Karen Lindhurst, the author of this article, has experience
in community mental health to include a substance abuse residential treatment
facility. The following are my thoughts on the pros and cons in using manipulation
in a therapy session.
Manipulation is a loaded word. It can
elicit very negative emotions. However, I propose that therapists attempt to re-frame
the word as they enter into practice. A common definition might be the
act of changing others by unfair means to serve ones own purpose." This first definition might be what we are most familiar with in our society. However, I would propose the following definition, the act of improving
ones life situation through the skillful management of another person or
system without consent from the affected party.
I see manipulation
daily in the mental health field. The clients I serve are actively trying to improve
their current life situation. Many of them are masters at managing other people
or systems. In practice, I often find myself as one of the people whom they attempt
to manage. The following paragraphs contain highlights of a few experiences Ive
observed in my years of practice.
Ethics - Marital issues
years ago, I was working with a couple struggling with marital issues. The husband
shared that he was not happy with his wife because she expected too much of him.
He stated that he wanted to have some time to go fishing, to play pool or to just
have an evening to himself once in awhile. He described her as manipulating
every hour of his life. The wife in turn shared that she believes the marriage
is falling apart because her husband is not happy being at home with her. She
admitted she plans activities for the two of them and is not happy if her husband
wants to spend time away from her. He responded with assurance that the marriage
was solid but that he needed more space. He said he felt smothered.
Further discussion revealed that the woman had been previously married and the
first marriage had ended in divorce. She became tearful as she expressed fear
that the same would occur with her current marriage. Several sessions went by
with the couple. It was fairly clear the woman was trying to control her husbands
free time or behavior to decrease her own anxiety about the marriage. She was
able to identify that her sense of security was better when her husband was physically
with her. Was it her motive to control her husband or preserve the marriage?
Thankfully, the couple was able to address the behaviors of concern and create
new behaviors focused on fulfilling both partners needs. Their relationship
improved as did the womans sense of security in the marriage. It was important
through the therapeutic process to identify the process of manipulation but not
to label it as a negative behavior. It was simply a survival skill used by the
woman. Redirecting the behavior was a key to a positive treatment plan.
Another example presented itself in my work with a family consisting of three
children living with their grandparents. The family had received outpatient services
off and on for a couple years for the two older children. Therapy focused on behavior
management and parenting strategies. The family received disability insurance
for the two children. A third child in the home had begun having behavioral issues
at school which prompted the contact with myself. The grandmother entered my office
and presented me with disability paperwork to complete for the youngest child.
Historically, the grandmother had struggled to maintain a job for various
reasons. She would work for several weeks and would leave the job with little
notice to her employers. She appeared to be a capable worker or employee. However,
the grandmother had never maintained steady employment. The grandfather was retired
but had suffered from health related issues for several years. He tried to do
odd jobs around the community but his abilities were limited due to his health.
The children had resided with their grandparents for more than three years. For
various reasons, there was limited support from the biological parents.
During the session, the grandmother shared that none of the children were doing
well. She wanted the older children back in therapy. She talked briefly about
the third child who was reportedly being disruptive at school. This had prompted
her visit to my office. Grandmother spoke of her latest job experience. She said
she had been working nights and couldnt get the kids to school on time because
she didnt get off until thirty minutes before they were to be at school.
She said she couldnt keep the job because the school was upset about tardiness
and attendance. She spoke of her concern about paying the bills and buying medication
for her husband. With increased emotion she again referred to the childrens
I asked some questions about the school and the behaviors of
concern. I touched briefly on some stress relief strategies for the grandmother,
agreed to look through the paperwork, and rescheduled to meet with the grandmother
and youngest child. She seemed somewhat relieved.
My Ethical dilemma
As I reviewed my session with the woman, I identified several areas of concern.
I was aware that I that I might have an ethical dilemma to address regarding the
disability paperwork, but I didnt believe this issue needed immediate attention.
My biggest concern was the amount of stress expressed by the grandmother. She
was struggling to maintain at many levels. She was physically tired, emotionally
drained, and was trying figure out how to generate enough money to pay bills and
maintain her husband. The woman was desperately trying to improve her life situation
by changing others behaviors and by trying to access services. To be specific,
the grandmother was trying to change her grandchildrens behavior, was trying
to get me to help her change their behavior, was seeking my service to help her
secure disability assistance, and was trying to manipulate a financial system
with little success.
The womans behavior could be identified as
manipulative. I would suggest that she was trying to skillfully manage others
for personal gain. However, the personal gain was at a level of self-survival.
She was trying to preserve her family in the only way she thought possible. Is
this a negative skill?
I can remember a conversation in my clinical practice
course during graduate school very clearly. This particular conversation evolved
as one of the students referred to a client as manipulative. The instructor
emphatically asked, What do you mean by that comment? It appeared
as though the entire class was taken back by the instructors question and
her pointedness. The student attempted to answer but was unclear as to what the
instructor was asking.
Our instructor went on to ask several questions.
The two that remain most clearly in my mind include, Why do we use the word
manipulation to describe perceived negative behaviors of a person? and Why
is it ethical for therapists to use manipulation in their practice? She
then gave us an assignment. The assignment seemed simple. We were to think about
how we used manipulation in our own lives and to write a two-page summary.
The responses presented in the next class period included a vast variety
of experiences. One student tried to get a good grade by spending time after class
talking with the instructor. Another male student talked about going on a date.
He washed his car for the first time in two months, got a much needed haircut,
and spent extra on cologne. He did all these things to try to impress a woman
he really didnt know. Other examples included interviewing for jobs, trying
to talk a police officer out of a ticket, and parents trying to gain good behavior
from children through rewards and promises. One student spoke of the process of
writing a check with the knowledge that you would not have money in your account
until tomorrow (or later) to cover the amount of the check. Another student even
talked about applying for a loan and not giving complete and accurate information
to the bank officer. There were many other examples but the instructor made her
point. We are all guilty of manipulation as we live our daily lives. Finally,
she concluded the lesson with the next question. Is manipulation a bad thing?
last example involves an intervention at a residential treatment facility.
Our staff at the facility had been struggling to maintain the group of teens in
the program. Behaviors of concern included defiance, refusal to maintain their
rooms, poor school performance and general negative attitudes. The staff had a
meeting to try to address the problems. A reward of some kind became the proposed
solution. The staff selected a pizza party for the reward if all the residents
maintained a certain point level through the week. The residents were made aware
of the incentive. Some were excited about the opportunity and others showed no
enthusiasm. Staff went ahead with the intervention plan to see if behaviors would
improve. The outcomes were not perfect but were positive. The group of teenagers
who had been so disruptive one week, showed improved response to the staff and
all activities the following week. Several positive leaders even began to emerge.
Although not all residents met the goal of maintaining the point level, the entire
groups behavior improved. We did go ahead and offer some pizza but not a
full blown party. The kids responded to the staffs reward intervention which
was actually an act of manipulation. Was this planned reward intervention an example
of negative manipulation or positive manipulation of the teens behavior? I believe
the staff actually utilized some positive manipulation skills.
references to manipulation very frequently. Shes manipulating the
system. He manipulates the kids every weekend. Her behavior
is so manipulative. All these comments can be heard in the clinical setting
as well as in our daily conversations. The references often have a negative overtone
to them. They hint that the person doing the manipulation is breaking some unwritten
rule of behavior. They also bring about the idea that the person involved in the
manipulative behavior is harming another person in some way. I believe this is
in part due to the lack of permission or awareness of the affected party or system.
Manipulation does not allow for one to seek permission to initiate change.
I would challenge the negative references to manipulation. I see the
skill as a strength that can be utilized to help persons improve their life situation.
The key in treatment is trying to redirect the identified manipulative behavior
into something that will benefit the client without harming others. If at all
possible, making the client aware of the behavior will create even more avenues
for future success and effective transference of the skill. If a client can skillfully
manage their own behavior, master the skill of managing others without harm,
and use these skills in a positive manner, the opportunity for self-growth and
self-survival is unlimited. Manipulation is only a negative behavior if we choose
to define it as such. It can be the strength or treatment tool necessary to successfully
empower clients to change their life situation. Manipulation is a word loaded
with treatment opportunities.
Ethics for Behavioral Health Professionals
- Rivera, Sierra & Company. (2009). Ethics for Behavioral Health Professionals. The article above contains foundational information. Articles below contain optional updates.
Reflection Exercise #2
The preceding section contained information on the
manipulation boundary. Write three case study examples regarding how you might
use the content of this section of the Manual in your practice.
Ethics CEU QUESTION 8 What are two definitions of manipulation? To select and enter your
answer go to Ethics CE Test.
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