The members of a treatment group are those who share a goal and state their desire to do something about making it happen. The members of a treatment group are those who share a goal and state their desire to do something about making it happen.
A solution-focused approach is a consumer model—that is, clients are the experts in stating what they are coming to see us about, and in deciding what they want to work towards. With this as a given, an important initial distinction is to determine if those coming to see us do so because they want to or because someone else wants them to. If we assume that the clients are the experts, what do we do about those who seem to be saying they are not customers for what we have to offer? What do we do with someone who says, “I do not need to be here, I do not want to be here, and I do not have a problem”?
We all have experienced the difference between working with those who come in with something they own and want to work on and those who do not want to be there and may even think the problem lies with those who sent them.
We have all, probably, at some point in our careers been grateful for having a self-motivated client or felt the dread that goes with anticipation of working with someone who does not want to be there.
We have all probably tried similar efforts with varied success with clients who are ordered to come to see us. These clients may be students ordered by the principal or the dean of discipline to talk to a counselor; probationers who have to be in treatment as a condition of their probation; couples who have been told to see a marriage counselor before the court will proceed with the request for a divorce; drivers who were convicted of driving while under the influence and ordered for substance abuse counseling; parents who have been ordered into therapy because of abuse and as a condition for the return of the children; supervisees who do not think they need supervision; or children dropped off for treatment by parents who say it is the children’s problem.
The distinction between voluntary and involuntary is basic to a consumer-oriented model and critical in the above situations. It is critical because we do not want to assume that clients are voluntary if, in fact, they are not. When this distinction is not made, the result is usually muddles of thinking, attempted solutions, and roles.
As de Shazer has stated, “Useful distinctions in conceptual schemes lead to explanatory or descriptive metaphors that have a clear form. Muddles, on the other hand, are created when useful distinctions that could be drawn are not …” (de Shazer, 1982, p. 71).
Some examples of the muddles and role confusion where the voluntary/ involuntary distinction is not drawn follow:
Therapist: What is your goal in coming here? (Goal frame)
Mr. Smith: Nothing. The judge ordered this treatment, but he does not understand that I do not need this.
Therapist: Mr. Smith, it seems to me that anyone with their second DUI conviction might think they have a drinking problem and should do something about it. (Attempting to convince the client of a need of a change)
Mr. Smith: Well, these convictions were a rigged deal from the git-go. I didn’t have that much to drink and I was driving fine. The police in this town have decided they are going to get me.
Therapist: But, Mr. Smith, with both of these convictions and your previous auto accidents, do you really believe all these professionals are wrong and just out to get you? Don’t you think you should take a look at this?
Mr. Smith: Whatever problems with drinking I have had, I have taken care of and I don’t need any help.
In the client’s view in this situation, the therapist has aligned with the decision of the court that he has a drinking problem he needs to work on. The therapist with an involuntary client has taken on the role of social control agent as an extension of the court. The therapist is attempting to make the involuntary client into a voluntary one through confrontation.
A colleague recently told us of her new position as a social worker. She was working within a state contract designed to keep the chronically mentally ill out of state hospitals and off the streets. She had a sizable caseload of individuals who had recently been discharged from the hospital. She complained that none of these clients seemed to be motivated for treatment or to want to make any changes.
When we asked what her clients would say they wanted from her (goal frame, for the other position), she said that most of her clients would probably say they wanted nothing or wanted her to secure their government assistance for them.
She had been doing considerable work for her clients in arranging housing and government assistance, but she was feeling burned out and discouraged that her clients seemed to want to do nothing for themselves around issues she saw as problematic.
In this situation, the client seems to be the State; it is the State that is the party with a goal. The State has decided that the cost of maintaining people in the hospital is prohibitive and has designed a program whereby someone—the social worker—is to maintain these people. The individuals in her caseload have seldom stated any goal that they would like to work on with her.
In this situation, she seemed to confuse who was the real client for her work—and that was the State.
There seem to be several roles for helpers and workers faced with involuntary clients. There is, for example, the reporter, the investigator, the monitor, and the therapist.
The reporter reports to someone in authority about some wrongdoing. The report often involves child abuse or neglect. The reporter is often a nonprofessional. Sometimes, the reporter may be you as the helping professional who hears the client talk about abuse or neglect that you are required to report by law. The reporter might be a neighbor or relative who witnesses or hears about the abuse. The reporter may be some medical professional who sees the signs of abuse or neglect.
The investigator is part of the state system that is required to investigate the situation and make an assessment of the wrongdoing.
The monitor or manager receives the case from the court, usually sets the requirements for change (requirements for return of children, conditions for probation, etc.), and monitors progress toward these requirements.
The therapist is the person who is assigned the role of facilitating solution construction with the client.
Keeping these roles separate and identified by using different people seems to be the optimal way of working with involuntary clients. You and the involuntary client can keep the roles and functions clear, avoiding the muddles of confusing these roles.
When involuntary clients can identify someone else as the investigator and someone else as the case manager, they can more easily identify you in the role of therapist as advocating their achieving their own goal. You are more cleanly in the neutral position of being able to identify a problem/solution of their choice.
When you are both therapist and manager, involuntary clients can have a harder time separating your role as social control agent who may take away their children or put them in jail from your role as a solution-focused therapist.
Ideally, you, as the therapist, want to be in a neutral, detached position whereby you can help clients identify what they may want. The therapist is not encumbered by other roles or demands.
How to work in the role of therapist with the involuntary client, is the focus of the following chapter.
QUESTION:
Don’t you think some of these clients are in denial and our responsibility is to break through the denial?
In our role as therapist, we take what people say at face value. If involuntary clients say they cannot think of anything they want to work on in therapy, we assume that from their point of view there is no problem or goal they want to use therapy for at this time. We do not interpret a client’s motivation or lack of it and we do not interpret what is “really” going on. Therefore, we do not try to convince clients that they have a problem.
This position is true in the role of therapist and does not mean that in other roles we might not make assessments beyond what the involuntary client says. Judges and protective service workers who are in the position of having to make some decision about the custody of children will look at physical evidence and make a decision about what is true about a parent in a given situation. In those other roles, judges and protective service workers make decisions, independent of the client’s view, of whether there is a problem or not. In the therapist’s role, however, we do not take on that responsibility or expert position.
Go through your list of involuntary clients, and ask yourself who among them is stating that she or he wants something from the therapy. Is the person who comes to your office stating she or he wants something out of coming in to see you? Are others involved in that case saying they want something from that person coming in to see you? If the answer to the first question is “no,” your client has no goal. If she or he says someone else is coercing her/him to come to therapy, you have an involuntary client.
You may find the next chapter useful in helping the involuntary client to identify goals and become a voluntary client.