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Section 12
Track #12 - Therapeutic Ruts

Question 12 found at the bottom of this page
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In the last track, we discussed dealing with clients' goals that are too vague, broad, or poorly-defined. Do you find that you tend to get into therapeutic ruts with your clients? By that I mean using the same brand or type or series or responses with your clients? During this track, you will be able to evaluate your therapeutic ruts in the areas of: Affirming Responses vs. Low-key Responses, Contextual Compliments, and the Key Therapeutic Crutch.

As you know, the importance of listening can never be overestimated in a therapist's work. Listening to a client, of course, conveys the implicit message that I expect the client to have something important to say. I'm sure you, like I, convey listening by the usual verbalizations such as "oh," "yeah," "wow," "okay," "right," etc. Obvious. Right? But what about using strongly affirmative responses with your male batterers as compared to more neutral verbalizations?

#1) Affirming Responses vs. Low-key Responses
How do you decide when to use less neutral, and strongly affirming responses such as "Super!" or "Great!" or "That's incredible!" I have found that if my expletive, for lack of a better term, "comes from the gut" it can be more effective than low-key verbalizations. Responses like "yeah" and "okay" merely show "I'm listening," but do not offer a strongly positive or negative reaction. As you know, affirming responses provide validation and affirmation of a client's behaviors, feelings, and thinking. Think of a time when you have used these strong affirmations and they have perhaps instilled hope in your client. I have found that an affirming response often encourages my clients to further pursue their goals. Think of a client you are currently treating. Do you need to exchange some of your "okays" and "rights" for "supers" and "greats?"

#2) Contextual Compliments
If you buy into that line of thinking, …Beyond simple affirming responses like "super" or "great," I find that a more powerful form of affirming response is the contextual compliment. The contextual compliment is presented in the context of a client's goal statement and involves more than a positive affirmation. Contextual compliments assist a client, like Tim, in making a connection between my compliment and his goal statement. I find that clients are less likely to perceive my compliments as being insincere, overly positive, automatic, or irrelevant when the compliments are contextual. Here's what I mean.

Tim, age 40, had strongly resisted therapy in the group setting from day one due to what he called his "stage fright." During one particular session, I noticed that Tim was remarkably more vocal than usual. I found it useful to give him a contextual compliment. I stated, "Here, there's this group, and you're the one saying you have a hard time being around people, and you're really, really shy, and now you can talk in groups, and today you talked more than anybody else." Do you see how I provided Tim with a compliment framed within the context of his behavior? Think for a moment about a client you are currently treating who has verbalized his insecurities. Would he benefit from receiving a contextual compliment that addresses his insecurities?

#3) The Key Therapeutic Crutch
As you know, restating responses simply paraphrase your clients' words as accurately as possible. You use restating all the time. But why does it work so well, and why do you use it so often? As I go through five benefits of restating, use them as a checklist with a particular client in mind. Is merely restating your best option, or are you therapeutically painting yourself into a box and putting yourself into a therapeutic rut? Restating:
1. helps your client to feel understood.
2. provides feedback as you understand it.
3. acts as a mirror.
4. acts as a sounding board.
5. clarifies behavior, meaning, or feeling.

I find this approach to be particularly helpful with Tim in a group setting because he wants to be heard. However, Tim is also fairly shy and is not quite ready to explore solutions.

How often do you use restating as an "escape hatch" or therapeutic crutch? For example, do you use restating when you are unable to create a useful question on the spot? Do you use restating when you are completely at a loss as to what responses would be most helpful? During these high- pressure moments, restating is almost always a safe and useful response. Think for a moment about one of your current clients. Would your increased awareness of the frequency with which you use the key therapeutic crutch of restating be of assistance to expand your therapeutic repertoire and get out of your therapeutically limiting-box? I would like to add a little aside here. I know restating is a great tool and referring to it as a key therapeutic crutch may be a little extreme, but my goal is simply to get you to rethink your ruts. What about expanding their words to produce new meaning instead of merely restating?

#4) The Expanding Response.
Besides listening, affirming, and the key therapeutic crutch of restating, I also try to use what clients have said and expand their words to produce new meanings. Of course the danger here is…is the expanded meaning your ideas or are they the client's? The production of new meanings, then, hopefully leads to new possibilities in the male batterer's goal statement.

Here's how I got out of the rut of merely restating and used an expanding response with Tim. Tim stated, "I can't argue with my wife in front of our kids. They're getting older. We can only fight in the bedroom." I saw this statement as an opportunity to move toward goal-setting by providing Tim with an expanding response. I said to Tim, "You can limit yourself to fighting in the bedroom, so you do have some control over the fighting. You don't fight around your kids, so you don't want your kids to experience any of this." Tim then stated, "No way. Kids don't need to see that stuff." In this case, my expanding response led to a suggestion of a goal idea. I stated, "So, what do you think of this as a goal, to lessen this pain for your children?" Think for a moment about the ways in which you encourage your clients to delve into goal-setting. Would expanding responses help to generate new goal statements?

In your next session, to get out of a therapeutic rut, you might consider evaluating your use of affirming responses versus low-key responses, restating responses, and expanding responses.

QUESTION 12
What are three therapeutic ruts you might evaluate in your next session? To select and enter your answer go to Answer Booklet.

This CD entitled "You Made Me Hit You: Interventions with Male Batterers" has covered such topics as altering attitudes, team pacing and playfulness, the three stages of abuse, red flags to violence, expanding choice points, overcontrollers vs. undercontrollers: masked dependency, nice guy positioning strategies, the invisible dragon of shame, checkpoints for change, goal-setting, problem goals, and therapeutic ruts.

We appreciate the fact that you have chosen the Healthcare Training Institute as a means for receiving your continuing education credit. I hope you have found the information to be both practical and beneficial. I wish you the best of luck in your practice. Thank you.