For additional creative leadership ideas, check out the following resources written by the authors of this article: Group Counseling: Strategies and Skills, seventh edition, by Ed Jacobs, Robert Masson, Riley Harvill and Christine Schimmel, 2012, Brooks/Cole, Impact Therapy: The Courage to Counsel by Ed Jacobs and Christine Schimmel, 2013, Impact Therapy Associates. These are people who are often with you day in and day out. They must bear in mind that, ultimately, resistance can provide helpful input to the therapeutic process, offering new insights and the opportunity for growth. The importance of flexibility for group therapy in SUD settings has complex implications relative to the use of EBTs. Clinicians from each clinic reported that their clinics would like to begin instituting formal outcome monitoring but that they had not yet done so. Broad empirical support has been documented for principles of group therapy (e.g., group cohesion; American Group Psychotherapy Association, 2007; Yalom & Leszcz, 2005), suggesting the importance of fully capitalizing on these principles if group therapy is to be utilized. gisdttir S, White MJ, Spengler PM, Maugherman AS, Anderson LA, Cook RS, et al.Rush JD. Each one can become a micro-confrontation and lead to unproductive answers. Palinkas LA, Schoenwald SK, Hoagwood K, Landsverk J, Chorpita BF, Weisz JR. An ethnographic study of implementation of evidence-based treatments in child mental health: First steps. This page According to the American Counseling Association, there are several exercises and approaches counselors can use to manage and reduce the negative impact of resistance (Shallcross, 2010): Ask the client how others in their environment treat them. Completely. So I scrolled up and thats exactly what I saw. Find out how they oppress them, reject them, make unreasonable demands on them and control them (Shallcross, 2010). Responding the wrong way whether by pushing back at the client or withdrawing can derail the client's progress, say Honda and others. Dont forget to download our three Positive Psychology Exercises for free. You probably got fidgety or sleepy, or even started talking or sending notes to the person next to you. The therapist should not avoid situations that risk challenging the process, but work to address the resistance (communicated directly or indirectly). This flexibility was evident in clinicians' commonly reported group therapy processes and activities. Hsieh HF, Shannon SE. Several participants, especially clinicians from New Day and SUD Intensive Clinic, had minimal group therapy training and experience at the time they were hired. Perhaps you simply retreated into your mind and started thinking about where to go on vacation, what to make for dinner or other things you could be accomplishing with your time. Instead, validate the client's feelings by saying, "You're angry with me because ." Let your manager know that you are constantly being challenged by your co-workers difficult behaviors and ask them to intervene.. If you have to engage the person, do it only one out of three times [that] they are provocative. When you know what causes a person to become difficult and on edge, you can figure out what steps you need to take to deal with their behavior. Every time I finish with the six-session series, there are at least three members who say they want to continue meeting because it helped them so much., Leader (with a kind, caring voice): Everyone has to be in the room, but I realize some of you are more invested than others. Carroll KM, Ball SA, Jackson R, Martino S, Petry NM, Stitzer ML, et al.Weiss RD. Facing a client who is resistant or possibly hostile to the therapeutic process or therapist can be unsettling and challenge the treatments success (Clay, 2017). If a client is frustrating you, remember the bigger picture that therapy is helping to bear the burden of another person's pain, says Schnitker. First and foremost, it is typically not prudent to engage in any type of challenge or restorative conversation when emotions are high, explains Joseph Galasso, PsyD, Chief Executive Officer and Clinical Psychologist at Baker Street Behavioral Health. "Once you do that, you're actually talking," says Brodsky. These vignettes suggest that clinicians attempt to check the pulse of entire groupswhere the group is atand adjust accordingly. Get busy and clean up Using the 'I' statement avoids accusing or blaming a person but expresses how their feelings affect you, states Bowman. Santa Ana EJ, Wulfert E, Nietert PJ. And what seems to work is here are all these strangers in the worst positions they are in in their lives, but they start helping each other. I trust life in these days will support our efforts and we should respect who we are and where we are in life. Be thick-skinned: Know that some members are going to challenge you, ignore you and accuse you of a variety of injustices. While they differ in their assumed causes and how to deal with resistant patients, they recognize similar behavior as resistant (Beutler, Moleiro, & Talebi, 2002). Finally, we suggest that training efforts focused on group MI may be especially promising. 12 Types of Difficult Participants in Group and This next activity may serve as an excellent movement exercise to focus on the idea of setting goals. Weiss RD, Jaffee WB, de Menil VP, Cogley CB. It focuses primarily on the deeply personal elements of this hesitation for potential group members, which include social anxiety, fear of anger from other group members, dread of experiencing shame or humiliation, and desire for individual attention. All eligible clinicians from the three clinics were recruited, and six from New Day (100%), four from Recovery Services (57%), and three from SUD Intensive Clinic (100%) participated (81% total participation rate). Behaviorists may not like the term resistance, but they recognize that clients often fail to comply with therapeutic instructions (Leahy, 2003). That may be coping with a specific medical condition, such as cancer or dementia, a mental health issue like depression, anxiety, bereavement, or addiction, for example, or caring for a family member or friend facing such a problem. Dealing with difficult members is a very tough situation. Martino S, Santa Ana EJ. The problem is you. The Dominator. Discuss why the client could not attend one or multiple group sessions, and ask if there are any other underlying reasons. Counselor: I know you are all very angry about having to be here, so lets get this group started by just getting all that anger and frustration out on the table. (Counselor pulls up a large trash can and opens the lid.) I felt unprepared. official website and that any information you provide is encrypted Observing and navigating resistance may require changing approaches and interventions. 2023 Dotdash Media, Inc. All rights reserved. Rather, the assumption seems to have been that existing EBTsdesigned for and tested on individual therapysimply need to be adapted into group format. The sample was diverse in gender (67% women), age (range from 25-65 years; mean of 39 years), years providing SUD services (range from 1-45 years; mean of 10 years), and personal recovery status (31% endorsed). Difficult patients: their construction in group therapy The person that wrote [a treatment manual] doesn't know the people in front of me. The first author contacted the clinical directors of the three clinics, and each director agreed for clinicians to be recruited. This requires poise and tact, but can be an effective way to segue from problematic discussion or behavior to another member or subject. In a group conflict sometime arises between two or more members. The Shy or Quiet One. I graduated from West Virginia Graduate College in the mid 1990s and was exposed to your Impact Counseling work during my courses with Bob Rubenstein. In other cases, clinicians from all three clinics discussed decisions to depart from what was planned at the outset, in light of last-minute appraisals of group needs. 204 CONDUCTING AND MANAGING GROUPS Rennie, D. L. (1994). ), Counselor: OK, now we are going to name this group. Coaching is a very verbal activity, rich with questions and dialogue. As a therapist, it can help to remember that you are there to bear the burden of your clients pain. The site is secure. You have people that are not willing to speak up, won't give you eye contact, maybe just sort of nod their head. WebDifficult patients: their construction in group therapy. There are several ways of fostering growth by encouraging the clients agency (Austin & Johnson, 2017): Skilled counselors balance how they handle avoidant responses, remaining sensitive to the clients needs and feelings while still tackling the reason for being in therapy. Such resistance, or objection, to both the therapist and therapy is sometimes referred to as realistic resistance and includes opposition to (Rennie, 1994): While having an issue with the general approach to therapy is an obstacle that may need specific focus, the therapist may moderate difficulties with in-session techniques and terms by building a solid working relationship between therapist and client (Austin & Johnson, 2017). Additionally, moving around is more engaging for the members than just talking about how they feel about their ability to change. Some group SUD treatment studies, particularly for motivational interviewing (MI) and cognitive behavioral therapy (CBT), have been conducted (Crits-Christoph et al., 2013; D'Amico, Houck, Tucker, Ewing, & Pedersen, 2017; Hogue, Henderson, Ozechowski, & Robbins, 2014; Santa Ana, Wulfert, & Nietert, 2007; Watkins et al., 2011). Although some attention has been given in the SUD treatment literature to incorporating unique group therapy principlessuch as group cohesion and interpersonal learning (American Group Psychotherapy Association, 2007; Center for Substance Abuse Treatment, 2005; Yalom & Leszcz, 2005)these principles have not been explicitly incorporated in most EBTs for SUDs (but see Martino & Santa Ana, 2012, for suggestions on integrating MI with the group principle of universality for groups with dually-diagnosed clients). Compassion for the client should also be accompanied by consequences, adds Abblett. According to such models, resistance, like other irrational beliefs, requires head-on confrontation. How Nonviolent Communication Can Change Your Relationship, How to Recognize and Cope With Micro Cheating, According to a Therapist, How Resilience Helps You Cope With Life's Challenges, Using Rationalization as a Defense Mechanism, 9 Yellow Flags in a RelationshipSigns and How to Deal With Them, 6 De-Escalation Techniques to Diffuse Conflict, Understanding the Psychology of Interrupting, Assertiveness Can Improve Your RelationshipsHere's How. For at least three clinicians at New Day and Recovery Services, a focus on education appeared to stem from a belief in the necessity of promoting a disease model of addiction. Care was taken to provide vignettes that are most exemplary and illustrative of the presented themes, while also being balanced among the three clinics and 13 participants. Remembering the bigger picture can help you handle the frustration while developing patience that can be valuable in this situation and beyond. If we were just to kind of follow CBT or do a manualized treatment, there would be no time creating this thing that happens amongst people. This research focus on individual therapy is understandable, in that groups with interdependent members are more difficult to study in clinical trials (see Baldwin, Murray, & Shadish, 2005; Morgan-Lopez & Fals-Stewart, 2008; Weiss et al., 2004). Substance abuse treatment and the stages of change. In contrast to individual therapy, clinicians discussed unique challenges with group therapy in terms of group dynamics. Reframed, uncomfortable interactions can strengthen the therapeutic relationship and further treatment, and encourage client growth. The use of the box is a unique approach, and the brain likes novelty. Content is reviewed before publication and upon substantial updates. Gifford EV, Tavakoli S, Weingardt KR, Finney JW, Pierson HM, Rosen CS, et al.Curran GM. Let's get somebody else's input. Not that it's not important, but I can kind of see people zoning out. Doing so, he says, helps clients see that their therapists understand them. Webactions they employ increase group fluidity and focus while dealing with difficult situations and behaviors. How to Deal with Difficult People: A Comprehensive With members who are mandated to group due to anger issues, a shaken Coke bottle or a bunch of long, medium and short fuses will work to grab their attention. Leader: Everyone stand and line up side by side. (Leader moves about 8 feet in front of the members and draws an imaginary line.) Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. Moreover, greater training, supervision, and resources clearly are needed for clinicians in delivering EBTs in group format. A second implication is that the ability for clinicians to balance flexibility and structure in group therapy may be limited inasmuch as clinicians have not received sufficient group training. Accept them exactly as they are. Group Therapy This creative technique has a much greater chance of engaging the members regarding the consequences of their drinking in comparison with simply asking them about the consequences. Written from the perspective of intersubjective theory, this article addresses how the leader and group members co Nonetheless, a more ecological approach would prioritize the design and testing of open-enrolling group therapies, which could then be adapted into other formats as needed. - The title of this article caught my attention because I am currently leading groups in an inpatient setting. Acknowledge the emotion that is driving the client's behavior, then emphasize that it's not acceptable for him or her to make threats or swear, refuse to pay for services or simply not show up, he says. But knowing the background story can give you effective tools for coping. WebResponding the wrong way whether by pushing back at the client or withdrawing can derail the client's progress, say Honda and others. The following results include a presentation of major interpretive themeslimited to those that cut across the three clinicsas a result of systematic coding and thematic content analysis of qualitative data. Indeed, when identified, it may be appropriate to let go of the planned agenda and focus on more pressing issues (Austin & Johnson, 2017). Ungreatful bricks! Dealing with difficult members is a very tough situation. To be sure, making clinical decisions on the status of an entire group (e.g., group cohesion) would be consistent with a systems approach to treatment that typically underlies group therapy theory (American Group Psychotherapy Association, 2007); however, in the case of short-term open-enrolling groups (where membership is constantly in flux), clinicians may have difficulty knowing how much to emphasize group-level appraisals versus the individual needs of group members who are most at risk. When a person makes life more stressful for you, it can be challenging to have empathy for them, or try to understand their point of view. Keep in mind that their attendance is due to being mandated, not because they look forward to attending. This research is not generally tailored for open groups, though Martino and Santa Ana (2012) discuss adaptations for these groups and illustrate several activities that could be used in both open and closed groups (see also Wagner & Ingersoll, 2012, p. 99). Our overall message to anyone leading mandatory groups is: A commitment to this list of ideas will make leading mandated groups a more interesting, exciting prospect. Dealing with resistance in group therapy Often group leaders are asked to use prepared material, but those who created the material did not necessarily consider that the members completing the material are doing so because they are mandated to participate in the program. Group members can also learn by imitating other members who are successfully dealing with difficult relational issues. To this end, we encourage researchers and clinicians to develop and make widely accessible EBTs that can be flexibly utilized in open groups. Ask them what techniques they have used in the past to cope and manage the situation and whether they were successful. Lash SJ, Timko C, Curran GM, McKay JR, Burden JL. Web . Positive Psychology 19 Apr 2023 Client Resistance in Therapy: How to Help Difficult Clients 21 Apr 2021 by Jeremy Sutton, Ph.D. Scientifically reviewed by Maike Neuhaus Ph.D. For average therapist, primary profession doesnt matter, any STEM problem is resistant if they try to solve it, even most simple cases which can go from paper to something that works in afternoon. It was very interesting, and not what I expected. WebResponding the wrong way whether by pushing back at the client or withdrawing can derail the client's progress, say Honda and others. The subsequent action created enough energy to allow the leader to spend the remainder of the group session simply processing the material that the continuum generated. Plus, be the first to receive exclusive content & discounts. Motivational interviewing groups for dually diagnosed patients. uMary, we havent heard from you tonight. uMary, I noticed that you havent said much tonight. So if we have got [clients] that are really struggling, then we are going to tap into that need on that day, as opposed to something else that we might have planned, you know? Without that time out, he says, "I knew I wasn't going to be able to be constructive.". Do they feel like their job is threatened by you or another coworker? This article explores, both theoretically and clinically, the behavior of the habitual group monopolist, an individual who dominates a group in a nontherapeutic manner. The answer needs to be, Yes, very appealing!. Following that, the leader focused on the purpose of the group, which was to discuss the members use of marijuana at school. (Meagan, SUD Intensive Clinic). Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The 1-10 rating round is also helpful for getting a sense of how the members feel about something. No, with right training it is not. Hogue A, Henderson CE, Ozechowski TJ, Robbins MS. I think I observed five or six groups and then a therapist observed me do one group. In the book: Clinician's Guide to Self-renewal: Essential Advice from the Field, 2014, Strategies for Working with Difficult Clients As presented above, although clinician participants emphasized the importance of having flexibility in group therapy facilitation, several challenges and obstacles were evident in offering this in group format. Limited Group Therapy He was working with two parents and their daughter, when the father started attacking Honda, making hostile comments about his abilities as a therapist. International Journal for Quality in Health Care. When someones behavior makes it difficult for you to do your job, carry out your everyday duties, or maintain a healthy relationship with them, they can be defined as difficult. Ranging from the words they say to their inability to work effectively with others, difficult people can drain you mentally, physically, and emotionally. The following techniques can help form a safe and trusting relationship that is ultimately productive: Each of the following strategies can be valuable in group (and often one-on-one) settings (modified from Austin & Johnson, 2017): Ask the group to confirm their understanding of the homework to ensure instructions were clear; discuss any confusion or obstacles they faced. How can psychologists respond effectively to challenging clients? In contrast, five clinicians expressed concern about the amount of education in their clinics' groups. WebFirst, make sure your own house is in order. Osilla KC, Alexis J, V N, Pedersen ER, Houck JM, D'Amico EJ. Before Seek support from your peers. It really is time-tested, field-tested material that makes counseling more concrete. Being tasked with leading a group whose members dont actually want to be there is an assignment that many counselors dread. When you dive into a topic, if you really start to explore and people are really trying to get something out of it, and then it triggers something, I feel that it's somewhat detrimental to not only the person who needs to address that stuff, but also to the group as a whole. Schnitker, S.A., Blews, A.E., & Foss, J.A. 8600 Rockville Pike In addition to challenges with having clients with varying levels of engagement, eight clinicians discussed challenges with working with clients having differing levels of severity or readiness to change. The toughest kinds of groups
Marlboro Elementary School Staff, Articles D