PLAGIARISM FREE "A" WORK SUMMARY TECHNIQUES

Chapter 12 Activating Client Expectations, Hope, and Motivation

Before learning the techniques for activating expectations, hope, and motivation, it is

important to recognize the immediate obstacles most clients are experiencing when

they first come for help: discouragement, lack of confidence, and demoralization.

Remember that seeking professional help is often a last resort. The clients have already

tried several ways to solve their problems. They have probably consulted clergy, family,

and friends. They have come to believe that there may be no way out of their difficulties.

Therefore, before the clients can attack their problems, they must first overcome the

conviction that their situation is hopeless.

The Demoralization Hypothesis

According to Jerome Frank (de Figueiredo, 2007; Kissane, 2017; Frank & Frank, 1991),

those who seek professional help are demoralized. Demoralization is described by Frank

as a “state of mind characterized by one or more of the following: subjective

incompetence, loss of self-esteem, alienation, hopelessness (feeling that no one can

help), or helplessness (feeling that other people could help but will not)” (p. 56). Frank

also proposes that client symptoms and mental demoralization interact. In other words,

according to the demoralization hypothesis client problems and symptoms are worsened

by the sense of discouragement and isolation. For example, sleeplessness may be seen

as a minor annoyance by one person, whereas the demoralized individual sees it as yet

another sign of the hopelessness of the situation. Seligman (1975) experimentally

discovered an aspect of demoralization called learned helplessness , which is a state

analogous to depression. In that research Seligman found that dogs and people exposed

to unsolvable problems became so discouraged that their later performance on solvable

problems was negatively affected. Many clients do not give the helping process their full

effort because they have little confidence that anything can help them. Thus, it is often a

first task of the helper to instill some hope that some of the presenting problems can be

solved. With renewed hope, the client will be more fully invested in the therapeutic

project.

Motivation and Readiness

Instead of classifying demoralized clients as resistant or unmotivated, you can think of

people as being at various stages of readiness for change. Steve de Shazer (1988)

classified clients as visitors , complainants , or customers . The analogy is that clients

who come to a professional helper are like clients in a retail store. Some are browsing

(visitors), others have a need to buy something and are checking out the prices and

options (complainants), and still others have come to the store looking for a specific

product, planning to buy something right away (customers). Salesclerks know they need

to treat each kind of shopper differently, from giving a brief greeting (visitors) to

describing options and features (complainants) to finalizing a sale (customers). Similarly,

helpers who do not recognize these differences in readiness will try to force a client into

a particular treatment. For example, most people are not prepared to enter substance

use disorder on the first day they seek help. Some clients need education (visitors), and

others require help thinking about the problem and weighing their options

(complainants). Only customers are prepared to take direct action to solve the problem.

One readiness approach that has shown considerable success is motivational

interviewing (MI) (Miller & Rollnick, 2013). This person-centered/cognitive approach has

been used most often with addictions. The method is based on the idea that clients

come for help at different stages of readiness. Using a nonjudgmental, nonadversarial

approach, practitioners try to help clients become more aware of the issue surrounding

a problem behavior and explore the costs, benefits, and risks associated with it. Special

training is required to practice motivational interviewing, but you already know the first

step—listen with empathy (Forman & Moyers, 2019). After that, motivational

interviewers carefully identify discrepancies, accept client resistance, and allow the

client to be self-directing. As you can see, the process is composed of many of the

building blocks you have already learned. The client’s motivation is unique to that

person and so each case must be understood individually.

The Stages of Change

Another way of looking at readiness is the stages of change theory, which is a part of the

transtheoretical model of psychotherapy (Prochaska, DiClemente & Norcross, 1992;

Prochaska & DiClemente, 1983). According to this approach, we first get ready to

change, we change, and then we try to maintain that change. At each step we need a

different kind of help. In the stages of change model, there are five stages. In the first

stage of precontemplation, the person is not even thinking about taking action—for

example, not even considering quitting smoking or drinking. In the contemplation stage,

clients are planning to change within 6 months. At this point they have become

conscious of both the positive and negative consequences of potential change. Yet

clients at this stage are ambivalent about making a change and are not ready to take

direct action to address the problem. People can be aware of the problem and yet

remain stuck in this stage for years. The preparation stage describes clients who have

taken some steps toward change during the last 12 months and are ready to consider a

specific action plan. For example, a client who needs to do more physical exercise has

joined a gym and is planning to begin a program, or the client may have obtained a self-

help book and seems to be taking some small concrete steps for improving self-esteem.

But it is really in the action stage that we find clients who have already made specific

changes in their lives. For example, the client has stopped drinking, started attending AA

meetings, or entered a treatment program. Although treatment has begun, the process

is not complete. The final stage of change is maintenance, which characterizes

individuals who have already changed their lives and behavior, such as by quitting

smoking or having instituted better communication in their relationships. The

maintenance stage may be the most critical and can last from 1–5 years. It is critical

because relapse is a constant threat. Relapse is a stage that propels clients back to an

earlier stage of readiness. Clients move back and forth between the stages especially as

they experience relapse. The most important implication of this theory is that people

benefit from different interventions depending on which stage of change they are in.

Clients do better in programs that tailor their treatments to the clients’ stage of change

than in those that do not (Norcross & Lambert, 2018). Those who are more ready

(further along in the stages) do better than clients who are at earlier stages.