Treatment With Defiant and Aggressive Adolescents
For individuals in the U.S. & U.S. territories
In Treatment With Defiant and Aggressive Adolescents, Dr. Fred J. Hanna demonstrates his practical approach to working with adolescents who have behavior problems. Dr. Hanna's precursors to change model has been used successfully with teenagers who are involved in drugs, gangs, violence, or serious misbehavior in school and other situations. This approach emphasizes seven precursors to change, including instilling a sense of necessity for change and the hope that change is attainable, along with the willingness to experience anxiety and confront issues.
In this session, Dr. Hanna works with a 17-year-old boy who says he wants to succeed in school, although he also asserts that it is all right to drink and party with his friends. Dr. Hanna first assesses the presence of the precursors to change, then creates cognitive dissonance between the two sides of the client's personality so that the client will seek to resolve this split and commit to making changes in his life.
This application of therapy is called the precursors approach. It utilizes the precursors model of change, and is specifically designed for use with difficult clients. The model and its corresponding techniques have been published in articles and in the book, Therapy with Difficult Clients: Using the Precursors Model to Awaken Change, published by the American Psychological Association. Since adolescents are among the most difficult populations, the model seems to fit well in such settings.
The model is based on seven empirically validated client variables, functions, qualities, or change factors that can be considered to be therapeutic change mechanisms or processes. The precursors can be considered to be prerequisites of change.
The essential idea behind the model is that if a person is not manifesting the precursors, change will not occur regardless of the therapeutic approach taken by the therapist. Conversely, if a person has the precursors to an ample degree, any reasonable approach to therapy will be effective. Thus, a client is difficult simply because the precursors of change are missing or absent in that person. The model suggests that if the missing precursors are established, then the client can, to that degree, begin to respond to conventional therapy approaches.
The precursors approach includes a host of techniques and strategies designed to initiate and expedite the therapeutic change process by helping to establish the precursors in a client for whom change is not, or has not been, forthcoming. There is a set of techniques and strategies corresponding to each of the seven precursors. A precursors assessment form is an intrinsic part of the model, used to determine which precursors are most in need of attention in a difficult client. The approach is specifically intended to be used with difficult clients and has been used widely with difficult adolescents.
The seven precursors of change are:
- a sense of necessity for change
- the willingness to experience anxiety or difficulty
- awareness of the problem
- confronting the problem
- effort toward change
- hope for change
- social support for change
The purpose of the approach is to help establish the precursors to clear the way for the more established theories and approaches, so that they can be more focused and more effective. Part of the precursors approach involves motivating adolescents to work in therapy through aligning their own desires and values with therapeutic goals such as abstaining from drugs or alcohol, improving school performance, and/or satisfying the simple desire to be happy. The approach is also designed to help them tolerate and experience anxiety rather than shunning it at all costs. It is an extremely supportive model, relying on high empathy and intense techniques, with the goal of producing an initial breakthrough with a client.
The initial breakthrough converts the client from being unwilling to engage in therapy, to being motivated and involved in the therapy process. The precursors approach applies to such adolescent behaviors and issues as stealing, lying, blaming, drug and alcohol abuse, cutting, eating disorders, anger, violence, and many others. There are many, many precursor specific strategies utilized in bringing about that initial breakthrough such as admiring negative behaviors and attitudes, courtesy and permission, the subpersonality approach, addressing the hurt, the freedom challenge, the life circles technique, real self vs. fake self, the attention remedy, therapeutic button pushing, the use of metaphors, in vivo confronting, the use of metaphors, and many more.
The precursors model can also be used in supervision, due to the interesting notion that therapists have precursors ratings toward clients, and that a therapist's level of precursors varies with each client with whom he or she works. A supervisor can thus address the precursor levels in a therapist who is having difficulty with a particular client, and explore the possibility that the therapist's low precursor ratings may be in part responsible for the client's lack of change in therapy.
With regard to adolescents, oppositional defiant, angry adolescents are quite appropriate for this approach, as well as violent, manipulative, and drug abusing adolescents as well. It is also appropriate for teens with attention seeking, power struggles, eating disorders, and those who are not forthcoming with self-disclosure. It would be appropriate, but challenging, to use this approach for teens who are bipolar.
Fred J. Hanna, PhD, is director of the School of Applied Psychology and Counselor Education at the University of Northern Colorado. Before arriving at UNC, he served as professor of counseling at Johns Hopkins University for 11 years and remains a faculty associate there.
He has held positions on the editorial boards of six scholarly journals and has published a wide range of scholarly and professional articles. In addition to many years of therapy practice, he serves as a consultant and trainer to community agencies and school systems across America, and his teaching and training methods and delivery are highly praised.
His research interests have focused on developing the precursors model of change. He has also developed and published many innovative clinical techniques aimed at positive change for addicted clients, victims of oppression, criminal personalities, and especially difficult adolescents. An accomplished world traveler, he has also developed therapeutic approaches in the areas of culture and spirituality. He is the author of the book, Therapy with Difficult Clients: Using the Precursors Model to Awaken Change, published by the American Psychological Association.
- Hanna, F. J. (2002). Therapy with difficult clients: Using the precursors model to awaken change. Washington, DC: American Psychological Association.
- Hanna, F. J., Talley, W. B., & Guindon, M. H. (2000). The power of perception: Toward a model of cultural oppression and liberation. Journal of Counseling and Development, 78 (4), 430–431.
- Kann, R. T., & Hanna, F. J. (2000). Disruptive behavior disorders in children and adolescents: How do girls differ from boys? Journal of Counseling and Development, 78 (3), 267–274.
- Hanna, F. J., & Hunt, W. P. (1999). Techniques for psychotherapy with defiant, aggressive adolescents. Psychotherapy, 36 (1), 56–68.
- Hanna, F. J., Hanna, C. A., & Keys, S. G. (1999). Fifty strategies for counseling defiant and aggressive adolescents: Reaching, accepting, and relating. Journal of Counseling and Development, 77 (4), 395–404.
- Ottens, A. J., & Hanna, F. J. (1998). Cognitive and existential therapies: Toward an integration. Psychotherapy, 35, 312–324.
- Hanna, F. J. (1996). Precursors of change: Pivotal points of involvement and resistance in psychotherapy. Journal of Psychotherapy Integration, 6 (3), 227–264.
- Hanna, F. J., & Ritchie, M. H. (1995). Seeking the active ingredients of psychotherapeutic change: Within and outside the context of therapy. Professional Psychology: Research and Practice, 26 (2), 176–183.
- Hanna, F. J., & Ottens, A. J. (1995). The role of wisdom in psychotherapy. Journal of Psychotherapy Integration, 5 (3), 195–219.
- Hanna, F. J. (1994). A dialectic of experience: A radical empiricist approach to conflicting theories in psychotherapy. Psychotherapy, 31 (1), 124–136.
- Adolescent Boys Who Are Suicidal
David A. Jobes
- Brief Therapy With Adolescents
John M. Littrell
- Dialectical Behavior Therapy for Adolescents With Multiple Problems
Alec L. Miller
- Harm Reduction With High School Students
Mary E. Larimer
- Practical Psychotherapy With Adolescents
Alice K. Rubenstein
- Working With Anger
- Adolescent Suicide: Assessment and Intervention, Second Edition
Alan L. Berman, David A. Jobes, and Morton M. Silverman
- Building Supportive Communities for At-Risk Adolescents: It Takes More Than Services
Martha R. Burt, Gary Resnick, and Emily R. Novick
- In the Room With Men: A Casebook of Therapeutic Change
Edited by Matt Englar-Carlson and Mark A. Stevens
- Preventing Youth Substance Abuse: Science-Based Programs for Children and Adolescents
Edited by Patrick Tolan, José Szapocznik, and Soledad Sambrano
- Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice, Second Edition
Edited by Euthymia D. Hibbs and Peter S. Jensen
- Therapy With Difficult Clients: Using the Precursors Model to Awaken Change
Fred J. Hanna