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An approach to working with clients who simply do not want to change. Therapeutic change, in the view of Fred J. Hanna, hinges on the presence of seven ""precursors"" of change: hope, awareness, a sense of the necessity of change, the willingness to experience anxiety or difficulty, the willingness to confront issues, the exertion of the will or effort, and the presence of social support. The presence of these precursors bodes well for a client no matter what the therapist's theoretical orientation. Their absence creates roadblocks to therapeutic change no matter how skilled the therapist, how potent the theory, or how close the relationship. In this guide, Hanna offers a tool for assessing the readiness for change in clients and in therapists. He offers strategies, examples and insights for therapists who face seemingly insurmountable obstacles in the therapeutic relationship.

Tabla de contenidos provista por Syndetics

• Preface(p. vii)
• Acknowledgments(p. ix)
• Introduction(p. 3)
• I. Understanding Difficult Clients, Therapeutic Change, and Resistance(p. 17)
• Chapter 1. What Makes a Client Difficult?(p. 19)
• Chapter 2. Toward a Model of Change for Difficult Clients(p. 31)
• Chapter 3. The Precursors Model: Skills and Functions of Change(p. 47)
• II. Assessing the Potential for Therapeutic Change(p. 111)
• Chapter 4. Rating Client Change Potential: Using the Precursors Assessment Form(p. 113)
• Chapter 5. Rating Therapist Precursors(p. 129)
• III. Clinical Applications: First Steps(p. 143)
• Chapter 6. Orienting the Relationship Around Change(p. 145)
• Chapter 7. Reducing Therapist Interference and Increasing Therapeutic Wisdom(p. 167)
• Chapter 8. Multicultural and Gender Considerations: A New Adaptation of Cognitive Therapy and a Framework for Empowerment(p. 181)
• IV. Clinical Applications: Implementing and Enhancing the Precursors(p. 193)
• Chapter 9. Instilling a Sense of Necessity(p. 195)
• Chapter 10. Establishing the Willingness or Readiness to Experience Anxiety or Difficulty(p. 211)
• Chapter 11. Cultivating Awareness(p. 227)
• Chapter 12. Enhancing Confronting(p. 241)
• Chapter 13. Increasing Effort or Will Toward Change(p. 255)
• Chapter 14. Building Hope for Change(p. 265)
• Chapter 15. Developing Social Support for Change(p. 275)
• V. Conclusion(p. 283)
• Chapter 16. At the Horizon of Change(p. 285)
• Appendix Characteristics of Wisdom(p. 295)
• References(p. 297)
• Author Index(p. 315)
• Subject Index(p. 321)
• About the Author(p. 329)

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CHOICE Review

An experienced and humane teacher and therapist, Hanna (Johns Hopkins Univ.) packs this pragmatic volume with transcription excerpts illustrating the process of assessing which precursors of change might be missing when a client does not seem to change (the "difficult client"). These interdependent preconditions for change include a sense of the necessity of change, willingness or readiness to experience anxiety or difficulty, awareness or consciousness of the problem, confronting issues, hope, making an effort, and social support. Examples of interaction with clients show ways of enhancing precursors, all actively involving the client. Hanna argues that these techniques for promoting precursors apply across diagnoses and therapeutic orientations. "Difficulty" is not regarded as residing in the client; when change seems difficult, the therapist should look at his or her own contribution to any weak precursors. Touch points of the precursor model of change with both classic and contemporary literature are abundant. Although the author does not say so, this original book seems appropriate for health programs (nursing, occupational and physical therapy, medicine, etc.) as well as for mental health programs (psychology, counseling, psychiatry); it will serve upper-division undergraduates through professionals. C. T. Fischer Duquesne University