Fostering Resilience: In-session boosters to help clients bounce back

Suppose someone asks you, a mental health practitioner, “What is the most important thing you do as a counsellor (psychotherapist/psychologist/social worker) for your clients?” Your response might go along the lines of “helping them sort out their problems”, “educating them and inspiring them to make their lives work,” or possibly “providing support and a safe container while they explore new [presumably more effective] ways of being”.

Whatever your particular way of framing the answer, the chances are that you have identified a role of supporting and helping build your clients’ resilience, even if you never call it that when you are with them. Indeed, fostering resilience – the great art of helping others to bounce back – is the foundation of what we do as mental health professionals. But just how, exactly, do you do it? What tools or techniques have you got in your bag of tricks to foster resilience at the very practical level of in-session work?

Resilience: Conceptual and practical

In Edition 2 (2013) of The Professional Therapist, we included a feature article about resilience (“What does resilience look like?” – p 10), in which we identified many resilience skills used by people observed to have prevailed over adversity. We used the schema of psychotherapist and resilience-researcher, Dr Meg Carbonatto (2009 and forthcoming), which groups skills into five superordinate or umbrella categories of resilience; our discussion centred on the conceptual/theoretical basis of the skills in each category, and the category as a whole. Space constraints did not permit us to elaborate on practical exercises that therapists could use in session with their clients to foster hardiness in each of the categories. That is the purpose of this article.

As in the previous one, we find it convenient to use Carbonatto’s framework, which classifies resilience skills as either those of optimism, will, social support, practical preparation, or purpose. If you are unclear about what we mean when we use any of those terms, or what types of skills tend to be included under each of those “umbrellas”, we advise you to have a look at the Edition 2 resilience article before reading this one. When you have read both articles, you will not only have a conceptual base for understanding resilience, but also a few practical exercises that you can use in session with clients. Let’s turn straight to the positive psychology favourite: optimism skills.

Optimism: Helping them walk on the sunny side of the street

You may recall, either from our earlier article or from your own reading on the topic of positive psychology, that many claims are made for the advantages that optimists have in just about every domain of life. Martin Seligman, called the “father of positive psychology”, has noted that there are “literally hundreds of studies” which show that pessimists get discouraged and give up more easily, while optimists’ performance at work and in academic and sporting arenas tends to exceed predictions made for them. They generally enjoy excellent health, the capacity to age well and even increased longevity (Seligman, 1992, p 5). Seligman says that whether a person is optimistic or not is partially determined by whether he or she has an “optimistic explanatory style”: that is, a look-on-the-bright-side way of attributing events in life in order to assume that things will work out alright. The beauty of Seligman’s work, however, is that even if someone appears to be a “born pessimist”, they can learn to explain things in a more upbeat way.

So what is your role if you would foster optimism in clients? There are several possibilities here. First, how optimistic (or not) is the client’s current way of thinking and explaining things? Recall that, for maximum optimistic mode, a person would be avoiding the three “p’s” of pessimistic explanatory style: that is, they would see that the Tough Times were not permanent, that they were not pervasive throughout their life, and that the Bad Event was nothing personal against them; (i.e., not personalised).

The Attributional Style Questionnaire

Many of the questionnaires and survey instruments designed to work out whether someone is an optimist or not are statistically complex and difficult to use. We include here a simplified questionnaire for general use developed by Dykema et al (1996) to assess how much your clients are using an optimistic explanatory style. While you probably do not have access to formal statistical analysis of your client’s responses, you will be able to see the general trend. The more clients give attribution to factors outside themselves for negative events, the more they see events/setbacks as temporary, and the more they see them as specific, affecting just one area of life (as opposed to being global or pervasive), the more optimistic they are.

The questionnaire asks respondents to vividly imagine themselves in each of twelve situations. For each situation, the respondent is asked what would have caused the situation to happen to them (which can help determine how personalised the person sees the situation or event as being) and then two questions are asked:

  1. How likely is it that this situation will continue to affect you (this determines how permanent the person sees the situation as being)?
  2. How much is the cause you gave likely to affect other areas of life (this determines how pervasive the person sees the event or situation as being)?

For each item, the client rates both his/her sense of permanence and his/her sense of pervasiveness on a 7-point scale from -3 to +3. On this instrument, the highest possible score is 72: six points possible for each of 12 situations. The lowest possible score is -72. The lower the scores (especially including total scores that are below zero and thus in negative territory), the more optimistic the person’s explanatory (attributional) style. The higher the total score, the more the person is engaging in pessimistic thought and is thus low on optimism. Those who score low on optimism can be trained to boost their optimistic outlook (more on that in a moment).

Here are the instrument instructions plus the twelve situations. We include the full sequence for the first situation only, due to space constraints. Each of the other eleven situations should follow the same format:

Attributional Style Questionnaire (for general use)

Try to imagine yourself in each of the following twelve situations. For each situation:

  1. If such a situation happened to you, what do you think might have caused it? Such situations may have many causes, but please choose the MAIN cause that made the situation happen to you; write the cause in the space provided after the question.
  2. Rate how likely it is that the situation will continue to affect you.
  3. Rate how much the cause you gave is likely to affect other areas of life.
  • Situation One: You have trouble sleeping.

How likely is it that this situation will continue to affect you?

Extremely unlikely (-3)
Very unlikely (-2)
Somewhat unlikely (-1)
Equally likely and unlikely (0)
Somewhat likely (1)
Very likely (2)
Extremely likely (3)

How much is the cause you gave likely to affect other areas of life?

Extremely unlikely (-3)
Very unlikely (-2)
Somewhat unlikely (-1)
Equally likely and unlikely (0)
Somewhat likely (1)
Very likely (2)
Extremely likely (3)

  • Situation Two: You feel sick and tired most of the time
  • Situation Three: You have a serious injury
  • Situation Four: You can’t find a job
  • Situation Five: You can’t get the work done that others expect of you
  • Situation Six: You are fired from your job
  • Situation Seven: You don’t help a friend who has a problem
  • Situation Eight: You have financial problems
  • Situation Nine: You don’t understand what your boss wants you to do
  • Situation Ten: A friend is very angry with you
  • Situation Eleven: You are guilty of breaking the law
  • Situation Twelve: You have a serious argument with someone in your family

(Adapted from Dykema et al, 1996)

We stated earlier that you may have several roles with clients. Once the above questionnaire shows a trend of pessimism and the client determines that he or she would be living more resiliently as an optimist, the game is on to identify places where the client is thinking or acting pessimistically, and help them change (if that is desired). Different therapies have different means of accomplishing this.

CBT/REBT

The easy choice for changing limiting (pessimistic) beliefs, Cognitive Behaviour Therapy or its first cousin, Rational Emotive Behaviour Therapy, can help clients to see how they have limited or undermined themselves by tracing back from intense emotions to underlying pessimistic beliefs. The job-seeker, for instance, who feels uncontrollably anxious about a job interview may be thinking, “Oh, they’ll never give someone like me that job.” Once the unhelpful beliefs are exposed for what they are (pessimistic but not necessarily realistic interpretations), the client can choose to “dispute” the beliefs by creating more optimistic ones to exchange them for.

Narrative therapy

Here the way that optimism skills can kick in is through re-storying a narrative which somehow seemed safer or more sensible to the client to frame in ways that made Horrible Happenings permanent, pervasive or personalised. The re-worked story can find places to include the possibility of more optimistic interpretations in instances where the client sees that s/he has created limitation through pessimism in the past.

Psychotherapy

In-depth exploration of the client’s past relationships may shed light, in a similar manner to Narrative Therapy, on just how/why choosing to view life through a pessimistic lens made sense to the client, who can be encouraged to examine whether he or she still finds the “payoff” (relationally or otherwise) for pessimism rewarding. The transpersonal psychology of Psychosynthesis can shed further light on the situation through subpersonality work (one part of the client may be very optimistic, but a pessimistic subpersonality may have constellated in order to protect the client from disappointment, as one example). The goal with subpersonality work is always to meet the needs of the subpersonalities, thus transforming and integrating them into the larger self.

Mindfulness

Ancient as a practice, new as a “therapy”, the practice of mindfulness can help clients to become aware of pessimistic interpretations. The goal is not necessarily to change such beliefs; rather, in mindfulness, the client may become acutely aware of them, allowing them to remain there in his/her mind, but consciously choosing to focus on and thus act from more helpful beliefs.

There are multiple ways (therapies) you could employ in order to help a pessimist change to a more optimistic outlook – or at least become aware of how s/he is functioning. One issue that will surely come up is the question of how actively a client is engaging his or will in order to prevail. The next exercise, from the category of will skills, looks at this question.

Will skills: Engage, surrender, or just give up?

Using the schema for will promulgated by Psychosynthesis founder Roberto Assagioli (1973/1984), Carbonatto (2009) showed how many of the subjects of her chapters had engaged their will – most mightily – in order to prevail over adversity. Some used strong will, some employed primarily skilful will, and still others were in situations where skills of good will were most adaptive in the struggle to triumph resiliently. Many of the Psychosynthesis courses of the Mental Health Academy also treat the question of will, and the reader is encouraged to access these for further explanation of this function deemed by Assagioli to be the closest to the self.

For our purposes of resilience, there is an important question concerning use of will which you are likely to encounter in your therapy rooms. That is: in their battle to overcome the Tough Stuff, do your clients know when to “keep on keeping on” and when to surrender? Carbonatto found that many of the people whose stories she analysed stressed the importance of never giving up hope. But, crucially, those same people in some instances understood that their best action was that of surrender. If you’re scratching your head and wondering if you read that right, let’s take a closer look.

Know when to surrender

Paradoxically, although there is much resilience in the capacity to remain ever-hopeful, genuine resilience also demands that we know when to surrender. Let us be clear here; surrendering is not the same as “giving up”, which is about loss of hope, a will disengaged, a spirit crushed. Surrender, rather, is a willed act, one which a person undertakes precisely because acknowledging human limitation and lack of control in a situation offers the greatest opportunity to prevail, to survive. Carbonatto’s book offers the well-known example of diver Rob Hewitt in New Zealand who, separated from his diving buddies, ended up treading water for over three days until currents carried him back to where he had gotten separated and he was rescued. Hewitt revealed how he had a moment of “giving up”. He lost hope and put his face into the water, but just when he was gasping for breath, he realised that he had much to live for. He took his face out of the water, and decided to live.

Some hours later, he considered the options open for survival. He had observed that every time he really engaged his will by trying to swim towards land, the currents pushed him back. The danger of trying to “swim for it” was that he might exhaust himself in the effort and drown. The converse danger, of just continuing to bob up and down and let the currents carry him, was that he did not know where they would take him. Hewitt ultimately decided that his best bet was to ride the waves and go along with whatever was happening (often, swells and storms). He acknowledged that the outcome was out of his hands. He came to be at peace, feeling balanced (Hewitt, 2007). While willing life, he surrendered. Crucially for the study of resilience, both his active will engagement – such as trying to swim for shore – and his surrender were acts of will undertaken for the purpose of survival.

What tendency do you observe in your clients: to actively engage their will, or to surrender? How do they know which is more appropriate in the context of their ultimate triumph over the difficult situation? If it is surrender, is it genuine surrender (that is, a willed act), or do you sense that they are just giving up? The following series of questions is an exercise Carbonatto (2009) developed in order to help people discern whether continued will engagement or surrender would make more sense in their situation. You may wish to informally lead clients through the exercise, or alternatively, they could take it away to do between sessions, coming back to discuss what has turned up.

Engaging will, but knowing when to surrender:

  1. What is at stake here? (Could be financial, emotional, or even physical survival)
  2. What are your objectives, both acknowledged and covert? (These can range from survival to maintenance of relationship, to recovery of dignity or even vengefulness)
  3. What are the consequences – from “certain” to “possible” of each course of action? (Encourage the client to face into these; if death is a possibility for a particular choice, that needs to be confronted)
  4. What needs are you trying to meet with each possible decision? (Get the client to consider all needs from physical needs for survival to needs for belonging, respect, and even self-actualisation)
  5. What feedback are you getting when you attempt action in any of the directions? This could include:
    1. Information coming to you from the outer world
    2. Sensations you are feeling in your body
    3. Emotions you are experiencing
    4. Thoughts you are generating in your mind
    5. Your intuitive or “gut-instinct” sense of the situation (It is important not to dismiss out of hand “gut-instinct” reactions that are opposed to information being received by other channels)
  6. How do you interpret that feedback in terms of your needs and aims?
  7. Consider the possibility that you are being asked to “trust the process of life”. How comfortable are you to do that? (Some people get stuck moving through a willed act because they are waiting for information that cannot be known.)
  8. What is it like to know that the guidelines for choosing a course of action may never be clearer than this? (adapted from Carbonatto, 2009)

In becoming more conscious of how we use will, we inevitably come to the question of how we use it in relationship with others. One of Assagioli’s three aspects of will was that of good will, which resilient people offer to – and receive from – others in their lives (1973/1984). Social support skills form the third of our five-part picture of resilience.

Social support skills

Both in studies of mass disaster recovery and individual conquering of difficult times it is shown consistently that those who are able to access good social support thrive much more than those who do not. Soldiers have been observed to experience loneliness and emotional distancing right before severe emotional distress sets in (Solomon, Mikulincer, and Hobfoll, 1986). In the wake of the 9/11 attack on and collapse of the Twin Towers in New York and also following terrorist attacks in Israel, one of the most common coping responses was to identify and link with loved ones (Bleich et al, 2003).

Connections with loved ones being delayed following the London bombings was a major risk factor for subsequent trauma (Rubin, Brewin, Greenberg, Simpson, & Wessely, 2005). And research on disasters and terrorist attacks in countries as disparate as the United States, Israel, Mexico, Palestine, Turkey, and Bosnia all show that social support is related to better emotional well-being and recovery following mass trauma (Galea et al, 2002; Bleich et al, 2003; Norris, Baker, Murphy, & Kaniasty, 2005; Hobfoll et al, 2007).

How solid are your client’s skills of garnering and also giving high-quality social support? By the time someone is in dire straits and needs a given relationship, it is too late to develop it, so advise your clients to start now. In the Edition 2 article, we noted Judith Lewis Herman’s comment that the core experiences of abuse (the opposite of social support) are those of disempowerment and disconnection from others. Recovery, therefore, must be based on empowerment and the creation of new connections (1994), and it is these which will serve resilience in future troubles.

In a similar vein, Julia Cameron, writing to encourage creative people to come out of their stuckness and renew their creative efforts, talks about “poisonous playmates” and “crazy-makers” (1995, pp 42 – 44). What she is referring to are people who might say and even believe that they are supportive of a person’s resilience, but in fact act in ways which are disparaging or mean-spirited and which constitute poor or no support. While Cameron is talking specifically about artistic recovery, the same notions hold for bouncing-back from other adversity as well. Those who wish to maximise their hardiness must connect (or re-connect) with others in their social sphere, but in a way which is empowering and which protects them from disempowering influences.

Your role in helping a client enhance this strand of resilience can be to guide them through an honest, in-depth examination of just who in their lives can/does offer high-quality social support and who does not, followed up by in-session discussion – and possible training in – skills the client will need to protect him/herself from the unsupportive ones (ideally, the person would also be coached, if necessary, on how to offer social support). So, yes, it is a question of boundaries, and the following exercise can help establish them vis-à-vis social support.

You can help manage expectations by noting to the client that the poisonous playmates and crazy-makers are so good at what they do because they have had a lot of practice. In the past, your client, through unassertiveness or naiveté, may have colluded with them to undermine their own support. Accordingly, it may take time and consistent effort to retrain both themselves (to not accept poor quality support) and the crazy-maker (to not foist onto the client low-quality, not-genuine support or blatant derailing and discouragement). The effort required may be huge, but the sooner your client gets started, the sooner s/he can create the webs of support that truly foster resilience.

Boundaries exercise

This exercise can be done repeatedly at intervals as clients build their circles of social support. Give the client a large sheet of paper (say, A3 size) and ask them to draw a large circle. The object of the exercise is to gain clarity about what they want in their lives (inside the circle) and are willing to protect, and what they do not want in their lives (outside the circle), against which they must defend. Inside the circle are topics, activities, and attitudes they love, plus people on whom they can count for genuine support. Outside the circle are expectations, demands, actions, emotions, topics, and people which are not helping them to recover from their Tough Time. It is here that the client should place the names of the poisonous playmates and crazy-makers, along with the attitudes, such as “lack of respect for my strategies of adaptation”, or “judgmental of me”, which the client needs to keep out in order to maximise their recovery from their adversity (adapted from Buffington, 2009).

Practical preparations for adversity

While this article and the primary assistance you are likely to offer clients is focused on emotional resilience, the reality for clients is that the more that they have prepared to face disaster ahead of time, the less loss they are likely to have to recover from when catastrophe hits. They may come to you after disaster has struck, so in the immediate post-disaster environment, they may not be interested in talking about steps toward future disaster loss minimisation (kind of like closing the barn door after the horse has gotten out!). In the medium- to longer-term, however, there is much to be gained from looking at practical preparations to build resilience.
Have a look at this sample preparedness checklist with your client. Are there any areas there that seem particularly urgent for your client to take care of given his/her circumstances?

  1. Arranging insurance (home/contents/health/life/car/travel/professional indemnity)
  2. Getting a survival kit together for the home (and keeping it up-to-date), including all the normal items: food/matches/fuel/blankets/medicines, etc.
  3. Important documents/items together, ready to be grabbed in an (emergency) instant; spare copies of documents in a safe (or safe place, such as bank vault)
  4. Plans developed for where family members assemble in an emergency
  5. Emergency numbers collected and copies with all household members
  6. Generators in working order, with fuel
  7. Some monies “liquid” and easily accessible for quick use
  8. Storm shutters and other emergency measures ready to be deployed
  9. Will written/estate executor assigned
  10. Alarm system installed and possibly monitored
  11. Medical and dental visits, examinations, and prescriptions up to date
  12. In terms of the longer-term, financial plans completed and being followed (Mental Health Academy course, Fostering Resilience in Clients, 2013).

There may be many more categories of preparation that would help people get through a disaster or difficult time in a resilient way. If it feels right, you may wish to brainstorm additions to this list with your client. The above items are mostly practical considerations, but if your client acknowledges that any of these would be useful or relevant and yet continues to foot-drag on getting them ready, you have potentially rich session material regarding the client’s resilience.
This level of preparation is important in terms of being prepared, grounded, and thus ready to take on whatever may come. Practical preparations, however, are unlikely to equal the advantage obtained from an engaged will matched by clear purpose. We turn now to purpose: the final skill category of our framework.

Adversity recovery on purpose

Are you clear on what your purpose in life is? If there is any hesitancy in your answer, you may find it easy to empathise with clients who are suddenly “all at sea” after experiencing a major setback. For example, stories abound of the celebrity athlete whose purpose is to excel at his sport – until a life-defining injury occurs which takes him off the playing field for good. Or the singer whose purpose is to entertain and uplift people with her powerful, inspiring voice; she loses the voice due to major throat illness and experiences a disorienting lack of purpose. The examples that come to your therapy rooms may not be so dramatic, but they are significant nonetheless.

In the Edition 2 resilience article, we made a strong case for the relationship between clarity of purpose and resilience; the literature is abundant in this regard. Suffice it to say here that, if you don’t know where you going, any road will take you there. Mindful of Assagioli’s stages of the willed act, we can also affirm the importance of purpose; it – the discovery of intention or purpose — is the first stage, without which other stages cannot unfold.

So, what you can you do in session with clients to encourage (re-) discovery of purpose? What follows is an exercise used by Psychosynthesis practitioners. You can lead a client through this in a single session, probably with time for discussion as well.

What is emerging: An exercise in discovering purpose

Have a large sheet of drawing paper and crayons, coloured pens, or magic markers ready. Before you begin, ask the client to divide the sheet into four equal-sized quarters with a marker or pen. You will ask the client a series of four questions, and each answer will be recorded as a drawing or symbol in one quarter of the sheet. Guide your client to relax in a comfortable but alert position and to attune to their inner self, with eyes closed. Instruct the client:

  1. Ask yourself: “Where am I now in life?” Allow images, sensations, feelings, and thoughts to arise in response. . . . When you feel ready, capture your response on the paper, in colours, shapes, symbols, or pictures. . . . When you finish, set the drawing aside and once again close your eyes, turning inward.
  2. Now ask yourself: “What is emerging in my life now?” “What is my next step?” Again observe the images, sensations, feelings, and thoughts that arise, drawing a response in a second quarter of the sheet. . . . When you are finished, return to the quiet place within.
  3. Ask yourself: “What is getting in my way?” “What is holding me back?” Observe your response and capture it in a section of the paper. . . . Again, return to the quiet of your inner self.
  4. Ask yourself: “What do I need to develop in order to take my next step and to move through my difficulty? What quality do I need to develop in my life?” Allow yourself the time necessary to receive images, sensations, and feelings in response. . . . Observe whatever comes up, and capture this response in the final section of the drawing paper. . . . Now, look at all four of your drawings/symbols and notice whatever is there to see. . . . You may wish to make notes about your responses to the questions, what you felt and thought (adapted from the Institute of Psychosynthesis; to author, 1996).

When we are clear on our purpose, it is possible to bring all aspects of will – strong, skilful, good, and even transpersonal will – to bear on a problem. With clarity of purpose, our clients are maximally prepared to triumph over even very hard times.

Summary

This article has shown how mental health practitioners can encourage clients to use five chief types of responses to adversity – clusters of resilience skills – which have been successfully used by hardy people to prevail over their difficult times. Those categories are the optimism skills, skills of effective use of will, skills of garnering social support, practical preparedness skills, and skills of connection with purpose. Clients may respond primarily from a single category of resilience skill, or they may draw from multiple categories. Their resilience profile may depend on the circumstances of the adversity and their own background, skill development, and preference. For each category of skill, we have offered an exercise that you can do with clients to help foster their resilience.

Ultimately, the best in-session hardiness-builder may be your positive regard and supportive presence which allows clients to access resources in the infinitely resilient Self.

References

  • Assagioli, R. (1973/1984). The act of will: A guide to self-actualization and self-realization. Wellingborough: Turnstone Press.
  • Bleich, A., Gelkopf, M., & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. Journal of the American Medical Association, 290(5) 612—6. In Hobfoll, S.E., Watson, Pl, Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J., Friedman, M., Bersons, B.P.R., de Jong, J.T.V.M., Layne, C.M., Maguen, S., Neria, Y., Norwood, A.E., Pynoos, R.S., Reissman, D., Ruzek, J.I., Shalev, A.Y., Solomon, Z., Steinberg, A.M., Ursano, R.J. (2009). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Focus, 2009, 7: 221 – 242. Reprinted with permission from Psychiatry 70 (4), winter, 2007.
  • Buffington, S.D. (2009). The law of abundance: Instructions for the personal boundaries exercise. Retrieved on 5 November, 2013, from: http://bit.ly/18jycOd.
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  • Carbonatto, M. (forthcoming). Resilience styles (working title).
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  • Seligman, M. (1992). Learned optimism. Australia: Random House.
  • Solomon, Z., Mikulincer, M., & Hobfoll, S. E. (1986). The effects of social support and battle intensity on loneliness and breakdown during combat. Journal of Personality and Social Psychology, 51, 1269—1276. In Hobfoll, S.E., Watson, Pl, Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J., Friedman, M., Bersons, B.P.R., de Jong, J.T.V.M., Layne, C.M., Maguen, S., Neria, Y., Norwood, A.E., Pynoos, R.S., Reissman, D., Ruzek, J.I., Shalev, A.Y., Solomon, Z., Steinberg, A.M., Ursano, R.J. (2009). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Focus, 2009, 7: 221 – 242. Reprinted with permission from Psychiatry 70 (4), Winter 2007.