Mandatory: Making it Worthwhile

“I don’t want to be here. I’m not going to say anything. I don’t know. Why should I talk to you?” You may find yourself thinking or saying thoughts like these in response to pressures to engage from a program, family, or friends. Perhaps you aren’t ready to share what’s brought you here, or what the challenges are that you are facing in this moment. Perhaps you feel like your personal freedom has been taken away, your choice to participate of your own free will. Understanding that you may feel angry, resentful, or withdrawn, please consider the following in support of getting the most out of something that is identified as mandatory.

Blocking or Belonging

You may come from a different background or hold different values from those you come into contact with, so what brings people together in this process? Shared experience around homelessness, financial instability, substance abuse, conflict in relationships, or a lack support can help one feel less isolated and alone in their experience. Although each person’s story is their own, the feeling of connection to others and belonging can go a long way in having an experience feel less mandatory and more voluntary. When you observe others engaging in the program or group, you may find yourself asking:

• Do I feel I can relate to others in the group?

• Do I feel this community is healthy, approachable, supportive, and willing to engage me in this process?

• Do I feel supported by staff and helping professionals to achieve my goals?

• Do I feel comfortable opening up and working on myself in the presence of others?

For many involved in Alcoholics Anonymous (AA), they speak of the community as an equally powerful element as the 12 Steps in to their ability to actively participate in their own sobriety. Due to the friendships they make, they feel they have a connection to others in ways that feel encouraging and uplifting in moments of challenge or struggle.

Building Perspective

In addition to identifying a supportive community, how you approach the experience for yourself matters. Do you have realistic expectations of what you can accomplish both short and long term? Can you set yourself up for success in your work with others? When starting this process, it is helpful to understand basic needs as the foundation for progress. Educating yourself on how basic needs such as food, safety, and shelter provide the foundation of stability gives you permission to organize goals for success. Abraham Maslow, who identified this relationship in the Maslow Hierarchy of Needs, emphasizes that only when basic needs are met can one focus on higher work around self-esteem, sobriety, and relationships.

Relational Rapport

When exploring relationships, research tells us that therapeutic rapport accounts for more than any other factor when measuring progress towards goals set in therapy. In other words, the therapeutic relationship, unconditional positive regard, and power of feeling seen, heard, understood, and supported has positive results on goal progression. If your past experience involves trust or mistrust, being aware of how therapy and/or relationships have helped or hindered you in the past can put current resistance and reluctance in perspective. A few questions that you may find helpful at ask at the first meeting with a helping professional include:

• What kinds of clients have you worked with before?

• How do you work with people who are uncomfortable with therapy?

• What do you do with feedback from clients?

• What can I expect from working with you?

All of these questions encourage healthy discussion around the therapeutic process and can provide insight into expectations and measurable goals when engaging a helping professional in your own growth process. 

Mandatory can feel restrictive and stressful when viewed as a loss of control or freedom. What better way to reframe it than to ask yourself, what can make it worthwhile? 

“If you change the way you look at things, the things you look at change.” Dr. Wayne Dyer

Geared towards Growth: Exploring Maslow’s Hierarchy of Needs

Have you had a client come into your office wanting to work on their relationships? What about a client who wants to work on self-worth and self-esteem? These goals are valuable and achievable, and could greatly benefit your client in their functioning and connection in the world.  However, depending on your client’s stressors and current life events, basic needs may need to be attended to first in order to achieve the growth and progress desired within your therapeutic work.

Hierarchy of Needs

Abraham Maslow first introduced the concept of a Hierarchy of Needs in a paper published in 1943. The image found most often in reference to his concept is a pyramid with the bottom representing the building block or foundation for higher functioning. According to Maslow, every human being has needs that must be met and stable prior to advancement to another level of human need. The levels he identified begin with physiological needs, followed by safety needs, love and belonging, esteem, and finally, self-actualization. Below are some examples of needs for each level:

• Physiological: food, water, oxygen, sex, sleep, excretion
• Safety: security of shelter, employment, resources, health, body
• Love & Belonging: family, friends, intimate partners
• Esteem: confidence, self-esteem, respect by others, respect for self
• Self-Actualization: Acceptance, lack of prejudice, enlightenment

Goals for Growth

So how do the levels of need impact your client’s therapeutic work? For many helping professionals, the awareness of the hierarchy manifest through client psychoeducation around basic needs. Perhaps your client wants to work fully on their relationships, but is impacted by the stress of not having a job to pay their bills. Maybe your client wants to strengthen self-esteem, but can’t identify housing in suffering from an eviction this month. The present crises will require therapeutic attention and intervention first prior to a client allotting mental energy to higher levels of functioning.

Within your work, it can be helpful to normalize and educate your clients on basic needs being the foundation for functioning. You may consider describing the imagery as basic needs being the foundation of a house. If the foundation is crumbling, the other parts of the house become low priority or unseen in trying to stabilize the problem due to risks of it all collapsing around them. With this analogy, clients can absorb the importance of a stable foundation of basic needs requiring their attention before other goals can be successfully met.

Accessing Needs

A stable foundation may require other resources outside of your office. As a helping professional, it is in your best interest to be aware of resources to provide additional support to your client. The databases in your state, (Colorado Crisis Services and Colorado 2-1-1 for example) can be helpful in identifying food, shelter, clothing, legal advice and more.  You may also consider coordination with helpful organizations that would warrant a release from your client in order to collaborate.

Assessing needs can also occur from a place of looking at client resistance. One way this may manifest is through your client’s capacity to work on homework or assigned tasks between sessions.  Although some clients don’t like homework out of personal choice, other clients may struggle to articulate the crises that prevent progress on the homework you assigned, including forgetfulness, loss of focus, or stressors demanding their attention instead. This attempt at juggling varying demands could even translate to cancelled sessions in trying to handle the stressors at home or work. By being aware of basic needs, it can help you as the professional to better understand contributing factors that may present like resistance as elements requiring attention to support client progress.

Maintenance and Motivation

With collaboration and stabilization of basic needs come the client’s motivation for maintaining the foundation.  It is the hope that client’s basic needs, once addressed, remain in good standing.  However, with clients experiencing poverty, trauma, or other adversity, the fluctuating circumstances of their life can delay progress on higher functioning goals. Encouraging ongoing boundaries and self-care can support the client in reaching higher goals around self-esteem and relationships. With awareness and effort, a client can harness a healthy sense of control and autonomy in their life. Remaining flexible to the stressors that may occur between sessions, it is important that you and your client continue to be mindful of what takes precedence to allow the deeper, meaningful work you both value to occur at the appropriate time.

Sufficiency through the Storm: Needs During and After Crisis

“What will I do now? Where will I go? How do I survive?” At any time, a client may walk into your office sharing a crisis situation that creates even more stress and anxiety in response to the unknown. Whether it be stressors of eviction, homelessness, loss of employment, disability, or financial strain, it can make it that much more difficult for a client to continue their therapeutic work around self-esteem, coping, or relationship development due to fear.  Fear of where they will sleep, fear of when they will eat, fear of what they will do to support their family, fear of not being able to find a job. As therapists, it becomes even more important to meet our clients where they are in a situation like this, not asking too much of them as they navigate their basic needs.  Needs for shelter, food and water, needs for safety and security. According to Abraham Maslow when introducing his hierarchy of needs, only then, when these basic needs are achieved and maintained, can a person advance to the next level of work on relationships, self-esteem, and creativity or purpose.

Hierarchy as a Roadmap to Change

Maslow first introduced the concept of a hierarchy of needs in studying extraordinary individuals in a quest to understand their happiness and ways of life. His concepts have since been applied in medical and mental health spheres to better support patients and clients as they navigate through difficulty and a variety of stressors. It is helpful to look at the healing journey through the lens of a hierarchy of needs to best support a client with treatment planning as well as identifying valuable resources to support growth and stability.

Access to Resources

Depending on their needs, knowing where to find valuable resources can be an immense help in supporting our clients through crisis. In Colorado, we can access resources through a variety of databases that allow searches for food banks, clothing, shelter, free legal services, and more. Colorado 2-1-1 and Metro Crisis Services both offer a “service finder,” accessing up-to-date resources throughout the state. The Community Assessment and Coordination of Safety (CACS) is a web tool for professional helpers that allows one to search for mental health and substance referrals including providers, self-help, and community support groups by level of need, city, region, and age. One final resource in Colorado that could be beneficial is offered by Mean Street Ministry, a 16-page resource guide with locations, hours, and type of service offered throughout Colorado that can be meaningful for client exploration and self-advocacy.

Awareness and Advocacy

In addition to being aware of appropriate resources, it is important to be aware of client limits in taking in new information during a crisis. For many providers, it is expected that we slow down our goal progression, maybe even put a topic or intervention on hold in order to support the client with the here and now, the need for stabilization. By remaining present with the client in the current moment, we can still serve them by identifying next steps and possibly advocating for their needs in connecting them to a variety of support services. Whether its providing them with a list of resources or connecting them to the most appropriate referral, our response to their needs in crisis can support them in personal advocacy and growth with an opportunity to gain control and practice coping skills to manage the existing stressors.

How We Can Help

For many clients, our ability to hold space for their fear, anxiety, and grief is healing in and of itself. Recognizing the immense stress crisis and unanticipated change can have on our clients, acknowledging their fears, and conveying they are not alone can be powerful catalysts for change. Helping to stabilize the crisis is necessary before other therapeutic goals and work can progress. In light of Hurricanes Harvey and Irma, many therapists are signing up to support those most in need and devastated by crisis, by volunteering their time to offer caring, compassion, and space to grieve and heal. There are several ways to help those in need. For more information on how to support our communities impacted by natural disaster, please visit www.redcross.org.

More information on resources in Colorado can be found at https://211colorado.communityos.org/cms/home or by calling 2-1-1, http://www.metrocrisisservices.org, or www.cacs-co.com