Therapeutic Change With Difficult Clients

Now in its second edition, Therapeutic Change with Difficult Clients describes a common factors model for understanding and activating the process of change with challenging clients.

For therapists, the most difficult clients to treat are often those who have little interest in change. Whether they believe that change is a waste of time, or a threat to their personal freedom or sense of being, the difficulty of treating such clients reveals the limits of typical approaches to psychotherapy. A thorough understanding of the true nature therapeutic change is often the most important step toward improving psychotherapy effectiveness.

The CHANGES model, which has been significantly expanded and updated since the first edition of this book, is founded on the seven precursors of change, which are identified, assessed, and activated in the context of therapeutic encounters. The authors examine the capacities of individuals to generate therapeutic change, identify the barriers to change, and discuss the power of therapists to catalyze the change process using a variety of well established techniques. In addition to updated supporting literature, the authors discuss recent advances in neuroscience and the cognitive sciences, as well as new developments in the interpersonal aspects of therapeutic engagement.

Preface

Acknowledgments

Introduction

Part I. Activating Change With Difficult Clients

• Chapter 1. Toward a Model of Change for Difficult Clients
• Chapter 2. What Makes a Client Difficult?

Part II. The CHANGES Model, Strategies, and Techniques

• Chapter 3. Orienting the Relationship Around Change
• Chapter 4. C: Confronting the Problem
• Chapter 5. H: Hope for Change
• Chapter 6. A: Awareness of the Problem
• Chapter 7. N: Necessity for Change
• Chapter 8. G: Grit, or Willingness to Experience Anxiety or Difficulty
• Chapter 9. E: Effort or Will to Change
• Chapter 10. S: Social Support for Change

Part III. The CHANGES Assessment

• Chapter 11. Rating Client Potential for Therapeutic Change
• Chapter 12. Rating Therapist Interference in the Change Process

Part IV. Specialized Applications

• Chapter 13. Guidance for Advanced Training and Supervision
• Chapter 14. Oppression, Perspicacity, and Liberation
• Chapter 15. Addiction and Substance Use

Part V. Conclusion

• Chapter 16. At the Horizon of Change

References

About the Authors

Brett Wilkinson, PhD, is an associate professor of counselor education at Purdue University Fort Wayne (PFW) and a licensed mental health counselor in private practice working with individuals, couples, and families. He is editor-in-chief of the ACA’s Journal of Humanistic Counseling and founding director of the PFW Institute for Counseling Research, which designs clinical practice and training studies in counseling and psychotherapy. He provides consultations and trainings on the CHANGES Model, clinical-reflective supervision, cognitive complexity, and embodied mindfulness to community agencies, school systems, and university programs.

Fred J. Hanna, PhD, is a professor and codesigner of the PhD Program in Counseling at Adler University, in Chicago. He was previously a senior faculty associate at Johns Hopkins University where he taught graduate counseling courses for 25 years, including 11 years full time, leaving as a full professor. Fred has served as a consultant and trainer to the medical, mental health, corrections, business, and education communities, including such places as the Johns Hopkins School of Medicine Department of Psychiatry, the Fort Peck Sioux Reservation in Montana, the Department of Psychiatry at Yale University, and a wide variety of school systems, community agencies, prisons, and criminal justice settings across the United States.

Even the most experienced and skilled therapists encounter challenges with clients that can stifle progress and bring frustration into the therapeutic relationship. In this volume, Wilkinson and Hanna explore a compassionate approach to working with these challenges that considers the unique individual client. It is an excellent resource for any therapist.
—Louis Hoffman, PhD, Editor, APA Handbook of Humanistic and Existential Psychology and coeditor, The Evidence-Based Foundations of Existential–Humanistic Therapy

If I could only grab one book to give to psychotherapists in training at any level it would be Therapeutic Change With Difficult Clients. It has enough theory, so it hangs together well, but the real treasure is the host of tools and techniques that are wonderfully explained and exemplified. No therapist, even experienced ones, should miss this valuable volume. This old dog learned lots of new tricks!
—David M. Young, PhD, Professor Emeritus, Psychology, Purdue University Fort Wayne, Fort Wayne, IN; coauthor of The Silent Language of Psychotherapy, Third Edition

Drs. Wilkinson and Hanna are percipient thinkers who have put together a truly invaluable book on how to work with some of the most challenging clients. Filled with keen insights and practical wisdom for practice, I am confident that this second edition will be widely read and cited for years to come.
—Matthew E. Lemberger-Truelove, PhD, American Counseling Association Fellow; Professor of Counseling at the University of North Texas, Denton, TX

Finally, a book about how to support people in their change process! This book’s focus on facilitating and enhancing people’s change process is a must-read for all mental health providers. Too often it is assumed our clients want to change, when in reality, most people have ambivalence about change. The authors guide readers, step-by-step, with practical tools they can use to help encourage change. The case examples and applications bring to life the most important thing we do as helpers—support others in their change process.
—Victoria Kress, PhD, Distinguished Professor, Youngstown State University, Youngstown, OH