Transcript HIGH CONFLICT CLIENTS

HIGH CONFLICT CLIENTS
UNDERSTANDING & INTERVENING WITH HIGH
CONFLICT DOMESTIC VIOLENCE CLIENTS
Gary Gibbens, MaPsy
Reasons Not To Label People
Stigmatizes the client
Diagnosis may be incorrect
May affect counselor's view of and
relationship with the client
Labeling without appropriate referral or
change in treatment approach is not
helpful
Common Issues of High
Conflict Clients
Rigid and uncompromising
Difficulty accepting or processing loss
Can appear logical until emotions
overwhelm logic
Avoids responsibility-focus on blaming
Depends on other people to solve
problems
Limited ability to self reflect
Almost no empathy for other’s issues
The Paradox of High Conflict
Clients
The Paradigm shift for Intervention
The HCC is always trying to focus on conflicts
with others and trying to involve us in
solving these conflicts
The Real issue: Conflict is WITHIN these
individuals
Characteristics of DSM-IV
Personality Disorders
Enduring patterns of problem behavior
from early childhood/adolescence
Extreme (all or nothing) thinking,
emotions, behavior
Interpersonal dysfunction
Impulse control problems
Not the result of substance abuse or
trauma
NIH Study 2001-02
National Institutes of Health, National
Institute on Alcohol Abuse and Alcoholism
found:
– 30.8 million Americans (14.8%) meet
diagnostic criteria for at least one personality
disorder under DSM-IV
– These diagnoses were found to be highly
associated with emotional disability and social
dysfunction.
Maladaptive Personality
Traits
Meet fewer DSM criteria than PD
Less rigid
Can function appropriately in some
environments but exhibit dysfunctional
traits in other environments (usually
family, home)
Potentially more workable
Diagnosis not essential for intervention
Private Working Theory
(William Eddy)
Private: If you decide that you are working
with a High Conflict Client, keep this information
to yourself or share only with those you need to
consult
Working: Use your assessment to guide your
approach to this client, not to judge or criticize
Theory: Your assessment is only a theory and
you may need to revise it as you work with the
client
Levels of Conflict Functioning
Non-disordered (“normal”) Client
Appropriately upset about conflicts; able to
resolve, de-escalate, and make adaptive
changes.
Maladaptive Personality Traits
Appear “normal”, but show inappropriate upset;
highly exaggerated ideation; distorted logic;
ABLE to resolve conflicts with careful
management.
Personality Disorders
Rigid pattern of behavior; chronic distress;
chronic interpersonal dysfunction; tend to be
unconscious of the effects of their own behavior;
MAY not be able to resolve conflicts
Personalities Either:
Adaptive or Maladaptive
 Adapts to changing world
as needed
 Able to accept feedback
and change behavior
 Resilient & Flexible
 Conscious control of
behavior
 Functions like a
computer’s operating
system
 Chronically fails to adapt
to changing environment
 Repeats failed behavior,
insists that others adapt to
their viewpoint—self
defeating
 Despite chronic, increasing
consequences, does not
adapt or change
 May have little conscious
control
 Functions like a computer
operating system that is
constantly crashing
High Conflict Clients:
Styles
vs.
Traits/Personality
• Does not have Personality
Disorder or Maladaptive Traits
• Can be self/aware
• Can turn high conflict behavior
on and off
• Has Cluster B Personality
Disorder or Traits:
– Borderline
– Narcissistic
– Antisocial
– Histrionic
• Despite Chronic Difficulties,
does not adapt or change. May
be unconscious of inappropriate
social behavior
• Cluster C Personality Disorders
– Avoidant
– Dependent
– Obsessive-Compulsive
Chooses:
• Not to Listen
• To Be Aggressive
• To Be Inflexible
• To Be Out of control
Negative Feedback Loop
of High Conflict Clients
Chronic feelings of Distress
Views source of distress/problems as external
Fails to self reflect or self awareness distorted
Chronic feelings of being a victim
Feelings of Helplessness
Wants of relieve distress—may use alcohol/drugs at this
point
 Blames others (usually family), attempts to change others
(often through abuse & violence), actively tries to recruit
negative advocates.
 Result is Negative feedback to Client—rejection, legal
consequences, isolation—self defeating Behavior
 Leads to chronic feelings of distress
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Consequences of Negative
Feedback Loop
 HCC has long history of Negative Feedback
 Experiences Feedback as a Threat
 Rather than learning from Feedback, Defends
against it (the four horsemen)
 As Intensity of Feedback increases, Client
defensiveness increases leading to abusive
behavior—again may abuse substances
 Result is more Internal Distress
 Client repeats the Loop again
HCC Negative Feedback
Loop
3.
Recruits Negative Advocates
Experiences self as victim
Tries to Change others
with verbal or physical attacks,
justification
1.
HCC feel Distress
Wants Relief
Tries to avoid consequences
Denial, Minimization
2.
Cause of Distress External:
Intimate others or “System”
Blaming
HCC: Extremes Of Behavior
Motivated by:
 Perceived threats
 Defending self against
losses
 Need to control or
change others
 Narcissistic Injury
 Any change in system
• Pregnancy of victim
• Job change
• Illness, Injury
HCC feels justified in
acts of:
 Verbal, emotional abuse
 Physical abuse
 Stalking
 Legal abuse
 Self destructive
behavior, suicide,
cutting
 Sexual affairs
 Substance abuse
HCC: Extremes of Emotion
 Explosive intense anger, panic, sadness, anxiety
 When rational thought fails, they feel
overwhelmed by emotions
 Emotional outbursts get more attention, are
more instrumental
 Emotions help HCC generate facts to fit the
emotion (distorted, paranoid)
 Emotions supersede logic and problem-solving
HCC: Extremes of Dependency
 Problems seen as
overwhelming, unsolvable
 Sees self as victim
 Sees others as very powerful:
either threatening enemies or
life-saving allies
 Life-long development of high
intensity bonding skills: charm,
seductiveness, child-like appeal,
emotional urgency,
manipulation of reality, trauma
bonding
 Results in “Instant Intimacy”
 Over responds to any emotional
interactions
 Lack of boundaries
 Unrealistic infantile expectations
lead to infantile emotional
reactions
 HCC assumes no responsibility
for maintaining relationship,
solving problems
 Loss of relationship results in
desperate attempts to re-attach,
YO-YO behavior, attach to
negative advocates
Typical Responses to HCC
 Counsellors feel
frustrated or frightened
by their emotional
sensitivity, abusive
behavior, and
dependency needs
 Counsellors get
emotionally “hooked” and
either withhold responses
or over respond.
 William Eddy
 Use your EAR
– EMPATHY
– ATTENTION
– RESPECT
Negative Advocates
 Believe cognitive distortions of HCC
 Want to help
 Misled or seduced by HCC’s charm, hurt, fear,
anger, pain
 Advocate against perceived enemies
 Protect HCC from natural consequences
 Escalate conflicts unintentionally
 May also be HCC’s
Be a Positive Advocate
 Avoid assumptions
 Investigate concerns/problems
 Provide support and information
 Establish appropriate boundaries, avoid taking
too much responsibility for problems and
emotions
 Avoid doing MORE work than HCC
 Don’t rescue—HCC needs to feel natural
consequences—but don’t automatically reject.
Developmental Basis for HCC:
Paul MacLean’s Triune Brain
"three interconnected
biological computers,
each with its own special
intelligence, its own
subjectivity, its own sense
of time and space and its
own memory". Each brain
operates as its own brain
system with distinct
capacities for perceiving
and responding to the
environment and each can
become dominant
depending on the
circumstances.
Three Levels of Brain Functioning
Neocortex
Cerebral Cortex or Cerebrum Center of abstract thought,
creative thinking, all higher cognitive functions.
Limbic System
Middle part of brain, “old mammalian” concerned with
emotions, instincts, feeding, fighting, fleeing, value
judgements, sexual behaviour.
Reptilian Brain
Basal brain consists brain stem and cerebellum. Center
of rigid, obsessive, compulsive, paranoid ideas and
behaviour, never learning from past mistakes. Automatic
functions; breathing, reflex, etc.
Cerebral Cortex: 2
Hemispheres
Left Hemisphere
 Logical
 Sequential
 Rational
 Analytical
 Objective
 Looks at parts
 Positive emotions
 Higher dopamine
Right Hemisphere
 Random
 Intuitive
 Holistic
 Synthesizing
 Subjective
 Looks at wholes
 Negative emotions
 Higher norepinephrine
Corpus Collosum
 The corpus callosum is a bundle of nerve fibers
that connects the two hemispheres of the brain,
enabling them to work together to process
information and regulate autonomic function
 Area where the two hemispheres are “stitched”
together—through nerve fibers
 Left Brain needs input from the right, to process
non-verbal information & process negative
emotional input
 Right needs input from the left to analyze
information, to assess danger, to communicate
verbally, to achieve positive emotions
Emotional Dysregulation of
HCCs
 Research with BPD and ASPD indicate brain
differences in the Hippicampus and Corpus
Collosum
Working Theory
HCCs have difficulty mediating powerful emotions
with logic and rationality; as a result they are
unable to self soothe or regain a sense of calm.
Flight or Fight Response
 Under conditions of emotional or physical stress,
the limbic system floods emergency systems
with adrenaline to energize for quick reactions,
over-riding the functions of the cerebral cortex.
 Children who have been abused over-respond to
“normal” situations and show developmental
brain differences
 HCCs tend to be HOT responders in handling
stressful situations exhibiting distorted thinking
about the situation
Cognitive Distortions
All or Nothing thinking
Magnification or Minimization
Should statements
Overgeneralizations
Jumping to conclusions
Personalization
Emotional reasoning
Intervention with Agitated
HCCs
 Help client shift focus to more Left Brain or
integrated activities: Brain gym, breathing
exercise, making a list of options and asking
client to logically review choices, make lists, etc.
 The shift to more “Left Brain” activities does not
require solution of the conflict or problem.
Client usually feels relief when you help them do
this
Preparing Staff for HCCs
Emotional Grounding and self-care
 Brain Gym
 Good stress management skills
Maintaining clear Boundaries
Understand and Explore Counter-transference
Co-therapy groups if possible
Debriefing support
Avoid the extremes: Seduction by or rejection of
the HCC
Avoid Trauma triggers
Service Agreements &
Interventions
Program involvement—clear simple rules
Sobriety
Non-abusive Behaviour and Language
Client acceptance that problem behaviour has
occurred
Acknowledges need for help
Accountable for own behaviour
Considerate & Aware of others
Involved in the process of Service Delivery
Avoids blaming others or systems
Karpman Triangle
Persecutor
Rescuer
If you are vulnerable in any
of these roles, a skilled HCC
will find out and exploit it.
Victim
Transactional Analysis
 Parent: Ingrained voice of
Parent
Adult
Child
authority. Value
statements, Right or
Wrong.
 Adult: Our 'Adult' is our
ability to think and
determine action for
ourselves, based on
received data.
 Child: This is the seeing,
hearing, feeling, and
emotional body of data
within each of us.
Counselling with HCC
 Listening with Neutral attention/respect to high intensity
emotions (set time limits--avoid being bullied or rejecting
client)
 Focus on Tasks—structure sessions
 Provide Active Reality Testing
 Use low-level but clear Confrontations
 Block development of Negative Advocates--Bullying
 Reflect back their Self Talk process/point out
inconsistencies
 Incorporate Time Outs in group/individual tx process
 Identify/emphasize Strengths
 Help client learn to identify body stress or stressful
emotions and “turn down the volume”
Listening to High-Intensity
Emotions
HCCs attempt to establish relationships through
trauma bonding.
They want to establish an unconditional “caring”
relationship which they can control & exploit
Staff needs to be very aware of their own limits
around emotional intensity
Staff needs to help HCCs shut down when the
intensity becomes repetitive, obsessive,
overwhelming to the client (Watch for looping,
fight or flight arousal) Breathing, safe place
exercises
Focus on Tasks
Whenever possible, move away from
emotional expression and help client
develop a “structure” for problem solving
Example: Brain Gym, relaxation, writing
down problems, brainstorming solutions
Help client break large overwhelming
issues into small steps
If client agrees to tasks, always follow
through to see if he/she has completed
them
Provide Low-Level Confrontations
Be aware of HCC Over-reaction to any
judgements, rejection, humiliation, abandonment
Statements like, “I wonder what else happened”–
“It seems like you left something out”– “It just
doesn’t make sense to me—I guess I don’t
understand you”
Sometimes clear, low intensity value statements
can be more effective than anything else
Don’t attack the relationship but Insist on
Accountability
Hypotheticals can also work
Reflect Self Talk Process
Help client reconstruct linkage between
stimulating event, self talk, emotional
response and behaviour
Explore choices at every step in the
linkage and involve client in
feedback/problem solving.
Remember the PROBLEM(S) is almost
always internal or inside the client’s mind
& body
Listening to High Intensity
Emotions
Model listening with respect & interest
Respond with caring, understanding
statements if indicated
Avoid taking on their emotions/insist on
client accountability
Be clear that staff cannot “fix” the
problem
If conflict involves others, ask HCC to
listen and respect feedback without
Identify/Emphasize Strengths
HCC may have some part of life where
they function non-abusively. (work,
school, church) Help them identify area
and what works for them in that part of
their lives.
Work on developing new strengths in the
program: Listening, Being aware of
other’s needs, Taking responsibility,
Taking Time Outs
Bibliography
• Eddy, B. HIGH CONFLICT PEOPLE IN LEGAL
DISPUTES, 2006
• Linehan, M. COGNITIVE-BEHAVIOUR
TREATMENT OF BORDERLINE PERSONALITY
DISORDER, 1993