Clients are always cooperating. They are showing us how they think change takes place. As we understand their thinking and act accordingly, cooperation is inevitable. Clients are always cooperating. They are showing us how they think change takes place. As we understand their thinking and act accordingly, cooperation is inevitable.
In workshop after workshop, therapists have asked what to do with the “resistant” clients, those who do not want to change, who have some investment in the problem, who sabotage treatment, who “yes but” every suggestion you make, who are just plain stubborn, or who are defensive or resistant because of the pain or price of change.
We have difficulty answering these kinds of questions from therapists in the form the questions are usually asked because to reply to the questions as phrased would mean that we subscribe to the assumptions within them. Sometimes we say we do not have these types of clients. The answer is true, but not very satisfying to the therapist troubled by the clients who prompt these questions.
We have a different experience with our clients, not because we select out all the clients that others complain about, but because we work under assumptions that enable us to work with them in a different way that facilitates cooperative interaction.
This approach is a consumer model and a solution-or goal-oriented model. Jay Haley in Problem-solving Therapy (1976) made the very important distinction between problem-solving models and growth models. Problem-solving models, although not unique in this regard, tend to focus on what clients want and to see them as the experts on what they want. Growth models, whether they are based on norms of health, pathology, or self-actualization, tend to see the therapist as the expert about the problem and about what clients need to do.
A solution-focused approach is positioned on the problem-solving side of Haley’s distinction. We assume that clients are the experts on what they want and that it is not up to us to tell them what is wanted.
Given the distinction between consumer model and therapist-as-expert-model, we can assume that clients coming in to see us want something. We do not have to take on the responsibility for talking clients into treatment, confronting them about what we see as the problem, or for solving the problem.
We do not claim expertise on mental health, normal development, normal family life, or normal marriages. Instead, our expertise and role are in asking questions that open up possibilities for clients to do something different or do what they want. We see this as similar to Goolishian and Anderson’s “participant-managers of the therapeutic conversation” (Anderson & Goolishian, 1988). We prefer the words conversational facilitator. Our role is to facilitate conversation between clients and ourselves that enables them to get what they want. What the client wants may be the dissolution of a problem or getting on track to solving a problem or attaining a goal.
With this definition of a consumer model, we assume clients want what they say they want, that they are motivated toward the goal, and that our job is to cooperate with their endeavor.
Along with the assumption that clients come to see us because they want something, we assume people usually show us how they think change takes place with regard to their goal. It is up to us to cooperate with their view. Their beliefs about change, about the problem, and about the hypothetical solution fit recursively with their actions.
The onus is upon us to join the clients with their view and find ways to fit with their view, while facilitating a more open process that introduces difference. Whether constructing solutions and introducing differences takes place in conversation, in providing feedback, or in suggesting tasks, we need to communicate with clients in ways they experience as fitting.
The general principles of cooperating are pacing and inviting.
The principle of pacing (Grinder & Bandler, 1976) involves reflecting back to the client or matching the client’s tone, affect, and words. If the client talks in a low tone that might be described as sounding discouraged or depressed, we use the same tone. If the client talks in higher tones that sound more “upbeat,” we use the same. If the client tends to talk in an intellectualized way, we do the same. If the client uses language loaded with action words, we respond with the same.
This is not just reflective listening. Although we are affectively empathic, we do not think of empathy as the only tool or as a primary treatment tool.
Someone doing reflective listening might say, “It sounds like you are very discouraged and angry with your children. How else does their behavior make you feel?” The intent of reflective listening is to facilitate the expression of feelings. Reflective listening follows the assumption that clients will change or grow in self-understanding by expressing their feelings and having the therapist understand and accept them.
The principle of pacing assumes that when clients feel supported by the same use of affect and the same language, they are more likely to accept our invitation to new and possibly more open directions or new language.
Pacing goes like this:
Therapist: What is your goal in coming here?
Client: I’m coming here because of my son (said with low tones and sad affect). He’s been messing up terribly at school and I can’t figure out what I’m doing wrong. I just can’t see my way out of this mess. Friends at Alanon tell me I have to turn it over to my higher power.
Therapist: (Also with low tones and sad affect) So you are coming here because you want things to be different with your son with regard to school and it seems at this point like you can’t see your way out of this. At the same time, your friends are advising you to turn it over. Is that right?
This response by the therapist reflects the same affect and voice tone while also referring to the areas of the parent’s concern—her sons messing up at school and her search for what she is doing wrong. The response also reflects her use of visual terms and wanting to see her way out. Her language seems to be drawn from the 12-step program. Pacing is not only affective support, but also a joining in her worldview. In this example, sharing her concerns and using her language of the 12-step program paces her thinking, and joins her view.
With pacing, the client will give us indications of appropriate fit by both nonverbal and verbal responses. If the client responds with a head nod or additional statements consistent with our own, we know we have paced well.
If the client, however, frowns, shakes her or his head, or gives us some other cue, we guess that our response did not fit and we try something else.
If the client also gave us verbal feedback that indicated we were off track, then we would need to adjust. For example:
Client: No, actually, it is his father that I am most upset about. If he weren’t drinking so much, I think we could see our way clear about what to do about our son. I need some help with what to do about his father’s drinking.
Therapist: Oh, I’m sorry, I misunderstood. So, you are thinking that the way to make things better for your son and his school performance is by doing something about your husband’s drinking.
This response would be feedback that her focus is more on her husband and that she sees a connection between her husband’s behavior and a solution.
Responses by the client are feedback of what the next step is for us. If the client responds with acknowledging signs or language, we know we can proceed to possible invitations to new areas or ask for further clarification of what she has already said. If the responses are negative in some way, they are feedback for what we may need to do differently in order to cooperate with this client and her unique affect and thinking.
This principle refers to how we introduce “difference” and an opening-up process in the therapeutic conversation. While pacing is necessary for clients to initially respond as if they are understood both affectively and cognitively, inviting is necessary for further change. If we only did pacing, the risk is that we would just support the clients’ view and solution may not be facilitated.
Inviting is the process whereby a therapist uses questions and the presuppositions within the questions to politely ask the client to search for or create a new meaning. Through the conversation centered around answering the questions (invitations), difference and new experience may be created by and for the client.
The introduction of “difference” on the part of the therapist and client comes about as a natural extension of the assumptions of the model. With the assumption that focusing on the positive, the future, and the solution facilitates change, we form our questions in line with the assumption. We ask about what the client wants, the times when change in the solution areas is already happening, and the hypothetical future.
Our questions which are positive, exception-oriented, future- or solution-oriented, are like invitations to new ways of thinking and acting. The questions are merely invitations and if the client does not respond or accept the first invitation, we try another.
Here are some ways of pacing and inviting the clients to advance the process of developing solutions.
When you are pursuing the pathways of the map and the clients seem to be talking in ways that open new possibilities, with more solution-focused talk taking place, then keep on doing what you are doing. The clients are then accepting your invitation to look at the positives in either the exceptions or the future. An example might go like this:
Therapist: What is your goal in coming here? (goal frame)
Client: I would like to have more harmony with my wife and her kid.
Therapist: How does that happen now, when it happens? (exceptions frame)
Client: I don’t know how to explain it, but sometimes my wife and I are right in “synch.” You know what I mean, we both know how to handle her little girl and what the other is thinking.
Therapist: What are you doing when you know that the two of you are in “synch?” (Specification)
Client: We look at each other and I know that she agrees with what I am doing and she is supporting what I am doing.
Therapist: And what are you doing when she is doing that?
Client: I guess I have talked with her beforehand and so we are both on the same wavelength.
Therapist: Let me double check. So, you want to be doing more of the things like talking beforehand that make for more “in synch” times with your wife? (clarification and bridging the exceptions as the goal of therapy)
In this example, the therapist has used the client’s language and invited him to talk about what he wants and some exceptions. The conversation seems to be positive and solution-focused. The tone is somewhat neutral, but the language is positive.
Oftentimes, clients come in and describe situations that are horrendous or several situations that are overwhelming. An example might go like this:
Therapist: What is your goal in coming here? (goal frame)
Client: I just don’t know what to do (with low tones and looking down). My son, here, never seems happy, my wife is on my back about him, my ex-wife is threatening to fight for custody of him again, and he is failing school. The school called me last week and called me over because they found marijuana on him. I try to stay on top of him, but I am changing jobs and my wife is working and taking care of the younger kids. I don’t know what is going on anymore.
Therapist: My God (with similar low and worried tones), there is really a lot going on. All these things happening at one time. Even just one of these problems would be enough. How have you managed to stay on top of things as much as you have? (In sympathy with the situation, but asking an exceptions-oriented question within the coping framework of “staying on top of things as much as you have”)
Client: Well, I don’t feel very on top of the situation, but I just can’t give up or let him go back to my ex.
Therapist: With that kind of pressure, how have you managed to stay on top even a little? (Said with the expectancy that to not be on top would have been more likely)
Client: Well (with voice tone rising some), I keep reminding myself that he has gone through a lot and that it will take time.
Therapist: (With similar rising tone) How does it help to remind yourself of that? (Specification)
Client: Somehow, I can keep the longer perspective that way.
Therapist: Keeping the longer perspective seems to work better. How do you manage that perspective when there are so many things going on? (Again with sympathetic tones, but oriented around the exception within his coping)
Client: I just know that this is a crazy time and how much I care about him.
Therapist: Keeping this longer perspective works better even though from the short view it looks bad sometimes. So, I guess keeping this longer perspective would be more of what you want? (Bridging the exception as the goal of therapy)
Client: Yes. When I keep that perspective, things seem to go better.
In this example, the therapist acknowledges what the client says—that things are overwhelming. The therapist would be too abrupt to push for a goal immediately upon the client coming in. At the same time, positives can be brought out by scaling down the questions to a frame of “managing as much as you are.” By asking him how he is able to manage or cope despite the overwhelming circumstances, the therapist acknowledges the situation, yet elicits positives and exceptions.
Frequently, clients present situations with all the reasons why nothing will work. The clients may indeed feel frustrated because they may think they have tried everything, but nothing has worked. They may want to let you know how hard they have tried. Also, they may have been burned in their efforts so many times that they are very afraid of trying again. Whatever the reasons within their thinking, they seem to be saying “Yes, but” to any positive suggestion or to respond with more negative talk whenever you try to invite them to talk about exceptions. The “Yes, but” may go like this:
Therapist: What do the two of you want out of coming here? (Goal frame)
Husband: I don’t want to get a divorce, but I cannot seem to please her.
Wife: That’s not true, but he just doesn’t act like he wants to be married. He is never home and when he is home he is so involved with his hobbies in the basement that he never acts as if he likes me.
Therapist: So, I guess you don’t want things to continue this way. How do you want things to be different? (An attempt to invite a positive statement of a goal)
Wife: Well, I want him to pay attention and to like being with me. But he never will. He doesn’t want a divorce because he can’t afford one, but he will never be married. He is just so wrapped up in himself.
Husband: That is not true. You don’t want me to be involved. Every time I suggest doing something, you say I don’t really want to.
Therapist: So, are there times when things aren’t so bad or that things go a little better? (Searching for exceptions)
Wife: Things have been like this for years, but I had the children to take care of before. But he has always been wrapped up either in the business or in his own things, never in me or the family.
Husband: She has never been satisfied.
Therapist: (Adopting their view and cooperating with their seemingly more negative presentations) It sounds like both of you are very unhappy. With things having been this way, what evidence do you have for hope that things can be any better?
Wife: When we were first married he was nice but not after the kids were born.
Therapist: (With sympathy for her frustration) I know and that was a long time ago. So is there anything happening lately between the two of you that gives you any reason to believe that it is worthwhile for you to try anything different? It sounds like you have tried a lot. (Therapist cooperates with the clients’ seemingly pessimistic view to find out if they will provide positives that can be built upon or if other options such as divorce are in fact what they want.)
Wife: Not much.
Therapist: So, are all the recent things between you telling you that you should separate or divorce? (Exploring the other options)
Wife: Well no, I am not there yet. There has to be something that can be done.
Therapist: Perhaps, but it sounds like you each have been burned and you probably don’t want that to happen again. Without any times recently when things have been at least tolerable, I would seriously wonder whether you might want to try again. (Advocating for the part of them that has been hurt and disappointed in the past and at the same time indirectly asking if there are exceptions to the problems that would be a basis for hope)
Wife: Well, he has been a good provider and he does come home.
Therapist: How does this make a difference to you? (Exploring the meaning of his behavior to her)
Wife: Well, because he used to just stay at work until late at night and I would never see him. Lately, he has been coming home a little earlier.
Therapist: How do you think he would explain that? Would he say that was anything different? (Exceptions frame from the “for the other” reporting position)
Wife: I don’t know. I would like to think he was coming home earlier because he wants to make things different for us.
Therapist: I know, but you don’t want to set yourself up for disappointment. How will you know if this is something for real? (Still advocating for the part of her that does not want to be hurt again and asking about a hypothetical solution)
Wife: Well, if he keeps on doing it, or calls when he can’t, or lets me know in some other ways.
Therapist: (To husband) This is true, you have been coming home earlier? (Checking the husbands perception of the exception)
Husband: Yes, I don’t want to lose her, but I don’t think she will ever be convinced that it is for real or that it is enough.
Therapist: How did you decide to make this change? You could have just thrown in the towel. (Exploring the exception within the frame that he chose to make a change)
Husband: Because I do love her, even if she doesn’t think so. If I have to do a few things her way, then that’s what I’ll do.
Therapist: Well, I am impressed that you are persisting. But how will you know that she is becoming more convinced in your changing? If she is pleased, you don’t want to miss her acknowledgments and then give up or be hurt. (Cheerleading and exploring signs for him of her being pleased)
Cooperating with this couple means pacing and joining with them in their skepticism about a positive future and supporting their disappointment and hurt. If you were to point out the positives in their relationship, the couple would more than likely shoot the positives down. For instance, if you said something like, “But there must be some reason that you are staying together, there must be some good things about him. He is a good provider after all, isn’t he?” she might agree initially and then “Yes, but.” She might say, “Yes, he has provided for us, but what good is that if he is never around!”
When the therapist advocates for the parts of them that do not want to be hurt again or are fearful of change, the couple can then offer the reasons for change and begin to bring out “exceptions to the problem” times as evidence for hope. These exceptions can then be used to build solutions. Even with the exceptions, however, the therapist must cooperate with their skepticism and caution.
The other possibility is that when you ask why not consider other options, the couple might actually choose other options and want your help in making the separation. That possibility is okay, also. Your work then lies in clarifying that as the goal.
The position you are taking as therapist is on their side—for them to get what they want. You are not necessarily advocating their staying together or separating, for change or no change. By supporting their fears as well as their desires for change, you free the couple to make their own choices.
Usually vague descriptions that clients present as goals are the broad meanings or contexts for specific behaviors or interactions that they want. We assume that a goal is more workable if the goal is defined as specifically as possible. We want the goal to be specific so that clients can more easily recognize their performance of it. Our concern with a vaguely stated goal is that clients may not have developed signs of the goal’s occurrence and, therefore, miss occasions when the goal is already happening. For example, clients may state that they would like to have a “positive attitude.” With the goal stated in this general form, we do not know and the clients may not know if “positive attitude” means: feeling good; feeling a certain level of positive; being positive all the time; being positive only in certain circumstances; being positive about certain things or situations; being positive in a way that is self-reinforcing; or something else. If clients meant a positive attitude was feeling positive all the time, they may think they are failing at any time they are less than positive. With such a vaguely defined goal, they would probably miss the potential of all the times they do something that leads to a positive attitude. Clients would also probably dismiss the times when they act with somewhat of a positive attitude because the attitude is not all the time.
Therefore, we want clients to go beyond the broad meanings and give us more detail of their goals so they can recognize how the goal may be happening now or how the goal will appear in the future.
Many clients report their situation only as they see it now—the problem situation and the end state when there will be no problem whatsoever. A behavioral technique of scaling enables clients to break down this “either/or,” black/white, and vague way of thinking, and fill in the movie with some exceptions and some intermediary actions in a process and specific way. The scaling technique can be useful for clients to more specifically define goals, as well as exceptions or hypothetical solutions.
We use a scale from one to 10 as a behaviorally oriented therapist would do, but we add on our solution-focused presuppositions. For example:
Therapist: What is your goal in coming here? (Goal frame)
Client: I would like to get out of this depressed state. I’m being a total couch potato. I just keep on procrastinating and watching TV. I just keep getting more and more depressed.
Therapist: So, how would you like to be acting differently? (Asking for a positive representation and in action terms)
Client: I don’t want to be depressed.
Therapist: What would you like to be doing instead? (Redirecting to a positive statement)
Client: I would like to be getting out of this depression and being more active about my day again.
Therapist: So, you would like to be more active about your day again. Tell me about times when that is happening now. (Searching for exceptions)
Client: I’m not active at all. All I do is sit around all day and feel sorry for myself.
Therapist: So, it seems to you like you have not been doing anything. Well, if we used a scale with one being total couch potato behavior, the worst you can imagine, and 10 being idealistically the most active you can imagine, how would you say you have been averaging this past week? (Introducing the scale)
Client: On an average, I guess about a two.
Therapist: About a two. So, I guess there have been some times when you have acted even less than two?
Client: Yeah, there were some totally bad days. I hardly made it out of bed.
Therapist: Hmm. You definitely do not want more of those, I guess. So, if two was the average and you had some one times, does that mean you also had some times where you were a little more active than a two? (Exceptions frame within the scale)
Client: Yeah, maybe a two and a half or three.
Therapist: What did you do differently at those times? (Specification)
Client: I just got so disgusted and bored with the TV that I decided that I had to talk to someone.
Therapist: How did you decide to do that? (Using “agency” language) You could have decided on something else less constructive, like drugs or a different TV channel. (Cooperating with his anticipated disqualification and asking for more specification)
Client: I know, but I am realizing that I have to do something.
Therapist: What do you mean? You could keep on doing what you are. No one is going to stop you, are they? (Requesting that he convince you)
Client: I know, but this is not a life. I want to do something more productive.
Therapist: (After more discussion of the exception times of two and a half or three) So this more active approach like you took the other day is what you want to be doing more. When you are no longer coming here, are you thinking you will be averaging a 10 or more? What will you be averaging then? (Using the scale to create the signs for concluding therapy)
Client: Well, a 10 average is not possible. But if I was averaging more like seven, that would do it.
Therapist: What will you be doing differently at seven? (Specification)
Client: I guess I will be making a plan for my day and sticking to most of it. You know, I will be going shopping and cleaning my apartment.
Therapist: So, are you thinking that as you continue to do more of what you are doing at this two and a half, this somewhat more active approach, that you will be eventually averaging seven? (Bridging the exceptions as the goal of therapy)
Client: Yeah, maybe. I just have to keep at it.
This conversation uses scaling with a solution-focus. We facilitate the client breaking down his goal into an average between two extremes. As part of pacing, we then ask for examples of when he was below his average. He says there were some “one” times. We then follow the logic of “averages” and ask about times that must have been somewhat better than the average. This gives us the opportunity for exception talk. He describes an exception of being bored and his taking a little action. We then can use the exception to find more details of what his solution will be like. His solution becomes more specific—his taking a more active approach, making plans for the day, shopping, cleaning the apartment, and following through on more of such activities.
Using the scale along with the concept of averaging gives us a way to find or create exceptions and to get more specifics about his solution. We are interested in the “one” times only to pace him and as an invitation to find out about the times that were slightly above his average, the two and a half or three.
We could also have used the scale to break down his next step beyond two and a half or three. For example:
Therapist: So when you are acting more like two and a half or three, you are recognizing your boredom, deciding that you want something different in your life, and calling someone or doing something other than TV. What will you be doing when you are at three and one quarter?
Client: You mean the next step? I will be looking for a job and filling out job applications.
Therapist: That sounds like it could be higher than just three and a quarter. Can you tell me what three and a quarter might be like.
Client: I guess if I just unplugged the TV and cleaned up the kitchen.
All of these modes of cooperating with clients’ initial presentation of their goal …
involve accepting the initial statement by clients and then using questions that balance their presentation and invite them into more expansive “realities.”
QUESTION:
Many of these modes of cooperating seem to be paradoxical and strategic. Isn’t that what they are?
These modes of conversing with clients may seem paradoxical because the modes seem initially to defy common sense. However, our intent is not to be paradoxical or strategic. We think that it makes more sense to accept the meaning clients ascribe to their situation than to try to talk them out of it. To accept their fears or what seems like pessimism as honorable, given how they are constructing their situation at the time, seems both respectful and reasonable. If clients think we understand and respect what they are saying, they are more likely to accept our invitation to try a new question.
We also do not think of cooperating modes as strategic. As Lynn Hoffman has said (1990), the strategic metaphor is fairly militaristic. With the strategic metaphor, we can begin to think of tactics and outflanking our clients or outpositioning them. As a strategic therapist, we might act pessimistic in order to get clients to be optimistic. We prefer to think we are cooperating with them as they are with us. If clients are presenting their situation as they experience it, we do not have the right to say they are pessimistic or that we are more optimistic. The clients are only presenting the situation as they experience it and evaluate it with their standards. We cooperate with them by adopting their language, even if by our own personal standards their language seems pessimistic. If clients present their situation in what seems a fairly negative way compared to our own standards, who is to say the clients are not responding to what they think is our unrealistic optimism? There are no negative clients.
QUESTION:
How do you handle suicidal clients?
We usually accept clients who are talking about hurting or killing themselves at face value—that is, they are thinking about it seriously or want to do something like that. We imagine that they must feel extremely hopeless and desperate for that to be a possible alternative at that time. Therefore, we are extremely supportive in the mode described above as if someone is barely coping. With that kind of empathy, the client eventually initiates a slight optimism and, surprisingly, we can even begin to explore goals and solutions.
1. Identify four clients or imaginary people who present their situations in a way that seems:
positive and future-oriented,
barely coping with life,
pessimistic and negative or scared, and
very vague in their descriptions.
With a partner, take on the role of the client with the orientations listed above and talk about a problem for possibly three minutes. Take note of how you think of yourself and the problem, as well as how you think and feel about the future and solutions.
Adopting the client’s role should give you some sense of how some clients feel and the process of their experience.
2. Next, have your partner ask questions from this chapter and you, as the client, take note of your experience.
With you acting as someone with a positive and upbeat presentation, your partner is to say, “Tell me more about the problem.” After you have described your problem for five minutes, take note of your experience. How did the question fit for you? How did you feel talking about the problem? Then have your partner say, “Tell me about times when the problem does not happen or how things will be when the problem is solved.” Take note of your experience.
With you acting with a “barely coping” presentation, have your partner try to point out the positives or convince you that your situation is not so bad. After taking note of your experience and how the therapist’s questions fit for you, have your partner say something like: “Given the circumstances, I am frankly impressed that you are managing as well as you are. How are you managing?” Take note of how your experience changes.
With you acting as having been burned and disappointed many times in the past and afraid of taking a similar risk again, have your partner try to point out the positives or to insist upon examples of good times. After you have taken note of how the therapist’s responses feel for you, your partner is to advocate for a more cautious or a more no-change approach. Take note of the difference in your own feelings and responses in the two modes of cooperating by your partner.
Finally, with you as the client presenting a vague description of a goal, have your partner ask you these scaling questions and write down your answers.
| (a) | On a scale from one to 10, with one being the worst of the problem situation and 10 being unrealistically the best that can be imagined, what are you averaging in the past week? | |
| (b) | What are the times like when you are lower than the average? | |
| (c) | What are you doing differently when you are acting slightly above the average? How do you think differently or what do you say differently to yourself? |
3. After going through the above exercise in the clients role, take the therapist’s role and use the questions out of the cooperating modes with your partner.
*This term was introduced to us in personal communication with Gene Combs and Jill Freedman. The term is used to describe how they use presuppositions within questions to open new experiences and storying with clients in Symbol, Story and Ceremony (1990).
*For other development and examples of this technique, see Lipchik, 1988a; de Shazer, 1988; Berg, 1990.