This online course is the first part of a two part series by Clifton W. Mitchell, Ph.D. First, traditional ideas and definitions of resistance, as well as, the many dynamics of resistance are explored. The social interactionist model of resistance, from which the course is based, is introduced. Common therapist errors that foster resistance are then presented, followed by important principles for dealing with resistance. Suggestions regarding therapeutic language and the significance of language in therapy are offered and arguments are made regarding the precise use of language in therapy. Helpful information on goal creating techniques and the perils of excessive questioning then follow. A key to managing resistance is the inherent power of the language used when discussing issues with resistant clients.
Upon completion of this course participants will be able to:
"Resistance is all."
Anderson & Steward
- Conceptualize resistance in a manner that empowers them to avoid, circumvent, and utilize resistance for client benefit.
- Describe and discuss the most common errors therapists make that foster and promote client resistance.
- Identify nine principles for dealing with resistance in therapeutic environments.
- Explain the importance of tending to each principle in therapeutic relationships in order to tactfully manage resistance.
- Explain and discuss the inherent power of language with regard to resistance.
- Explain critical issues in goal development with resistant clients.
- Explain the pitfalls of over-questioning when working with resistant clients and how to employ more effective alternative approaches.
, 1983, p. 5
Developing a Personal Philosophy for Handling Resistance
The effective management of resistance is the pivotal point of good therapy. Consequently, it is recommended that all mental health professionals take time to develop a personal philosophy for dealing with resistance. Your personal philosophy of resistance should include two interrelated components.
The first component is an understanding of what resistance is—what it represents psychologically. Resistance is not one thing. The word "resistance" is actually a very limiting term utilized by mental health professionals that represents a host of states and reactions from clients. In order to effectively deal with resistance you should have an understanding of the many possible psychological interpretations. One of the purposes of this manual is to expound upon this point, and thereby, provide an understanding of the many meanings of what is commonly referred to as resistance. This understanding should lead you in your approaches to managing resistance.
The second component of your personal philosophy is a wide variety of approaches and techniques for directly managing resistance. These conceptualizations and tactics should equip you with several alternative responses to virtually any client position. Your tool box of techniques should provide you with approaches that gracefully and eloquently manage client reactions. You should have a balance between responses that are too passive and responses that might appear to be too confrontive. Ideally, you should be able to react in a situationally appropriate, yet, decisive manner when resistance is encountered.
Thus, your personal philosophy should include theories for conceptualizing resistance and techniques that allow you to maintain your emotional comfort as you deal with resistance. Your theories and approaches should aid you in conceptualizing the resistance in a manner that avoids futile battles with your clients. You should easily circumvent getting pulled into the stuck state that your clients are experiencing, and you should be able to remain objective as you establish a clear perspective about what is occurring.
Your personal philosophy should equip you with the skill to see resistance coming well in advance
so you will not be surprised when it presents in therapy. Interestingly, as your skills develop, your knowledge will help you to remain at ease as you bring to the surface the internal struggles of clients. Because of your increased comfort, you will allow yourself to more quickly get to critical issues. Thus, you more quickly reach the place in therapy where you can be helpful. Ultimately, your understanding of resistance will decrease treatment time.
In summary, you should have a plan for dealing with resistance before you encounter it in therapy
. You should be able to articulate to other professionals your position on resistance and your methods for dealing with it. If you were asked to state your theoretical position on resistance and your approaches and techniques for dealing with it, could you? If not, it is likely that your therapy is not as productive as it could be and that your highly resistant clients are quite frustrating to you.
Indications that resistance may have gotten the better of you.
1. You feel like you are fighting and arguing with your clients. Many times you may have felt like you were trying to convince your clients of something and not making headway.
2. Your clients are "Yes, butting…" you to death.
3. You are sitting on the edge of your chair for the entire session.
4. You are working harder in your sessions than your clients. If, after finishing your sessions, you have more work to do than your clients, then you should take a close look at what you are doing. It is likely that something is amiss.
5. You are worrying more and carrying more tension about clients' problems than clients are. The therapeutic tension should stay with the client, not the therapist.
6. You find that you are feeling compelled to say "we" as you discuss client problems.
7. You dread the session before it begins.
8. You dread the session after it ends.
9. You feel stressed and drained in an unhealthy manner after sessions.
10. You are feeling burnt out with your work.
Resistance Control Equals Stress Control
"Resistance feels personal to therapists" (Anderson & Steward, 1983, p. 2). The desire to help others is strong in those who choose to work in mental health. It is this strong desire coupled with the difficulties inherent in promoting client change that gives resistance a personal feeling. Resistance can result in feelings of insecurity, incompetence, frustration, hopelessness, stress, and burnout. When these feelings are indirectly communicated to clients, additional resistance results and a negative spiral develops. Novice therapists are especially vulnerable to the negative effects of resistance and the downward spiral that can develop.
One of the keys to dealing with resistance is to recognize that resistance is not personal. Resistance is a fact of therapy. All therapists experience resistance. All therapists go through periods where resistance gets the best of them. All therapists have to learn to manage resistance. There is nothing personal about it, other than that which we allow to be personal.
The mistake is letting yourself get sucked in by the alluring nature of resistance; most commonly, to personally take on clients' struggles and to try to fight their internal conflicts for them. When you begin fighting clients' internal struggles as if they were your struggles, you allow the resistance to snare you in its trap. You allow clients' resistance to become personal and, in your zeal to help, you become helpless.
An extremely beneficial byproduct of understanding resistance is an accompanying reduction in therapist stress. Stress and burnout among mental health workers is well documented. Much of this stress comes from high therapist expectations coupled with minimal client progress. Both of these factors are intimately tied to resistance. A comprehensive understanding of resistance and effective methods for dealing with resistance are essential to controlling therapist stress and burnout. This manual was written to teach counselors how to avoid resistance frustrations and the accompanying stress. You owe it to yourself to study resistance if for no other reason than to help you deal with the stress inherent in mental health work.
"The first step…therapists must take to master resistance is to decide for themselves the question of how much responsibility for change they can take realistically."
Anderson & Steward
, 1983, p. 36
I do not like the word "resistance." It conjures up precisely the image that I wish to eliminate. Indeed, this material was written in order to overcome the outdated and useless ideas that the word typically conveys. Yet, I am stuck with using the word. This is because "resistance" is so commonly used that it provides a starting point from which to discuss the most serious frustrations encountered by therapists. Moreover, I have no single alternative word to adopt in its place of which the meaning is commonly understood among therapists or that does not carry the same pitfalls. Further, given the choice of attending a seminar on "fostering client movement" verses "dealing with resistant clients," the great majority of therapists are much more responsive to the latter. This is because "dealing with resistant clients" carries with it the added appeal of solving therapists' problems as well as the clients'.
Thus, throughout this manual and in my trainings I use the very word that I wish to redefine and, ultimately, eliminate from the minds of therapists. Such are the binds in which language places us. In future chapters, this manual will offer some techniques that use similar language binds in ways that greatly benefit the therapeutic process. For now, I am compelled to use "resistance" in order to begin with a common language.
Resistance has been defined from a number of perspectives. Traditional definitions have their roots in Freudian theory. Freud primarily spoke of resistance from several highly related perspectives. Generally, resistance represented the client's efforts to repress anxiety provoking memories and insights (Otani, 1989). In other words, resistance is an attempt to control anxiety. In this sense, resistance protects clients from frightening discoveries about themselves. If we use this understanding to guide us in our manner of presentation of ideas to clients, there is merit and utility in this definition.
Freudian theory also postulated that clients who do not accept the interpretations of their problems offered by their therapist are resistant. The idea that the therapist was wrong, that the therapist presented the issues in an unpalatable manner, or that there may be other factors that resulted in the client rejecting the interpretations, did not appear to be considered. Further, Freud also believed that resistance resides in the unconscious. This position could make change even more difficult to accomplish depending on one’s ability to access and disrupt unconscious processes. Overall, Freud conceptualized resistance solely as a client problem. It is this component of Freudian definitions that renders them outdated and counterproductive. As will be explained, the more we view resistance as a client problem, the less we empower ourselves to do something about it.
The following are representative of outdated definitions found in mental health literature. Such definitions still carry the influence of Freud and are limiting in that they portray resistance as something that has its origin in clients. Figuratively speaking, resistance is seen as "residing" in clients.
"Any client behavior that exhibits a reluctance, on the part of the client, to participate in the tasks of therapy as set forward by the therapist,"
"…any behavior that indicates covert or overt opposition to the therapist, the counseling process, or the therapist’s agenda," (Bischoff & Tracey, 1995, p. 488).
"Resistance refers to the client's unwillingness to change," (Ritchie 1986, p. 516).
"…ways utilized by the client to deter the counselor from his purpose of helping him to change can be called resistance…" Kell & Mueller, (1966, p. 12). (It should be noted that these authors also discuss the therapist's resistance to the client.)
The next definitions offered have much merit and utility when used to conceptualize and understand clients. When compared with the definitions above, they expand the perspective and meaning behind resistance. Yet, they are incomplete in that they fail to include therapists' contributions as a component of the resistance. To varying degrees, each of the following definitions still tends to view resistance as something that resides with clients. Such perspectives leave therapists lacking control and too much at the mercy of other influences when attempting to foster change.
The cognitive therapists view resistance as being a result of negative cognitions. Although the source of resistance is still seen as internal to clients, there is some truth in this logic. The therapeutic mistake that arises from viewing resistance as resulting solely from clients' cognitive distortions is that therapists can become overly focused on trying to change clients' thinking, rather than on changing their therapeutic approach. As will be addressed later, some resistance is a result of therapists'
cognitive distortions that lead to unproductive approaches.
Some behaviorists see resistance as noncompliance with behavioral assignments. Similarly, resistance may be a result of a failure to find the right contingencies, reinforcements, punishments, etc. Kahn (1999) saw resistance as a good measure of secondary gain inherent to the problem. These perspectives do have the benefit of taking the source of the resistance out of clients. Unfortunately, they require considerable control over the environment before anything can be done to overcome the resistance—a luxury most therapists do not have.
Typically, resistance conjures up ideas of stubbornness, obstinacy, defiance, hardheadedness, rigidity, opposition, etc. Even with useful conceptualizations, negative labeling is common. However, there is little benefit from conceptualizing resistance in this way. When you place negative labels on your clients, you move into a position of stuckness with your clients. In order to avoid the consequences of negative labeling, you may want to consider other perspectives on resistance. For instance:
Resistance is a reflection of the developmental level of your client.
Resistance is a signal the client is dealing with a very important issue (Moursund & Kenny, 2002).
Perspectives that view resistance as solely a client problem have lingered in modern counseling literature. New, more insightful perspectives have been presented, but have been slow to emerge as a dominant school of thought. Likewise, these new perspectives still do not appear to be taught in many training programs.
Alternative Perspectives: The Social Interaction Theorists
The most insightful and useful definitions of resistance come from the social interaction theorists. From this perspective, resistance occurs as a result of a ''…negative interpersonal dynamic between the therapist and the client" (Otani, 1989, p. 459). Or, as Strong and Matross (1973) more specifically state: "Resistance is defined as psychological forces aroused in the client that restrain acceptance of influence (acceptance of the counselor's suggestion) and are generated by the way the suggestion is stated and by the characteristics of the counselor stating it" (p. 26).
Here, resistance is seen as something that results from the interactional style of the counselor and the client. The counselor allows
the client to form a mutual communication pattern that hinders counseling and the change process. This view of resistance forces the counselor to remain aware of what he/she may be doing that actually promotes resistance. The great benefit of this perspective is that changing your interaction style results in changing what has been deemed resistance. This perspective empowers therapists.
This position is primarily what is expounded in the Solution-Focused Brief Therapy literature. Solution-Focused approaches never label clients as resistant. The concept of resistance is eliminated from conceptualizations of clients and their problems. No matter how much reluctance may be displayed, all responses are simply viewed as information regarding how clients perceive and proceed with change (Walter & Peller, 1992). Taking a position opposite traditional views, Brief Therapy models replace resistance with the idea of cooperating. Clients are not resistant; they are cooperating in ways that are not always understood by most therapists. Indeed, de Shazer (1982) presented arguments that the terms "resistance" and "cooperation" are two sides of the same coin, suggesting that their differences are a matter of perspective.
Client cooperation juxtaposed with traditional views of resistance is a major paradigm shift for the field of therapy. Do we react to clients' responses in a manner that views their behavior as resistant or do we react in a manner that implies cooperation? This manual presents approaches that avoid the traps of interaction styles that interpret client responses as resistance. Such interpretations are likely to create resistance where none may have existed previously.
There are numerous ways in which the perspectives and interaction styles of therapists foster resistance. A number of these will be addressed later. At this point in the discussion, in order to help shift your perspectives to a more therapeutically empowering stance, the following ideas are offered. These statements take a different approach to resistance by viewing the source as coming from therapists. Read through the statements below and notice how resistance is defined around therapist behavior and not as something that resides within clients. As you read, perhaps you will become aware of your own reticence toward what is being suggested. Are you resisting or just conveying that these ideas are a bit difficult to accept at this time? (Perhaps the writer should present these ideas in a more palatable manner?)
Resistance occurs when the counselor fails to recognize that all
clients are ambivalent about change.
Resistance sometimes occurs when the counselor wants more for clients
than clients want for themselves. In this sense, resistance can be a values
clash between the counselor and clients in which the counselor's values are
Resistance is a result of the therapist being too intent on his/her
Resistance = counselor expectations.
Resistance occurs when the counselor starts solving the client's problems.
Resistance occurs when the therapist is going too fast.
Resistance occurs when the counselor does not know what to do.
Resistance occurs when the counselor asks the wrong question
or makes a poorly worded, unacceptable statement.
To the client your statement was unfathomable and unrealizable.
Resistance is "...anything the client does that makes the therapist
feel inadequate" (Pipes & Davenport, 1990).
Resistance occurs when the counselor fails to cooperate with the client.
Whenever you feel that your client is being resistant, you also must be
resisting your client's position. From this perspective, you are being
resistant. When considered in this context, resistance
is a counselor problem.
Moursund and Kenny (2002) suggested that there are two types of resistance. The first has to do with what the client is struggling with inside. The second is resistance that results from therapist error. When you closely examine personal struggles, you discover that resistance is a natural, necessary part of every client's problems. It is neither good nor bad, and the knowledgeable counselor neither abandons, rescues, nor attacks the client because of his/her resistance. Resistance is the problem at hand.
In the case of therapist error, the counselor is trying to get the client to do what he/she is not ready to do or is afraid to do or does not even understand. In this case, the counselor's own impatience creates resistance and is the counselor's greatest enemy. Many times the counselor is trying to proceed in a manner that is not suited to the client. Perhaps the counselor has used language in a way that does not promote movement. Regardless, you cannot push or verbally bludgeon your client into genuine change
. Approaches different from the commonplace must be learned and applied in order to promote change.
"Highly resistant clients are experts at winning the client-therapist struggle. They are experts at making us feel incompetent."
Resistance and Influence: Breaking the Negative Cycle
In order to further clarify and expand upon the social interaction theories of resistance, the following model is offered. This model conceptualizes and defines resistance as being a mismatch between the therapist's mode of influence and the client's current willingness to accept that influence. The approaches and techniques presented in this manual are based upon this model.
There are many ways to influence people and promote change. If you were to create a rough hierarchical list starting with the least forceful and moving toward the most forceful methods to influence people, it might appear something like this:
Each method of influencing has its benefits and drawbacks. Further, the benefits and drawbacks vary depending on the situation at hand. Effective therapy hinges upon therapists using an appropriate level of influence with regard to clients' current state of mind. With highly resistant clients, it is critical to be on target with the method of influence you use relative to their current degree of acceptance of your approach. Resistance is created when the method of influence is mismatched with clients' current propensity to accept the manner in which the influence is delivered.
For example, although there is definitely a time and place for direct confrontation, it is usually not in the initial stages of counseling. Confrontation delivered early in the process will likely be incongruous with most clients' initial inclinations toward accepting such a forceful method of influence. To be effective, direct confrontation should only be employed after considerable rapport and respect have been established and other approaches exhausted.
This is not to say that therapists are not to influence clients. Indeed, it is impossible not to influence. The key is to understand the benefits of each method of influence and to maximize the use of diverse methods of influence at various times during the therapeutic process. More specifically, in order to manage resistance you must incorporate the most fitting method of influence relative to the dynamics that are present in the therapeutic relationship at a particular point in time. Effective therapists are constantly adjusting and matching their method of influence with their client's current state of mind. This is perhaps why research continues to support the idea that the therapeutic relationship is the most critical factor
in successful therapeutic outcomes. When the method of influence used is incongruous with the client's current state of mind, what is commonly labeled as "resistance" occurs. If you deal with clients who display much reluctance to change, it is important to understand the relationship dynamics at work.
Clients who display what appears to be resistance do not, for some reason, want change in the manner prescribed by their therapist. Here, the method of influence utilized is likely mismatched with clients' current inclination to accept that method of influence. In order to subvert therapist influence, clients must expend energy as they focus on not coming under another's control (i.e., resistance). In reaction to clients' reluctance to accept their influence, most therapists try even harder to influence. As therapists' attempts to influence increase, so do the clients' rationale and inner need to circumvent this influence. A vicious cycle is formed that is fueled by the escalating attempts of therapists and clients to not be influenced by each other. Often, what originated from an inappropriate method of influencing intensifies into an arduous battle of wits.
In such relationships, it is as if clients and therapists are in a tug of war, each pulling harder on their end of the rope in order to drag the other across the line into submission. Each is exerting considerable effort to force the other to give in and agree with the opposing perspective. The result is that clients are reinforced by the secondary gain of not having to face their struggles and change, and therapists are exhausted and approaching burnout in their work.
"An effortless yielding of one's agenda is a major signal to the client's unconscious that here is a person I do not have to resist."
, 1990, p. 60
The way out of this cycle is to avoid directly fighting clients' positions. Stop pulling the rope and join clients on their side of the line. Upon doing this, there is no reason for clients to focus on and expend energy to oppose therapist influence. This same energy is now free to be used for other pursuits. Once this is accomplished, a more suitable method of influence can be established. Typically, at such junctures, therapeutic influence that is indirectly presented has a much better possibility of shifting perspectives and behavior.
Clients only have so much energy to focus on the difficult struggles before them. Therapists do not need to do anything that diminishes the amount of energy available for the therapeutic work at hand. When therapists apply mismatched methods of influence with clients, they increase resistance and decrease the energy available for change.
Client Dynamics Often Mislabeled as Resistance
The redefining of resistance has two interrelated components. The first component is to understand resistance from a social interaction perspective. The ground work for this was presented in the previous discussion. The second component is to learn to replace conceptualizations that inaccurately label client dynamics as resistance with more precise conceptualizations that provide a useful framework from which to proceed. To this end, therapists are strongly cautioned against labeling any behavior as resistance. The more you study what is commonly labeled as resistance, the more you will recognize that such labeling is of little therapeutic benefit. Indeed, it is most likely harmful. Before any behavior is deemed resistant, the counselor should rule out a host of alternative conceptualizations.
There are a multitude of possible explanations and meanings to what is often labeled resistant behavior. Below are some of my own and some from various sources. These ideas are offered in an effort to be thorough and to add utility to this manual by increasing the understanding of the many client dynamics to which therapists must adjust. These ideas are not presented to be a definitive list nor are they assumed to be mutually exclusive. Many have overlapping components. They are presented to stimulate ideas about what may be occurring within clients that may appear as resistance to therapists.
When you find yourself frustrated with a client's lack of progress, read through this list and assess whether some of these ideas may be legitimate conceptualizations of the underlying factors resulting in the lack of movement. Typically, after a client dynamic is understood, it is less likely to be perceived as resistance. Subsequently, you can adjust your approach and deal with the dynamics at hand.
Resistance could be a sign that the client does not want to be there—
The Positive Side of Resistance
that the client came to counseling to satisfy demands of someone else.
Resistance could be an adjustment reaction to the novel situation of
counseling, of actually talking to someone about problems,
of being in the office of a "shrink."
Resistance could be a reaction to the openness of the therapist.
Such openness may be experienced by the client as very strange behavior.
Resistance can be an indication that the client does not know how to be a
client. For example, they may not be skilled at "going inside" and assessing
and experiencing their own feelings (Moursund & Kenny, 2002). Thus,
when feelings are suggested and stated by the therapist, the client may be
perplexed and bewildered.
Resistance could be an indication that the client has been hurt in previous
close relationships. Thus, in order to prevent additional pain, they stop
moving forward to guard against the perceived pain that may arise in the
client-therapist relationship (Moursund & Kenny, 2002).
Resistance could be a sign of an underlying fear of failure. This fear of
failure may be toward making changes in one's life. Alternatively, this fear
may be from the client not knowing how to be a client and, at the same
time, having a high need for success or perfectionism. Thus, resistance
may be a result of the fear of failure at being a client.
Resistance may be a result of feelings of shame that exist because the
client has not been able to resolve issues (Teyber, 2000) or because of the
social implications surrounding the issues.
Resistance could be a result of the fear of taking risks. It might be that
counseling is seen by the client as highly risky behavior whereas the client
is actually very conservative in his/her approach to life.
Resistance may be an indication that the client feels as if he/she is
"…having familiar things taken away or tinkered with in ways that do not yet
feel safe" (Murphy & Dillon, 1998, p. 126).
Resistance could be a sign of social fear that emerges as a result of poor
Resistance could be a desire from the client to flex his/her individuality.
Resistance may be a sign that the client enjoys manipulating others and, by
not "moving" or responding therapeutically, he/she realizes that he/she can
manipulate the therapist. Opposing the therapist may be one of the only
empowering elements of the client's life.
Resistance can be passive-aggressive behavior. The client may be angry
with the counselor or some other adult or authority figure that the counselor
represents (i.e., transference). This anger is expressed as resistance.
Resistance could be a result of life experiences. Perhaps the client has
learned that parental or authority figures are not to be trusted. It may be
that he/she has learned that to survive you should not trust authority
figures. Thus, what appears to be resistance may be a survival mechanism
in reaction to authority figures in general (Kaplan, 2001).
Resistance can be an indication that the client is psychologically drained
and does not have the energy to take on the tasks that will lead to change.
Here, the therapist needs to back off and allow for replenishing of energy.
Take a therapeutic break.
Resistance can be a personality style. Some people enjoy the battle of
resisting. In such people, the stimulation that results from arguing and
controversy may reinforce resistant behavior. Such people often switch
positions if they find others agreeing with them in order to keep the
stimulation going (Kottler, 1994).
Resistance may be a reaction to the loss of personal freedom inherent in
the counseling relationship (Anderson & Steward, 1983). "Entering any
form of psychotherapy constitutes the formation of a dependent relationship
and therefore a loss of personal freedom" (p. 30).
From an Adlerian perspective resistance is the client's way of avoiding
personal responsibility and of gaining respect and sympathy from others
(King, 1992). Adler viewed all behavior as purposeful and concluded that
these two justifications explained the underlying purposes behind what is
deemed resistance and the related symptoms.
Resistance can be an act of jealousy or sabotage in order to maintain the
counseling relationship. "If I get better, then I will not be able to come to
these sessions and get all of this attention and maintain my relationship
with my counselor." In this instance, an unhealthy dependence has
developed between the client and therapist.
Resistance may be a healthy response to bad counseling (Hammond,
Hepworth, & Smith, 1977). Therapists who lack empathy, dominate
discussions, lecture to clients, move too quickly, offer advice from a know-
it-all stance, etc. will likely arouse resistance in healthy clients seeking
someone with better counseling skills.
To fully understand resistance, it is also important to recognize that there are many positive benefits that result from it. Resistance has a purpose, otherwise, it would not be. When you understand the many benefits of resistance, you begin to realize that it is essential for mental health. The following purposes and benefits of resistance are compiled from the writings of Anderson and Steward (1983) as well as my own analyses.
Without resistance all social systems would dissolve into chaos and
Food for thought:
confusion, changing with every new idea presented.
Without resistance families would not have the stability necessary to
provide the structure required to raise healthy children.
Resistance is what prevents us from being victims of charlatans and
sociopathic con artists.
Resistance is what prevents us from buying every product presented to us
in commercials and infomercials.
Without a certain amount of resistance we would have no stability,
predictability, security, and comfort.
Without resistance there would be no sense of self.
Feminists regard resistance as an indicator that the client is fighting against
unjust systems and as a sign of power in the face of oppression (Brown,
1994, as cited in Corey, 2001).
Resistance provides us with a sense of being right. Can there be right and
wrong without resistance?
Resistance can be a sign of good mental health and judgment. Without
resistance there would be no mental health.
Would you rather have a client that does everything you suggest, or would you rather have a client that takes time to adjust to new ideas? Which is most frightening?
“Without resistance we would all be out of a job.”
Pipes & Davenport
Common Errors Therapists Make That Create and Foster Resistance
Although the initial points presented here are highly interrelated, they are presented as separate issues for clarity.
Your Client is Not Making Progress Toward What?
Among other things, when we experience resistance we say that our client is "not going anywhere." The client is not "invested in changing" and is "showing no progress." We feel stuck. Central to these statements are the questions: Where is the client supposed to be going? The client is showing no progress toward what? One of the primary therapist errors that causes resistance is failure to establish a mutually agreed upon objective.
If you and your client are not in agreement about a desired outcome, problems are inevitable. Further, you and your client should be able to clearly state the mutually agreed upon objective. If a mutually agreed upon objective has not been established and a reasonable time has been devoted to establishing rapport and understanding the client's situation, then it is critical to focus session time on the creation of such an objective.
The key word here is "mutually." Clients should be active participants in goal establishment, particularly resistant clients. Counselors who impose goals on clients without regard for clients' desires are like salespersons who try to sell you a product that you do not want. Many people enter the counseling profession because they do not like business and sales type work. Yet, these same people go into a sales role when attempting to impose therapeutic objectives on clients. We should strive to stay in a customer service mode where we aid shoppers in finding what they desire. This mode of interaction is also considerably less stressful.
The next time one of your colleagues complains to you about a particularly difficult client who does not want to change, ask, "What is the goal?" If he/she begins stuttering or goes into a vague, rambling explanation, you will know that a mutually agreed upon goal has not been established. Then inquire, "If the client was asked what the goal is, would the client agree and could he/she state it?" It is mind-boggling how many times this essential therapeutic component has not been formulated.
"…conflict between the goals of the therapist and those of the client's, often implicit and unacknowledged, forms the very fabric of therapy and contributes significantly to resistance."
, 1992, p. 167
Why Most People Come to Therapy?
Understand this: Most people do not come to therapy to find solutions to their problems. Most people come to therapy, "…because they realized what the solution was and were terrified" (Walter & Peller, 1992, p. 100). Although there may be exceptions to the above statement, more often than not, it is true. Perhaps you have heard the commonly stated axiom that all clients have the solution to their problem inside, the job of therapists is to help them find it. The reason people are unable to come to grips with a possible solution is that the solution is terrifying. Making the changes necessary to resolve issues in their life scares the hell out of them. Thus, it becomes much easier not to recognize possible solutions at all.
From this perspective one of the primary jobs of therapists is to normalize the fears surrounding the solutions and support their courage to move forward in the midst of the perceived, impending terror. In cases where fear of the solution is great, focusing too strongly on the solution may actually increase fear. To break the impasse, focus on dealing with the fear that accompanies the solution before moving the focus forward toward actions to be taken. The primary point being, therapists may inadvertently create what appears to be resistance because they have focused the discussion on the wrong issue, or on an issue that should not be approached until other issues are addressed and, at least, partially resolved. In such instances, therapists have gotten ahead of clients in problem resolution.
The issue of defining the problem and thus, the solution and goal, is often directly tied to the "horror of the solution." The more terrifying the solution, the more likely clients will be to dance around the real problem. They will discuss a series of seemingly disjointed incidents or never actually present a clear picture of why they are seeking help. In these instances, the problem is not clearly emerging in the dialogue. Generally, such dialogues are unfocused, scattered, inconsistent, contradictory, and just do not add up and make sense. If this occurs, it is likely that the discussed problem is not the primary problem that needs to be addressed.
Clients that dance around the central issue often feel to therapists as if they are resistant. The real issue facing such clients is only discerned from the overall impression of what’s going on in the session. The therapist must step back and look at the session as almost an abstract work of art. You must look at the big picture and then find the primary underlying theme that prevents clarity in the dialogue. As a picture of this theme emerges, the therapist's next task is to find a way to present the theme to the client in a supportive, palatable manner. From this discussion a coherent problem definition can be developed.
In our clinic we once had a woman who talked for four sessions about how much she hated her husband and how badly she wanted a divorce. We were dumbfounded that she was not proceeding with the divorce. As we addressed the issues further, she began discussing her financial dependence on her husband and the fact that she had no marketable skills to use toward getting a job. This was compounded by the fact that she had children to support and returning to school for training would be costly and scary. At this point, the entire session changed from focusing on the desire to divorce to focusing on the fears that accompanied the divorce. Hence, we began dealing with the real issues.
"The immature therapist has trouble backing off. Frustration comes easily and is usually answered with more technique and method. Stepping back is letting go of doing things and just taking a look at what's going on."
, 1990, p. 60
The Essential Ingredient Necessary Before We Help Anyone
Here is a simple but powerful premise that was taught to me by Dr. David Burns, author of Feeling Good: The New Mood Therapy, at a seminar he conducted. Dr. Burns stated that you can never help your client until the problem is defined around a specific person, place, and time. I have contemplated and tested this assumption numerous times and have yet to disprove it. If your discussion with your client has not reached the point where the problem can be formulated around a specific person, place, and time, then there is clarifying yet to do.
This is a very interesting idea. Sometimes the person, place, and time are obvious. It is a husband or wife or boss or child, etc. In other instances the person, place, and time is the client at an earlier age in a traumatic experience with someone. Sometimes it is the client and you at the present moment in the session! In most instances, something needs to change regarding the particular person, place, and time. Something must be done to interrupt the current modus operandi. At other times the client needs to "return" to a point in time in his/her life and discuss and reframe events and emotions. Regardless of the case specifics, the person, place, and time components are always present in solvable problems. If you cannot readily state the person, place, and time of your client’s problem, then the problem definition is too vague and progress will be hindered.
"Muddiness is not merely a disturber of prose, it is also a destroyer of life, of hope…."
Strunk and White
, 1979, p. 79
The Perils of Assuming a Knowing Attitude
There is an interesting paradox that occurs with highly resistant clients. The greater the resistance, the greater the likelihood that the client is refusing to consider any of a host of possible solutions. Because there are so many changes that may bring improvement, possible solutions appear abundant from the therapist's perspective. As you become aware of the myriad of possible solutions, you become more certain that your knowledge can help them. As a result of your certainty, you begin talking more and more as an expert regarding the problem at hand.
But here’s the catch, the more of an expert you become, the more you provide the client something definitive to resist against. Furthermore, the more of an expert you become, the less psychological freedom the client has to explore possibilities on his/her own. Thus, your expertise results in the client loosing the sense of freedom that is necessary to willingly embrace change.
One sure sign that you have become too much of an expert is "Yes, but…" answers. "Yes but…" responses most commonly follow advice and suggestions, or questions that are intended to convey alternative behaviors clients might try. The problem with such comments is that they communicate your expert knowledge. With highly resistant clients, the more knowledge you present about solutions, the greater the likelihood of resistance. Conversely, the less knowledgeable you present yourself, the less you provide a position to resist against and the more you give clients freedom to "move" therapeutically.
Hence, the way out of this situation is to reverse the paradox. The more obvious possible solutions become, the more naïve, inexperienced, and uncertain your displayed attitude toward these solutions should be. In other words, your highly resistant clients should experience you as more uncertain as obvious solutions are approached. You want to avoid creating a situation where your knowledge of solutions emerges in such an overbearing, know-it-all manner that you increase the motivation of your highly resistant clients to try to prove you wrong. You can avoid this dilemma entirely by assuming a naïve position toward solutions. The principle at work here is that your clients cannot be resistant if there is nothing to resist against.
My students have referred to this approach as the "Columbo technique" because it is very similar to the approach taken by detective Columbo as he fumbled and yet, cleverly hoodwinked his suspects into revealing key pieces of information necessary to solve the murder. Columbo always apprehended his suspect by constantly appearing to not understand the basic components surrounding the murder and by asking questions that forced the suspect to clarify his/her actions. Although Columbo always appeared to be two steps behind the murderer, in reality he was two steps ahead.
It should be noted that there are certain pseudo therapeutic statements that convey a knowing attitude without substantiation and invite a challenge from clients. To make such statements is a classic error that should be avoided. Gerber (1986) provided examples of two such statements. They are, "I know how you feel," and "I understand." If you suspect you know how clients feel or you understand their situation, then say it explicitly; do not just expound that you know it. (Can anybody really know how another feels?) The problem with such statements is that, if the client challenges your knowledge and you are forced to explain what you think you know, the client can always say you are wrong and you have no grounds from which to defend your position.
"Where ignorance is bliss, ‘Tis folly to be wise.”
(1716-1771), English poet
Rogers is Still Right and Why People Change
A long-standing maxim in counseling is: "Clients do not care how much you know until they know how much you care." Yet often, after some therapeutic experience is gained, counselors forget the powerful impact and importance of empathic statements. We become lax in consistently including empathy throughout our sessions. Commonly, sessions become loaded with an excessive quantity of questions without a foundation of understanding. What typically follows is that clients lose the feeling of psychological support necessary to proceed safely. Much of the time the decreased use of empathy may be more of an unconscious than conscious progression on the part of the therapist. You have slowly moved away from the basics as your job has become routine. Subsequently, sessions begin to stagnate. An essential component to breaking through resistance is to maintain a foundation of understanding through a dialogue that consistently includes empathic statements.
In addition, there is an even more important reason
to consistently use empathic statements. Many times therapists discount and limit the consistent use of empathy once rapport has been established. The logic here is something like, "Now that I have rapport, I will build a logical case for change." However, people do not change because of logic. People change when they have an emotionally compelling reason to change.
The energy and drive for all change is derived from an emotionally charged base. Logic alone is not enough. If people changed because of logic, no one would smoke, no one would drink, everyone would exercise, we would not eat the vast majority of the food in vending machines, we would never try to outrun a yellow light or a train, and a host of other stupid human behaviors. Yet, people continue to do these things on a regular basis.
I am not saying that logic is not present in change. It almost always is. Most of the time it is presented as the reason for change. However, when you closely examine the underlying forces that actually move people to change, they are not logically based. They are emotionally based. You must look below the surface to fully understand the dynamics of change. Logic provides the socially acceptable, sensible reason to change; emotion provides the underlying motivation to initiate and implement the change.
Compelling reasons are compelling because they arouse strong emotions. Yet, because emotions are often linked to uncomfortable feelings, most clients have blocked awareness of or are in denial of their own emotions. It is through the use of empathic statements that therapists get clients in touch with the emotional energy they need to initiate change. Empathy is the tool by which therapists get and keep clients in touch with the emotions that ignite and fan the fires of change.
Highly resistant clients need to experience consistent empathic responses in order to build a compelling emotional foundation to motivate their logical reasons to change. For most resistant clients, logic without an underlying emotional charge is just talk. Failure to consistently include empathic statements in counseling dialogue inevitably makes the task of overcoming the client's ambivalence to change much more difficult and will likely be experienced as resistance by therapists. For a compelling study that substantiates the influence of empathy in treatment, see Burns and Nolen-Hoeksema (1992).
"If the therapist is not being sensitive to something the client needs, something about safety or being understood, then the client will resist. It is a mistake to attempt at the level of method before relationship is firmly established."
, 1990, p. 58
Timing is Everything and “Baby Steps” are Not a Joke
A significant amount of resistance comes from poor timing. The most common timing mistakes center on introducing new ideas prior to your client being ready to accept those ideas. Anytime you are experiencing resistance ask yourself, "Am I getting ahead of my client?" If you find that you are ahead of your client, slow your pace, back up, and take smaller steps. Explaining before the client is ready to accept, confronting too soon, and moving too quickly to a major action phase are all common forms of bad timing.
In the movie What About Bob
, Richard Dreyfuss plays a psychiatrist who suggests to his client, Bob, played by Bill Murray, that he read his book entitled "Baby Steps."
He further instructs Bob to only take baby steps toward solving his host of neuroses. As the movie progresses, Bob develops a highly dependent relationship with his psychiatrist as he begins to take baby steps and solve his problems. Although this movie was a hilarious spoof on therapy, the concept is not to be taken lightly. In many areas of life, you must slow down to go faster. Therapy is clearly one of these areas. Teaching and allowing the client to take smaller steps is a vital component of effective therapy. Getting ahead of your client in the change process is a sure way to experience the frustrations of what appears to be resistance.
In order to not rush your client, I suggest that you constantly ask yourself, "What could I say that might move my client the smallest step possible toward where he/she needs to be to resolve his/her problem?" In other words, although your client may have an ultimate goal, your immediate task is to simply move your client closer to that goal using the smallest step possible. Rarely should your immediate task be to reach the ultimate goal.
This approach solves two problems. First, it does not push the client excessively and, thereby, create resistance. In fact, if you can stay "behind" your client in the process, then you can actually have the client pulling you along toward his/her solution. Second, this approach takes an enormous amount of pressure off of you. The task at hand becomes manageable and you are more able to remain balanced in sessions. Therapists also need to learn to take baby steps. This skill is an enormous stress reducer.
Many therapists use scaling techniques to get a feel for the client’s position relative to psychological concepts such as the level of emotion or commitment or tolerance, etc. Most therapists use a 1 to 10 scale for such assessments. However, in order to allow movement in even smaller steps, I suggest using a 1 to 100 scale. Moving from a six to a seven may be difficult for your client. However, moving from a 63 to a 65 will likely be perceived as achievable.
Accepting the Invitation to Take the Pain
People come to counseling because they feel bad. They are worried, stressed, lonely, in conflict, unresolved, etc., and are bewildered as to the direction to go in order to relieve themselves of their pain. To some extent, all clients want to be relieved of their pain without suffering. They do not want to move through their pain, they want to avoid it altogether. Clients would love for you to just take away their pain without any additional distress. As a result, all clients to varying degrees regularly "invite" you to take their pain. Even though the ultimate objective is for clients to feel better, this, in and of itself, should not be the immediate or primary objective.
It is a mistake to put too much of the immediate focus on techniques and comments that result in clients feeling better temporarily. Therapists who do this in excess run the risk of creating a therapeutic relationship that repeatedly band-aides clients' problems with no long-term resolve. You will know if you have done this because you will recognize the patterns that emerge. Clients will come in with their current catastrophe, you will talk with them and get them momentarily relieved of their agony, and they go their way only to return again and repeat the pattern. Or perhaps clients will make statements such as, "I just love talking with you. I feel so good for the few days that follow. Then I get down on myself and have to come back to get another boost from our talks. You are a wonderful person. I am so glad you are in my life." Although such comments may be immediately gratifying for counselors, they can be an indication of a classic therapeutic error.
The mistake is that you have accepted the invitation to take the therapeutic tension. You have not designed a dialogue that keeps the therapeutic tension with clients. This therapeutic error fosters resistance in a covert manner. The error is often unseen because your repeated band-aiding appears to be effective initially; however, the effect is short-lived. Problems arise because the motivation for genuine, lasting change is diminished as a result of clients being able to get quick, temporary relief. You have used your understanding and skills to take away too much of your clients' pain and motivation.
Unfortunately, such clients are often the ones that you carry in your mind as you go through your weekend. You hurt while your clients go nowhere. As the pattern repeats, such clients become quite exhausting. After a while you wonder if you should stay in this business when you feel so bad and your clients make so little progress. You experience your clients as resistant when, through your style of dialogue, you have removed their motivation to change through an over emphasis on feeling better. You have forgotten the wisdom of Albert Ellis who is fond of pointing out that feeling better does not equal getting better.
The key to avoiding this dilemma is to avoid band-aiding and constantly maintain a therapeutic dialogue that keeps the therapeutic tension with clients without placing blame in the slightest way. With highly resistant clients, recognition of the clients' part in creating their pain should emerge from within as a result of their constantly explaining the dynamics of their situation to you. The dialogue styles taught in this manual always have the underlying goal of keeping the therapeutic tension with clients.
"Feeling better does not equal getting better."
Failure to Recognize and Respond to the Clients' Stage of Change
Although we commonly view change as a momentary or short-term event, it is not. In most instances, change takes place gradually, over time. To help understand the process of change, Prochaska has developed a transtheoretical model of change that conceptualizes change as occurring over time, in relative stages (Prochaska, DiClemente, & Norcross, 1992). However, this perspective has appeared to be ignored by many counseling theories. Most counseling theories approach clients as if they were all at the same general point in their struggles. Yet, experience teaches us otherwise. The Transtheoretical Model construes change as a process involving one's progression through a series of five stages. A brief explanation of the five stages follows.
is the stage in which people are not intending to take action in the foreseeable future, usually measured as the next six months at least.
Although family, friends, or employers may be acutely aware of the problem, people in this stage are typically unaware or under-aware of their problem. Alternatively, they may have tried to change a number of times and may have become demoralized about their inability to change. Such people tend to avoid reading, talking or thinking about the negative consequences of not changing. When they show for therapy it is often because of pressure or coercion from others.
People who attend therapy because of threats of losing their job, threats of divorce, or threats from parents or principals, and people who are court ordered or people who must attend in order to receive medications are often in this stage. Those in denial typically fall into this stage. Many times, once pressure to attend is removed, they drop out. They may make statements like, "I guess I have faults, but there's nothing I really need to change," or they may only "wish" to change. Such clients are often characterized in most theories as resistant or unmotivated or as not ready for change. The fact is traditional counseling theories are often not designed for such clients and do not present approaches that are effective in helping and managing them.
Unfortunately, a substantial portion of clients seen at community mental health centers fall into this category and are immediately pigeon holed as resistant. For such clients it is imperative to spend much time building rapport and discussing their situation in a non-threatening manner. As difficulties are presented, focus on establishing how their situation is a problem for them
. Remain puzzled and naïve in the midst of overwhelming evidence of issues. Do the unexpected by not pointing out the obvious. They are masters at avoidance and you cannot create movement if they do not allow it. You will likely lose the battle if you appear coercive. Remember, if you push the client, all they have to do to frustrate you is nothing.
All a client has to do to sabotage and thwart your efforts is nothing.
is the stage in which people are aware that a problem exists and are intending to change in the next six months. However, people can spend years
in this stage. It is in the contemplation stage that people are deeply struggling with the pros and cons of change. The internal conflict between the costs and efforts necessary to change and the benefits of changing produces profound ambivalence that keeps people stuck in this stage. Thus, there is awareness that a problem exists, but no commitment to action. They make statements such as, "I have a problem that I think I should work on," with the operative word being "think" and not "work on." We often characterize this phenomenon as chronic contemplation or procrastination. These people are not suitable for approaches that assume immediate action is forthcoming. Examples of people in this stage may include those considering divorce, changing jobs, losing weight, or starting an exercise program. The therapeutic focus should be on examining the internal struggle. Gestalt techniques such as the empty chair may be appropriate but can be experienced as quite threatening.
is the stage in which people are intending to take action in the immediate future, usually measured as the next month. They have typically taken some significant action in the past year. These individuals have a plan of action, such as joining a health education class, consulting a counselor, talking to their physician, buying a self-help book, or relying on a self-change approach. Thus, the primary characteristics are commitment to action, with small behavioral changes occurring, and additional action planned for the very near future. These are the people best suited for most commonly taught counseling theories.
is the stage in which people have made specific overt modifications in their life-styles within the past six months. This is the point where issues of relapse emerge as a result of the consequences of change becoming more real. Thus, along with promoting continued movement, the focus should include vigilance against relapse.
is the stage in which people are working to prevent relapse but they do not apply change processes as frequently as do people in the action stage. They are less tempted to relapse and increasingly more confident that they can continue their change. However, maintenance should not be viewed as a static stage! Maintenance does not mean completion. It is critical that clients continue to work to nourish implemented changes. Therapists should focus on gathering an understanding of what the client is doing that is working and reinforcing a continuation of such behaviors. Alcohol and drug clients who have been clean for a reasonable period fall into this category. Failure to properly understand and attend to the maintenance stage could result in backsliding into old familiar patterns.
"…it is well known among experienced clinicians that rigidly expecting a client to change at the therapist's rate, rather than according to the client's own internal rhythms and personal abilities, is tantamount to setting that person up to fail."
, 1985, p. 20
The relationship between Prochaska's model and resistance is self-evident. Not infrequently, therapists approach clients as if they were in a latter stage of change when they are not. Most commonly, we assume clients come to therapy ready to change (preparation stage) when they are actually in a precontemplative or contemplative stage. Highly resistant clients are almost always in the precontemplation or contemplation stage.
Further, the therapeutic approaches used for each stage vary considerably. What works for a preparation or action stage will likely be ineffective for the precontemplation or contemplation stage. What is effective for someone in the preparation stage will indeed create much resistance for the precontemplator or contemplator. Adjusting approaches and goals relative to the client's stage of change results in a much more cooperative relationship. Although what is presented in this manual will work to some degree in all stages, most of what is presented is focused on dealing with those in the precontemplative and contemplative stages.
It is also important to be aware that people do not progress through these stages only once. The more common pattern is to cycle through the stages several times. Clients may also be at different stages of change relative to different problems and components of problems. Recognizing this, therapists may have to constantly adjust approaches as different problems are addressed. To enhance movement, therapists should learn of past progress and struggles, building a knowledge base of client strengths and resources from which to draw as new issues arise.
The following brief assessment questionnaire comes from Littrell (1998) who adapted it from the work of Prochaska, Norcross, and DiClemente. This brief assessment is useful in determining general stages of change.
Answer the following “yes” or “no”:
#1. I solved my problems more than six months ago.
#2. I have taken action on my problem within the past six months.
#3. I am intending to take action in the next month.
#4. I am intending to take action in the next six months.
Assess the stage of change using the following criteria:
no to all
yes to #4 and no to all others
yes to #3 and #4, but no to the others
yes to #2 and no to #1
yes to #1
After a stage of change is determined, therapists should be careful to set goals appropriate for the current stage or one stage beyond the client's present stage (Littrell, 1998). This approach results in more manageable goals and more motivated clients.
It should be noted that Prochaska, DiClemente, and Norcross (1992) argue that the stage of change is the second best predictor of client progress. The most influential factors are centered on therapeutic components such as helping relationships, consciousness raising, self-liberation (i.e., self-commitment), etc. It follows that correctly identifying a client's stage of change and aiming toward taking small steps that consistently prepare the client for the next stage of change is strategic for utilizing these findings.
If you have not currently conceptualized your clients by their stage of change, I suggest you do so. Then, before each session, review the stage of change in which you suspect your client to be and acquire a mindset going into each session to respond accordingly. This is yet another technique that will not only reduce resistance and help your clients, but will greatly reduce your personal stress. As you learn to approach clients not expecting more than is reasonable relative to their stage of change, you take pressure off of yourself to perform therapeutic miracles. Your assessment of what can realistically be expected becomes more grounded in reality. In turn, you will feel better about your work.
Cognitive Distortions of Therapists That Foster Resistance
Cognitive distortions are most commonly associated with client problems. Yet, some therapists hold internal beliefs that lead to unproductive therapeutic approaches that invite resistance. Many times we may not be consciously aware of our beliefs and how they lead to the resistance we wish to avoid. Sometimes one needs to look inward and ask what fundamental beliefs are held about one's self and therapy, and how these beliefs may be encouraging resistant behavior from clients.
There are numerous cognitive distortions that promote what feels like resistant behaviors. Some of these distortions are listed below along with a brief discussion of the pitfalls inherent in them. I am certain that there are many other cognitive distortions with similar themes; however, a study of these should suffice to exemplify how our own attitudes, no matter how good the intentions, may work against us. Some of the distortions discussed are my own and some are adapted from the writings of Aldo Pucci (2001) and Corey, Corey, and Callanan (2003).
As you read, ask yourself how many of these might apply to you. It is very difficult to be a counselor and not at some time or another have embraced some of these thoughts. Beginning therapists are especially likely to fall victim to these notions. If, as you read, you realize that you are hearing echoes of your own mind, consider how you might adjust your thinking in order to reduce resistance.
"My clients want to change."
"My clients do not want to change."
"My clients should not be ambivalent toward changing."
"My clients should be easy to work with."
These statements cloud accurate perception of the truth: Clients are ambivalent about change. That's why they are talking to a counselor. To hope for or assume anything other than ambivalence with regard to change is unrealistic and unproductive. Erroneous beliefs about motivations and conflicts associated with change often lead the dialogue in unrealistic directions. Learn to accept and be at peace with your clients' ambivalence toward change.
"It is beneficial to try to remove my clients' distress and discomfort."
"My job is to make my clients feel better."
The notion that clients come to counseling to feel better does not necessarily mean that we should attempt to alleviate all of their distress. Too much sympathy and distress abatement may lead to a lack of motivation to change on the part of clients. In such instances you are only "band-aiding" the problem. With resistant clients, counselors should strive to keep prominent the emotional distress that results from repeating unproductive behaviors. This provides an emotional reason to act. Hence, the therapeutic tension should stay with the client, not with the therapist.
"My clients should and will change when they understand the logical flaws
of their current behavior and the logical benefits of alternative approaches."
"If I could only present stronger arguments for change, my clients would
'see the light' and begin doing things differently.”
These two statements stem from the assumption that change occurs because of logic. Oh, if it were only so easy! As noted elsewhere in this material, people do not change because of logic; they change when they have an emotionally compelling reason. The problem with the above cognitive distortions is that they lead to a dialogue that presents what appear to be logical arguments for change. Rarely will logical arguments, in and of themselves, produce change. More importantly, arguing for change through logic often creates
resistance. Change is a much more complex process than mere logic. The fact is that logic plays only a small part in the overall dynamics that foster change. Therapy is the art of getting clients in touch with all of the underlying factors that support the logic.
"The more I put pressure on my clients to change, the faster they will
"I go into every session with an agenda to get the client to do something
To the contrary, with resistant clients pressure often slows change and promotes resistance. Therapists' agendas aimed at getting clients to do something are a primary cause of resistance. With resistant clients, to promote change, remove the pressure to change.
"My clients should work as hard as I am."
"I have to be successful with all of my clients."
"My job is my life." (Thus, failure at work = failure in life.)
"I am responsible for my clients' behavior."
Such statements will likely put undue pressure on you to promote change in your clients. When this pressure is transferred to clients, resistance may result. The fact is, your work and your clients' work are different. You should be working hard to create a dialogue that maximizes the potential for change and avoids the pitfalls of the nonprofessional whose understanding of the change process is limited. Clients should be working hard at facing their inner struggles and at adjusting to the realities of their life. If you feel you are working harder than your clients toward a resolution of their problems, something is amiss. You are likely working at the wrong thing.
Further, I know of no therapist who has been successful with all of his/her clients. The truth is that sometimes the therapeutic process just does not work, no matter how hard you try. If you are unrealistically burdening yourself with your clients' lack of progress, then get real and cut yourself some slack.
General Principles for Dealing with Resistance
This chapter addresses overarching ideas for handling resistance. Some of what is presented here is based on correcting the errors presented in the last chapter. This creates some redundancy in the presentation of some of the material. However, from my experiences in teaching these concepts, I have concluded that it is more practical and effective to divide the "what not to do" and "what to do" components into two separate sections. Besides, redundancy is not necessarily a bad thing. Most learning is a result of spaced repetition; in other words, redundancy.
Please bear in mind that the ideas and techniques presented in this manual are intended for use with clients who display considerable resistance
in therapy. In general, the more resistant the client, the more you will be required to adjust your approach. Although you could use these techniques with all clients, if clients are highly cooperative, some of these techniques may be unnecessary or even excessively time consuming. Furthermore, if I am confident of my rapport and of the motivation of clients to implement change, I may respond in a manner quite opposite of what I am suggesting. The bottom line is, do not assume that you must employ certain approaches in all situations. One of the things that makes therapy so interesting is that each situation is unique and there are no set rules on how to approach every situation. What may increase resistance in one situation may be extremely therapeutic in another. Research has repeatedly indicated that the client-therapist relationship is a critical or primary factor that contributes to change. Therapeutic relationships are often quite unique across clients.
That being said, below are some fundamental guidelines to consider. Bear in mind that resistance is a complex matter. You cannot effectively resolve your resistance problems with just one or two maxims. Yet, you can have great impact through the application of these principles, as these points are pertinent for the majority of situations.
Basic Principle #1: Do the Unexpected
Clients vary considerably in their degree of embarrassment and willingness to discuss problems. Some clients are fearful of discussing their problems. Such clients may feel inadequate or shame for having problems. Clients reluctant to talk often anticipate responses that include criticism. Other clients, however, talk openly about their diagnoses and problems as if they are proud of them and are challenging the counselor to do something about them. Open clients who are also resistant are often prepared for confrontation and have a packaged set of responses regarding their situation.
Clients who have talked to non-mental health professionals (and some professionals!) have likely received typical "how-to-fix-your-situation" advice in response. Years of research and experience has taught us that such socially typical responses are of little benefit. If socially typical responses were beneficial, we would not need trained counselors
—clients could talk to anyone and get better! Regardless of the degree of openness to discussion, clients tend to anticipate certain socially typical responses.
As therapists we know that socially typical responses are, by and large, ineffective in creating therapeutic movement. Typical responses beget typical reactions, and typical reactions keep clients stuck in their situation. In such scenarios, what appears to be resistance is fueled by the commonplace. This is one reason why the brief therapists argue that problems are maintained by attempted solutions that are ineffective (Walter & Peller, 1992). Our typical responses and reactions are likely to be incorporated into established, ineffective, attempted solutions. The more we respond in a typical manner, the more likely we are to become part of the system that maintains problems.
In order to avoid the pitfalls of typical responses and the resistance that follows, you must consistently strive to avoid the commonplace. You must avoid typical verbal and non-verbal responses. In doing this, you surprise clients, you confound their anticipation of your response, and you begin disrupting the patterns that are inherent to their problems.
The unexpected does not have to be complex or foreign to counselors. The better techniques taught in training programs are unexpected by most clients. The empathic statement, the avoidance of questions with preordained answers, the lack of criticism, the nonjudgmental posture, or the statement that has the appearance of puzzlement or agreement with the client are all unexpected. Most of what is recommended in this manual is unexpected by clients, but known in some manner by counselors.
Basic Principle #2: Slow the Pace, Focus on Details, Process Feelings Relative to Meaning
When resistance is encountered, the prevailing urge is to speed up the session and break through the resistance. Instead, slow the pace. Increase your use of silence. Make sure that each statement by the client is fully addressed and processed in detail. "The devil is in the details," is more than a bit of folk wisdom. By addressing the details you show genuine concern and respect for the client’s issues, and you are more likely to get to the crux of the issue. Also, process the client's feelings relative to meaning. Seek to answer the question: What does this situation mean relative to the client and his/her world? This will have a very different feel for clients (and perhaps for some therapists), and will begin slowly dissolving the ineffective positions of clients. That which is processed, changes
. A pace that is too quick does not allow time for thorough processing.
One way to slow the pace is to increase your use of silence. Increasing your use of silence does two things: it creates pressure to fill the space and it provides time to think and feel (Gerber, 1986). Most resistant clients avoid both of these tasks. Yet, it is the pressure to fill the space as well as the time to think and feel that promotes the possibility of clients doing the work. As noted earlier, when you try to go too fast, you begin doing the work yourself and change takes longer. In counseling you will be rewarded if you slow down. The devil is in the details and so is the solution.
Taking this a step further, many therapists often feel as if they are trying to pull and push their clients along through the change process. This is not only hard work, it is very stress producing. To make matters worse, it fuels resistance. The key is to slow your pace to the point that you appear to be "behind" clients in your understanding and awareness. Thus, you keep clients explaining to you
in order to pull you along and to catch up with them.
When this state is achieved, resistance dissolves.
Please note, however, that slowing the pace does not mean to become passive and slow the therapeutic work. To the contrary, you slow the pace to intensify the therapeutic work. You slow the pace in order to focus on and magnify clients' internal struggles and search for answers. The therapeutic tension should not be between therapists and clients as the therapists try to pull their clients along or coerce new perspectives. The therapeutic tension should be within clients as they face their inner struggles. Increasing the pace often places the therapeutic tension between the clients and therapists. Slowing the pace places the therapeutic tension within clients where it should be.
Sometimes clients get nervous and excited as they approach difficult material. Others are slow to take cues that suggest slowing the pace. In such instances you might directly instruct clients to slow their discussion by making statements such as, "In order for you to help me fully understand your world, let's go over this in slow motion.
“Direction is more important than speed.”
Basic Principle #3: Treat Clients' Resistance with Respect
Much of the time, clients are not very logical in their behavior and assessment of their situation. Yet, regardless of how foolish, ridiculous, inappropriate, absurd, etc. we think their perceptions are, clients have a perceived need to cling to it. Thus, you should always address clients’ perceptions and the accompanying resistance with care and respect. Disrespecting the client's perceptions and resistance is to reject the client's experience of reality and thus, to reject the client. As Moursund and Kenny (2002) noted, "A client who is stuck is very likely to experience whatever you do as criticism, since he is already criticizing himself for being stuck" (p. 94).
Historically, one of the best predictors of counseling outcomes is the client's experience of the counselor's acceptance. Showing a genuine respect for the client’s resistance is typically your first opportunity to do the unexpected. It will be quite unexpected by most clients, particularly when they have some awareness of the absurdity of their position.
The exception to this rule would only come after a lengthy number of sessions when rapport was substantiated, when issues were well formed and processed, and when the right of the therapist to confront has been well established. At such junctures it may well be appropriate to openly dismiss inappropriate logic that has been confirmed from prior discussions. However, until such a time, respect all client positions, thereby minimizing the chances of intensifying resistance.
Basic Principle #4: Maintain an Attitude of Naïve Puzzlement
As discussed previously, with highly resistant clients the more you become an expert, the greater the likelihood of creating resistance. In order to combat this dilemma, maintain an attitude of naïve curiosity. Constantly exhibit a posture of puzzlement. This in turn will keep your clients in a mode of constantly having to explain things to you. The more they are explaining, the more they are working. They more they are working, the less they are resisting. If someone were watching your sessions, it should appear as if the clients are the experts and you are being taught by clients about their situations.
As one of my colleagues is fond of expressing, you should become like an anthropologist who is completely uninformed about a new culture—your client's life. With this approach you are constantly learning and observing in an attempt to put the pieces of your client's life together to make sense. Another way to conceptualize this is to imagine you were from another planet and you are completely uninformed of the ways of the planet on which you have just landed. Your client is your guide to life on this new planet. Further, because you do not want to make any social blunders, you want to learn about life in this new world, the rules that people follow, and why people act as they do. You listen intently as your client explains his/her world, as if it were the first time you are learning of these new ways and behaviors.
It’s amazing how many headaches you can avoid through being naïve. When the going gets tough, think and act like Columbo. Ignorance is bliss, and the appearance of ignorance may be as close to bliss as it gets when dealing with a highly resistant clients. The general rule is something like this:
The more resistant the client, the less you know. The more motivated the client, the more you know.
If clients are motivated and cooperative, and you have a good idea, by all means tell them. If they accept your suggestion, move forward. If they are reluctant to accept your suggestion, become naïve.
Directly related to maintaining a position of naïve curiosity is the fact that about 85% of what we communicate is through paralanguage. Paralanguage consists of the voice tones and inflections, facial expressions, and physical gestures we make as we talk. Approximately 50% of paralanguage is communicated through body movements and gestures, and approximately 35% of paralanguage is communicated through voice tone and inflections. Only about 15% of what we communicate is through words alone. Thus, most of what we are communicating is received by the listener through paralanguage. As you apply the approaches presented in this manual, remember that your paralanguage is critical to successfully dealing with resistance
. A well-worded statement delivered with incongruous paralanguage could be extremely detrimental. The art of maintaining a puzzled, naïve position is built largely upon paralanguage. To be convincing in your naiveté, make certain that your voice tone, facial expressions, and body posture convey puzzlement.
The art of therapy may be more in how you say your words, than the words you say.
Basic Principle #5: Never Label Clients with Terms That Imply Resistance
We create what we talk about. If we discuss negative, resistance-promoting characteristics as if they are a reality, we reinforce their presence and influence. Interestingly, this is true even if the negative characteristic is discussed in an unfavorable manner with the intention of discouraging its presence. How can an undesired characteristic or behavior be pointed out without, to some degree, implying that the undesired characteristic or behavior currently exists? Thus, when possible, it is best to avoid labels that create and foster resistant behavior.
It is unfortunate that I have to add the "when possible" comment. However, I am well aware that the procurement of most counseling services is dependent on ascertaining and assigning a diagnostic label. Unfortunately, once a diagnostic label is attached to a person, that label in itself may contribute significantly to resistance.
Yet, as therapists, we do not have to continually add to the negative impact of diagnostic labels with the language and terms we use in sessions. It is a grave mistake to label a client as stubborn, obstinate, hard headed, resistant, etc. Such labeling not only belittles the client, it feeds the very characteristics to be overcome. Many uninformed texts teach that therapists should be careful to "criticize the behavior and not the person," or "label the behavior and not the person." Such tactics are presumed to get around the labeling problem. I think this is pure bunk. Most people do not discriminate between themselves and their behavior. Further, most people never take the time to analyze whether a statement was made about something they did as opposed to who they are. To most people such statements are personal criticisms, period. And, when used in therapy, they promote resistance.
Recognizing that it is virtually impossible to conduct a therapeutic dialogue without some reference to the undesired, what are we to do? How do we discuss the negative characteristic or unwanted behavior without promoting it? It is really quite easy. When discussing the negative, simply refer to the lack of the presence of a desirable
characteristic or behavior. For just as a negative behavior cannot be discussed without it being presumed at some level, likewise, a positive behavior cannot be discussed without it being presumed at some level.
Read the four example statements below.
"You really are stubborn."
"At that point in time, you responded in a rather
"At that point in time, you responded in a 'less than open'
"At that point in time, you struggled to…be open to
Notice how the first response directly labels the client as "stubborn," a poor choice of words. The second response attempts to label the behavior and not the client. However, the statement is detrimental in that the implication that the client was stubborn is still present. The third and fourth responses discuss the client's actions in terms of a positive behavior that was not present; there is no mention of a negative behavior or label. In addition, these two statements also bring to mind and, subsequently, prime
the client for an alternative, perhaps more helpful, behavior (See Chapter 5, the section entitled, The Compelling Power of Priming).
Master therapists are aware of the pitfalls that come with a poor choice of words and consistently edit their dialogue in a manner that avoids unproductive labels while priming the client for alternative responses. Later sections discuss and teach the linguistic techniques presented in this example.
“Humans tend to resist changing enough on their own, without being helped to do so by negatively being labeled for their distressing.
, 2002, p. xii
Basic Principle #6: Focus Where Clients are Stuck
Often, when a point of resistance is reached it is only touched upon briefly. This is followed by the client, and sometimes the therapist, deflecting and changing the subject to lead the conversation away from the point of resistance into a more palatable topic of discussion. Although there may be a host of specific reasons for the client's deflection, it is generally because the conversation is in some way threatening or uncomfortable. The therapist deflects because he/she senses the resistance and does not know how to proceed effectively. The hope is that some progress may be made with another topic of conversation. Although this tactic may prove effective on occasion, it typically just becomes an endless dance of avoidance. The unfortunate reality is that this is likely one of those times that the therapist feels inadequate and, in turn, labels the client as resistant.
A more effective approach would be to slow the pace, attend to details, become naïve, respect the client's beliefs, and go into the resistance; but not in a direct manner
. From the client's perspective, the conversation should feel as if it is a supportive quest for understanding. From the therapist's perspective, the conversation should always have the ultimate goal of dealing with the current point of struggle. There should always be a clandestine focus on the current issue on which the client is stuck.
Interestingly, many clients appreciate this approach at some level, particularly those who have a part of them that recognizes the importance of changing. Those who do not appreciate your efforts will, nonetheless, be dealing with their struggles. Remember that the real reason clients are there is to deal with their resistance. Do not disappoint them.
It should be noted that the current point of struggle is also the place where clients will attempt to lure therapists into taking on the burden of their problems. Be careful not to take this bait. Do not accept the invitation to take the client's pain. Many resistant clients are masters at sucking you into their world and enveloping you with their issues. While approaching the resistance it is important to keep the "ball" in the client's court. Do not let your clients hand you their problems and manipulate you into accepting their immobilized mindset.
Change results from a crystallization of discontent.
Basic Principle #7: Frame All Desires in the Positive
Universally, clients come to sessions and discuss problems from a negative language framework. They rarely use words that express what they want; rather, everything is expressed in terms of what they don’t want. They make statements such as, "I don’t want to be depressed," "I don’t want to feel nervous," "I want to stop fighting with my spouse." "I have got to stop this procrastinating." "I want to stop obsessing about…." Statements such as these are only stating what isn’t wanted—the desire to remove a negative. Such descriptions say nothing about what is wanted. As long as your clients are talking in the negative, there is no expression of what is desired. There is no direction in which to go. There is no goal.
Further, continuing to discuss what is not wanted actually maintains it. As such, always take the time to establish a positive reframe on negatively expressed desires. For example, not wanting to be nervous may be reframed as wanting to be calm, poised, or cool. Not wanting to fight with a spouse may be reframed as cooperating, listening, respecting, or understanding each other. Not wanting to procrastinate may be reframed as "doing it now," "beginning tasks," or "acting immediately." Please note that these are just examples and that the client's own words should be used instead of the therapist's reframe. To do this you simply inquire, for example, "Tell me what would you be feeling or doing if you weren’t feeling nervous," or, "Give me an idea of what you would be doing if you weren’t fighting with your spouse." Once you get the information, from that point forward, make all of your discussion statements from the positively desired perspective. It is a significant therapeutic mistake to allow negative framing of goals and desires to remain the norm of the dialogue. Once the positive frame is established, in the future conversations avoid bringing up what is not wanted. This should be a consistently occurring dialogue style.
Commonly, when the inquiry is made as to an alternative positive behavior, clients cannot respond in the positive. Many times they state that they do not know. If this is the case, then this is the precise issue that should be focused upon. This is where you want to be working. Refer to Chapter 8, Managing "I Don't Know" Responses
, for details on how to proceed.
The significance of this idea cannot be overstressed. The theory behind this concept is discussed in detail in Chapter 5, Words, The Fundamental Tool of Therapists.
Ideas and techniques aimed at developing the want or positive side of change are presented throughout this manual.
Basic Principle #8: If They Are Not Confused, Confuse Them
Change rarely occurs when someone feels certain. Change usually occurs as a result of confusion. If your client is not confused, change is not likely. If you try to fight a position of certainty, you will likely create resistance. Certainty is common with teenagers—the age of infinite wisdom—and with adults who are strongly entrenched in their position.
When you encounter people who are quite confident of their position, listen with great curiosity and keep seeking explanations and details. Eventually clients will corner themselves with their own contradictions. For some clients it can be quite helpful to make statements that foster confusion. Once confusion is established, the stage is set for change. When their logic fails, the critical window opens that creates the possibility for change.
When a contradiction emerges it is important that you become puzzled and confused in seeking to understand the contradiction. Empathize with the client’s confusion. This, in turn, can be followed by a suggestion that new ideas may emerge to resolve their confusion. For example, "This is really a confusing situation for you. Perhaps you will discover some new perspectives as you work to resolve your confusion and move toward clarity." Of course, this must be done with a paralanguage that conveys genuine puzzlement and concern. If your paralanguage reveals that you think you are clever because you have confounded their logic, you will likely make matters worse. Your apparent lack of understanding and apprehension for the client as he/she struggles to reach resolve should be founded on a base of genuine concern for the client’s growth and well-being.
In summary, for the resistant client who is not confused it is important to foster confusion before introducing new ideas. It is much easier to germinate change from confusion than certainty. Thus, if a client is not confused, first confuse him/her, and then promote alternative perspectives and change.
Basic Principle #9: Resist the Urge to Confront Initially
Although there is definitely a place for confrontation in counseling, if you confront too early in the process, it will likely be counterproductive. There are two fundamental reasons to avoid early confrontation. First, with highly resistant clients, confrontation that comes before considerable rapport and a thorough discussion of surrounding issues will almost always result in even greater resistance. The right to confront must be earned over time. Confrontation that occurs before a critical level of respect is earned will likely hinder the process. Effective confrontation is always dependent on proper timing.
Second, rarely is the initial issue the "real issue." Likewise, the initial reason for resisting is often just a "surface reason" and deeper reasons that carry more significance have yet to emerge. Thus, premature confrontation precludes the emergence of the more significant issues that are critical to promoting genuine change. When deeper reasons for resisting are addressed, surface reasons dissipate. Thus, the rule of thumb is to avoid early confrontation. Confrontation is typically best delivered after respect is well established. Furthermore, excessive, repeated confrontation can also promote resistance. This is because the impact of confrontation is lost due to desensitization from being confronted repeatedly. Confrontation is discussed in detail in Chapter 12 in the section entitled, After Much Time and Consideration, Confront.
"Some therapists, most likely beginning ones, are so eager to form a relationship that they do so on terms that forever destroy any therapeutic potential. Other therapists are so eager to force a client toward maturity that they bring pressures to bear on him that are beyond his ability to withstand; unwittingly they drive the client out of the relationship"
, 1967, as cited in Moursund, 1985, p. 80
Words: The Fundamental Tool of Therapists
This section introduces some fundamental, overarching concepts about language that are critical for effective therapeutic dialogue. Every suggested response in this manual incorporates, to some degree, these points. Study these ideas until you have a thorough understanding of their significance. Much resistance can be avoided through the consistent application of these points of language.
Two Fundamental Rules of Language Every Therapist Should Know
The primary point asserted throughout this manual is that a considerable amount of resistance is overcome through the meticulous, precise use of words accompanied by congruent paralanguage. This fundamental premise is based on two underlying, rudimentary ideas. The first is that all language is hypnotic. All words and paralanguage influence. Words and paralanguage are
the primary vehicles by which influence is transmitted and conveyed. Words are the tool by which our minds are changed. Your indigenous language is the programming language of your mind. Even if not openly acknowledged, anything heard or read by someone impacts that person to some degree. Well-stated comments have a great deal of impact and influence.
Understanding this, the second rudimentary point is that, if you are talking to another, you cannot, not manipulate. If you are talking to another, you are manipulating him/her. And, if you are listening to someone, he/she is manipulating you. The degree of influence and manipulation varies considerably from one situation to the next. Everyday conversation does not generally result in substantial manipulation or impact. However, each of us can recall a time when an off-the-cuff comment by another greatly shifted our perspective. Although most advertisements do not greatly manipulate the average person, there are times when advertisements have struck a chord in each of us and influenced us to buy a product. Some people are more easily influenced by everyday conversations and advertisements, and are often taken advantage of by the endless manipulations present in our world.
The times when a comment or advertisement seem to influence us the most are when the message delivered connects with some internal need or struggle we are currently experiencing. If, at some conscious or unconscious level, we are searching for clues to aid in discovering the solution to an internal struggle, it appears that we are more open to the influence of statements that connect with this struggle. It is as if our need for an answer automatically focuses our attention on things that may lead to that answer. Thus, if we have a problem with dirty carpets, we are likely to tune into advertisements that proclaim the power of products to clean carpets. The degree of influence from language is directly related to our internal needs to hear what is being said. Therapy is, by design, a place where the influence of words is magnified.
In therapy, the client has internal needs. We provide words and language that hopefully tap into those needs and influence the client toward finding his/her way to fulfill those needs. The influence of our words is magnified by a number of factors. One such factor is clients' foremost needs, which are usually quite high as is evidenced by their seeking counseling. Another is the physical environment—usually a rather neutral room, in a private setting, with few distractions. In addition there are the rules and content of the conversation. For example, the conversation is held in strict confidence and is usually very focused on emotionally burdening issues. Thus, the therapeutic environment is one in which the manipulative power of words is augmented by the nature of issues and the context in which they are discussed. The therapeutic environment is designed to be one of the places where words have greater influence. In therapy, the fact that we cannot, not manipulate is amplified.
Although it is not conventional or kosher to describe therapy as manipulative, it is. The job of the therapist is to acquire an understanding of the client and use this understanding to manipulate the client into doing the difficult task he/she desires to accomplish. We manipulate the client into accomplishing the goal sought through providing a dialogue that aids the client in resolving the struggles inherent in the goal accomplishment.
The idea of manipulation is frequently not used in conjunction with discussions of therapy because the term often carries negative connotations. This is a result of the term being commonly associated with self-serving agendas. However, we do not manipulate for our benefit, we manipulate for the client's benefit. Not to understand that therapy is manipulative is naïve. Because we cannot, not manipulate, we must constantly be aware that we are manipulating and learn to actively manipulate for the client's benefit. Thus, the question is not, "Do we manipulate?" The question is, "In what direction and in what manner do we manipulate?"
Some of the most ineffective and dangerous therapists are not cognizant of these points. They go about their craft unaware that they are manipulating constantly, whether they want to or not. Their lack of awareness leads to a haphazard, deleterious use of language that promotes resistance and may even make problems worse. Those who realize that all language is hypnotic and that you cannot, not manipulate, understand that language is a primary force that creates realities and moves people in one direction or another. A careful choice of words is the cornerstone of effective therapy.
"Words are our most precious natural resource."
, host, Inside the Actors Studio
Lessons from Aikido
(ì'kê-do, ì-kê'do) noun:
A Japanese art of self-defense that uses the principles of nonresistance in order to debilitate the strength of opponents.
Aikido is an Asian form of fighting in which all of the moves focus on defending against attack. It is a pure form of self-defense that has no tactics for attacking. The theory behind Aikido is quite sophisticated. The Aikido master is always evading and using the energy created by the attacker against him/her. One of the fundamental questions the Aikido master asks is, "Where is the one place that I can stand that my attacker cannot hit me?" The answer to this question is, "The place where the attacker is standing when the attack occurs." If I could move to the center of where you are standing you could not hit me. Your physical center is the point at which the attack begins, all energy moves away from this point. Thus, there is no way to be hit at that point.
Although it is not physically possible to stand exactly where another is standing at the same time, the Aikido master frequently moves in a manner that places him/her where his/her attacker just was. The purpose is to move to the position from which the force is coming. At the moment of the attack, this position is unattackable. This is a very different tactic when compared to blocking or defending against an attack. When you block or defend against an attack, you are using force against force.
Fighting force with force is risky business depending on your size and speed. When you use an Aikido style to defend against an attack, you slip and slide the attack moving in a manner that avoids and dissipates the attacking force rendering it harmless. The issue of size becomes moot. The issue of speed is important but is augmented by direction and manner of movement.
A similar approach is needed when dealing with resistant clients except that our defensive movements are not physical; they are built upon the eloquent use of language. To carry the analogy further, size is analogous to authoritarian power in the therapeutic relationship. As noted elsewhere in this manual, there is very little true authoritarian power in the therapeutic relationship. (Except perhaps in cases that involve court sanctionings or the withdrawal of welfare money, and even then clients have a choice.) We cannot force clients to do anything. As repeatedly noted, all clients have to do to thwart our efforts is nothing. The primary power therapists have arises from their use of words
Words are analogous to the movement of the Aikido master. Language is the tool by which we evade the resistance (the attack). The primary way that we prevail over the resistance is to not provide a verbally expressed position to resist against. Thus, we constantly try to avoid being in a position of opposition to the clients. We avoid "us-verses-them" and "give-in-or-dig-in" situations. Instead, we make statements that, if not in agreement, always appear to carry a degree of understanding.
Ideas contrary to that which is readily acceptable to clients are introduced indirectly, primarily through some form of indirect or embedded suggestion. In this manner, we steadily prime clients for new ideas and alternate responses. While doing this, we maintain a posture that conveys that the responsibility for change lies with the client. Language that directly or indirectly implies that we are responsible for or capable of creating change is avoided. This is because we are aware that, the more we take the responsibility for change, the less likely clients are to implement change. Thus, we are careful to avoid creating an atmosphere where clients become dependent on the illusion that the therapist will somehow implement some sort of a mystical procedure that will result in change without any effort on their part.
When it comes to therapeutic dialogue, its not just semantics, its all semantics.
Why it is Crucial to Develop the "Desire Side" of the Motivation to Change
"You do not have to want to stop your current behavior in order to change; you simply have to want something else more."
There are basically two interrelated reasons for change. The first is that you do not like the status quo and the second is that you want something else more. Not liking the status quo pushes the client while desiring something new pulls the client. Clients who don't like the status quo only and who do not have something they desire more, are much more difficult to work with than clients who desire a specific alternate lifestyle. This is because they are only thinking in terms of not wanting rather than desiring. Figuratively speaking, they are only being pushed away from a problem; they have nothing pulling them toward something new. They have no specific direction to go. Psychologically, being pulled toward something is more pleasant than being pushed away from something. Although not wanting (pushing) and desiring (pulling) are always linked, most clients have not clearly formulated the "desire side" of the equation—the pull side.
By far the most difficult clients are those that find comfort and pleasure in their current state, only partially desire to change, and, yet, have a host of problems in their lives. Such clients have little push and no pull. Drug and alcohol clients frequently fall into this category. Those in the precontemplative and contemplative stages of change likely fall into this category also.
By and large both therapists and clients conceptualize change from the "fed-up-with-the-status-quo" perspective—the push side. Unfortunately, it is very difficult to change based solely on disliking the status quo. This is because, regardless of the pain of the current state, the status quo is familiar, and a painful "known" is typically less threatening than a new "unknown." This emotional bind is the basis for the old expression, "Better a known devil than an unknown saint." In order for change to be permanent, clients have to discover and define something that they want more
than the current state. Once discovered, this realization becomes a powerful force fostering change.
One of the reasons that the development of the desire side is so vital to change is that nature abhors a vacuum. Whenever something is taken away, the void that remains is immediately filled by something else. When change occurs, old behaviors (including cognitions) are stopped. This leaves a void to be filled. It is critical to consciously develop new behaviors to fill this void. When new behaviors are not deliberately created to fill the void left by the ceasing of old behaviors, backsliding to old behaviors is likely. In some instances, other nonproductive behaviors emerge. The desire side provides the new behaviors to fill the voids left by change and, thus, prevent backsliding. Consequently, the desire side of the change equation has a dual purpose. It motivates by pulling as well as fills voids left when replacing old behaviors.
The more you study the desire side of the change equation, the more you realize that this aspect is more important to change than the "don’t want" side. This idea is fundamental to Solution-Focused Brief Therapy approaches that depend almost exclusively on developing the desire side of change. Yet, it is most frequently the "don't want" side of change that brings clients to counseling. A few examples may help illustrate these ideas.
People do not stop smoking because they do not like cigarettes. Smokers love their cigarettes. They stop smoking because they desire good health, a long life, fresh breath, more money, or to be a good model for their children more
than they desire cigarettes.
People do not get off welfare because they want to stop receiving free money from the government. They get off welfare because they desire more money, more possessions, a better self concept, more for their children, or to be good models for their children more
than they desire free money.
People do not stop using drugs because they do not like drugs. They stop using drugs because they want better health, they want to have more money, they want to take care of their children, they want a good job, or they want positive relationships more
than they desire drugs.
Much resistance can be overcome by creating and clarifying the desire side of the change equation. Wise therapists take considerable time to establish and crystallize the desire side of client's problems. The next section explains the overarching reason why the specific wording used in therapy is critical to this objective.
The Influence of Words on Mental Processing: Why the Words You Choose are so Important
Don't think about an elephant. What did you just do? For a brief moment, you likely pictured an elephant in your mind. But the sentence stated to not think about an elephant. However, it is impossible to read that sentence and not think about an elephant. Now read this sentence: Think about an elephant. What did you just do? Again, you thought for a moment about an elephant. It was of no consequence whether you were directed to think about an elephant or not, you still thought about an elephant.
Although this may appear to be a minor point, it is not. To the contrary, it is an enormously significant point when it comes to creating influential therapeutic dialogue that promotes change. The reason why this concept is so important is this:
The mind moves you and your listener in the direction of the dominant thought regardless of whether the thought is stated in the positive or the negative.
For statements made in the positive, the dominant thought is simply the content of the statement. However, for statements made in the negative, the dominant thought is the opposite of what is grammatically stated. For example, if you were to say, “Don’t procrastinate,” the grammatically stated meaning is “get the job done.” However, the dominant thought is still “procrastinate”—what is not desired. Other examples that include inappropriate dominant thoughts would be: “Don’t worry,” “Don’t get angry,
” or “Try not to yell.
” In each instance, the dominant thought in the statement brings to mind what is not desired.
To quickly discover the dominant thought of negatively worded statements, simply remove the "no's," the "nots," the "shouldn'ts," the "wouldn'ts," the "don'ts," and the "won'ts." What is left is the dominant thought. Statements including these words only convey the "not want" side of change—the push side. They do not convey the desire side of change—the pull side. Such statements ask someone to move away from a behavior but offer no direction or place to move toward
. Conversation styles that incorporate the "not want" side of change are only half of the needed dialogue. Further, they are the lesser half. The reason they are the lesser half is because they are bringing to mind and, thus, moving clients in the direction of what is not wanted. This is because the dominant thought is still the "not want" component.
Some might say that this is a trivial point. However, when you study the power of priming and the covert influence of words, you quickly realize that it is not trivial. I assert that much therapeutic failure is a result of a lack of understanding of these points. When talking to clients, the message received is not necessarily what you intended to convey. The only way to assure that your responses are not focusing clients on unproductive behaviors is to consistently attend to the dominant thoughts in each statement you make. To decrease resistance, it is critical that therapists learn to consistently speak to clients using dominant thoughts that lead in the desired direction.
For example, if you say, "Concentrate on not fighting with your spouse," the dominant thought is "fighting with your spouse" (remove the "not" from the statement to reveal the dominant thought). It is very unlikely that the instruction will have much effect toward diminishing fighting. In fact, it may actually increase
fighting. On the other hand, if you tell your client, "Listen, respect, and be cooperative with your spouse," you have given a very different instruction that will lead and move your client in a more productive direction. Interestingly, if you tell your client, "Don't listen, respect, and be cooperative with your spouse," and your client remembers your instructions, you may still be leading him/her in a productive direction! It is doubtful that you would ever make such a statement, however. On the other hand, you might say, "At this time you are searching for a way to listen, respect, and cooperate
with your spouse." Here, your reflection of the client's struggle also defines and suggests the desired behaviors. Thus, your dominant thoughts lead appropriately.
Clients inevitably present problems in the negative. That is, they tell you what they do not want, instead of what they do want. This is, in part, one of the reasons they are stuck in their present state. They do not have dominant thoughts that move them away from their current state and lead in a new direction. Most likely, their current dominant thoughts are moving them in a direction they do not want to go.
Many times when inquired of clients, "Tell me what you want," they will honestly reply that they do not know. This is very significant because, if clients do not have a dominant thought that is leading them in a desired direction, they will inevitably remain in their current state. Similarly, if you instruct, for example, a worrywart client to, "Tell me the opposite of worrying for you." They will most likely say, "Not worrying." As you can readily see, the dominant thought is the same, worry. In both cases, all thoughts remain on the undesired and lead nowhere.
The concept of the dominant thought should be applied at all times in therapeutic dialogue. Whenever clients state concerns or desires in the negative, time should be taken to discover the positively stated opposite of the negative. From then on, you should speak only in terms of the positive side of the concerns and desires. Whenever you establish a goal, it should be stated in the positive in order to deliver a dominant thought that moves clients in a beneficial direction. In your general responses to clients, you should consistently plant seeds of possible actions or direction by using the power inherent in dominant thoughts. In doing so, you are constantly priming clients for future changes.
The Compelling Power of Priming
Effective therapists recognize that their benefit to clients comes from the skilled use of language. All language has inherent power that is either working for or against the speaker and listener. This power comes from the influence of words and is constantly present regardless of whether or not there is an overt awareness by the communicator or the listener.
One of the language skills that good therapists constantly employ is that of priming. The word "priming" means to prepare for action. As used in this manual, priming is a general, overarching term to describe any type of statement that directly or indirectly introduces new ideas to clients and, thus, prepares them for new perspectives and behaviors.
Whenever you incorporate deficit statements, embedded suggestions, suggestions that the current state is temporary, etc., you are priming clients for new perspectives and actions. You are introducing new ideas indirectly through the words you choose in your therapeutic dialogue. Whenever you directly suggest or promote a new behavior (e.g., positively worded goals or suggestions of when to implement goals), you are directly priming clients to implement alternative behaviors. Most examples of priming presented here introduce new ideas indirectly. In such instances, we are not arguing with clients about what they should do. Rather, we are using language in a manner that gently suggests and contributes new ideas in indirect ways. All dominant thoughts prime clients for future action.
A simple example of the power of priming can be observed if you first ask someone to say the word spelled by the letters S-H-O-P. Then ask, "What do you do when you come to a green light?" The most common answer is "stop" (Reason, 1992, as cited in Kirsch & Lynn, 1999). In this example, the word "shop" resembles the word "stop" in spelling and sound. Because of this similarity, it influences the listener to respond to the question with the incorrect answer, "stop." Although this an elementary example, the power of the priming influence of language is nonetheless observed. With all priming, the nature of the words that are presented early in the discussion influence the listener in the considerations that follow.
The concept of priming is directly tied to the two basic aforementioned premises: All language is influential and we cannot, not manipulate. It should be clear by now that, whether you are conscious of it or not, you prime your clients. It follows that an understanding of priming is essential for good therapy and that skill should be developed such that you are priming for the benefit of clients. Even the basic empathic response has priming influence. As is well known, clients are often out of touch with their degree of emotional distress or the deeper meaning of their discomfort. When counselors make empathic responses, clients assess if the words presented accurately describe their world. The words used by counselors prime clients to consider their current emotional state carefully and precisely. Thus, priming leads to greater clarity and self-understanding. Clarity is empowering because it generates more definitive action. Whether we are aware of it or not, we are constantly directing clients' thoughts through the words chosen to describe and understand their worlds.
All priming statements utilize the power of the dominant thought. It follows that the correct use of the dominant thought within such statements is of paramount importance. This is because all priming components of your responses are, ideally, the building blocks for the desire side of change. Thus, it is critical to word all embedded suggestions, deficit statements, goals, etc. in the positive to plant the seeds that begin creating movement toward specific objectives. If the dominant thought is worded in the negative, it loses significant impact. At the worst, it could be harmful. After studying and speaking about this concept for many years, I am convinced that consistently implanting properly worded dominant thoughts in priming statements is a hallmark of successful therapists.
I cannot emphasize enough the importance of developing an understanding of the concept of priming and the significance of its use in therapy. The research supporting the impact and influence of priming is quite compelling. For those desiring further scientific study of priming, I suggest you start with three articles that review current findings: Bargh and Chartrand, 1999; Gollwitzer, 1999; and Kirsch and Lynn, 1999.
Summary Points Regarding Language and Therapy
All language is hypnotic and influential.
We cannot, not manipulate.
We circumvent resistance by moving into a position of understanding and
agreement with clients, and by avoiding "us-verses-them"
and "give-in-or-dig-in" relationships.
We are aware that developing the desire side of change is
vital to lasting change.
We recognize that the mind moves our clients in the direction of the
dominant thought regardless of whether it is stated in the positive or
negative. Thus, we are careful to create and consistently make statements
that are worded in a positive manner.
Priming is a potent tool by which new ideas are introduced through the
language that is used to describe current situations.
All correctly stated priming statements use
positively worded dominant thoughts.
Goal Creating Language and Techniques
As noted, one of the keys to effective therapy is to establish a mutually agreed upon goal with the client. It is astonishing how many times I hear of stories from therapists and clients about therapy that continues for session after session with little or no direction. Often the dialogue just rambles around in circles.
There is an art to creating dialogue that produces meaningful objectives. When done well, clients will experience goal establishment as something that naturally developed as a byproduct of the therapeutic conversation. Clients will not feel in conflict with the goals that emerge. Properly established goals will provide motivation and hope for clients. Subsequently, clients will have a greater sense of meaningful direction.
Timing is critical to goal development. Rushing the process, before issues surrounding the problems are discussed, may foster resistance. This resistance is often a result of failing to address critical barriers to goal accomplishment. In such cases, clients may openly agree to the goal without having any intention of following through. On the other hand, allowing the conversation to ramble excessively without at least an indirect introduction of a goal can be equally unproductive. Clients rarely have clear goals in mind. One of the primary functions of the therapist is to sort through the issues, pain, and confusion, and assist in developing a direction that promotes growth. Many times clients are threatened by the discussion of goals because the underlying implications are that they must face an intimidating task. Thus, great care should be taken in goal creation. When a goal is established, it should have congruence with the client's perception of the world and what is possible.
Counselors should be flexible and open with regard to what is deemed a worthwhile goal by clients. A small, seemingly insignificant goal to therapists may be quite significant to clients. Therapists' acceptance of such goals increases rapport, mitigates resistance, and paves the way for future action.
This chapter discusses specific methods for creating goals. As with much of therapy, goal creation is largely a result of careful wording on the part of therapists. Goals can be gently and subtly introduced into the conversation through the style of responses provided. For example, many times clients will state that they, "Just need to talk to someone." Even such vague comments can be politely framed around a goal-oriented empathic statement: "You're experiencing some confusion, and you desire to discuss some of your concerns in order to ventilate, analyze, and sort through issues in your life." Or, "You sound uncomfortable and unclear about some things and want to provide yourself a forum in which you can more clearly determine where you stand in relation to what's going on in your life and what you want." Although the implied goals in these responses are general in nature, the goal oriented conversation style primes clients for discussions of more specific goals in the future.
Similar to the above example, the approaches below allow goals to emerge as a byproduct of therapists' responses and not so much as a result of direct inquiry. Although direct inquiry can be effective in establishing goals, highly resistant clients may find it threatening and will many times deflect when directly approached. Such deflections often attempt to frame problems in a manner that makes them unsolvable. To this end, resistant clients are masters at constructing a conversation that appears to make problem resolution impossible. We do not want to give them any help.
Interestingly, the first step to effective goal creation is not to focus directly on goals or what the client wants. Rather, the first step is to clearly determine how the problem is a problem from the client's perspective.
Once this is accomplished, goal creation builds from a foundation formed by the client's words and meaning. A technique that promotes this process is discussed first, followed by other goal creating techniques.
Always Take Time to Establish an Answer to This Inquiry
With all clients, and particularly resistant clients, much can be gained if time is taken to seek a detailed answer to this inquiry: "Tell me how this is a problem for you" (adapted from Walter & Peller, 1992). Unfortunately, many therapists, after hearing a plethora of overwhelming problems, assume
why the issues presented are problems for clients. Although such assumptions are likely correct, not taking time to directly ascertain this information limits therapists' capacity to formulate a dialogue that promotes change.
Below are some fundamental reasons why not directly ascertaining this information is detrimental to the therapeutic process.
The assumptions of why the issues are problems may be wrong. In my seminars, when I ask participants how many of them have ever proceeded to help a client resolve issues only to later discover that their understanding of the issues was all wrong, most hands go up! When you have such misunderstanding, the motivation for change, the approach for enhancing change, and the desired change may be misconstrued. Subsequently, the therapeutic dialogue may move off course relative to what the client views the problem to be and is willing to do about it. Occurrences of misconstruing the problem components and motivations can be greatly reduced by directly ascertaining how the problem is a problem for the client.
A universal characteristic of clients is that problem definitions are muddy, unclear, and not well formulated. Most clients are in "vagueville." Many times clients have never fully clarified why their issues are a problem for them. As they clarify the reasons, clients often discover new reasons for change as well as possible solutions. Any effort and movement toward clarity is an effort and movement toward resolving resistance. Clarity is always empowering.
In addition, people often come to therapy because they are stuck when weighing reasons
for change against fears
of change. This is the cardinal characteristic of clients in the contemplative stage. When you take the time to clarify and crystallize the reasons for change, these reasons are often amplified and strengthened. As such, they begin outweighing the fears associated with change. At the very least, the reasons for change can be realistically assessed against the fears of change. Sometimes the solution is worse than the problem and clients decide to maintain the status quo.
Directly related to number two above is the fact that issues presented initially are often not the primary issues. Typically, below the surface clients are struggling with deeper issues that are at the root of the problems presented. Thus, as the counseling dialogue progresses, problems often metamorphosize and are redefined around new struggles. By taking time to process how the issues presented are problems from the client's perspective, problem metamorphosis is expedited
and the issues underlying the presenting problem more quickly emerge. These new issues are what we commonly refer to as "the real problem." Frequently, such issues center on a client fear or internal struggle. This is where the critical work is done because it is here that the real meaning of the problem from the client's perspective is discovered. Often this discovery is just as new to clients as it is to therapists.
Through directly seeking why the problem is a problem for the client, therapists and clients are able to construct positive, viable goals building from strengths. (This is as opposed to continuing to discuss a negative, how-do-I-get-rid-of, how-do-I-stop, not-doing goals that are counter productive.) The conversation format goes from exploring why the situation is a problem for clients, to clarifying what they "don't want," then to turning this around and clarifying what they do want. Finally, strategies for attaining what they do want are ascertained. Note that the change process is founded on clients' reasons
for how the situation is a problem for them.
When this is clearly established, change is easier to accommodate.
When you directly seek an understanding of why the problem is a problem for clients, you are provided reasons for change directly from clients' mouths. These reasons can be referred to when needed to help clients remain motivated. When clients hear their own reasons for change, they are more likely to be motivated. In addition, if clients choose not to change at this point, they are not resisting the therapist's desires; rather, they are resisting their own, previously stated motivations. Thus, the struggle (therapeutic tension) remains with clients and not between clients and therapists.
Sometimes counselors are reluctant to attend to this step. This is because it is often quite apparent why problems are problems, and the process appears redundant and time consuming. I agree with both of these points. However, I suggest that the trade-offs are worth it. Keep in mind that we are not doing this merely to establish why problems are problems. There are multiple reasons for directly attending to this step, not the least of which is to have clients work through it and experience the problem definition insights and shifts that result. The primary benefit comes from clients openly stating and, thus, clarifying to themselves why problems are problems. Of course, counselors' jobs are made easier as they gain access to the deeper motivations for change that emerge.
I have personally concluded that the failure to directly ascertain this information is a fundamental mistake of many therapists. If you cannot explicitly state clients' reasons for the issue being a problem, then perhaps you should consider deliberately taking time to discuss this point in your next session. The greater error is to omit the step.
It should also be noted that this is not a one-time process. Most clients will cycle through—or should be led to cycle through—this process many times; each cycle of discussion leading to greater crystallization of clients' discontent and greater clarity of reasons for change.
With clients in the precontemplative stage, inquiring as to why the problem is a problem for them should be the primary focus and approach. Remember, precontemplative clients do no typically see themselves as having a problem or as part of the problem. They often complain about others and the demands placed upon them by others. For precontemplators it is often hard to solidify a problem. Thus, problem solidification is a paramount initial step for this group of individuals. By constantly seeking an understanding of how others and their demands are a problem for clients, problems are clarified for clients. Subsequently, the dialogue inevitably moves to discussing clients' actions that might alleviate the concerns. With this approach, the process of exploring what clients are doing to maintain problems is introduced into the conversation by clients as they discuss how to eliminate their
With clients in the precontemplative stage, this approach is much more effective than trying to explain to them why they have a problem. When done in an atmosphere of curiosity and concern, clients build their own case for change. Such dialogue also leads clients to build their own web that captures them in their denial and hypocrisies. Comments that promote this discussion might go something like this:
"Tell me how this is a problem for you."
"This may sound like a bit of a strange request, but tell me how this is a
problem for you."
"Let me confirm that I am on track with you, you have stated that… and you
have stated that this is a problem for you because…. Tell me other reasons
how this is a problem for you."
You might also pace and lead as you approach this point:
"As you sit there examining and discussing your situation, and getting in
touch with your feelings of…go inside and, John, assess if there are other
reasons how this is a problem for you." Or
"As you sit there examining and discussing your situation, and getting in
touch with your feelings of…tell me any other reasons that have emerged
about how this is a problem for you."
Enhancing the “Desire Side” of Change
Sometimes it is beneficial to take time to amplify the desire side of change before moving to goal creation. This is because, even though clients might clearly know how the problem is a problem for them, it is sometimes difficult for clients to obtain a clear picture of what they want. When clients are struggling in their conceptualization of what they want, it is important to slow down and take time to explore ideas and possibilities. As noted, the clearer the reasons for change become, the less resistance occurs. The more clients develop and recognize their own motivations for change, the more likely they are to follow through.
In order to cultivate the desire side of change and to increase motivation, it is useful to explore the benefits of change and the consequences if no change occurs. Statements similar to the examples below can be utilized to promote this exploration with clients. Those familiar with Brief Therapy approaches will recognize this style of dialogue. It is common to Brief Therapy approaches because they focus almost exclusively on developing future goals. The primary difference in the following examples is that the grammatical structure avoids using questions—a practice common in Brief Therapy texts.
Exploration of benefits:
"Tell me how your life would be different without this problem."
"Tell me how your life would be different if you were resolved on this issue."
Hypothetical exploration of past decisions:
"If you had your life to lead over, tell me what one thing you would change
relative to this situation."
"Looking back at the beginning of your current situation and knowing what
you know now, tell me what you would have done differently."
Looking back from the future:
"If it is a year from now and you are looking back to this point in time and
nothing has changed, tell me what you will wish you
would have done differently."
"Imagine it is a year from now and you still have this problem;
tell me what that would feel like."
I suggest that such comments be delivered in a rather slow, thoughtful, philosophical manner as opposed to a brisk, quick, inquisitive manner. The reason for this is that you want to maintain a paralanguage that conveys that you truly do not know what clients will say in response (See the discussion on asking questions with preordained answers
in Chapter 7). This is much easier to convey with a slow, thoughtful manner of speaking. Also, the thoughtful, philosophical manner of speaking models for clients that they are to take the time to explore the answer for themselves. Much can be accomplished with the message conveyed through paralanguage. Attending to such details is critical in managing resistant clients.
Goal Creating Dialogue for Resistant Clients
After the desire side of change is clarified, it is common to move to goal creation. As noted, direct inquiry is always an option for goal creation:
"Tell me what you want."
"Tell me what you want more of in your life."
If direct inquiry results in goal creation, by all means use it. However, highly resistant clients have a knack at avoiding conversation that focuses on actually doing something. It is at such junctures that the wise therapist continues to place responsibility for goal creation with clients and to focus on discovering clients' desired outcomes. You want to avoid talking in circles with no ultimate objective, or worse, creating assumed goals that clients resist. The following statements are adapted from the excellent writings of Walter and Peller (1992) and are very powerful tools that aid in avoiding these traps. When clients continue to offer complaints about their circumstances, empathize with their plight and say something such as:
"Tell me, what about this situation you would like to change or in what ways
you would like to be handling things differently."
"Tell me, what about this I can help you with."
"Tell me again what you would like as a result of coming here and
discussing your situation."
"I realize that _____ is definitely something you do not want. Help me to
understand what you do want."
Such statements should be delivered with candor and genuine inquisitiveness. Be acutely aware of your tone and body language. Uniform inflections across all words generally work well. Do not accent the "I" or the "me." Such subtle shifts in vocal inflections could result in a sarcastic tone that would be extremely counterproductive.
As with all such requests, after you have spoken, model thinking and allow ample time for contemplation on the part of clients. Do not rush this process! You have likely just requested something that clients are not expecting or prepared to answer. Give them time. If they appear stumped by the request, you might respond with something to the effect, "This requires some thought." After you make this statement, model thinking. Such statements and actions convey an understanding of the immediate feelings and mind set, imply that clients should be thinking, and acknowledge that they can take even more time to think about it.
Many times clients will avoid the request by changing the subject and returning to their previous dialogue style. This dialogue typically has an emphasis on expressing complaints. When this happens, empathize and repeat your request. This may take several attempts. If needed, reconfirm how the complaint is a problem for the client.
Note how clients' responses to the above example statements begin creating objectives and goals, and place the responsibility for their construction with clients. They also establish a boundary regarding therapists' duties. By using such statements, you distance yourself from taking responsibility for clients' situations and solutions. These statements further establish a position of naiveté regarding therapists' knowledge of a solution. You relieve yourself from feeling like you have to figure out what clients need or want and thus, you insulate yourself psychologically. I have students who have successfully used these statements with elementary school students!
If clients respond with a "don't want" style of response, empathize, confirm or establish why they do not want what they have expressed, and begin clarifying what they do want
. For example respond, "Tell me what you want more of in your life." If clients respond with "I don't know," refer to Chapter 8, Managing "I Don't Know"
Responses. Conversely, sometimes clients never openly state that they do not know, they just continue talking around the issue. In such instances, point out what is occurring using an empathic response such as, "As I hear you discuss your situation, I get the feeling you really are stumped as to what you really want." The ability to recognize that clients are not sure of what they want is very important information regarding their mind set and should be treated as such. Not knowing what you want from the therapist parallels not knowing what you want for yourself. At such junctures, slow down, keep the focus here, process deeply and precisely. Address meaning. As noted, therapy often requires that you slow down to go faster. This is one of those times.
“…we change when we become aware of what we are as opposed to trying to become what we are not.”
, (2001), p.196
Goal Creation Through Enhanced Empathic Responses
Much has been written on the importance of empathy in therapy, and justifiably so. Most master's programs in mental health spend much time teaching students how to actively listen and make empathic statements. When dealing with highly resistant clients, empathy is paramount. However, empathy alone will not solve all problems. Some well-entrenched clients will respond to basic empathic statements in a manner that attempts to suck the therapist into their stuck world. In such cases, the conversation may simply get mired in the misery of clients without actually creating movement. In order to prevent this problem and to help establish direction and movement in the conversation, deficit statements should accompany empathic statements.
A deficit is defined as that which is lacking. Deficit statements implicitly recognize what clients are lacking and explicitly state what clients need at the moment. By adding deficit statements to empathic statements, therapists bring to the forefront of the conversation what is needed in clients' lives. In this way the deficit statement primes clients for direction, movement, and goal creation. Yet, when added to the end of an empathic statement, the priming effect goes completely unnoticed by clients. When stated with an air of concern, clients never experience the idea presented as being imposed upon them. Effective therapists understand and take advantage of this feature.
The construction of deficit statements is presented below. Simply attach a phrase similar to those below to the empathic statement and follow this with a statement of what is lacking.
Empathic statement + and what you're looking for + deficit
…and what you need…
…and what you're searching for…
…and what you want is…
…and what you require is…
…and what you desire is…
…and what you wish is…
…and what you crave is…
Examples of empathic statements that include a deficit component might be:
"You are very distraught over the divorce from your wife. The marriage in
which you have invested nine years of your life appears to be coming to an
end, and you are searching for a way to make some sense of what has
"You have tried to have a child for quite some time and are experiencing
much grief over the possibility that it may not occur. As you talk about now,
it appears you are looking for a way to begin resolving the enormous
dissonance this causes in you."
"You are at your wits end with your children and are experiencing much
anger at your husband's reinforcing their misbehavior. You strongly
desire a way to obtain support from you husband and to develop more
effective methods of discipline for your children."
If you are correct in your perception of the current deficit, such statements will provide direction and open the door for a discussion of how to go about acquiring what is needed. If you are wrong in your perceptions, clients will likely correct you. When corrected, empathize and clarify the new need, then proceed toward a clarification of goals.
Even though we are labeling this as a "deficit statement," be careful to word in the positive. For example, it would be unproductive to state:
"Your situation is quite irritating to you and you are
lacking the guts to speak out."
A much better statement would be:
"Your situation is quite irritating and you're searching for the best words to
say in order to have a significant impact."
Although it does recognize a deficit, the first statement above is critical of the client. Conversely, the second statement gets at the client's struggle to find the right words and to say them in an effective manner. In this statement there is no mention of a personal shortcoming. In addition, the second statement primes the client to consider making an assertive statement.
Empathic statements are powerful therapeutic tools. The use of empathic statements that include a deficit component is a characteristic that separates the average from the truly skilled.
Ask the Miracle Question
The miracle question has been presented in numerous Brief Therapy texts as a means of moving the client toward the creation of a solution. When preceded by appropriate therapeutic discussion and delivered at the appropriate time, it is a very useful tool. Its utility stems from its uniqueness and its propensity to move the client toward an exploration of possibilities not yet explored. Once these possibilities are developed, it is a simple matter to begin converting them into goals. It is important to remember that this is an unusual question to pose to clients. Provide time and understanding as they work to develop an answer.
Suppose that one night, while you were asleep, there was a miracle and
this problem was solved. How would you know? What specifically would
you be doing differently? How would your husband, wife, children, etc,
know that the problem was solved without you saying a word about it?
As will be elucidated, I have a strong bias against over-questioning. Thus, it may be beneficial to convert the miracle question to the miracle statement or, to be grammatically precise, the miracle command delivered with paralanguage that conveys curiosity.
Suppose that one night, while you were asleep, there was a miracle and
this problem was solved. Imagine I am a fly on the wall or standing in the
room with you, tell me what you would be doing differently. Explain to me
how you would know. Give me an idea of how ______ would know the
problem was gone.
Littrell (1998) notes that statements that are tailored to the client's world are much more likely to strike a chord and have impact. He suggests that the miracle question can be adapted accordingly. For example, if your client was a person with strong religious beliefs you might say:
"If God changed your life with a miracle tonight, tell me what it
would be like tomorrow."
If your client was a young child you might say:
"If a good fairy was to wave a magic wand tonight and tomorrow things
were different, tell me…."
A Few Points on Creating Viable Goals
Therapists need to assist clients in developing goals that are appropriate and manageable. When goal setting goes astray, goals are not accomplished, and clients lose faith in themselves, the goal setting process, and the therapeutic process. There is an art to co-creating effective goals, some of which has been previously discussed. Characteristics of good goals are commonly addressed in texts and at seminars, also. Because many sections of this manual address central points to well-created goals and because the subject is frequently taught, the most common characteristics will not be discussed extensively. However, aspects of goal setting that fall outside of conventional, mainstream teachings will be given additional consideration.
Before reviewing some critical points on goal setting, I would like to point out a rarely taught, little understood aspect of the process: For most people, goals should not be labeled as "goals.
" Biehl (1995) wrote a very interesting and enlightening book entitled, "Stop Setting Goals If You Would Rather Solve Problems."
In his years of work with goal setting, Bobb Biehl discovered that most people do not like setting goals and are "turned off" by the idea. Most people have a built-in, negative knee-jerk reaction when the topic of goal setting is introduced. However, most people like to solve problems and readily label themselves as "problem solvers." Thus, Biehl separates people into two categories: goal setters and problem solvers. A few general examples of the preferences of goal setters and problem solvers will perhaps further clarify the differences between the two.
Goal setters typically like to create new things while problem solvers like to improve on the status quo. For example, goal setters would rather buy a new house, whereas problems solvers would rather remodel the old house. Goal setters prefer to write a book, problem solvers would prefer to edit a book. Goal setters prefer to score points (offense); problem solvers prefer to keep the opposing team from scoring (defense). Goal setters would rather change their academic curriculum to something new, while problem solvers would rather improve on the current curriculum. Goal setters are concerned with the direction things are going; problem solvers are concerned with what's currently broken and how to fix it. When the boss comes to the meeting and declares next year's goals, the goals setters are excited while the problem solvers are asking when last year's goals are going to be met. Goal setters tend to not see the problems at hand, get bored easily, and fail to tend to details. Problem solvers fail to see the big picture, are leery of the untried, and distrust their instincts in new situations. In the final analysis, goal setters are energized by goals and drained by problems; problem solvers are energized by problems and drained by goals. Say the words "goals" and "problems" to yourself. Perhaps you have an internal sense of which word stimulates and which word burdens.
The benefits of understanding these differences emerge when you recognize that goal setters are much more motivated when they have a goal to accomplish, and problem solvers are much more motivated when they have a problem to solve. Regardless of whether or not you view this as a matter of semantics (which it may well be), the distinction appears to be real in the minds of people and how they perceive themselves. Biehl estimates that between 60 and 90 percent of people prefer problem solving to goal setting.
This being the case, how you frame the task at hand can significantly influence clients' motivations to accomplish it. For most people, instead of talking about goals, simply talk about solving problems. This reframe can be critical and may change the course of therapy. In order to discover whether clients are goal setters or problems solvers, Biehl suggests you ask the following question: "Which would you rather do, define a problem and solve it or set a goal and reach it?" It is interesting how many people are immediately clear as to which they prefer. For those who are not as aware or who may not have a strong preference, a bit more discussion regarding the differences may be warranted. The distinctions presented above can provide a starting point from which to begin such discussions.
Critical Points for Viable Goals/Problem-Solutions
should be created in conjunction with the client in a manner that indicates that they originated in response to client needs. Ideally it should appear as though the client thought them up.
should be specific and measurable.
should not be too difficult or too easy relative to the client. They should be realistically accomplishable, yet should require some effort on the part of the client. Goals perceived as too easy may be discounted by the client because "easy" is often not equated with effective. Goals perceived to be too difficult will likely not be attempted. It may be helpful to directly enter a discussion with the client about these points and together work to seek a realistic balance between the extremes.
should always be worded in a positive, "to do" manner. Never have a "don’t do" task.
should be based on accomplishing the action proposed and not on the outcome of that action. For example, making an assertive statement is a reasonable goal, assuming that it will be effective is unreasonable.
If more than one goal/problem-solution
is established, then they should be prioritized.
Once goals/problem-solutions are established
, consideration of how to keep them in the forefront of the client's life is important. There needs to be a way to keep them in the mind of the client. Many times, clients’ lives are so hectic and in disarray that goals are quickly forgotten after leaving the therapist's office. Thus, a discussion of how to keep goals as a primary focus would be beneficial. Clients might write them down, carry a list, put them on note cards, or put pictures and reminder notes where they will be seen.
Related to the idea of keeping goals/problem-solutions conspicuous
in the clients' lives is the concept of "implementation intentions." Implementation intentions are different from goal intentions. Goal intentions only specify the end point of accomplishment in the goal setting process. They are what must be achieved for the goal to be accomplished. Goal intentions are typically the primary focus of goal setting endeavors. Indeed, most pen and paper forms used for recording client goals only include space for stating what is needed for completion. Although important, goal intentions should not be the primary focus. Once goal intentions are established, implementation intentions should be the primary focus.
Implementation intentions focus on when, where, and how behaviors that may lead to goal accomplishment should be executed. When focusing on implementation intentions, therapists discuss with clients the specific situations in which alternative responses should be made that would likely lead to goal accomplishment. This discussion clarifies the time, place, and details of what is needed in order to begin moving toward goal accomplishment.
The significance of this differentiation may appear obvious to those therapists who instinctively discuss implementation intentions with clients. However, many therapists do not focus enough time on implementation intentions. Failure to tend to implementation intentions is devastating to goal accomplishment and problem solving. Research has indicated that even a brief mentioning of implementation intentions can have a significant effect. Further, the more detailed the discussion, the greater likelihood of client follow through (Gollwitzer, 1999).
There are two primary benefits which result from focusing on implementation intentions. The first is that, by detailing when to begin a new behavior, a link is formed between the new behavior and the opportunity to apply it (Gollwitzer, 1999). By discussing implementation intentions, you create the chance for an automatic response or an "instant habit" that overrides the former response style. The second benefit is that this link helps to protect against the influence of distractions and competing responses that may subvert goal attainment. When clients leave your office they return to their hectic lives filled with automatic patterns and distractions. The real challenge to accomplishing goals is in overriding these patterns and distractions. Detailed discussions of implementation intentions put the focus on ways to override such automatic responses. The research on implementation intentions is impressive. To review the current research, I suggest you read Gollwitzer.
The more you understand the distinction between goal setting and implementation intentions, the more you realize that the focus should be on the latter. Those who have attended time management seminars have likely been taught that, when trying to accomplish tasks, it is more effective to schedule and commit to blocks of time for doing the work, rather than committing to deadlines and overall goals. This distinction is a good example of the difference between focusing on implementation intentions and focusing on goals.
Once clear goals/problem-solutions are established
, client commitment levels should be obtained. Implementation intentions do not work when goal intentions are weak (Gollwitzer, 1999). Scaling techniques are useful in confirming commitment. Low levels of commitment may be an indication that additional processing is warranted. Weak levels of commitment may also be a result of neglecting to firmly establish emotionally compelling reasons for change. However, one must keep in mind that, with some clients, a low level of commitment may be acceptable and should be reinforced. The following example illustrates such an instance.
I once observed the Reality Therapist, Dr. R. E. Wubbolding, skillfully demonstrate a Reality Therapy group approach in which he proceeded to ask each group member his/her level of goal commitment on a 1 to 100 scale. Although most members responded with relatively high numbers, one member responded with a "three." To the surprise of the audience and the group member, Dr. Wubbolding quickly and sincerely responded with, "That's good!" Rather than criticizing the client for a low level of commitment and entering into a discussion with the client aimed at seeking a higher level of commitment, Dr. Wubbolding accepted the level of commitment with glee. He refused to take the bait to enter into a discussion from an openly resistant client. He did not fight the resistance. Imagine the confusion the client experienced as his low level of commitment was embraced. The client who moments ago was poised to verbally battle, now sat there wondering what had just happened. There was also a slight sense of embarrassment that he had not offered greater commitment in order to balance out the surprising level of acceptance he received. This was an excellent example of not fighting the resistance while, at the same time, doing the unexpected.
When dealing with resistance, it is vital to be vigilant in avoiding typical responses to such obvious invitations for confrontation. As can be gleaned from this example, sometimes low levels of commitment should be sincerely embraced in order to prevent an escalation of resistance.
To Ask or Not to Ask, That is the Question
It has been my experience that the use of questions is a very controversial component of therapeutic dialogue. Some approaches, Reality Therapy, Brief Therapy, and Gestalt Therapy, for example, rely heavily on questions. Other approaches, such as Rogerian Therapy, are much less dependent on questions and are often taught with an emphasis on avoiding questions.
One reason why there is so much disagreement on the use of questions is that the pitfalls of questions do not readily emerge in the therapeutic process. Much of the time, therapy progresses or appears to progress even if you use questions. This is particularly true with motivated clients. In fact, with highly cooperative clients (those in the preparation or action stage), questions can be effective and save time. Those in private practice who have hurting, paying, motivated clients have likely made considerable progress through questioning and may have difficulty accepting arguments against the excessive use of questions. With highly resistant clients however, the dynamics are different.
Another reason why the perils of questions go unnoticed is because questions are such a common part of our language. Your clients are accustomed to them and so are you. This is particularly true when you go to see professionals such as medical doctors or auto mechanics. If your car breaks down, you take it to a mechanic. The mechanic immediately starts asking a series of questions about the problem. If you are like most people, with every question and answer you are filled with hope that the problem will be fixed and, in a short time, you will have your car back. Because they are seen as an aid to getting your car fixed, such questions provide you with hope and reduce stress. We have a deep appreciation for them and we are disappointed if we are not asked enough of them.
However, taking your car to the mechanic is not analogous to therapy. In the case of the car, you are not going to have to do the work! All you have to do is pay. There is no personal, internal struggle you have to endure when having your car repaired. To the contrary, you are highly motivated because fixing your car is highly desired. It is a win-win situation. Such is not the case with therapy. In therapy, in order to "win," the client must work and struggle (and hopefully, pay).
It should be noted that questions are not readily accepted in some cultures and are considered rude. However, they are quite acceptable in Western cultures. Yet, when dealing with highly resistant clients, questions are likely to impede progress and foster resistance. Thus, the question deserves attention.
In attempting to create better therapeutic conversation, this chapter offers some guidelines regarding questions. Please remember that they are only guidelines and that there are always exceptions. I personally would break any rule presented in this manual if I believed that it would be of benefit to the client. Nonetheless, the great majority of the time, the guidelines presented offer the better therapeutic approach.
Although it is very difficult to establish hard and fast rules in counseling, there is an overarching principle that should guide therapeutic dialogue: In order for therapeutic dialogue to be effective and of value, there must be something different about how it is conducted when compared to everyday, lay conversation.
One of the components that makes therapeutic dialogue unique is that we do not respond in typical ways when clients present information. The asking of questions is extremely common in everyday conversation and, thus, offers little variation from what people receive from talking to untrained, lay persons. When you avoid questions, you avoid the common place and the problems that questions spawn.
The Problems with Questions Lie Just Beneath the Surface
The problems that arise from asking questions are subtle to the untrained practitioner and most often go unnoticed. In order to shed light on this aspect, an explanation of some problems that questions generate will first be addressed.
Questions have a tendency to put people in a "one-down" defensive position (Ivey & Gluckstern, 1974). The person asking the question has put the ball in the other's court so to speak, thus there is pressure to provide an answer. This one-down positioning occurs because questions are frequently asked with preordained answers in mind. In this manner people are attempting to lead others toward insights or actions with what they think is an indirect approach. However, this approach is so common that it is very transparent and, thus, feels condescending and arrogant to the recipient. In our culture, people often comment incredulously about the "loaded" question. Too often, many questions are "loaded" and, as a result, we have become unconsciously skittish as soon as we are asked anything. The bottom line is that questions tend to put people on the spot and, as a result, resistant clients will likely "dig in" and defend—the very response we want to avoid.
Another problem with questions centers on the fact that, when we have problems, we all dialogue in our mind about our problems. Because the question is such a common part of our language, our mental dialogues include internally asked questions. Because we are usually afraid of the solution to our problems—perhaps more than we are the problems—we tend to develop answers to our internal questions that do not solve our problems, but that keep us stuck in them.
When therapists ask resistant clients questions, it is very likely that these clients have already asked themselves the same questions. Furthermore, these clients have developed answers to these questions that are of little benefit in solving their problems. In responding to the therapist, such clients provide answers that are not helpful and, in the process, lure the therapist into their stuck state in order to validate their belief that little can be done. When this dialogue pattern is closely examined, it becomes apparent that counselors are asking questions in hopes of leading clients toward some insight. However, what actually happens is that clients are prepared for the questions and answer in a manner that is of no benefit. Consequently, asking questions provides the means by which clients draw therapists into their stuckness.
When you ask a question, be careful that you are not setting your own trap!
When you ask a series of questions, the implied message the client perceives is something like this: "Once I answer all of these questions my therapist is going to make his/her assessment and tell me what to do." This interpretation is particularly common with highly dependent clients. This implied message occurs because it is the commonly occurring dynamic with questions. Similar to the auto mechanic dynamic presented above, people often assume that a therapist's questions ultimately lead to direct instruction and advice. Several problems arise from this underlying message.
The first problem stems from the fact that resistant clients do not respond well to advice. As you ask questions, they are preparing their rebuttals. Some oppositional clients will not follow suggestions simply because you suggested them! On the other hand, dependent clients, who are often seeking advice, end up disappointed because, as good therapists, we do not provide the advice they seek.
Another problem with this questioning dynamic is that it takes responsibility for change away from clients. When we ask questions, clients assume that we are homing in on a solution—that we are going to "fix" their problems. However, our protocol is not that of an auto mechanic as we do not "fix" any of the client's problems ourselves. Responses that take responsibility for internal struggles away from clients will likely foster resistance. Remember, many clients come to therapy because they looked at the obvious solutions and were horrified. They are hoping that you will have a solution that avoids the frightening difficulties that they foresee. When you ask questions, you are building the hope of an alternative solution without pain. When clients come to the realization that the solution includes personal suffering, you are right back where you started. When analyzed from this perspective, it becomes apparent how the underlying dynamics of questions often run counter to the therapeutic process.
Questions invite "Yes, but…" responses. Because many questions are typically asked with preordained answers in mind that are intended to promote a particular perspective or behavior, they open the door for "Yes, but…" responses. This occurs because clients readily see the assertion being imposed on them and are quick to defend their position. Remember, they have likely asked themselves the same questions already. They are likely well armed with a surplus of "Yes, but…" ammunition. "Yes, but…" responses generally indicate that you are working too hard and have taken responsibility for finding solutions to clients' problems instead of allowing clients to find their own solutions (Walter & Peller, 1992).
The asking of questions often has the built-in assumption that change will occur as a result of logic. As noted, the position presented in this manual is that change only occurs when there is an underlying emotionally compelling reason. Thus, we are more effective when we clarify the emotionally compelling reasons for change than when we try to establish logical reasons to change. Many questioning styles have a tendency to lead to a logical analysis of situations. Thus, questions frequently send your clients into their head to "think" about issues. Although this can be beneficial, excessive logical questioning that is not accompanied by emotionally based reasons, more often than not, bogs down sessions. Excessive questioning frequently results in an unproductive logical discussion that is void of the emotional fuel for propelling change.
In summary, most people ask questions because they are seeking a known answer and, through that known answer, they are trying to lead the other person toward some conclusion or action. The truth of the matter is that questions suck therapists into the stagnant worlds of clients and trap them in unproductive dialogues.
To make matters worse, a question-loaded dialogue may actually feel as if it is making progress. Indeed, you can sit for session after session with a question filled dialogue and actually sense that a break through is eminent. Yet, after numerous sessions, your client has made no progress. You wonder what is going wrong. The endless stream of questions you ask doesn’t even enter your mind as the reason for the stagnation. The subtle pitfalls that questions create are well hidden in the conversation. You have fallen prey to one of the most common linguistic errors therapists make.
I am not saying that you can't have a therapeutic dialogue that includes questions. You certainly can. What I am saying is that such dialogues rarely make significant headway with resistant clients. With highly resistant clients, it is a deception that the excessive use of questions will result in any sort of break-through. Rather than creating insights in clients, most questions are perilous hazards that should be avoided when possible.
"When we indulge ourselves with too many questions, the situation quickly becomes one in which the client feels they are there to be 'worked on,' to wait for questions, to answer them and to wait again, either for another question or to be told what to do next."
, 1990, p.154
Generally, Do Not Ask Questions Under the Following Circumstances:
Do not ask questions to ascertain information that is apparent by the client’s paralanguage or affect. Typically, this would include asking a question about how the client feels when it is obvious how the client feels from the statements made and paralanguage. This is a common mistake among beginning therapists. An example of such a response would be, "How does that make you feel?" A much better approach would be to respond with an empathic statement that includes a deficit. Even if you are wrong in your perception, your client will likely self-correct and continue without the negative implications inherent in asking questions. In the above example, the negative implication from asking a question is that you are not very perceptive.
Do not use a question to grill a client in a way that arouses guilt or ideas of ineptness on the part of the client. Typically, this would be asking, "Why didn't you…?" or "Why did you…?" questions, or questions with an implied "why." Also, questions that impose a value such as, "Why did you not use birth control?" These types of questions should be avoided at virtually all cost.
If for some reason you find yourself forced to gather information through questioning, do not ask more than two questions in a sequence without an intervening, empathic statement. In other words, if you have just asked a question, make sure you have fully verified the experience of the client before you proceed with asking another question. However, I would assert that, if you have properly worded your empathic statement and included a deficit component, it is unlikely that you will have to follow with another question.
As a general rule, given the option to communicate with a question as opposed to a statement or command, it is more therapeutic to communicate with the latter. When you make a properly phrased statement or command, you are less likely to create resistance in your client and you are more likely to maintain an atmosphere in which your client is willing to talk openly and explore new perspectives. Of course, as previously noted, this should all be done with paralanguage that communicates naïve, caring, genuinely inquisitive curiosity.
What to do if You Have the Urge to Ask a Question
The urge to ask questions can be powerful. When you feel this urge growing, the following guidelines are suggested.
First, slow down, sit there and do not ask the question until you further assess the reasoning and need behind the question.
Ask yourself, "Is it absolutely necessary to know the information about which I want to inquire?" "Is it important to know or am I just curious to know the information?" If you are just curious, do not ask the question.
If you think the information is important enough to warrant a question, then ask yourself, "What is happening inside me that makes me want to ask this question?" Many times you will find a strong emotion within yourself, such as fear or concern for the client. Or, you may be aware of an urge to have the client recognize or do something, or an urge to jump ahead because you want to know something about the situation before the client has offered the information. If this is the case, do not
ask the question. Instead, make a statement to the client about what you are experiencing. In other words, rather than inquiring about the information, tell the client your motivation or what is happening inside of you that is creating the motivation to ask the question.
This is a much more powerful therapeutic practice. By telling clients what is occurring inside of you as you hear them speak, you are providing powerful feedback to clients and modeling the expression of emotions. This feedback raises their awareness of the emotions that they are likely experiencing, but of which they are not fully aware. In this way you help construct emotionally compelling reasons for change that will enhance therapeutic movement. You are also avoiding the pitfalls intrinsic to questions. Developing this fundamental skill is one of the first steps to moving from a typical conversation style to a therapeutic conversation style.
How to Convert Questions Into Curious Commands
To circumvent the problems created by questions, therapists should avoid asking them whenever possible. With just a few adjustments in grammatical structure and voice tone, it is possible to avoid questions a great deal of the time. Ordinarily, most questions can be converted to statements or commands by avoiding certain introductory or closing words and phrases. Summers (2001) wrote a superb manual covering a host of therapeutic issues and skills. This manual includes one of the best chapters I have read on asking questions. The following table is adapted from this manual and was originally developed to provide a formula for asking open-ended questions in interviewing. Although this is an excellent presentation of how to create open questions, because of the points noted above, problems may still arise with this approach when dealing with resistant clients. In addition, clients can still simply answer "no" to your question, handing the ball back to you. However, if your voice tone and paralanguage communicate a genuine concern and curiosity, you can simply eliminate the "openers" at the beginning of questions and, in doing so, convert them into gentle commands that do not have a commanding feel. I call these statements "curious commands." This is because, when done properly, your response is grammatically a command, but has the feel of a genuinely, curious inquiry. The table below presents the basic structure for converting questions into curious commands.
Converting Open Questions into Curious Commands
Openers…..Directives…..Add-ons/Softeners…..Object of the Inquiry
tell me…..a bit more about…..your husband
describe…..a little about…..your childhood
explain…..a little more about…..your medication
summarize…..something about…..what the move was like
outline…..the problems with…..the move
clarify…..something more about…..the larger picture
share…..a little more about…..regarding the move
talk some more about…..what your dad said
give me information about…..your illness
give me an idea of…..your job
help me to understand…..your relationship with…
help me to get an idea of…..the situation
help me get a picture of….
Like "openers," tags on the end of statements are also unnecessary. Such tags convert perfectly acceptable statements into questions that tend to convey the added message that "I" (the therapist) am right in my assessment. Though subtle, for resistant clients these tags may feel arrogant and result in shutdown. The "I am right" component of these statements also conveys a position of knowing that may unconsciously suggest to clients that we (therapists) also know the solution to their problems. When we use such tags, we relinquish our not knowing, naïve, puzzled posture. The result is that such tags tend to foster dependence by subtly taking responsibility for change away from clients. Likewise, these tags create an atmosphere that precludes clients from coming up with their own solutions. Some examples of statements with unnecessary ending tags are provided below.
"You feel quiet annoyed, don't you?"
"You have thought a lot about getting a divorce, haven't you?"
"You wish you had never had kids, don't you?"
"You really let your family down, didn't you?"
(This question is bad all around. It implies criticism and interjects a
counselor value. In addition, it conveys an "I am right" attitude.)
As is so often the case with therapeutic principles, there are exceptions and, in certain situations, such grammatical tags may have utility. Sometimes converting statements into questions is necessary in order to get the non-verbal, unresponsive clients to respond. In this case, the tags provide a verbal cue that a response is needed while triggering an almost reflex-like answer. Thus, the tag can be used to help promote dialogue. Nonetheless, try to dialogue without the tag initially.
Comments on Brief Therapy's Use of Questions:
Most Brief Therapy approaches are couched around asking a series of judiciously designed questions that lead clients toward significant perceptual shifts with regard to problems and, ultimately, solutions. However, virtually every Brief Therapy question can be restated as a curious command and, thus, lose the interrogating feel of an over-questioning mode of dialogue. I have already noted how the miracle question can be restated as a curious command. Presuppositional questions that assume certain conditions and, thus, more readily move clients toward a conclusion, can also be converted to commands. Below is an example of a commonly stated Brief Therapy question followed by an example of how easy it is to convert such questions into curious commands. This same concept can be applied to virtually any question.
"When the problem is not a problem, how are things different?"
This statement assumes that there are times when the problem does not exist, assumes things are different at those times, and, implicit to asking a question, is the idea that clients can describe how they are different. However, the question may have a leading-the-client feel, may feel a bit like interrogation, and is likely to invite an "I don't know" response.
"When the problem is not a problem, tell me how things are different."
This statement assumes that there are times when the problem does not exist, assumes things are different at those times, and explicitly assumes that clients can tell you what these things are. When asked with a paralanguage expressing curiosity, this style avoids feeling like it is leading clients or the subtle feeling of interrogation. With this mode of responding, you are less likely to get an "I don’t know" type response.
As previously noted, significant resistance can be alleviated with careful attention to paralanguage, particularly, voice tone. It is difficult to communicate through the written pages of this manual the significant influence that paralanguage has on resolving resistance. You cannot hear the example statements. Suffice it to say that, without the proper voice inflection, very little of what is presented will have therapeutic value. The following examples may shed some light on this point. Say each of the questions and statements below with an emphasis on the underlined words. Notice how the underlying message changes with different inflections.
"What did you
do?" (Personal sounding, accent on the "you" tends to imply a comparison of "you" to others.)
"What did you do
?" (Accent on the "do" tends to maintain a not knowing, information-seeking attitude. This is a much better inflection for a question.)
"Tell me what you
did." (A command that still tends to imply a comparison to others.)
"Tell me what you did
." (Accent on the "did" conveys curiosity. The better method for gathering information.)
"How do you
get along on the job?" (Focus may appear to be on finding a fault in the client.)
"How do you get along
on the job?" (Inquires as to methods of "getting along" and not finding faults.)
"What did you
do when your husband hit you?" (Possible negative presupposition: You did not do the right thing if it is still a problem.)
"And when your husband hit you, tell me what you did
." (Conveys curiosity about the client's response.)
"And when your husband hit you, tell me what happened next." (Much less personal feeling.)
Generally, Use Questions for These Purposes
The primary reason that so much presumably "therapeutic" dialogue tends to emanate as questions is that the legitimate reasons for asking questions are also convenient excuses for over-questioning. Recognizing this, the challenge to therapists is to not allow the convenient, legitimate rationale for questions to result in excessive questioning that destroys the therapeutic climate. This being said, I am going to present several therapeutically legitimate reasons for asking questions with the understanding that the circumstances for such use should be limited
If not provided an option, it may be necessary to use a question to verify your understanding of information provided by clients. Sometimes clients do not display good paralanguage and do not communicate back to you that your perceptions of their world are accurate. In such cases, you would be better off directly asking clients if you are accurate in your perceptions of their situation than to continue with a dialogue that may be off track.
You may also find it useful to use questions to emphasize a point. An example of this would be a question that is intended to normalize an experience. Example: "Who wouldn't be upset if they had that happen to them?"
If you need to gather information that is essential
to understanding the situation and that is not obvious from what has been said, then ask. The operative word here is "essential." If you do not absolutely need the information, it is better to "sit on it" for a while and see what develops. However, please note that even essential information can also be gathered with gentle command. Keep in mind that most people who are "trying" to help others often go into a questioning assault mode of conversation. By being careful to avoid such conversation styles, you are automatically doing the unexpected. This will have a foreign feel for clients and, in and of itself, begins to disrupt clients' perspectives of their problems.
Another legitimate use of questions arises when you are assessing clients' capabilities at doing some therapeutic task. For example, some techniques require clients to imagine their problem in terms of its color or shape. Not everyone has the ability to do such tasks. It is legitimate to ask, "Can you place your problem on the chair beside you?" "If so, what shape would it be?" "What color would it be?" Note that such questions are not trying to lead the client to a predetermined answer and, as such, do not have the accompanying pitfalls. Still, when assessing clients' skills at imaginative exercises, be sure to deliver questions with a sense that the answer is truly unknown to you and with a paralanguage that conveys that not being able to do the task is entirely acceptable.
Many clients have difficulty doing imaginative exercises and you do not want your questions to convey fault. I have a colleague who is a master at presenting such questions. Even before clients answer, he has conveyed through his paralanguage an acceptance if they cannot do the task. When delivered with proper paralanguage, such questions can be quite therapeutic.
Finally, questions can be used as tools to lead clients toward exploring new perspectives and possibilities that have not been previously addressed. This is what most people think they are doing when they ask loaded questions with preordained answers. This is also the logic that frequently lures therapists into over-questioning. However, we want to avoid the pitfalls of obvious preordained answers and of over-questioning. We want to approach this use of questions with great forethought and care.
The most common mistake is to prematurely ask leading, exploration questions before the proper atmosphere has been established. A "proper atmosphere" would be one in which you have explored the issues surrounding the answer to the point that clients are ready to provide the answer, or one in which you are certain that clients have the answer in mind and simply need to be gently nudged to embrace it. You will know if you have asked prematurely if clients either evade the question (often perceived as resistance) or are not able to answer. In such cases, you asked before they had begun to form the new possibility in their mind. For the therapeutically leading question to be effective, timing and voice tone are critically important
. It may take several sessions before such a question is posed. Use sparingly! One such question a session will likely be enough for a highly resistant client.
In order for a therapeutically leading question to work it must be delivered in the proper manner. Be genuinely puzzled about what you are asking so as to convey a state of true befuddlement on your part and to avoid the appearance of a preordained answer. Your paralanguage must convey a state of authentic inquiry and be completely convincing that you are truly without an answer. It is recommended that you incorporate a pace before you lead with a question (see Pacing and Leading
in Chapter 11).
After you have asked the question, say no more. Do not look at the client. Rather, look off and model pondering the answer. Now wait. Give the client more than ample time to respond. This silence should convey that this is a time for thought, that you are waiting for an answer, and that you will not speak until an answer is given. If the client does not respond after more than ample time, say something to the effect, "This appears to be a quite difficult issue to ponder," and then process the difficulties. If the client evades, you may have asked too soon. Back off and process the evasion. If the client evades consistently, use immediacy and address the consistent evading. Consistent evasion is a sign that your client is not yet ready to change and is likely in a precontemplation or contemplation stage. In such cases, stand down and adjust your dialogue to accommodate the level of readiness.
Interestingly, if you wait long enough to ask a rather obvious question, the client may begin wondering if you were ever going to ask. In anticipation, the client may tell you the answer in advance. Alternatively, if you wait long enough, the client may be more likely to provide an answer because the waiting has built a special therapeutic tension. The client may even respond with, "I thought you would never ask!" Here, your patience has created an "elephant in the room" effect with regard to the obvious question. The difference being that you have deliberately created the "elephant in the room" effect in order to prime the client for the impending question. In such instances, you have slowed your pace to the point that the client is pulling you rather than you pushing him/her. Because of your patience and your understanding of the power of waiting, you have masterfully circumvented the resistance that comes with asking too soon.
Advantages of Avoiding Questions
There are a number of psychologically significant problems that over questioning promotes. Conversely, there are a number of benefits to avoiding questions. A summary list of some of the benefits that emerge as you reduce questioning follows.
You greatly diminish the opportunity for the client to "Yes, but…" you.
You greatly reduce the opportunity for the client to respond with,
"I don't know."
By avoiding questions, you are doing the unexpected. Your dialogue will not
be common in style. It will have an indefinable, unique feel for clients. It is
amazing how disrupting the avoidance of questions is when clients are
poised to give you their pre-thought out, stagnating answers.
Your client will be less likely to feel in a one-down position. As such, he/she
will not feel indirectly criticized about his/her behavior, or embarrassed
about the lack of a suitable answer.
By avoiding questions with preordained answers, you avoid appearing to be
a know-it-all to your clients. Likewise, you avoid creating an interrogating
feel to your sessions. Subsequently, you prevent yourself from moving into
a position of opposition to clients.
You are more likely to keep responsibility for change with the client. You do
not create an atmosphere where you indirectly convey that you will have a
solution once the answers to questions are provided.
You avoid deceiving yourself into believing you are making progress when
you are just talking in circles. You avoid setting your own trap and being
pulled into the client's stuck world. Ultimately, you will likely make more
progress and appear more capable to your clients.
Copyright ©2005 Clifton W. Mitchell
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Copyright Clifton W. Mitchell, Ph.D.
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