This document outlines strategies for working with resistant clients and families. It discusses various types of resistant families and challenges counselors may face. Key strategies covered include using motivational interviewing techniques like expressing empathy, developing discrepancy, rolling with resistance and supporting self-efficacy. Other approaches discussed are solution focused therapy, using reflections, decisional balance worksheets, exploring ambivalence, and eliciting change talk through evocative questions. The document provides examples of how to implement these strategies in counseling sessions.

1. Heroic Journeys -Working with
Resistant Clients and Families
 Dr Louise A. Stanger Ed.D ,
LCSW, BRI II, CIP
 MINT Trainer of Trainers
 Faculty SDSU
 Director All About Interventions
 Member at Large Association of
Intervention Specialists
 Member Network Of
Independent Interventionists
 National Association of Social
Workers

2. Objectives
 Identify and describe the resistant client
 Learn alignment strategies using
Motivational Interviewing and Solution
Focused Therapy
 Practice the art of Crucial Conversations
 Learn Parallel Processes
 Identify Emotional Attunement
 Practice Reflective Listening and Speaking
 Identify Ways to Integrate these strategies
into your practice

3. Superwomen Counselor

4. Superman Counselor

5. How do our clients arrive ?

7. Family History

8. Dance
 Mental Health Issues
 Substance Abuse
 Sudden Death
 Adoption

9. Attributes of Healthy Families
( McMannis PHD & McMannis MSW)
 Talking & Loving
 Expressing Language
 Adapting to Change
 Sharing Time Together
 Who’s in Charge
 Balancing Closeness &
Difference
 Accepting Difference
 Seeing The Positive
 Effective Problem
Solving
 Parenting Together

10. Family Strengths
( Lamm, 2009)
 Communication
 Caring
 Health
 Commitment
 Resilience
 Spirituality

11. Family Systems –Salvadore Minichun

12. Families that have Substance Abuse and
Mental health
 Are behavioral systems in which SA and MH-related behaviors have
become the central organizing structure
 An identity is forged around this, family accommodates to the special
needs of the person with SA or MH behavior
 Daily rituals reflect this new identity and can alter the balance that
exists between growth and regulation in the family
 Families begin to count on a conscious or unconscious way of this new
identity and are somewhat resistant to change in other words SA is
actually maintained by the family
 Hence the introduction of change most often appears as emphasis on
short tem stability at the expense of long term growth.
 Family distortions

13. Good - Not So Good

14. Portlandia

16. Family Fusion
 Lack of personal space
 Taking over-Controlling
 Blurred Lines
 Blaming
 Power
 Denying
 Rescuing Faulty Reasoning
 Boundaries

17. Before Treatment Families
 Confused
 Bewildered
 Attached to The Problem
 Deny
 Minimize
 Operate From a Base of
Fear –Fear for their lives,
what’s going to happen etc
(Dr. Candace Till)

18. Feelings Families Have
 Confusion
 Anger
 Sadness
 Love

19. So What Type of Families Do You
Encounter
 Agreeable Family –Does everything you ask
 The Invisible Family-always in the background
 The Questioner- calls all the time and emails …
 The Know it all-Knows everything about everything
 The Talker – Talks –Talks and Talks
 The Complainer- Nothing is ever good enough
 The Worrier
 The Micro-Manager
 The Confuser says one thing does completely the opposite.

20. What’s your Attitude ?

22. Families are Hurting Experts (SFT)
1.Client is the expert about their
own life
2. Professionals adopt posture of
not knowing (easier said then
done)!
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23. 27
Families/Clients are experts
3. Counselor expertise is
called along the way.
4. Remember this is not
about you
5. Avoid one upmanship

24. What About Your Marbles ?
Are They Out ?
Are They In ?

25. Assumption Families are motivated
 Probability of behavior
change or movement toward
or against goal
 Extrinsic…….
 Intrinsic ……
 What are they motivated to
do?

26. Parallel Processes
 Families must have opportunities
to grow alongside their loved one
that is in treatment
 The Truth is all parents fail their
children…..
 The Task of growing is to find our
own ways of parenting ourselves
 To Parent from a Place of Love
 Krissy Pozatek. LICSW

27. Parallel Process
 Letting Go of the reins
 Emotional Attunement
 Listening-Reflective
 Learning how to speak
 Shifting Responsibility Back to
your loved one

28. Multidimensional Family Therapy
Solution-based
 Behavioral
 Narrative
 Family systems model
 Family disease model
 Cognitive-behavioral
 Multidimensional

29. What if
 The Parent is right
 The Procedures and or
policies are incorrect
 The flow of information is
wrong
 The presentation of material
needs adjusting
 The parents get caught in an
alienation coalition

30. Recovery Issues
Issues Early Middle Advanced
Grieving Identify ones
losses
Learning to grieve Grieve past and
present losses
Neglecting ones
own needs
Realization of
needs
Beginning to get
needs met
Getting needs met
Being Over
responsible
Identifying
boundaries
Setting limits Responsible for
self-clear
boundaries
Low self-esteem Identify Sharing Affirming –
improved SE
Control Identify Taking
responsibility
Responsibility&
letting go
All or none
thinking
Recognize &
identify
Learning there are
choices
Multicolored
world
Being Real Recognize Risking being real Being real

31. Recovery Issues
Issues Early Middle Advanced
Trust Trust can be
helpful
Selective
Trusting
Trusting
appropriately
Feeling Recognizing &
Identifying
Experiencing Observing &
Using
Hi Tolerance
inappropriate
beh.
Questioning
behaviors
Learning Knowing &
having safe folks
Abandonment &
Conflict
Recognizing &
Identifying
Grieving &
Resolving
Freedom From &
work thru current
conflicts
Giving and
Receiving Love
Defining: What is
love
Practicing Refining, loving
self, higher power
Dependence &
Independence
Identifying Learning/
Practicing
Being healthy

32. Stages Of Change

33. In between the cravings
Find the Spaces In between
Omar Manejawa MD
Cravings – Myopic
Spaces- Change
Habits -Actions

34. Motivational Interviewing
 Directive client center
approach
 Process not Technique
 Collaborative
 Evocation- elicit clients
internal viewpoint
 Autonomy
 Roll With Resistance

35. MI Spirit
 Rogerian approach
 Coupled with a direction
 Equalitarian
 Warm, Empathetic, Affirming
 Respectful,
 Responsive
 Guiding & eliciting vs.
instructing & persuading

36. Characteristics of MI
 Counselor is active and directive
 Counselor helps shape behavior
 MI strategy is specific and systematic
 Consistent with principles of client choice and
empowerment
 Consistent with cultural sensitivity in that client leads and
counselors agenda is not imposed

37. Traps to Avoid
 Question-Answer
 Labeling Trap – dx codes
 Premature Focus Trap-start with
clients concern not yours
 Expert
 Taking sides
 Blaming Others _ who is to
blame is not as important as to
what your concerns are

38. MI Principles EE-DD-RR-SS
 Express Empathy
 Develop Discrepancy- help one get unstuck from ambivalent
feelings
 Roll with Resistance ( get out of the way )
 Support Self Efficacy ( Bandura) The capacity of a person to
believe they can carry specific act or behavior

39. How to Express Empathy
Use your Oars
 Open Ended Questions
 Affirmations
 Reflections
 Summaries

40. What Type of Communication Skills Do you
Have?
 Echo Key Words
 Open Ended Questions
 Paraphrase
 Body Language
 Summarize
 Self -Disclose

41. How do you Listen ?

42. Listening Exercise
 Break up in dyads
 I want a new phone or I
want to leave treatment
 Practice Listening – 3
minutes- Listen to what
is said and what is unsaid
 Debrief

43. Personal Roadblocks
 Kids are sick
 Had a fight with partner
 Phones are ringing-cannot
spend a lot of time
 Woke up late
 Boss is edgy
 Oh no not that Family– AGAIN !

44. 12 Roadblocks to Listening
 1. Ordering, directing, commanding
 2. Warning or threatening
 3. Giving advice, suggestions,
solutions
 4. Persuading with logic, arguing,
 5. Moralizing, preaching
 6.Disagreening, judging, criticizing ,
blaming

45. 12 Roadblocks to Listening
 7.Agreeing, approving, praising
 8. Shaming, ridiculing or
labeling
 9. Interpreting or analyzing
 10. Reassuring, sympathizing
 11. Questioning or probing
 12.Withdrawing, distracting

46. Assumptions To Avoid
 Person OUGHT to change
 Person WANTS to change
 Persons health is prime
motivation factor
 If she/he decides not to
change consultation is a
failure
 Individuals are either
motivated to change or
they are not
 Now is the right time to
consider change
 A tough approach is always the
best approach
 I am the expert and know best
 I am right my child, young
adult , grown child is wrong
 A equalitarian approach is
always best

47. Listen Reflectively- Listen with Emotional Attunement
 Being quiet and actively
listening
 Responding with a statement
that accurately reflects the
essence of what the client
meant
 Listen carefully think
Reflections

48. Reflections
 Think in terms of
forming an hypotheses
or best guess at what
client is saying
 Take a guess –Do you
mean…
 You have to
differentiate between
a question and a
statement
 Voice goes down at end of
statement rather then up
with a question
 “It sounds like you are
angry with your mother …
 A statement does not
require an answer .
 Used strategically
emphasize, clients view ,
feelings, ambivalence,
emotion change talk

49. Level of Reflection
 Repeating repeat what someone has just said
 Rephrase – substitute a few different words
 Paraphrasing-make a fairly major restatement
inferring what you think a person has said
 Reflecting feeling – special kind of paraphrase
where you are not necessarily reflecting content
rather feeling

50. Simple Reflection
 Client: This parent is driving
me crazy trying to make a
decision
 Counselor; Her methods are
really bothering you
 Client: I don’t have anything to
say
 Counselor- You are not feeling
talkative today

51. Amplified Reflections
 Exaggerate what client says
be careful not to be sarcastic
 So if I hear you correctly your
son/daughter needs…you to
bring him xx
 So you are likely to keep
bailing ..

52. Other strategies for Handing Resistance
 Clarification
 Shift focus away
from stumbling block
 Emphasize Personal
Choice and Control

53. Provide Summaries
 Communicate what you have tracked what the client has said so
that you have understanding of what is being said
 Helps structure session so you do not get sidetracked
 Provide opportunity to emphasize statements a client has made
about change talk gives client another opportunity to hear
what she has said in context provided by the counselor
 Example
Jonathan it sounds like you have made the choice to seek
continuing care. If I heard you correctly you said it feels like the
right thing thou scary thing to do. You have started to look at
some structured living situations that include monitoring and
help worth getting a job etc…..

54. Decisional Balance Worksheet
(Fill in what you are considering as change )
Good things about
Changing behavior
Good things about
changing behavior
Not so good things about
behavior
Not so good things about
changing behavior

55. Exploring Ambivalence
 The Existence of
conflicting emotions
or thoughts about a
person object or idea

56. DARN (Desire, Ability , Reason, Need)
 What do you think you will do ?
 What does this mean about your
habit ?
 What are your options?
 What's the next step for you?
 What are some good things
about making a change ?
 Where does this leave you?

57. Scaling Questions- Motivation and
Confidence

58. Resistance
 Traditional
 Client not getting it
 MI View
 Counselor may not be getting it
 Case Example –Jon

59. Signs of Resistance
 Arguing
Challenging
Discounting
Hostility
 Ignoring
-Inattention
-Non-answer
-No response
-Sidetracking
 Denying
 Blaming
 Disagreeing
 Excuses
 Claiming impunity
 Minimizing
 Pessimism
 Reluctance
 Unwilling to
change

60. Signs of Resistance
 Arguing
 Challenging
 Interrupting
 Resisting
 Discounting
 Hostility
 Discouraging
 Ignoring
 Inattention
 Not Talking
 Side Stepping=Filibustering
 Taking Over
 Cutting Off
 Denying
 Blaming
 Excusing
 Claiming impunity
 Minimizing
 Catastrophizing
 Pessimism
 Unwillingness to Change
 Demanding

61. Ten Strategies for Evoking Change
 1. Ask Evocative questions
 Why would you want to make this change? (Desire)
 How might you go about that ? (Ability)
 What are the three best reasons for doing that ?
(Reasons)
 How important is it for you to make this change?
(Need)
 So what do you think you will do? (Commitment)

62. Ten Strategies for Evoking Change
 2. Ask for Elaboration
 When change talk emerges ask for more detail. In what ways?
 3. Ask For Examples
Ask for specific examples, when was the last time that happened
? give me an example
 4. Look Back
Ask about a time before current concern emerged. How were
things better? different?

63. Ten Strategies for Evoking Change
 5. Looking Forward-
What would happen if things stay the
same/ If you are 100% successful in
making changes you want what
would life look like ?
 6. Extremes
What is the worst thing that could
happen? What is the best thing that
could happen

64. Ten Strategies for Evoking Change
 7. Use Change Rulers
 On a scale of 1-------------------
10
 8. Explore Goals and Values
 What are the persons values
and goals
 9. Join up –Come along side

65. Ten Strategies for Evoking Change
 10. Responding to Change Talk
(EARS)
 EXPLORE
 AFFIRM
 SUMMARIZE

66. Solution Focused Coaching
1. Not necessary to understand
deeper cause or meaning
2. Goals are defined by client,
focusing on the possible and
changeable, honoring client
choice
3. Small change is often all that is
possible
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67. Assumptions of SFT
4. When goal is defined by client,
you have cooperative client
5. Counselor, interventionist,
admissions, call center person
adopt a posture of inquiry, of
not knowing

68. Assumptions of SFT
4. When goal is defined by
client, you have cooperative
client
5. Counselor, interventionist,
admissions, call center person
adopt a posture of inquiry, of
not knowing

69. Crucial Conversations
1. Client is always right
2. Agree with clients goal, its
about choice
3. Use client’s language
4. Develop Compliments to
support change

70. Talking With Families
4. Develop Compliments to support
change
5. Provide bridging statement and
rationale for suggestions
6. Assign Tasks based on
relationships
7. Seek solutions
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71. The SFT Interview
 Initial
 Break
 Ending or Close

72. Interview Questions
1. Precession Change
2. Coping
3. Relationship
4. Exception
5. Miracle- In a Perfect
6. Scaling
78

73. Compliments
 Direct: Positive verb, attribute
or reaction to client
 Indirect-Something that implies
positive
 Self Compliment- “I”
statement
79

74. Assignments
 Always based on relationship
 Readiness to Change
 Focus on Attainable goals
 Design ,Small steps Proceed
slowly
80

75. Cases
 I want to know everything
that is said in treatment
 You are not responding to my
child’s needs

76. King Baby
 I am very important
and only can talk
with the CEO at least
3 times a day at my
loved one

77. Queen Baby
 The problem is you, your treatment
center does not understand our
daughter. She is unique
 My daughter must talk to me at
least once a day
 My daughter demand s a special diet
 My daughter wants her phone

78. Family’s After Treatment –Heroic
 Operate from a Place of Love
 Shift Responsibility from
bailing out to responsible
choice
 Attunement
 Individualization
 Healthy Boundaries-enforce
consequences Own Recovery
 Talking care of themselves
 Good physical health
 Emotionally sound
 Acting from ones values

79. Heroic Counselors – Help Create Heroic
Families

80. Recovery is Like Walking on Sunshine

81. Resources
 The Daring Way- Brene Brown
 Crucial Conversations – Patterson etal
 The Parallel Processs- Kathy Prozatek LICSW
 The Journey of The Heroic Parent –Brad M Reedy PHD
 If You Meet The Buddah On The Road-Kill Him- Sheldon Kopp
 Motivational Interviewing- Miller and Rollnick
 http://www.motivationalinterviewing.org
 Solution Focused Therapy= Young and Berg
 http://www.solutionfocused.net
 Dr Louise Stanger http://www.allaboutinterventions.com