How to manage defensiveness in gambling counseling

1
How to manage defensiveness in gambling
counseling?

• Polly Lam
• Clinical psychologist
• The Resilience Centre (Macau Social Welfare
  Bureau)

2
Why Clients become Defensive?

• What will client bring into counseling room?
• Clients emotions
• Clients needs and expectations
• Clients past experiences related to quitting
  or counseling
• Clients stages/motivations for change
• Clients original relationship patterns

3
Clients emotions

• What sorts of emotions may clients experience
  before coming to see a counselor?
• Anxiety
• Anger/frustration
• Disappointment
• Confusion/puzzlement
• Sadness
• Hopelessness/helplessness
• Meaninglessness

4
Clients emotions

• Six dimensions need to be assessed
• Awareness self-aware vs. non self-aware
• Referent referring to self vs. referring to
  others or both or dont know
• Modes of expression implicit (body language,
  being late) or explicit (verbal) or no expression

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Clients emotions

• 4) Underlying emotions is this the only emotion
  or just the manifested emotion? What are the
  underlying emotions?
• 5) Constructiveness Are these emotions
  constructive or destructive to clients
  functioning?
• 6) Clients intentions for dealing with emotions
  Problem first? Emotions first? Other needs?

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Implications of treatment

• Why should counselors be aware of clients
  emotions?
• To build therapeutic relationship
• To decide the theme and flow of the counseling
  session
• To create an atmosphere that facilitates the
  clients in talking about their emotions
• To reduce defensiveness
• To rebuild clients attachment and relating style
• To facilitate clients in being aware of and
  managing emotions

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Implications of treatment

• How is this related to treating of gambling
  addiction?
• What is craving? (craving is an emotion)
• Talking about emotions helps to develop awareness
  of emotions, which is crucial for management of
  craving (Pic. 1)
• When clients can talk about their hurts and pain,
  healing process begins and it would reduce their
  motivation to use gambling to manage their
  emotions (narrator/observer vs. actor). Gamblers
  use gambling to alter their emotional states, and
  identified 3 types of emotion-altering effects
  arousal, shutting off and achievement.
  (Ricketts Macaskill 2003)
• Motivate clients to remain in therapy

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Question to discuss

• Is this contradicted
• by
• Cognitive-Behavioral Therapy?

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Assessing Clients Emotions

• How can we know clients emotions?
• By observing body/non-verbal language
• By listening to clients verbal language
• By listening to counselors self-talk
• By consulting clinical supervisors after sessions

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Observing body/non-verbal language

• Being late or early (compared with clients
  patterns)
• Eye contact (beware of cultural difference)
• Walking speed
• Body gestures
• Dressing
• Accompanied by other people
• Seat selection

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Listening to clients verbal language

• F levels of meaning
• Factual meaning
• Contextual meaning
• Emotional meaning
• Existential meaning

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Factual Meaning

• Describing facts and events
• Not always linear and logical
• Not always clear (who, when, where, what, how)
• Be careful of asking Why?
• Counselors have to clarify without disturbing the
  flow
• If case may involve child abuse, neglect,
  domestic violence, suicidal risk, or criminal
  offence, counselor must clarify the safety issues
  of the clients and family members (In this
  situation, therapeutic relationship comes second)

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Contextual Meaning

• Meaning understood only within certain cultural
  contexts
• Important to understand clients own cultural and
  sub-cultural practice (different types of
  gamblers always have their own sub-cultures and
  information sharing systems).
• Clients sometimes assume counselors understand
  their cultures and sub-cultures (e.g. some belief
  systems related to manipulating luck or winning
  money), and may feel disappointed if counselor
  seems not familiar with these.
• Counselors must not assume they know clients
  sub-cultures even though they have seen thousands
  of clients already.
• Counselors must always show interest in
  understanding clients belief systems even though
  they disagree with them. (Remember, clients
  listen only to those counselors who can
  understand both the positive and negative sides
  of their beliefs) (more difficult than we think)

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Contextual Meaning

• Both factual and contextual meaning belong to the
  category of manifested meaning, and both
  emotional and existential meaning belong to the
  category of latent meaning.
• Factual Manifested meaning
• Contextual
• Emotional
• Existential Latent Meaning

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Emotional Meaning

• Unspoken underlying emotional contents exist
  within facts and event
• e.g. My husband has tried his best to pay my
  debt, he even wants to sell the house
• e.g. You cant help me
• What is the underlying emotional content of these
  sentences?

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Decoding the Meaning

• The factual meaning of first sentence
• Husband is paying Clients debt
• Husband is suffering a heavy financial burden
  because of clients gambling problem
• Family may lose the house
• Husband is the one who solves the financial
  problems and makes important financial decisions,
  not the client

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Decoding the Meaning

• The contextual meaning of first sentence
• In clients family, husband may be the dominant
  problem-solver
• Husband feels responsible for solving clients
  financial problem regardless of price
• Client seems agree to this family culture
• (most important thing client assumes that
  counselor understands and agrees with this family
  or cultural practice. The counselor can disagree
  with this practice but it is better not to argue
  at this stage)

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Decoding the Meaning

• The emotional meaning of the first sentence
• I am happy about being supported by my husband
• I am proud of having a good husband
• I feel guilty for what I have done to him
• I am afraid of jeopardizing our relationship
• (Question Does the client feel remorse for her
  behavior?)

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Existential meaning

• The existential meaning of the first sentence
• Being loved unconditionally is very meaningful
  to me (unconditionally means I can continually
  receive care and support from others without
  paying for that care and support)
• I deserve to be loved unconditionally
• I cannot cope by myself

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How to respond to emotional meaning?

• Response to (1) Fit into her irresponsibility
• Response to (2) Fit into her ego-centrism
• (Both responses could also diminish the
  significance of seeking professional help)
• Response to (3) Clients reply maybe not genuine
• Response to (4) Probably the best because it is
  her real concern reflecting her existential
  meanings (1) (2) (3)

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The real dilemma of the client

• Being Loved Unconditionally
• vs.
• Taking Responsibility

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What counselors can do

• Analyze pros and cons of being loved
  unconditionally
• Pros stable, comfortable, sense of power
  control
• Cons fixed role, not adaptable to environmental
  change, always feel insecure
• (Counselors can lead clients to understand that
  Pros will finally become Cons as time goes by,
  and show confidence in clients ability for self
  growth)

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Exercise

• What is the factual, contextual, emotional and
  existential meaning of Sentence (2)?

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Situations that may cause defensiveness

• Correctly responding to Clients emotions could
  significantly reduce defensiveness and motivate
  clients to remain in therapy.
• Some other situations may cause defensiveness
• Clients needs and expectations not being met
  (may involve boundary issues)
• Clients past experiences related to counseling
  
• Clients stages/motivation for change (not ready
  for change)
• Clients original relationship patterns

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Types of defense commonly found

• Justification
• Rationalization
• Blaming
• Minimizing
• Denial
• Side-tracking
• Monologue

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Justification

• Clients justify their reasons for gambling
• Not very useful to argue whether those reasons
  are rational or not
• Rather than argue with clients, counselors could
  respond to clientsemotional and existential
  meanings behind those reasons, and demonstrate
  that their means (gambling) cannot not achieve
  their ultimate goals.

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Rationalization

• Clients use a rational, detached, and
  third-person perspective to purely describe or
  analyze their own gambling behaviors
• Best for counselors not to discuss with the
  causes, effects, or reasons for the
  behaviors, but to ask more questions related to
  clients emotions and meanings attached to
  gambling.

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Blaming

• Clients blame someone or a situation instead of
  themselves as being responsible for their
  gambling behaviors.
• Acknowledge clients anger without playing into
  his/her victim role
• Always lead clients back to practical solutions
  to solve the problem. If client does not have
  one, work it out together. Show confidence in
  clients ability to manage the problem.

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Minimizing

• Clients minimize negative effects of their
  gambling problems
• Best for counselor not to argue about the
  reality, rather demonstrate the loss caused by
  delay in remedial action or no action,
  compared with what is gained by taking immediate
  remedial action to solve the problem.

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Denial

• Clients deny any gambling problem
• Best for counselor not to argue whether clients
  really have a gambling problem, but to simply
  listen, give them positive advice and emotional
  support about other issues
• Build rapport for next time

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Side-tracking

• Clients often side-tracked during discourse
• May not be intentional
• Counselor could try decoding the side-tracked
  dialogue to see whether there is some emotional
  meaning
• If it seems no underlying meaning, counselor
  could get back on track by asking I am very
  concerned about your situationcould you tell me
  more about?

32
Monologue

• Clients just want to talk about themselves and
  not listen to the counselor (dominating the
  counseling sessions)
• Commonly found in clients who suffer borderline,
  histrionic and narcissistic personality disorder
• Most difficult to handle
• Depends on whether counselor wants to do
  long-term psychotherapy
• Need special training

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Counselors listening skills

• Every counselor should learn listening with four
  ears
• What are Four Ears?
• Ear 1 listens to clients factual contextual
  meanings
• Ear 2 listens to clients emotional
  existential meanings
• Ear 3 The ear that listen to Counselors own
  self-talk
• Ear 4 borrows Clients ears and listens to
  what counselors will say (censoring the speech
  before it is said)

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Counselors listening skills

• With four ears listening skills, a counselor
  can
• Reduce defensiveness
• Design a tailor-made therapy for clients that
  facilitates changes and personal growth
• Help client to work on his or her emotions and
  create meanings

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How can a counselor learn four ears listening
skills?

• Be sensitive to non-verbal emotional cues
• Be sensitive to verbal emotional cues
• Be mindful of own emotions
• Practice mind observation
• Practice delay responses
• Be aware of value judgments
• Receive supervision

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Question Discussion

• Thank you very much!