Solutions for the Treatment Resistant Addicted Client

Therapeutic Techniques for Engaging Challenging Clients

Nicholas A. Roes

• Editorial: Routledge
• Año: 2014
• ISBN:
  9781317789017
• Edición: 1
• Categoría: Psicología
• Categoría: Asesoramiento psicoterapéutico

Help addicts to better their lives, even though they oppose treatment! This useful volume, the result of more than ten years of work in researching and refining the techniques most likely to lead to positive client outcomes, offers field-tested methods for dealing with the most challenging addicted client types. These include hopeless clients, clients considered to be in denial, and those who are in treatment not because they desire it, but because of a mandate from an outside authority. The techniques you'll find in Solutions for the "Treatment-Resistant" Addicted Client have proven to be successful with even the most difficult clients. The techniques you will learn in this book avoid generating resistance on the part of the client and are easily integrated into any treatment model. You'll also find case studies, practice worksheets, and suggestions for therapeutic tasks to assign to your clients. Solutions for the "Treatment-Resistant" Addicted Client will teach you:

• why treating even the most challenging clients with respect is vital to successful therapy
  
• why the concept of the client's "treatment readiness" is a myth; it is you, the therapist, who must be "ready" for the most challenging client!
  
• how to give your therapeutic message greater impact and break out of unproductive patterns of relating to your clients And the book's final section, presented in Q&A format, addresses:
  
• practical applications of the techniques discussed
  
• theoretical frameworks for the interventions suggested
  
• ethical concerns relating to dealing with clients who don't want treatment

Alcohol and drug counselors, probation/parole officers, social workers, and other mental health professionals who work with addicted clients will find this book an invaluable aid in their work. Students preparing to enter these careers, as well as those preparing for certification as alcohol or drug abuse counselors, also need the information found here. Solutions for the "Treatment-Resistant" Addicted Client is must reading for anyone dealing with this extraordinarily difficult population.

Section I: Meeting the Challenge of Hopeless Clients

"Hopeless" is certainly not a label we wish to hang on our clients. It is used here to distinguish one group of challenging clients from other challenging clients, with the idea of encouraging a more, rather than less, individualized treatment approach.

Some challenging clients have an unrealistic and unfounded optimism, sometimes called denial. They may feel, despite what many others are telling them, that they will he "okay." Hopeless clients are unrealistically pessimistic about their future. Despite what they may be told by supportive family members or therapists, they can see no way out of their current it difficulties. While some challenging clients have unrealistically high self-esteem and self-confidence, clients without hope have an unrealistically low self-esteem and very little self-confidence.

While some challenging clients seem to take the view, "nothing is my fault," hopeless clients are more likely to think "everything is my fault." Hopeless clients often accept the blame for the behavior of adults who abused them when they were children, for the marital problems of their parents, or for the infidelity of I heir spouses.

Some challenging clients only seek treatment because of external pressure. They come to see us when treatment is the lesser of two evils offered by a court, their employers, or their families. Hopeless clients may seek treatment because they have internalized their problems. They feel fundamentally flawed, damaged goods with problems that they can't separate from themselves, much less solve.

Some clients, often mandated to treatment, present a challenge be cause they are convinced they can handle their own lives without a counselor's interference. Many hopeless clients are convinced their problems are unsolvable—even with the help of a treatment professional. Finally, many challenging clients appear to be resistant because they don't really want to change in the ways others want them to change. Perhaps hope less clients are viewed as resistant because they don't really believe they can change.

Research suggests that hope plays a major role in improvements that take place during treatment (Hubble, Duncan, and Miller, 1999). A lack of enthusiasm for treatment that is due to a darkly pessimistic view of the prospects for change is sometimes mistaken for resistance. It's not necessarily that hopeless clients wouldn't want to change; it may be that they see no realistic basis for hope that their efforts will lead to the types of changes they want. Many have tried repeatedly to address the problems in their lives, but have now given up.

Clients rarely present at the first sign of a problem. They more often present when they've lost hope that they can solve the problem on their own (Jerome Frank, cited in Hubble, Duncan, and Miller, 1999). When initial treatment attempts fail to achieve the desired results, clients may lose hope that they can ever solve their problems.

The following techniques are designed to reintroduce hope.

Chapter 1
Hope-Inspiring Reflections

Many hopeless clients make statements that exclude or preclude the possibility of change. "I never do anything right," or "I'm too old to change," or "I was born this way; it's in my genes." But directly challenging tins point of view rarely works.

Depressed clients have already been told many times that things aren't so bad. Anorexics have already been told many times that they are not overweight. So far, this has been of little help to them. Worse yet, disagreeing with our clients may make them feel as if we're not listening—that we don't truly understand how much their problems are upsetting them.

Hope-inspiring reflections* offer an alternative to explaining to hopeless clients that "things aren't so bad." They open up possibilities for our clients, while helping them to feel understood.

For example, if a client says "I never do anything right," you might say. ''You're feeling like you don't succeed very often." This reflection, which sounds to the untrained ear to be just about the same as what the client said, actually opens up several possibilities.

First, there is the possibility that this idea is only a perception or feeling and may not square with reality. Second, there is the recognition that the client does succeed at least sometimes. Not succeeding very often is infinitely better than never doing anything right. Not succeeding very often is a much more hopeful situation, because you are succeeding to some degree at least some of the time. There is the hope that these exception times can become more frequent with practice.

Your hope-inspiring reflections are designed to offer your client a way of looking at things as less catastrophic. At the same time, you demonstrate your ability to understand and respect the client's point of view. Your reflections help your clients learn to redefine their problems in more accurate, realistic, and solvable ways.

For another example, a client says, "I'm terrible in relationships; women can't stand me, and I always make a fool of myself." You might say, "In the past, your relationships with women haven't worked out as well as you would have liked them to."

This introduces the idea that the problem is "in the past," and not necessarily forever into the future; and, again, the possibility that even though the relationships haven't worked out as well as the client would have liked, they did work out to some small degree—and that's a starting point to build upon.

Other hope-inspiring reflections recognize clients' efforts to overcome the problem. For example, if a client says, "I'll never be happy," you might say, "The way you look at it now, you'll be struggling with these sad feelings a long time." "The way you look at it now" opens up the possibility of a different way to view the problem. The phrase "for a long time" opens up the possibility of an eventual end to the problem.

And this hope-inspiring reflection also acknowledges and encourages action on the part of the client. The "struggling against" suggests that the client is not taking this lying down. It reinforces the idea that the client's choices make a real difference. The client begins to realize that the problem could be even worse if he or she gave up entirely, and that the client can decide to do other things that will have a definite impact on solving the problem. Encouraging and acknowledging action helps clients take an active, rather than passive, approach to therapy.

Still another helpful type of reflection externalizes the problem (Freedman and Combs, 1996; Friedman, 1993; Hopps and Pinderhughcs, 1999; Metcalf, 1998; O'Connell, 1998; White and Epston, 1990). For example, a client says, "I'm a fat pig." You might say, "You're feeling as if a weight problem has been getting the best of you lately." The "you're feeling" and "lately" open up the possibilities that this is only a perception, and that it doesn't necessarily have to last forever. Also, the choice of the words "weight problem" separates the problem from the person, in a way that "I'm a fat pig" does not. This helps clients realize that they are not the problem. The problem is the problem, and not an intrinsic and inseparable part of themselves.

People who have problems have hope that they can solve them. People who are problems, or see themselves as fundamentally and permanently flawed, are less likely to change. Fat pigs cannot realistically hope to live their lives as anything but pigs. There can be no realistic hope that a pig will turn into a gazelle or a zebra. But a person with a weight problem does have a realistic basis for hope that the problem maybe successfully addressed.

Five Types of Hope-Inspiring Reflections

We have touched on five ways you can reflect back to your hopeless clients that expand their possibilities. They work subtly, but powerfully.

1. Put the problem in the past, or the solution in the future. Preface your reflection with "up until now" "recently" "so far." "in the past," "lately," "for a long time," or "at this point," or end it with "yet" (as in "You haven't been able to find a way to keep from drinking yet"). This opens up the possibility that the future will be different.
2. Introduce the idea that perceptions can be different from reality. In these cases, your reflection might begin with, "It's your feeling that...," "So in the way you see things ...." "It seems as if...," "Your perception is ...," and phrases like that. This opens up the possibility that there are other, less pessimistic ways to view the client's situation.
3. Open up the possibility of exceptions to the problem, especially when clients use exaggerations such as "never" or "always." If the client says, "I never have any fun," you might reflect, "So there's not as much fun in your life as you would like." Here phrases such as "sometimes," "most of the time," "much of the time," "very often," "not as often as you would like," "less successful than you would like," and "not as satisfying as you would hope" are helpful. They open up the possibility that the client can learn from these exceptions and make them happen more often.
4. Acknowledge, expect, anticipate, and encourage action on the part of the client. Here use phrases such as "battling against," "grappling with," "struggling with," "trying to overcome," or "doing your best." This opens up the possibility that clients can address problems, rather than passively and powerlessly watch their own lives as if they were spectators and not participants.
5. Externalize the problem. These reflections can often be combined with the acknowledging/expecting action type when you say, "So you've been fighting these sad feelings ...," Your struggle with the green-eyed monster ...," or "These times when [problem] gets the best of you...." This opens up possibilities for overcoming problems, rather than maintaining the status quo. This technique can be especially helpful with children, who often blame themselves for things that are beyond their control.

It's very important to fight our urge to disagree with a hopeless statement, and we sometimes have to go against our first instincts. Don't tell someone with an eating disorder, for example, that you think they are very attractive, and not fat at all. They've been told this many times by many people, and it hasn't helped. It's the same with "Cheer up, things aren't so bad" to somebody who's dep...