With a Court-referred or ‘coerced’ client, the issue is always motivation. At the beginning, it’s all external. You hope to build internal motivation to replace it. That starts with compliance — defined as adherence to a recommended course of treatment.

As in, the medication will help, if the patient takes it as directed. Therapy should benefit, provided the client sticks with it.

With ‘coerced’ clients, it’s easy to fall into a little game with the client striving to appear in compliance while covertly doing whatever he wants. We can waste a lot of valuable time playing that game.

Here are a few practical guidelines for achieving real compliance and avoiding game-playing with a Court-referred client.

1. Before you meet with a resistant client, always have a specific behavioral outcome in mind.

Wrong: “We’d like you to participate more in group.”

Right: “We want you to attend four sessions per week, selected from the following list (or, complete your treatment plan by this date; stop harassing the female clients; attend all activities; be on time, etc.)”

2. If the client is very resistant, don’t be afraid to involve other staff to increase your impact.

Wrong: The client meets with you one on one – again — to discuss issues.

Right: Assemble a mini ‘intervention team’ of 3 people to confront the client about specific noncompliance, and to propose steps for a quick turnaround.

3. Anticipate objections

Wrong: ”I think he feels threatened because he had an authoritarian father.”

Right: Imagine exactly what he might say when confronted – you’ve probably heard him say it before – and prepare an effective response.

4. Follow the rules of effective confrontation

Wrong: Get angry, make vague observations, ask too many questions, get into one-on-one conversations, give up before result is obtained.

Right: Express concern, provide specific examples, avoid argument, remain positive, persist through defenses.

5. Finish with a ‘yes or no’ decision

Wrong: “We’re hoping you agree to try to do better from now on.”

Right: Agree in writing to be on time for every group, with these consequences should you fail.

6. Use leverage

Wrong: “Don’t you realize that if you don’t stop drinking, you’ll go to jail? Or possibly die?”

Right: “It’s your right to refuse. However, if you do so, this is how we will be forced to respond.”

7. Be prepared for logistical objections

Wrong: “I didn’t know you had enrolled in school. That’s really poor timing.”

Right: “Here’s how you can get around that obstacle.”

 

Just for fun:

Rehab Soundbyte: Everything But Abstinence