In our last blog we discussed a profile with defensive responding on the SASSI. In this blog, we would like to discuss strategies for handling clients who respond in this manner and the steps that might be taken to reduce defensiveness prior to administration of the SASSI.

The two factors most frequently related to defensive responding are 1) the purpose of the evaluation – i.e. to determine if there is a high probability of a substance use disorder and 2) the context or setting in which the evaluation is taking place – i.e. situational factors that may result in serious consequences for the individual such as jail time, loss of a job or loss of child custody. While there may be little that can be done to change the reason for a SASSI screening, there are a few things you can do to reduce the effect of the stigma and fear that many individuals feel in legal, EAP, or child welfare settings. Research suggests that professionals working with a client in any setting are more likely to have positive successful results with that person if they are able to develop a positive rapport with them. Specifically, you can help the client view your role as one of a helping professional who values them as an individual, recognizes and is empathetic to the difficulty they are currently facing and desires not to punish or demean them, but to assist in getting them any help they may need.

Building rapport with a client before presenting the SASSI to them can be as simple as meeting them in the lobby, smiling at them genuinely, asking about their well-being, and spending some time talking to them in a manner that you would use with anyone you were interested in getting to know better, rather than immediately “getting to the business” of the trouble that brought them there. Talking to the client in this friendly, engaging and empathetic way can be useful in helping the client to develop a higher level of trust in you, to lower their defensiveness, and to be more forthright and honest in their answers on the SASSI questionnaire. Using this procedure gives you a chance to put the client at ease and reduce any perceived threat by beginning to develop a trusting and empathic relationship. Letting clients know that you understand their pain and acknowledging how scary it must be to go through this process will also help to reduce the fear and apprehension that often leads to defensive responding.

Additionally, clinical experience has shown that clients tend to respond less defensively when told in advance that they will have a chance to talk over their answers to the questionnaire with you after they’ve finished. Letting the client know upfront that you will discuss their responses with them after they finish gives clients the message that you view them as important and value their input and perspective. One very common fear among mandated clients is that they will be mistakenly or unfairly judged by a system that doesn’t care much about their well-being. If clients know that you are someone who will not jump to conclusions and are willing to listen to their point of view, they will usually have less of a reason to feel threatened. Letting them know that the questionnaire is simply a way for you to get to know them better and to find out what problems, if any, you can help them with, as well as telling them that there are no right or wrong answers increases the likelihood that they will respond in a more open and forthright manner. It is also often useful to refer to the SASSI in terms that are not perceived as negative such as “questionnaire” rather than “test”; “survey” rather than “screening instrument.” Taking these steps will help to ensure that clients will be more open to hearing your feedback and comments when it is time to review the SASSI results.

In short, the two most effective ways to reduce the likelihood of defensive responding on the SASSI are to 1) spend some time building a positive trusting rapport with the client before ever introducing the SASSI or talking about why the client is seeing you, and 2) administer the SASSI in the context of an empathic and trusting relationship and let the clients know that they will have a chance to review the results with you.

If you would like to discuss any of your clients screening results, feel free to call the free clinical helpline at 800-726-0526, option 2.

The profile being discussed is for Julia, a 21-year-old single parent female, who is participating in mandated counseling following an allegation that she has been neglecting her child. The child was removed from her care and placed with family members temporarily. This counseling will play a major role in her being allowed to resume custody of her child.

There is probably no circumstance more likely to evoke feelings of defensiveness in a person than revealing the details of personal, family life, and private attitudes for others to scrutinize, particularly when other people are given the power to determine an individual’s parenting abilities and possibly remove one’s child from custody. It is no surprise then that Julia’s DEF score is elevated, given the difficult situation she is in. In reviewing Julia’s SASSI scores, she does not meet the criteria for classification as High Probability of having a substance use disorder (SUD). While elevated DEF scores, when coupled with a Low Probability result, can potentially imply an increased possibility of the SASSI missing an individual with an SUD (a false negative), an elevated DEF may also reflect serious and difficult situational factors facing Julia with custody of her child at risk.

The most striking and important feature of her profile is that most of her individual scale scores are rather “flat”, not really deviating very far from the mean (T Score of 50), which is where most average people would score. Besides the DEF scale score, only the COR score is significantly elevated. This suggests that overall she responded in a generally “average” way (answering similarly to people not in treatment for SUD). The two exceptions are DEF and COR.

Her high DEF score indicates a possible tendency to endorse only things that make her look good to others, to have her guard up so as to not reveal anything about herself that may be viewed as negative. Again, when one is being accused of child neglect and one’s child could be removed from the parent, it is quite normal for that parent to have their defenses, their guard way up and not want to show any weakness or negative traits, even though all humans have weaknesses with which they struggle. Therefore, this high level of defensiveness could be seen as entirely situational or perhaps even a personality trait. In addition, it is noted that while Julia’s DEF scale score is very high, her SAM scale score is not at all high. Prior case studies reveal to us that often when a person has a high DEF scale score and also has a high SAM score, this could be an indicator that the person’s defensiveness may be related to substance abuse. That is not the case here though. It is therefore most likely that her defensiveness is more general and situational rather than being specifically related to substance misuse.

Julia also had a very high score on the COR scale. While this score has nothing to do with the SASSI decision rules leading to a result of high or low probability of a substance use disorder, our experience with high COR scores indicates that a person with high COR scores is answering the questions on that scale very similarly to the way a person with a long history of criminal justice involvement would answer. Therefore, a person with a high COR scale score could be at greater risk of engaging in behavior that may get them arrested. Sometimes certain personality traits of the individual can be found in clients with high COR scores that may contribute to their risk of acting out and being arrested. Therefore, it is often recommended that the therapist explore for signs of low frustration tolerance, anger management problems, poor social skills, poor impulse control or being one who enjoys engaging in high risk behaviors and add these to the treatment plan to try to lower risk.

In summary: While Julia is alleged to have engaged in child neglect, there can be many reasons why a parent may engage in this behavior, with substance abuse being only one of them. As the SASSI is not designed to be a measure of a wide variety of pathologies, but is limited to the role of determining the likelihood of a substance use disorder, the results indicate that substance use disorder is not likely.

It is important to acknowledge the reality of the fear and pain underlying defensive responding on the SASSI. In order to do so, it is valuable to have a good understanding of the nature of your client’s defensiveness. There is no clear evidence in this case that defensiveness is an ongoing characterological feature or personality characteristic of Julia. Her defensiveness therefore is likely to stem from situational factors. Having said that, her high COR score indicates potential risk of engaging in behaviors that could cause her to get in trouble which may be fueled by difficulty controlling her anger and frustration and may cause her therefore to display poor judgement and act impulsively. These potential issues could indeed put her child at risk as well as herself and so should be explored carefully.

Be sure to read our next blog which will discuss tips for reducing defensiveness.

As always, feel free to call our free clinical helpline M-F 1-5 pm ET for assistance in administering, scoring, and/or interpretation of profile results at 800-726-0526 Option 1.