Client change scale

Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society 9th Edition

Allen E. Ivey

Mary Bradford Ivey

Carlos P. Zalaquett

Copyright © 2018 Cengage Learning. All Rights Reserved.

Chapter 10

Empathic Confrontation:

Identifying and Challenging

Client Conflict

Copyright © 2018 Cengage Learning. All Rights Reserved.

Chapter Goals and Competency Objectives (slide 1 of 2)

Awareness and Knowledge

Identify conflict, incongruity, discrepancies, ambivalence, and mixed messages in behavior, thoughts, and feelings/emotions.

Consider multicultural and individual differences when using confrontation.

Observe an interview on microaggressions illustrating one approach to positively change cognitions and emotions, and discuss action steps the client might take.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Chapter Goals and Competency Objectives (slide 2 of 2)

Skills and Action

Encourage and facilitate exploration and creative resolution of conflict and discrepancies.

Evaluate client creative change processes occurring during the session and throughout treatment sessions, using the Client Change Scale.

Consider multicultural and individual differences when using confrontation.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Introduction: Empathic Confrontation, Creating the New (slide 1 of 3)

Clients come to counseling “stuck.”

Having limited alternatives for resolving their issues and conflicts.

Stuckness describes the opposite of intentionality, or a lack of creativity.

Other expressions include:

Immobility and ambivalence, blocks, repetition, compulsion, inability to achieve goals, lack of understanding, limited behavioral repertoire, limited life script, impasse, and lack of motivation.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Introduction: Empathic Confrontation, Creating the New (slide 2 of 3)

Empathic confrontation is a more gentle skill.

Involves listening to the client carefully and respectfully; and then encouraging the client to examine self and/or situation more fully.

Empathic confrontation is not “going against” the client; rather, it represents “going with” the client.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Introduction: Empathic Confrontation, Creating the New (slide 3 of 3)

Empathic Confrontation: Supportively challenge the client to address observed discrepancies and conflicts. 1. Listen, observe, and note client conflict, mixed messages, and discrepancies in verbal and nonverbal behavior. Give attention to both cognitive and emotional dimensions. 2. Paraphrase and reflect feelings to clarify internal and external discrepancies. As the issues become clarified, empathically summarize what has been said—for example, “on one hand you feel ____, but on the other hand you feel ____.” Bring both cognition and emotions into most summaries. 3. Evaluate how the client responds and whether the confrontation leads to client movement or change. If the client does not change, flex intentionally is needed; try another skill and approach the conflict from another direction. Anticipated Result: Clients will respond to the confrontation of discrepancies and conflict by creating new ideas, thoughts, feelings, and behaviors, and these will be measurable on the five-point Client Change Scale. Again, if no change occurs, listen. Then try an alternative style of confrontation.
Copyright © 2018 Cengage Learning. All Rights Reserved.

Awareness, Knowledge, and Skills: Empathic Confrontation for Results

Key components of empathic confrontation:

Empathic relationship

Good listening skills

Non-nonjudgmental approach

Suspend your own opinions and attitudes and assume value neutrality in relation to your client.

Copyright © 2018 Cengage Learning. All Rights Reserved.

The Skills of Empathic Confrontation: An Integrated Three-Step Process

Confrontation involves three major steps.

Listen: Identify the conflict by observing incongruities, discrepancies, ambivalence, and mixed messages.

Summarize: Point out and clarify issues of internal and external conflict and work toward resolution.

Evaluate: Evaluate the change (effectiveness).

Copyright © 2018 Cengage Learning. All Rights Reserved.

Observe: The Client Change Scale (CCS) (slide 1 of 7)

The effectiveness of a confrontation can be measured by how the client responds.

The five-point Client Change Scale (CCS) provides a framework for evaluating how the client responds to your confrontation.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Observe: The Client Change Scale (CCS) (slide 2 of 7)

Client Change Scale (CCS): CCS helps you evaluate where client is in the change process. Level 1. Denial. Level 2. Partial examination. Level 3. Acceptance and recognition, but no change. Level 4. Creation of a new solution. Level 5. Transcendence. Anticipated Result: The CCS can help you determine the impact of your use of skills. This assessment may suggest other skills and strategies that you can use to clarify and support the change process. You will find it invaluable to have a system that enables you to (1) assess the value and impact of what you just said; (2) observe whether the client is changing in response to a single intervention; or (3) use the CCS as a method for examining behavior change over a series of sessions.
Copyright © 2018 Cengage Learning. All Rights Reserved.

Observe: The Client Change Scale (CCS) (slide 3 of 7)

Denial

Partial Examination

Full Examination But No Change

Decides to Live With Incongruity

Discusses and is fully aware of decision impact.

Denies or fails to hear incongruity.

Discusses part, but not all of incongruity.

Discusses incongruity completely, but will not change.

Decides to Change From Incongruity

Discusses and alters choices when faced with incongruity.

5

4

3

2

1

Copyright © 2018 Cengage Learning. All Rights Reserved.

Observe: The Client Change Scale (CCS) (slide 4 of 7)

Example Session Interview: Nelida

Three skills are reviewed in this interview:

Listening skills, used to obtain client data.

Empathic confrontations of client discrepancies.

Use of the Client Change Scale (CCS) to determine effectiveness of confrontations.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Observe: The Client Change Scale (CCS) (slide 5 of 7)

Key to Nelida’s process was her becoming more aware of her identity as a cultural person:

Spanish-speaking Latina, a minority person in a predominantly White environment.

Cultural background is a major part of personal identity, even though she, and many of your own clients, are not aware of this.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Observe: The Client Change Scale (CCS) (slide 6 of 7)

Conformity stage: The client may be unaware of racial identity and conforms to what he or she sees as societal expectations. There may be a lack of awareness or denial of the impact of culture on who we are. This corresponds to Level 1 of the Client Change Scale.

Dissonance stage: This compares to the partial bargaining of the CCS. The client is aware that something “doesn’t fit” and moves positions as new discoveries are made. For those in many groups, this leads to conflict between self-appreciation and self-doubt. Awareness of the impact of culture has started.

Resistance and emersion stage: Two things can happen here. Minority clients often become angry at what they see around them. As they grow and mature, they may immerse themselves fully, for example, in African American culture. Nelida for the first time recognized her anger and began to take more pride in her Cuban culture. White clients may also find themselves angry and try to understand other cultural groups’ values more fully. Or they may move to active resistance, another form of conformity and denial.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Observe: The Client Change Scale (CCS) (slide 7 of 7)

Introspection stage: Clients increasingly think for themselves, whereas before they were embedded in a group view of the world. They focus on themselves and understanding themselves and their own cultural group. Nelida saw that her grandparents represented strength, and she became prouder of her Cuban heritage.

Integrative awareness stage: A fuller sense of caring for oneself and one’s cultural heritage appears. Along with this often comes a fuller understanding of other cultures. This may lead to appreciation, or it may lead to a movement to resistance and action, but this time based on pride and awareness. It is a transcendent stage that has many variations.

Copyright © 2018 Cengage Learning. All Rights Reserved.

Action: Key Points and Practice of Applying Empathic Confrontation in the Real World

Empathic Confrontation

Empathic Confrontation and Change Strategies

The Client Change Scale

Multicultural and Individual Issues

Cultural Identity Theory

Helping Clients Cope with Microaggressions and Related Concerns

Copyright © 2018 Cengage Learning. All Rights Reserved.

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