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 ■ 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 1. Understand Resistance 2. Develop a personal philosophy on dealing with resistance. 3. Understand reasons teens are often resistant to treatment 4. Learn tools to help teens gain motivation to engage in treatment
How do you define Resistance?
1. What is my personal philosophy on resistance? 2. What feelings does resistance from this girl/my clients bring up in me? 3. How do I typically respond to resistance?
1. What is my personal philosophy on resistance? 2. What feelings does resistance from this girl/my clients bring up in me? 3. How do I typically respond to resistance?
Resi esistance stance Def Defined ined the refusal to accept or comply with something; the attempt to prevent something by action or argument.
Resi esistance stance Def Defined ined Con onven enti tiona onal l Th Ther erapy: something that comes from within the client “If you’re not buying what I’m selling, you’re resistant.”
Desire to help other + Unmotivated Clients ___________________________ Feels Personal Results in feelings of: insecurity, incompetence, frustration, hopelessness, stress, and burnout
Resi esistance stance is is NO NOT T Per ersonal sonal "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
Indications ‘Resistance’ is getting th the e best est of of you ou: : 1. You feel like you are fighting and arguing with your clients. 2. Your clients are "Yes, but-ing ..." you to death. 3. You are sitting on the edge of your chair, leaning toward your client with your neck stretched out while the client sits there relaxed! 4. You are working harder in your sessions than your clients are. 5. You are worrying more and carrying more tension about clients' 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: 6. 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 burned out with your work.
What if ‘resistance’ is all about the therapist?
Wha hat t Cau auses ses Res esis istance? tance? ■ 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.
Resi esistance stance Def Defined: ined: Soc ocial 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 inte in tera ract ct wi with th your ur cli lients nts
Refr eframing aming Resi esistance stance 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).
Resi esistance stance Def Defined ined resistance is what we do to protect ourselves from awareness of that which we fear will overwhelm us
Under nderstandi standing ng Resi esistan stance in T ce in Teens eens
Developmental Tasks of Adolescence ■ 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
Developmental Tasks of Adolescence ■ 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
SO WHAT WORKS?
“What works best is ANYTHING that increases the quality and number of relationships in the child’s life”. - Bruce Perry The Boy Who was Raised as a Dog
Pos ositiv itive e Rel elationshi tionships ps In order for a person to ‘grow’ and heal, they need: 1. Genuineness 2. Acceptance 3. Empathy
"Clients do not care how much you know until they know how much you care."
DBT Tools
Lean in to discomfort, lean in to resistance!
Basic sic assum ssumptions ptions The client is doing the best they can
Ba Basic sic ass assum umptions ptions The Client wants to get better
Ba Basic sic ass assum umptions ptions 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.
Ba Basic sic ass assum umptions ptions The client cannot fail in therapy/school; the therapy/school fails the client
Co Commitment mmitment Str Strat ategies egies o Devil’s Advocate o Foot-in-the-Door and Door-in-the-Face o Connecting to Prior Commitments o Generating Hope
Devil’s Advocate Take the counter argument and be only slightly weaker than the student’s argument
Foot t in in th the e door/Door or/Door in in th the e fac ace Foot in the door Door in the face Small request gradually increased large request gradually decreased
Connect onnecting ing to pri o prior or co comm mmitments itments Connect past commitments and goals with current behavior options
Ge Gene nera rating ting Ho Hope: pe: Che heerl erleading eading o Express faith in the client o Point out progress o Use stories for why you know they will succeed o Explain that client already has everything it will take to overcome problems
DBT and Validation 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, oughts, emoti em tions ons, , 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 opinions cannot be trusted, are invalid.
d ch change ange Val alid idation tion an and The paradox of therapy is that people do not begin to change until they feel as accepted as they are
Invalidating Statements • Counter argument • Demand behavior change • Warning/Threatening • Missing the point he is trying to make • Telling him what he “should” think, feel, do • Making things ok: reassuring, sympathizing, consoling, and leaving it there
Motivational Interviewing Tools
Motiv Motivational ational Int nter ervie iewing wing – Resistance met with reflection – Goals negotiated by client and clinician – Builds motivation – Reflects/explores client’s own perceptions
Th The e 5 5 Basic asic Pr Principles inciples of MI f MI
Exp xpressin ressing g Empa pathy See and feel the world the way our clients do. o Listen to get an idea of their concerns and reasons for behaving the way they do o Put yourself in their place, view the world through their eyes. o When people feel understood, they are more likely to open up and share their experiences.
Recommend
More recommend
