The client is Mark, a 39-year-old accountant struggling with drug abuse (alcoholism). Mark claims that his job is so stressful that he has to pass by a local pub each evening to ‘unwind’ but ends up overdrinking. Although alcohol has ruined his relationships and affected his health, Mark claims he needs to drink to get over stress from work. During a treatment session, Mark appeared ambivalent about the change, fearing that he will soon relapse. In addition, the client was defensive, unmotivated, unconcerned about his drug use, and in denial of his addiction problem.
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In my view, Mark’s could be described as a resistant client. He displays negative responses that are characteristic of client resistance. His aversion to the change process could be linked to his heightened anxiety and conflicting motivations over the treatment. The therapeutic change process requires that clients actively engage in the treatment plan. It begins with teaching the client new skills to support psychological awareness and commitment to the plan.
The Nature of the Client’s Behavior
Mark’s resistance may stem from a lack of understanding of the therapeutic process and his role in it. He may be feeling discouraged that the process will not make any difference. As Newman (2002) writes, some resistant clients believe that they are irredeemable while others believe the therapeutic process is not worth the time or effort. Mark’s aversion to the change could be ascribed to conflicting motivations or ambivalence over the treatment. Ambivalence can be paralyzing as it hinders progress.
Mark also displays negative responses such as denial and indifference towards his alcohol problem. Negative responses towards therapy often stem from individual experiences or a feeling that the therapist is not supportive or understanding (Newman, 2002). His aversion to the change may be an indication of a dysfunctional coping style for stress. He self-medicates his anxiety by drinking but appears defensive citing job-related stress. He seems unmotivated and unsure if the change is possible.
Contextual Factors that may have jeopardized the Therapeutic Relationship
The dyadic relationship between the therapist and the client can be strained by a lack of client motivation for the change process. In the current case, my failure to help Mark understand his problem and address his conflicting motivations might have jeopardized our relationship at the outset. Developing a good rapport and a working alliance with the client is an essential pillar of any therapeutic relationship. From a cognitive-behavioral standpoint, a good rapport is created through therapist-client collaboration in developing a problem list (Willshire & Brodsky, 2001).
I could have pointed out the discrepancy between Mark’s reasons for continued alcohol use and desire for emotional well being and healthy relationships. A clear indication that he will not achieve these goals through drinking could have motivated him to be more receptive to the change. In addition, I could have expressed more empathy for Mark to get an idea of his fears and motivations for his defensive, indifferent behavior. Had the client felt more understood, he could have been more willing to engage in the process and share the conflicting motivations causing his ambivalence. Thus, emphatic listening could have helped minimize resistance.
Building an effective working alliance would have been useful in identifying Mark’s problem before developing an appropriate treatment plan. Establishing an initial connection with the client through reflective listening and motivational interviewing techniques could have been essential in overcoming the client’s resistance. Shallcross (2010) suggests that therapists should connect with clients through their “perceived locus of control” (para. 3). Concentrating on “feelings, behaviors, or a sense of responsibility” would only intensify the recalcitrant conduct (Shallcross, 2010, para. 4). In the case of Mark, my failure to work on his motivation could have reduced my chances of bonding with the client and building a working alliance.
Treatment Plan for Rectifying the Situation
The plan will involve diverse strategies to motivate Mark to engage more actively in the change process.
Work on Motivation
Interactive communications through motivational interviewing (MI) can help resolve ambivalence, reduce resistance, evoke ‘change talk’, and support the client through the phases of change (Braastad, 2014). As a client-centered approach, MI reinforces the intrinsic motivation to change and overcome ambivalence. I will use open-ended questions in our next session to encourage Mark to talk more about his job and its stresses. This method will evoke self-motivating statements from him to drive his engagement in the change. Additionally, I will use affirmations as opposed to judgmental assertions to boost Mark’s confidence in his capacity to change. This method would communicate support and respect to the client and motivate him to recognize his challenges and strengths.
Increase Awareness of the Need to Change
I will highlight the discrepancy between Mark’s goals of achieving emotional and social wellbeing and his continued alcohol use. Pointing out the discrepancies can make the individual recognize that his/her current behavior does not drive him/her to the desired goal (Braastad, 2014). Thus, through this strategy, Mark will be more motivated and receptive to the change.
Helping the Client Move through the Stages of Change
Assisting clients to move through the change process requires prior awareness of the necessity of the change. People with a drug-use problem go through six stages, i.e., “pre-contemplation, contemplation, preparation, action, maintenance, and relapse” as they realize they need for change (Braastad, 2014, para. 3). I will use positive methods such as emphatic listening as opposed to confrontation to help Mark to start moving through this process. By showing genuine empathy to Mark’s work-related stress, I will increase his disposition to the change. Further, I will assist him identify effective coping strategies for his stress to prevent relapse.
Enhancing Motivation and Commitment to Change
By urging clients to develop individual solutions to their problem through empathic listening, a therapist can enhance motivation and commitment to the treatment (Braastad, 2014). I will employ the same approach to elicit solutions from Mark in a collaborative way based on his perspectives without appearing to impose my ideas on him. In this way, I will give him a sense of control over his alcohol problem to encourage him to engage effectively in the change process. I will also avoid confrontational methods as they can escalate the resistance and reduce his commitment to the change.
Causes of Client Resistance to the Change Process
I can speculate a number of factors that might have contributed to Mark’s resistance to the change process. First, Mark lacks clear goals for the treatment. He has conflicting motivations that make him ambivalent. He wants to change but feels that he may not cope with the stress in his work without drinking.
Second, Mark’s resistance may also stem from his lack of psychological awareness of how his problem relates to his social and emotional distress. He may be holding the belief that it is only through drinking that he can be relieved from stress and anxiety. Thus, he does not understand the need to learn alternative coping styles to overcome his job-related stress. Third, Mark lives in denial of his alcohol problem. This could explain his resistance to the change process.
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A Plan to Motivate the Client for Change
The plan will involve a series of four action steps to motivate the client to change.
The therapist will not reveal his values or beliefs about divorce or separation in the therapeutic setting. Instead, the therapist will explore the client’s views on the subject to avoid coming across as a judgmental person. A neutral environment will motivate the client to share his feelings and opinions freely to facilitate the change.
The client will be involved in choosing appropriate therapy-related tasks. As Brodsky and Lichtenstein (2009) write, even subtle controlling behaviors from the counselor demoralize the client and elicit resistance. Therefore, I will utilize Mark’s feedback in selecting supplementary readings to encourage him to engage actively in the process.
Use of Reflective Listening
I will echo Mark’s message by paraphrasing his statements during the therapy session as a motivational strategy (Braastad, 2014). Reflective listening will let the client know that I understand what he says during our interactions. Additionally, the approach will enable Mark to understand his thought patterns as echoed through my responses.
I will use open-ended questions to probe Mark’s responses in order to understand his problems without appearing indifferent. Further, I will ask him to give his choices with an emphatic tone. I will then explain to him the ramifications of each option to determine the best choice. This approach will motivate Mark to participate in the change, as he will feel like a contributor to his own healing process.
Braastad, J. (2014). Using Motivational Interviewing Techniques in SMART Recovery. Web.
Brodsky, S.L., & Lichtenstein, B. (2009). Don’t Ask Questions: A Psychotherapeutic Strategy for Treatment of Involuntary Clients. American Journal of Psychotherapy, 53, 215-220.
Newman, C. (2002). A Cognitive Perspective on Resistance in Psychotherapy. Psychotherapy in Practice, 58(2), 165–174.
Shallcross, L. (2010). Managing Resistant Clients. Web.
Willshire, D., & Brodsky, S. (2001). Toward a Taxonomy of Unwillingness: Initial Steps in Engaging the Unwilling Client. Psychiatry, Psychology and Law, 8(2), 154-160.