GCU PCN 515 Client Resistance & the Positive Professional Environment

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1. You notice that a client has started to withdraw and engage in some “Yes, but…” behaviors. What are some strategies you could use to help reengage this client?

 

2. Read and complete the “Challenging Practice Session.” What did you discover during the practice session? What did you learn about yourself as a new counselor to be?

 

Additional Question – Common myths of addiction exist some being that 1) addicts are easy to identify i.e. poor, homeless, and 2) all addicts are bad people.

Many of us will work with clients who may have addiction and being genuine and empathic are characteristics that clinicians are expected to possess.

Think of time when someone was genuine, accepting or empathic toward you or someone you know when you felt like you or they did not deserve it. What did you do in that situation? Has it changed you in anyway? Responses to this specific question are optional. Your substantive response will count toward participation.

Read Chapter 7 in The Skilled Helper.

Egan, G., & Reese, R. J. (2018). The skilled helper: A problem-management and opportunity-development approach to helping (11th ed.). Cengage Learning.

 

Read “Motivational Interviewing- An M.I. Learning Resource Clip” located on the MINT website.

http://www.motivationalinterviewing.org/

 

“Motivational Interviewing: Facilitating Change Across Boundaries,” located on the Columbia Alumni Association website.

https://youtu.be/6EeCirPyq2w

 

“Assessing Strengths, Resilience, and Growth to Guide Clinical Interventions,” by Tedeski and Kilmeer, from Psychology Research and Practice (2005).

 

“Therapist Emotional Reactions and Client Resistance in Cognitive Behavioral Therapy,” by Westra Aviram, Connors, Kertes, and Ahmed, from Psychotherapy (2012).

 

“Rethinking Client Resistance: A Narrative Approach to Integrating Resistance into the Relationship-Building Stage of Counseling,” by Gold, from the Journal of Humanistic Counseling, Education, and Development (2008).

 

“Training for Teamwork: A Case Study,” by Sudano, Patterson, & Lister, from Families, Systems, & Health (2015).

 

“Confidentiality and Mental Health/Chaplaincy Collaboration,” by Bulling et al., from Military Psychology (2013).

 

“Lives of Quiet Desperation: The Conflict Between Military Necessity and Confidentiality “ by Neuhauser, from Creighton Law Review (2011).

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1. You notice that a client has started to withdraw and engage in some “Yes, but…” behaviors. What are some strategies you could use to help reengage this client? 2. Read and complete the “Challenging Practice Session.” What did you discover during the practice session? What did you learn about yourself as a new counselor to be? Additional Question – Common myths of addiction exist some being that 1) addicts are easy to identify i.e. poor, homeless, and 2) all addicts are bad people. Many of us will work with clients who may have addiction and being genuine and empathic are characteristics that clinicians are expected to possess. GCU PCN 515 Client Resistance & the Positive Professional Environment

Think of time when someone was genuine, accepting or empathic toward you or someone you know when you felt like you or they did not deserve it. What did you do in that situation? Has it changed you in anyway? Responses to this specific question are optional. Your substantive response will count toward participation. Read Chapter 7 in The Skilled Helper. Egan, G., & Reese, R. J. (2018). The skilled helper: A problem-management and opportunity-development approach to helping (11th ed.). Cengage Learning. Read “Motivational Interviewing- An M.I. Learning Resource Clip” located on the MINT website. http://www.motivationalinterviewing.org/ “Motivational Interviewing: Facilitating Change Across Boundaries,” located on the Columbia Alumni Association website. https://youtu.be/6EeCirPyq2w “Assessing Strengths, Resilience, and Growth to Guide Clinical Interventions,” by Tedeski and Kilmeer, from Psychology Research and Practice (2005).

“Therapist Emotional Reactions and Client Resistance in Cognitive Behavioral Therapy,” by Westra Aviram, Connors, Kertes, and Ahmed, from Psychotherapy (2012). “Rethinking Client Resistance: A Narrative Approach to Integrating Resistance into the RelationshipBuilding Stage of Counseling,” by Gold, from the Journal of Humanistic Counseling, Education, and Development (2008). “Training for Teamwork: A Case Study,” by Sudano, Patterson, & Lister, from Families, Systems, & Health (2015). “Confidentiality and Mental Health/Chaplaincy Collaboration,” by Bulling et al., from Military Psychology (2013). “Lives of Quiet Desperation: The Conflict Between Military Necessity and Confidentiality “ by Neuhauser, from Creighton Law Review (2011).

Professional Psychology: Research and Practice 2005, Vol. 36, No. 3, 230 –237 Copyright 2005 by the American Psychological Association 0735-7028/05/$12.00 DOI: 10.1037/0735-7028.36.3.230 Assessing Strengths, Resilience, and Growth to Guide Clinical Interventions Richard G. Tedeschi and Ryan P. Kilmer This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. University of North Carolina at Charlotte Recently, the field of mental health has incorporated a growing interest in strengths, resilience, and growth, psychological phenomena that may be associated with healthy adjustment trajectories and profitably integrated into strategies for clinical assessment and practice. This movement constitutes a significant shift from traditional deficit-oriented approaches.

Addressing clinical practitioners, this article (a) provides a broad overview of these constructs and phenomena, (b) discusses their relevance for clinical assessment and intervention, and (c) describes selected strategies and approaches for conducting assessments that can guide intervention. relevant to these approaches, (b) discuss their relevance for clinical assessment and intervention, and (c) describe selected strategies and approaches for conducting evaluations that can guide intervention. Clinical psychologists and other mental health practitioners have traditionally focused on what “goes wrong” for clients and how to treat it (Cowen, 1999). More recently, the field has seen a growing emphasis on wellness enhancement (Cicchetti, Rappaport, Sandler, & Weissberg, 2000; Cowen, 1994), the development of competence (Masten, 2001; Masten & Coatsworth, 1998), and human strengths and growth (Calhoun & Tedeschi, 1998, 1999; Seligman & Csikszentmihalyi, 2000; Tedeschi & Calhoun, 1995, 2004). Such work has a substantial history (Cowen & Kilmer, 2002; Tedeschi & Calhoun, 1995; Tedeschi, Park, & Calhoun, 1998), with roots including Hollister’s (1965) introduction of the concept of strens, that is, experiences that enhance or strengthen people psychologically, contrasting with the prevailing emphasis on negative experiences, as well as Antonovsky’s (1979) use of the term salutogenesis to describe processes that contribute to healthy physical and psychological outcomes, challenging the field’s emphasis on pathogenesis and processes associated with dysfunction. Such shifts in orientation go beyond the heuristic or semantic; they have clear practical implications.

In fact, numerous applied domains, clinical frameworks, and promising practices have incorporated a strengths focus (Burns & Goldman, 1999; Stroul & Friedman, 1986), integrated findings from resilience research (Luthar & Cicchetti, 2000; Richardson, 2002), and acknowledged client growth in the aftermath of trauma (Calhoun & Tedeschi, 1998, 1999; Tedeschi, Park, & Calhoun, 1998). In this article we seek to (a) provide a broad conceptual overview of the constructs Assessing Strengths: A Shift in Focus Traditionally, clinical assessment has focused on identifying symptoms, problem behaviors, emotional concerns, deficits, and functional difficulties. Although clearly a requisite component and primary goal of many assessments, this deficit- or problemfocused approach may reduce the range of information sought and considered, limiting the clarity of the picture painted by the evaluation and emphasizing negative aspects of individuals and situations (Harniss, Epstein, Ryser, & Pearson, 1999).

In contrast, Epstein and Sharma (1998) define strength-based assessment as the measurement of those emotional and behavioral skills, competencies, and characteristics that create a sense of personal accomplishment; contribute to satisfying relationships with family members, peers, and adults; enhance one’s ability to deal with adversity and stress; and promote one’s personal, social, and academic development. (p. 3) With its focus on clients (whether a child, an adult, or a family) as bearers of unique talents, skills, resources, life experiences, and unmet needs, this approach has received growing attention. Methods for Assessing Strengths Informal, qualitative methods for assessing strengths (e.g., listening to clients’ narratives for evidence of strengths, interests, hopes, etc., instead of simply working through a protocol) can be a part of any assessment process (Saleebey, 1996), and clinicians from a variety of perspectives have informally practiced strengthsbased assessment (VandenBerg & Grealish, 1996).

For instance, in addition to addressing presenting concerns, many clinicians integrate non-pathology-oriented questions (“Why don’t we pause for a moment and talk first about what Johnny does well”; “Let’s discuss what goes well between you two and what drew you to him”; “Tell me what you’re good at and what makes you proud”). However, such strengths-based approaches have not been the RICHARD G. TEDESCHI received his PhD in clinical psychology from Ohio University. He is professor of psychology at University of North Carolina at Charlotte and a licensed psychologist in North Carolina. His clinical and research interests include bereavement, posttraumatic growth, and psychotherapy process. RYAN P. KILMER received his PhD in clinical psychology from the University of Rochester. An assistant professor of psychology at University of North Carolina at Charlotte, his research interests include child risk and resilience, clinical assessment, and systems of care.

CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Richard G. Tedeschi, Department of Psychology, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223. Email: rtedesch@email.uncc.edu 230 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

SPECIAL SECTION: STRENGTHS, RESILIENCE, AND GROWTH subject of the same empirical and psychometric attention as more pathology- or deficit-oriented approaches (Harniss et al., 1999). In recent years, in addition to the multiple available and widely used measures for documenting symptoms and problem behaviors in clinical settings, researchers have developed psychometrically sound scales that assess clients’ assets. For example, the Behavior Assessment System for Children (Reynolds & Kamphaus, 1992) includes both adaptive and problem behaviors (clinical scales include Conduct Problems, Anxiety, and Depression but also Adaptability, Leadership, and Social Skills), as does the Teacher– Child Rating Scale (Hightower et al., 1986; Perkins & Hightower, 2002), containing Behavior Control, Assertiveness, Task Orientation, and Peer Social Skills subscales. Although few scales are solely strength based or developed specifically to assess competencies, one such measure is the Behavioral and Emotional Rating Scale (Epstein & Sharma, 1998), a 52-item scale that assesses the strengths and competencies of children and adolescents (ages 5–18) across Interpersonal Strength, Family Involvement, School Functioning, Intrapersonal Strength, and Affective Strength.

The Behavioral and Emotional Rating Scale yields norm-referenced standard scores and a global strength quotient for children and youth diagnosed with emotional and behavioral disorders, as well as nondiagnosed youngsters. Clinical Implications: Why Assess Strengths? Although many individuals or families might be surprised when asked to describe or identify their strengths (Handron, Dosser, McCammon, & Powell, 1998), when assets and risks are both assessed, clients are more likely to experience the intervention as affirming and empowering, even motivating (Cowger, 1994; Saleebey, 1996). Moreover, such an approach sends a clear message that one is recognizing a client’s identity and competencies beyond his or her presenting concerns and diagnostic profile (Saleebey, 1996). Thus, the assessment process (in addition to its product) carries substantial weight, and attending to the whole person can create a different, more positive set, influence the power differential between client and professional, and positively impact client–therapist rapport (Cowger, 1994; Harniss et al., 1999).

In child work, assessing strengths as well as problems can prove fruitful in communicating with caregivers; a strengths orientation can foster supportiveness and trust, facilitate positive caregiver–practitioner relationships, and redirect caregivers from focusing only on the child’s symptoms or problem behaviors. Beyond these positive relational influences, assessing strengths (a) yields a more holistic, balanced view of the individual that can help place the evaluation within a context; (b) identifies competencies and resources that can be built on in developing a treatment plan and monitored in evaluating outcomes; and (c) in turn, provides clinicians with further direction in their interventions (Cowger, 1994; Epstein, 1999; Harniss et al., 1999). For example, the Behavioral and Emotional Rating Scale manual (Epstein & Sharma, 1998) details several uses for the scale, including (a) identifying strengths and need areas for intervention, (b) informing goals for individualized treatment plans, (c) documenting progress in a strength area as a consequence of specialized services, and (d) identifying children with limited resources. GCU PCN 515 Client Resistance & the Positive Professional Environment

Knowledge and understanding of a client’s strengths can also help professionals to reframe and redefine problems so that they 231 can be addressed from a solution-focused perspective (Handron et al., 1998); the focus of interventions can be shifted from seeking to “fix” a problem to enhancing and building on a characteristic or behavior (Harniss et al., 1999). For example, a child’s clinician seeking collateral information from a teacher via the Teacher– Child Rating Scale may learn that, by the teacher’s account, the youngster shows high levels of positive peer social skills but struggles at times with staying on task until an assignment’s completion. The student’s scholastic performance and adjustment may benefit from involvement in a cooperative learning/peertutoring intervention that capitalizes on his or her strengths in the social arena, channeling them in a positive manner.

The Relevance of Resilience to Practitioners: Assessing and Applying the Construct

In accord with the growing attention to strengths and what “goes right” in development, the construct of resilience, effective coping and adaptation in the face of major life stress, has been the focus of burgeoning recent interest (Cowen, Work, & Wyman, 1997; Luthar, 2003; Luthar, Cicchetti, & Becker, 2000; Masten, 2001; Masten & Coatsworth, 1998). Although resilience can be achieved at any point in the life span (e.g., Shiner & Masten, 2002; Werner & Smith, 1992), most work in the area has focused on children. This research has identified factors that relate to resilience and appear to serve a protective function under conditions of stress, reducing risk for adjustment problems and increasing the likelihood of positive health outcomes. Clinicians and researchers alike agree about the relevance of the construct; however, operational definitions of resilience have varied, and many consider resilience to be a personal trait or attribute of an individual, rather than a dynamic developmental process reflecting positive adjustment despite adversity (see Cowen, 2001, and Luthar et al., 2000, for cogent discussions of these concerns).

Despite such issues, common findings have emerged from resilience research, suggesting three main clusters of variables that appear to facilitate positive adaptation under conditions of risk: (a) individual attributes or characteristics, including positive temperamental or dispositional qualities; good intellectual functioning; self-efficacy; positive self-worth; perceived competence; sound problem-solving skills; internal locus of control; accurate and realistic attributions of control; and positive future expectations, or a sense of optimism; (b) a warm, nurturant family environment; quality parenting and a structured, stable home; a sound relationship with a primary caregiver; and (c) broader contextual variables such as positive extrafamilial support sources and identification models; links with extended family support networks; effective schools; connections to prosocial organizations; and neighborhood qualities (Luthar et al., 2000; Masten, 2001; Masten & Coatsworth, 1998; Werner & Smith, 1992; Wyman, Sandler, Wolchik, & Nelson, 2000). Connections with competent, caring adults in the family and community, good intellectual functioning, selfregulation skills, and positive self-views and self-system functioning are among the most consistently reported (Luthar et al., 2000; Masten, 2001; Wyman et al., 2000). Although some researchers have identified symptomatology among participants identified as “resilient” (Luthar, Doernberger, & Zigler, 1993), by many definitions, one’s presentation for services in a clinical setting would preclude such classification.

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TEDESCHI AND KILMER

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 232 Nevertheless, the literature can provide useful information to providers regarding strategies to inform assessment and guide clinical intervention. As Luthar and Cicchetti (2000) noted, even in circumstances where problems have developed and crystallized, a resilience framework includes an emphasis on strengths and assets that may be harnessed in work for positive change. As such, assessments can address potential resilience-facilitating resources, and intervention goals can include enhancing assets and facilitating protective processes, in addition to ameliorating symptoms (Masten, 2001). It is important to note that these potential protective influences stem from multiple levels of the client’s context, that is, individual, family, and community.

Qualities of the individual may surely antecede or correlate with resilience, but resilience may often be associated with factors external to the individual, including aspects of their families (and caregiving environments) and characteristics of their wider contexts (Luthar et al., 2000; Werner & Smith, 1992). Thus, rather than viewing a goal of evaluation as assessing resilience per se, it may be more appropriately framed as seeking to assess factors associated with positive adjustment, competence in core domains, and healthy outcomes under adversity. Methods of Assessing Resilience Numerous authors have developed and used checklists, scales, or interviews seeking to assess “resilience” (e.g., Baruth & Carroll, 2002), risk and protective factors in their clients’ lives (e.g., Vance, Fernandez, & Biber, 1998), or competence in one or more domains (e.g., Ewart, Jorgensen, Suchday, Chen, & Matthews, 2002). In some cases, professionals may choose to use validated instruments to assess specific potential protective factors that have been found to relate to resilient adaptation and may be particularly salient in the population with which they work. For instance, given the consistent identification of a warm, supportive family milieu as an important factor associated with resilience, measures addressing family functioning could be profitably integrated into the assessment process. One such instrument, the Family Environment Scale (Moos & Moos, 1994), assesses perceptions across Relationship (e.g., subscales include Cohesion, Expressiveness, Conflict), Personal Growth (e.g., Active–Recreational Orientation, Independence, Intellectual–Cultural Orientation), and System Maintenance (e.g., Organization, Control) dimensions. GCU PCN 515 Client Resistance & the Positive Professional Environment

Another, the Family Assessment Device (Epstein, Baldwin, & Bishop, 1983), assesses family functioning across Problem Solving, Communication, Roles, Affective Responsiveness, Affective Involvement, Behavior Control, and General Functioning scales. The latter scale can provide a global screen of family functioning. The use of such ratings can facilitate discussion about the family and diverse aspects of its functioning, begin the process of change by providing information about family climate, and inform well-targeted interventions to promote family growth by identifying strengths and areas in need of attention within a given family (Moos & Moos, 1994; see Moos & Moos, 1983, for more on the clinical use of the Family Environment Scale). Other measures may be used to assess more specific components of family functioning or parenting, such as parent– child relationships (Wyman et al., 1999) or adaptive approaches to discipline (Slater & Power, 1987). Scales reflecting individual correlates of resilient functioning— for example, self-efficacy (Cowen et al., 1991), perceived compe- tence (Harter, 1985), realistic control attributions (Wannon, 1990), coping styles (Carver, Scheier, & Weintraub, 1989), future expectations (Wyman, Cowen, Work, & Kerley, 1993), or optimism (Scheier, Carver, & Bridges, 1994)—may also be employed and used as self-report measures. For instance, Harter’s (1985) SelfPerception Profile for Children assesses youngsters’ perceived competenc … GCU PCN 515 Client Resistance & the Positive Professional Environment.