Besides “There's no problem; I can handle it,” at least two other belief systems keep clients stuck and acting against their own best interests. It is important for counselors to assess for these other belief systems, which are based in a lack of confidence and feelings of shame, because they can hold a client back. Also, they probably are much more common than the classic denial thinking embodied in “There's no problem.”
Nicholas A. Roes, PhD
All three belief systems support the same type of client behavior—missing appointments, avoiding answers to our questions, expressing a lack of interest in recovery. But what can prove helpful to each client is very different. And what's helpful in the case of classic denial actually may be harmful to clients with different belief systems.
One of the other two unhelpful client belief systems revolves around the thinking, “I'll never be able to do it, so why try?” It is easy to mistake this lack of confidence for lack of interest in change, especially since some of these clients exhibit a false bravado that makes us think they are in denial.
If we try to raise awareness of the problem as we would with a client who genuinely doesn't see one, our efforts likely will backfire. The client will hear us confirming what he/she already thinks: “I'm a failure and I've made a lot of mistakes; what's the use in trying?”
Another belief system that keeps clients stuck is the shame-based belief system of those who think they aren't worth saving or don't deserve to be happy. These clients also seem uninterested, sabotage their own recovery, and fail to show a sustained effort.
If we approach these clients as we would clients in denial, by raising awareness of the harm done by their past choices, our efforts again are likely to backfire. The client will hear us confirming what he/she already thinks: “I have done so many bad things and have hurt so many people; I don't deserve a happy life.”
The “I can't do it” and “I don't deserve it” thinking often exist together and support each other. These beliefs are not compatible with “I have no problem” beliefs.
Uncovering the right approach
Here are some suggestions for determining which belief system needs to be addressed:
Consider the client's self-esteem. Clients with no interest in change often have an unrealistically high self-esteem. They think they can handle things on their own. Clients with low interest in change have unrealistically low self-esteem. They think they are incapable of handling life effectively.
Consider the client's optimism/pessimism. Clients with no interest in change are unrealistically optimistic. Regardless of past history, they are sure that the future is bright. Those with low confidence in change are unrealistically pessimistic. They don't believe you, God, or a trip to Vienna in a time machine could be of assistance.
Consider whom the client holds responsible for his/her situation. Those in denial blame everyone else for their problems. Those with low confidence in their ability to change also might do this to save face, but deep down they blame themselves for everything. For some clients, this includes holding themselves responsible for childhood abuse or being victims of spousal violence.
Consider how badly the client is hurting. Those in denial have an almost enviable way of disconnecting from the painful consequences of their choices. Almost everyone around them is suffering, but they don't connect with it. Those with low confidence often are consumed by their pain. Others with low confidence might cling to their pain as the only thing that lets them know they are alive. This difference in pain may explain the variable success of confrontational approaches. Perhaps there is an optimal level of pain that is motivating.1 Clients who are too comfortable with their situation might become motivated by being made uncomfortable. But clients already paralyzed by their pain will not benefit from any increase in discomfort.
Moving to the next stage
All three types of thinking qualify a client as a precontemplator—someone in the first stage of change in the transtheoretical model. The precontemplator is not currently in the market for change, and the counselor strives to move the client to the contemplation stage. In contemplation, the client is ambivalent about change but aware that change may be desirable/possible.
Of course, the counselor needs first to establish therapeutic relationships in which clients feel comfortable sharing what they really think. Once the counselor has determined the belief system supporting client behaviors, interventions can be tailored specifically to address these.
Clients with no confidence will never try until their self-efficacy increases. So this should be a priority. Clients who don't think they deserve to be happy should work on self-esteem issues until they overcome this obstacle to stronger motivation.
Therefore, work with each type of precontemplator to help him/her gain the awareness necessary to move to the next stage of change. For clients who don't think they have a problem, use consciousness-raising techniques to move them toward an awareness that change is desirable. For clients who don't think they can change, move them toward an awareness that change is possible. And for clients who don't think they are worth it, work toward an awareness that even they deserve to be happy.
Nicholas A. Roes, PhD, has written hundreds of articles and several books, including
Solutions for the ‘Treatment-Resistant' Addicted Client (Haworth Press, 2002; reviewed in the January 2003 issue of
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