When a client is in denial about a behavior that is limiting improvement of the reporting problem or an issue that is blocking their progress, I have found that direct confrontation almost never works. Instead I engage them in a conversation either before or after (after seems to work best) a session about a problem that I am having. I describe the issues and how I resolved them by doing a covert behavior modification. It goes something like this; Can you imagine what it is like to sneak around and eat Twinkies behind your wife's back? She would look everywhere, but I got really good at watching her and moving them from where I had hid them, to where she had just looked. I was spending a huge amount of my time buying Twinkies and hiding them from her. I mean she was convinced that I was a medical marvel. Nothing would keep my weight off, (This for a smoker who had promised to quit) This confessional story can be altered to fit the clients need, but the key is describing their behavior, cloaked in a metaphor about your self, with just enough changed to hide the truth. I am constantly amazed that not only do the clients accept this pattern they actually start to try and help me solve my problem by suggesting ways to improve. If engaged in the story long enough, a conspiratorial atmosphere emerges where the client confesses their secret "cheating" to me. The light bulb usually goes off around this point in the process (That's Me!), and some real progress can be made when the client realizes they are working against themselves, or alternatively that they really do not want to change their behavior.

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