Strength-Based Approaches in Therapeutic Intervention for Difficult Students on College Campuses

1. Brian Van Brunt, Ed.D. MJ Raleigh, Ph.D. Western Kentucky University St. Mary’s University of Maryland brian.vanbrunt@wku.edu mraleigh@smcm.edu

2. Muse & Inspiration Equanimity & Balance Goal Focused Empathy Dogged Encouragement • We will be discussing an approach to helping which focuses on strength-based models of therapeutic intervention. • These approaches are useful in working with difficult students on college campuses. By difficult, we mean frustrated, unmotivated, angry and outright hostile. • These approaches are described in a way primarily useful for therapists – but may also be useful for student affairs staff, faculty and others in higher education with student helping roles.

3. Muse & Inspiration Equanimity & Balance Goal Focused Empathy Dogged Encouragement • The focus here is not on pathology, instead on the potential we each have to learn, grow and change. • This is a parallel process form of helping, a term first defined by Searles[6] to describe the reflection between the therapist-supervisor relationship and the client-therapist relationship. (group home staff) • These approaches are not only for our clients, but useful for all of us. As Rogers explains it “A Way of Being”…

4. Muse & Inspiration Equanimity & Balance Goal Focused Empathy Dogged Encouragement

5. Muse & Inspiration Equanimity & Balance Goal Focused Empathy Dogged Encouragement

6. Muse & Inspiration • In Greek mythology, the muses were a sisterhood of nine goddesses, the daughters of Zeus. They inspired mere mortals in the areas of poetry, history, tragedy, song, comedy and astronomy.

7. Muse & Inspiration • The metaphor here – therapist as muse to client, implies that the therapist inspires and aids the client towards greater development or becoming. Progressing towards a more aware or, as Maslow[7] puts it, actualized self. • Clearly (hopefully?) we don’t adopt flowing robes or whisper in clients’ ears; but nonetheless we inspire them, offer ideas and new ways of thinking.

8. Muse & Inspiration • We were at a training in Keene, NH where a therapist who worked with at-risk, adolescent girls was sharing from her 20 years of experience shared: • “It is imperative that someone in the therapy room has hope. Sometimes it is the patient, sometimes it is the therapist. But someone must always have hope that things will improve.”

9. Muse & Inspiration • Clients often come to therapy at a low point in their life. As such, it would make sense that the therapist has an enormous opportunity to provide the client with the potential for growth and the excitement that comes with exploring the self and branching out in new directions. • Parents know this concept well—creating environments that foster growth and discovery.

10. Muse & Inspiration • The candle graphic is used to represent this area. The “fire” of inspiration is spread to our clients and, when done well, does not diminish the original source. • There is a protective nature in being the muse or inspiration to others – nurturing growth and inspiring movement. • We’ve all seen Stand and Deliver and Mr. Holland’s Opus. Teachers have long understood the power in being the muse and inspiring others towards their personal excellence.

11. Muse & Inspiration • The challenge for the therapist is inspiring those who do not want to be inspired; serving as the muse for those who do not wish to grow and create. • The therapist must believe – in their heart, in the core humanistic concepts. That those who we seek to help have the ability to be wonderful; yet the environmental obstacles have blocked their way. • Our goal is to inspire their individual greatness, their own sense of Brilliance [8].

12. Muse & Inspiration • Frankl’s [5] work on meaning and suffering applies here. Frankl argues meaning is found in every moment of living; life never ceases to have meaning. Humans become lost when separated form their greater meaning. • Those we try to help often lose track of their meaning in life, why they continue to wake up, go to school, go to work – it is here we need to help them find their meaning, their greater purpose.

13. Muse & Inspiration • Stephen Covey [4] wrote the book The Seven Habits of Highly Effective People. One of the tenets is to “begin with the end in mind.” • We need to hold firm the vision of the client’s positive “end” amidst their struggle. Holding onto the goal and the hope of change, which they so often lose connection to when feeling overwhelmed.

14. Muse & Inspiration • Brian has a client who often says at the end of the session, “Tell me something good.” This request for a positive stroke (referring to Eric Berne’s Transactional Analysis [15] model) is related to her inability to keep these positive, self-affirming thoughts in her head. • She becomes so overwhelmed with her day to day depression, difficult relationships, academic struggles and financial problems that she forgets there is something good she is headed towards becoming.

15. Muse & Inspiration • Hearing “something good,” “something hopeful” is at the heart of why she returns to therapy. • We too often lose sight of the power of relationship and connection – trained to rely on techniques, behavioral interventions and normalization. • Yalom [17] , in his book Every Day Gets a Little Closer, offers a patient (Ginny) a chance to write down her experience of each therapy session in lieu of payment.

16. Muse & Inspiration • Yalom writes down his impressions of each therapy session as well and the two co-author the book. • There is one exchange where Yalom’s experience of the session is grand and cathartic, he recalls making powerful analytic connections and offers insightful therapeutic comments. • Ginny finds the session helpful because he asks about her weekend and a movie she had seen. It is the caring questions, not always the bold therapeutic insights that our clients find helpful.

17. Equanimity & Balance • What we are talking about here is one of our favorite words – developing a sense of equanimity; the art and quality of being calm and even-tempered in the face of adversity. • John Byrnes [9] talks about developing this mindset when working with aggressive individuals. Gene Deisinger [10] suggests this approach when developing threat assessment team interventions on college campuses. Retaining a sense of balance, calmness and poise.

18. Equanimity & Balance • Gavin de Becker [11] in his work in executive protection talks about this in terms of “being like water.” He refers to this as Zen and the Art of Protection (ZAP). • The “mind like water” is ready to the respond to what the situation demands without pretext or attitude; it is our most peaceful state, ready to offer our best. It is when we bring our “A” game. • The challenge is keeping a mind in this neutral state given the demands of multiple clients, paperwork, crisis appointments and insurance billing.

19. Equanimity & Balance • We become overwhelmed with our daily duties and struggle with our ability to achieve a “mind like water” state. • Yet it is those distractions that keep us available to our client. Irving Yalom [17]cautions therapists from being distracted from the here and now. • When we watch the clock in session, when we think about running errands later in the day or what we are having for lunch – we are outside the moment.

20. Survival Love / Belonging Power Freedom Fun Equanimity & Balance • William Glasser [2] offers that we each have five separate needs in our lives. A healthy individual keeps these needs filled, fulfilling each in balance with the others.

21. Equanimity & Balance • Too often, our clients lose sight of their sense of balance. Work and achievement push hard and suddenly family and friends suffer. Or vice/versa. • They seek power in their study and career and end up losing a sense of freedom and fun in their lives. Balance is illusive and students find themselves shifting chaotically between juggling their various needs – in the end, often leaving them all unfulfilled. • When they watch TV, they think about studying. When they are studying, they rush to go out with friends.

22. Equanimity & Balance • Fredrick Perls [16] and Erving & Miriam Polster [16] talk about this in Gestalt therapy’s figure/ground theory.

23. Equanimity & Balance • Balance and harmony fall away as the figure overwhelms the individual and everything else (the background) fades. • The therapist’s role is to return balance and perspective, reminding them there is more to life than the current problem in front of them.

24. Goal Focused Empathy • Empathy is the art of putting oneself into the psychological frame of reference of another. Seeing from their eyes and actually experiencing the feelings of the other. • Carl Rogers[1] was instrumental in pushing the ideas of empathy, genuineness and unconditional positive regard when working with clients. The approach helps by creating a strong rapport between client and therapist leading to the client being free to achieve their goals, now free of their obstacles.

25. Goal Focused Empathy • Clients in distress often need someone who is not in distress to aid in their recovery. A therapist is able to make a determination of what is the client’s best interest – a difficult feat, though made easier as they gain a better understand the patient. • The therapists assists with the healing in much the same way a new tomato plant needs a stick tied to it to keep it straight or the way a lifeguard who helps the swimmer who struggling.

26. Establish Rapport • Establish Connection • Find Common Ground Goal Focused Empathy • Deepen Connection • Grow Relationship • Develop Deeper Understanding • Move Towards Goal • Use Connection • Persuade towards goal

27. Goal Focused Empathy • First, the therapist develops a basic, foundational rapport with the client – a beginning sense of trust, understanding and insight. • Second, the therapist seeks to deepen their understanding and experience the feelings, thoughts and actions from the perspective of the client. • Third, the therapist uses the new found connection to assist the client in moving towards a goal.

28. Goal Focused Empathy • Byrnes [9] would refer to this process as persuasion, or motivating an individual away from their aggression or potential violence. • Rogers [1] saw empathy (and the client’s appreciation of this empathy) as necessary and sufficient for change. • We suggest taking this a step further.

29. Goal Focused Empathy • Goal Focused Empathy is a step beyond what Rogers suggests. Moving away from the strictly humanistic venue of the client always having the ability within themselves to choose the right path. Sometimes a client needs help. • There is a directedness to GFE that requires the therapist to guide the client towards more positive choices, using their previously established empathetic connection as an aid to the process.

30. Goal Focused Empathy Establish Rapport • Stage One • People enjoy being cared for and understood. Questions which convey interest and which attempt to understand their individual perspective are ways to establish initial rapport. • Carl Rogers [1], in his person-centered therapy approach, focuses on the importance of making this connection, establishing rapport and ensuring that the client is aware of the therapist’s empathy.

31. Goal Focused Empathy • It is not enough for the therapist to empathize with the client – but also to convey this empathy to the client. The therapist must have the empathy and ensure the client knows they are understood. • John Byrnes [9], in his book Before Conflict, argues the importance of building a connection and establishing trust as a way to deescalate a potential aggressor. This trust building has been proven useful to establishing connection with others as a precursor to moving them to a common goal.

32. Goal Focused Empathy Deepen Connection • Stage Two • Developing a deeper connection with clients increases the likelihood of developing trust. • Kopp [12] suggests we attend to the specific metaphors and examples a client uses as they offer keys to the client’s inner thoughts and dialogues. By attending to and repeating these examples, therapists gain a deeper understanding into their inner language.

33. Goal Focused Empathy Deepen Connection Overview of Michael White’s Narrative Therapy[13] • People organize and give meaning to their experiences through their stories. • Narrative therapists help people by reworking the telling of their stories in a manner that gives the patient more ownership and ability to gain dominion over negative past experiences.

34. Goal Focused Empathy • People are encouraged to separate from their stories in order to explore unique outcomes and obtain some freedom from the stories that previously restricted their options. • This process of “storying” their experiences – adding description, sensation and detail to their creations – gives clues to the meaning they ascribe to their own life problems and experiences.

35. Goal Focused Empathy • Imagine a patient has learned over time that she is unattractive, common and has little in the way of anything special to offer anyone in a relationship. • Stories are collected as she develops that support these ideas, I’m someone who cannot do anything right. No one would like to marry me. I have nothing to offer anyone. • These stories become stifling and overwhelming.

36. Goal Focused Empathy • The stories must be set aside, relieved of their power, before the process of reconstruction can begin. • The therapist helps the client set aside her negative stories through confrontation, charisma and enlisting her in the creation of metaphors and imagery. • Perhaps the therapist and client create an imaginary box where the negative stories can be temporarily laid down for the length of their sessions together.

37. Goal Focused Empathy • This joint creation of a metaphor should use descriptive terms and attempt to create a memorable, realistic image.

38. Goal Focused Empathy • With the negative stories safely locked away for a time, the therapist and client are free to dream of other stories that put the client in a more positive, advantageous light. • It is this process of imagination, freedom and creation which creates the tapestry of narrative therapy.

39. Goal Focused Empathy Move Towards Goal • Stage Three • With rapport established and the connection deepened, the therapist can then move the client towards their goals. • One approach which is useful are the techniques of Motivational Enhancement Therapy and Motivational Interviewing [3].

40. Goal Focused Empathy Overview of Motivational Interviewing[3] 1. Express Empathy 2. Develop Discrepancy 3. Avoid Argumentation 4. Roll with Resistance 5. Support Self-Efficacy

41. Goal Focused Empathy Express Empathy • Communications that imply a superior/inferior relationship are avoided. • The client’s freedom of choice and self-direction are respected. While the therapist is in a position of power, encouraging change happens through listening rather than talking. • Attitude change attempts are gentle, subtle, always with the assumption that change is up to the subject.

42. Goal Focused Empathy Develop Discrepancy • Change occurs when clients perceive a discrepancy between where they are and where they want to be. • In certain cases such as the "precontemplators" in Prochaska and DiClemente's stages of change model, it may be necessary first to develop such discrepancy by raising the client's awareness of the adverse personal consequences of their negative behavior choices.

43. Goal Focused Empathy Avoid Argumentation • Avoid direct argumentation, which tends to evoke resistance. • The therapist does not seek to prove or convince by force of argument. • Instead, the therapist employs other strategies to assist the client to see accurately the consequences of their negative behavior, and to begin devaluing the perceived positive aspects of their negative choices.

44. Goal Focused Empathy Roll with Resistance • Do not meet resistance head-on, but rather "roll with" the momentum – with a goal of shifting client perceptions in the process. • New ways of thinking about problems are invited but not imposed. • Ambivalence is viewed as normal, not pathological, and is explored openly. Solutions are usually evoked from the client rather than provided by the therapist.

45. Goal Focused Empathy Support Self-Efficacy • According to Bandura, self-efficacy is the belief that one can perform a particular behavior or accomplish a particular task. • In this case, the client must be persuaded that it is possible to change his or her own behavior and thereby reduce their overall problems.

46. Goal Focused Empathy A bit about Prochaska and DiClemente…

47. Goal Focused Empathy A bit about Prochaska and DiClemente… • They suggest that the reason people fail to achieve the change they are seeking is because helpers focus their efforts on the action stage too quickly (skipping pre-contemplation, contemplation and preparation). • Many of the frustrations we face when working with difficult, hostile or unmotivated clients can be explained by this process.

48. Goal Focused Empathy A bit about Prochaska and DiClemente… • When working with someone who is trying your patience, being hostile or being unmotivated, what is your goal? • Your goal should be to assist the person in moving toward a higher stage of change, maintaining positive momentum or gaining a better understanding of their current situation and their decision to make a change.

49. Dogged Encouragement • There are times when we all need help. We need support and encouragement to reach our goals. • Someone who believes in us and who pushes use forward, even though we struggle to do this on our own. • For some, this is a significant other, our parents, teachers or friends. They listen to us and offer support. They believe in us when no one else will.

50. Dogged Encouragement • For others, this encouragement comes from their therapist. • The “dogged” here – a word we love – refers to an act of not giving in readily. Being persistent to the point of stubbornness.