Exam 10: Empathic Confrontation and the Creative New: Identifying and Challenging Client Conflict

Define empathic confrontation and its place in the session and the counseling process.

Developmental Change Scale—Rater Training Examples Instructions: Imagine you are a counselor or therapist working with an array of client problems. You make a statement or have approached a case in a certain way. Then the client responds. For example, imagine a client who is being abused by her husband. You, as interviewer, may say: "Jane, this is the third interview in a row that you've come in beaten and bruised. Each time you say you need to try harder to meet your husband's expectations. When are you going to realize that it is he who is at fault, not you?" The client responds to you in five different ways: 1. "But, I can't do anything about it. I have no place to go. I've simply got to try harder. Won't you please help me do better?" 2. "Yes, you're right, I am beginning to think he is involved in this, too. But I know how hard he works and if we just hang in there, maybe it will work out." 3. "I guess you're right. I am trying to meet what he wants. I can't stand being beaten. I know you think he's at fault and it isn't my responsibility to take care of him. I think I understand what you are saying." 4. "I'm beginning to get your drift. I used to think I could solve things if I tried harder, but I've been doing that now for months. Clearly, hitting me isn't right—it has to stop." 5. "Aha, I'm finally seeing what you mean. The more I try, the more he demands. I think the situation isn't safe for me anymore. How can I plan to get out, just as soon as possible?" The above five responses correspond to specific ways a client might respond in the interview. Below are descriptions of each of the five responses. Note how the first response represents a form of denial, the second a partial response, etc. Level 1. Denial, The negative alpha solution. The client seems unable to accommodate new data from the counselor or therapist. The client will fail to deal with the conflict or contradiction, make an abrupt topic shift, or show a clearly incorrect "off-the-wall" response. Level 2. Partial examination, The more mature alpha solution. The client deals with only a portion of the issue or counselor's statement. The client may over-generalize, delete, or distort what has been said, but not as seriously as in Level 1. You may find irrational ideas and some blindness to problems. Level 3. Acceptance and recognition, Beta solution. The client recognizes the situation as it is and the client's comment, feeling, or thought seems close to that presented by the therapist, but nothing new is added by the client. This level characterizes homeostasis or no change. Score as Beta if the client tends to describe a situation, event, or self-picture fairly clearly, but tends to leave it there. Level 4. Generation of a new solution, Early gamma solution. In response to the counselor, the client moves to the creation of something new. The client has added something that was not there before. At times, the underlying conflict may remain—acceptance of insoluble problems begins here. Level 5. Transcendence, Full gamma solution. The client has arrived at a new synthesis, a new way of thinking, behaving, or feeling. These are relatively rare moments in counseling and therapy and may represent the development of useful or important insights, the ability to engage in a truly new way of behaving, and the generation of a new ability to engage emotionally. You will now be given a variety of counselor-client situations. The possible client responses are in random order. Please classify each client response at one of the five levels. -Depressed client​ Counselor (to hospitalized patient): "Could you tell me what brought you to the hospital?"​​ ________A)"I wasn't able to get up in the morning, yet I couldn't sleep at night and I have​​all these awful thoughts. I know I scared mom."​​​​ ________B)(Tears-no response)​​​​ ________C)"I guess mom just wanted to get rid of me."​​​​ ________D)"Well, when I came here I was pretty depressed and mom was worried. But now​​I'm doing a better. Last night I slept through the whole night for the first time."​​​​ ________E)"Extreme depression-I was immobilized. Small wonder mom brought me in.​​I know now that I can't stay home all the time and do nothing. I'm going to start getting out and being more active."

Achieving a major more lasting transformation in client thinking and behavior may require:

Developmental Change Scale—Rater Training Examples Instructions: Imagine you are a counselor or therapist working with an array of client problems. You make a statement or have approached a case in a certain way. Then the client responds. For example, imagine a client who is being abused by her husband. You, as interviewer, may say: "Jane, this is the third interview in a row that you've come in beaten and bruised. Each time you say you need to try harder to meet your husband's expectations. When are you going to realize that it is he who is at fault, not you?" The client responds to you in five different ways: 1. "But, I can't do anything about it. I have no place to go. I've simply got to try harder. Won't you please help me do better?" 2. "Yes, you're right, I am beginning to think he is involved in this, too. But I know how hard he works and if we just hang in there, maybe it will work out." 3. "I guess you're right. I am trying to meet what he wants. I can't stand being beaten. I know you think he's at fault and it isn't my responsibility to take care of him. I think I understand what you are saying." 4. "I'm beginning to get your drift. I used to think I could solve things if I tried harder, but I've been doing that now for months. Clearly, hitting me isn't right—it has to stop." 5. "Aha, I'm finally seeing what you mean. The more I try, the more he demands. I think the situation isn't safe for me anymore. How can I plan to get out, just as soon as possible?" The above five responses correspond to specific ways a client might respond in the interview. Below are descriptions of each of the five responses. Note how the first response represents a form of denial, the second a partial response, etc. Level 1. Denial, The negative alpha solution. The client seems unable to accommodate new data from the counselor or therapist. The client will fail to deal with the conflict or contradiction, make an abrupt topic shift, or show a clearly incorrect "off-the-wall" response. Level 2. Partial examination, The more mature alpha solution. The client deals with only a portion of the issue or counselor's statement. The client may over-generalize, delete, or distort what has been said, but not as seriously as in Level 1. You may find irrational ideas and some blindness to problems. Level 3. Acceptance and recognition, Beta solution. The client recognizes the situation as it is and the client's comment, feeling, or thought seems close to that presented by the therapist, but nothing new is added by the client. This level characterizes homeostasis or no change. Score as Beta if the client tends to describe a situation, event, or self-picture fairly clearly, but tends to leave it there. Level 4. Generation of a new solution, Early gamma solution. In response to the counselor, the client moves to the creation of something new. The client has added something that was not there before. At times, the underlying conflict may remain—acceptance of insoluble problems begins here. Level 5. Transcendence, Full gamma solution. The client has arrived at a new synthesis, a new way of thinking, behaving, or feeling. These are relatively rare moments in counseling and therapy and may represent the development of useful or important insights, the ability to engage in a truly new way of behaving, and the generation of a new ability to engage emotionally. You will now be given a variety of counselor-client situations. The possible client responses are in random order. Please classify each client response at one of the five levels. -Death and dying ​The following client statements could be expected following the discovery that the client has terminal cancer.​​ _______A)"It's so hard for me all the time. But it's hard for the family, too. Sometimes I​​just cry. But lately, I find that if I focus on the positives available to me still, I gain some peace."​​​​ _______B)"There really isn't any problem. I'm sure it's an error on the X-ray. It can't be​​correct."​​​​ _______C)"Why me? What happened?" With anger: "It isn't fair."​​​​ _______D)"I've been spending my time working with a cancer support group. I want to​​help others face this-somehow fighting and working with others to the end makes it seem easier."​​​​ _______E)"I accept it. I've had a good life, with my share of problems for sure. Sure I​​don't like it, but there's nothing I can do."

According to the authors, an important goal of interviewing is to move clients from

Regarding discrepancies between you and your client, which of the following is NOT true?

Developmental Change Scale—Rater Training Examples Instructions: Imagine you are a counselor or therapist working with an array of client problems. You make a statement or have approached a case in a certain way. Then the client responds. For example, imagine a client who is being abused by her husband. You, as interviewer, may say: "Jane, this is the third interview in a row that you've come in beaten and bruised. Each time you say you need to try harder to meet your husband's expectations. When are you going to realize that it is he who is at fault, not you?" The client responds to you in five different ways: 1. "But, I can't do anything about it. I have no place to go. I've simply got to try harder. Won't you please help me do better?" 2. "Yes, you're right, I am beginning to think he is involved in this, too. But I know how hard he works and if we just hang in there, maybe it will work out." 3. "I guess you're right. I am trying to meet what he wants. I can't stand being beaten. I know you think he's at fault and it isn't my responsibility to take care of him. I think I understand what you are saying." 4. "I'm beginning to get your drift. I used to think I could solve things if I tried harder, but I've been doing that now for months. Clearly, hitting me isn't right—it has to stop." 5. "Aha, I'm finally seeing what you mean. The more I try, the more he demands. I think the situation isn't safe for me anymore. How can I plan to get out, just as soon as possible?" The above five responses correspond to specific ways a client might respond in the interview. Below are descriptions of each of the five responses. Note how the first response represents a form of denial, the second a partial response, etc. Level 1. Denial, The negative alpha solution. The client seems unable to accommodate new data from the counselor or therapist. The client will fail to deal with the conflict or contradiction, make an abrupt topic shift, or show a clearly incorrect "off-the-wall" response. Level 2. Partial examination, The more mature alpha solution. The client deals with only a portion of the issue or counselor's statement. The client may over-generalize, delete, or distort what has been said, but not as seriously as in Level 1. You may find irrational ideas and some blindness to problems. Level 3. Acceptance and recognition, Beta solution. The client recognizes the situation as it is and the client's comment, feeling, or thought seems close to that presented by the therapist, but nothing new is added by the client. This level characterizes homeostasis or no change. Score as Beta if the client tends to describe a situation, event, or self-picture fairly clearly, but tends to leave it there. Level 4. Generation of a new solution, Early gamma solution. In response to the counselor, the client moves to the creation of something new. The client has added something that was not there before. At times, the underlying conflict may remain—acceptance of insoluble problems begins here. Level 5. Transcendence, Full gamma solution. The client has arrived at a new synthesis, a new way of thinking, behaving, or feeling. These are relatively rare moments in counseling and therapy and may represent the development of useful or important insights, the ability to engage in a truly new way of behaving, and the generation of a new ability to engage emotionally. You will now be given a variety of counselor-client situations. The possible client responses are in random order. Please classify each client response at one of the five levels. -Family therapy Therapist: "The problem with this family is not just Sue's eating problem; what we need to work on as well is the way this family interacts."​ _______A)Mother: "Somehow that makes sense. I never thought of it that way before."​​​​ _______B)Father: "Yes, I now see that our perfectionism and constant demand for success​​left her with a feeling of being empty."​​​​ _______C)Sue: (5'6", 87 pounds) "I don't see why all the fuss. I'm overweight a little,​​that's all."​​​​ _______D)Mother: "Yes, doctor, that way we can work together better and you can help​​show us how to get Sue to eat."​​​​ _______E)Mother: "I see how we've avoided our own conflicts and used Sue to help us​​hide them. We're going to be more direct in the future."

Which one of the following is NOT a technique to supportively challenge or confront a client?

Instructions: Imagine that you are talking with a client about emotional child abuse. You have just confronted the client with the following statement: "On one hand, you say you love your child, but on the other hand you continue to put her out in the hall of your apartment where you force her to stand in the dark. How do you put that together?"Classify the following client's response using the CCS scale . -Client response: "I heard what you are saying. I want to change, but right at the moment I just can't do what I want. I tried last week, it didn't work. The divorce is getting to me. I'll do the best I can to change, but it is so hard."​ This client is where on the CCS?

"I've been avoiding my anger, and it is getting in my way. I'm going to start dealing with it." An interviewer may hear this statement in which level of the Client Change Scale (CCS)?

____________ developed the Racial/Cultural Identity Development (R/CID) model. A)​Ivey and Ivey B)​Sue and Sue C)​William Cross D)Zalaquett and Montenegro

Uncontrollable conflict and discrepancy bring stress to the client resulting in ____.

"On the one hand..., and on the other hand..." This is typically used in _________.

Instructions: Imagine that you are talking with a client about emotional child abuse. You have just confronted the client with the following statement: "On one hand, you say you love your child, but on the other hand you continue to put her out in the hall of your apartment where you force her to stand in the dark. How do you put that together?"Classify the following client's response using the CCS scale . -Client response: "I think I see what you're saying. There is a big incongruity there. I want to stop, but I was abused and hit by my parents. I think I'm doing better than they did-at least I don't strike Amie. But perhaps I can do something different next week. I'll try your new idea about disciplining her."This client is where on the CCS?

If your client starts with you at denial or partial acceptance (Level 1 or 2) and then moves with your help to acceptance and generating new solutions (Level 3 or 4), you have clear evidence of:

Nelida and Allen's two sessions highlight the importance of helping clients address conflicts related to racial/cultural identity.

The counselor's or interviewer's task is to move clients beyond their issues and problems to realize their potential as human beings.

Discuss some of the key multicultural issues in the use of confrontation.​

Counseling helped Nelida:

A nonjudgmental attitude requires that you assume: