Chapter 10—Empathic Confrontation and the Creative New: Identifying and
Challenging Client Conflict
MULTIPLE CHOICE
1. “Mobility” is to “immobility” as cultural intentionality is to ____.
a.
stuckness
b.
impasse
c.
blocked
d.
all of the above
2. According to the authors, an important goal of interviewing is to move clients from
a.
ideas to feelings.
b.
problem focus to person focus.
c.
closed questions to open questions.
d.
stuckness to intentionality.
3. Uncontrollable conflict and discrepancy bring stress to the client resulting in ____.
a.
active inhibition of neurons and damaging glucocorticoids and cortisol are released
b.
gradual strengthening of an individual through development of protective neural structures
c.
an ultimate challenge to the counselor
d.
the need to refer the client to the emergency room for medication
4. Empathic confrontation is:
a.
a direct, harsh challenge guiding clients to face hard issues.
b.
a complex of skills requiring observation and listening.
c.
seeking clarification by “going against” client idea.
d.
the primary skill used by interviewers to cause clients to see their errors.
5. Careful listening is one of the most powerful influencing skills. Which one of the following statements
about influencing is NOT true?
a.
Paraphrasing is particularly useful when decisions need to be made.
b.
Reflection of feeling is useful to feedback of mixed emotions.
c.
Direct and firm confrontation helps clients identify their errors.
d.
A good summary brings together many thoughts, feelings and behaviors.
6. Empathic confrontation is:
a.
a direct, harsh challenge guiding clients to face hard issues.
b.
a gentle skill that includes listening.
c.
seeking clarification by “going against” client ideas.
d.
the primary skill used by interviewers.
7. Empathic confrontation is best described as _____________.
a.
direct eye contact and a clear voice
b.
identifying mixed messages
c.
a gentle, but firm, challenge
d.
all of the above
8. As a result of effective and empathic confrontation, a counselor or interviewer can anticipate that the
client will ________.
a.
resolve his or her issues
b.
move to a more productive topic
c.
come up with new ideas, thoughts, and feelings
d.
become angry
9. Which one of the following is NOT a technique to supportively challenge or confront a client?
a.
Observe and note discrepancies and conflict.
b.
Feed back internal and external discrepancies to the client.
c.
Match tonal quality with the client during the feedback of discrepancies.
d.
Evaluate the client response and whether there is client change.
10. According to the authors, direct confrontation may be inappropriate for:
a.
European-American clients.
b.
African-American clients.
c.
European-Canadian clients.
d.
Native American clients.
11. _______________ is essential if you are to challenge the client with a confrontation.
a.
An empathic relationship
b.
An assertive personality
c.
A strong affirmation
d.
All of the above
12. A nonjudgmental attitude requires that you:
a.
assert your opinions with a positive attitude.
b.
stop your listening skills and let client speak.
c.
suspend your own opinions and attitudes.
d.
all of the above.
13. A nonjudgmental attitude requires that you assume:
a.
an evaluative listening to detect client deception.
b.
a value neutrality in relation to your client.
c.
an active and assertive communication with your client.
d.
all of the above.
14. A nonjudgmental attitude is expressed through which of the following?
a.
Body language
b.
Vocal qualities
c.
Statements that indicate neither approval nor disapproval
d.
All of the above
15. “On the one hand…, and on the other hand…” This is typically used in _________.
a.
reframing
b.
empathic confrontation
c.
psychoeducation
d.
interpretation
16. What are the three major steps of confrontation?
a.
Step 1: Identifying conflict; Step 2: Pointing out conflicts and issues; and Step 3:
Evaluating effectiveness
b.
Step 1: Building rapport; Step 2: Identifying discrepancies; and Step 3: Confronting
client’s thinking
c.
Step 1: Identifying conflict; Step 2: Countering client talk; and Step 3: Closing with a
directive
d.
Step 1: Building rapport; Step 2: Pointing out conflicts and issues; and Step 3: Evaluating
client response
17. The first step in confrontation is:
a.
establishing rapport.
b.
asking the client why he or she did it.
c.
identifying a contradiction or discrepancy.
d.
confronting the client.
18. Which word is NOT interchangeable with all the others?
a.
Discrepancy
b.
Incongruity
c.
Conflict
d.
Observation
19. Discrepancies internal to the client include:
a.
mixed messages observed in nonverbal client behavior.
b.
incongruities between two verbal statements.
c.
differences between what the client says and what the client does.
d.
all of the above.
20. Incongruities and discrepancies of the interviewee to be identified include all EXCEPT which of the
following?
a.
Between two statements
b.
Between statements and nonverbal behavior
c.
Between the influencing skill used by the interviewer and the interviewee response
d.
Between what one says and what one does
21. “You really want to meet him, but you’re a little bit anxious.” In which step of supportive confrontation
would an interviewer most likely make this statement?
a.
Step 1: Identify conflict
b.
Step 2: Point out issues of incongruity
c.
Step 3: Evaluating change
d.
This is not included in supportive confrontation.
22. Discrepancies between the client and the external world include:
a.
conflict between the client and another person.
b.
conflict between the client and a challenging situation.
c.
conflict between the client and a nurse at a hospital.
d.
all of the above.
23. Which of the following is TRUE?
a.
Confrontations exist in the form of both listening and influencing skills.
b.
Confrontation only exists as listening skills.
c.
Confrontation only exists as influencing skills.
d.
None of the above.
24. “On the one hand…, and on the other hand…” In which step of empathic confrontation would an
interviewer most likely make this statement?
a.
Step 1: Identify conflict
b.
Step 2: Summarize
c.
Step 3: Evaluate
d.
This is not included in supportive confrontation.
25. Regarding discrepancies between you and your client, which of the following is NOT true?
a.
Never hide differences you may have with your client.
b.
If you sense differences, support the client by listening.
c.
Note your own or the client’s discomfort with possible differences.
d.
If you listen carefully, most discrepancies with your client will disappear.
26. Which of the following statements about the Client Change Scale (CCS) is NOT true?
a.
CCS measures the effectiveness of confronting clients about mixed messages.
b.
CCS assesses the client’s position relative to how he/she copes with life changes.
c.
CCS measures the intensity of counselor statements during direct confrontation.
d.
The way a client deals with a variety of life change issues can all be considered using the
CCS.
27. Confrontation during a single session and over a series of interviews may be measured on a 5-point
scale called the Client Change Scale. Which of the following represents this scale?
a.
Denial, Identification, Recognition, Generating Solutions, and Development
b.
Denial, Partial Examination, Acceptance But No Change, Generation of New Solution,
and Transcendence
c.
Identification, Examination, Acceptance, Forgiveness, and Evaluation
d.
Identification, Partial Examination, Acceptance, Forgiveness, and Transcendence
28. The reality of the story is acknowledged during __________________ of the Client Change Scale
(CCS).
a.
Level 1: Denial
b.
Level 2: Partial examination
c.
Level 3: Acceptance and recognition, but no change
d.
Level 4: Generation of a new solution
29. The client may distort his or her story and blame others unfairly in which level of the Client Change
Scale (CCS)?
a.
Level 1: Denial
b.
Level 2: Partial examination
c.
Level 3: Acceptance and recognition, but no change
d.
Level 5: Development of new constructs, patterns, or behaviors
30. Achieving a major more lasting transformation in client thinking and behavior may require:
a.
several interviews.
b.
time to internalize new solutions.
c.
moving from denial or partial acceptance.
d.
all of the above.
31. A client who is dying comments, “It won’t happen—not to me.” This is an example of:
a.
denial.
b.
partial acceptance of reality.
c.
acceptance and recognition.
d.
generation of a new solution.
32. After four interviews, Dominic comments, “Wow, it’s really working. Things are great at home. Sara
and I are doing well. Working together works!” Dominic is in what level of the CCS scale?
a.
Denial
b.
Partial examination
c.
Acceptance and recognition, but no change
d.
Development of new, larger, and more inclusive constructs, patterns, or behaviors—
transcendence
Instructions: Imagine that you are talking with a client about emotional child abuse. You have just
confronted the client with the following statement: “On one hand, you say you love your child, but on
the other hand you continue to put her out in the hall of your apartment where you force her to stand in
the dark. How do you put that together?”
Classify the following client’s response using the CCS scale.
33. Client response: “I understand what you are saying, it just doesn’t make sense what I’m doing. I seem
to be saying one thing, but doing another.”
This client is where on the CCS?
a.
Denial
b.
Partial examination
c.
Full examination, no change
d.
Development of new constructs, patterns, or behaviors
34. Client response: “I don’t understand what you are saying. There’s no need to put it together. There’s no
problem. That’s the way I do it.”
This client is where on the CCS?
a.
Denial
b.
Partial examination
c.
Decision to live with incongruity
d.
Development of new constructs, patterns, or behaviors
35. Client response: “I think I see what you’re saying. There is a big incongruity there. I want to stop, but I
was abused and hit by my parents. I think I’m doing better than they did ⎯ at least I don’t strike Amie.
But perhaps I can do something different next week. I’ll try your new idea about disciplining her.”
This client is where on the CCS?
a.
Partial examination
b.
Full examination, no change
c.
Decision to live with incongruity
d.
Development of new constructs, patterns, or behaviors
36. Client response: “Yes, I do love her. I care for her very much. She is extremely important to me. We
do everything together. We really do so many things that work out OK.”
This client is where on the CCS?
a.
Denial
b.
Partial examination
c.
Full examination, no change
d.
Decision to live with incongruity
37. Client response: “I heard what you are saying. I want to change, but right at the moment I just can’t do
what I want. I tried last week, it didn’t work. The divorce is getting to me. I’ll do the best I can to
change, but it is so hard.”
This client is where on the CCS?
a.
Partial examination
b.
Full examination, no change
c.
Decision to live with incongruity
d.
Development of new larger and more inclusive constructs, patterns, behaviors
38. “I‘ve been avoiding my anger, and it is getting in my way. I’m going to start dealing with it.” An
interviewer may hear this statement in which level of the Client Change Scale (CCS)?
a.
Level 1: Denial
b.
Level 4: Generation of a new solution
c.
Level 5: Development of new constructs, patterns, or behaviors
d.
Level 3: Acceptance and recognition, but no change
39. An interviewer may hear, “Yes, I hurt and perhaps I should be angry,” in which level of the Client
Change Scale (CCS)?
a.
Level 1: Denial
b.
Level 2: Partial examination
c.
Level 3: Acceptance and recognition, but no change
d.
Level 5: Development of new constructs, patterns, or behaviors
40. An interviewer may hear, “You helped me see my mixed feelings; I need to express my feelings
more,” in which level of the Client Change Scale (CCS)?
a.
Level 1: Denial
b.
Level 2: Partial examination
c.
Level 3: Acceptance and recognition, but no change
d.
Level 5: Development of new constructs, patterns, or behaviors
41. ____________ developed the Racial/Cultural Identity Development (R/CID) model.
a.
Ivey and Ivey
b.
Sue and Sue
c.
William Cross
d.
Zalaquett and Montenegro
42. Which of the following is NOT part of the Racial/Identity Development Model?
a.
Disillusionment Stage
b.
Resistance and Immersion Stage
c.
Introspection Stage
d.
Integrative Awareness Stage
43. Counseling helped Nelida:
a.
appreciate her culture and feel “proud” of her grandparents.
b.
appreciate herself and feel “proud” of her achievements.
c.
appreciate her mainstream culture and feel “proud” of her classmates.
d.
appreciate and “proudly” adopt the counselor’s worldviews.
44. Which of the following contextual factors may lead to clients’ low self-worth and self-esteem?
a.
Self-talk and internal dialogue
b.
Cognitive distortions and negative schemas
c.
Oppression and racism
d.
All of the above
45. If your client starts with you at denial or partial acceptance (Level 1 or 2) and then moves with your
help to acceptance and generating new solutions (Level 3 or 4), you have clear evidence of:
a.
the effectiveness of your therapy process.
b.
the capacity of your client to achieve progress without your help.
c.
the strong need for leadership and direction your client has.
d.
the powerful impact of the environment on our clients.
46. Which of the following statements regarding empathic confrontation and mediation is NOT true?
a.
There is a need for actual contact and communication between combatants.
b.
Power needs to be equal between the two individuals or groups.
c.
There is need to search for common goals and areas of agreement.
d.
A win-win resolution is most achievable when two individuals or groups meet to address
issues.
New
47. The most common empathic confrontation uses:
a.
paraphrasing.
b.
reflection of feelings.
c.
summarizations.
d.
all of the above.
48. The CCS can be used be used to:
a.
determine the creative effect of your confrontation.
b.
assess success of your interventions.
c.
determine client progress over a series of sessions.
d.
all of the above.
COMPLETION
Developmental Change Scale—Rater Training Examples
Instructions: Imagine you are a counselor or therapist working with an array of client problems. You
make a statement or have approached a case in a certain way. Then the client responds.
For example, imagine a client who is being abused by her husband. You, as interviewer, may say:
“Jane, this is the third interview in a row that you’ve come in beaten and bruised. Each time you say
you need to try harder to meet your husband’s expectations. When are you going to realize that it is he
who is at fault, not you?”
The client responds to you in five different ways:
1.
“But, I can’t do anything about it. I have no place to go. I’ve simply got to try harder.
Won’t you please help me do better?”
2.
“Yes, you’re right, I am beginning to think he is involved in this, too. But I know how hard
he works and if we just hang in there, maybe it will work out.”
3.
“I guess you’re right. I am trying to meet what he wants. I can’t stand being beaten. I know
you think he’s at fault and it isn’t my responsibility to take care of him. I think I understand
what you are saying.”
4.
“I’m beginning to get your drift. I used to think I could solve things if I tried harder, but
I’ve been doing that now for months. Clearly, hitting me isn’t right ⎯ it has to stop.”
5.
“Aha, I’m finally seeing what you mean. The more I try, the more he demands. I think the
situation isn’t safe for me anymore. How can I plan to get out, just as soon as possible?”
The above five responses correspond to specific ways a client might respond in the interview. Below
are descriptions of each of the five responses. Note how the first response represents a form of denial,
the second a partial response, etc.
Level 1. Denial, The negative alpha solution. The client seems unable to accommodate new data from
the counselor or therapist. The client will fail to deal with the conflict or contradiction, make an abrupt
topic shift, or show a clearly incorrect “off-the-wall” response.
Level 2. Partial examination, The more mature alpha solution. The client deals with only a portion of
the issue or counselor’s statement. The client may over-generalize, delete, or distort what has been
said, but not as seriously as in Level 1. You may find irrational ideas and some blindness to problems.
Level 3. Acceptance and recognition, Beta solution. The client recognizes the situation as it is and the
client’s comment, feeling, or thought seems close to that presented by the therapist, but nothing new is
added by the client. This level characterizes homeostasis or no change. Score as Beta if the client tends
to describe a situation, event, or self-picture fairly clearly, but tends to leave it there.
Level 4. Generation of a new solution, Early gamma solution. In response to the counselor, the client
moves to the creation of something new. The client has added something that was not there before. At
times, the underlying conflict may remain ⎯ acceptance of insoluble problems begins here.
Level 5. Transcendence, Full gamma solution. The client has arrived at a new synthesis, a new way of
thinking, behaving, or feeling. These are relatively rare moments in counseling and therapy and may
represent the development of useful or important insights, the ability to engage in a truly new way of
behaving, the generation of a new ability to engage emotionally.
You will now be given a variety of counselor-client situations. The possible client responses are in
random order. Please classify each client response at one of the five levels.
1. Career choice
Counselor: (To student who was referred by his engineering professor for failing grades) “John, we’ve
gone through the tests and reviewed your work history. Given all the information we’ve come up with,
how do you put it together?”
Client:
a.
“Well, I see the results. They seem to be saying that I don’t look like an
engineer and that I appear more like a journalist or English major. And, it’s true
that I haven’t done too well in math and that English courses have given me my
best grades.”
b.
“The tests don’t seem to make much sense. I’m going to work harder. I can’t
see why they referred me here anyway.”
c.
“It makes sense. I did enjoy the English courses. I guess it’s time to give myself
a chance to do what I want. My dad wanted me to be an engineer like him. I’ve
always tried to please him too much.”
d.
“I don’t know. Engineers make the best salaries. It’s really important that I do
what dad wants.”
e.
“That settles it. I‘ve given dad’s idea a good try, but I haven’t done well and I
really like English better. I am going to do what I want and makes sense for me.
I’m going to change my major.”
a.
3
b.
1
c.
4
d.
2
e.
5
2. Depressed client
Counselor: (To hospitalized patient) “Could you tell me what brought you to the hospital?”
a.
“I wasn’t able to get up in the morning, yet I couldn’t sleep at night and I have
all these awful thoughts. I know I scared mom.”
b.
(Tears⎯no response)
c.
“I guess mom just wanted to get rid of me.”
d.
“Well, when I came here I was pretty depressed and mom was worried. But now
I’m doing a better. Last night I slept through the whole night for the first time.”
e.
“Extreme depression ⎯ I was immobilized. Small wonder mom brought me in.
I know now that I can’t stay home all the time and do nothing. I’m going to start
getting out and being more active.”
a.
3
b.
1
c.
2
d.
4
e.
5
3. Death and dying
The following client statements could be expected following the discovery that the client has terminal
cancer.
a.
“It’s so hard for me all the time. But it’s hard for the family, too. Sometimes I
just cry. But lately, I find that if I focus on the positives available to me still, I gain
some peace.”
b.
“There really isn’t any problem. I’m sure it’s an error on the X-ray. It can’t be
correct.”
c.
“Why me? What happened?” (with anger) “It isn’t fair.”
d.
“I’ve been spending my time working with a cancer support group. I want to
help others face this ⎯ somehow fighting and working with others to the end
makes it seem easier.”
e.
“I accept it. I’ve had a good life, with my share of problems for sure. Sure I
don’t like it, but there’s nothing I can do.”
a.
4
b.
1
c.
2
d.
5
e.
3
4. Gestalt therapist
Therapist: “You say you’re angry at your lover, but I see you smiling. Phony!”
a.
“What do you mean ⎯ I’m really mad. You can’t say that.”
b.
“Am I really smiling? I thought I was angry, but…”
c.
“OK, OK. Let me try again.” (angrily) “Jean ⎯ you really tick me off. You
simply can’t do that.”
d.
“When I’m angry, sometimes I smile. So what?”
e.
“Dammit, I did it again! I’m beginning to think I’m afraid to allow myself to
really feel.”
a.
1
b.
3
c.
5
d.
2
4
5. Family therapy
Therapist: “The problem with this family is not just Sue’s eating problem; what we need to work on as
well is the way this family interacts.”
a.
Mother: “Somehow that makes sense. I never thought of it that way before.”
b.
Father: “Yes, I now see that our perfectionism and constant demand for success
left her with a feeling of being empty.”
c.
Sue: (5’6″, 87 pounds) “I don’t see why all the fuss. I‘m overweight a little,
that’s all.”
d.
Mother: “Yes, doctor, that way we can work together better and you can help
show us how to get Sue to eat.”
e.
Mother: “I see how we’ve avoided our own conflicts and used Sue to help us
hide them. We’re going to be more direct in the future.”
a.
3
b.
4
1
d.
2
5
6. Carl Rogers
(To Mrs. Oak) “It’s an experience that’s awfully hard to put down accurately into words, and yet I get a
sense of difference in this relationship, from the feeling that ‘This is mine,’ ‘I am doing it,’ and so on, to
a somewhat different feeling that ⎯ ‘I could let you in’.”
a.
“Yes, it’s as though that’s how it should be. There’s a feeling that this is good. I
feel that it’s right for me. I feel more open. I feel more me.”
b.
“Well, sort of. I do want to be close, but it doesn’t seem safe.”
c.
“I do so much for others. Why do you accuse me like that?”
d.
“Yes, I am doing it and I feel I could let others in.”
e.
“It feels like a beginning, it’s inevitable.”
a.
5
b.
2
c.
1
d.
3
4
7. Child counseling
Counselor: “Johnnie, why did you hit Susie on the playground?”
a.
“I know she’s the best student and I’m jealous. It makes me mad that I can’t do
as well. I’ll try not to do it again ⎯ next time I’ll count to ten like you taught me to
do when I get angry.”
b.
“I didn’t do good in math today and she laughed. I felt bad.”
c.
“I hit her because she teased me.”
d.
(Looks down) “She made me do it.”
e.
(Defiantly) “I didn’t hit her.”
a.
5
b.
4
3
d.
2
1
TRUE/FALSE
1. The counselor’s or interviewer’s task is to move clients beyond their issues and problems to realize
their potential as human beings.
2. Confrontation is relevant to all clients, but it must be worded to meet individual and cultural needs if
real creativity is to occur.
3. Judgments should never be implicated in the counseling session.
4. If you observe closely in the here and now of the session, you can rate how effective your
interventions have been.
5. You can assess the direct impact of confrontation, as well as any other microskill, in the here and now
with the Client Change Scale (CCS).
6. Clients complete each developmental task in fairly quick succession, and their progress can be quickly
assessed on the Client Change Scale (CCS).
7. Nelida and Allen’s two sessions highlight the importance of helping clients address conflicts related to
racial/cultural identity.
8. If you practice assessing client responses with the CCS model, eventually you will be able to make
decisions automatically “on the spot” as you see how the client is responding to you.
9. Empathic confrontation serves as a solid base for mediation.
New
10. Confrontations are frequently observed in session conversations.
11. According to Ivey, Ivey, and Zalaquett, empathic confrontation is a not a distinct skill; it is a set of
skills that may be used in different ways. The most common confrontation uses the paraphrase,
reflection of feeling, and summarization of discrepancies observed in the client, or between the client
and her or his situation. However, questions and influencing skills and strategies can also lead to client
change.
12. According to the authors, empathic confrontation is a distinct skill that relies heavily in influencing
skills and strategies to client change.
ESSAY
1. A client comes to you saying the following: “I have no problems in stopping smoking, I’ve stopped ten
times in the last year.”
a.
Identify the incongruity in the statement.
b.
Write a confrontation you might say to the client including the important check-out.
c.
Follow this by writing client statements that would represent denial, partial examination,
full examination, decision to live with the incongruity, and the development of new
patterns, constructs, or behaviors.
2. Define empathic confrontation and its place in the session and the counseling process.
3. Describe the integrated steps of empathic confrontation and provide examples of each.
4. Present the Client Change Scale and explain how it is used in counseling and therapy. Illustrate each of
the levels and uses.
5. Explain and illustrate with clear examples the different stages of the Racial/Cultural Identity
Developmental (R/CID) model.
6. Discuss some of the key multicultural issues in the use of confrontation.