Post on 23-Dec-2015
HOW TO FACILITATE CHANGE WITH DIFFICULT CLIENTS
KIMBERLY R . BECK, M.ED. LPC, CRAADC, CCJP, CCDP-D
REGIONAL SOCIAL SERVICES DIRECTOR, MIDLAND DIVISION
YOU CAN’T HELP ME!
INTRODUCTION
Masters Degree in Counseling – Boston University
Bachelor of Science in Psychology – University of Maryland
Doctoral Candidate in Counseling –University of Missouri St. LouisEmphasis Areas
AddictionMarriage and FamilyCrisis InterventionVeteransHomelessAt- Risk YouthProfessional Development
LEARNING OBJECTIVES
ARTICULATE BEHAVIORAL PATTERNS AND CHARACTERISTICS OF PEOPLE WHO TEND TO BE RESISTANT/DIFFICULT
EXPLAIN COMMON RESPONSES TO DIFFICULT CLIENTS AND ARTICULATE MORE EFFECTIVE RESPONSES TO THAT BEHAVIOR
EVALUATE STRATEGIES COUNSELORS/CASE MANAGERS CAN USE TO EFFECTIVELY COUNTER THE DIFFICULT BEHAVIOR AND DISENGAGEMENT
PRACTICE UTILIZATION OF STRATEGIES THROUGH ROLE PLAY IN SMALL GROUPS
REALITY CHECK
Professional Development Training is often delivered via a one-time clinical workshop.
Is it realistic to believe that practitioners will actually acquire skillfulness through such training?
Study by William Miller ant Kathy Mount () suggest the following: -on paper and pencil measures participants reported large
increase in skills - observational measures reflected more modest changes in
practice -clients did not show the responses changes that were found
to be predictive of better outcomes of the skill attainment
PRE-TEST
1) Gather information about your knowledge of the topic prior to participating in the training
2) To call your attention to topic areas prior to participation in the training
3)Wake you up after lunch by scaring you half to death!
Please take a few minutes to complete this and do not share answers with your neighbors
Ice-Breaker
Your NameYour PositionYour LocationDescribe your most challenging clientTell us what you want from this training
What Makes A Case Difficult?
Diagnostic dilemmaPoor prognosisMultiple problemsLack of interagency coordinationInvoluntary participationLack of ProgressMalingering and Deception
What Makes A Case Difficult?
Imminent dangerCultural competency gapsConflicting ethical principalsEligibility limitationsLimited resourcesUnacceptable client expectations
Natural Categories of Difficult Cases
Challenges to the professional’s skillChallenges to the professional’s personalityUnmatched expectationsSystem issues such as eligibility and
coordination problemsPhysically dangerous clientsLegally dangerous clientsSocially dangerous clients
Six Categories of Intervention
A. Authoritative CategoriesA. i. Prescriptive interventionsB. ii. Informative interventionsC. Ii. Confrontational interventions
B. Facilitative categoriesi. Cathartic interventionsii. Catalytic interventionsiii. Supportive interventions
Degenerate Types of Interventions
1) Unsolicited2) Manipulative3) Compulsive4) Unskilled
Degenerate Classes of the six categories
Authoritative categories Prescriptive Degeneration
Benevolent take-over Moralistic oppression
Informative Degeneration Seductive over-teach Oppressive over-teach
Confronting Degeneration Sledgehammer Smiling demolition (the smiler)
Degenerate Classes of the six categories
FacilitativeCathartic Degeneration
Encouraging dramatisation Nut cracking (too deep too soon)
Catalytic Degeneration Implicit take-over (the compulsive search for order) Scraping the bowl
Supportive Degeneration Moral patronage (or your character is coming along nicely) Qualified Support
I JUST WANT TO HELP YOU!
Why are clients difficult and resistant when all we are trying to do is help them?
Why do some clients come in for help with the attitude or notion that “ You can’t help me!” “Resistant client behavior seems …to conform to
Newton’s third law of motion: For every force there is an equal and opposite counter force. In a mode in which overcoming resistance potentially becomes a contest, the client will often win.” Cowan and Presbury, 2000, p. 412
I JUST WANT TO HELP YOU!
“ We tell our clients things like, ‘You can’t change other people; you can only change yourself.’ Then we go into a session trying to change our clients. This is hypocritical. I teach, You can’t change your clients. You can only change how you interact with your clients and hope that change results. That’s all you get” Clifton Mtichell – Effective Techniques for Dealing
With Highly Difficult Clients
Who’s Who of Difficult Clients
Intimidating clientsCritical clientsRageful clientsThreatening clientsAutonomous clientsActing-out clients
Who’s Who of Difficult Clients
Wealthy, influential clientsAngry victim with cultural or gender
differencesUncooperative clientsPassive-Aggressive clientsMistrustful clientsUnempathic clients
Reasons Clients Are Resistant
FearFear of FailureFear of SuccessFear of taking riskFear of changeManipulationPassive-aggressive behaviorShameJealousy or desire to sabotage the
relationship
Reasons Clients Are Resistant
ExhaustionA personality styleLack of optionsCultural and value differencesOver-reactionImpaired by chemicals or catastrophic mental
illnessEmotional paralysisLimited approachesNeeds are met
Reasons Clients Are Resistant
Conflict gains attentionIgnoranceThe familiarity trap
Let’s Try A Reframe
Creating Lasting Change
People rarely change because of the logic of the situation; people change when they have an emotionally compelling reason.
Clifton Mitchell
The Therapeutic Alliance
The counselor client relationship is key to helping the client move forward. Clients are less resistant if they feel connected to the counselor. If the client will not disclose their inner wants, actions, feelings and thinking, change is very difficult.” Robert Wubbolding- Director of Training William Glasser Institute
It’s All About You!
Start with self-awarenessUnderstand the concept of changeSharpen the Saw (Practice, Practice,
Practice)
General Principles for Dealing with Resistance
Do the UnexpectedSlow the Pace, Focus on the Details, Process feelings
relative to meaningTreat Clients’ Resistance with RespectMaintain an Attitude of Naïve PuzzlementNever Label Clients with Terms that Imply
ResistanceFocus Where Clients Are StuckFrame All Desires in the PositiveIf they are not confused, Confuse themResist the Urge to confront Initially
• CLIFTON MITCHELL
11 Solutions For Counseling Difficult Clients
Eliminate the Power struggleFeed Your Clients Therapeutic Big MAC’sTeaching is CounselingStop Believing In Denial Use Strengths to Compensate for DeficitsMotivation Is the Key to ChangeGive Your Clients A Million DollarsParadoxical InterventionsBring In OthersHealthy ModelingLet the Train Wreck Happen
• RICHARD K NONFARD
FRAMES
Feedback is given to the individual about personal risk or impairment.
Responsibility for change is placed on the participant.
Advice to change is given by the provider.Menu of alternative self-help or treatment
options is offered to the participant. Empathic style is used in counseling. Self-efficacy or optimistic empowerment is
engendered in the participant.Source: Miller and Sanchez, 1993
Motivational Enhancement Techniques
Ask Open Ended QuestionsUse AffirmationsUse Reflective Listening, Reframing, Roll
With ResistanceSummarizing
Closing Thoughts
How does a therapist (case manager) position himself or herself to work with reluctant clients? How does he or she react to clients who potentially challenge his or her sense of power, confidence, and effectiveness as a therapist (case manager)? (Wessler, Hankin &Stern, 2001)
Self-awareness/reflection, education/training, practice, practice, practice, feedback/evaluation….continually
Let’s Practice
Group Work
Post -Test
Demonstrate an understanding of the material presented in the workshop
Officially document your participation in the workshop
Freak you out at the end of the workshop!
Resources
Succeeding With Difficult Clients –Applications of Cognitive Appraisal Therapy - Wessler, Hankin & Stern
A Small Study of Training in Motivational Interviewing: Does One Workshop Change Clinical and Client Behavior? Miller and Mount
Managing resistant Clients – Lynne Shallcross , Counseling Today February 2010
11 Solutions for Counseling Difficult Clients, Richard K. Nongard
Effective Techniques for Dealing With Highly Resistant Clients, Clifton Mitchell, 2006
Heron, J (2001) (5th ed) Helping the client – a creative practical guide.
Contact Information
Kimberly R. Beck314-646-3154 work314-960-2530 cellKimberly_Beck@usc.salvationarmy.org
Thank You!!!!!!!!!!!!!!!!!