Working with Resistance and People Bereaved by Suicide
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1 22 Nov 2007 SPINZ 2007 Symposium: Building the Jigsaw – Collaborating for Suicide Prevention Working with Resistance and People Bereaved by Suicide Chris Bowden Lecturer, School of Education Studies, Victoria University of Wellington. [email protected] & Caroline Cole Counsellor, Skylight, Wellington South, Wellington. [email protected] Outline 1. Power and Suicide 2. What is Resistance? 3. When Does it Occur ? 4. Positive & Negative Effects The importance of reframing, reflective practice, communication and collaboration 5. Working Through it 6. Controlling vs. Embracing Resistance? Power and Suicide • The bereaved are often left feeling powerless following suicide. • Professionals have a responsibility to help the bereaved regain control and exercise power. • Often the values, ideals and methods used by professionals serve to reinforce powerlessness in the bereaved rather than empower them. • When the support that is offered to those bereaved by suicide does not meet their needs, or when it is not offered in an appropriate way or at an appropriate time – resistance can occur. Foucault (1990) • By looking at resistance within the bereaved we can better understand how the bereaved view and mediate the exercise of power. • “Resistances are defined as practices which express opposition to rules and norms in specific contexts, and which contain critiques of social relations, from the lived experience of marginalisation” (Bottrell, 2007, p.599). • Our understanding of resistance must go beyond conceptualisations of oppostional behaviour and personal deficit to include an analysis of social relations (Bottrell, 2007). • In dealing with marginalisation, difficult circumstances and competing demands, the bereaved’s resistances may be seen as attempts to counter negative images and to create new identities for themselves. To exercise power. • The bereaved have to negotiate their own inner world after the death (make sense of suicide) but also have to negotiate sociocultural norms about grief, loss and life after suicide. For many, this does not occur in a linear way and their grief does not fit the pattern outlined in stages theories of grief (Begley & Quayle, 2007). Why Do People Resist Going to Counselling? 1. Negative perceptions of counselling (e.g., for certain people, for people with serious mental illness). 2. Confidentiality issues. 3. Counselling not seen as the ‘best remedy’. 4. Preference for lifecoaching. (Gyllenten, Palmer & Farrants, 2005)
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Transcript of Working with Resistance and People Bereaved by Suicide
- 1. OutlineWorkingwithResistanceandPeople BereavedbySuicide1.PowerandSuicide2.WhatisResistance?3.WhenDoesitOccur?4.Positive&NegativeEffects ChrisBowden5.WorkingThroughitLecturer,SchoolofEducationStudies,VictoriaUniversityofWellington. [email protected] &6.Controllingvs.EmbracingResistance? CarolineColeCounsellor,Skylight,WellingtonSouth,Wellington. [email protected] Theimportanceofreframing,reflectivepractice,communication22Nov2007 SPINZ2007Symposium:BuildingtheJigsaw andcollaboration CollaboratingforSuicidePrevention PowerandSuicide Thebereavedareoftenleftfeelingpowerless followingsuicide. Professionalshavearesponsibilitytohelpthe ecnatsiser tuohtiw rewop on si erehT bereavedregaincontrolandexercisepower. Oftenthevalues,idealsandmethodsusedby Foucault(1990) professionalsservetoreinforcepowerlessness inthebereavedratherthanempowerthem. Whenthesupportthatisofferedtothose Bylookingatresistancewithinthebereavedwe bereavedbysuicidedoesnotmeettheirneeds,canbetterunderstandhowthebereavedview orwhenitisnotofferedinanappropriatewayorandmediatetheexerciseofpower. atanappropriatetimeresistancecanoccur.WhyDoPeopleResistGoingtoCounselling? Resistancesaredefinedaspracticeswhichexpressopposition 1. Negativeperceptionsofcounselling torulesandnormsinspecificcontexts,andwhichcontain (e.g.,forcertainpeople,forpeoplewith critiquesofsocialrelations,fromthelivedexperienceof marginalisation(Bottrell,2007,p.599).seriousmentalillness). Ourunderstandingofresistancemustgobeyondconceptualisations2. Confidentialityissues. ofoppostionalbehaviourandpersonaldeficittoincludean analysisofsocialrelations(Bottrell,2007). 3. Counsellingnotseenasthebest Indealingwithmarginalisation,difficultcircumstancesand remedy. competingdemands,thebereavedsresistancesmaybeseenas attemptstocounternegativeimagesandtocreatenewidentitiesfor themselves. Toexercisepower. 4. Preferenceforlifecoaching. Thebereavedhavetonegotiatetheirowninnerworldafterthedeath (Gyllenten,Palmer&Farrants,2005) (makesenseofsuicide)butalsohavetonegotiatesociocultural normsaboutgrief,lossandlifeaftersuicide.Formany,thisdoesnot occurinalinearwayandtheirgriefdoesnotfitthepatternoutlined instagestheoriesofgrief(Begley&Quayle,2007).1
2. WhyDoPeopleResistChangeWithinCounselling? AccordingtoWorrell(1997)resistancehasbeenacentral AccordingtoWorrell(1997): concerntomostmodelsofcounsellingandpsychotherapy. Resistancecanalsobeviewedasanintersubjective Resistancehasbeendefinedas:phenomenaoccuringbetweenpeople. Itcanbeinterpretedasexpressiveofpeoplesattempts Residingintheindividualandexpressiveofirrationaltopreserveasenseofselffromperceivedattack.beliefs(e.g.,Itstoohardtochange,Icantchange). Clientbehaviourthatisdefinedbythetherapistasanti Itrequiressupportprovidersto:therapeutic. connecttothebereaved, Defensiveoperationsandnoncompliancetospecific bewiththebereavedandfindouthowtheyarebeingtherapeuticgoals/tasksanddirectives.intheworld, Relatedtoshortcomingsinthetherapistandthe findouthowtheyaredefiningtheirselfinrelationtotherapistnothandlingaparticularpersonintherightway. others,and findoutwhatmaybethreateningthem.Why/WhenDoesResistanceOccur? Peoplebereavedbysuicidemaybeatvariouspointsintheir Garon(2006)arguesthatresistanceoccurswhen: adjustmenttolossandhavedifferentabilitiestocopewith theircircumstances(Mitchell,Wesner,Garand,Gale,Havill Peoplefeeltheylackpower. &Brownson,2007). Powerisabused. Whenpeopledonthaveavoice. Whenpeoplefeeltheyaretreatedunfairly,insensitivelyorwith Peoplemayshowresistancewhentheyareascribedan alackofrespect. identityandsocialposition.Peoplemaystrugglefor Whenpeoplearenotinvolvedindecisionmaking. chosenidentitiesandagainstunchosensocialidentitiesand whenprocessesreinscribemarginalisedindividualsalso DentandGoldberg(1999)reportthatresistancecanalsooccur consitutefurthermarginalisation(Bottrell,2007)(e.g., when:labellingthebereavedatriskofsuicide). Peoplearenotclearaboutthewho,what,why,when,and Whenchangeisimposed,comesatthewrongtime,when whereofthechange. theyhavelittesayinthenatureorthedirectionofthe Changethreatenssomeonesstatus. change(Dent&Goldberg,1999). Thechangecanisolatesomeone. Andwhenpeoplearealreadyoverburdened. Whenpeoplefearchangeorfuturefailure(Worrell,1997).PositiveorNegative? Worrell(1997)discusseshow:Powerful Powerless Expertknowledge Layknowledge ResistanceisoftenseenbyprofessionalsandInneed Provider counsellors/therapistsasnegative. UnderstandsStuck Thefocusisoftenontheindividualwhoisseenas resistanttochangeandnotmuchattentionisgivento changethatis Difficultyvoicing required concerns therelationshipandwayofbeing. Professionals Bereaved Garon(2006)arguesthatresistancecan: Beseenasawaythatthelesspowerfulspeakup. Requirescourage. OftenwefocusonCONTENTofsupport Leadtochangeparticularlywhenlesspowerfulareandprogrammesratherthanonsocial givenanopportunitytospeakup. discourseandpowerrelations.2 3. ActsofResistanceQUESTION1 Takingastand. Expressingconcerns. Protesting. Whatactsof Failingtocooperate,stopping,goslows.resistancehaveyou Whistleblowing. Confrontingandquestioning. experiencedwhensupportingsomeone Occurwithinrelationships.whohasbeen Therecanbeindividualandcollectiveactsof bereaved?resistance. Canbeexpressedincreativewaysareformsofcommunicatingprivatediscourseorhiddentranscriptshttp://www.artintime.com/images/Original%20PaintingsGene%20Gould/grief.jpg(Scott,1990citedinGaron,2006).ExamplesfromaBereavedbySuicideQUESTION2 SupportGroup Resistancebetweenthebereaved&facilitators: Whydidtheseactsofresistanceoccur? Whenassessmentisinvolvedthatlabels,focusesonclinicaldiagnoses,orproblemsinthebereaved(ratherthananeedsassessment). Whenpracticeorsupportdoesntmeetneeds. Timingandreadiness.Whentasksofgriefareemphasisedandbereavednotatthatstage,feeltheyarenotreadyforinformation. Whatcircumstancesledtothem? Resistancebetweengroupmembers: Whenjudgmentsaremadeandprogresscompared. Languageused(gender,culturalattitudes,personalbeliefs). Strategiesofferednotperceivedasappropriateorrelevant. Notparticipatingsilent. NeedtolookatindividualANDgroupprocesses,safety,structureandfacilitation. NeedtocreateSPACESforpeopletohaveavoiceexpresshowtheyarebeingintheworld,wheretheyareatintheirjourney.NegativeViewsandEffectsofPositiveViews&EffectsofResistanceResistance Positiveview Negativeview Bereavedexercisingpower,communicatingconcerns, Seenasdisobedient,disrespectful,challenging,aperson ethicalsafetyvalve,timetostopandreflect. attack. Negativereactionretaliation,puttingdowntherebellion, Positivereactioncollaboration.ignoring. Positiveeffects Negativeeffects BereavedgivenavoiceandrealisetheyhavePOWER Bereavedareoftensilenced,labelledtroublemakers,excluded, andcontrol.chastised,andasaresultdisengage. Sharedunderstandings. Professional/supportpersonfailstocorrectpowerimbalanceorlearnfromindividualorgroupnochanceforchange. Findawayforwardproblemsolve. WhatoftenholdspeoplebackfromspeakingupFEAR. Learnfromoneanother,increasedselfknowledge, Littlechanceoffutureopportunitiesforresistanceandcollaboration. growth. Changedroles,newpoliciesandstandardsofpractice. 3 4. ControllingResistance EmbracingResistance Whenresistanceisviewedasnegativeandsomethingto Resistanceisalwayspresentwheretherearepowerrelationships. becontrolled: Tofindouttheinformationthatresistancebringsitisimportanttoseekitout. Ignoreit:andhopethatwhatevercauseditgoesaway too. Peoplewhoareresistanthavevaluableinformationthatothersdonothave. Usepower:Trytomakepeoplegoalong. Usereason:Explainwhychangemustoccuronceagain Theyseechangefromadifferentperspectiveandviewitas inmoredetail. problematic. Manipulate:Playonepersonagainstanotherand Needtoembraceandrespectthisviewandresistance. maybeyouwillgetsomeonetochange. UseRelationships:Callinfavoursthatyouareowed. Needstrongworkingrelationshipsthatarefoundedonrespect,honesty,giveandtake,andonachievingmutualgoals. MakeDeals:Compromiseanddilutethechange. Giveuptoosoon:Losemotivationandquit. Peoplewhoresistchangearevaluableassets,theycanbringenergyanddifferentviewtotheplanningandimplementationprocessofachievingchange.SomeSuggestions:WorkingThrough Question3:ManagingResistance Resistance 1.ACCESS/CONNECT&CLARIFYStartadialogue,findoutwhatisnotworking,whatarethepersonsconcerns,fearsaboutchange? 2.ANALYSE Howweretheactsofresistance Whatsnotworking?Whyhasthisoccurred?Whereisthispersoncomingfrom?Howaretheybeing? managed?Breakdowninteractions/relationship. 3.EVALUATEHowhavewebeencommunicating?Whatarethemostimportantconcerns?Howbestcanthisbeaddressed? 4.COMMUNICATEGivethebereavedavoice. WhatweretheoutcomesforyouandtheLISTENacknowledgewhatthepersonsays.Resistancecanbeaboutnotbeingheard. bereaved? Discussandagreeonhowyouwillworkthroughandfindasolution,howroleswillchange,stepsthatneedtobetakenandwhowilltakethemandhowyouwillmeasuresuccess. 5.CREATEChangeandaction,anewunderstandingorrelationship. CollaboratetoExamineForcesImportanceOfReframing Worktogethertoexamine Resistanceanddissentarenotpersonalattacksor whatKurtLewintermedcriticism. drivingforcesandRestraining restrainingforces. DrivingForces Forces Seethemasearlywarningsignsoftroubleahead.ForChange ResistingChange Forchangetooccur drivingforcesmustbe Openandcollaborativestylesofcommunicationare morepowerfulthanimportant.Authoritarianandunidirectionalstylescauseresistance(Bisese,1990). restrainingforces. External External SeeForceFieldAnalysis Silenceisharmfulwithholdinginfoaboutpotential Analyzingchangeproblemscanimpedechangeandcollaboration factors(12Manage, (participatorygovernancestructures). 2007).Internal Internal Seeactsofresistanceasmotivatedbyprinciplesanddesiretobeingaboutandbeapartofchange. 4 5. ImportanceofReflectivePractice LookatMotivesforChangeHultman(1998)outlines8reasonswhypeoplewillsupport ResistanceisInformation. change: Itisaboutsayingchangetheplan.CHANGE Mustlearntolistentoresistance. 1. Theybelievetheirneedsarenotbeingmet.2. Theybelievethechangewillmakeiteasierforthemto Focusonthereasonsbehindthe FORMOF meettheirneeds.RESISTANCEresistance,notyourassumptionsabout 3. Theybelievebenefitswilloutweightherisks(ofnotit.changing). Lookforcausesnotsymptoms.POSSIBLE 4. Theybelievethechangeisnecessarytoavoidorescape REASONaharmfulsituation. Lookatwhatchangethepersonisbeing5. Theybelievetheprocessisbeinghandledproperly.requiredtomake.6. Theybelievethechangewillwork. Whatformstheirresistancetakes.RESPONSE7. Thechangeisconsistentwiththeirvalues. Whatthereasonisfortheirresistance. 8. Theybelievethoseresponsibleforthechangecanbe Possibleresponsestotheresistanceintrusted.allparties(e.g.,changeplan,newplan).Strategies Establishpositiveclimatewhereresistanceiswelcomed Treatpeopleascompetentandhelpthemdevelopskillsand andexploredsafely. confidencetoengageinchange.Involvepeopleindecision making:helpthemfindTHEIRanswernotTHEanswer. Eliminatefearprovidebereavedwithopportunitiesto expresstheiropinionandviewonhowandwhenchange Usemotivationalinterviewing,structuredproblemsolvingthat canoccur. incorporatesanexaminationofthecostsandbenefitsof changing(ornotchanging)(McCutcheonetal.,2007). Takeacurious,nonintrusiveandrespectfulstance. Seekthepersonsopinion(McCutcheon,Chanen,Fraser, Usemetaphoricalexpressionstohelpthebereavedwork Drew&Brewer,2007).throughambivalenceandfearofchangebyindirectlyallowing themtoexpresscertainfeelingsthatifdealtwithdirectlymay engenderstrongresistance. Showpeoplethatovercomingresistancetochangecan helpthem. Metaphorscanprovideasafebridgetoexplorechange withoutresultinginrealchange(Lyddon,Clay&Sparks, 2001).ImportanceofCommunication ImportanceofCollaboration SHIFTthePOWERbacktothem. SHAREthePOWER. Acknowledgetheaffectchecktoseewhythepersonisangry,non cooperativeetcaskthepersonwhattheywantandestablishyourown needsandlimits(McCutcheonetal,2007). Shareideasaboutwhatmighthelp,butletthebereaved workoutwhatwillworkandhow. Talkthroughthingstheyhavelearntfromtheirresistanceandhow theyhavegrown. Bewiththemintheirresistancedontbeinahurry Talkthroughhowyouwillbothusetheknowledgetochange toshiftthemon,explorethisaspectoftheirbeinginthe practiceandrelationship. world. Empowerthebereavedtofindtheirvoice:Narrativesofresistance. Showthemhowseekinghelpisapositiveformof Usestorytellingeveryonehasastorytotell,providepeoplewith confidenceandplatformtosharethem.Createsafespaceforpersonalresistanceinitselfresistingisolationanddependence. andcollectivestorytelling(Horsley,2007) 5 6. ResistanceLeadstoChange References Resistancealwaysleadstochange. 12Manage(2007).ForceFieldAnalysis(Lewin).Available http://www.12manage.com/methods_lewin_force_field_analysis.html Accessed16 November2007. Withoutchangethereisnoprogress. Begley,M.&Quayle,E.(2007).Thelivedexperienceofadultsbereavedbysuicide:A phenomenologicalstudy.Crisis,28(1):2634. Bisese,V.S.(1990).Therapistspecificcommunicationstylesandpatientresistance:An Resistancecanbepositiveand/ornegative.analoguestudy.CounsellingPsychologyQuarterly,3(2):171182. Bottrell,D.(2007).Resistance,resilienceandsocialidentities:ReframingProblemYouth andtheproblemofschooling.JournalofYouthStudies,10(5):597616. Resistancecanleadtotransformationand changewithinthebereavedandthosewho Dent,E.B.&Goldberg,S.G.(1999).Challengingresistancetochange,TheJournalof AppliedBehaviouralScience,35(1):2541. supportthem. Foucault,M.(1990).Thehistoryofsexuality:Anintroduction.NewYork:VintagePress. Theoutcomesofresistancedependonhowwe Garon,M.(2006).Thepositivefaceofresistance:Nursesrelatetheirstories.TheJournal ofNursingAdministration,36(5):249258. viewresistanceandhowitismanaged. Gyllensten,K.,Plamer,S.&Farrants,J.(2005).Perceptionofstressinterventionsinfinance organizations:Overcomingresistancetowardscounselling.Counselling PsychologyQuarterly, 18(1):1929. Horsley,K.(2007).Storytelling,conflictanddiversity.CommunityDevelopmentJournal,42 (2):265269. Hultman,K.(1998).Makingchangeirresistible:Overcomingresistancetochangeinyour organization.PaloAlto,California:DaviesBlack. Lyddon,W.J.,Clay,A.L.&Sparks,C.L.(2001).Metaphorandchangeincounseling.Journal ofCounseling&Development,79(3):269274. McCutcheon,L.K.,Chanen,A.M.,Fraser,R.J.,Drew,L.&Brewer,W.(2007).Tipsand techniquesforengagingandmanagingthereluctant,resistantorhostileyoungperson.The MedicalJournalofAustralia,187(7):S64S67. Mitchell,A.M.,Wesner,S.,Garand,L.,Gale,D.D.,Havill,A.,&Brownson,L.(2007).A supportgroupinterventionforchildrenbereavedbyparentalsuicide.JournalofChildand AdolescentPsychiatricNursing,20(1):313. Worrell,M.(1997).Anexistentialphenomenologicalperspectiveontheconceptofresistance incounsellingandpsychotherapy.CounsellingPsychologyQuarterly,10(1):515. 6
