Question

what are the strategies for developing goals with involuntary clients?

Answer 1

Involuntary clients or mandated clients are those who come for therapy under the coercion of a legal body or pressure from significant others, family members and institutions such as child protective services. Engagement is defined as the process through which a client begins to actively participate in therapy. It is also considered the stage of the therapeutic relationship that assists in having positive treatment outcomes. The engagement process involves developing agreement on the goals and tasks of treatment through the collaboration of the therapist and the client. Based on literature and practice experience, it is well documented that engagement for involuntary clients is often a different and more difficult process than engagement with voluntary clients due to the coercion of the legal system or significant others.

The therapist can choose to employ certain strategies that encourage and assist in the engagement process with the involuntary clients. These strategies allow the clients to develop a trusting relationship with the therapist, and the therapist to develop a stronger rapport with the clients. The following strategies may be adopted:

1. Client-Centered Approach

The client-centered approach is a framework for working with clients that focuses primarily on the client with respect to his or her treatment responsibility. Carl Rogers identified four tenets of a client-centered approach, these include: " viewing the client as choosing to grow and develop," " the emotional, feeling aspects of a client's experience, " the client's experience in the present, " the therapeutic relationship..as a potential situation for growth, where the client learns to understand himself". This approach stresses on goals that encourage the congruence of the client's observations and thoughts about behavior as well as focus on the client's strengths.

2. Stages of Change

This model was introduced by Prochaska and Diclemente (1982), it assists therapists in identifying the stages a client in treatment will go through during the changing process. The five changes that the client will experience are precontemplation, contemplation, preparation, action and maintenance. In the precontemplation stage, clients have little intention to make any changes in their life. In the contemplation stage, they acknowledge that the problem exists but have not made a commitment to change. The preparation and action stages involve clients preparing to and actively working towards the change. Finally, in the maintenance stage, the clients are working to maintain the change that they had made. In recent years, another stage of change, relapse was added in order to prepare clients and therapists for the possibility of a relapse into the old harmful behaviors. If this occurs then clients are guided back into the maintenance stage. These stages of change help the therapist to tailor treatment to where the client is and inturn further engage the client in the treatment process.

3. Stages of Group Development

The stages of group development serve as indicators for the progression of the clients through the group therapy process. These stages of group process area pre-group planning and preparation stage, the beginning stage, the work phase and the ending phase. Together, these stages identify the natural progression of a group.

4. Relational Approaches

The primary therapeutic concepts of relational cultural theory indicates that as people develop and grow, the connections and relationships that are formed become the foundation of development. This concept focuses on the idea of "we" rather than "I". Mutual empathy between the therapist and the client forms the basis of engagement between the client and the therapist.

However, there are major challenges in process of engagement. Resistance and reluctance are seen as major challenges with treatment non-compliance and non-completion. Reluctance is associated with clients preferring to not be around a therapist or talk about their lives with a therapist. Resistance on other hand is described as hostility towards change. Mistrust is another dimension faced especially from clients who have faced consequences at the hands of any authority figures.

Engagement for involuntary clients can be improved by motivational interviewing, a strengths perspective and the group process combined with an understanding of the stages of change. Motivational interviewing improves engagement through a client- centred approach that insists in motivation. A strength-based approach focuses on healthy choices and behaviours and identifying clients particular strengths to aid in engagement. Behavoirs and strengths serve as protective factors for clients and assist in fostering cooperation, responsivity and engagement. The stages of change and the stages of group process begin with clients being unaware of the need for change and the purpose of the group. Relational Approaches with involuntary clients work primarily with involuntary women due to their tendency to gravitate towards the meaningfulness and importance of relationships. The major role of the therapist here is to develop empathy for the client regardless of their involuntary status. This focuses on resolving past relationships and forming healing connections by reconnecting.

In conclusion, many involuntary clients are offenders and are unable to advocate for themselves on a macro policy level, hence it is the responsibility of the mental health practitioners, social workers, and other professionals to take up this advocacy.