Despite our best efforts, some clients are reluctant to engage in the therapeutic process. Just as the reasons for pursuing psychological therapy are varied, so, too, are the reasons individuals are reticent to make full use of counseling. How can we address this challenge and help clients move towards successful outcomes?
Listen to Your Own AdviceReluctant clients are often labeled “oppositional,” “noncompliant,” “unmotivated,” or “intractable.” They are called “resistant.”
While reluctant clients can be challenging, these labels place the blame squarely on these individuals. It’s their fault. They are doing something wrong, or, at least, not doing something right.
This is a dynamic or frame of mind that can irreparably damage the therapeutic alliance. In recent years, and as a result of continued research, the definition and perception of “reluctant” has begun to change. As Dr. Joshua Watson, assistant professor of Counselor Education at Mississippi State University, writes:
For many, the counseling process might seem quite daunting. Unsure of what to expect, clients are asked to enter into a working relationship built on trust and intimacy with an individual they have just met for the first time. They must be ready to explore personal issues they might not have shared previously with even their closest friends and family. For other clients, the choice to seek counseling help might not have been their own… Given the unique dimensions of the counseling process, it is only natural that some clients feel a sense of resistance toward the counseling process.
Reluctance is not only natural and normal, it can help strengthen therapeutic alliances and outcomes.
Clifton Mitchell, professor at East Tennessee State University, has this advice:
We tell our clients things like, “You can’t change other people; you can only change yourself.” Then we go into a session trying to change our clients. This is hypocritical. I teach, “you can’t change your clients. You can only change how you interact with your clients and hope that change results.”
According to Dr. Mitchell, removing blame is essential. “[I]f what you’re doing with the client is not working, then do something else because your interaction is creating resistance. The beauty of viewing resistance from a social interaction theory is we’re empowering ourselves to do something about it.”
The key point here is that reluctance is not your “fault” either, but it is your responsibility to address during the client's psychological therapy. Let’s take blame away and empower ourselves to act. How?
Using Outcome Measurement Tools to Address Client ReluctanceThe Partners for Change Outcome Management System (PCOMS) provides an effective way to address reluctance via accurately identifying those who are not benefiting and more importantly, to address lack of progress in a positive way. At the forefront of PCOMS is client empowerment; there is no blame. There is a focus on proactively working together to find new ways forward.
PCOMS utilizes the Outcome Rating and Session Rating, or ORS and SRS, scales during each session to ensure clients are involved in the therapeutic process and that therapists/clients have access to objective data on progress (not process).
A key benefit of the ORS and SRS is that they are designed to be a “light touch.” They take only minutes to administer and integrate into sessions.
PCOMS becomes a routine that involves clients in their own treatment and progress at every step. It also builds greater transparency into the process; when clients can leverage these tools to start conversations and make decisions, it can reduce reluctance and effectively engage people in therapy.
How Does PCOMS Work?
Using PCOMS, you start each session with the ORS, which consists of four lines for the following domains: individual, interpersonal, social, and overall. Each line is 10 centimeters long. It is designed to be quick and easy: clients simply place a mark on each line corresponding with how they perceive to be functioning in that area. You add the score (using Better Outcomes Now technology, you can do so automatically). The maximum score is 40, and lower scores indicate greater areas of distress or challenge.
The goal of the ORS is to see how the client is doing in the major areas of life; it represents their lived experiences and helps identify the reasons for seeking treatment. It is a means of tracking progress while focusing treatment. When scores increase in subsequent sessions, it is important to frame it as a result of the client’s efforts.
The SRS is also a four-item scale that is delivered toward the end of the session. This feedback tool encourages clients to express their opinions about the therapeutic relationship and the counseling process.
One way to explain it to clients is that the SRS is like taking the temperature of the session. Was it too hot? Too cold? Do I need to change the thermostat to ensure you more comfortable next time? For those identifying problems in the alliance, it is especially imperative to discuss what can be one to improve therapy.
Rather than thinking of reluctant clients as “noncompliant” or “oppositional,” or “resistant,” take a lack of benefit as an opportunity to reflect on your own practices and processes. Integrating PCOMS, and specifically the ORS and SRS scales, is a vital piece of the puzzle. Obtain the data you need to guide treatment decisions and empower clients to take ownership of their outcomes.
Better Outcomes Now is the web application for PCOMS; integrating this technology into your practice can be seamless - and powerful.