Chapter 7 The Helping Process
GOALS OF MOTIVATIONAL INTERVIEWING
The primary goals of motivational interviewing are to support the client in recognizing their own motivations for change and to enhance their intrinsic motivation by validating their feelings and fostering a collaborative relationship with the helper.
PHASES OF A CRISIS
Crisis phases include: 1) Pre-crisis, 2) Impact, 3) Recoil, and 4) Post-crisis. Skills for crisis intervention involve active listening, empathy, and the ability to de-escalate tension while guiding clients toward finding solutions.
RESOLUTION-FOCUSED BRIEF THERAPY
Resolution-focused brief therapy (RFBT) is a strategy developed in response to the demands, guidelines, and funding constraints of managed care, offering time-limited and scope-limited help. This approach focuses on achieving specific, measurable outcomes quickly by fostering immediate behavioral changes and guiding clients to make new choices in thinking and behaving. It emphasizes action and prompt results, and is commonly used in contexts like chemical dependency, children and youth services, and mental health. RFBT is grounded in client strengths, with a focus on present and future problem-solving, and posits that even small changes can significantly impact a client's life. The goals of the helping process are articulated in positive, measurable terms, enabling both helpers and clients to monitor progress effectively.
The four stages of resolution-focused brief therapy are:
Preparation: This stage involves the initial work of establishing rapport and understanding the client's needs before formal sessions begin.
Client Arrival: During this phase, the helper continues to build a trusting relationship and begins to engage with the client regarding their challenges.
Problem Exploration: At the heart of this brief counseling process is the dual focus on relationship building and identifying client strengths. The helper establishes rapport and uses active listening skills to obtain a precise description of the problem, while concurrently assessing the client's strengths and examples of past successful problem-solving. This stage continues by identifying client strengths through discussions about positive outcomes the client has experienced. The emphasis shifts from detailing the problem to recognizing the client's successes in managing challenges, helping them relate their own problems to "normal problems in living." Helpers also actively seek out client characteristics, skills, and supportive resources from family, friends, and community organizations.
Intervention Strategies: This final stage focuses on collaborating with the client to develop actionable goals and implement specific strategies to facilitate desired changes and maintain progress. Each stage collectively emphasizes establishing a rapport, understanding the client’s needs, and working towards actionable goals to facilitate change.
NATURE OF THE HELPING PROCESS
The helping process is structured yet versatile, occurring in various formal contexts such as agencies and offices. Helpers must tailor their approach considering the client’s cultural background, needs, and strengths while maintaining a clear focus on empowerment and self-responsibility.
THE HELPING RELATIONSHIP
The helping relationship is characterized by trust, mutual understanding, and respect. It is distinct for its goal-oriented nature and the mutual authority shared between helper and client. Essential skills include effective communication, cultural competence, and establishing a supportive environment.
HANDLING CLIENTS
Effective helping requires building rapport through attentive behaviors and open communication. Helpers must engage in reflective listening to ensure they understand clients' verbal and nonverbal cues. Strategies for managing reluctant or resistant clients include clarifying the helping process and expressing understanding of their concerns.
SUMMARY POINTS: STRATEGIES FOR RESISTANCE
Recognize and accept the antagonism
Ask for the client's perception of the problem
Ask the client for solutions
Change the pace or topic
THE OVERLY DEMANDING CLIENT
An overly demanding client exhibits behaviors such as calling the helper at home, monopolizing time in the office, and scheduling frequent and unnecessary appointments. These behaviors can lead to the client becoming dependent and the helper feeling resentful. To address this, the helper must appropriate deal with the client's behavior. Strategies include establishing boundaries for the relationship, limiting client-helper contact to decrease dependence, and examining the helper's own role in encouraging the demanding behavior.
THE UNMOTIVATED CLIENT
Clients who are unmotivated may not recognize the need for help or may be coerced into seeking help by external authorities like parents or the court. They may be unwilling to change and merely go through the motions of the helping process. This can lead to resentment and frustration for the helper. Unmotivated clients are often classed as reluctant clients. Strategies for working with them include focusing on establishing rapport, similar to managing reluctant clients. An example is a parolee who must have regular meetings with a parole officer as a condition of their probation.
INTERVENTION STRATEGIES
Now that the helping process has been understood, it is important to consider three key intervention strategies utilized by human service professionals: Motivational Interviewing, Crisis Intervention, and Resolution-Focused Brief Therapy. Motivational Interviewing specifically focuses on the client by exploring internal or intrinsic motivation for change. Crisis intervention is a helping process designed to respond to stressful events and emergencies. Resolution-focused brief therapy is used when there are limited time or resources and requires a short-term intervention.
MOTIVATIONAL INTERVIEWING
Motivational interviewing provides a methodology to encourage behavior change. This approach emphasizes the development of internal, rather than external, motivation for change. It creates a client-centered, safe environment where clients and helpers can explore ambivalence about change. The ultimate goal is to increase the client's desire for change, with professionals reporting positive outcomes in various populations, including youth, individuals with substance abuse issues, and families. The primary goals are to support clients in recognizing their own motivations for change and to enhance their intrinsic motivation by validating their feelings and fostering a collaborative relationship.
Three aspects of motivational interviewing establish a positive helping environment and address a client's motivation for change:
Collaborative Role: The helper engages the client in a special conversation, setting aside an expert role to assume the role of an equal partner in the change process.
Drawing out Ideas: The helper's goal is to elicit the client's own ideas and feelings about changing their behavior, assessing their strengths in the process.
Client Autonomy: The client retains autonomy for choice and responsibility for actions, with helpers encouraging them to explore ways to engage in a change process.
Techniques supporting the motivational interviewing approach include expressing empathy, providing support for self-efficacy, de-escalating resistance, and identifying discrepancies between the client's current situation and their desired outcome. Additionally, open-ended questions, affirmation (recognizing client strengths), reflections, and summaries are crucial strategies that assist the helper in assessing the client's readiness (ready), importance (willingness), and confidence (able) to change.
Social Context in Motivational Interviewing
While the primary focus of motivational interviewing remains the interaction between the client and the helper, aspects of the social context are significant influences on clients' lives. The importance of significant others is acknowledged. Motivational interviewing needs to address the cultural dimensions of clients' lives, which include aspects such as history and political experiences around immigration, contexts of immigration, receptivity of the host community, the language barrier, and discrimination. The goal of integrating the social context is to enhance the helping relationship.
CRISIS INTERVENTION
Crisis intervention is a helping process that occurs at a much faster pace than other helping, incorporating many helping roles and skills. It can be experienced when an individual finds themselves unable to cope with stressful events or emergencies. For example, a crisis can be precipitated by suicide threats, the discovery of an unwanted pregnancy, abandonment, or natural disasters such as hurricanes or tornadoes. This section will describe crisis intervention as a human service, including the types of crises, the development of a crisis, the principles and skills of intervention, and the role of the human service professional in providing this service.
Defining Crisis
Stressful events and emergencies are inevitable; individuals may handle some but often find themselves unable to cope with others. This inability to cope creates the potential for crisis, disrupting an individual's equilibrium. This imbalance results in stress so severe that the person is unable to find relief using previously effective coping skills. When identifying crises, it's crucial to distinguish between the event or situation and the person's response. The crisis is fundamentally the individual’s emotional response to the threatening or hazardous situation, rather than the situation itself. Thus, the crisis lies in the individual’s interpretation or perception of an event; the same event does not lead to crisis for all people, as what one individual can handle may be a crisis for another.
Types of Crises
Crises can be divided into two primary types: developmental and situational.
Developmental Crisis: This is an individual’s response to a situation that is reasonably predictable within the life cycle. Examples include major transitions such as childhood to puberty, puberty to adolescence, and adolescence to adulthood. Stresses can occur at each phase of development. For many individuals, the stresses of these stages, when not coped with effectively, can have destructive effects, such as suicide attempts, rejection from others, and depression. Such reactions delineate a developmental crisis in these circumstances.
Situational or Accidental Crises: These crises do not occur with any regularity; their sudden and unpredictable nature makes preparation or individual control impossible. Examples include fire or other natural disasters, a fatal illness, relocation, an unplanned pregnancy, and rape. Such hazardous situations may cause periods of significant psychological and behavioral upset. The outcome of a crisis may vary depending heavily on the individual’s personal and social resources available at the time of the event.
Crisis Development Process
Crisis development for an individual typically unfolds in four identifiable phases.
Phase One: Reaction to a Traumatic Event with Increased Anxiety
The individual reacts to a traumatic event with heightened anxiety and attempts to reduce or eliminate stress using existing problem-solving mechanisms.
Case Example: Ben and Joan Matthews
Background: Ben and Joan Matthews, along with their three children (ages nine months, two years, and five years), left their rural Illinois home for Florida after Ben lost his job, hoping for work on fruit farms. When that hope did not materialize, they headed back to Illinois. During the return trip, their car broke down twice, and arguments between Ben and Joan escalated. They eventually ran out of money for food, lodging, or gas. Stopping at a fast-food restaurant, Joan escorted the children inside while Ben took the car. Joan's cell phone was in the car.
Initial Response: Joan initially believed Ben had simply gone to get gas. She returned to the restaurant, found an out-of-the-way booth, and she and the children sat watching and waiting for his return. This reflects an attempt to manage the situation with a familiar problem-solving approach (waiting for a simple issue like getting gas to resolve).
Phase Two: Failure of Problem-Solving Ability and Increasing Anxiety
The individual's usual problem-solving abilities fail, and the stimulus causing the initial anxiety persists, leading to further increases in anxiety. Initial attempts to cope prove ineffective.
Case Example: Ben and Joan Matthews
After some time, the restaurant manager approached, offering assistance. By now, the children were crying, hungry, and tired, sensing Joan's rising tension. Joan, feeling frightened and alone but trying to avoid upsetting her children further, explained to the manager that Ben would be back soon to pick them up, despite her growing awareness of the deteriorating situation.
Phase Three: Failed Resolution Attempts and Mobilization of Resources
All attempts at resolution have failed, anxiety intensifies, and the individual mobilizes every available resource to solve the problem and reduce their anxiety.
Case Example: Ben and Joan Matthews
During the next hour, Joan became increasingly frightened. Her children were very hungry and tired, and she worried the manager might ask them to leave. She asked to use the restaurant phone to call her mother in Illinois. Upon calling, she received a message that the number was no longer in service, indicating a critical loss of a potential support resource.
Phase Four: Unresolved Problem and Unbearable Increase in Tension and Anxiety
The problem remains unresolved, and the tension and anxiety continue to increase to an unbearable degree, indicating a full-blown crisis state demanding intervention.
SUMMARY POINTS: CRISIS DEVELOPMENT
Reaction to a traumatic event with increased anxiety
Problem-solving ability fails
Additional attempts at resolution fail and anxiety increases
Problem remains unresolved and tension and anxiety increase to an unbearable degree
Skills and Strategies for Crisis Intervention
The skills and strategies that helpers use provide immediate support for a person in crisis, forming the core of crisis intervention. This is a form of short-term therapy focused on solving immediate problems and helping the individual to quickly reestablish equilibrium. Common practice areas where crisis intervention is applied include childhood and adolescence, various mental health problems, marital and family conflicts, emergency hospitalization, suicide prevention, and substance abuse. It's recognized that even sudden or short-lived crises have identifiable components that follow a pattern of development. The different techniques used in crisis intervention can be categorized into several key areas, including active listening, providing emotional support, developing a safety plan, and facilitating access to resources.
Active Listening: Engaging attentively and empathetically to understand the individual's feelings and thoughts without judgment.
Providing Emotional Support: Offering reassurance, validation, and empathy to help the individual feel understood and less isolated.
Developing a Safety Plan: Collaboratively creating a plan to ensure the individual's safety, particularly in cases of self-harm or suicidal thoughts.
Facilitating Access to Resources: Connecting individuals to necessary services and support networks that can assist in their ongoing recovery.