In Behavioral Health, SAPTA, Tools, Trainings

Enhancing Outcomes for Reluctant Clients w/ Challenging Issues

It can be difficult to define what a reluctant client is when it comes to psychotherapy. The majority of clients seek therapy because they have known issues and they are ready to make changes and improve their lives. According to the Journal of Psychology and Clinical Psychiatry a reluctant client is defined as a person’s unwillingness or hesitancy to participate fully in the helping process because of the reluctance to change1. Some of the reasons a client may be reluctant is because they have been mandated to attend therapy by the court for things such drug abuse, child abuse, and violence. Other clients may have been coerced by a loved one such as a spouse who tells them they need to go to therapy to keep the family intact. Whatever the reason may be, it is important to learn ways to foster an environment that will allow the client to become invested in their therapy sessions.

When working with reluctant clients it can be difficult to establish an effective relationship. In order to establish a relationship and gain the clients trust there are some well-researched techniques to get them to open up. Two of the most proven techniques are presupposition and neurolinguistics. According to Joshua Uebergang, who teaches communication techniques, neurolinguistics look at how an individual’s thoughts, feelings, and actions produce the results they get right now. Presupposition gives the therapist the foundation to understand how someone perceives the world and presents an opportunity for changing behaviors2. Counseling Today discusses using these techniques for managing resistant clients and states that their job is the understand the client’s world to the degrees that they see the behavior for what it is and not as resistance3

According to Saul Singer, a marriage and family therapist who teaches continuing education classes on this topic, it is important to utilize these methods to get patients involved and invested in their therapy. Clients who do not want to be in therapy often participate until they have received the outcome they want. If a client is only going to therapy because a judge ordered them to, they may not be working on goals that will help them in the long run. Therapists need to utilize presupposition and neurolinguistics to communicate with clients, gain their trust, and begin to peel back the layers of their issues. An article written by Jennifer Lipack discusses that people in court-mandated treatment often feel that it is a waste of time, and he or she may resent the time spent in a counseling session, which interferes with the person’s daily routine4.

Communication is an important aspect of working with reluctant clients. It is important to ask open-ended questions, affirm and support, listen reflectively, summarize and elicit self-motivational statements5. The use of neurolinguistics and presupposition revolves around how therapists ask questions and word statements. For example, asking a question that says, “when you do this…” instead of “if you do this….” makes the subject seem more tangible in the client’s mind.

These techniques can also help therapists understand the hierarchy of client’s needs. Often, clients have multiple issues and it can be difficult to peel back all the layers and discover what the client really requires. In cases like this, therapists will often utilize the miracle question. The miracle question, created by Steve de Shazer, one of the pioneers of solution-focused therapy in 1988, is a creative way to devise good therapeutic goals6. The miracle question basically asks people to imagine, however fantastical it may be in their particular circumstances, that their life has already dramatically changed for the better. This will allow the therapist to get the client to open up to them along with discovering what is really important to the client.

Today, we see more and more reluctant people going to therapists. The use of neurolinguistics, presupposition, and various communication skills is an invaluable tool. Specific techniques can get clients to trust their therapists, understand that they have some things that need to be worked on, and to invest in themselves on working towards set goals.

For additional information on this topic and other behavioral health issues check out our learning lab and Resources section as well as future training’s from CASAT

 

This article was developed by Karen Bowers at CASAT, feel free to use this information. A link to our site and attribution would be much appreciated.

References

  1. Ucar, S. (2017). Reluctance and Resistance: Challenges to Change İn Psychotherapy. Journal of Psychology and Clinical Psychiatry,7(6). Retrieved from http://medcraveonline.com/JPCPY/JPCPY-07-00464.pdf
  2. Uebergang, J. (2015, February 03). Neuro-Linguistic Programming Presuppositions – 12 Rules to Change Your Reality. Retrieved from https://www.towerofpower.com.au/nlp-presuppositions
  3. Shallcross, L. (2010, February 14). Managing Resistant Clients. Counseling Today. doi:http://ct.counseling.org/2010/02/managing-resistant-clients/
  4. Lipack, J. (2012, July 11). When People Are Mandated to Treatment. Retrieved from https://www.goodtherapy.org/blog/mandated-substance-abuse-treatment-0711124
  5. Shallcross, L. (2010). Success stories with challenging clients. Counseling Today. Retrieved from http://ct.counseling.org/2010/10/success-stories-with-challenging-clients/
  6. Tyrrell, M. (n.d.). How to Use the Miracle Question With Your Therapy Clients: 3 Examples. Retrieved from https://www.unk.com/blog/miracle-question-examples/
  7. Interview with Saul Singer, MFT, LCADC. Continuing education instructor at CASAT, interview date (February 5, 2018).

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