This intervention may have contraindications if the client is not fully educated about the purpose of the skills training from the start. The client must understand that assertive communication is for the sake of the client and not for the sake of changing others. Clients must recognize that standing up for their rights and expressing their views will provide them with a greater sense of freedom, enhanced self-esteem and self-worth, and assist him or her in eliminating self-destructive behaviors by uncovering some of those pent-up thoughts, feelings, and desires. They will feel more empowered to overcome obstacles, which in the past they were too fragile to overcome, simply by getting it "off their chest" rather then consciously suppressing their thoughts and feelings.
If the clients irrationally believe they are going to change the response of others simply because they are speaking up, there may be unnecessary frustration that would cause the clients to withdraw, once again, into a world of self-destructive thoughts and behaviors.
Another contraindication to learning this type of skill is a possible loss of a current relationship. It is sad but true. For example, in the case of a marriage or other intimate partner relationship, the more dominating partner may have chosen the more passive partner for obvious reasons: control. Once this passive partner becomes more assertive (hence enhancing his or her sense of self-esteem), the more dominating partner may not appreciate this newfound sense of self-worth on behalf of his or her partner and become frustrated and experience feelings of insecurity due to the loss of control and anxiety over the new direction in which the relationship has begun to develop.
Therefore, both partners should learn this technique together. If both partners are not willing to learn this skill together, this may be the very reason that one partner came in for therapy, in the first place, that is, to learn how to speak up and find a voice. I strongly urge the clinician to use a disclaimer prior to beginning of this type of skills training by explaining to the client the benefits and consequences of enhancing his or her sense of self-esteem through this method. Obviously, the long-term benefits certainly outweigh the short-term consequences for the client. Living in passive fear will only hinder striving toward one's greatest potentials, and the loss of a current abusive relationship is hardly a consequence to gaining a skill that will enhance the client's future in all aspects of his or her life.
Delamater, R. J. & McNamara, J. R. (1986). The social impact of assertiveness-
Research findings and clinical implications. Behavior Modification, 10, 139-158. Markman, H. J. (1981). Prediction of marital distress: A five-year follow-up. Journal of Consulting and Clinical Psychology, 49(5), 760-762. Mendelsohn, S. (2007). It's Not About the Weight: Attacking Eating Disorders from the Inside Out. New York: iUniverse.
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