events and key changes.
Step 3: Determine if a Mode Shift is Required
As described briefly in Chapter 3, a mode shift is an inten- tional change in the way a therapist relates to a client. Mode shifts assume that a therapist is already interacting with a client within the framework of one of the six thera- peutic modes (i.e., advocating, collaborating, empathizing, encouraging, instructing, or problem-solving), and a change from one mode to another is required. Mode shifts are frequently required in response to an interpersonal event or to some other change in the client’s interpersonal behavior. For example, during our discussion in which Vera shared her unhappiness about living in the group home, she asked me if she could come live with me instead. Remaining within the empathizing mode, I empathized with Vera’s unhappiness and questioned her about the reasons for wanting to live with me. However, Vera refused to process her feelings with me and demanded that I answer either “yes” or “no.” At that point I decided that a different type of action was required to protect Vera from continuing to push the boundaries and to prevent myself from reacting to her behavior in a nonther- apeutic manner. I decided to shift into the instructing mode to send Vera a stronger message about the limitations to our professional relationship. Thus, I explained why it would be neither appropriate nor realistic for her to live with me. The following are additional examples of circum- stances in which a mode shift would likely be required. • A client provides the therapist with feedback that she wants to feel more independent in performing self-care activities within the milieu. In this case, a therapist who was previously relying heavily on the instructing mode might switch to the collaborating mode in an effort to promote client decision-making and autonomy.
Chapter 7 Navigating the Challenges: Therapeutic Responding and Interpersonal Reasoning 141
• An otherwise enthusiastic client is reluctant to engage in an activity that the therapist knows would be possible for the client to do. The therapist attempts to reassure the client, but the client remains apprehensive. In this case, a therapist might change from the encouraging mode to an empathizing mode so she can better under- stand the client’s reaction.
• A client appears overwhelmed during a discussion about goal setting. When asked to provide input, he becomes more anxious and tells the therapist that he has no idea where to begin. At this point, a therapist might switch from the collaborating mode into an instructing mode, counting on the likelihood that the client’s anxiety is reduced by the introduction of structure and guidance. • A client appears disengaged from therapy and generally
hopeless. Although she does not appear to mind the therapist’s use of the empathizing mode to better under- stand her perspective, the client remains stagnant in terms of progress toward goals. In this instance, the therapist might switch to the encouraging mode in an attempt to instill hope and entice the client into engag- ing in a previously cherished activity.
• A client reveals that she did not complete the assigned activity at home because the assignment required a part- ner. The client discloses that she could not think of any- one on whom she might rely to assist her. In this instance, a therapist might shift from the problem- solving mode into an empathizing mode, as the client has just made an important and rather sensitive self- disclosure about her lack of connection with others.
These are just a few of numerous possible therapeutic situations in which a mode shift would be appropriate. When considering whether a mode shift is necessary, you should consider the exact nature of the interpersonal event and the unique constellation of client interpersonal charac- teristics. In some cases, an interpersonal event may occur, but the therapist and client do not deem it as particularly significant or consequential for the relationship. In other cases, an interpersonal event may occur, but a mode shift is not appropriate because a therapist is already interacting in a mode that is perceived as therapeutic by the client. For example, a therapist who is already using the instructing and encouraging modes with an anxious and disorganized client would likely continue using those modes if an event such as a contextual change occurred that made the client feel even more unstable.
In other cases, a client’s personality requires that a therapist use a single mode as consistently as possible. For
example, there are certain clients who want to have as much control over the therapy process as possible and require therapists to do nothing else but listen, strive to understand their dilemmas, and support their desires (even if they do not serve the client’s best interest). These clients prefer consistent use of the empathizing mode. Other clients, including other health care professionals and other types of individuals with extensive knowledge, may want to engage in a collaborative or problem-solving relationship with the therapist and may feel insulted when the therapist attempts to use the instructing mode. Clients who are anx- ious or appear to be seeking direction are likely to relax when a therapist relies heavily on the instructing mode to structure and guide the activities of therapy. Clients who prefer a single mode or a more limited range of modes are easy to identify because they appear less comfortable and are less likely to engage in therapy when therapists use other modes.
Even if a client tends to prefer a single or more lim- ited range of modes, there are still occasions when a mode shift is necessary. Without practice, mode shifts are not easy to accomplish. They require the therapist to possess the following capacities.
• Knowledge of the therapeutic modes and how they differ • The ability to correctly label your own use of modes
during live interactions
• An acknowledgement that not all modes are equally therapeutic at all times for all clients
• An openness to learning to communicate in ways that are unfamiliar, uncharacteristic, or less comfortable • Capacity to relate effectively with a wide range of
personality styles
• Knowledge of which modes are likely to work best given a client’s interpersonal characteristics • Knowledge of which modes are likely to work best
given the interpersonal event that is occurring • Capacity to match the primary mode or modes chosen
for a client to the implicit and unspoken expectations and preferences of the client and to the circumstances that are occurring during therapy or in the therapeutic milieu at any given time
• Capacity to identify when a mode shift might be required based on an empathic awareness of the poten- tial interpersonal events of therapy and needs of the client at any given time
Another guideline to bear in mind when shifting modes is the importance that the new mode is communi-
cated to the client accurately in its pure form. In some cases, it may be important to inform a client that you are shifting to a different mode of communication and explain why. For example, a therapist shifting from the instructing to the empathizing mode might say something like: “It seems to me I may be asking you to do something you are not comfortable with yet, so I’m going to pause for a moment and just check in with you to see why this is not working for us.” Similarly, if a therapist shifts modes too rapidly it may also lead to confusion or weakening of the communication, depending on the cognitive level and emotional maturity of the particular client. In circum- stances where a therapist is unsure whether the client has received the intended message accurately, he or she may benefit from explaining the need for a mode shift and from seeking feedback from the client that his or her interper- sonal message has indeed been interpreted accurately.
An exercise designed to enable continued practice and development of the ability to accomplish mode shifts smoothly is provided in the Activities section of this chap- ter. Box 7.1 includes a depiction of Michele Shapiro suc- cessfully executing a mode shift during her work with an 8-year-old client.