2010 Better Counseling

This post was published to DBT Counselor's Blog at 1:41:29 AM 4/9/2010
Be a Better Counselor
Account DBT Counselor's Blog
Scott E. Spradlin, MA, LPC
New Leaf DBT, Christian Counseling Center of Wichita
http://www.cccwichita.com
Those of us who have chosen the vocational path of professional helping have some
predilection toward assisting other people to live into a better way of life.
Among our ranks are those professionals who have a knack for enfolding their patients with
great welcoming warmth and genuine interest, breaking down all of the natural barriers that
exist in the mind of their patients, that if it were otherwise they may not stay to see the
benefits of counseling.
Also among our ranks are professionals who are not mindful to their influence on the overall
health of the therapeutic relationship. Even those of who are trained to understand the role of
emotions and the power of learning and socialization that influences an individual’s behaviors
become inattentive to the power of the counselor to influence the outcomes of the therapy
offered. We are human, after all.
While there are a host of patients who seek counseling who are fairly high functioning and
somewhat uncomplicated who come to counselors with an uncanny commitment to the work,
there are also a great number of patients who are quite complicated and bring a number of
unseen internal challenges that threaten the life of the therapeutic relationship.
This latter group may be called difficult-to-treat patients. What I mean by this term is that there
are patients who have biological variances in their emotional composition that they tend to be
highly reactive to stress and challenge. This term also refers to individuals who have histories in
which the relational styles that were modeled for them in their formative years were chaotic,
detached, shame-based and in many cases outright abusive. Additionally these two elements
can be further complicated by the donning of identities as outsiders and deviants and
substance abuse and addiction.
It's this later group that requires enhanced skills on the part of the therapist to dance in elegant
stride with these challenges in order to increase attendance in therapy, which alone provides
an increased opportunity for counseling to work. Patients in this later group are often
mandated to counseling either by the legal system or their family.
These patients often come with negative expectations of counseling, viewing the therapist as
another authority figure who may be judging them. They oft come by edict of their probation
officer, so the therapeutic relationship starts on the rocky grounds of coercion. There is typically
a cloud of hostility and resentment hovering over these patients.
The skillful and mindful counselor will attend to his/her internal responses, guarding against
personalizing certain reflexive behaviors that new patients present. The mindful counselor will
also consider from the moment of contact to the moment of completion of treatment, how
each action either contributes to the success of counseling or contributes to the pool of
obstacles.
As a practitioner of Dialectical Behavior Therapy (DBT) I have the benefit of training in the use of
various methods and strategies which were designed specifically to keep patients in therapy
who are diagnosed with Borderline Personality Disorder (BPD), which is no small feat. The
origins of these practices lay in my training with the skilled professionals at the Portland DBT
Program under the direction of founder Soonie Kim, PhD and were "Christened," if you will, by
my attendance and completion of DBT intensive training offered by Marsha Linehan and her
trainers. These strategies are highly commended, and are effective in removing unnecessary
emotional obstacles from therapy, with the likely increase of client attendance in counseling,
even among the most difficult.
The following list will be a mixed list of assumptions and strategies for becoming a better
therapist.
1. Adopt a new assumption: All of my patients are doing the very best that they can.
Given this assumption you assume that regardless of apparent "attack" behaviors,
demonstrations of apparent aloofness (especially present among teens), or irritation, assume
that your patient is doing the very best that they can, in this very moment. Considering their
biology, current skill levels, context and learning history, this is the patients very best. Just as is
this is the best I can do in this particular engagement with this patient, this is their best.
From this assumption we can look at many of their self-destructive behaviors as attempts to
solve problems. Booze and pot ease anxiety, cutting can bring a calm to an internal emotional
storm, pornography binges create a false transcendence and escape from daily hassles of living.
When we helpers witness our patients lapsing and relapsing, we need to realize that all things
considered, this is the best our patients can do in the moment.
This is also grounds for acceptance of one's actual ability and moves our understanding closer
to what the actual problems are. With acceptance comes effective problem solving.
2. Adopt this assumption, too: And my patients need to do better, try harder and be more
motivated to change.
Assuming that each patient is doing their best in a given moment doesn't preclude their need to
do better, and it doesn't preclude that we don't push our patients harder. We do, and do so for
their benefit. As for our patients needing to be more motivated, each of us professional helpers
must consider how we are enhancing our patients’ motivation. Motivation fluctuates for all
people with respect to certain behaviors, depending on factors that range from lack of sleep,
stress about the fruits of one's own decisions.
We helpers need to be on our toes and ready to help our patients connect their goals and
desires for improved health with the effort required to get there. Counseling is work and
frankly, it's easier to stay the same than to try to change fifteen, twenty or even thirty years of
habits. When motivation seems to flag in our patients, we must address this and work with them
to up the juice to keep going, not giving into the temptation to consider them "not ready" or
"lazy."
3. Be a Cheerleader.
We need to give hope to our patients by telling them, in realistic terms, that they're making
progress. We can let them know that we believe in them and that while there is some
discomfort arising from new levels of efforts, the pain is worth it. As helpers we can remind
them of their prior successes in counseling, or if counseling is a new project, draw upon any
past success in school, work, standing up for a friend, etc. And it's important for us to remind
them that difficult moments are only moments and that they don't have to endure the whole
enchilada.
4. Provide positive reinforcement.

Assuming that we care about the well being of our clients, since we chose the vocational path
to help, let us be vigilant to provide positive reinforcement at every moment we see our
patients move closer to their goals, whether an inch closer or a mile closer. If we're successful
at developing a strong relationship with our patients, our smile, our approval, celebration or
even pointing out to them their small steps as success where they miss it we can strengthen the
likelihood that their efforts and practices will take and become generalized.
Adding reinforcement at every incremental improvement is what the behaviorists refer to as

shaping. Each incremental approximation to improved communication, self-control or other
adaptive responses to stress is a significant move. Our responses in the moment help our
patients keep that ground and to continue moving forward. So in our attentiveness, let's not let
the slightest improvement escape unnoticed, if we can help it.
Many helping professionals reading this will find this piece rudimentary. Perhaps they'll find it a
refreshing reminder. For other helpers, inexperienced or highly experienced who have not put
these assumptions or methods into practice, hopefully they will consider applying them to see
what kind of difference it makes in their practice.
We simply cannot expect listening and a straight didactic approach to be effective with each
patient we treat. Much of the success comes in our mindsets and expectations, and how well
we express them.

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This post was published to DBT Counselor's Blog at 1:41:29 AM 4/9/2010

Scott E. Spradlin, MA, LPC

New Leaf DBT, Christian Counseling Center of Wichita

4. Provide positive reinforcement.

Adding reinforcement at every incremental improvement is what the behaviorists refer to as

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2010 Better Counseling

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2010 Better Counseling

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2010 Better Counseling

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This post was published to DBT Counselor&#039;s Blog at 1:41:29 AM 4/9/2010

Scott E. Spradlin, MA, LPC

New Leaf DBT, Christian Counseling Center of Wichita

4. Provide positive reinforcement.

Adding reinforcement at every incremental improvement is what the behaviorists refer to as

You might also like

This post was published to DBT Counselor's Blog at 1:41:29 AM 4/9/2010