11 Solutions to Highly Difficult Clients - Book

11 Solutions to Highly Difficult Clients
Effective Counseling Interventions

Professional Resource - Paperback - 6 CE Credits Available*

Stop Struggling and Start Succeeding with Frustrating Clients!

Whether you have 1 difficult client on your caseload or 100, this book offers practical understanding and useful interventions to help increase your therapeutic effectiveness.

- Minimize manipulations.
- Increase compliance.
- Eliminate denial.

- Understand motivations and create targeted interventions to build client trust and maximize efficacy.

- Possibly the best explanations and responses ever offered for overcoming challenging client behaviors!

TABLE of CONTENTS

INTRODUCTION ----------------------------------   1

SECTION I  ---------------------------------------    9
11 Reasons Clients are Difficult
Fear, Lack of Options, Cultural Values Clashes, Overreaction, Impaired by Chemicals or Catastrophic Mental Illness, Emotional Paralysis, Limited Approaches, Client Needs are Met, Conflict Gains Attention, Ignorance, Familiarity Trap

SECTION II  --------------------------------------  33
11 Solutions to Highly Difficult Clients
Let the Train Wreck Happen, Emilinate Power Struggles, The Case of the Clam, Feed Clients Therapeutic Big Macs, Teaching Is Counseling, The case of Jim, Stob Believing in Denial, Use Strengths to Compensate for Deficits, Motivation as the Key to Change, Give Them a Million Dollars, Paradoxical Intention, Bring in Others, Healthy Modeling, Let the Train Wreck Happen
Stop Believing in Denial  --------------------------  55
Using Client Strengths  ---------------------------   59
8 Principles of Client Motivation ------------------  70

SECTION III  ------------------------------------- 103
The Paradigm of Denial, The Easier, Softer Way
Bonus Solutions #12  ---------------------------- 108

CONCLUSION  ------------------------------------  111
CONTINUING EDUCATION INFO----------------  113

EXCERPT:

INTRODUCTION

When I was in graduate school and learned how to do counseling, I looked forward to the opportunity to finally treat real clients. After graduation, when I took my first counseling job, I began working with substance abusers. When conducting therapy sessions, I did exactly what I was taught to do in graduate school: Sessions were 50 minutes long, during which time I sat at a 45-degree angle from the client. I used my training in appropriate body posture, which was S-O-L-E-R, or Sit down, Open body posture, Lean forward, make Eye contact, Relax. I reflected back on what I thought I heard my client say. I said “uh-huh” and sounded as if I had a Master’s Degree.
 
When my substance abusers left their counseling sessions, they all did the exact same thing: they left my office and immediately got high.
 
Counseling is usually a second career choice. Most of the professionals I speak with were something else before they became a counselor. Perhaps they were a teacher or a salesperson first, or had worked in accounting before going on to finish a graduate degree and becoming a psychotherapist. 

For me, counseling was a first profession. When I graduated with my Master’s degree, I was only 23 years old. Because I didn’t have a gray beard and a gray mustache, I couldn’t get the “good jobs” that other counselors had. Instead, I got the jobs that nobody else in our profession wanted. I worked in the halfway house environment, with substance abusers, with adolescents in state custody, and with criminal justice populations.
 
I learned a lot in graduate school, but after becoming a licensed professional and actually providing real services to real clients, I recognized something important: graduate school had taught me how to think, but it did not teach me the skills necessary to actually conduct effective counseling, especially with highly difficult clients.
 
Most people don’t want to work with highly difficult clients. Consequently, in my young and untenured state, HDC’s filled my caseload. I worked with angry clients, raging clients, substance abusing clients, the chronic mentally ill, and the adolescent mislabeled with the “psycho fad” of the day (who probably acted out his behavior only because he was a conduit for parental stressors and had become the identified patient).
 
I got into the field like most other counselors - not only because I didn’t have to take math to get the degree - but also because I genuinely wanted to help people. Therefore, early on in my career I was quite frustrated about being ineffective - not because of low self-esteem, but because I genuinely wanted to have a positive impact on other individuals.
 
Now, older and wiser and obviously more experienced, as I think back to the highly difficult clients I worked with over the years and the interventions I provided in treatment settings, I realize that those frustrations are conquerable.
 
Graduate school likely did not prepare most of us for what to do with the suicidal person in our office at 4:45pm, when we’re getting ready to leave at 5:00pm. And graduate school probably didn’t prepare us to provide effective intervention services to the client who replicates the same self-destructive behavior time after time, every time they leave the doors of our office. Nevertheless, there are strategies that can impact highly difficult clients such as these. 
 
Even the most difficult aspects of counseling - resistance, denial, sabotage, rage, staff-splitting and chronic failure - have solutions. There are even solutions for the couple who shows up for marriage counseling not to repair their marriage, but to begin the mediation process for divorce. There are solutions for the difficult youth in treatment labeled as the identified patient in the family, who would likely be better served if their parents were the ones behind the locked door of the seclusion room. 
 
Highly difficult clients are usually not difficult due to any real complexity, and so the solutions offered in this course aren’t very complex either. Generally, clients are difficult because the behavior we have labeled as difficult serves to meet the client’s specific needs. 
 
This text offers eleven key solutions for working with highly difficult clients, which can have a positive impact regardless of the treatment setting, with the old client, the young client, and the mentally ill client, the substance abusing client or the couple on couples counseling, regardless of a client’s cognitive abilities.
 
This text also comes with a simple disclaimer: Even though these interventions are easy to apply, like anything else in counseling, they will not all work for all clients all of the time. Clients are human, and therefore every client and every situation is unique. Some interventions will work with some of our clients, some of the time, and others will not.  
 
I think one of the most effective interventions in counseling is to recognize that effective counseling is not about helping most of the people most of the time, but rather it’s about helping those who we are able to impact some of the time, with the hope that these healthy individuals can then go on to impact other people in their lives in a healthy way. 
 
When I was in high school, things did not bode well for me. In fact, when I was 16, everyone either died or moved. Life was simply not going my way. A friend of mine named Bob worked as the youth minister at a local church. During this particularly difficult time in my life, Bob was really helpful. He opened his home to me; he supported me, prayed for me, encouraged me and helped me enroll in college after I finished high school.
 
Because Bob was such a wonderful friend to me, I kept casual contact with him, calling now and then to say hi and check in. He married and over the years had four children, while I married and had three. I met Bob while growing up in Chicago. Eventually he moved over to Michigan and I migrated to Texas, Oklahoma and now Kansas.
 
A few years back, I called Bob shortly before Christmas, just to say hello. He was excited that I called, because he had news he wanted to share with me: After 20 some years of youth ministry, he was now going to sell hydraulic hoses.
 
I was shocked! After two decades of successful youth ministry, selling hydraulic hoses was not a career move that I would have expected Bob to make.
 
Dumbfounded, I asked, “Gee, Bob, why hydraulic hose?”
 
He replied, “Well, it’s a commission sales job, and since my four children are getting older, I need to make more money to pay for their education.” He must have sensed my confusion because he added, “Don’t worry; I’ll still be involved in ministry, but just as a layman, not as a professional.”
 
I then asked, “Um, after 20 years of youth ministry, how do the other kids you’ve worked with over the years feel about your job change?” 
 
The phone was silent. Apparently, Bob was thinking of an answer. Finally, he said, “I don’t know.” 
 
This surprised me. Maybe he just didn’t want to tell me how upset everyone was to hear this news. So, I pressed him a little. “What do you mean you don’t know? When you talk to them, what do other people say about your career move?” 
 
“Well, Richard, now that I think about it, I don’t really talk to too many of the kids who I worked with over the years.” 
 
“What? Twenty years of youth ministry, and you don’t keep up with any of the kids you worked with over the years?” 
 
“Richard, I work with kids. If they have problems in college during their first year, I usually hear from their parents and sometimes I talk to them, but most just move on. They graduate, relocate and get on with their life. If they didn’t go to college, they joined the military. Occasionally someone will show up in a hot new car purchased with military credit union money, and they’ll cruise around the parking lot a few times, and then disappear. In my role as a youth minister, I’ve come to accept that the young people I work with simply grow up and move on with their lives.”  
 
“Wow, Bob, that must be enormously frustrating - not to hear from the kids later and know how they’ve turned out. Didn’t you wonder if you were having a successful impact on them or not? How could you just keep doing it all these years, without that kind of reinforcement?” 
 
Bob responded with a light chuckle, “Well, you kept calling.”
 
For Bob, satisfaction as a youth minister did not come from helping most of the kids that he worked with most of the time. Instead, he learned that satisfaction came from helping some of the kids, some of the time.
 
Bob has probably snarfed Jell-O with thousands of adolescents over the years. He probably spent twenty New Year’s Eves at a lock-in, eating cardboard pizza and sharing the Gospel. He probably can’t even count the number of weekend retreats he’s held or the times he’s been on the campuses of Chicago and Michigan high schools.
 
Of the thousands of kids Bob has worked with, he only positively impacted some of those kids, some of the time. Bob ended his career as a professional youth minister, satisfied with how he had helped individuals, not frustrated by failures of reaching the masses.
 
The counselor frustrated with highly difficult clients would do well to learn from helpers like Bob. The true measure of our success comes from the quality of help we provide, rather than the quantity.

*OPTIONAL CE CREDIT:

We offer a 6-Credit Hour Online CE Course based on this textbook, and therefore you can read this book, then take the Evaluation of Learning Quiz and receive a CE Certificate. The fee for receiving the CEUs is $89 (the same as taking the Online Course).

This book's contents and the equivalent CE-CEU-CNE course is appropriate for all mental health professional counseling counselors (LPC, LCPC, LPCC, MHC, RMHC, NCC), marriage and family therapy therapists (MFT, LMFT, RMFT), social work social workers (SW, LCSW, LMSW, SWA, LICSW), psychologists, psychology associates (LPA), chemical dependency substance abuse counselors (LCDC, CADC, CAD, DAC, CAAD, CSAC), and nursing registered nurses (RN, LPN, LVN), and related behavioral health professionals.