When working to help people change, I wrote 20 years ago about the “What, Why, How, Where and When” to Develop the Treatment Contract. In any therapy or helping endeavor, the first priority is to develop a truly participatory treatment plan, one most likely to succeed in being followed.
Tip 1
What is the client a customer for in therapy? Developing the treatment contract.
Clinicians are often more focused on what they think the client needs, than on what the client wants. It isn’t that we shouldn’t do an assessment and identify what the client needs to achieve wellness and recovery. It is just that if we start on what you think they need versus starting with what they are a customer for, you will spend more time cajoling, nagging, shaming and trying to convince the “resistant” client into seeing things your way.
What
First, be clear what the client really wants, not what they’ve been told they need; not what you (perhaps correctly) feel they need to change; and not what they think the clinician wants to hear.
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What is the agreed upon treatment contract collaboratively arrived at?
Why
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Why is it now that the client is wanting help; and not a year, a month, a day ago?
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Did someone threaten a loss of job, or loss of children or a relationship so that what they want is to keep their job, children or relationship, not wellness and recovery? Have I dug deep enough?
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Determining what the client wants means going deeper beneath the surface of a rote presenting complaint like “depression” or “I’m sick and tired of being sick and tired.” Are they just saying what they think you want to hear?
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Or has life and functioning gotten so painful and onerous that they will do whatever it takes to feel less depressed, anxious, or compulsively addicted?
Tip 2
If the client has their own clear ideas about how they will get what they want, start with their plan and then hold them accountable to its success or not.
How
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How does the client plan to achieve his/her goal?
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Do they have their own tenacious treatment plan, which blinds them to your plan?
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If you have laid out your plan and tried to attract them into seeing the wisdom of that course of action, but the client disagrees, start with their plan.
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Hold them accountable to its success. If it works, great, you are happy to be wrong so long as the outcomes are good. But if it doesn’t work, you have a client more willing to listen to other ideas and recommendations as they got to try it their way first.
Tip 3
Assess how determined the client is on where and when they want to get treatment.
Where are they willing to receive treatment? Do they have tenacious ideas about the level of care and type of program?
Where
The client may have strong reasons for wanting outpatient treatment versus more intensive levels of care (I have childcare responsibilities; work obligations; financial constraints etc.) Unless there is imminent danger of harm to self or others, treatment starts where the client wants it to start.
When
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When are they willing to receive treatment?
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Are they ambivalent about when to start getting help?
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Are they strongly committed to doing whatever it takes for wellness?
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Do they have tenacious ideas about when to start and the length of treatment?
Example:
Family may well have brought in the client to get help, but what the person states is that he/she wants “to be left alone.” The treatment contract can genuinely be based on this specific “want.”
Client: “I want to be left alone.” Therapist: “I will help you to be left alone.”
Take the client at his/her word. You can then discuss:
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Why people are not leaving the client alone; what is the client doing to attract attention and to have people telling them what to do?
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How does he/she plan to think, feel or act differently to get people to leave him/her alone;
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Where and when do they plan to do this to achieve their goal of being left alone?
This is person-centered work.
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Authored by Dr. David Mee-Lee, “Tips & Topics” is a monthly blog covering three sections: Savvy, Skills and Soul, with additional sections varying from month to month. Topics include Stump the Shrink, Success Stories and Shameless Selling.