Managing frustrations...

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Managing frustrations...

Postby jo2212 » Sun Jul 16, 2017 7:49 pm

Hi,

I am currently supporting a client who is very unengaged during our sessions and I can feel some frustrations emerging from myself. I'm aware that my reactions have important consequences and so I am keen to hear any advice or recommendations for readings that can help me my manage frustrations, and also help me engage with him in a more positive and constructive way.

Any help would be much appreciated. :)
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Re: Managing frustrations...

Postby alexh » Mon Jul 17, 2017 6:40 pm

Hi Jo,
I guess the important consequences you may be referring to is the literature that showed that the clients whom their therapists felt hostile towards tended to have poor clinical outcomes? If you don't mind I'll take a slightly different tack to your request of management strategies. I think noticing frustration and other feelings is vital but that the feelings are not there only to be managed and hidden, they can be used to guide and redirect the therapy.

Can you express this feeling and others about clients freely in supervision? It can be hard to tell our supervisors that we dislike or are frustrated with clients but it's OK and common to have the feelings and valuable to discuss them. It may be a peculiarity of the therapeutic and supervision spheres to be so open, and it as certainly a new skill for me.

Following supervision, can you bring that feeling into the therapy? Is that acceptable in the model and service you are working in, and would you feel OK with doing it? What exactly is the feeling? Frustration, hostility, pity, disgust, anger, etc.

I'd guess, given your frustration, that there's also a lack of progress towards the goals of the therapy. I think it is nearly always better to have a conversation about a lack of progress rather than hope that if we simply persist long enough change will result. Maybe you could say 'it feels to me like we're not making much progress here, what do you think?' or even 'I am feeling frustrated that I'm not able to help you as much as I would like, is there anything I/we could do differently?'. Maybe they're as frustrated as you but they find it hard to say, possibly due to the power differential. Or they're happy but they believe they're working on a different goal to you.

My interpretation of your question is informed by the concept of the therapeutic alliance (agreement on the goals, task and bond - Bordin, 1979), feedback informed treatment (Michael Lambert et al or Scott Miller & Barry Duncan and other's work along the same lines) and Jeremy Safran and colleagues work on therapeutic ruptures - you might interpret a lack of engagement as a withdrawal rupture.
Alternatively, you could think about the stages of change model, (Prochaska and DiClemente) what stage is the client at?
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Re: Managing frustrations...

Postby maven » Tue Jul 18, 2017 3:09 am

Well said. Also consider using sessional rating scales to get feedback from the client, and using CAT or a similar interpersonal model to map out the processes/transference during supervision, so you can see what your part is in the pattern and how to change that.
Maven.

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare
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Re: Managing frustrations...

Postby jo2212 » Tue Jul 18, 2017 8:55 pm

Your interpretation was near on perfect! Thank you so much for the advice! :D
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