Working With Difficult Clients

Dr. J Huffine, Primary Therapist,
Clinical Director, Second Nature Cascades

Second Nature Wilderness Programs exist to assist “difficult” or resistant adolescents and young adults in making positive changes in their lives.  But what makes one “difficult”?  Why do some adolescents (and adults) seem to resist change?  

It is a hallmark of therapeutic wilderness programs to help clients begin to engage in their own therapeutic process, so that lasting change can occur.  But how?  What is actually changing?

I stumbled across a book several years ago that had a profound impact on how I view therapy in the woods, a book written by Fred J Hanna, Ph.D. entitled Therapy With Difficult Clients: Using the Precursors Model to Awaken Change.   Dr. Hanna conducted reviews and meta-analyses of research on change, whether that change occurred in a therapeutic context or not.  He found that there were seven factors (which he called precursors) that were necessary for change: 

1.     A sense of urgency

2.     Awareness

3.     An ability to tolerate uncomfortable feelings

4.     A willingness to consistently confront problems

5.     Effort

6.     Hope

7.     Social support

After becoming aware of these factors, I began to think about clients we work with in wilderness therapy.  No matter what the profile of the student, the common thread amongst almost all students is a pattern of problematic behaviors (and/or emotions) and an apparent resistance to changing behaviors.  Understanding these seven factors led to my own “aha” experience.  It has greatly helped my understanding of why some students are more “resistant”, i.e., stuck, than others.  

Resistant students are usually deficient in some or all of these areas.   The profile of students that I typically work with includes the more “acting in, clinically layered” adolescent male.  Often these are individuals with some depression, anxiety, school failure, and some with significant processing issues, social difficulties, and family conflicts. 

Often, these adolescents were miserable at home, but showed no urgency to change because of deficiencies in the other precursors.  There were often promises to do better, “I’m going to start on that tomorrow”, etc.  But unless they had really “hit bottom” there was often a lack of urgency.  In wilderness, if for no other reason than to “get out”; students are motivated to do something other than what they had been doing. Motivation for change gradually becomes more internal as students see that something positive is really occurring for them.

Awareness includes both internal awareness (also called insight) and external awareness, how one’s actions affect other people.  Progress is impossible without an awareness of internal processes (if you believe in cognitive behavioral therapy), and lack of awareness of one’s own role in his or her own problems results in an inability to improve outcomes by altering behaviors.  Wilderness therapy works on awareness constantly through the writing of Impact Letters, giving and receiving feedback, utilizing the  “I feel” statement, providing time and space for reflection and introspection.   We hold up figurative mirrors and ask, “Do you notice…”

An ability to tolerate uncomfortable feelings?   This is huge.  Think about changes you have made in your own life.  What discomfort did this require?  How many teenagers are willing to do something uncomfortable today to benefit themselves down the road?   Especially those that have limited resources for coping, or who lack emotional resilience, or have been “rescued” from their feelings too often.  Wilderness therapy helps increase emotional capacities, by providing an environment where students can experience their emotions, gain emotional resilience and the ability to tolerate sadness, frustration, disappointment, anxiety, stress, etc.  Feelings that come with life.

A willingness to consistently confront problems?  Most students I work with show a strong pattern of avoiding their problems.  In the woods, this is impossible.  The size of the group, the staff to student ratio, the structure all allow for constant monitoring of students’ behaviors.  They simply can’t get around their problems, and we help them learn how to work through them.

Effort?  Seems obvious that effort is necessary for change, but often there has been a tremendous lack of effort at home in areas that are instrumental to positive change.   In wilderness, effort is put into those areas that are important to growth and development.  I’ve heard new students say, “hiking isn’t therapeutic, it just ticks me off”.  Yet, most students later recognize that effort obviously was necessary and really paid off.  Not just physical effort, of course, but emotional and mental effort as well.

Hope is the belief that what we do matters; that we can make a difference in our own lives and that we are not helpless victims.  Many students I work with have reasons they have come to the conclusion that, “It doesn’t matter what I do, I’ll never be happy, have the friends I want, feel better, be successful, etc.”  They may have biologically based factors that have made their lives more difficult than others.  They may have developed “learned helplessness” which is a major cause of depression.  Wilderness, above all else, gives hope to the participant.  You can’t “not” increase self-efficacy in wilderness therapy.  All students are going to succeed on some level.

Lastly, students need a social support system to effect change.  Support, encouragement, feedback, and praise, are all necessary.  Adolescents typically hear constructive feedback better from each other than from adults.  Wilderness provides an instant source of peer and therapeutic support.  There is also considerable energy invested in working with each student’s primary support group at home, that is, the family system, which is critical to the long-term success of “difficult/resistant” clients.

It is my belief, that on some level, all people want to live functional, successful lives. When I ask students to rate themselves in relation to the seven “precursors”, they are often quite accurate in their perceptions.  We encourage students to understand some of the reasons why they have been stuck and struggling and often, they are relieved to realize that they are not “bad, stupid, lazy”, etc.

Second Nature is highly effective at helping teenagers “engage in their own therapeutic process”.  Not only are the very precursors or ingredients necessary for change so directly addressed while they are in wilderness, but foundations for change are laid for the future.  By increasing capacities in these areas, adolescents are better able to benefit from future therapeutic opportunities.