people in the client’s day-to-day life who see the client in action enough to make it meaningful, who care enough to give it, and who have the skills to provide it constructively. Help Clients Use Checklists as a Way of Initiating Directional Action A lot of jokes have been made about people who let checklists, often ignored, rule their lives. One obsessive artist even made a list of his lists. Gawande (2010) showed how the use of the checklist reduced the number of medical errors in hospitals and saved thousands of lives. In his book he ties to show the value of checklists in many other areas of life. Though he has his critics (Howard, 2010) and the overuse of checklists can be stultifying, they can be very useful in therapy. To-do lists can help clients move into action, stay the course, and even change the course when necessary. Howard rightly cautions that checklists can stand in the way of creativity: “If [clients] are thinking about a checklist, they may not be focused on solving the problem” (p. A21). What he is really saying, however, is that the misuse or overuse of any methodology is often self-defeating. In therapy, a to-do list reminds clients of the importance of action and progress. Clients who stay in the driver’s seat use to-do lists rather than becoming captives of them. Help Clients Identify Possible Obstacles to Action Years ago Kurt Lewin (1969) codified common sense by developing what he called “force-field analysis.” In ordinary language, this is simply a review by the client of the major obstacles to and the major facilitating forces for implementing action plans. The slogan is “forewarned is forearmed.” The identification of possible obstacles or restraining forces to the implementation of a program helps forewarn clients. Raul and Maria, a childless couple living in a large Midwestern city, had been married for about five years and had not been able to have children. They finally decided that they would like to adopt a child, so they consulted a counselor familiar with adoptions. The counselor helped them work out a plan of action that included helping them examine their motivation, reviewing their suitability to be adoptive parents, contacting an agency, and preparing themselves for an interview. After the plan of action had been worked out, Raul and Maria, with the help of the counselor, identified two possible obstacles or pitfalls: the negative feelings that often arise on the part of prospective parents when they are being scrutinized by an adoption agency and the feelings of helplessness and frustration caused by the length of time and uncertainty involved in the process. The assumption here is that if clients are aware of some of the “wrinkles” that can accompany any given course of action, they will be less disoriented when they encounter them. Identifying possible obstacles is, at its best, a straightforward exploration of likely pitfalls rather than a self-defeating search for every possible thing that could go wrong. Obstacles can come from within the clients themselves, from others, from the social settings of their lives, and from larger environmental forces. Once an obstacle is spotted, counselors can help clients identify ways of coping with it. Sometimes simply being aware of a pitfall is enough to help clients mobilize their resources to handle it. At other times a more explicit coping strategy is needed. For instance, the counselor arranged two role-playing sessions with Raul and Maria in which she assumed the role of the examiner at the adoption agency and took a “hard line” in her questioning. These rehearsals helped them stay calm during the actual interviews. The counselor also helped them locate a mutual-help group of parents working their way through the adoption process. The members of the group shared their hopes and frustrations and provided support for one another. In short, Raul and Maria were trained to cope with the restraining forces they might encounter on the road toward their goal. Help Clients Deal with Inertia Inertia is the human tendency to put off problem-managing action. I sometimes say to clients who I suspect are prone to inertia something like this, “The action program you’ve come up with seems to be a sound one. The main reason that sound action programs do not work, however, is that they are never tried. Do not be surprised if you feel reluctant to act or are tempted to put off the first steps. This is quite natural. Ask yourself what you can do to get by that initial barrier.” The sources of inertia are many, ranging from pure sloth to paralyzing fear. Understanding what inertia is like is easy. We need only look at our own behavior. The list of ways in which we avoid taking responsibility is endless. We will examine several of them here: passivity, learned helplessness, disabling selftalk, getting trapped in vicious circles, and disorganization. Passivity One of the most important ingredients in the generation and perpetuation of the “psychopathology of the average” is passivity, the failure of people to take responsibility for themselves in one or more developmental areas of life or in various life situations that call for action. Passivity takes many forms: doing nothing—that is, not responding to problems and options; uncritically accepting the goals and solutions suggested by others; acting aimlessly; and becoming paralyzed— that is, shutting down or becoming violent, blowing up (see Schiff, 1975). When Zelda and Jerzy first noticed small signs that things were not going right in their relationship, they did nothing. They noticed certain incidents, mused on them for a while, and then forgot about them. They lacked the communication skills to engage each other immediately and to explore what was happening. Zelda and Jerzy had both learned to remain passive before the little crises of life, not realizing how much their passivity would ultimately contribute to their downfall. Endless unmanaged problems led to major blowups until they decided to end their marriage. Passivity in dealing with little things can prove very costly. Little things have a way of turning into big things. Learned helplessness Seligman’s (1975, 1991) concept of “learned helplessness” and its relationship to depression is an important one (Garber & Seligman, 1980; Peterson, Maier, & Seligman, 1995). Some clients learn to believe from an early age that there is nothing they can do about certain life situations. There are degrees in feelings of helplessness—from mild forms of “I’m not up to this” to feelings of total helplessness coupled with deep depression. Learned helplessness, then, is a step beyond mere passivity. Bennett and Bennett (1984) saw the positive side of helplessness. If clients’ problems are indeed out of their control, then it is not helpful for them to have an illusory sense of control, unjustly assign themselves responsibility, and indulge in excessive expectations. Somewhat paradoxically, they found that challenging clients’ tendency to blame themselves for everything actually fostered realistic hope and change. The trick is helping clients learn what is and what is not in their control. A man with a physical disability may not be able to do anything about the disability itself, but he does have some control over how he views his disability and his power to pursue certain life goals despite it. The opposite of helplessness is “learned optimism” (Seligman, 1998) and resourcefulness. If helplessness can be learned, so can resourcefulness. Indeed, increased resourcefulness is one of the principal goals of successful helping. Optimism, however, is not an unmixed blessing; nor is pessimism always a disaster (Chang, 2001). Although optimists do live longer and enjoy greater success than pessimists, pessimists are better predictors of what is likely to happen. The price of optimism is being wrong a lot of the time. Perhaps we should help our clients be hopeful realists rather than optimists or pessimists. Disabling self-talk Inviting clients to challenge their dysfunctional self-talk was discussed earlier. Clients often talk themselves out of things, thus talking themselves into passivity. They say to themselves such things as “I can’t do it,” “I can’t cope,” “I don’t have what it takes to engage in that program; it’s too hard,” and “It won’t work.” Such self-defeating conversations with themselves get people into trouble in the first place and then prevent them from getting out. Helpers can add great value by helping clients challenge the kind of self-talk that interferes with action. Vicious circles Pyszczynski and Greenberg (1987) developed a theory about self-defeating behavior and depression. They said that people whose actions fail to get them what they want can easily lose a sense of self-worth and become mired in a vicious circle of guilt and depression. Consequently, the individual falls into a pattern of virtually constant self-focus, resulting in intensified negative affect, self-derogation, further negative outcomes, and a depressive self-focusing style. Eventually, these factors lead to a negative self-image, which may take on value by providing an explanation for the individual’s plight and by helping the individual avoid further disappointments. The depressive self-focusing style then maintains and exacerbates the depressive disorder. (p. 122) It does sound depressing. One client, Amanda, fits this theory perfectly. She had aspirations of moving up the career ladder where she worked. She was very enthusiastic and dedicated, but she was unaware of the “gentleman’s club” politics of the company in which she worked and didn’t know how to “work the system.” She kept doing the things that she thought should get her ahead. They didn’t. Finally, she got down on herself, began making mistakes in the things that she usually did well, and made things worse by constantly talking about how she “was stuck,” thus alienating her friends. By the time she saw a counselor, she felt defeated and depressed. She was about to give up. The counselor focused on the entire “circle”— low self-esteem producing passivity producing even lower self-esteem—and not just the self-esteem part. Instead of just trying to help her change her inner world of disabling self-talk, he also helped her intervene in her life to become a better problem solver. Small successes in problem-solving led to the start of a “benign” circle—success producing greater self-esteem leading to greater efforts to succeed. Disorganization Tico lived out of his car. No one knew exactly where he spent the night. The car was chaos, and so was his life. He was always going to get his career, family relations, and love life in order, but he never did. Living in disorganization was his way of putting off life decisions. Ferguson (1987, p. 46) painted a picture that may well remind us of ourselves, at least at times. When we saddle ourselves with innumerable little hassles and problems, they distract us from considering the possibility that we may have chosen the wrong job, the wrong profession, or the wrong mate. If we are drowning in unfinished housework, it becomes much easier to ignore the fact that we have become estranged from family life. Putting off an important project—painting a picture, writing a book, drawing up a business plan—is a way of protecting ourselves from the possibility that the result may not be quite as successful as we had hoped. Setting up our lives to insure a significant level of disorganization allows us to continue to think of ourselves as inadequate or partially-adequate people who do not have to take on the real challenges of adult behavior. Many things can be behind this unwillingness to get our lives in order, like defending ourselves against a fear of succeeding. Driscoll (1984, pp. 112–117) has provided us with a great deal of insight into inertia. He described it as a form of control. He says that if we tell some clients to jump into the driver’s seat, they will compliantly do so—at least until the journey gets too rough. The most effective strategy, he claimed, is to show clients that they have been in the driver’s seat all along: “Our task as therapists is not to talk our clients into taking control of their lives, but to confirm the fact that they already are and always will be.” That is, inertia, in the form of staying disorganized, is itself a form of control. The client is actually successful, sometimes against great odds, at remaining disorganized and thus preserving inertia. Once clients recognize their power, then we can help them redirect it. Help Clients Deal with Entropy: The Tendency of Things to Fall Apart Entropy is the tendency to slow down and give up action that has been initiated. Kirschenbaum (1987), in a review of the research literature, uses the term “self-regulatory failure.” Programs for constructive change, even those that start strong, often dwindle and disappear. All of us have experienced problems trying to implement programs. We make plans, and they seem realistic to us. We start the steps of a program with a good deal of enthusiasm. However, we soon run into tedium, obstacles, and complications. What seemed so easy in the planning stage now seems quite difficult. We become discouraged, flounder, recover, flounder again, and finally give up, rationalizing to ourselves that we did not want to accomplish those goals anyway. False hopes Under the rubric of “false hopes of self-change,” Polivy and Herman (2002) suggest that this scenario occurs all too frequently. Perhaps it is even the norm in self-change programs such as dieting, which they use as their point of reference. At the center of the false-hope syndrome, they say, are the clients’ unrealistic expectations. They refer to things like New Year’s Eve resolutions. Most of us can immediately think of many of our own resolutions that fell by the wayside. Fletcher (2003), Lowe (2003), and Snyder and Rand (2003) all quite vigorously challenge Polivy and Herman’s findings and even the concept of “false hopes.” They say that the authors paint an overly pessimistic picture of self-change programs, especially dieting. That makes a priori sense if we consider outcome research in helping. When it comes to counseling, if we start with the premise that helping does help, then the kind of pessimism that Polivy and Herman suggest must be wrong. Right? Well, let’s take a look. We have already seen that hope and expectancy, on the part of both client and helper, are key ingredients in successful therapy. But substantive change is hard work. Even “true hope” can grow grey hairs in the face of adversity. That said, we should be able to help clients spot “false hopes” in their search for problem-managing outcomes. Expectancy is an ally only when it is realistic. We therapists will run across both true hopes and false hopes in our practice, but we will encourage the former and help clients challenge the latter. Even if the work of Polivy and Herman is as flawed as its critics say—and by the way, how could something so flawed end up in the American Psychologist?—there is something about it that rings true. Discretionary change The track record of discretionary change—change that is not forced in one way or another—on the part of both individuals and institutions is poor. This is my read of individuals (including ourselves), companies, institutions, and countries. The change may not actually be discretionary, but if it is seen, at whatever level of consciousness, as discretionary. If we think we do not have to change, then often we do not, even though we say we want to. In my (GE) work with organizations, I talk about the Okavango-Kalahari phenomenon. When the waters from the highlands in the north flood into the Okavango Delta in Botswana, it becomes an ecological wonderland. But somehow those waters disappear into the Kalahari Desert, though hydrologists do not know exactly how. I ask the managers, “Does this sound like any of your change programs?” They laugh. “Where’s that management development program you started so vigorously two years ago?” “In the Kalahari!” shouts one. I’m not sure that I have the Okavango-Kalahari hydrology right, but the challenge of discretionary change will always be with us. As you sit with clients, how much of the change being discussed is discretionary? “Forewarned is forearmed” is realism, not pessimism. The decay curve Phillips (1987, p. 650) identified what he called the “ubiquitous decay curve” in both helping and in medical-delivery situations. Attrition, noncompliance, and relapse are the name of the game. A married couple trying to reinvent their marriage might eventually say to themselves, “We had no idea that it would be so hard to change ingrained ways of interacting with each other. Is it worth the effort?” Their motivation is on the wane. Wise helpers know that the decay curve is part of life and help clients deal with it. With respect to entropy, a helper might say, “Even sound action programs begun with the best of intentions tend to fall apart over time, so do not be surprised when your initial enthusiasm seems to wane a bit. That’s only natural. Rather, ask yourself what you need to do to keep yourself at the task.” Brownell and her associates (1986) provided a useful caution. They drew a fine line between preparing clients for mistakes and giving them “permission” to make mistakes by implying that mistakes are inevitable. Preparation, yes; permission, no. They also made a distinction between “lapse” and “relapse.” A slip or a mistake in an action program (a lapse) need not lead to a relapse—that is, giving up the program entirely. Consider Graham, a man who has been trying to change what others see as his “angry interpersonal style.” Using a variety of self-monitoring and self-control techniques, he has made great progress in changing his style. On occasion, he loses his temper, but never in any extreme way. He makes mistakes, but he does not let an occasional lapse end up in relapse. Help Clients Avoid Imprudent Action For some clients, the problem is not that they refuse to act but that they act imprudently. Rushing off to try the first strategy or tactic that comes to mind is often imprudent. Elmer injured his back and underwent a couple of operations. After the second operation he felt a little better, but then his back began troubling him again. When the doctor told him that further operations would not help, Elmer was faced with the problem of handling chronic pain. It soon became clear that his psychological state affected the level of pain. When he was anxious or depressed, the pain always seemed much worse. Elmer was talking this through with a counselor. One day he read about a pain clinic located in a western state. Without consulting anyone, he signed up for a 6-week program. Within 10 days he was back, feeling more depressed than ever. He had gone to the program with extremely high expectations because his needs were so great. The program was a holistic one that helped the participants develop a more realistic lifestyle. It included activities that focused on such things as nutrition, stress management, problem solving, and quality of interpersonal life. Group counseling was part of the program, and training was part of the group experience. For instance, the participants were trained in behavioral approaches to the management of pain. The trouble was that Elmer had arrived at the clinic, which was located on a converted farm, with unrealistic expectations. He had bought a “packaged” program without studying the package carefully. Because he had expected to find marvels of modern medicine that would magically help him, he was extremely disappointed when he found that the program focused mainly on reducing and managing rather than eliminating pain. Elmer’s goal was to be completely free of pain, but he failed to explore the realism of his goal. A more realistic goal would have centered on the reduction and management of pain. Elmer’s counselor failed to help him avoid two mistakes— setting an unrealistic goal and, in desperation, acting on the first strategy that came along. Obviously, action cannot be prudent if it is based on flawed assumptions— in this case, Elmer’s assumption that he could be pain free. Understand How Reluctance and Resistance Are Obstacles to Action LO 8.3 Helpers inevitably run into clients who are reluctant to engage in the often hard work needed to bring about problem-managing change. Helpers also encounter clients who not only drag their feet in the helping process but, sometimes vigorously, “push back” against any kind of helping at all or parts of the helping process. This is resistance. In these pages a distinction is made between reluctance and resistance although these two terms are often used interchangeably in the literature. Learning how to deal with “difficult” clients in general and with reluctance and resistance (both yours and the client’s) is an essential set of skills (Bonelli, 2017, https://www.brightlocal.com/2017/05/09/how-to-handle-difficult-clients/; Brodsky & Titcomb, 2013; Chapman & Rosenthal, 2016; Clay, 2017; Sullivan, 2014; Yep-Martin, http://blog.time2track.com/working-with-challenging-clients-in-psychotherapy). See Reluctance as Misgivings about Change The seeds of reluctance are in the client. Managing problem situations and spotting and developing unused opportunities is hard work and the rewards for that work are not always immediately evident. Karl knows that he needs to get back into community. He talks to Laura about actions he thinks he should take such as reestablishing some kind of relationship with his local church, but he is slow in getting around to doing it. He talks the talk, but he keeps finding reasons for not walking the walk. Being slow to seek help or accept help when it is offered is an early form of reluctance. Vogel, Wester, and Larson (2007) outline the main reasons why, in terms of the beliefs, troubled people avoid helping in the first place. Here are some common beliefs: “Society looks down on those who seek help” (of course, some members of society do). “The whole experience will be too emotionally painful.” “Counseling probably won’t help me very much.” “I’ll have to reveal all my dark secrets.” “My family and friends will see me as odd.” “I’ll be embarrassed and feel worse about myself than I do now.” For those who do work up the courage to see a helper, reluctance refers to their hesitancy to engage in the work demanded by the tasks of the helping process. Problem management and opportunity development involve a great deal of work. Therefore there are sources of reluctance in all clients—indeed, in all human beings. A great deal of effort may be involved in trying to rehabilitate or save a failing marriage. Conquering an addiction is hard work. Some people “give up” smoking dozens of time before finally succeeding. Unused opportunities also provide challenges. Developing unused opportunities means venturing into unknown waters. Although this is a charming idea for some, it strikes something akin to terror in others. Socially shy clients often enough choose living a lonely life than taking even small steps toward establishing real friendship. One client who acquired dozens of “friends” on Facebook but never met any of them in person became deeply depressed over her “make-believe” social life. She referred to herself as an “Internet fraud.” Clients exercise reluctance in many, often covert, ways. They talk about only safe or low-priority issues, seem unsure of what they want, benignly sabotage the helping process by being overly cooperative, set unrealistic goals and then use them as an excuse for not moving forward, do not work very hard at changing their behavior, and are slow to take responsibility for themselves. They tend to blame others or the social settings and systems of their lives for their troubles and play games with helpers. Or they do not come for counseling in the first place. For instance, Tim is reluctant to join his wife in her sessions with a counselor. He says that he’ll “think about it,” that he doesn’t feel “any real need” to talk to a counselor, that right now the demands of his job are too pressing and that he can’t “find the time” for the sessions, and so forth. Deep down he’s afraid of what might happen were he to go. There are many ways clients drag their feet. We need only to reflect our own experience. Reluctance to change is normal. Reluctance also admits of degrees; clients come “armored” against change to a greater or lesser degree. The reasons for reluctance are many. They are built into the human condition. Here is a sampling. Fear of intensity If the counselor uses high levels of tuning in, listening, sharing empathic highlights, and probing, and if the client cooperates by exploring the feelings, experiences, behaviors, points of view, and intentions related to his or her problems in living, the helping process can be an intense one. This intensity can cause both helper and client to back off. Skilled helpers know that counseling is potentially intense. They are prepared for it and know how to support a client who is not used to such intensity. They certainly know when to back off. Lack of trust Some clients find it very difficult to trust anyone, even a most trustworthy helper. They have irrational fears of being betrayed. Even when confidentiality is an explicit part of the client-helper contract, some clients are very slow to reveal themselves. A combination of patience, encouragement, and invitations to self-challenge is demanded of the helper. Fear of self-exploration Some people fear self-disclosure because they feel that they cannot face what they might find out about themselves. The client feels that the façade he or she has constructed, no matter how much energy must be expended to keep it propped up, is still less burdensome than exploring the unknown. Such clients often begin well but retreat once they start to be overwhelmed by the data produced in the problem-exploration process. Digging into one’s inadequacies always leads to a certain amount of disequilibrium, disorganization, and crisis. But breakthroughs and growth often take place at crisis points. That said, a high degree of disorganization immobilizes the client, whereas very low disorganization is often indicative of a failure to get at the client’s core concerns. By inviting clients to take “baby steps” that do not end in disaster, counselors help clients build confidence. Shame Shame is a much overlooked variable in human living (Bradshaw, 2005; Brown, 2007; Kaufman, 1989; Lynd, 1958; M. Miller, Retrieved 2008; Myers, 2017; Nathanson, 1987). Dearing and Tangney (2011) have edited a book that looks at shame from many different points of view. Shame can be an important part of disorganization and crisis. The root meaning of the verb to shame is “to uncover, to expose, to wound,” a meaning that suggests the process of painful self-exploration. Shame is not just being painfully exposed to another; it is primarily an exposure of self to oneself. In shame experiences, particularly sensitive and vulnerable aspects of the self are exposed, especially to one’s own eyes. Shame is often sudden—in a flash, the client sees heretofore unrecognized inadequacies without being ready for such a revelation. Shame is sometimes touched off by external incidents, such as a casual remark someone makes, but it could not be touched off by such insignificant incidents unless, deep down, one was already ashamed. A shame experience might be defined as an acute emotional awareness of a failure to be in some way. Farber and Shon (2007) observe that shame is often an obstacle to frank discussions of sexuality: “Sexuality is the least extensively disclosed theme in psychotherapy and the second least discussed item within marriage….Even the relative safety and the near-absolute confidentiality of the therapist’s office are not sufficient at times to overcome the shame in discussing this most personal issue” (p. 230). Of course, empathy and support help clients deal with whatever shame they might experience. But shame is not limited to issues concerning sexuality. It is often an issue in clients with substance-abuse problems (Potter-Efron, 2011) and PTSD disorders (Herman, 2011). Laura realizes early on that Karl felt deeply ashamed about letting down his comrades, the army, and his country. He covered this over with a great deal of bravado, but when he was counseled to accept an honorable discharge, he felt strangely relieved because he know he “deserved” to be let go. The diversity issue makes helping clients deal with reluctance more difficult. Research findings on one population do not automatically transfer to another (Furukowa & Hunt, 2011). Some individuals or even populations may well be glad to share the most intimate details of their personal lives without experiencing any shame or other debilitating emotion. On the other hand, some more conservative cultures abhor the thought of discussing intimate issues. Recall the guidelines for dealing with diversity outlined in Chapter 3. The cost of change Some people are afraid to take stock of themselves because they know, however subconsciously, that if they do, they will have to change— that is, surrender comfortable but unproductive patterns of living, work more diligently, suffer the pain of loss, acquire skills needed to live more effectively, and so on. For instance, a husband and wife may realize, at some level, that if they see a counselor, they will have to reveal themselves and that once the cards are on the table, they will have to go through the agony of changing their style of relating to each other. Some clients come with the assumption that counseling is magic and are put off when change proves to be hard work. In cases like this, counselors need to help clients see that the outcomes are worth the effort. It took one client several years to quit smoking, but when she finally did so she told everyone who would listen, “I just love the sense of freedom I have now. I was a prisoner, but now I’m free. Why did I wait so long?” We know why. A loss of hope Some clients think that change is impossible, so why try? A man in his 60s, a participant in a counseling group, complained about constant anxiety. He had given up hope. How could anyone who had been treated as brutally as he was by his father have any hope? Running away from home was just the beginning. He kept running from hope the rest of his life. But after being challenged by both helper and his fellow participants, he rediscovered hope and, with it, self-responsibility. He no longer focused on the “scars” inflicted by his father’s mistreatment. He no longer focused on the self-inflicted scars of a life lived irresponsibly. He found hope in both the care he experienced in the group and the life struggles revealed by the other participants. He found hope in community. This is just a sampling. We need only to look at our own struggles with growth, development, and maturity to add to the list. See Resistance as Reacting to Coercion Clients who resist tend to think that they are being forced to do something. They may even want to engage in therapy or in some therapeutic exercise, but feel that their helpers are demanding participation rather than inviting them to participate. When Laura suggested that Karl use the feedback surveys, Karl said no because he experienced her invitation as a demand. Later on he told her that at the time he felt that she was more or less saying, “Be a good boy and fill these surveys out for me.” Of course that was not Laura’s intention, but she in no way tried to impose the surveys on him. There were other collaborative ways of introducing feedback into the helping process. Reacting to perceived mistreatment Clients who think that they are being mistreated by their helpers in some way tend to resist. Clients who believe that their cultural beliefs, values, and norms—whether group or personal—are being violated by the helper can be expected to resist. Resistance is the client’s way of fighting back (Dimond et al., 1978; Driscoll, 1984). Spouses who feel forced to come to marriage counseling sessions are often resistant. They resist because they resent what they see as a power play. Tony gets angry when his wife suggests that he come with her to her counseling sessions. Knowing that she has talked this over with her mother, he feels that he is the focus of a conspiracy. They are looking for ways to coerce him to go. “I don’t care what happens, but they’re not going to get me,” are his sentiments. Of course, some clients see coercion where it does not exist. But because people act on their perceptions, the result is still some form of covert or open fighting back. Resistant clients, feeling abused, let everyone know that they have no need for help, show little willingness to establish a working relationship, and often enough try to con counselors. They are often resentful, make active attempts to sabotage the helping process, or terminate the process prematurely. They can be either testy or actually abusive and belligerent. Resistance to helping is, of course, a matter of degree, and not all resistant clients engage in extreme forms of resistance behaviors. Involuntary clients Involuntary clients (Brodsky, 2011)—sometimes called “mandated” clients—are often resisters. A high school student gets into trouble with a teacher and sees being sent to a counselor as a form of punishment. A felon receives probation on the condition of being involved in some kind of counseling process. A manager accused of sexual harassment keeps his job only if he agrees to a series of counseling sessions. Clients like these are found in schools, especially schools below college level, in correctional settings, in marriage counseling, especially if it is court-mandated, in employment agencies, in welfare agencies, in court-related settings, and in other social agencies. But any client who feels that he or she is being coerced or treated unfairly can become a resister. Clients can experience coercion in a wide variety of ways. The following kinds of clients are often resistant. Clients who see no reason for going to the helper in the first place. Clients who resent third-party referrers (parents, teachers, correctional facilities, and social service agencies) and whose resentment carries over to the helper. Clients who do not know what helping is about and fear the unknown. Clients who have a history of rebelliousness. Clients who see the goals of the helper or the helping system as different from their own. For instance, the goal of counseling in a welfare setting may be to help clients become financially independent, whereas some clients may be satisfied with financial dependency. Clients who have developed negative attitudes about helping and helping agencies and who harbor suspicions about helping and helpers. They do not trust “shrinks.” Clients who believe that going to a helper is the same as admitting weakness, failure, and inadequacy. They feel that they will lose face by going. By resisting the process, they preserve their self-esteem. Clients who feel that counseling is something that is being done to them. They feel that their rights are not being respected. Clients who feel a need for personal power and find it through resisting a powerful figure or agency. “I may be relatively powerless, but I still have the power to resist” is the subtext. Clients who dislike their helpers but do not discuss their dislike with them. Clients who differ from their helpers about the degree of change needed. Clients who differ greatly from their helpers—for instance, a poor kid with an older middle-class helper. Kiracofe and Wells (2007) object to mandated or disciplinary counseling, at least in educational institutions, on both professional and ethical grounds. For instance, they claim that disciplinary counseling muddies the issue of self-responsibility: “An implied assumption of the mandatory referral is that disruptive behavior can be managed and changed as a result of regular counseling sessions. This assumption, in effect, removes the responsibility for behavior change from the student and places it on the counseling process” (p. 263). They offer a set of strategies for judicial action based on disruptive students’ readiness for change that are aligned with Prochaska’s readiness for change stages outlined in Part III. Student misconduct is not going to go away and both teachers and administrators have been traditionally too ready to pass the buck. Kiracofe and Wells’s article calls for a more professional debate and a systemic solution. Many sociocultural variables—gender, prejudice, race, religion, social class, upbringing, cultural and sub cultural blueprints, and the like—can play a part in resistance. For instance, a man might instinctively resist being helped by a woman and vice versa. An African American person might instinctively resist being helped by a white person and vice versa. A person with no religious affiliation might instinctively think that help coming from a minister will be “pious” or will automatically include some form of proselytizing. In the end it’s your job to spot resistance and work with the client to determine what is causing it. Healthy resistance Of course, resistance can be a healthy sign. It can mean that clients are standing up for their rights and fighting back. Koenig (2011) makes an excellent point. Although he is talking about patients who resist the recommendations of medical doctors, what he says applies also to therapy clients. Resistance creates an opportunity for collaborative decision making: “Through resistance to a treatment recommendation, patients work to negotiate and collaboratively co-construct what counts as an acceptable recommendation”(p. 1105). That is, through resistance clients become agents, negotiating or fighting for what they need. In practice, of course, a mixture of reluctance and resistance is often found in the same client. If therapy is to become more efficient, then counselors need to find ways of helping their clients deal with reluctance and resistance as expeditiously as possible. Use Guidelines for Helping Clients Deal with Reluctance and Resistance LO 8.4 Because both reluctance and resistance are such pervasive phenomena, helping clients manage them is part and parcel of all our interactions with clients (Kottler, 1992). Here are some principles. Avoid Unhelpful Responses to Reluctance and Resistance Helpers, especially beginning helpers who are unaware of the pervasiveness of reluctance and resistance, are often disconcerted when they encounter uncooperative clients. Such helpers are prey to a variety of emotions—confusion, panic, irritation, hostility, guilt, hurt, rejection, and depression. Distracted by these unexpected feelings, they react in any of several unhelpful ways. They accept their guilt and try to placate the client.
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