PLAGIARISM FREE "A" WORK SUMMARY TECHNIQUES

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Chapter 8 Challenging Skills

"When Should We Use the Challenging Skills?

During the initial stages of the relationship, the helper strives to understand the client’s unique

worldview by getting the client to open up. As a client tells the story, the helper listens

attentively using the nonjudgmental listening cycle (NLC). After several cycles, the helper

begins to detect distortions, blind spots, and inconsistencies and may then use challenging skills

to help clients function with more accurate information about themselves. With heightened

self-awareness, they are better able to make decisions and to operate free of illusions and “vital

lies.” Challenging is consistent with the primary goal of empowering clients by encouraging

them to explore their thoughts, feelings, and behaviors and to take steps toward their dreams

and goals.

When challenging skills are used, the aura of safety and support, so carefully constructed by

the helper, is at risk (Moeseneder, Ribeiro, Muran, & Caspar, 2018). There is a fundamental

shift from relationship building to a focus on the goals set by the client and helper, conveying

to the client that the helping relationship is not a friendship but a business partnership during

which the helper may have to hold the client’s feet to the fire in order to attain the agreed-upon

outcomes. Clients need to be challenged when:

They are operating on misinformation about the self. For example, a client may underestimate

her intelligence, feeling that she is not capable of attending college when there is evidence to

the contrary.

They are operating with mistaken ideas and irrational beliefs. For example, the client believes

she must be perfect.

They misinterpret the actions of others. This tendency is called mind reading and is a common

problem among couples. A client may act on assumptions without confirming them, making

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statements such as the following: “I could tell by the way he acted that he did not want to date

me anymore.”

They are blaming others rather than examining themselves. For example, a client may blame

the boss at work but refuse to look at his own responsibility for the poor relationship or his own

work performance.

Their behavior, thoughts, feelings, and values are inconsistent. For example, a client talks about

how much she values honesty but at the same time discusses how she hides her financial

difficulties from her partner.

They are not operating according to their own values.

They are not working on the goals that they participated in setting.

In this chapter, we will focus on two building blocks, or basic skills, used to challenge clients

and help them deal with problems more consciously. The first of these is giving feedback:

providing information and your honest reaction to the client. The skill of giving effective

feedback is one that has wide application in helping, including group work, couples counseling,

and individual and family therapy. Second, we tackle the skill of confrontation, the challenging

skill that is the art of pointing out inconsistencies and blind spots in the client’s story."

"Confrontation”

Confrontation is the second challenging skill we will address in this chapter. Confrontations

point out discrepancies in client beliefs, behaviors, words, or nonverbal messages. As a result

of confrontation, client awareness of inconsistencies is stimulated, and the client is motivated

to resolve them. In essence, it is an educational process that brings information to the client’s

attention that has been previously unknown, disregarded, or repressed. The most powerful

confrontation urges the client to resolve the inconsistencies. Confrontation creates emotional

arousal and can lead clients to develop important insights and motivate them to change their

behavior.

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What Is a Discrepancy?

A discrepancy is an inconsistency, mixed message, or conflict among a client’s thoughts,

feelings, and behaviors. In fact, every problem contains discrepancies. For example:

A client says that she wants an equal, sharing relationship but goes out only with domineering

people.

A client says that she loves her job, but she complains about it constantly.

A client states that he wants to improve his marriage, but he forgets to go to marriage

counseling sessions.

A client is intelligent and tenacious but is convinced he will not do well in school.

Why Should Discrepancies Be Confronted?

Ivey and Simek-Downing (1980) say that “the resolution or synthesis of incongruities may be

said to be a central goal of all theoretical orientations” (p. 177). In fact, most well-known

therapeutic systems use confrontation to some degree. The Gestalt therapist Fritz Perls

confronted clients about incongruities in their nonverbal and verbal behavior (which he labeled

“phony”). Albert Ellis, the founder of rational emotive behavior therapy, liked showing clients

the gap between their beliefs and rationality by directly exposing them to the “nuttiness” of

their ideas. Albert Ellis used loud voice tones or even curse words to intensify confrontations.

Some early group therapy methods for treating substance abuse (the Synanon approach,

Straight Inc.) used personal attacks and abusive confrontation to create client movement in

dealing with deeply ingrained behavior patterns. However, there is little evidence to support

the use of such strong confrontation. In fact, it appears that, even with substance abusers, a

consistent highly confrontational therapist style is not as effective as a moderately

confrontational one (see Figure 8.1 and Miller, Benefield, & Tonigan, 1993). This information

has added support to a theoretical approach called motivational interviewing (MI), which has

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been successfully practiced and researched in addictions programs. In MI, helpers are careful

to acknowledge the client’s point of view while pointing out the conflict. They use

confrontations but qualify them as “double-sided reflections.

In this double-sided reflection, the helper acknowledges the client’s statement that he wants to

continue to drink for social reasons and at the same time does not pull any punches by

reminding the client of the problems alcohol has caused him. The helper’s agreeing with part

of the client’s statement softens the blow of the confrontation, making it moderately

challenging. To use anything stronger could create a rupture in the helper/client relationship,

which is the very thing that keeps the client in treatment and engaged with the helper (Eubanks,

Muran, & Safran, 2018).

In this chapter, we urge you to consider how to raise inconsistencies without alienating the

client. Confrontation is an advanced reflecting skill that should be developed after the early

helping building blocks of invitational and reflecting skills have been firmly established.

Research confirms that highly trained (doctoral) counselors used confrontation more often than

students (Tracey, Hays, Malone, & Herman, 1988). At the same time, doctoral-level counselors

demonstrated less dominance and verbosity than student helpers. It appears, then, that as

helpers gain experience, they use confrontation more frequently, talk less, and are less pushy.

Cognitive Dissonance and Confrontation: Why Confrontation Works

Do you remember the concept of cognitive dissonance from your first Introduction to

Psychology class? Cognitive dissonance theory states that we are motivated to keep cognitions

such as values, beliefs, and attitudes consistent (Festinger, 1957). When people experience

inconsistencies in their thoughts, feelings, and behaviors, this creates tension, and they are

motivated to reduce the tension. As a consequence, we can either convince ourselves that the

incongruity is unimportant or else change one of the incompatible elements. Let us take the

example of quitting smoking. Smokers are aware of the health risks but also continue smoking.

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The conflict between smoking behavior and putting oneself at risk creates cognitive

dissonance. Smokers may reduce the dissonance in a number of ways: to either ignore or

misinterpret the facts about health risks or else tell themselves that they are “addicted” and

therefore quitting is not under their control (self-handicapping strategy) (Jenks, 1992). Either

way, smokers are pushing the risks out of awareness. One study of college students who

smoked asked them to view an online program about the effects of smoking (Simmons,

Heckman, Fink, Small, & Brandon, 2013). They were then asked to make a video recording of

their own negative experiences with smoking, then they watched their recording. The

researchers found that the students whose awareness of the risks had been heightened were

more motivated and had higher rates of smoking cessation than those in comparable treatments.

Heightening of awareness led to motivation.

Consider also the case of Donna, a 25-year-old woman who describes her job as good-paying

but also as repetitive and boring. She needs the job to help her mother, who is struggling to

survive on social security. Donna wants to go to college because she is not intellectually

challenged in her present position, but the costs are too great. This creates dissonance. She

deals with the tension caused by these conflicting thoughts by telling others and herself that

education and intellectual challenge are not really important. We all use such defense

mechanisms to distort reality so that we can reduce anxiety. In this case, the distortion masks

the fact that Donna does really want to go to college, and the lack of intellectual stimulation

does bother her. For her, going to college may not be possible, but pretending that her desire

does not exist is creating a giant “blind spot” in her life. Many times, clients use defense

mechanisms to escape dissonance rather than making choices based on thinking and planning.

When helpers confront people with these discrepancies, anxiety often resurfaces, but so does

awareness of choices. Donna may realize that there may be nontraditional and incremental

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ways of taking classes she has not considered, but first she must be confronted with her

tendency to push the inconsistency out of awareness.

Kiesler and Pallak (1976) reviewed dissonance studies and found a link between dissonance

and physiological arousal (Cooper, Zanna, & Taves, 1978; Croyle & Cooper, 1983; Pittman,

1975; Zanna & Cooper, 1974). It seems that clients actually change their attitudes in order to

reduce the stress when the helper makes the client aware of the two incompatible elements.

The confrontation causes anxiety because the client then becomes aware of this split, which is

normally kept out of awareness by psychological defenses. The client’s frozen position has

provided some security, but now the client is acutely aware of both sides of the conflict again

and becomes uncomfortable but motivated to change (Elliott & Devine, 1994). Being aware of

the inconsistency is now being used to help clients with disordered eating. Clients are asked to

confront the discrepancy between their vision of themselves as thin and costs of pursuing that

ideal (Stice, Rohde, Shaw, & Gau, 2019). In the case of Donna, the helper might encourage

Donna to become more aware of her need to be intellectually stimulated and ask her to talk

about the competing need to take care of her mother. Without blind spots and defense

mechanisms, it is possible to make decisions that are more reality-based and personally

satisfying (Claiborn, 1982; Olson & Claiborn, 1990).

Although we may use confrontation to bring buried elements into consciousness, we must

remember that clients do not really like it because it produces negative emotions (Harmon-

Jones, 2000; Hill et al., 1988). If the helper’s confrontation is too powerful and the client’s

emotional arousal is too great, the client not only will reject the message but also may be less

willing to explore feelings and trust the helper (Hill et al., 1988). Thus, therapists tend to use

confrontations sparingly because doing so is strong medicine; they should combine it with a

liberal helping of support, or else they risk causing a rupture in the relationship (Barkham &

Shapiro, 1986; Norcross, 2011; Strong & Zeman, 2010).

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"Other Ways of Challenging

Besides pointing out discrepancies using confrontation, there are other methods for challenging

clients to pay attention to discrepant, irrational, or troubling issues and focusing the

conversation in that direction. Among these are relationship immediacy, teaching the client

self-confrontation, challenging irrational beliefs, and using humor. These are more advanced

skills, but we mention them here because you will likely run into them early in your training

through films or reading. We hope that you will mentally note that they fall in the category of

challenging skills and that supervision is necessary as you learn to use them.

Relationship Immediacy

When you meet someone for the first time, think about what issues are the most difficult to

discuss. It is easier to talk about past problems and previous relationships rather than present

issues and relationships. It is easier to discuss issues that are positive and uplifting rather than

those that are negative or depressing. It is also easier to talk about issues that concern neither

of us, such as the weather, rather than talking about what is going on between us right now. By

the same token, it is sometimes difficult for the helper to bring up issues affecting the helper

or the relationship between helper and client. However, the ability to give honest feedback and

discuss the helper/client relationship openly gives it a special meaning that separates it from

social interactions. The relationship can be a laboratory where clients learn about their effect

on others. Relationship immediacy (Kiesler, 1988) is a technique that helpers use to give clients

here-and-now feedback about their effect on another person—the helper. Relationship

immediacy is a comment by the helper about what is happening in the relationship right now.

Immediacy statements by the helper should have three characteristics:

The helper uses the word I in the statement to indicate that this is the helper’s perspective.

The helper describes the client’s behavior or the helping relationship issue in nonjudgmental

terms.

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The helper expresses personal feelings in a way that does not overload or burden the client.

These three characteristics are illustrated in the following helper statement: (1) “I am aware

that (2) when I make a suggestion, such as the one about your supervisor, we seem to end up

in a struggle and the issue gets dropped. (3) I am a little concerned about whether or not we are

communicating.”

Helpers use relationship immediacy because the client’s interactions with the helper are

probably similar to the client’s interactions with significant others. For example, a client might

talk incessantly, not leaving room for the helper to respond. Using an immediacy challenge,

the helper might say, “You tell me that other people say you don’t listen to you. As I am sitting

here, I don’t feel listened to either. Can we talk about that?” In this vein, Murray (1986) cites

the example of a young woman who came to therapy because she felt she was overly dependent

on her father. For example, whenever she had car trouble, she turned it over to him. After a

month of therapy, she brought in her auto insurance policy, which she was having trouble

deciphering, and handed it to the therapist, who began reading it. After a moment, the therapist

laughed and exclaimed, “Look, I’m behaving just like your father.”

Relationship immediacy is “you-me” talk. It challenges the client to focus on the helper’s

impressions of the therapeutic relationship. Relationship immediacy can enhance intimacy in

a relationship because it acknowledges the mutual bond and gives the client liberty to look at

feelings toward the helper. It is one of the best ways of dealing with so-called resistance and

transference reactions. Relationship immediacy is also an invitation to examine the

client/helper relationship conflict as a microcosm of the client’s difficulties. It can be used to

address or prevent ruptures by asking the client to honestly assess the quality of the therapeutic

bond. It should only be used if it seems that the relationship issues between client and helper

relate to the client’s goals or if the therapeutic relationship is strained and needs to be repaired.

Relationship immediacy can be of the “here-and-now” variety such as, “Right now, I feel a lot

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of tension between us because we brought up the alcohol issue. What is your reading on that?”

Alternatively, the helper can ask the client to reflect on the relationship as it has progressed up

to that point. For example, “Over the past few weeks, I have found that our relationship seems

to have changed. My experience is that the sessions are much more fun and productive. What

do you think?”

Teaching the Client Self-Confrontation

Although it is good to have the input of others, it may be more useful to have the client learn

to self-confront, a skill that could provide lasting benefit when the helping relationship is over

(Visser, 2016). Self-confrontation has been studied as a complex assessment and research tool

(Hermans, Fiddelaers, de Groot, & Nauta, 1990; Lyddon, Yowell, & Hermans, 2006). But the

method can be applied more simply as a research project that the client conducts with the

assistance of a helper. One way to teach self-confrontation is to ask the client to write down

every conflict in the client’s life. For example, “I am in love with this woman, and I keep trying

to develop a relationship, but she has made it clear I am only a friend,” or “My parents want

me to get better grades, but I really don’t want to go to college.” If given as a writing

assignment, the client might be asked to respond to questions such as:

What is it that I don’t really want to do?

What would it say about me if I changed in the ways people want me to?

In what ways am I lying to myself?

What possibilities in my life am I not paying attention to?

What conclusions am I drawing about life that have no evidence to support them?

The helper then guides the discussion of these issues in the past, present, and future and helps

the client explore the issues collaboratively. Together client and helper try to identify key

themes in the client’s life and ultimately identify a plan to solve the dilemmas.

Challenging Irrational Beliefs

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Some cognitive therapists challenge clients’ strongly held beliefs when these beliefs are

responsible for clients’ emotional suffering. Challenging beliefs involves making the client

aware of their irrational nature and teaching them to dispute these disturbing thoughts when

they arise. Although the helper highlights the irrational ideas in the session, disputing and

replacing irrational thoughts becomes a form of self-confrontation, and the client practices

confronting erroneous beliefs as homework. Following is a short list of irrational beliefs

adapted from Ellis and Velten (1992). Ellis has longer lists of common irrational beliefs, but

this will give you a feel for the general categories.

Shoulding and musting: “I must be the best in my class. I should have learned this by now.”

More rational challenge: “Have you ever tried saying, ‘I would like to be the best in my class’

without laying a ‘must’ or ‘should’ on yourself? I think it is those words that cause you to feel

so upset when you can’t reach perfection.”

Awfulizing: “When I don’t get it right the first time, it is a tragedy, a catastrophe, and it is

awful.”

More rational challenge: “Isn’t it more accurate to say that it’s unpleasant but not the end of

the world?”

Low frustration tolerance: “I can’t stop myself from calling my ex-girlfriend. I can’t wait to

buy things when they are on sale, and I get myself into big credit card debt.”

More rational challenge: “So it’s uncomfortable for you to wait, right? But is it really true that

waiting is impossible, or is it just annoying?”

Blaming: “No one even tried to help me. It’s their fault that I wasn’t able to register for classes,

not mine. This is the worst school.”

More rational challenge: “I wonder about this idea that it is the responsibility of other people

to get you registered and help you when you didn’t even request assistance.”

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Overgeneralizing—“always” or “never” attitudes: “I went to one AA meeting, and all they did

was drink coffee and smoke cigarettes. The organization is crazy. No one gets helped there.”

More rational challenge: “I’d like to take issue with this idea that attending one AA meeting

gives you enough information to make this blanket statement. Isn’t it possible that there were

some positive aspects of the meeting? Tell me why you think you must look at this in black

and white. Is it really true that you get nothing from a meeting like this?”

You can probably see how confronting a person’s beliefs can feel like a very strong

intervention. It takes a great deal of skill to challenge beliefs in a way that does not alienate the

client. The goal is for both client and helper to gang up on the irrational beliefs while

maintaining a good working relationship.

Humor as Challenge

Humor can be one way of relating to clients and teaching them to view situations in a different

way. It can be a needless distraction, but humor can also be a way of making a confrontation

(Arminen & Halonen, 2007). Both stories and humor seem to bypass the client’s defenses.

Clients tend to accept humorous stories because they are not seen as preachy or mean. Once, a

client told me about her fears that, as a divorced woman, everyone would be looking at her and

treating her differently. I responded by agreeing that although she lived in a city of one million

people, at first rumors would be spreading like wildfire. There would be newspaper headlines

and, of course, television news. I reassured her that after the requests from talk shows were

rebuffed, she would be able to resume her private life once again. She laughed with me and

admitted that her fears were overblown as usual. I was able to get away with this because I

knew the client well, and she did not perceive me as laughing at her. That is, of course, the

primary precaution of using humor as confrontation. It could belittle the client or convey that

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you think those concerns are unimportant. Again, there is no substitute for knowing your client

and having the kind of relationship where you can talk about ruptures when they occur."