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Institute Inbrief - 08/10/2015


Welcome to Edition 234 of Institute Inbrief! Most practitioners would be shocked to hear it, but without realising it, many build resistance in clients – lowering their capacity to engage – through protocols and habits which communicate something very different to the client than what the practitioner is asking or intends to convey. In this edition, we explore five ways in which practitioners may inadvertently build resistance in clients.

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Diploma of Counselling
It’s time to start loving what you do!

We’ve been training qualified Counsellors for over 24 years. Overwhelmingly, the number one reason people cite as why they became a Counsellor – to start loving what they do. They were stuck in a rut doing something they had no passion for, and it was dragging them down.

If you want a deeper understanding of yourself, and to use that knowledge to assist others overcome their challenges and start enjoying life again – then counselling is likely for you.

Too often we get drawn into a career that offers little personal satisfaction. Counsellors are passionate about the important work they do. They’re often someone that friends and family naturally come to for assistance. And they get immense personal reward helping others.

If that sounds like you, then it’s time to start pursuing your passion:
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Five Ways Practitioners Build Resistance in Clients
Most practitioners would be shocked to hear it, but without realising it, many build resistance in clients – lowering their capacity to engage – through protocols and habits which communicate something very different to the client than what the practitioner is asking or intends to convey (Rosengren, 2009). In this article, we explore five ways in which practitioners may inadvertently build resistance in clients.
The assessment trap
Therapists are trained to get a history from the client straight away. Most agencies and institutions have specific assessments they need the practitioner to complete during the first session. The resultant question-and-answer hour may not be representative of the types of sessions which will follow, but the client does not know that. What s/he experiences is the clinician taking the lead, asking all the questions, and expecting him/her to give short answers which get the assessment form filled in, rather than the elaborated responses (born of more open questions) which are consistent with a client-centred – and thus less resistance-building – style of therapy.
Of course, if there is any possibility that the client is suicidal or there is any imminent emergency, the clinician needs to have a complete enough picture to ensure the proper care and safety of the client. But the form-filling protocols of the typical assessment session steer the client into a passive, one-down role. Think about it: do you as a practitioner really need to know everything about the client before you can even have a conversation? When closed (assessment) questions come thick and fast, the client has no choice but to pull back, defending him/herself and building resistance. This assessment trap leads into another.
The expert trap
Once the client has been squeezed into a passive role, it is only a tiny baby step, process-wise, from there to the clinician becoming the “expert”. The short-answer questions, fired one after the other, communicate “I’m in control here”. When someone takes over a process (as the acknowledged professional), asking all the questions and writing down the answers, most clients (logically!) expect to be told in due course what the solution is, what they need to do (Miller & Rollnick, 2013).
That’s a fair enough expectation for someone who presents with, say, a sprained arm, sore throat, or cut finger; Western general practitioner systems are predicated on the notion of “information in, answer out” and the patient expects at the end of the questions to be given a prescription, a sling, or a plaster – or at least instructions on how to treat the problem. Personal change, however, is not amenable to passively being “done to” and such role-taking as expert-patient is not expected to achieve real conversation about change, let alone change itself.
Premature focus trap
Let’s face it: as mental health professionals, we do have expertise. In fact, when clients come in and start talking about their problems, we often can see beneath the presenting issues to those that are inevitably at the core of the problem. But it is a swift ride to power struggles, discord, and disengagement if we prematurely attempt to get clients to focus on concerns we may hold for them while ignoring their “take” on the problem. Rather, we must engage with clients from their starting point. Our concerns are probably related to how they see the problem and, as they engage and disclose, the connection is likely to become relevant to them as well (Westra, 2012; Rosengren, 2009; Miller & Rollnick, 2013).
An example of avoiding this trap occurred in a Northern Territory clinic. The client presented with generalised anxiety disorder and was particularly anxious over the potential removal of her daughter from her care. The therapist, an alcohol and drug specialist, wanted to address the question of the woman’s substance abuse, but restrained herself, focusing with the client on the custody question. As a trusting therapeutic alliance grew, the woman gradually ventured the reason for the daughter’s imminent removal from her care: the drinking. Having been listened to respectfully and made a partner in the problem-solving process, the woman came on board with how she might change her drinking habits in order to keep custody of her daughter. Change talk was elicited, and gradually a plan was formulated by the therapist and the woman together. In this case, the therapist also avoided the following trap.
The labelling trap
One strand of premature focus is when the practitioner “needs” to name the “diagnosis” to the client, thus labelling him or her. It is hard enough for many clients to front up for mental health help; they feel further stigmatised or “boxed in” by labels. Some writers claim that it is a way that the practitioner retains control; others contend that it is at least a judgmental communication (Miller & Rollnick, 2013). Either way, it builds resistance and moves the client toward disengagement.
Ultimately, if the client is a fully participating partner in the process and is moving toward changing that which is harming his/her life, the appropriate therapeutic conversation – one preserving client respect and autonomy – finds no need to resort to labels; the disharmony thereby engendered hinders progress (this does not mean that you need to discourage clients who self-label in recognition of what they are dealing with: e.g., “I really have a phobia about flying” or “I want to get rid of my PTSD”) (Westra, 2012).
Stuck on side issues: Blaming and chatting
Similarly to labelling, it is neither helpful nor necessary in most therapies to be concerned with affixing blame. Clients are sometimes quite active in trying to apportion it (to anyone else but themselves, or alternatively, taking too much responsibility for how things turned out). The engagement-promoting intervention here runs something like, “I can see why you hold your parents responsible for the high anxiety you feel most of the time, but this process is a no-fault one. It is about seeing what can help you to feel better, not ascribing blame for why you feel so anxious.”
Off-topic chatting, apart from a few exchanges to build rapport at the beginning of sessions, also does not help the client move toward engagement with the considered change. Rather, when the primary focus is on the client’s goals and concerns, he or she can move forward toward reducing or eliminating the anxiety or other problems (framework for traps adapted from Miller & Rollnick, 2013).
Miller, W.R. & Rollnick, S. (2013). Motivational interviewing: Helping people change, Third edition. New York: Guilford Press.
Rosengren, D.A. (2009). Building motivational interviewing skills: A practitioner workbook. New York: Guilford Press.
Westra, H.A. (2012). Motivational interviewing in the treatment of anxiety. New York: Guilford Press.

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Getting smart with giving feedback

“Your meals are disgusting!” she shouted. A look of deep hurt flashed across his face before anger kicked in. “You don’t need to be cooked for anyway,” he retorted. “Your bottom’s gone way beyond cute!”

Does anything familiar echo here? What about in the following exchange?

“Darling,” he said, repeating his familiar compliment, “You’re beautiful.” The mirror reflected dark bags under her eyes from sleep deprivation, a face pale from stress, and a head of dirty hair. Beautiful? They both knew that this was far from her most beautiful moment. Why did he tell her this when it was so obviously false today?

Most of us would prefer to be party to the second exchange than the first one, yet the two scenarios have something lethally in common for relationships:  they contain evaluative feedback.

We often give little thought to the comments we make to others in our life sphere unless, as teachers, coaches, counsellors or the like, we are giving that feedback professionally and in an asymmetrical relationship (e.g. teacher/student, supervisor/employee, professional/client, or parent/child). But we can also use feedback effectively in our “equal” relationships - that is, between partners, friends, or equal co-workers - to build a strong and nurturing relational base founded on respect and genuineness.

The comments you make: descriptive or evaluative?

We probably don’t even think about comments we make to others as being “feedback”. Chances are, we generally just react to whatever is happening in the moment, as in the above examples. Yet feedback it is, and most of it can be divided into two categories: descriptive and evaluative. You may well wonder what the difference is – or why we should even care. Let me explain. 

“Evaluative” means judging

Anyone who’s been schooled knows about evaluative feedback. We cheered when we got an “A” or felt bad when the teacher wrote “sloppy work”. Evaluative feedback is for the purpose of measuring achievement with a score or grade: great for schools, perhaps, but not as effective in interpersonal relationships. The nature of evaluating is that we are making a judgment. The first woman above judged her husband’s cooking as “disgusting”, and he made an equally potent judgment about a part of her body. But even in the second example, the loving husband telling his wife she is “beautiful” is also judging.

All judging creates problems

We can easily get why negative judging comments are problematic for our relationships, but it’s harder to understand how the positive version – evaluative praise – also undermines our interactions. Think of it like this: evaluative feedback tends to be general, not specific, and is often directed to our person rather than our behaviour (i.e. who we are rather than what we do). Because it is subjective, it fosters approval-seeking:  a sense of being beholden to others’ opinions. This can trigger both perfectionism and shame in us.  It can, even when positive, make us feel worse, or that we should have done better. It doesn’t increase our confidence or self-reliance. Moreover, we may feel doubtful or even manipulated when, in cases such as the second one above, we know the feedback is being given because the person cares – or wants something – not because we are truly “beautiful”, “excellent”, or whatever quality is being ascribed to us. Whether negative or positive, we feel “thinged” – rendered less than fully human – when we are judged.

“Descriptive” tells it like it is

Descriptive feedback, on the other hand, describes a behaviour, situation, or incident as the feedback giver sees it. Because it is a description, it is based on something specifically observed and therefore able to be objectively verified. Often delivered in a calm, casual voice (as opposed to evaluative feedback’s exclamatory style), it is about noticing what someone does: his or her effort, process, and behaviour. It can be used to reinforce values between two people and emphasises steps in the right direction; improvements in behaviour, habits or attitude, or the absence of undesirable behaviour.  Regular use of it increases a person’s self-esteem, capacity for cooperation, and ability to accept disappointment.

To engage this relationship-building form of commentary, include two parts, a description of:  (1) what you see and hear and (2) what/how you feel.

Feedback in action

Let’s set a few examples to make it clearer.

1. Evaluative: You’re so strong!
Descriptive: Thank you for your help in carrying that heavy load.
2. Evaluative: Your cooking is disgusting.
Descriptive: I notice it’s almost always hard-boiled eggs and microwaved peas on your nights to cook; I feel bored with this and wonder what else you might be able to create.
3. Evaluative: You’re fabulous.
Descriptive: I feel deeply met when you give me your full attention and show empathy for my problem.
4. Evaluative: Your desk is a pigsty. 

Descriptive: When papers from our several projects are strewn over your desk, I feel anxious that we will not take needed actions in time.

Someone once compared feedback to fats in the body. Evaluative feedback is like the dangerous fats that clog our arteries, increase our cholesterol, and shut down blood flow. Here, it’s the healthy flow of relational energy being shut down. Descriptive comments are like the fats which lower our cholesterol, helping nourish heart and brain with blood flow. In our analogy, they keep the communication zone from getting clogged, nourishing our relationships.

Which would you prefer?

Written by Dr Meg Carbonatto B.S., M.A., and Ph.D.

This article was originally published in Asteron Life’s Balance Blog. AIPC regularly contributes to Balance’s wellbeing blog category.

Counselling and the Brain: Five Major Processes

The research in neuroscience is highly supportive of counselling’s emphasis on deep listening, empathic understanding, strength building, and wellness (Ivey, Ivey, Zalaquett, & Quirk, 2011). Counselling is shown to change the organisation of the brain: a learning process as the brain responds to stimuli and creates neural pathways to accommodate new information (Ivey, 2009). “Information” includes experiences, actions, thoughts, and cues: both those emanating from within ourselves and those from others and most especially including those stimuli arising within the therapeutic relationship. As John Ratey (2008, in Sullivan, 2012) said, “Experiences, thoughts, actions and emotions actually change the structure of our brains” (emphasis added).

Click here to continue reading this article.

Challenges of Same-Sex Couple Families

Nowhere is a discussion of dynamics in the changing family more pertinent than with lesbian and gay couples, and of the four functions that a family is meant to carry out for its members, the question of family formation is primary. Although gays and lesbians are not permitted to marry in most locations around the world, they do come together in civil unions, and many post-divorce families consist of a gay or lesbian couple with the children of one or both of them from a previous heterosexual marriage.

Click here to continue reading this article.

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How to understand anger

Familiar with this scenario? The idiot cuts in front of you, causing you to nearly crash into him. Your pounding heart, flushed face, tight chest, and gritted teeth tell you: you are angry. Or, maybe someone you know violates you in a despicable way, steals from you or betrays you. You are a “nice” person, so you don’t experience anger, but a dark cloud descends over your life. You stew. Nothing is fun anymore, and you feel grumpy. You, too, are angry.

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