Your success as a therapist depends on the level of client engagement you can trigger. By client engagement, I mean your client’s level of interest in their own progress and change in therapy.
While client engagement is a natural part of many therapies, client inactivity or apathy can be the result of any number of factors. The following are some of the most common ways that client engagement can be threatened—and more importantly, how to overcome these obstacles for greater client investment.
Resistance from Symptoms
When clients have had long-term symptoms or problems that they would like remedied, it is easy to focus too much on symptom reduction and not enough on other areas that may be critical for improvement.
An example would be if an individual has been depressed for a very long time; he or she may want to feel “normal”, but may not be willing to tackle the life changes and actions that are necessary to actually make significant improvement. In a case like this, it may be beneficial for the client to realize that symptom reduction is not the only (or even primary) goal of treatment.
Failure to Communicate Realistic Goals
When clients have no idea what they are trying to accomplish in therapy, it can be impossible for them to feel invested in their progress. In order to engage your client, you need to help him or she identify realistic goals and then let your client know how he or she will benefit from reaching these goals before asking client input on what those goals should be.
For example: Say you see a client who reports feeling sad frequently and disliking his or her current social life. This client has come to you seeking relief from this constant sadness and the new way of interacting with others that makes him or her feel even sadder.
Without first seeking client input on what he or she wants, your client is left frustrated as you discuss how communication styles can affect mood (for example) for the next three sessions in a row.
After three weeks of feeling like it’s all about you, not only will clients’ interest in discussing their problems wane fast, but they may also view treatment as frustratingly remote from what they hoped would help them…
In contrast: When your client has input into his or her own goals, he or she feels empowered because he or she knows exactly what ‘success looks like at the end of the therapeutic trajectory.
Another factor to consider in client engagement is client autonomy. Client autonomy is basically the ability of a client to choose his or her own goals, and how to get there…
While deciding on client goals you might be tempted to encourage your client in settings that are too sweeping or vague for their current capacities in order to ‘get something done. The problem with this strategy is that clients may agree to goals they cannot yet feasibly realize- only for them not to be achieved as a result – which can begin another cycle of failure and abandonment. So it’s important to allow a client time and space, at the start of treatment, to decide on exactly what he or she does want; then once an initial goal has been settled on, help the client figure out how he can there; how to decide on client goals and what he can feasibly achieve at that point in time.
The client’s evolving capacity for self-knowledge is crucial here, but it will only develop along with his or her experience of actually making decisions. The client has to be able to gain a sense of their own abilities – as well as determine how far they are from reaching the goal – before they can realistically commit to any time frame. Your client needs time to weigh up things like current capabilities, resources, aspirations, and obstacles; as well as have space for uncertainty about where they stand (Kohlenberg et al., 1991). This means you should give your client enough leeway during sessions and between sessions so that they don’t feel pressured into setting unrealistic goals.
For more information on this topic, you can also refer to my article on how to motivate clients in therapy.