CH. 10. Empathic Confrontation Identifying and Challenging Client Conflict

Question 1

Empathic Confrontation, Creating the New

Answer 1

EMPATHIC, CONFRONTATION, CREATING THE NEW:

• Many clients come to counseling “stuck”—having limited alternatives for resolving their issues and conflicts.

INTERNAL CONFLICTS – Are those that reside primarily within the client’s thoughts and feelings.

EXTERNAL CONFLICTS – Are those between the client and the surrounding world.

• Our task is to assist in freeing the client from stuckness and facilitate the development of creative thinking and expansion of choices.

STUCKNESS – Describe the opposite of intentionality, or a lack of creativity. (Gestalt; Fritz Perls)

• Other words and phrases that represent stuckness include inability to achieve goals, lack of understanding, and lack of motivation.
• Stuckness may also be defined as an inability to resolve conflict, reconcile discrepancies, and deal with incongruity.

CONFRONTATION – Hostile or argumentative behavior between opposing persons.

• This suggests that counselors assertively force the client to look at themselves in an “accurate” or “honest” way.
• Confrontation requires the ability to engage in self-reflection, something that may not be part the client’s world because of various forms of egocentricity.
• This type of confrontation does not work in counseling and therapy, leads to dropping out, and leaves lingering negative memories of counseling.
• The microskill of confrontation is used in a very different way in counseling.

EMPATHIC CONFRONTATION – Is a gentle skill that involves first listening to client stories carefully and respectfully and then encouraging the client to examine self and/or situation more fully.

• Empathic confrontation is not a direct, harsh challenge, or “going against” the client; rather, it represents “going with” the client, seeking clarification and the possibility of a creative New.

NEW BEING – A person who has moved from the past to a new present and future. The creation of the New is the desired result of empathic conversations between client and counselor/therapist.

• Empathic confrontation is based on listening to conflictual stories carefully and effectively responding using the listening skills.

CONFRONTATION:

Supportively challenge the client to address observed discrepancies and conflicts.

1. Listen, observe, and note client conflict, mixed messages, and discrepancies in verbal and nonverbal behavior. Give attention to both cognitive and emotional dimensions.
2. Paraphrase and reflect feelings, to clarify internal and external discrepancies. As the issues become clarified, empathically summarize what has been said—for example, “on one hand you feel ____, but on the other hand you feel ____.” Bring both cognition and emotions into most summaries.
3. Evaluate how the client responds and whether the confrontation leads to client movement or change. If the client does not change, flex intentionally; try another skill and approach the conflict from another direction.

Question 2

Awareness, Knowledge, and Skills: Empathic Confrontation for Results

Answer 2

Awareness, Knowledge, and Skills: Empathic Confrontation for Results:

• As you draw out client stories and strengths, you will be looking for verbal and nonverbal conflict and discrepancies.
• An essential part of confrontation is paraphrasing the conflict, reflecting the feelings of mixed messages, and providing an accurate summary of the situation.
• Even with empathic listening, clients who are challenged or confronted may feel put on the spot, perhaps even that you are attacking them.
• NONJUDGEMENTAL empathy will be most helpful.
  
  • Nonjudgmental attitude requires that you suspend your own opinions and attitudes and assume value neutrality in relation to your client.
  • You do not have to give up your personal beliefs to maintain a nonjudgmental attitude; rather, you need to suspend your private thoughts and feelings.
    
    • At times, however, judgment may indeed be called for.
      
      • For example, the Nelida session in the preceding chapter is basically nonjudgmental and supportive, but Allen clearly is judging those who have not respected her Latina heritage.
      • This type of judgmental feedback may be appropriate here, as it tends to provide some safety to continue.
      • But joining clients too soon and agreeing with their views could distort the facts of issues and concerns. It also could be a violation of counseling boundaries.
    • Go into the story in necessary depth so that both you and the client have a clear understanding of the conflict.
  • As the client’s conflict becomes clear, an overall summary can provide both you and the client a full picture of the situation.
  • This full picture includes both cognitive and emotional understanding and leads to mentalizing—seeing the client’s issue holistically.

Question 3

Confront, but Also Support

Answer 3

CONFRONT, BUT SUPPORT:

• On confrontation the following issues as central:
  
  • Don’t confront unless you have trust and relationship.
  • Pay attention to and understand the client’s point of view, way of thinking, and feeling about the issue. Summarize the client’s interpretation of the situation.
  • Share with the client only if he or she can listen to and hear you.
  • The client needs to be in charge of what happens and how things are interpreted.
  • Knowledge of the client’s cultural background and general personal style is essential. If you know even a few words of the client’s first language, this will help.
  • Attending skills such as eye contact are critical in the relationship.
  • Maintain neutrality; avoid judgments.
  • Follow up, both in the session to examine how the conflict was resolved or not resolved and after the session to see if new knowledge has generalized into action in the real world.
• Attending and listening skills are used frequently in the session, but you’ll find that confrontation strategies are used only occasionally.
• Confrontations accounted for only 1% to 5% of counselor statements.
• The reviewers noted that confrontations are useful, but they also often make clients uncomfortable. Empathic listening is required.
• As the session progresses, more eye contact and more confrontations are acceptable.

Question 4

The Skills of Empathic Confrontation: An Integrated Three-Step Process

Answer 4

THE SKILLS OF EMPATHIC CONFRONTATION: AN INTEGRATED THREE-STEP PROCESS:

• Empathic confrontation is best described as an integrative skill involving both listening and influencing.
• You can identify the confrontation skill most easily when the counselor paraphrases or summarizes observed ambivalence or conflicts in some form of the classic “On one hand . . ., but on the other hand . . .; how do you put that together?”
• In this form, the conflict, discrepancy, or mixed message is said back to the client clearly.
• The story is brought out conflict in that story is identified, along with thoughts and feelings.
  
  • Learning the behaviors of the client and the other person through looking at antecedents, behaviors, and consequences is helpful and will lead to a better understanding of thoughts and feelings.
  • Drawing out positive stories is very helpful in the confrontation process.
• Counseling and psychotherapy have the goal of enabling clients to explore their ambivalence and conflict, rather than just complaining.
• They also seek to facilitate clients’ finding their own resolution—the creative New.
• However, when you face situations of abuse or danger to the client, or the client faces a severe crisis and cannot act, or the client is oppressed by racism, sexism, classism, and the like, then it may be necessary for you to take action and work both inside and outside the session in the community to help find a satisfactory resolution.

Question 5

Empathic Confrontation in the Interview

Answer 5

EMPATHIC CONFRONTATION IN THE INTERVIEW:

• First step is to listen empathically and nonjudgmental.
• Here you will see the general story of Nelida’s concern brought out primarily through listening skills.
• The purpose is for clients to become less distressed about future occurrences and develop their own plans to cope with the next one that occurs.
• Nelida’s story focuses on a microaggression that affected her total experience of her graduate program. The microaggression goes into long-term memory immediately as it occurs. Why? Emotion often drives cognition. The microaggression “hits” Nelida like a brick.
• Counseling goal is to listen and facilitate awareness of emotional and cognitive experience.
  
  • The next step is counseling appropriately on emotional regulation so that later the client will cope more effectively with the expected next microaggression.
  • The second step of the session will emphasize more specifics and clarify internal and external conflicts. In both portions, look for multicultural issues and their impact on Nelida.

Question 6

Step 1: Listen

Answer 6

STEP 1: LISTEN – Identify conflict by observing incongruities, discrepancies, ambivalence, and mixed messages.

• The first session, based on the community genogram, helps us see Nelida as a person-in-relationship to family and community.
• Emphasis on strengths, so important for building resilience as we work with clients on their issues.
• While you listen, silently search in your mind for what is “going on now” with the client. Listen and think before you help clients clarify their issues.

METACOGNITION – Awareness and understanding of one own’s thoughts.

MENTALIZING – Interpreting someone’s behaviors based on their internal mental states.

• All this is empathic MENTALIZING on your part as you seek to integrate the client’s world in your own mind.

Question 7

Step 2: Summarize and Clarify Issues of Internal and External Conflict and Work Toward Resolution

Answer 7

Step 2: Summarize and Clarify Issues of Internal and External Conflict and Work Toward Resolution:

• While our central focus always is on the client, Nelida’s conflicts and internal incongruity relate to cultural/ environmental/contextual issues.
• Attending to issues of conflict and discrepancy, which are starting to move to empathic confrontation.
• The Counselor seeks throughout this interchange to draw out further aspects of the conflict, but typically focuses on individual and cultural strengths, for creative resolution, and therapeutic lifestyle change of cultural health.
  
  • Nelida early on responds internally with embarrassment about her Cuban background. There is a need to reframe the encounter so that she is fully aware that she is not “the problem,” but rather the external forces of the aggressor and people like him are “the problem.”
• We build resilience and solve our difficulties best from our strengths, resources, and positive assets.
• If you have a solid relationship, you may consider asking the client, “Feelings inside our bodies often provide clues to how deeply we are reacting to challenging experiences and issues. Can you notice any part of your body reacting as you say that?”
• External conflicts almost always becomes internal as well.

Question 8

Client Change Scale (CCS)*

Answer 8

CLIENT CHANGE SCALE (CSS)*:

• The third step in empathic confrontation is to determine if what was said affects how clients think and feel about their situation.
• We can evaluate this process using the Client Change Scale (CCS).
  
  • If you pay attention in the here and now of the session, you can rate how effective your interventions have been.
  • You will discover if your attempt at confrontation is subtractive, interchangeable, or additive.
  • With a facilitative empathic confrontation, you will see the client change (or not change) language and behavior in the session.
  • When you don’t see the change you anticipate or think is needed, it is time for creative intentionality, flexing, and having another response, skill, or strategy available.
• Imagine that you have provided an empathic confrontation by summarizing a client conflict (“On one hand, you feel ____ , but on the other hand, you think____ . How do you put that together?”).
• CCS gives you a framework for evaluating how the client responds to your confrontation.

Although the progression from denial through acceptance to significant change can be linear and step by step, this is not always the case,

• At one session the client may seem acceptant of what is to come, but in the next session move back to partial examination or even denial.

The Client Change Scale is also useful as a broad measure of success and outcome in several types of counseling and psychotherapy, as it provides a useful framework for accountability and measuring client growth.

Referring to a Drug Addict: Level 5, transcendence and the development of new ways of being and thinking, may occur, but not all clients will achieve this level.

• Level 5 is represented by the user who becomes fully active in support groups, helps others move away from addiction, and continues to work on feelings, behaviors, actions, and relationships that led to the alcohol abuse and addiction. This person achieves changes in life’s meaning and a much more positive view of self and the world—far more than just “getting by.”
• When you confront clients, ask them a key question, or provide any intervention, they may have a variety of responses.
• Ideally, they will actively generate new ideas and move forward, but much more likely they will move back and forth with varying levels of response.
• The idea is to note how clients respond (at what level they answer) and then intentionally provide another lead or comment that may help them grow.
• Clients do not work through the five levels in a linear, straightforward pattern; they will jump from place to place and often change topic on you.

Depending on the issue, change may be slow. For some clients, movement to partial acceptance (Level 2) or acceptance but no change (Level 3) is a real triumph. For a variety of issues, acceptance represents highly successful counseling and therapy.

CLIENT CHANGE SCALE (CSS):

The CCS helps you evaluate where the client is in the change process.

• Level 1. Denial
• Level 2. Partial examination
• Level 3. Acceptance and recognition, but no change
• Level 4. Creation of a new solution
• Level 5. Transcendence

ANTICIPATED RESULTS:

The CCS can help you determine the impact of your use of skills. This assessment may suggest other skills and strategies that you can use to clarify and support the change process. You will find it invaluable to have a system that enables you to (1) assess the value and impact of what you just said; (2) observe whether the client is changing in response to a single intervention; or (3) examine behavior change over a series of sessions.

To facilitate significant change, seek an appropriate balance of stress while supporting the client. Too much stress is damaging, but too little stress likely won’t lead to change.

Question 9

Cultural Identity Development

Answer 9

CULTURAL IDENTITY DEVELOPMENT:

• We have seen Nelida move from Level 1 to Levels 4 and 5 on the Client Change Scale. Key to this process was her becoming more aware of her identity as a cultural person—a Spanish-speaking Latina, a minority person in a predominantly White environment.
• Cultural background is a major part of personal identity,

CULTURAL IDENTITY DEVELOPMENT THEORY – has useful parallels to the Client Change Scale. Five levels of identity.

• Several other theorists have explored the Cross five-stage model and applied it not only to racial/ethnic issues, but also to gender awareness, gay/lesbian identity, people with disabilities, and many other groups. Included in this is White awareness, which focuses on Whiteness and the White experience as a culture.
• The five stages of cultural identity theory are:
  
  • ​Conformity Stage: The client may be unaware of racial identity and conforms to what he or she sees as societal expectations.
    
    • Corresponds to Level 1 of the Client Change Scale.
  • Dissonance Stage: ​This compares to the partial bargaining of the CCS. The client is aware that something “doesn’t fit” and moves positions as new discoveries are made.
    
    • Awareness of the impact of culture has started.
  • Resistance and Emersion Stage: ​Minority clients often become angry at what they see around them.
    
    • As they grow and mature, they may immerse themselves fully, for example, in African American culture.
    • White clients may also find themselves angry and try to understand other cultural groups’ values more fully. Or they may move to active resistance, another form of conformity and denial.
  • Introspection Stage: ​Clients increasingly think for themselves, whereas before they were embedded in a group view of the world.
    
    • They focus on themselves and understanding themselves and their own cultural group.
  • Integrative Awareness Stage: ​A fuller sense of caring for oneself and one’s cultural heritage appears.
    
    • Along with this often comes a fuller understanding of other cultures.
    • This may lead to appreciation, or it may lead to a movement to resistance and action, but this time based on pride and awareness.
    • It is a transcendent stage that has many variations.
• Moving from one cultural identity stage to another requires confrontation of the discrepancies within life at that stage.
• Many White people deny that they have a culture or a cultural identity, and this may be an issue for counseling itself where creating the New may be challenging. A good place to start identity development with White individuals is ethnicity or region of the nation.

Question 10

The CCS as a System for Assessing Change Over Several Sessions

Answer 10

The CCS as a System for Assessing Change Over Several Sessions:

• Review the CCS as it might appear in a counseling session with virtually any topic.
  
  • DENIAL (LEVEL1) – does not deal with reality.
    
    • When the client is confronted effectively, the story becomes a discussion of inconsistencies and incongruity.
  • BARGAINING AND PARTIAL ACCEPTANCE (LEVEL 2) – the story is changing.
  • ACCEPTANCE (LEVEL 3) – Reality of the story is recognized and acknowledged, and thus storytelling is more accurate and complete.
  • NEW SOLUTIONS and TRANSCENDENCE (LEVEL 4 & 5) – Moreover, it is possible to create new solutions and transcendence.
  • When changes in thoughts, feelings, and behaviors are integrated into a new story, we see the client move into major new ways of thinking accompanied by action after the session is completed.​
  • The five levels may be seen as a general way to view the change process in counseling and therapy.
    
    • ​If you practice assessing client responses with the CCS model, eventually you will be able to make decisions automatically “on the spot” as you see how the client is responding to you.
      
      • For example, if the client appears to be in denial of an issue despite your confrontation, you can intentionally shift to another microskill or approach that may be more successful.

Question 11

Key Points

Answer 11

KEY POINTS:

EMPATHETIC CONFRONTATION AND CHANGE STRATEGIES – Explicit empathic confrontation can be recognized by the model sentence, “On one hand . . ., but on the other hand . . . . How do you put those two together?”

THE CLIENT CHANGE SCALE – A tool to examine the effect that microskills and empathic confrontation have on client verbalizations immediately in the session. At the lowest level, clients may deny their incongruities; at middle levels, they may acknowledge them; at higher levels, they may transform or integrate incongruity into new stories and action.

MULTICULTURAL AND INDIVIDUAL ISSUES – Empathic confrontation is believed to be relevant to all clients, but it must be worded to meet individual and cultural needs.

CULTURSL IDENTITY THEORY – five stages of cultural identify development are:

• Conformity
• Dissonance
• Resistance and Emersion
• Introspection
• Integrative Awareness

The Cross model helps the counselor understand where the client is in his or her cultural identity development and determine the role of cultural/contextual factors.

• Based on this knowledge, counselors can offer interventions to empower clients to embrace their cultural identity, promote life improvements, and assess progress.

HELPING CLIENTS COPE WITH MICROAGGRESSIONS AND RELATED CONCERNS:

1. Listen empathically and search for internal and external conflict and contradictions in client stories.
2. Validate their cognitions and emotions around the incident(s).
3. Build resilience by focusing on internal strengths as well as external resources that provide strength and support to cope with challenges.
4. Explore and reframe the contradictions in the situation as appropriate.
5. Facilitate an action plan for the next steps toward cultural health.

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