The method used in this vignette of a case originates from Motivational Work, constructed by the author. To begin with, I will present a summary of the main features of the approach to facilitate the reading of the case.
The fundamental idea is that everyone can be motivated. Every human being has a positive core. The objective of motivational work is to nourish this positive energy. The effect for the client is strengthened self-esteem and self-confidence and eventually, more constructive behaviour.
One conclusion from the belief of the positive core is that there are no hopeless cases. Because everyone has positive life energy, there is a potential in all people which can be kindled and encouraged to evolve. This fundamental belief leads to the motivational worker always having hope for change in the client. He is thus able to keep up a positive commitment and not become burned out. Motivational work is never meaningless. There is always the possibility of change.
The fundamental tenet of the theory is that the prime purpose of all forms of defense and resistance is as an indirect means of making contact. Henceforth, such an indirect communication strategy will be termed a “contact rebus”, rebus meaning a puzzle comprising pictures, words, and letters that together can be decoded into a particular word or phrase.
The client is looking for someone who can affirm him and whom he can trust. Although he desires help, he is suspicious and bears a degree of psychological pain. At the same time, he hopes that the motivational worker will have the energy to deal with his anguish and not abandon him.
The response of the motivational worker to the client in the form of the motivational relationship effects an inner mental change in the client, whose positive core gains an injection of life energy. There occurs, at the same time, a degree of bonding between the two. The client is emboldened to take a step closer, and as the motivational worker moves closer too, their relationship is deepened and strengthened.
The belief in the positive core and the theory of the contact rebus all act to support the motivational worker in giving life energy. In this way, the motivational worker has created a protective suit, which helps him stay committed. The protective suit is essential. If the motivational worker has a hole in his safeguard, he will be drained of life energy, i.e. be burnt-out. There are three emotions above all that the client’s positive core needs, namely a commitment, hope, and trust.
The two main methods of motivational work are confrontation and continuity. Confrontation is an interview technique where the client is put under emotional “pressure”. Continuity means that the motivational worker is responsible for contact with the client in two ways. He has sole responsibility for the continuation of meetings with the client. Since the client is unmotivated, he will find it challenging to maintain contact himself. The motivational worker is also responsible for his motivational relationship to the client – that he keeps his commitment and thus also ensures continuity of emotional communication.
Case
When I supervised motivation workers this week, I was once again reminded of the risk of being burnt out, especially when you are afraid of your client.
This situation reasonably often appears in my supervision groups. The staff is all the time confronted with very destructive and out-going behaviour. If you do not have control over your protective suit, you are drained of your emotional energy, that is your fear is getting increasingly stronger, and you are at the same time more and more paralysed
A Supervision Group
I especially remember one supervision group I met some years ago. The staff was working at a shelter for drug addicts, alcoholics, and mentally ill. The institution accommodated clients who were not accepted anywhere else in society.
Almost every afternoon and evening came a former client, Hans 45 years, back to the shelter. Each time, he took command of the day room where the staff and clients spent much time.
He did this by being very aggressive and sometimes indirectly threatening. It was evident that he was, under the influence of drugs and alcohol. Many of the clients avoided being in the day room when he was present. Hans always came at times when there were only a few staff members on duty.
In the supervision group, the staff complained about the situation with the client. Many of them were afraid of Hans. This fear became stronger each time I supervised.
It did not help that I explained about the functions of the aggressive contact rebus and the client’s concealed cry for help. Many of the staff were lax about his destructive behaviour. On the other hand, a few wanted to throw him out. In this way, they could not as a group decide what to do.
As a supervisor, I gave positive confirmations back to the staff members to strengthen their positive core by being concerned about them, transmitting hope, and trust. I told them that the essential professional demand you can put on yourself is to have the courage and self-esteem to admit that you have a hole in your protective suit.
In this case, it meant to acknowledge your fear. As a motivational worker, you can never avoid incidences, where you are used as a container for the client’s destructive feelings and anxiety. If you notice them, you can improve your protection and avoid being burnt out. It also makes it possible to continue your motivational work.
As time went by, the staff members felt increasingly helpless and paralyzed. A feeling of hopelessness and desperation spread itself among them. It seemed that the team hoped Hans would stop coming by himself. Instead, the intensity of his behavior became stronger. He appeared to be more and more aggressive and threatening.
It came to a point where the staff could not continue to escape the situation anymore. Instead, the team had their backs to the wall. Either you conceded, letting Hans run the place, or you tried to set limits.
Ultimately, through discussions in the supervision group, the staff were willing to confront him together. They assembled one afternoon when they were confident that Hans would arrive.
In their confrontation, the staff members set limits to him by telling that they respected him as a human being and wanted to help him. On the other hand, they did not accept his aggressive and threatening behavior. It was evident that Hans was shocked and did not know what to say.
The staff continued to confront him for almost an hour and wanted to talk to him about his life situation. They offered to help him contact his social welfare agency. After this confrontation, Hans received help from his social worker with indirect support from the staff, and he stopped coming to the shelter. The experience of the group confrontation gave the team renewed self-esteem and their fear diminished.
Discussion
By being more and more scared of the client, the staff developed a negative (demotivational) relationship to the client. Through his aggressiveness and threating behavior, Hans cried indirectly for help. By only seeing his overt aggressive actions, the staff created a hole in their protective suit. Consequently, they were drained of their positive energy by being increasingly fearful.
Unconsciously, Hans wanted that the staff would not be scared of him but instead would see his outreached hand hidden in “barbed wire”. Because of the staff members’ anxiety, he could not receive a reliable positive confirmation from them, which would have strengthened his self-esteem and self-awareness and would also have created a stronger bond between him and the staff.
However, he succeeded in dumping his fear over to the staff, which gave him temporary relief. The drawback with this solution was that he had to repeat the behavior several times each week.
Eventually, the staff could stop their draining, create a positive engagement (motivational relationship) and strengthen Hans’ constructive energy (his positive core). They did this by seeing his indirect cry for help (his contact rebus) and confirm him by being emotionally engaged and take action (group confrontation and contacting social worker).
My most important role as a supervisor was to give back positive confirmations. It gave renewed energy to the supervision group, alleviated the draining, and made possible constructive alternatives. In this way, motivational work was able to offer a positive solution for both the client and the staff.
Per Revstedt is a licenced psychologist and psychotherapist with supervisor expertise and a specialist in clinical psychology (www.revstedtblog.com ). Author of “Motivationsarbete” 1986, fourth edition 2014 (only in Swedish and Danish), “Motivational Work” 2014, and chapter 16 in Rooney, R. (ed.) and Mirick, R. (ed.) third edition 2018. Strategies for Work with Involuntary Clients.
