Assertiveness Training in Couple and Family Therapy
Name of the Strategy or Intervention
The consensus definition of assertiveness is a verbal and nonverbal interpersonal behavior and a direct expression of one’s feelings and wants that is based on the person’s best interest, which respects the person and the other people’s rights (Alberti and Emmons 1974; Wolpe and Lazarus 1966). Assertiveness training (AT) was developed to help people effectively express their feelings, wants, and rights in their relationships with others and in various contexts of their lives (Speed et al. 2017). The purpose of AT has gone through an evolution and has been used in a wide range of population, including both clinical and nonclinical contexts. Peneva and Mavrodiev (2013) noted that in the 1960s, AT was utilized to overcome mental illnesses and to attain personal growth; in the 1970s, to protect individual rights; in the 1980s to 1990s, to attain self-accomplishment and self-approval and to advocate for women’s rights; and in the twenty-first century, to improve communication skills in diverse fields such as medicine, education, politics, business, and sports. Assertion training has shown to be effective in treating anxiety, depression, addictions, and personality disorders and improving self-confidence, self-esteem, personal satisfaction, interpersonal communication, and socialization (Lee et al. 2013; Peneva and Mavrodiev 2013).
Assertiveness training has a long history. The concept of assertiveness originated from an American psychologist and psychotherapist, Andrew Salter, in 1949 (Lazarus 1968). When Salter was working with clients with depression, his efforts to find the cause of uncertainty/nonassertiveness and to treat its neurotic influence were shown in his theoretical explanation, “Conditioned Reflex Therapy” (Peneva and Mavrodiev 2013). Salter indicated that inhibitory individuals are not able to openly express their feelings, desires, and needs and consequently experience difficulties in their interpersonal relationships (Peneva and Mavrodiev 2013). Salter contrasted inhibition with excitation. Salter described excitation as the outward expression of feelings and emotions that leads to a healthy intra- and interpersonal functioning (Lazarus 1968). Later in 1958, Joseph Wolpe, a psychiatrist, used the term assertiveness and utilized assertiveness training (a) to decrease social fears, which Wolpe identified as the reason people are unassertive, and (b) to maintain a high level of self-esteem (Wolpe 1958).
People are either assertive or nonassertive, and those who are nonassertive range from being excessively passive/submissive to being excessively hostile/aggressive (Speed et al. 2017). Caballo (1993) described people who are assertive as those who are satisfied, confident, and able to cope well in their daily social life. Caballo explained that those who are unassertive avoid conflicts, are ignored by others, and lack self-respect and confidence by not being able to express their thoughts and feelings to others. Lastly, Caballo explained that those who are aggressive break the ethical norms and do not care about others’ rights.
Assertive training has its roots in behavior therapy (Speed et al. 2017). However, AT progressed from being a unidimensional model to a multidimensional model that incorporates behavioral, cognitive, and affective components (Peneva and Mavrodiev 2013). Although literature has supported the clinical efficacy of AT as a “stand-alone” intervention in treating diverse clinical problems, AT is typically embedded within large treatment programs currently (Speed et al. 2017).
Peneva and Mavrodiev (2013) provided a history of how AT, a behavioral model, gradually integrated the cognitive and affective models. From the behavioral point, Salter and Wolpe addressed that people need to acquire habits to be able to openly express their feelings. Wolpe identified social fear as the source and the cause of nonassertiveness. Wolpe’s examples of social fear were fear of criticism, rejection, bosses, new situations, and fear to ask for help or to provide help. Wolpe stated that the effects of social fear become associated with a certain social situation and become enhanced and self-produced that it eventually becomes an automatic response that is spread out in other daily life situations (Peneva and Mavrodiev 2013). Peneva and Mavrodiev indicated that in 1971, Lazarus combined behavioral therapy with cognitive therapy. Lazarus defined assertive behavior as a social competence and addressed that people need to be able to differentiate assertive and socially acceptable behaviors from aggressive behaviors, which requires people to use cognition to assess their own personal life philosophy. Lastly, Peneva and Mavrodiev explained that the German psychologists Rita and Rüdiger Ullrich identified the feelings of guilt and shame as significant agents of nonassertiveness and therefore affirmed that assertiveness, in addition to behavioral and cognitive components, consists of an emotional component. According to Rita and Rüdiger Ullrich, as a person assesses one’s own personal life philosophy and tries to become assertive, emotions are evoked, which leads to a process of cognitive interpretations and emotions that can in turn be an overwhelming emotional condition that affects one’s self-assessment, self-esteem, and personal significance (Peneva and Mavrodiev 2013).
Rationale for the Strategy or Intervention
Most of the assertive trainings utilize various cognitive behavioral interventions in order to assist people in eliminating maladaptive behaviors (e.g., decreasing anxiety) and gaining new responses (e.g., building social skills and being assertive; Speed et al. 2017). Behavioral skills aim to build social skills, to verbally and nonverbally express oneself, to decrease the level of social fear, and to increase the level of self-esteem (Speed et al. 2017). Consequently, AT utilizes behavioral interventions such as relaxation, role plays, modeling, reinforcement, homework, coaching, guided imagery, desensitization, videotape feedback, exposure, and behavioral rehearsals for communication skills such as making requests, using “I” statements, and practicing to maintain an appropriate eye contact, affect, volume, and posture (Lee et al. 2013; Peneva and Mavrodiev 2013; Speed et al. 2017). On the other hand, cognitive skills aim to restructure negative thoughts about the self and anxious thoughts that lead to unassertiveness and to gain control over the misconceptions about oneself and the world in order to improve self-confidence (Peneva and Mavrodiev 2013; Speed et al. 2017). Consequently, AT utilizes interventions that help objectify misperceptions, identify maladaptive patterns of thoughts (e.g., selective attention, illogical conclusions, overgeneralizations, exaggerations, and underestimation), and evaluate thoughts and behaviors (Peneva and Mavrodiev 2013).
Description of the Strategy or Intervention (Critics and Application)
Researchers have criticized AT for defining appropriateness based on the values of a White majority culture and consequently addressed the importance of assessing whether assertive skills are contextually and culturally appropriate for diverse groups or need modification (Lease 2018; Speed et al. 2017; Wood and Mallinckrodt 1990). Culture plays a role in defining what is appropriate and inappropriate. Ethnic minority groups such as Asian-American, Black, Latino, and Native American have different values, expectations, and definitions on assertiveness compared to the dominant culture (Wood and Mallinckrodt 1990). This means that a behavior can be viewed as appropriate and assertive in one culture and as inappropriate and aggressive or passive in another culture.
Wood and Mallinckrodt (1990) addressed that people from the ethnic minority groups may need to learn to be assertive in the dominant culture in order to effectively interact with the dominant culture and may also need to learn how to respond in an assertively appropriate way in their own cultures in order to cope in their daily lives. Hence, Wood and Mallinckrodt recommended that therapist to be culturally sensitive by exploring and discussing cultural differences in regard to the appropriateness of assertiveness depending on the clients’ sociocultural contexts and by helping clients to make their own choices instead of therapist implying or persuading clients to change or reject their own values. Wood and Mallinckrodt noted the importance of considering the possible consequences of being assertive for the minority groups such as experiencing discrimination, shame, and ostracism from their families and friends. Wood and Mallinckrodt also advised considering acculturation levels of the immigrant families.
In addition to the ethnic minority groups, Speed et al. (2017) suggested that women’s assertive behavior in their workplace may lead to negative consequences. Lease (2018) addressed the influence of the microsystem that consists of supervisors, colleagues, and supervisees with whom women directly interact on a daily basis and the influence of the macrosystem that consists of the cultural values, expectations, and norms that the society defines as appropriate. Consequently, Lease warned that if women are assertive, women can become norm violators and therefore be negatively affected. Therefore, it is imperative to broaden perspectives and to consider the clients’ socioecological system when utilizing assertiveness training.
Kate, a 58-year-old Chinese-American, is seeking individual therapy. Kate stated that she had a divorce 12 years ago and is now living with her 30-year-old daughter, Annie. Kate stated that she was happy and content at home and at her previous work until she started working at her current job 8 months ago. Kate stated that she has been feeling “down” for the last 4 months and has been “dragging” herself to go to work every day. Kate reported that she is a “horrible employee” and added that has recently started to think that she is a horrible mother as well. Kate concluded, “I am not good at anything.” Kate reported that her boss does not like her and “picks on” her. Kate stated that her boss always criticizes her for not doing her job on time. Kate reported that she is worried that she may get fired any time soon for being “an incompetent employee.” Kate stated that she cannot afford to lose her job.
During the assessment, Kate stated that she would like to talk to her boss and explain her situation, but Kate reported that she cannot do so. Kate’s cultural values and expectations for working with coworkers and communicating with superiors were further explored. While exploring the reason that Kate cannot talk to her boss, Kate reported that she does not want to “backstab” or “shame” her coworker/partner in the group project. Kate explained that she does not want her partner to get into trouble because of her. Kate also reported that she does not want to give excuses or “talk back” to her boss when her boss criticizes her for not doing her work on time. Kate explained that she cannot disrespect her boss. When detailed questions were asked in regard to Kate’s group project, Kate revealed that her partner has not been doing her part of the work and she has been doing her best to cover her partner’s role. Kate reported that she is not good enough and fast enough to complete and turn in the weekly reports on time to her boss. Kate reported that her boss questions and accuses her of not doing her work in a timely manner. When specific questions were asked in regard to Kate’s work context, Kate reported that her boss is a White man who is older than her. Kate also explained that her partner is one of the people who has the longest seniority while Kate she is the newest employee in her department.
Assertiveness was introduced, explained, and discussed with Kate. Cultural differences in defining appropriateness were explored and discussed, and Kate indicated her willingness to become more assertive at work. Kate’s cultural and the societal expectations were further considered and explored. Therapist and Kate adjusted the assertive skills accordingly. Kate’s worries/concerns that she will “backstab” her coworker and that she will be disrespectful to her boss were further explored, discussed, and differentiated based on the differences in the culture and the context. Kate learned relaxation techniques in order to cope with her feeling of anxiety whenever she tried to be assertive. Therapist and Kate explored, discussed, and modified the appropriateness of being assertive based on Kate’s own beliefs and values. The therapist modeled for Kate on how to be assertive by using “I” statements based on Kate’s level of comfortableness. Appropriate eye contact, voice volume, and physical posture were also discussed, modified, and rehearsed based on Kate’s culture. Kate engaged in role plays with the therapist wherein the therapist played the role of Kate and Kate played the role of being the boss and vice versa to practice being assertive. Kate did her homework by practicing the use of “I” statements and being assertive with her daughter Annie at home. Therapist performed guided imagery with Kate on Kate explaining to her boss about the work situation. In addition, Kate’s maladaptive thoughts of “I am a horrible employee,” “I am not good at anything,” “I am not good enough and fast enough,” and “I am an incompetent employee” were identified, evaluated, and challenged. Eventually, Kate became successful in being assertive by expressing the situation to her boss, and appropriate changes were made in the office. Kate also reported that she was able to be assertive with her coworker/partner in the group project as well. Kate reported that she is feeling high levels of self-confidence and satisfaction at work, at home, and in her daily life.
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