Reading D

Confrontation, also known as challenge, is an influencing response in which the helper describes discrepancies, conflicts, and mixed messages apparent in the client’s feelings, thoughts, and actions. Hepworth and associates (2010) describe this response as follows:

Although some other authors prefer the term challenge over confrontation, we will use these terms interchangeably because they both have the same function in the helping process, and that is to support and move the client forward simultaneously.

Confrontation/challenge has several purposes. One purpose is to help clients explore other ways of perceiving themselves or an issue, leading ultimately to different actions or behaviors. Egan (2010) refers to this purpose as challenging the client’s “blind spots,” things the client fails to see or chooses to ignore (p. 223). This may involve challenging distortions as well as discrepancies. These distortions may be cognitive ones (often the result of inaccurate, incomplete, or erroneous beliefs and information) or affective ones, involving attributions made from inaccurate or erroneous perceptions (Hepworth et al., 2010).

A second purpose of the confrontation/ challenge response is to help the client become more aware of discrepancies or incongruities in thoughts, feelings, and actions. This is important because discrepancies can be indicators of unresolved, contradictory, or suppressed feelings.

Many times during an interview a client may say or do something that is inconsistent. For example, a client says she doesn’t want to talk to you because you are a male but then goes ahead and talks to you. In this case, the client’s verbal message is inconsistent with her actual behavior. This is an example of an inconsistent, or mixed, message. The purpose of using a confrontation to deal with a mixed message is to describe the discrepancy or contradiction to the client. Often the client is unaware or only vaguely aware of the conflict before the helper points it out. In describing the discrepancy, you will find it helpful to use a confrontation that presents or connects both parts of the discrepancy. Motivational inter-viewing theory describes this as a double-sided reflection.

Six major types of mixed messages and accompanying descriptions of confrontations are presented as examples (see also Egan, 2010; Ivey, Ivey, & Zalaquett, 2010).

1. Verbal and nonverbal behavior
   1. Client says, “I feel comfortable” (verbal message) but at the same time is fidgeting and twisting her hands (nonverbal message).
      Helper confrontation: You say you feel comfortable, and you’re also fidgeting and twisting your hands.
   2. Client says, “I feel happy about the relationship being over – it’s better this way” (verbal message) but is talking in a slow, low-pitched voice (nonverbal message).
      Helper confrontation: You say you’re happy it’s over, and at the same time your voice suggests you have some other feelings too.
2. Verbal messages and action steps or behaviors
   1. Client says, “I’m going to call her” (verbal message) but reports the next week that he did not make the call (action step).
      Helper confrontation: You said you would call her, and as of now you are reporting that you haven’t done so yet.
   2. Client says, “Counseling is very important to me” (verbal message) but calls off the next two sessions (behavior).
      Helper confrontation: Several weeks ago you said how important counseling is to you; now I’m also aware that you called off our last two meetings.
3. Two verbal messages (stated inconsistencies)
   1. Client says, “He’s sleeping around with other people. I don’t feel bothered (verbal message 1), but I think our relationship should mean more to him than it does” (verbal message 2).
      Helper confrontation: First you say you feel okay about his behavior; now you’re feeling upset that your relationship is not as important to him as it is to you.
   2. Client says, “I really do love little Georgie (verbal message 1), although he often bugs the hell out of me” (verbal message 2).
      Helper confrontation: You seem to be aware that much of the time you love him, and at other times you feel very irritated toward him, too.
4. Two nonverbal messages (apparent inconsistencies)
   1. Client is smiling (nonverbal message 1) and crying (nonverbal message 2) at the same time.
      Helper confrontation: You’re smiling and also crying at the same time.
   2. Client is looking directly at helper (nonverbal message 1) and has just moved chair back from helper (nonverbal message 2).
      Helper confrontation: You’re looking at me while you say this, and at the same time you also moved away.
5. Two persons (helper/client, parent/child, teacher/ student, spouse/spouse, and so on)
   1. Client’s husband lost his job two years ago. Client wants to move; husband wants to stick around near his family.
      Helper confrontation: Edie, you’d like to move. Marshall, you’re feeling family ties and want to stick around.
   2. A woman presents anxiety, depression, and memory loss. You suggest a medical workup to rule out any organic dysfunction, and the client refuses.
      Helper confrontation: Irene, I feel it’s very important for us to have a medical workup so we know what to do that will be most helpful for you. You seem to feel very reluctant to have the workup done. How can we work this out?
6. Verbal message and context or situation
   1. A child deplores her parents’ divorce and states that she wants to help her parents get back together.
      Helper confrontation: Sierra, you say you want to help your parents get back together. At the same time, you had no role in their breakup. How do you put these two things together?
   2. A young couple has had severe conflicts for the past three years, but still they want to have a baby to improve their relationship.
      Helper confrontation: The two of you have separated three times since I’ve been seeing you in therapy. Now you’re saying you want to use a child to improve your relationship. Many couples indicate that stress increases from having a child and being parents. How do you put this together?

Ground Rules for Challenging

Confrontation needs to be offered in a way that helps clients examine the consequences of their behavior rather than defending their actions (Johnson, 2009). In other words, confrontation must be used carefully in order not to increase the very behavior or pattern that the helper feels may need to be diminished or modified. The following ground rules may assist you in using this response to help rather than to harm.

First, be aware of your own motives for challenging at any particular time. Although the word itself has a punitive or emotionally charged sound, confrontation/challenging in the helping process is not an attack on or an opportunity to badger the client (Welfel & Patterson, 2005). Confrontation also is not to be used as a way to ventilate or dump your frustration onto the client. It is a means of offering constructive, growth-directed feed-back that is positive in context and intent, not disapproving or critical (Welfel & Patterson, 2005). Ivey; Ivey, and Zalaquett (2010) describe confrontation as a “supportive” kind of challenge and a “gentle skill that involves listening to the client carefully and respectfully, and then seeking to help the client examine oneself or the situation more fully…it is not going against the client, it is going with the client” (p. 241).

To avoid blame, focus on the incongruity as the problem, not on the person, and make sure your supportive stance is reflected in your tone of voice and body language. In describing the distortion or discrepancy; the confrontation should cite a specific example of the behavior rather than make a vague inference. A poor confrontation might be, “You want people to like you, but your personality turns them off.” In this case, the practitioner is making a general inference about the client’s personality and also is implying that the client must undergo a major overhaul in order to get along with others. A more helpful confrontation would be, “You want people to like you, and at the same time you make frequent remarks about yourself that seem to get in the way and turn people off.”

Moreover, before a helper tries to confront a client, rapport and trust should be established. Confrontation probably should not be used unless you, the helper, are willing to maintain or increase your involvement in or commitment to the helping relationship (Johnson, 2009). The primary consideration is to judge what your level of involvement seems to be with each client and adapt accordingly. The stronger the relationship is, the more receptive the client may be to a confrontation.

The timing of a confrontation is very important. Because the purpose is to help the person engage in self-examination, try to offer the confrontation at a time when the client is likely to use it. The perceived ability of the client to act on the confrontation should be a major guideline in deciding when to challenge. In other words, before you jump in and confront, determine the person’s attention level, anxiety level, desire to change, and ability to listen. A confrontation is most likely to be heard when the client feels safe with you; it is less likely to be heard when it occurs early in the relationship. An exception to this general ground rule is in instances of legal violations and danger to self or to others, when confrontation would be mandated earlier in the helping process (Hepworth et al., 2010).

Appropriate use of timing also means that the helper does not challenge clients on a “hit-and-run” basis (Johnson, 2009). Ample time should be given after the confrontation to allow the client to react to and discuss the effects of this response. For this reason, helpers should avoid confronting near the end of a session.

It is also a good idea not to overload the client with confrontations that make heavy demands in a short time. The rule of successive approximations suggests that gradual learning undertaken via small steps in implementing new behaviors is much easier than trying to make big changes overnight. Initially, you may want to challenge the person with something that can be managed fairly easily and with some success. Carkhuff (1987) suggests that two successive confrontations may be too intense and should be avoided. With clients who are fragile or clients who are experiencing severe stress or emotional strain, it is wise to avoid using confrontation altogether (Hepworth et al., 2010).

The gender and cultural affiliations of clients also have an impact on the usefulness of the confrontation/challenge response. This response may be more suitable for European American male clients, particularly manipulative and acting-out ones (Ivey, Ivey, & Zalaquett, 2010). Some traditional Asian and Native American clients may view confrontation as disrespectful and insensitive (Sue & Sue, 2008). For all clients, it is important to use this response in such a way that the client views you as an ally, not an adversary (Welfel & Patterson, 2005).

Finally, acknowledge the limits of the confrontation/challenge response. Confrontation usually brings about client awareness of a discrepancy or conflict. Awareness of discrepancies is an initial step in resolving conflicts. Confrontation, as a single response, may not always bring about resolution of the discrepancy without additional discussion or intervention strategies. Genuine client aware-ness is often difficult to detect because it may be not an immediate reaction but one that occurs over a period of time. According to Strong and Zeman (2010), the interactional process that occurs between helper and client when confrontation is used is more important than any other verbal skill because confrontation is part of a dialogic or relationally responsive way of communicating and interacting. They assert that “a skill such as confrontation tends to be inadequately depicted in the literature given that the counselor’s utterance is only one part of a dialogic exchange between client and counselor. Thus, confrontation combines timing, perspicacity, careful delivery, equally careful responses to client responses when confronted, and talking until both client and counselor adequately accomplish the aim of the confrontation” (p. 332).

Client Reactions to Challenge

Sometimes helpers are afraid to challenge because they are uncertain how to handle the client’s reactions to the confrontation. Even clients who hear and acknowledge the confrontation may be anxious or upset about the implications. Further, as Strong and Zeman (2010) note, clients will “do things with counselor confrontations, not simply receive them” (p. 333). From their dialogic perspective, what matters most is not just what the helper says in the challenge/ confrontational response but what the clients do with the challenge.

Hill and Nutt-Williams (2000) note that the empirical evidence surrounding client reactions to confrontation is mixed. A qualitative study also found mixed reviews for the effects of confrontation on clients (Levitt et al., 2006). In this study, many clients did not have a positive reaction to being challenged by their helper, but there were two notable exceptions: clients who were being manipulative and clients who were avoiding difficult material. These clients felt that being challenged was useful for them. One client noted that it was extremely helpful to have a therapist who was “stronger than her eating disorder” (p. 320). For clients who have reasons (often cultural ones) to distrust helpers, or for clients such as some adolescents who may be oppositional, challenging can produce resistance and lead to poorer client outcomes. Some evidence suggests that in these cases, a process called motivational interviewing, which is based on the client-centered listening responses and basic empathy, may yield better client outcomes (Miller & Rollnick, 2002).

Generally, a practitioner can expect four types of client reaction to a confrontation: denial, confusion, false acceptance, or genuine acceptance.

In a denial of the confrontation, the client does not want to acknowledge or agree with the helper’s message. A denial may indicate that the client is not ready or tolerant enough to face the discrepant or distorted behavior. Egan (2007) lists some specific ways in which the client might deny the confrontation:

1. Discrediting the helper (e.g., “How do you know when you don’t even have kids?”)
2. Persuading the helper that his or her views are wrong or based on misinterpretation (e.g., “I didn’t mean it that way.”)
3. Devaluing the importance of the topic (e.g., “This isn’t worth all this time anyway.”)
4. Seeking support elsewhere (e.g., “I told my friends about your comment last week, and none of them had ever noticed that.”)
5. Agreeing with the challenger but not acting on the challenge (e.g., “I think you’re right. I should speak up and tell how I feel, but I’m not sure I can do that.”) (pp. 157-158)

At other times, the client may indicate confusion or uncertainty about the meaning of the challenge. In some cases, the client may be genuinely confused about what the practitioner is saying. This reaction may indicate that your confrontation was not concise and specific. At other times, the client may use a lack of understanding as a smoke screen – that is, as a way to avoid dealing with the impact of the confrontation.

Sometimes the client may seem to accept the confrontation. Acceptance is usually genuine if the client responds with a sincere desire to examine her or his behavior. Eventually such clients may be able to catch their own discrepancies and challenge themselves. But false acceptance also can occur. In this case, the client verbally agrees with the helper. However, instead of pursuing the confrontation, the client agrees only to get the helper to leave “well enough” alone. The risk of having confrontation rejected is greatest among clients who need to be challenged the most but, because they are less likely to engage in self-confrontation and may have lower self-esteem, are more likely to read criticism or blame into this response when none is intended (Hepworth et al., 2010).

There is no set way of dealing with client reactions to confrontation/challenge. How-ever, a general guideline is to follow up with basic empathy and go back to the client-oriented listening responses of paraphrase and reflection. Indeed, as Strong and Zeman (2010) note, following a challenge response, returning to core listening skills is a critical part of the dialogic process that occurs surrounding the confrontation process in helping. A helper can use these responses to lay the foundation before the confrontation and return to this foundation after the challenge. The sequence might go something like this:

Helper: You seem to feel concerned about your parents’ divorce. [reflection]

Client: (says in a low, sad voice): Actually, I feel pretty happy. I’m glad for their sake they got a divorce. [mixed message]

Helper: You say you’re happy, and at the same time, from your voice I sense that you feel unhappy. [confrontation]

Client: I don’t know what you’re talking about, really. [denial]

Helper: I feel that what I just said has upset you. [reflection]

Steps in Confronting/Challenging

There are four steps in developing effective confrontations or challenge responses.

1. Observe the client carefully to identify the type of discrepancy or distortions that the client presents. Listen for a period of time so that you can detect several inconsistencies before jumping in with a confrontation response.
2. Assess the purpose of your confrontation. Make sure that it is based on the client’s need to be challenged in some way and not on your need to challenge. Assess whether the relationship is perceived to be sufficiently safe enough by the client for him or her to be able to benefit from the confrontation. Also assess whether the confrontation is appropriate based on the client’s race and ethnicity, gender, and age.
3. Summarize the different elements of the discrepancy. In doing so, use a statement that connects the parts of the conflict rather than disputes any one part, for the overall aim of confrontation is to resolve conflicts and to achieve integration. A useful summary is “On one hand, you____, and on the other hand____.” Notice that the elements are connected with the word and rather than with but or yet. This approach helps you present your confrontation in a descriptive rather than a judgmental way. Make sure that your tone of voice and nonverbal behavior convey concern and caring for the client as well.
4. Remember to assess the effectiveness of your confrontation. A confrontation is effective whenever the client acknowledges the existence of the incongruity or conflict. However, keep in mind that the effectiveness of your confrontation might not be immediate. Watch also for cues that the client may feel defensive or signs indicating indirect reactions to your confrontation. Remember that the client may be adept at masking an overt negative reaction but may subtly withdraw or shut down in the rest of the session if the confrontation has not been well received. Also, bear in mind that “confronting can bring with it breaches not only in the flow of conversation but also in the rapport established in the counselling relationship… What comes after a confrontation is, for us, analytically, a very interesting and often artful rhetorical improvisation by client and counsellor as they talk through where to go thereafter” (Strong & Zeman, 2010, p. 337).

To formulate a confrontation, consider the following cognitive learning strategy:

1. What discrepancy or distortion do I see, hear, or grasp in this client’s communication?
2. What is my purpose in challenging the client, and is it useful for this client at this time?
3. How can I summarize the various elements of the discrepancy or distortion?
4. How will I know whether my confrontation is effective?

Notice how a helper uses this cognitive learning strategy for confrontation in the following example:

Client: (says in low, soft voice): It’s hard for me to discipline my son. I know I’m too indulgent. I know he needs limits. But I just don’t give him any. I let him do basically whatever he feels like doing.

Helper: (asks and answers covertly):

Self-question 1: What discrepancy or distortion do I see, hear, or grasp in this client’s communication?

A discrepancy between two verbal messages and between verbal cues and behavior: client knows son needs limits but doesn’t give him any.

Self-question 2: What is my purpose in challenging the client, and is it useful for this client at this time?

My purpose is to challenge the inconsis-tencies between what this parent actually does with his son and what he wants to do but has not yet been able to do, and to support him in engaging in the desired action. There doesn’t appear to be anything about the client that would make him more defensive with the use of this response at this time.

Self-question 3: How can I summarize the various elements of the discrepancy or distortion?

Client believes limits would help son; at the same time, client doesn’t follow through.

Self-question 4: How will I know whether my confrontation is effective?

Observe the client’s response and see whether he acknowledges the discrepancy.

At this point the helper’s self-talk or covert visualization ends, and the following dialogue occurs:

Helper confrontation: William, on one hand, you feel like having limits would really help your son, and at the same time, he can do whatever he pleases with you. How do you put this together?

Client response: Well, I guess that’s right. I do feel strongly that he would benefit from having limits. He gets away with a lot. He’s going to become very spoiled, I know. But I just can’t seem to put my foot down or make him do something.

From the client’s response, which confirms the discrepancy, the helper can conclude that the confrontation was initially useful (further discussion of the discrepancy seems necessary to help the client resolve the conflict between feelings and actions).