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In the last track, we discussed dealing with clients' goals that are too vague, broad, or poorly-defined. Do you find that you tend to get into therapeutic ruts with your clients? By that I mean using the same brand or type or series or responses with your clients?
During this track, you will be able to evaluate your therapeutic ruts in the areas of: Affirming Responses vs. Low-key Responses, Contextual Compliments, and the Key Therapeutic Crutch.
you know, the importance of listening can never be overestimated in a therapist's
work. Listening to a client, of course, conveys the implicit message that I expect
the client to have something important to say. I'm sure you, like I, convey listening
by the usual verbalizations such as "oh," "yeah," "wow,"
"okay," "right," etc. Obvious. Right? But what about using
strongly affirmative responses with your male batterers as compared to more neutral
Therapeutic Rut #1 -
Affirming Responses vs. Low-key Responses
As you know, affirming responses provide validation and affirmation of a client's behaviors, feelings, and thinking. Think of a time when you have used these strong affirmations and they have perhaps instilled hope in your client. I have found that an affirming response often encourages my clients to further pursue their goals. Think of a client you are currently treating. Do you need to exchange some of your "okays" and "rights" for "supers" and "greats?"
Therapeutic Rut #2 - Contextual Compliments
Tim, age 40, had strongly resisted therapy in the group setting from day one due to what he called his "stage fright." During one particular session, I noticed that Tim was remarkably more vocal than usual. I found it useful to give him a contextual compliment. I stated, "Here, there's this group, and you're the one saying you have a hard time being around people, and you're really, really shy, and now you can talk in groups, and today you talked more than anybody else."
Do you see how I provided Tim with a compliment framed within the context of his behavior? Think for a moment about a client you are currently treating who has verbalized his insecurities. Would he benefit from receiving a contextual compliment that addresses his insecurities?
Therapeutic Rut #3 - The Key Therapeutic Crutch
I find this approach to be particularly helpful with Tim in a group setting because he wants to be heard. However, Tim is also fairly shy and is not quite ready to explore solutions.
How often do you use restating as an "escape hatch" or therapeutic crutch? For example, do you use restating when you are unable to create a useful question on the spot? Do you use restating when you are completely at a loss as to what responses would be most helpful? During these high- pressure moments, restating is almost always a safe and useful response. Think for a moment about one of your current clients.
Would your increased awareness of the frequency with which you use the key therapeutic crutch of restating be of assistance to expand your therapeutic repertoire and get out of your therapeutically limiting-box? I would like to add a little aside here. I know restating is a great tool and referring to it as a key therapeutic crutch may be a little extreme, but my goal is simply to get you to rethink your ruts. What about expanding their words to produce new meaning instead of merely restating?
Therapeutic Rut #4 - The Expanding Response
Here's how I got out of the rut of merely restating and used an expanding response with Tim. Tim stated, "I can't argue with my wife in front of our kids. They're getting older. We can only fight in the bedroom." I saw this statement as an opportunity to move toward goal-setting by providing Tim with an expanding response. I said to Tim, "You can limit yourself to fighting in the bedroom, so you do have some control over the fighting. You don't fight around your kids, so you don't want your kids to experience any of this."
Tim then stated, "No way. Kids don't need to see that stuff." In this case, my expanding response led to a suggestion of a goal idea. I stated, "So, what do you think of this as a goal, to lessen this pain for your children?" Think for a moment about the ways in which you encourage your clients to delve into goal-setting. Would expanding responses help to generate new goal statements?
In your next session, to get out of a therapeutic rut, you might consider evaluating your use of affirming responses versus low-key responses, restating responses, and expanding responses.
Online Continuing Education QUESTION
This CD entitled "You Made Me Hit You: Interventions with Male Batterers" has covered such topics as altering attitudes, team pacing and playfulness, the three stages of abuse, red flags to violence, expanding choice points, overcontrollers vs. undercontrollers: masked dependency, nice guy positioning strategies, the invisible dragon of shame, checkpoints for change, goal-setting, problem goals, and therapeutic ruts.
We appreciate the fact that you have chosen the Healthcare Training Institute as a means for receiving your continuing education credit. I hope you have found the information to be both practical and beneficial. I wish you the best of luck in your practice. Thank you.
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