Helping Clients Tell Their Stories in the Therapeutic Dialogue
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Clients look to therapists for guidance with problem issues they consider beyond self-management. The therapeutic dialogue represents a critical and decisive engagement that sets the stage for presenting narratives, defining issues, formulating goal-oriented outcomes and creating strategies that inspire motivated action. To underestimate the value, the stakes, or the potential outcomes of the therapeutic dialogue would be tantamount to culpable disregard – or perhaps even gross malfeasance– especially when clients report sustained problematic symptoms or terminate therapy prematurely. Therapists can enhance the therapeutic dialogue and improve client satisfaction by using probes, being aware of distorted listening, challenging client presentations, discerning reluctance and resistance behaviour, and developing empathy.
The Benefits and Risks of Using Probes
The intended purpose of probing is to gather any helpful information that will optimise goal formulation and increase the potential for successful outcomes. By using probes therapists can assist clients to “identify and explore opportunities…clear up blind spots…translate dreams into realistic goals (Egan & Schroeder, 2009, p. 150) and exhibit genuine interest in understanding every possible nuance of their multidimensional story. Probing questions create the opportunity to develop a more complete picture of the client’s story from which to formulate a therapeutic plan. Without pertinent information an action plan is incomplete. For example, knowing a client’s history of unsuccessful treatment completions may help in the selection of alternative treatment options. Other potential benefits include helping clients to fully participate, to be clear and concrete in presenting the problem situation, to disclose and describe perspectives and intentions, to unearth all relevant information, to consider other viewpoints, to navigate and stay focused on a change-oriented process, and to encourage the skill of challenging self while recognizing the benefit of being challenged (Egan & Schroeder, 2009).
A risk factor relative to probing may include a client feeling overwhelmed by a barrage of multiple questions – especially those that are considered as not having a direct bearing on the presenting problem. In a correctional setting (where I provide therapy) inmates can feel scrutinized, observed and suspicioned throughout the incarceration process, and may therefore be reluctant to disclose information deemed sensitive or personally intrusive. Thus it is important in a therapeutic session that exploration not be unreasonably invasive or increase feelings of vulnerability. Another risk may involve possible misinterpretations of verbal or non-verbal probing. A probe can relay the wrong message from what was intended. For example, I once asked a client why he was at the location where he was arrested. He retorted with a defensive and challenging tone, asking, “Are you suggesting that I knew what was going down? I didn’t know he planned to kill them…Nobody fuckin’ believes me”. My question had more to do with my curiosity than what the client wanted from the helping dialogue. The tone of our discussion changed as a result. A probe can disrupt both the client-centred process and the therapeutic relationship if caution is not exercised.
A technique for probing may take the form of a statement that asks the client to provide clarification or an enhanced description. I may respond to a client’s story by stating, “I’m trying to follow you, but I’m not sure I understand what you mean by…” Another method involves making a request for more information (e.g., “Can you describe for me what you mean when you say you went into a rage?”). Questions are the most common form of probing for information from clients. Open questions (e.g., “How afraid were you?”) are preferable to closed questions (e.g., “Were you afraid?”) as they elicit more client-originated information. Also, using a single word or phrase that communicates a need for further explanation sends the signal to the client that he or she is being heard and that more clarification is desired. Accentuating the client’s choice of words helps to stay focused on the issue at hand.
Probes are an effective way of guiding a client through the storytelling process. When applied appropriately, probes express interest, empathy and attentiveness – which are often appreciated as a rare commodity in a correctional setting.
Distorted Listening
A therapist’s primary role is to listen intently to client presentations. When listening involves preconceptions, or incorrect interpretations, a therapist may be prone to distorted listening. Egan and Schroeder (2009) have highlighted six forms of distorted listening. They include filtered listening, evaluative listening, stereotype-based listening, fact- centred rather than person-centred listening, sympathetic listening and interrupting. Two forms of distorted listening I have experienced and am challenged by in my context of helping include evaluative listening and sympathetic listening.
In a correctional setting there is a tendency to regard clients according to the particulars of their offence history and assessed classification (e.g., maximum security). Many clients are well known in our facility as “recidivists” (i.e., repeat offenders) and are often treated as incorrigible. As a frontline staff member I am privy to a client’s criminal/legal reason for being incarcerated. But as a chaplain/therapist I try to maintain an awareness that complex personal factors are also relevant and remain for the most part unknown – until opportunities are created to unearth this material. By taking a holistic approach (i.e., considering any and all biopsychosocialspiritual factors), I am able to reduce the tendency to assess clients based solely on behavioural reports. In fact, unless one is postured to listen to clients beyond the presenting information, distorted listening is likely to occur. As Egan and Schroeder (2009) point out, unless clients are first understood, then helped, the default of an evaluative listening approach can result in “advice giving”, which may “put clients off” (p. 118).
It can sometimes be challenging to resist the urge to just tell a client (from a position of expertise) how to navigate his predicament before understanding the complete story. On this point my strategy to prevent premature helping involves taking the time in the first session to listen and formulate a clear understanding of the client’s request before succumbing to the pressures of the “I need it now” sense of urgency that often accompanies inmate requests for help. Another strategy used to counter an evaluative-listening-tendency involves mentally separating a person’s behaviour from other aspects of the person. I cannot help but disapprove of (and sometimes be repulsed by) an offender’s criminal acts; but when I meet with a particular offender I try to maintain a non-biased and professional demeanour that focuses on the nature of the request, and the reasonableness of providing services. This strategy has been particularly difficult for me (e.g., In two separate cases one of my clients murdered another, which created a multi-level personal and professional conflict).
Another form of distorted listening that can affect the therapeutic process is sympathetic listening. It is important to differentiate between sympathy and empathy when counselling clients. Empathy – the ability to discern and even feel or sense a client’s emotional experience – is an asset in formulating a therapeutic relationship; sympathy can compromise the role of the helper and, by way of transference and countertransference, “reinforce self-pity” (Egan & Schroeder, 2009, p.119).
In my dual role as chaplain and therapist I am expected by many to be compassionate and caring on a personal level, while at the same time providing a professional service. I must admit, the line between empathy and sympathy is a fuzzy one for me. Sometimes I have a tendency to take sides as an “accomplice” (p. 119) in the helping relationship. Other times I am caught in transference and countertransference and may disclose personal experiences in the online counselling dialogue. Most often I am aware of the limits of this vulnerable interaction. But the tendency to succumb to sympathetic listening is prevalent by nature.
So, strategies that minimise the potential for this type of distorted listening include two approaches (for me). First, if I am engaged in a dialogue that begins with an emotional storytelling, I listen intently for key factors (i.e., problems/complaints) that will form the basis of our collaborative problem/solution-management focus, respond when appropriate to the client’s presentation by acknowledging the emotion that the problem is connected to, and then discern what type of support the client is requesting (e.g., pastoral presence, advocacy, therapeutic intervention). Secondly, I try to communicate to the client what resources and options are available to address the identified issue. An emotional presentation may require tissues, more time in a quiet space outside the unit, a private phone call to family, or a scheduled follow-up session – rather than a sympathetic hug.
Challenging
Challenging clients means endeavouring to “do some reality testing and invest what they learn from this in their futures” (Egan and Schroeder, 2009, p. 170), and to encourage them to challenge themselves by exploring available ways and means of achieving desired outcomes. As therapists we can be instrumental in providing other viewpoints, exposing cognitive distortions, enhancing self-assessment strategies and even being the “devil’s advocate” in constructive or deconstructive ways.
Five challenge targets include self-defeating mind-sets (e.g., affirmed or imposed negative stereotypes from others), self-limiting internal behaviour (e.g., believing treatment will be ineffective), self-defeating expressions of feelings and emotions (e.g., hopeless resignation that bail will not be granted), dysfunctional external behaviour (e.g., refusing to converse with correctional officers in accordance with the inmate code) and discrepancies in thinking and acting (e.g., “I’m incarcerated for trafficking narcotics to support my family”)(Egan & Schroeder, 2009).
Challenging adult male clients in a correctional setting involves potential risks (e.g., aggressive behavioural responses, misinterpretations, emotional response that may incur hostile behaviour from other inmates if viewed as vulnerable). It is prudent therefore to ensure directed challenges are delivered at an appropriate stage in the helping dialogue and in a manner that is compatible with an established therapeutic relationship.
It is sometimes difficult for me to challenge clients who are being disruptive in a group counselling session. Given the inmate subculture, such a challenge would pose two possible responses. They either take responsibility for the challenged behaviour and modify it to satisfy the challenger; or they view the challenge as a threatening confrontation that requires a hostile retort to ‘save face’ in the presence of other inmates in order to avoid the appearance of being perceived as weak. I have experienced both scenarios.
I have learned to prevent most potential risks related to challenging by understanding the social culture within a correctional setting and by enhancing my skills training. To reduce potential difficulties with challenging, I look for areas that challenging would represent a benefit to clients and would be most effective in addressing barriers to optimal functioning (e.g., improving the therapeutic relationship, better social integration among peers).
I once completed a “conflict style” inventory questionnaire that indicated avoidance as being my primary approach when faced with potential stress related to interp
