Typically a person seeks treatment because of external motivators: the courts, the schools, the parents, the angry spouse. Think about it…a person is going to tell me that something is wrong with me and I don’t think that there is. Yeah, sign me up for that! I’m calling for an appointment tomorrow. And in addition to someone telling that person that they have a problem, I’m telling them that they have a problem with alcohol or marijuana because in most court-ordered cases, drunk-driving or possession charges are one of those commonly used substances.
How can I tell a person that they have a problem with alcohol, a substance that is legal and that is weaved into the fabric of our adult, and as I am told by most teenagers, adolescent social life. Not to mention, there is the decriminalization of marijuana taking place this very moment. How do I tell them they have a problem? I don’t.
What I find helpful in cases that it is apparently obvious the person does not want to be there is acknowledging it. However, you want to also set clear and concise boundaries as a professional. That means accountability.
For example, I mention that a no call/no show or late cancellation (less than 24 hours) of an appointment is subject to a charge and I let them know how much it will cost them. Besides that, it is printed on the appointment card that I give the client. I also, have a set time that I let the clients know I will not allow them into group. That is also considered a no show and subjected to the same charges.
I learned early in my career in dealing with clients’ resistance that I will only work as hard as the client, not harder. So doing something that is holding them accountable is helping because this may not have ever been expected of them before. It also conveys the message that this is going to be a mutually respectable relationship that I think you are able to manage. They eventually will come back and I have a discussion about seeking treatment.
Whether it is court-ordered or voluntary it is a professional service that I provide. I’ll ask them, would your physician or dentist see you if you fail to show up and didn’t pay for the no show? Probably not? Well, it’s the same thing. I’m not doing charity work is what I tell other therapists that seem to struggle with this strategy of charging no show fees. They too eventually agree and find that it helps them in the long-run because you’ll grow less resentful of your clients. Resentment is not a healthy feeling when you’re working as a helping professional. It lends to burnout quickly.
Another strategy that I use to form a therapeutic alliance when a person is being assessed for admission into treatment is the following two questions. They are helpful at the beginning of treatment or when I get a new participant in group:
1) What is bringing you into treatment? (What’s the reason for coming to group?)
2 )What are you expecting from treatment (group)? If the client is coming in voluntarily, this question is more appropriate. Or, What are OTHERS expecting from you as you come to treatment (group). If the client is coming involuntarily, it lets them know, “I know you you’re not coming of your own will.”
Resistance is a double-edged sword. You may think it is unnecessary and unyielding. But just like exercise and resistance training, the work with resistance is building strength to progress and get results. Sort of reminds me of when I use ankle-weights in jogging long-distance and the next time I go for a fast run, it feels less difficult. It prepared me. I find after managing a resistant client through completion of treatment as preparation. The next time I’m prepared because I’m trained in this area. I’ve worked up enough strength to respond in a helpful and effective manner.
I’m not saying it’s easy but if you’re going to work in substance abuse or any type of behavioral health care clinic for that matter, you may want to prepare yourself. So, then when you get a “working-outside-the-home-mother” who is suffering from anxiety and comes in voluntarily, the “resistance training” you had makes working with her a walk in the park without the ankle weights.
Karen Bates is a counselor, addiction specialist, and a doctoral student at Walden University.