Managing threats: A grounded theory of counseling engagement in clients with experiential avoidance

Abstract

Constructivist grounded theory methods were used to explore counseling engagement in clients with strong tendencies to avoid aversive emotion. Participants initially viewed counseling as a potentially adversarial and harmful relationship. An expectation and fear of judgment, as well as shame and self-judgment, contributed to this view. Participants also reported anxiety about addressing specific issues. Their perceptions led to withholding of personal information and minimal engagement. The participants were initially susceptible to negative or fruitless counseling episodes. However, if a trusting therapeutic relationship developed, engagement increased. Trust developed if the participants perceived their counselors as nonjudgmental and genuine. Recognizing possible benefits-in addition to risks-of counseling also contributed to their decisions to engage. The participants reported that counseling helped change their perspectives. They eventually perceived and appreciated the benefits of emotional engagement. Implications for counselors are provided.

When psychotherapy runs into shame: A scoping review of empirical findings.

“…Among those reporting negative impacts (I−), several sources, both quantitative (Baumann & Hill, 2016; Hill et al, 1993) and qualitative (Blanchard & Farber, 2020; Farber et al, 2006; Tursi et al, 2022), identified in-session manifestations of shame as a common reason for nondisclosure. Moreover, shame also affected treatment outcome: Trait and trauma-related shame assessed during treatment were found to predict lower improvement in (Harned et al, 2020) and higher levels of (Øktedalen et al, 2015) PTSD symptoms, and lower improvement in suicidal and self-harming tendencies in BPD (Rizvi & Fitzpatrick, 2021).…”