Keeping the focus positive in Family counselling

« Psychiatry

 

Helen Cameron, School of Social Work & Social Policy Magill Campus, University of South Australia

Introduction

Counselling and family work in the human service field has often had a rather bad press! Part of this collective bad opinion of the professions like social work, psychology and psychotherapy has possibly derived from their tendencies to be interested in what goes wrong with people, and to focus on the bad news and on problems. Well, you say, what else are we supposed to focus on? And that is the issue I discuss in this paper.

I begin with describing some changes that have crept across the counselling literature in recent years and some of the cultural shifts surrounding these. I trace some of the recent influences on both counsellors, and other helping professionals, and their clients, to strive for ideal standards of mental health. I relate this striving to society’s obsession with psychological problems, fed by the helping professions’ pathologising focus. I then move on to a discussion of some approaches and techniques in counselling and interviewing that adopt a more positive frame and emphasise clients’ coping capacities, and thus challenge the traditional negative focus in helping. The essence of this approach is termed ‘the strengths perspective’ after Saleebey (1992). Overall, in this paper I challenge the idea that effective interviewing work in the helping professions has to be negative in focus, and suggest this negativity is an inheritance from what has gone before.

The Modern Self

The social and cultural conditions of the 20th century, that have produced these counselling theories, have also re-shaped the modern 'self', now described by Giddens as self-consciously striving to achieve 'special potentialities' (Giddens, 1991, page 74). In this sense, Giddens names the centre of the burden placed on the Western individual in this century. He explains that the pre-modern individual was more passive and less reflexive, and consequently less troubled by ideals of personal psychological perfection. But as Hunt (1999, pages 20–27) says, self-regulation is not a recent thing, and has been an important aspect of human existence for centuries. It has been focused variably, from century to century, on diverse and related issues, such as aspects of moral character, manners, public behaviour, religious observance, gambling, use of drugs and alcohol, gender roles and, of course, sexuality. To some extent, these remain issues for modern existence, even if perhaps the drugs have changed, and religious observance has been reincarnated into concerns about Sunday trading (Hunt, 1999, page 20). However, a focus on psychological perfection has become much more intense for the individual in this century. Modern individuals are likely to invest much more time, and money too, in examining their behaviour, ideas and values, in worrying about whether they measure up to current ideals of personhood, and in trying to change their personality and life circumstances.

So, constructing and regulating the self today has become a much more complex and mandatory requirement. Giddens proposes that modern individuals struggle to manage what he terms the 'trajectory of the self' (Giddens, 1991, page 77). This trajectory is constructed around the person's shifting projections about psychological, physical and temporal selves, which are culled from cultural and social ideals and are promulgated through various social agencies, including the media. All such ideals involve a lot of conscious positioning of self, and such positionings are filled with risk and uncertainty for the individual. The guidelines are no longer very clear, if they exist at all in some areas. Can we really measure up and attain the desired standards of personal appearances, and negotiate presentations of self in reference to gender roles, relationships and lifestyles? And, if not, how can we consider ourselves a worthwhile member of society? This shaky self-esteem is the burden of the individual self in a consumerist, modern society.

Pathologising professions

Psychology's (and social work's) modernist flowerings have been agents for increased individualising and pathologising of human beings. A plethora of counselling approaches have been developed in the last fifty years or so, spawned largely from the emergence of the psychological sciences in the 19th century. As described by Hunt (1999), the 20th century has seen a shift from a concern for moral good character, as in the previous centuries, to a fascination with personality, or 'personal self-formation through self-discovery and thus with the "work" of forming a distinctive individual identity' (Hunt, 1999, page 4). These modern images, promoted in a number of ways and through a range of agencies, work to universalise ideal frames of personhood that are largely Euro-American in origin. Rose (1998, page 25) refers to the 'regimes of the person', which were implanted in the institutions of Western societies and which worked their ways into definitions of the modern self and other features of twentieth-century living. So, to give some of these spectres names, this century has been characterised by the emergence of idealised frames of the person, such as in psychoanalysis, existentialism, behaviourism, gestalt therapy, rational emotive therapy, reality therapy, and so on. These are examples of what Rose (1998, page 75) calls 'technologies of subjectivity'. From these perspectives, theorists and writers encumber ordinary clients with views of the sane and socially responsible self, alone and in charge of the daily presentation of self over the course of their lifetimes. Those who are unable to measure up may suffer loss of self-esteem and define themselves as dysfunctional, improper and in need of help, therapy, care and control.

The focus of psychology, social work, psychotherapy or counselling then, has traditionally been one of working with clients' problems and on problem-solving as a hallmark of professional expertise, and in challenging clients to learn to self-disclose, and to recognise and name their dysfunction, and then perhaps, to commit to change. Rose (1998, page 75, 76) says such approaches are really about 'educating citizens … in their personal lives'. It is also about increasing the ways in which individuals feel obligated to regulate and take control over the self, not only in terms of moral virtue, but also in terms of identity and personality. Many presume this is what counsellors, social workers and the like are supposed to do, as this is the traditional socialising and regulating perspective that has become imbedded in most approaches in the human welfare professions. Yet Hunt (1999, page 193) points out that by the 1960s 'welfare had become a profoundly paternalistic set of disciplinary practices' - and, because it has largely remained so, this now sits in stark contrast to 'the new hegemonic discourses of consumerism invoked "choice", and the individual as "consumer"…' or customer. This uncomfortable mix of paternalism, consumer choice and the economic pragmatism of recent times, renders the helping professions increasingly ineffective and socially alienated.

In addition, pathologising perspectives on mental health and therapeutic processes have been incorporated into many other professions as a kind of underground movement, such as in teaching, nursing and the judiciary. More insidiously perhaps, the psychology of the idealised trajectory of the self is also written about in newspapers and popular magazines, and has become the substance of conversations in pubs and cafes, at the dinner table, and between parents and children. Terms such as defensiveness, mid-life crisis, acting out, sexual identity, psychological games, and many other ideas from the pathologising discourses of psychology, psychotherapy and social work, are all to be heard in social conversation.

Discourses of challenge

Recently, however, challenges have occurred. A heightened recognition of the intrusive hegemony of many psychological approaches has brought criticism from several quarters. Claims about universal frames of personhood are being challenged, demonstrating growing suspicion of, and disillusionment with, modernist ideals of individualism. Broader acceptance of social pluralism has led to the questioning of many traditional approaches in professional human service work. Consequently, some of the literature in this domain has begun to shift ground. On a broader level, authors like Bankart (1997) and Coale (1998) also challenge a few sacred cows. One such example is the universality of talking about ourselves (focusing on ourselves as separate individuals or individualism versus collectivism—see Gudykunst and Kim (1997). Another is the right or obligation for everyone to be assertive, when in some instances this would be damaging to the equilibrium of clients in their family and cultural contexts. Bankart (1997), Coale (1998) and Ivey and Ivey (1999) stress the basic importance of affirming the individual's cultural and personal frames, and of not imposing the practitioner's own views of mental health, personality or social competence on clients. But the means by which this imposition occurs are subtle, and are not avoided merely through increased consciousness. Standard practices in human service have a 'taken-for-grantedness' about them, and may be beyond questioning, either in the mind of the practitioner or in agency procedures.

Several authors have also renamed skills and processes, recognising that names are powerful containers of perceptions and experience. I believe this renaming also reflects a tectonic shift in professional values. So, in some recent texts, counselling becomes, or is at least accompanied by, the more neutral interviewing (Ivey and Ivey, 1999). Counselling implies the presence of some expert frames, even when the approach is client centred. The terms therapy and problem-solving are dropped for the more positive and outcome-focused problem-management (Egan, 1998), or solution-building (De Jong and Berg, 1998), where results strongly reflect the client's interests. The focus of processes and skills then becomes that of working with clients to help them to identify their strengths (Saleebey, 1992, 1997), (Ivey and Ivey, 1999), and on positively challenging clients to draw on any unused strengths (Egan, 1998). Additionally, working on problems or deficits is turned around to become focused on coping strengths (De Jong and Berg, 1998). A fairly broad consensus on these issues has recently developed, reflected in many new editions from the established writers in the area, such as Egan (1998), Ivey and Ivey (1999), Bankart (1997) and Saleebey (1997). I interpret these shifts as strong signs that the tacit belief in the value of many of the therapeutic goals and processes of traditional psychology is fading.

Both the strengths perspective and working with a focus on positive goals are approaches that are particularly well suited for application in family counselling. Work in the family areas calls most strongly for approaches that focus positively to affirm the skills and capacities of clients, and to build their self-esteem. Families are often dealing with loss, grief and personal despair. The experience of loss—of either physical or psychological capacity, or of work roles—and the sense of hopelessness that clients feel in the face of such loss, calls for approaches that help people to relocate their strengths, build self-esteem and to regain control over their lives. The development of positive self-images is acknowledged as instrumental in assisting clients to recover from loss and despair (De Jong and Berg, 1998; Saleebey, 1997).

There has also been a less positive shift, from a broad social justice perspective in human service provision, to a stronger and more unashamedly open declaration of the need for greater economic efficiency in service delivery. This is indicated through an increased emphasis on 'outputs' and on efficiency in client outcomes. The tenets of economic rationalism, together with the philosophy of the 'new managerialism', subordinates other principles and values previously seen as a basis for the distribution of resources and effort at political, professional and personal levels in the human services (Hough in Reece and Rodley, 1995, page 187). Many Australian agencies, fuelled by economic-rationalist government policies, are demanding greater efficiency from their human service workers.

Predictably then, there is also acknowledgment in the literature—for instance, in De Jong and Berg (1998), Coale (1998) and Egan (1998)—of the need to address corporate and government pressures to achieve increased accountability and efficiency in human service work. In particular, De Jong and Berg (1998) have articulated the case for an approach to practice that is both briefer and more focused on client outcomes. Fortunately there is some intersection of concern here. More shortly-framed, solution-focused work with clients, such as is suggested by De Jong and Berg (1998, page 191), is gaining support as the central approach of choice for clients and workers, as well as funding bodies. Drawing on the experience of their agency, the Brief Family Therapy Center (BFTC), De Jong and Berg (1998, page 194) provide data indicating that, on average, 66% of clients with positive outcomes from counselling came for two sessions. Effective and brief work has an attraction for agencies (hell-bent on doing more with less and quickly!), for ethical practitioners who like to see positive results, and for clients wanting value for their financial and/or personal investment.

What I wish to do in the rest of this paper is to review some of the major ideas of the writers who focus on the strengths perspective, positive goals and brief, solution-focused work, and to identify their common themes.

Working from a strengths perspective

In a journal article which he published in 1994, Dennis Saleebey wrote: 'Practice is the intersection where the meanings of the worker (theories), the client (stories and narratives) and culture (myths, rituals and themes) meet' (Saleebey, 1994, page 35). Ivey and Ivey (1999, page 225) echo Saleebey's themes in their approach characterised by 'Focusing the narrative' or 'Exploring the story from multiple perspectives'. These writers, along with others—such as Egan (1998) and De Jong and Berg (1998)—emphasise the foundational importance of finding and working with positives in the client's world as fully as possible.

Locating client strengths

Saleebey (1997) also underlines the key importance of valuing the client's strategies and skills as much as, if not more than, the so-called expert opinions of the professional. So, asking clients what they have tried so far, what has worked best and what they have learned from their efforts, might be the best place to start in exploring solutions and locating the client as expert in their own life. This is quite different from a 'what's wrong?' focus, when diagnoses, advice and 'solutions' emanate from the practitioner's frame of reference.

Writers, such as Saleebey (1992, 1994, and 1997), Egan (1998) and De Jong and Berg (1998), suggest some further processes in the motivation of clients. Instead of focusing on problems and problem-solving processes, which suggest the client is either abnormal or dysfunctional, they suggest that practitioners actively look for, and focus on, the skills and strengths that the client has either used in the past or is currently using, to manage the structures and pressures of life. It can be presumed that clients who have been dealing with difficult life circumstances have inevitably learnt many skills in managing the challenging aspects of their life in the present and the past. De Jong and Berg (1998, page 12) insist that, in focusing on the skills of clients, practitioners can work as fully as possible within clients' frames of reference, thereby promoting the self-esteem of clients as well as strengthening their expert status over their own lives.

Relocating unconditional positive regard?

A genuine focus on client strengths requires the establishment of conditions reminiscent of Rogers' concept of unconditional positive regard (1951), which Bankart (1997) defines as a primary conceptual frame in the operation of client acceptance. He describes Rogers' level of client–worker engagement as 'something like the attentional focus required in Zen' (Bankart, 1997, page 301). The ability of workers to motivate clients through expressing a positive regard for their capabilities and capacities is powerful, and sometimes, though not always, sufficient to flip clients towards a more positive coping approach to their life. This sort of focus acts to reinforce self-esteem, and engender positive self-talk. We know that managing life's demands effectively is locked together in a tight feedback loop with self-esteem, positive self-talk, and an internal locus of control. So, instead of asking 'What's the problem?' or 'What has brought you in here today', counsellors need to learn to ask 'What's working for you?' or 'What is happening in your life that you want to continue to have happen?' (de Shazer in De Jong and Berg, 1998, page 13).

Challenging clients to draw on unused strengths

Sometimes clients will need help in being lured out of self-defeating thinking, and, even if the worker stays focused on the client's strengths, it may not immediately motivate positive coping behaviours. While emphasising the positive effects of fully accepting people, Egan (1998, pages 146–168) also suggests that to dislodge self-defeating patterns of thought and behaviour, sometimes clients will need to be nudged, or challenged positively. To achieve this, the practitioner may need to actively work at fostering self-acceptance in the client's thinking, rather than negativity and self-defeating ideas. Self-supporting internal actions (or positive thought patterns and self-talk) may need to be actively encouraged, as opposed to negative self-talk, which is often at the basis of an entrenched pattern of low self-esteem. Self-supporting/protecting external actions are positively encouraged, and aggressive behaviour or self-destructiveness and low levels of social skill are quietly reworked, so that the energy behind these is tapped, but the flow is redirected. Positives are featured and negatives are reframed. Successful challenging of the client's unused strengths, skills and capacities is about reshaping the client's self-image from one that is self-defeating to one that is more positive. All this involves the worker in creating four particular process goals for clients, seeing unused opportunities, stating their problems as solvable, moving beyond self-limiting views, and chipping away at the everyday self-limitations they impose on their experience of life.

However, in challenging the self-perceptions of clients, even negative ones, the worker will encounter resistance. People cling to their self-images. So, it is clearly very important to understand this, and to work gently in challenging clients. The process of challenging needs to be surrounded with support for the client, and the following may help to build this support.

Encouraging the client in self-challenge

Rather than confronting clients, it is far more preferable for practitioners to focus on supporting the client to confront and challenge themselves. At times, this may mean gently challenging the client on some issues to clear the way for movement. It is essential to deal with the defensiveness of clients, if it occurs, with honesty, gentleness and creativity. More direct, worker-initiated challenges may be required to help clients to move out of their 'stuckness', but these should only be applied if the usual processes of empathic exploration and client self-challenge do not achieve results.

Earning the right to challenge

Practitioners must earn the right to challenge clients through a solid background of empathic work and the establishment of Egan's 'working alliance' (1998, page 41). All challenges need to be focused on the client's currently used and unused strengths, rather than their perceived weaknesses or lack of skill. Practitioners need to work with an eye on the interviewee's emotional state, personal strength, and cultural context. It is also essential to affirm clients' skills frequently, and build strongly on their success when it occurs in sessions and when they report it from outside experiences.

For instance, an example of a positive, challenging statement is:

You talk about yourself as a bad mother, but you also show to me your deep concern about your children's welfare—and that sounds more like a good mother to me. Tell me about some of the good things you make happen with your family.

To some, this may sound like Pollyanna reincarnate. Students sometimes complain that if a client comes into the agency with lots of problems, it is difficult to focus on positive things. I agree that it can be difficult. The primary focus of the worker should remain one of empathic listening, and this means that, at times, the problems of the client do become a focus for a while. Many clients come along expecting the focus of counselling work to be problem focused, and the worker may also need to engage the client in a gradual educational process before clients can begin to focus on their own strengths. But overall, the weight of the effort in counselling needs to remain on the positive skills and attributes of the client, and not on problems, and to achieve this the practitioner certainly requires the application of sound professional skills and capacities.

Next, I describe some key skills and functions needed to support the successful use of a strengths perspective.

Supporting the use of a strengths perspective

Empathy

This is called a number of things by writers, such as active listening, paraphrasing or empathic responding. It refers to the ability to pick up and acknowledge the feelings and experiences of the client both meaningfully and consistently. This is the cornerstone skill in a strengths perspective, along with minimal, appropriately applied and focused, open questioning, such as in coping goals work and the miracle question (De Jong and Berg, 1998, page 71), which I discuss later in this paper.

Worker self-disclosure

Whether intentionally or not, all practitioners disclose the self to their clients as they work with them. For instance, worker values and opinions seep through and show themselves in the interaction with clients. Good use of self-disclosure also entails the practitioner being aware of the extent to which they intentionally share information, make suggestions and recommendations and, at times, express hunches. Effective workers are not inactive. In positive goals work, the practitioner is not passive, responds frequently and briefly, primarily with empathic responses, and shares ideas, thoughts and feelings, always with a keen sense of purpose and direction. De Jong and Berg (1998, page 27) stress the importance of the worker using frequent but brief paraphrases to assist the client's focus, and to demonstrate their own listening and attention to the client's issues and feelings. So, the worker is active and gives out lots, but still ensures that such self-disclosure is primarily focused on the client's interests and concerns, and is aimed at helping the client to develop a stronger appreciation of their own strengths and skills.

Immediacy—direct, mutual talk

A strengths perspective with a positive goals focus demands a high level of genuine engagement from the practitioner. This approach will not work if the practitioner hides behind expert roles, and distances themself from the client. The 'working alliance' (Egan, 1998, page 41) needs to be up-front as an explicit contract between client and worker. Through participating in this kind of relationship, clients learn that in good practice, honesty is a two-way engagement. This demands as much from the client as from the worker.

Talking about specifics

Many clients need to be actively encouraged to talk in concrete ways about their circumstances. It is essential to help clients break down the areas selected for work into manageable sub-steps, and tangible skills which, when emphasised, can lead to noticeable success, and improvement in their life circumstances. In addition, workers need to resist their own tendencies to become vague and theoretical with clients when working with goals in a strengths-focused way. Instead, workers need to remain primarily concerned with behaviours and skills.

A focus on positive goals is about supporting clients to identify skills and areas of competence which they recognise as worthwhile in their lives. It is not about practitioner-generated diagnoses of past patterns in the client's life. The tendency for practitioners to analyse and interpret client's motivations is counterproductive, and does not contribute to a strengths perspective.

Egan (1998, page 201–216) also describes a process he calls leverage, which involves helping clients to work on the right things first. He suggests that workers try to focus first on things that are causing clients the most pain, and the issues they believe are most important. These will also usually be areas where the benefits of work on an area will outweigh the pain involved in disclosing thoughts and feelings on the issue, so there are opportunities here. De Jong and Berg (1998, page 69) talk about respecting the client's decisions about what is most important to them to work on. This means not imposing so-called expert professional opinions about what are the real issues.

Focusing on coping goals

De Jong and Berg (1998, page 173) suggest some specific ways to use 'a coping focus', rather than a deficit goal one, especially when clients feel overwhelmed by their life circumstances as often occurs as they begin to focus on themselves in counselling. To work from this perspective, practitioners need to remind clients about their usual (or past) coping behaviours and successes. They also need to begin a solution-building process through focusing on the following questions:

The last question sounds a little irreverent, but it is intended to tap into the skills the client is currently using to hold a situation together, perhaps without being much aware of these, and helping the client to 'unpack' these.

This focus by De Jong and Berg (1998, page 242) presents a real challenge to workers to be honest about their own motivational and professional effectiveness. They suggest beginning a session by asking clients to state explicitly what they expect or want from the worker in a session, up-front, at the start of it. They suggest this reinforces the client's ideas and self-worth, along with asking the client to say what they have tried so far that works, and how they have made things better. They also recommend the use of the miracle question.

The 'miracle question'

This is a particular technique, using a positive, coping goals perspective, to 'unstick' clients. De Jong and Berg (1998, page 77) suggest this sort of question goes something like:

Suppose a miracle happened, and the problem that brought you here is being managed by you. What would be different about your life?

The client is encouraged through such an approach to think beyond the square, to imagine a better world, and to work backwards from this to be able to specify what to emphasise in order to attain this state of being.

Solution-focused procedures are also a catch-cry of De Jong and Berg (1998). They see the formulation of coping goals as both promoting client success, and assisting workers to integrate values and practice. De Jong and Berg (1998, page 204) say that contradictions between worker values and 'the procedures adopted in the problem-solving paradigm are what has prompted the call for more collaborative and empowering approaches to practice'.

Moving towards a solution entails taking the ideas coming out of the miracle question (or other positive goal approaches), breaking these down into small steps and processes, and looking at what will be needed to manage these steps well. Reality checks are taken to make sure these goals are achievable. Homework tasks are set, and the client is also encouraged to think of ways to reward self for good things accomplished, and how to use positive imagery in between sessions. The client is affirmed and complimented throughout the sessions, and again, always as they leave a session, as a kind of inoculation against negative self-talk.

Managing blocks in to success in the strengths perspective

In case the approach described so far seems unrealistically optimistic, I recognise there are other factors in working with clients that workers need to manage to ensure successful outcomes. Some factors derive from residual effects of our recent history of negativity in the helping professions, and some are related to clients’ perceptions of what we do and what we require of them, when they approach us for help.

Workers resisting change

Egan (1998, page 166–168) discusses some of the worker variables that may impede them implementing a strengths perspective and assisting clients to formulate coping goals. One of the major barriers to taking on this perspective is that it can be difficult for practitioners to make the shift away from a traditional approach that focuses on the problems of clients. Old ways of doing things linger, and some blocks to change reside in worker attitudes, values and usual work practices.

Practitioners may feel it is okay to support clients in talking about problems, but may feel discomfort with aspects of positive challenging and positive goals. De Jong and Berg (1998, page 11) point out that, as practitioners, we are oversupplied with techniques and perspectives that focus on problems rather than solutions. If this is the case, the tendency becomes one of looking at problems, talking about problems and getting clients focused on trying to fix up problems. The interview situation spirals down into negative views, disempowering the client, and reinforcing negative self-talk and low self-esteem, all of which stifle the creativity of both the client and the worker.

Managing anger

Many people have difficulty with anger per se, and when clients are angry, the discomfort of workers with anger may cause their skills and effectiveness to fly out the window. In particular, Corey and Corey (1998, page 91–93) discuss anger as a transference issue. Transference in clients means they are making you someone you are not, such as their fathers or their wives, and then they direct their anger towards the 'you' of their imagination. Displaced anger needs to be carefully managed, but Corey and Corey (1998, page 93) suggest it is important to recognise that this as a two-way street. Workers' own transference issues may play a role, as may personal family injunctions and other unresolved experiences in dealing with anger. They stress the importance of defining professional limits—what is tolerable for the worker—and setting boundaries with some clients. This may also entail working out ways to deal with the anger of clients without rejecting them, which also implies managing the client's anger without personalising it.

It is also essential for practitioners to locate their own feelings, and to seek sources of support in managing clients who project a lot of anger. However, it is important to consider that sometimes a client's anger may be deserved, by the worker, and/or the agency. In such cases, it is important to hear it, acknowledge it, accept it, and apologise if warranted.

Other features of a worker's personal style, such as levels of defensiveness, fear of exposure and feelings of inadequacy, may make it particularly difficult for a worker to change counselling approaches. Practitioner blind spots are also hard to scrutinise in isolation or without the help of others, and role expectations about being the 'perfect counsellor' may also prevent practitioners from engaging in honest review of their work practices with peers or work supervisors.

Management of crises in motivational counselling

Egan (1998, page 216) focuses on the importance of dealing first with issues that are of crisis proportion for the client. Clients in the midst of crisis situations can rarely focus on anything except what is happening in their life at that particular moment. But client crises are a real challenge for workers to manage, and may test the ability of any worker to motivate the client. The special factors of crisis need to be put into the equation of motivational processes. Crises are frequently a combination of developmental and situational factors and are rarely entirely about the precipitating event—the proverbial straw that breaks the camel's back. De Jong and Berg (1998, page 166) agree that it is important to note that it is not the event or situation that is the centre of a crisis, but the person's emotional reactions and their perceptions and cognition about what has happened.

Practical assistance, such as medical help, burial arrangements, and so on, may need to be dealt with effectively before a focus on motivating the person in crisis can take place. The first focus of work with clients is on their feelings, perceptions and judgements about the issues, rather than remaining focused on the crisis situation itself. Following the immediate provision of emotional and practical support, De Jong and Berg (1998, page 168) discuss the need to provide a process that enables clients to begin to relocate their strengths and to manage their life again. When the situation has settled somewhat, and the client is able to focus productively on their situation, De Jong and Berg (1998, page 173) also suggest the use of 'coping questions' and solution-building processes, rather than goal defining or problem-solving in crisis intervention.

De Jong and Berg (1998, page 77) warn that we should be somewhat careful of using the 'miracle question' in crisis situations, as clients may lack the capacity to think outside the frame at such times. Reserve it for more stable times. In a crisis, solution-building processes need to be activated promptly, so the strengths and capabilities of the client can be brought into play, setting up the feedback loop between positive self-esteem and coping actions.

However, there are times when 'talk' cannot 'fix it'. Even De Jong and Berg (1998, page 186) admit there are points in working with clients in some situations when the issues surrounding them are too big for the client, and for the worker as well. The client remains overwhelmed and does not seem to have either the inner or the outer resources to cope. All motivational approaches fail to work, and other supports may need to be sought, such as referral to other sources of help or, in some cases, admission to institutional care. A good process in the interview usually means the client is more open to using additional resources and information. Clearly it is essential in such circumstances for workers to have accurate and up-to-date referral procedures, and to use careful follow-up processes.

Client reluctance

Egan (1998, page 139) describes reluctance as a relatively passive block to client cooperation in the processes of productive work with the counsellor. In fact, he suggests, it is so common as to be a part of human nature, and that workers should expect some reluctance on the part of clients. The underlying causes for client reluctance may reside in the following:

Fear of intensity. Being asked to focus on self, and to talk about feelings and experiences may cause many clients to experience difficulty, despite all the modern pressures to focus on self that I have discussed previously in this paper. Many clients feel fearful and anxious about the threat of disorganisation, or of being shaken through the unearthing of feelings. They also fear being rejected by their family members, work mates and other people, for needing to seek help in managing their lives. Fear of change also operates. We all fear change and fight to maintain things, but when clients have low self-esteem, they feel there is much to lose in being honest about exposing their thoughts and feelings to another person, and they defend themselves. Clients need early signs that it is all going to be worth the effort, and that it is safe. This takes us back to the need for practitioner skills in empathy and acceptance.

Lack of trust of the agency, the worker, and the professional process. Clients from minority cultures will take longer to trust the worker (Corey and Corey, 1998, page 188). Clients from the dominant cultural groups will trust a worker more readily than those from minority groups. Even in cases where workers themselves are from a minority culture, the association with the agency, and the usual negative, problem-based procedures used in the human services, causes clients to approach the agency and the worker with caution. Trust is earned through the worker demonstrating their skill and competence in empathic listening, and in positive, goal-focused processes in counselling.

De Jong and Berg (1998, page 63) write that perceptions of particular clients as being resistant, derive from 'a Freudian-influenced medical model of helping people'. They believe that this is at the heart of attempts to classify clients as resistant and uncooperative, and the expert as omnipotent and knowing what is best for clients (De Jong and Berg, 1998, page 65). Client non-compliance is more likely to be a product of the relationship between the client and the worker, especially where coercion exists in agency practice or worker style variables. As they note:

Impasses and apparent failures in our work do not result from client resistance to our best professional efforts to make them well; rather they result from our failure to listen to clients and to take seriously what they tell us. (De Jong and Berg, 1998, page 65).

Egan (1998, page 143–145) explores the range of way that workers can strengthen their capacity to motivate their clients. He suggests it is important for workers to explore their own resistance, and to commit to working through it. He also stresses the importance of establishing a 'just society' with clients. Finally, De Jong and Berg (1998, page 65) remind us to quieten 'our own frames of reference, so that we listen with solution-building ears and invite clients to participate in solution-building conversations'.

Other client behaviours that cause stress to workers include suicide (statements, attempts and 'successes') and aggression and hostility (Corey and Corey, 1998, page 320). Hutchins and Vaught (1997, page 59) stress the importance of planning particular procedures for dealing with violence, or self-destructive behaviours in clients. They also mention premature termination of client–worker contact as stressful for workers. On this last point, there is some good news in that 78% of single-session clients report feeling much better (Hutchins and Vaught, 1997, page 59), even if they do terminate prematurely. De Jong and Berg's (1998, page 191) statistics, about successes in single and limited numbers of sessions, are also encouraging.

Pushing clients in directions they do not want to follow, or attempting to accelerate the progress of counselling has non-motivating effects. Egan (1998) and De Jong and Berg (1998) warn against trying to move the client prematurely into coping goal work, and stress the essential nature of a foundation of client exploration and worker empathy, and the establishment of the 'working alliance' (Egan, 1998, page 41). It obviously takes time and good process for the interviewee to trust the worker, and to open up. It cannot be emphasised too strongly that all clients achieve their best in counselling when they know they are being listened to, and when a clear understanding of their own issues, strengths and abilities is established early in the process.

Summary

In summary, a strengths-focused, positive approach to counselling, challenges the client to do the following:

To achieve these aims, the strong presence of a range of key processes, skills and qualities in the counselling practitioner is essential. These include, as a kind of bedrock, the continual presence of empathy in the responses of the worker. This is matched with a strong sense of genuine engagement, with straight talk, rather than both client and worker using the traditional expert role as a kind of shield against honest contact. Of absolute importance is the strong focus on coping goals and solution-building, and of locating the strengths and competence of clients early on in the counselling process. A major outcome of this focus is the strengthening of the client's self-esteem, and the affirmation of their cultural and personal contexts. Even in a crisis situation, which may mean a period of dependency on the worker, the strengths perspective allows the client to relocate their skills and competence quickly. Brief, solution-focused work, with an emphasis on client strengths, self-esteem building and positive goals, is effective, efficient and ethical, and deserves a central place in human service counselling, especially family counselling.

 

References

 

Bankart, C Peter (1997). Talking cures: a history of Western and Eastern psychotherapies. Pacific Grove, California: Brooks/Cole.

Coale, Helen W (1998). The vulnerable therapist: practicing psychotherapy in an age of anxiety. New York: The Haworth Press.

Corey, Marianne Schneider and Corey, Gerald (1998). Becoming a helper. 3rd edition. Pacific Grove, California: Brooks/Cole.

De Jong, Peter and Berg, Insoo Kim (1998). Interviewing for solutions. Pacific Grove, California: Brooks/Cole.

Egan, Gerard (1998). The skilled helper: a problem-management approach to helping. 6th edition. Pacific Grove, California: Brooks/Cole.

Giddens, Anthony (1991). Modernity and self-identity: self and society in the late modern age. Cambridge: Polity.

Gudykunst, William B and Kim, Young Yun (1997). Communicating with strangers: an approach to intercultural communication. 3rd edition. New York: McGraw-Hill.

Hunt, Alan (1999). Governing morals: a social history of moral regulation. Cambridge; Melbourne: Cambridge University Press.

Hutchins, David E and Vaught, Claire Cole (1997). Helping relationships and strategies. 3rd edition. Pacific Grove, California: Brooks/Cole.

Ivey, Allen E and Ivey, Mary Bradford (1999). Intentional interviewing and counselling: facilitating client development in a multicultural society. 4th edition. Pacific Grove, California: Brooks/Cole.

Rees, Stuart and Rodley, Gordon, editors (1995). The human costs of managerialism: advocating the recovery of humanity. Leichardt, NSW: Pluto Press Australia.

Rogers, Carl R (1951). Client-centered therapy. Boston: Houghton Mifflin.

Rose, Nikolas (1998). Inventing our selves: psychology, power and personhood. New York: Cambridge University Press.

Saleebey, Dennis, editor (1992). The strengths perspective in social work practice. New York: Longman.

Saleebey, Dennis, editor (1997). The strengths perspective in social work practice. 2nd edition. New York: Longman.

Saleebey, Dennis (1994). 'Culture, theory and narrative: the intersection of meanings in practice'. Social Work, number 39, pages 351–359.

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