6 Reasons Client Engagement May Be Difficult
By Amy Spriggs, Multisystemic TherapistMultisystemic Therapy (MST) is an evidenced based program that treats juvenile delinquent and violent behaviors by addressing interventions based on community and relational characteristics in the youth’s environment. MST provides support and guidance to caregivers and youth to help reduce delinquent behaviors while teaching sustainable interventions. Part of the MST model at Touchstone Health Services is to engage in booster training to address common issues therapists encounter in MST. This past quarter, the topic of the booster addressed engagement of client and families to MST services and the impact it has on successful completions. Below is an overview of what was discussed at the booster as it provided clarity and interventions to help therapists assess, address, and improve engagement with clients and families.
I once had a supervisor tell me “there’s at least one thing about every client you can find to love”. Being a service worker can be challenging, overwhelming, and many times exhausting, making it difficult to follow this advice. I have little doubt that at some point in their job, service workers engage in power struggles with clients, take big sighs when that client calls or comes in, or feels burnt out having to be creative in engaging with clients. I also believe, that many times the client is also feeling challenged, overwhelmed and even more exhausted. It can take more energy talking about their problems than for someone else to try and help them in their problems.
So why is engagement so difficult when both client and service worker are meeting for the same underlying reasons? There could be many reasons engagement with a client is more difficult than actually working on the problems. This post discusses some of those reasons and how to move through those barriers to help improve engagement and recovery.
Feelings of Overwhelm and Hopelessness
A client/family is coming to treatment because they often feel overwhelmed and hopeless in resolving their own issues. You are most likely meeting them when they are at their worst. It may also be that you are their 8th service provider in a year and they’re thinking “I have to tell my story again?”. You, on the other hand, may be exposed to similar issues with different families, telling yourself “I’ve seen this before, I know exactly what needs to be done”. Although it would be nice if there was a “one size fits all” approach to problems, it is unlikely, as each client’s experience differs in severity, frequency, duration, culturally, cognitively, etc.
In order to better engage with clients, it is helpful to validate that they are coming to you because they feel overwhelmed and at times hopeless. It is important to validate that you will be there to help support them, even if that means doing things that have been done in the past, trying new techniques, and meeting each client where they are at. Many times service providers have to help client’s move through these feelings to even understand and assess the problems at hand.
Defense Walls
Imagine having to go through life with a brick wall built around you to help protect, filter, and remain safe from untrustworthy people, unsafe environments, and broken hearts. Many of our clients have had to experience this from day one. Therefore, putting their trust into a service worker can be more difficult than admitting they need help. Trust is not deserved, it is earned. Small ways to build trust go a long way. To start…follow through. Call when you say you’re going to call, follow up with any promises that you made, check in regularly even if it is for a couple of minutes. These are ways to not only prove that you are a trustworthy person, but to give each client a sense of support, understanding, and care. Second, validate to each client that it’s okay to have these walls up as they are survival techniques. Encourage them that things can get better if they learn to open up. Teach them what trust looks and feels like by leading in example, many times they don’t even know.
Defensive walls are not always noticeable, but when you’re feeling stuck with engaging a client, it may be helpful to ask yourself “what has this person’s experiences been like in the past? Could it be that those experiences are making it difficult to trust and open up to me?”.
Busy Schedules
Let’s face it, you’re busy, I’m busy, everyone’s busy. Meeting with service workers takes up a lot of time and energy, and is usually on the bottom of the list when it comes to having to provide food on the table, keep a structured house, and having fun. The more someone gets to know you and work with you, the more likely they are to return. Ways to improve contact to help build engagement include, meeting for short periods at a time, meeting them where they are at (work, home, the bus, etc), asking the best way to reach them (email, phone, face to face), and presenting as hopeful and positive upon meeting them. Getting time in the door can help to have the conversations about investment in treatment and priorities at a later time. Starting out with those conversations may only push someone further away and reduce engagement.
Low skill sets
You might be noticing that clients/families aren’t following through with identified resources, techniques, and skills that you are teaching them. Although what you are teaching might not be wrong, it could be that these clients don’t have the skill set to implement what you are teaching. One important aspect of each case is to meet a client where he/she is. It might be a good idea to assess if they are capable of implementing the skills. Questions to ask might include, “do you feel comfortable doing this?” “Do you anticipate any barriers doing these things?” or using scaling methods to assess if they are apt to using these skills. If you find that they are not comfortable or capable of implementing these techniques, the use of role play, identifying predicted barriers, or modifying the skills can be useful to improve implementation. You will find that engagement will improve if a client can believe and see progress through empowerment and skill development.
Cultural Incompetence
Low engagement can result in lack of cultural competence with each client. Awareness and understanding of differences can be helpful in moving through power struggles, low alignment, and low engagement. Many times when you ask a client “what are your cultural preferences?” they stare at you with a blank look, like “huh?”. In order to move around this barrier and to gain a more complete perspective of the client and problem, it is helpful to ask the right questions. The Cultural Formulation Interview by the American Psychiatric Association is a helpful tool in gaining cultural perspectives on the problems at hand. It can give you and the client more understanding and perspective of their problems. Engagement may improve when you are more aware of the cultural needs to incorporate into your treatment plans.
Burn Out/Transference
Lastly, low engagement may also come from you. It is important to regularly assess and check in with your own burnout, feeling of overwhelming, and transference. If you find that these are impacting engagement with clients, talk with your supervisor or colleagues. The best part of working as a team is you have a team to help support you. The use of self-care activities is important in maintaining balanced lives. Remember when you’re on vacation, you’re completely on vacation (mind, body, and spirit). Give yourself time to recharge!
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