HIGH CONFLICT CLIENTSHIGH CONFLICT CLIENTS

UNDERSTANDING & INTERVENING WITH UNDERSTANDING & INTERVENING WITH HIGH CONFLICT DOMESTIC VIOLENCEHIGH CONFLICT DOMESTIC VIOLENCE

CLIENTSCLIENTS

Gary Gibbens, MaPsy

Reasons Not To Label Reasons Not To Label PeoplePeople

Stigmatizes the clientStigmatizes the clientDiagnosis may be incorrectDiagnosis may be incorrectMay affect counselor's view of and May affect counselor's view of and

relationship with the clientrelationship with the clientLabeling without appropriate referral Labeling without appropriate referral

or change in treatment approach is or change in treatment approach is not helpfulnot helpful

Common Issues of High Common Issues of High Conflict ClientsConflict Clients

Rigid and uncompromisingRigid and uncompromisingDifficulty accepting or processing lossDifficulty accepting or processing lossCan appear logical until emotions Can appear logical until emotions

overwhelm logicoverwhelm logicAvoids responsibility-focus on blamingAvoids responsibility-focus on blamingDepends on other people to solve Depends on other people to solve

problemsproblemsLimited ability to self reflectLimited ability to self reflectAlmost no empathy for other’s issuesAlmost no empathy for other’s issues

The Paradox of High Conflict The Paradox of High Conflict ClientsClients

The Paradigm shift for InterventionThe Paradigm shift for Intervention

The HCC is always trying to focus on The HCC is always trying to focus on conflicts with others and trying to conflicts with others and trying to

involve us in solving these conflictsinvolve us in solving these conflicts

The Real issue: Conflict is The Real issue: Conflict is WITHINWITHIN these individualsthese individuals

Characteristics of DSM-IV Characteristics of DSM-IV Personality DisordersPersonality Disorders

Enduring patterns of problem behavior Enduring patterns of problem behavior from early childhood/adolescencefrom early childhood/adolescence

Extreme (all or nothing) thinking, Extreme (all or nothing) thinking, emotions, behavioremotions, behavior

Interpersonal dysfunctionInterpersonal dysfunctionImpulse control problemsImpulse control problemsNot the result of substance abuse or Not the result of substance abuse or

traumatrauma

NIH Study 2001-02NIH Study 2001-02

National Institutes of Health, National National Institutes of Health, National Institute on Alcohol Abuse and Institute on Alcohol Abuse and Alcoholism found:Alcoholism found:

– 30.8 million Americans (14.8%) meet 30.8 million Americans (14.8%) meet diagnostic criteria for at least one diagnostic criteria for at least one personality disorder under DSM-IVpersonality disorder under DSM-IV

– These diagnoses were found to be These diagnoses were found to be highly associated with emotional highly associated with emotional disability and social dysfunction.disability and social dysfunction.

Maladaptive Personality Maladaptive Personality TraitsTraits

Meet fewer DSM criteria than PDMeet fewer DSM criteria than PDLess rigidLess rigidCan function appropriately in some Can function appropriately in some

environments but exhibit dysfunctional environments but exhibit dysfunctional traits in other environments (usually traits in other environments (usually family, home)family, home)

Potentially more workablePotentially more workableDiagnosis not essential for Diagnosis not essential for

interventionintervention

Private Working TheoryPrivate Working Theory(William Eddy)(William Eddy)

Private: Private: If you decide that you are working If you decide that you are working with a High Conflict Client, keep this with a High Conflict Client, keep this information to yourself or share only with information to yourself or share only with those you need to consultthose you need to consult

Working: Working: Use your assessment to guide Use your assessment to guide your approach to this client, not to judge or your approach to this client, not to judge or criticizecriticize

Theory:Theory: Your assessment is only a theory Your assessment is only a theory and you may need to revise it as you work and you may need to revise it as you work with the clientwith the client

Levels of Conflict Levels of Conflict FunctioningFunctioning

Non-disorderedNon-disordered (“normal”) Client(“normal”) ClientAppropriately upset about conflicts; able to Appropriately upset about conflicts; able to resolve, de-escalate, and make adaptive resolve, de-escalate, and make adaptive changes.changes.

Maladaptive Personality TraitsMaladaptive Personality Traits Appear “normal”, but show inappropriate upset; Appear “normal”, but show inappropriate upset; highly exaggerated ideation; distorted logic; highly exaggerated ideation; distorted logic; ABLE to resolve conflicts with careful ABLE to resolve conflicts with careful management.management.

Personality DisordersPersonality DisordersRigid pattern of behavior; chronic distress; Rigid pattern of behavior; chronic distress; chronic interpersonal dysfunction; tend to be chronic interpersonal dysfunction; tend to be unconscious of the effects of their own behavior; unconscious of the effects of their own behavior; MAY not be able to resolve conflictsMAY not be able to resolve conflicts

Personalities Either:Personalities Either:Adaptive or MaladaptiveAdaptive or Maladaptive

Adapts to changing Adapts to changing world as neededworld as needed

Able to accept Able to accept feedback and change feedback and change behaviorbehavior

Resilient & FlexibleResilient & FlexibleConscious control of Conscious control of

behaviorbehaviorFunctions like a Functions like a

computer’s operating computer’s operating systemsystem

Chronically fails to adapt Chronically fails to adapt to changing environmentto changing environment

Repeats failed behavior, Repeats failed behavior, insists that others adapt insists that others adapt to their viewpoint—self to their viewpoint—self defeatingdefeating

Despite chronic, Despite chronic, increasing consequences, increasing consequences, does not adapt or changedoes not adapt or change

May have little conscious May have little conscious controlcontrol

Functions like a computer Functions like a computer operating system that is operating system that is constantly crashingconstantly crashing

High Conflict Clients:High Conflict Clients:

• Does not have Personality Does not have Personality Disorder or Maladaptive Disorder or Maladaptive TraitsTraits

• Can be self/awareCan be self/aware• Can turn high conflict Can turn high conflict

behavior on and offbehavior on and off

ChoosesChooses: : • Not to ListenNot to Listen• To Be AggressiveTo Be Aggressive• To Be InflexibleTo Be Inflexible• To Be Out of control To Be Out of control

• Has Cluster B Personality Has Cluster B Personality Disorder or Traits:Disorder or Traits:– BorderlineBorderline– NarcissisticNarcissistic– AntisocialAntisocial– HistrionicHistrionic

• Despite Chronic Difficulties, Despite Chronic Difficulties, does not adapt or change. does not adapt or change. May be unconscious of May be unconscious of inappropriate social inappropriate social behaviorbehavior

• Cluster C Personality Cluster C Personality DisordersDisorders– AvoidantAvoidant– DependentDependent– Obsessive-CompulsiveObsessive-Compulsive

Styles vs. Traits/Personality

Negative Feedback Loop Negative Feedback Loop of High Conflict Clientsof High Conflict Clients

Chronic feelings of DistressChronic feelings of Distress Views source of distress/problems as externalViews source of distress/problems as external Fails to self reflect or self awareness distortedFails to self reflect or self awareness distorted Chronic feelings of being a victimChronic feelings of being a victim Feelings of HelplessnessFeelings of Helplessness Wants of relieve distress—may use alcohol/drugs at Wants of relieve distress—may use alcohol/drugs at

this pointthis point Blames others (usually family), attempts to change Blames others (usually family), attempts to change

others (often through abuse & violence), actively others (often through abuse & violence), actively tries to recruit negative advocates.tries to recruit negative advocates.

Result is Negative feedback to Client—rejection, legal Result is Negative feedback to Client—rejection, legal consequences, isolation—self defeating Behaviorconsequences, isolation—self defeating Behavior

Leads to chronic feelings of distressLeads to chronic feelings of distress

Consequences of Negative Consequences of Negative Feedback LoopFeedback Loop

HCC has long history of Negative FeedbackHCC has long history of Negative FeedbackExperiences Feedback as a ThreatExperiences Feedback as a ThreatRather than learning from Feedback, Rather than learning from Feedback,

Defends against it (the four horsemen)Defends against it (the four horsemen)As Intensity of Feedback increases, Client As Intensity of Feedback increases, Client

defensiveness increases leading to abusive defensiveness increases leading to abusive behavior—again may abuse substancesbehavior—again may abuse substances

Result is more Internal DistressResult is more Internal DistressClient repeats the Loop againClient repeats the Loop again

HCC Negative Feedback HCC Negative Feedback LoopLoop

1.HCC feel DistressWants ReliefTries to avoid consequencesDenial, Minimization

2.Cause of Distress External: Intimate others or “System” Blaming

3.Recruits Negative AdvocatesExperiences self as victimTries to Change others with verbal or physical attacks, justification

HCC: Extremes Of HCC: Extremes Of BehaviorBehavior

Motivated by:Motivated by: Perceived threatsPerceived threats Defending self against Defending self against

losseslosses Need to control or Need to control or

change otherschange others Narcissistic InjuryNarcissistic Injury Any change in systemAny change in system

•Pregnancy of victimPregnancy of victim• Job changeJob change• Illness, InjuryIllness, Injury

HCC feels justified in HCC feels justified in acts of:acts of: Verbal, emotional Verbal, emotional

abuseabuse Physical abusePhysical abuse StalkingStalking Legal abuseLegal abuse Self destructive Self destructive

behavior, suicide, behavior, suicide, cuttingcutting

Sexual affairsSexual affairs Substance abuseSubstance abuse

HCC: Extremes of HCC: Extremes of EmotionEmotion

Explosive intense anger, panic, sadness, Explosive intense anger, panic, sadness, anxietyanxiety

When rational thought fails, they feel When rational thought fails, they feel overwhelmed by emotionsoverwhelmed by emotions

Emotional outbursts get more attention, are Emotional outbursts get more attention, are more instrumentalmore instrumental

Emotions help HCC generate facts to fit the Emotions help HCC generate facts to fit the emotion (distorted, paranoid) emotion (distorted, paranoid)

Emotions supersede logic and problem-solvingEmotions supersede logic and problem-solving

HCC: Extremes of HCC: Extremes of DependencyDependency

Problems seen as Problems seen as overwhelming, unsolvableoverwhelming, unsolvable

Sees self as victimSees self as victim Sees others as very Sees others as very

powerful: either powerful: either threatening enemies or life-threatening enemies or life-saving alliessaving allies

Life-long development of Life-long development of high intensity bonding skills: high intensity bonding skills: charm, seductiveness, charm, seductiveness, child-like appeal, emotional child-like appeal, emotional urgency, manipulation of urgency, manipulation of reality, trauma bondingreality, trauma bonding

Results in “Instant Intimacy”Results in “Instant Intimacy” Over responds to any Over responds to any

emotional interactionsemotional interactions Lack of boundariesLack of boundaries Unrealistic infantile Unrealistic infantile

expectations lead to expectations lead to infantile emotional reactionsinfantile emotional reactions

HCC assumes no HCC assumes no responsibility for responsibility for maintaining relationship, maintaining relationship, solving problemssolving problems

Loss of relationship results Loss of relationship results in desperate attempts to re-in desperate attempts to re-attach, YO-YO behavior, attach, YO-YO behavior, attach to negative attach to negative advocatesadvocates

Typical Responses to Typical Responses to HCCHCC

Counsellors feel Counsellors feel frustrated or frustrated or frightened by their frightened by their emotional sensitivity, emotional sensitivity, abusive behavior, and abusive behavior, and dependency needsdependency needs

Counsellors get Counsellors get emotionally “hooked” emotionally “hooked” and either withhold and either withhold responses or over responses or over respond.respond.

William EddyWilliam Eddy Use your Use your EAREAR

– EEMPATHYMPATHY

– AATTENTIONTTENTION

– RRESPECTESPECT

Negative AdvocatesNegative Advocates

Believe cognitive distortions of HCCBelieve cognitive distortions of HCCWant to helpWant to helpMisled or seduced by HCC’s charm, hurt, Misled or seduced by HCC’s charm, hurt,

fear, anger, painfear, anger, painAdvocate against perceived enemiesAdvocate against perceived enemiesProtect HCC from natural consequencesProtect HCC from natural consequencesEscalate conflicts unintentionallyEscalate conflicts unintentionallyMay also be HCC’sMay also be HCC’s

Be a Positive AdvocateBe a Positive Advocate

Avoid assumptionsAvoid assumptionsInvestigate concerns/problemsInvestigate concerns/problemsProvide support and informationProvide support and informationEstablish appropriate Establish appropriate boundariesboundaries, avoid , avoid

taking too much responsibility for problems taking too much responsibility for problems and emotionsand emotions

Avoid doing MORE work than HCCAvoid doing MORE work than HCCDon’t rescue—HCC needs to feel natural Don’t rescue—HCC needs to feel natural

consequences—but don’t automatically consequences—but don’t automatically reject.reject.

Developmental Basis for Developmental Basis for HCC: Paul MacLean’s Triune HCC: Paul MacLean’s Triune

BrainBrain "three interconnected biological computers, each with its own special intelligence, its own subjectivity, its own sense of time and space and its own memory". Each brain operates as its own brain system with distinct capacities for perceiving and responding to the environment and each can become dominant depending on the circumstances.

Three Levels of Brain Three Levels of Brain FunctioningFunctioning

NeocortexNeocortexCerebral Cortex or Cerebrum Center of abstract Cerebral Cortex or Cerebrum Center of abstract thought, creative thinking, all higher cognitive thought, creative thinking, all higher cognitive functions.functions.

Limbic SystemLimbic System Middle part of brain, “old mammalian” concerned with Middle part of brain, “old mammalian” concerned with emotions, instincts, feeding, fighting, fleeing, value emotions, instincts, feeding, fighting, fleeing, value judgements, sexual behaviour.judgements, sexual behaviour.

Reptilian BrainReptilian Brain Basal brain consists brain stem and cerebellum. Basal brain consists brain stem and cerebellum. Center of rigid, obsessive, compulsive, paranoid ideas Center of rigid, obsessive, compulsive, paranoid ideas and behaviour, never learning from past mistakes. and behaviour, never learning from past mistakes. Automatic functions; breathing, reflex, etc.Automatic functions; breathing, reflex, etc.

Cerebral Cortex: 2 Cerebral Cortex: 2 HemispheresHemispheres

Left HemisphereLeft Hemisphere LogicalLogical SequentialSequential RationalRational AnalyticalAnalytical ObjectiveObjective Looks at parts Looks at parts Positive emotionsPositive emotions Higher dopamineHigher dopamine

Right HemisphereRight Hemisphere RandomRandom IntuitiveIntuitive HolisticHolistic SynthesizingSynthesizing SubjectiveSubjective Looks at wholes Looks at wholes Negative emotionsNegative emotions Higher norepinephrineHigher norepinephrine

Corpus CollosumCorpus CollosumThe corpus callosum is a bundle of nerve The corpus callosum is a bundle of nerve

fibers that connects the two hemispheres of fibers that connects the two hemispheres of the brain, enabling them to work together to the brain, enabling them to work together to process information and regulate autonomic process information and regulate autonomic functionfunction

Area where the two hemispheres are Area where the two hemispheres are ““stitchedstitched” together—through nerve fibers” together—through nerve fibers

Left Brain needs input from the right, to Left Brain needs input from the right, to process non-verbal information & process process non-verbal information & process negative emotional inputnegative emotional input

Right needs input from the left to analyze Right needs input from the left to analyze information, to assess danger, to information, to assess danger, to communicate verbally, to achieve positive communicate verbally, to achieve positive emotionsemotions

Emotional Dysregulation Emotional Dysregulation of HCCsof HCCs

Research with BPD and ASPD indicate brain Research with BPD and ASPD indicate brain differences in the Hippicampus and Corpus differences in the Hippicampus and Corpus CollosumCollosum

Working TheoryWorking Theory

HCCs have difficulty mediating powerful HCCs have difficulty mediating powerful emotions with logic and rationality; as a emotions with logic and rationality; as a result they are unable to self soothe or result they are unable to self soothe or regain a sense of calm.regain a sense of calm.

Flight or Fight ResponseFlight or Fight Response

Under conditions of emotional or physical Under conditions of emotional or physical stress, the limbic system floods emergency stress, the limbic system floods emergency systems with adrenaline to energize for quick systems with adrenaline to energize for quick reactions, over-riding the functions of the reactions, over-riding the functions of the cerebral cortex.cerebral cortex.

Children who have been abused over-respond Children who have been abused over-respond to “normal” situations and show to “normal” situations and show developmental brain differencesdevelopmental brain differences

HCCs tend to be HOT responders in handling HCCs tend to be HOT responders in handling stressful situations exhibiting distorted stressful situations exhibiting distorted thinking about the situationthinking about the situation

Cognitive DistortionsCognitive Distortions

All or Nothing thinkingAll or Nothing thinkingMagnification or MinimizationMagnification or MinimizationShould statementsShould statementsOvergeneralizationsOvergeneralizationsJumping to conclusionsJumping to conclusionsPersonalizationPersonalizationEmotional reasoningEmotional reasoning

Intervention with Intervention with Agitated HCCsAgitated HCCs

Help client shift focus to more Left Brain or Help client shift focus to more Left Brain or integrated activities: Brain gym, breathing integrated activities: Brain gym, breathing exercise, making a list of options and exercise, making a list of options and asking client to logically review choices, asking client to logically review choices, make lists, etc.make lists, etc.

The shift to more “Left Brain” activities The shift to more “Left Brain” activities does not require solution of the conflict or does not require solution of the conflict or problem. Client usually feels relief when problem. Client usually feels relief when you help them do thisyou help them do this

Preparing Staff for HCCsPreparing Staff for HCCsEmotional Grounding and self-careEmotional Grounding and self-care

Brain GymBrain GymGood stress management skillsGood stress management skills

Maintaining clear BoundariesMaintaining clear BoundariesUnderstand and Explore Counter-Understand and Explore Counter-

transferencetransferenceCo-therapy groups if possibleCo-therapy groups if possibleDebriefing supportDebriefing supportAvoid the extremes: Seduction by or Avoid the extremes: Seduction by or

rejection of the HCCrejection of the HCCAvoid Trauma triggersAvoid Trauma triggers

Service Agreements & Service Agreements & InterventionsInterventionsProgram involvement—clear simple rulesProgram involvement—clear simple rulesSobrietySobrietyNon-abusive Behaviour and LanguageNon-abusive Behaviour and LanguageClient acceptance that problem behaviour Client acceptance that problem behaviour

has occurredhas occurredAcknowledges need for helpAcknowledges need for helpAccountable for own behaviourAccountable for own behaviourConsiderate & Aware of othersConsiderate & Aware of othersInvolved in the process of Service DeliveryInvolved in the process of Service DeliveryAvoids blaming others or systemsAvoids blaming others or systems

Karpman TriangleKarpman Triangle

Persecutor Rescuer

Victim

If you are vulnerable in any of these roles, a skilled HCC will find out and exploit it.

Transactional AnalysisTransactional Analysis Parent: Ingrained voice Parent: Ingrained voice

of authority. Value of authority. Value statements, Right or statements, Right or Wrong.Wrong.

Adult: Adult: Our 'Adult' is our Our 'Adult' is our ability to think and ability to think and determine action for determine action for ourselves, based on ourselves, based on received data. received data.

Child: This is the Child: This is the seeing, hearing, seeing, hearing, feeling, and emotional feeling, and emotional body of data within body of data within each of us. each of us.

Parent

Adult

Child

Counselling with HCCCounselling with HCCListening with Neutral attention/respect to high Listening with Neutral attention/respect to high

intensity emotions (set time limits--avoid being intensity emotions (set time limits--avoid being bullied or rejecting client)bullied or rejecting client)

Focus on Tasks—structure sessionsFocus on Tasks—structure sessionsProvide Active Reality TestingProvide Active Reality TestingUse low-level but clear ConfrontationsUse low-level but clear ConfrontationsBlock development of Negative Advocates--BullyingBlock development of Negative Advocates--BullyingReflect back their Self Talk process/point out Reflect back their Self Talk process/point out

inconsistenciesinconsistenciesIncorporate Time Outs in group/individual tx Incorporate Time Outs in group/individual tx

processprocessIdentify/emphasize StrengthsIdentify/emphasize StrengthsHelp client learn to identify body stress or stressful Help client learn to identify body stress or stressful

emotions and “turn down the volume”emotions and “turn down the volume”

Listening to High-Intensity Listening to High-Intensity EmotionsEmotionsHCCs attempt to establish relationships through HCCs attempt to establish relationships through

trauma bonding.trauma bonding.They want to establish an unconditional “caring” They want to establish an unconditional “caring”

relationship which they can control & exploitrelationship which they can control & exploitStaff needs to be very aware of their own limits Staff needs to be very aware of their own limits

around emotional intensityaround emotional intensityStaff needs to help HCCs shut down when the Staff needs to help HCCs shut down when the

intensity becomes repetitive, obsessive, intensity becomes repetitive, obsessive, overwhelming to the client (Watch for looping, overwhelming to the client (Watch for looping, fight or flight arousal) Breathing, safe place fight or flight arousal) Breathing, safe place exercisesexercises

Focus on TasksFocus on Tasks

Whenever possible, move away from Whenever possible, move away from emotional expression and help client emotional expression and help client develop a “structure” for problem solvingdevelop a “structure” for problem solvingExample: Brain Gym, relaxation, writing Example: Brain Gym, relaxation, writing down problems, brainstorming solutionsdown problems, brainstorming solutions

Help client break large overwhelming Help client break large overwhelming issues into small stepsissues into small steps

If client agrees to tasks, always follow If client agrees to tasks, always follow through to see if he/she has completed through to see if he/she has completed themthem

Provide Low-Level Provide Low-Level ConfrontationsConfrontations

Be aware of HCC Over-reaction to any Be aware of HCC Over-reaction to any judgements, rejection, humiliation, abandonmentjudgements, rejection, humiliation, abandonment

Statements like, “I wonder what else happened”– Statements like, “I wonder what else happened”– “It seems like you left something out”– “It just “It seems like you left something out”– “It just doesn’t make sense to me—I guess I don’t doesn’t make sense to me—I guess I don’t understand you” understand you”

Sometimes clear, low intensity value statements Sometimes clear, low intensity value statements can be more effective than anything elsecan be more effective than anything else

Don’t attack the relationship but Don’t attack the relationship but InsistInsist on on AccountabilityAccountability

Hypotheticals can also workHypotheticals can also work

Reflect Self Talk ProcessReflect Self Talk Process

Help client reconstruct linkage Help client reconstruct linkage between stimulating event, self talk, between stimulating event, self talk, emotional response and behaviouremotional response and behaviour

Explore choices at every step in the Explore choices at every step in the linkage and involve client in linkage and involve client in feedback/problem solving.feedback/problem solving.

Remember the PROBLEM(S) is Remember the PROBLEM(S) is almost always internal or inside the almost always internal or inside the client’s mind & bodyclient’s mind & body

Listening to High Intensity Listening to High Intensity EmotionsEmotions

Model listening with respect & interestModel listening with respect & interestRespond with caring, understanding Respond with caring, understanding

statements if indicatedstatements if indicatedAvoid taking on their emotions/insist on Avoid taking on their emotions/insist on

client accountabilityclient accountabilityBe clear that staff cannot “fix” the problemBe clear that staff cannot “fix” the problemIf conflict involves others, ask HCC to listen If conflict involves others, ask HCC to listen

and respect feedback without interruption and respect feedback without interruption

Identify/Emphasize Identify/Emphasize StrengthsStrengthsHCC may have some part of life where HCC may have some part of life where

they function non-abusively. (work, they function non-abusively. (work, school, church) Help them identify area school, church) Help them identify area and what works for them in that part of and what works for them in that part of their lives.their lives.

Work on developing new strengths in Work on developing new strengths in the program: Listening, Being aware of the program: Listening, Being aware of other’s needs, Taking responsibility, other’s needs, Taking responsibility, Taking Time OutsTaking Time Outs

BibliographyBibliography

• Eddy, B. Eddy, B. HIGH CONFLICT PEOPLE IN LEGAL HIGH CONFLICT PEOPLE IN LEGAL DISPUTES, 2006DISPUTES, 2006

• Linehan, M. Linehan, M. COGNITIVE-BEHAVIOUR COGNITIVE-BEHAVIOUR TREATMENT OF BORDERLINE TREATMENT OF BORDERLINE PERSONALITY DISORDER, 1993PERSONALITY DISORDER, 1993