The classic example of compliance based on fear of consequences is compulsory or mandated treatment. That’s often used as an alternative approach for lower-level offenders who have drug or alcohol problems. It’s been around long enough to yield a good foundation of outcome research.

Some advantages to this model:

More consistent attendance

Missing sessions results in consequences. Since no-shows are the bane of voluntary programs, this is a real plus.

Mandated testing

Drug testing provides at least some assurance of reduced substance use. The tests can be regular or random, in response to an incident or to suspicion of a return to use. Example: In Program Z, clients call in daily to find out if they are required to show up and submit a sample for a drug test.

Increased supervision

Such programs often put two sets of “eyes” on the offender– a counselor plus a Court monitor. This increases the chance of prompt intervention when problems emerge.

It’s easy to see why mandated programs appeal to the public, given their interest in reducing crime.

Now, some of the challenges:

Client resistance

Those compelled into treatment are often angry about it — the arrest itself, or the fines and penalties, or the inconvenience. They’re frequently in denial of a problem, unconvinced of the value of change, and resistant to participation.

Difficulty establishing therapeutic bond

See above. The classic therapeutic relationship is based on mutual trust. That’s not easy to establish with someone who equates treatment with punishment.

Extra expense

Programs such as a Drug Court can be costly to operate (a judge, courtroom staff, etc.) The client may be asked to bear some of the cost, along with fines and legal fees.

In practice, working with coerced or involuntary clients is different from treating the self-referred. Long-term outcomes may be comparable, but the counseling process requires some adaptation. (You can access our series on Leverage for more detail and some helpful techniques.)

“This isn’t not for everybody,” admitted a veteran case supervisor, acknowledging that some counselors  eventually throw up their hands and move on. “You have to be comfortable with resistance. You don’t see much motivation or insight. But I guess that’s why they have to be compelled in the first place, right? Still,” he continued, “you do see change. And if it saves somebody from an OD, or prevents a highway fatality, that’s all the justification I need.”

Fair enough. Next, we’ll look at treatment that seeks to motivate compliance not through negative consequences but through the use of reward and reinforcement.


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