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 “don’t know” Modes of expression: implicit (body language, being late) or explicit (verbal) or no expression

5. 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?

6. 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

7. 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

8. Question to discuss: Is this contradicted by Cognitive-Behavioral Therapy?

9. 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

10. 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

11. Listening to clients’ verbal language F levels of meaning: Factual meaning Contextual meaning Emotional meaning Existential meaning

12. 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)

13. 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)

14. 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

15. 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 can’t help me…” What is the underlying emotional content of these sentences?

16. Decoding the Meaning The factual meaning of first sentence: Husband is paying Client’s debt Husband is suffering a heavy financial burden because of client’s gambling problem Family may lose the house Husband is the one who solves the financial problems and makes important financial decisions, not the client

17. Decoding the Meaning The contextual meaning of first sentence: In client’s family, husband may be the dominant problem-solver Husband feels responsible for solving client’s 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)

18. 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?)

19. 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

20. 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): Client’s reply maybe not genuine Response to (4): Probably the best because it is her “real concern” reflecting her existential meanings (1) + (2) + (3)

21. The real dilemma of the client Being Loved “Unconditionally” vs. Taking Responsibility

22. 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)

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

24. 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

25. Types of defense commonly found: Justification Rationalization Blaming Minimizing Denial Side-tracking Monologue

26. 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 clients’emotional and existential meanings behind those “reasons”, and demonstrate that their “means” (gambling) cannot not achieve their ultimate goals.

27. 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.

28. 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.

29. 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.

30. 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”

31. 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 situation…could 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

33. Counselor’s 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 Client’s ears” and listens to what counselors will say (censoring the speech before it is said)

34. Counselor’s 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

35. 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

36. Question & Discussion Thank you very much!