TR TREA EATMEN TMENT T RE RESIS SISTANT ANT TE TEENS NS - - PowerPoint PPT Presentation
WOR ORKING KING WITH TH TR TREA EATMEN TMENT T RE RESIS SISTANT ANT TE TEENS NS Emily Scoffield, LCSW Clinical Director Provo Canyon School Intr ntroduction oduction Background information Ask questions/ Make comments
Emily Scoffield, LCSW Clinical Director Provo Canyon School
Intr ntroduction
■ Background information ■ Ask questions/ Make comments ■ Think of the most difficult client you are currently working with, find something that fits. ■ What’s your take home message? That’s up to you!
Objectiv bjectives es of T f Tra raining ining
resistance.
treatment
treatment
girl/my clients bring up in me?
girl/my clients bring up in me?
the refusal to accept or comply with something; the attempt to prevent something by action or argument.
Con
enti tiona
l Th Ther erapy: something that comes from within the client “If you’re not buying what I’m selling, you’re resistant.”
Results in feelings of: insecurity, incompetence, frustration, hopelessness, stress, and burnout
"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
:
client with your neck stretched out while the client sits there relaxed!
problems than clients are. You take your clients' problems home with you on your weekend while your clients go home relaxed and confident that their therapist has the situation under control.
Indications ‘Resistance’ is getting the be best st of y f you: u:
discuss client problems.
manner after sessions.
■ When the therapist fails to recognize that all clients are ambivalent about change. ■ When the therapist wants more for clients than clients want for themselves. ■ Therapist being too intent on his/her own agenda. ■ Resistance = therapist expectations. ■ When the therapist starts trying to solve the client's problems. ■ When the therapist is going too fast. ■ When the therapist does not know what to do. ■ "... anything the client does that makes the therapist feel inadequate" (Pipes & Davenport, 1990). ■ When the therapist fails to cooperate with the client.
Soc
al In Interaction eraction Th Theo eory
■ a mismatch between the therapist's mode of influence and the client's current willingness to accept that influence ■ Resistance is borne out of the interaction ■ “if what you’re doing with the client is not working, then do something else because your interaction is creating resistance,”
Yo You u ca cann nnot t ch chan ange ge yo your ur cl clien ients ts; ; yo you u ca can n onl nly y ch chan ange ge ho how yo w you u in inte tera ract ct wi with th your ur cli lients nts
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).
■ Adjust to sexually maturing bodies and feelings ■ Develop and apply abstract thinking skills ■ Develop and apply new perspective on human relationships ■ Develop and apply new coping skills in areas such as decision making, problem solving, and conflict resolution ■ Identify meaningful moral standards, values, and belief systems
■ Understand and express more complex emotional experiences ■ Form friendships that are mutually close and supportive ■ Establish key aspects of identity ■ Meet the demands of increasingly mature roles and responsibilities ■ Renegotiate relationships with adults in parenting roles
Under derstanding standing Res esistance istance
Social Stigma
Und nder erstanding tanding Resistance esistance
Poor Insight
Und nder erstanding tanding Resistance esistance
Denial Misconceptions Concealing
Und nder erstanding tanding Resistance esistance
Fear Embarrassment
Und nder erstanding tanding Resistance esistance
Holding On Feeling Unworthy
“What works best is ANYTHING that increases the quality and number of relationships in the child’s life”.
The Boy Who was Raised as a Dog
Pos
itive e Rel elationshi tionships ps
In order for a person to ‘grow’ and heal, they need:
Lean in to discomfort, lean in to resistance!
Basic sic assum ssumptions ptions
The client is doing the best they can
The Client wants to get better
The client must learn new behaviors. The client may not have caused the problems, but they have to solve them anyway. The client needs to do better, try harder, and be more motivated to change.
The client cannot fail in therapy/school; the therapy/school fails the client
Take the counter argument and be
than the student’s argument
Foot t in in th the e door/Door
in th the e fac ace
Foot in the door
Small request gradually increased
Door in the face
large request gradually decreased
Connect past commitments and goals with current behavior
know they will succeed
has everything it will take to overcome problems
Val alid idation tion is is:
Fin indi ding somethin ething g rel elevant, ant, ju justi tifia iable ble, , and d app ppropr pria iate e in in thoughts,
em emoti tions
, and d beh ehavior iors
Highli ghlight ght their eir wisdom sdom
An invalidating environment (abuse and trauma being the ultimate invalidation) teaches a child that his sense of self, beliefs, and
invalid.
DBT and Validation
Val alid idation tion an and d ch
The paradox of therapy is that people do not begin to change until they feel as accepted as they are
Invalidating Statements
consoling, and leaving it there
– Resistance met with reflection – Goals negotiated by client and clinician – Builds motivation – Reflects/explores client’s
Th The e 5 5 Basic asic Pr Principles inciples of MI f MI
See and feel the world the way our clients do.
concerns and reasons for behaving the way they do
the world through their eyes.
they are more likely to open up and share their experiences.
Resistance of clients is not challenged by the clinician
confrontational and met with resistance
perspectives
Ambivalence to change is normal. Help client recognize it in order to avoid getting stuck.
can lead to being stuck
different ‘sides’ they are dealing with
Assist clients in identifying discrepancies towards goals and current behaviors.
currently, and where they want to be
behavior is not leading them towards their goals
There is no “right” way to change. Support all clients attempts/plans to change.
possible is critical!
will help them believe change is possible AND attainable
OARS RS
■ Open Ended Questions ■ Affirmations ■ Reflective Listening ■ Summarize
Int nteract raction ion Tec echniq hniques ues (OARS) ARS)
Ope pen-End nded ed Que uesti tions
– Attempts to create forward momentum. – Decrease the use of questions where clients will only answer “yes” or “no”.
– Example ple of an open-ended ended question: tion: “Why might you be ready for change in your life today?”
Affirma irmations tions – Utilize statements that reflect strengths of a client. – Be genuine with affirmations in order to build rapport and establish a trusting professional relationship
Reflec lectiv tive e Listening ening – Listen, Listen, Listen! Clients are best helped when what has motivated them to change in the past is recognized as well as what has proved to be an obstacle to success. – Keep the reflections focused on change talk. MI works when there is Forward Momentum.
Summ mmari aries es – Summarize back what the client has been stating in order to ensure accuracy of what the client has shared. – Focus on change talk, again continuing forward momentum. – This is also beneficial for rapport building as the client will be aware that they have been heard
Def efinition inition: An emotional battle of will between parent/caregiver and child over who is in control.
Power er Str truggles uggles
Child’s thoughts: “I’m going to be told what to do and I’m not going to do it” “It’s them against us” “Just because you are an adult or ‘in charge’ doesn’t mean you are right” Pa Pare rent nt/Caregi /Caregiver er thoug ughts: hts: “I’m in charge here” ”It’s for your own good” “Because I said so” “You are the one with the problem not me”
Res esoluti lution:
not as a problem
rules as often as needed
Caring
who is in charge
discomfort
better