Client Engagement in Psychological Therapeutic Practice

Abstract:

Engagement is a vital part of therapy with clients – getting them interested in interacting with the therapist rather than being a passive recipient of analysis and clarification from a counselling situation. In this paper from over 35 years of client (patient) contact I will examine some of the techniques of engagement using models and exercises to bring out a more interactive experience in therapy.

Introduction:

Although in psychological thought, interactionism, is a well accepted concept such as in the idea of nature and nurture as not two separate concepts, but instead as a dynamic interaction of basic elements that through, a too and fro motion, create a unique outcome that expresses itself through the very being of our character, so we become a thinking, feeling, behaving human being of complex mental states and outcomes. As engagement is seen as a viable learning instrument, in that through situations, we can internalize and process information about the world and ourselves, leading to change and a fusion of self examination and outward understanding to become a new unique person with a changed perspective.

Some clients (patients) have fixation and so reject or refuse to accept change as this would challenge their world view. Security of the ego comes from not accepting alternatives to their comfort zone even when they acknowledge this is leading to poor functioning in everyday situations. It is through active engagement that we (the therapist) can help the client not only make internal mental changes but by using action can fundamentally move forward to a better mental health position. Insight is still the main tool of any well versed therapist – change can only be seen when the client accepts and understands their present position in relation to the past, present and future tenses of personal perception.

The word – stance – is the place is which you start. It is the beginning of engagement the client and therapist must have a clear view of where the client feels they are in relation to interactionism of both other people in their social circle and strangers. How they react to conflict and the situations of others. Do they possess empathy, insight, self-intelligence and the ability to engage at all levels? Intelligence does not mean IQ, but in fact smartness about your world and life challenges. Poor street children in South America can be street smart but not considered high IQ achievers, yet can survive and make money in a very difficult situation of danger and poverty. So self-intelligence is how smart are you about yourself. In engagement we hope to increase this self-intelligence to a new level of understanding.

Engagement:

To clarify what we mean by engagement we should have a definition of its common parlance. Engagement means to interact through an action to affect the outcome of our understanding either in mental change or physical outcomes. If a footballer engages with his teammates in a 情緒輔導 planned outcome through each playing a particular strategy then the expectations of the team is to win the game – however through these interactions that both succeed and fail – change is inevitable to the next planned play or actions. So in a therapeutic situation this can also apply. As the therapist shows or explains a model of interactive behaviour or understanding – the client can strategize their own position in relation to others and situations that are familiar to them and in doing so can make re-evaluations as to their present position and the position they wish to achieve.

Engagement then means involving the client in active participation in the therapy session in order to effect change that will have positive outcomes and challenge fixated thinking through client acknowledgement of their current position being dysfunctional at best.

In Practice:

My personal preference is always to have a whiteboard in my counselling room. It is a godsend for making lists such as – pros and cons – when talking to a woman considering an abortion for example – the engagement being the client creates the list and actively is participating in making choices. In other instances the whiteboard can act as a catalyst for thought as in a brainstorming session.

In the first session with a client, a model can help the client to outwardly focus on something outside of their internal thought process and so engage the client away from their initial concerns. By focusing on the model the client can concentrate on the whiteboard illustration and so focus on the concept at hand. For example – the, I’m OK – Your OK model of interactionism with others (1. Transactional Analysis E. Berne 1960 – developed by Franklin Ernst 1971) the client at first watches the model being created on the whiteboard by the therapist talking through the concepts and their meanings, at some point the therapist marks a circle on the diagram showing his healthy position while being realistic – the client is then invited to stand and using the whiteboard pen – mark their own perceived position. This engagement enables the client to have a point of reference in which to recognize a need for change and their current fixation on where they are right now. Many clients comment on their past position and so engaging in reflective thought about how they could be back at a healthier outcome if they could move from depression or anxiety for example.

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