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 of a counseling situation. In this article from over 35 years of client (patient) contact, I will examine some of the engagement techniques using models and exercises to achieve a more interactive experience in therapy.
Introduction:
Although in psychological thought, interactionism is a well-accepted concept, as in the idea of nature and nurture, not as two separate concepts, but as a dynamic interaction of basic elements that, through back and forth movement, create a single result that is expressed through the very being of our character, so we become a human being who thinks, feels and behaves with mental states and complex results. How engagement is seen as a viable learning instrument, in which through situations, we can internalize and process information about the world and ourselves, leading to change and a fusion of self-examination and external understanding to become a new unique person with a different perspective.
Some clients (patients) are fixated and therefore reject or refuse to accept change as it would challenge their world view. Ego security comes from not accepting alternatives to their comfort zone, even when they recognize that this leads 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 through the use of action we can fundamentally move towards a better mental health position. Perception remains the main tool of any well-versed therapist: change can only be seen when the client accepts and understands her current position in relation to the past, present, and future tenses of personal perception.
The word -posture- is the place where you start. It is the beginning of the compromise: the client and the therapist must have a clear vision of where the client feels in relation to the interactionism of other people in their social circle and strangers. How they react to the conflicts and situations of others. Do they possess empathy, insight, self-intelligence, and the ability to participate at all levels? Intelligence does not mean IQ, but intelligence about your world and life’s challenges. Poor street children in South America may be street smart but not considered high IQ, but they can survive and earn money in a very difficult situation of danger and poverty. So self intelligence is how smart you are about yourself. In engagement we hope to increase this self-intelligence to a new level of understanding.
Commitment:
To clarify what we mean by commitment we should have a definition of its common language. Engagement means interacting through action to affect the outcome of our understanding, be it mental change or physical results. If a footballer engages with his teammates in a planned outcome through each playing a particular strategy, then the team’s expectation is to win the game; however, through these interactions that both succeed and fail, change is inevitable for the next play or planned actions. So in a therapeutic situation this can also apply. As the therapist demonstrates or explains a pattern of interactive behavior or understanding, the client may strategize his own position in relation to others and familiar situations, and in doing so may make reassessments as to his current position and the position you are in. I wish to achieve.
Engagement then means involving the client in active participation in the therapy session to bring about change that will have positive results and challenge fixed thinking through the client’s acknowledgment that their current position is dysfunctional at best.
In practice:
My personal preference is always to have a whiteboard in my counseling room. It’s a godsend to make lists like – pros and cons – when talking to a woman considering an abortion, for example – the commitment is that the client creates the list and actively participates in the decision making. In other cases, the whiteboard can act as a catalyst for thought, such as in a brainstorming session.
In the first session with a client, a model can help the client focus externally on something outside of their internal thought process and thus move the client away from their initial concerns. By focusing on the model, the client can concentrate on the illustration on the whiteboard, thus focusing on the concept at hand. For example, the model of interactionism with others I’m fine – Your fine (1. Transactional analysis E. Berne 1960 – developed by Franklin Ernst 1971) the client at first watches as the therapist creates the model on the blackboard while speaking. the concepts and their meanings, at some point the therapist marks a circle on the diagram that shows his healthy position while being realistic; The client is then invited to stand and, using the whiteboard marker, marks the client’s own perceived position. This commitment allows the client to have a reference point in which to recognize a need for change and their current fixation on where they are at this moment. Many clients comment on their previous position and thus engage in reflective thinking about how they might return to a healthier outcome if they could overcome depression or anxiety, for example.
Another example of participation is in visualization techniques. Here the client is shown several illustrations that have no immediate obvious story, (ambiguous) then the client is asked to comment on the meaning of each image. This commitment helps the client to project his own situation onto the illustrations. (Usually only 10 illustrations are used for a one hour session.) The therapist then tells the client what he saw most of the people and how their responses differed; this then led to insight into how they personally perceived the world. This engaging process helps many clients see their biases and fixed thoughts about other people from their own perspective. (In projection work there is no right or wrong answer.) Another projection technique for interactionism is visualization storytelling: here the client closes their eyes and listens to a story told by the therapist, at some point the client is asked to take over the story and make it their own . The therapist’s opening story contains visual, emotional, and feeling elements (both physical and emotional) to help the client experience the narrative. From this type of engagement, the client experiences empathic understanding as they attempt to participate in their own ongoing version. Often this participatory technique generates interesting results, such as the prevalence of recognized fears, prejudices and perceptions. One patient reported on hearing a story about a lake that she actually has a fear of water (aquaphobia) that had never come up in therapy. A frequently used technique is to introduce a familiar stranger at the end of the story for the client to take over. Many clients recognize this person as someone they know and is an important figure in their lives (significant other), again often not reported in therapy as it focuses primarily on an inward looking perspective. The compromise allowed the therapist to examine why this couple was so important to the client’s psychology.
In client engagement in therapy, both client and therapist can interact to create understanding and a reference point from which to initiate the movement for mental, physical, and emotional well-being. Training for most counselors is short and often poorly conducted, they are given the basics of theory and the technique of listening, clarifying, and analyzing. Although the last one, analysis, is often a scary prospect for most new counselors, as they fear making a comment that might be a self-projection of their own biases. As in the Christian counselor who got angry when a patient wanted to divorce his wife to marry another woman. Therefore, most counselors fear committing themselves as a risk of self-exposure to their own mental problems (and many do) and this is why Cognitive Behavioral Therapy is not popular with many counselors because it carries a degree of challenge for counselors. faulty thinking or maladaptive perceptions of clients. . (Although CBT is very limited in its overall effectiveness, despite its popularity in psychiatry.)
Engagement is an educational approach to therapy in which by illustrating theory models, the client can make use of the simple focus that a model can provide to understand a complex emotional feeling. It is this simplicity that engages the client in psychological understanding and change. By interacting with the therapist, by standing up and modeling, by taking charge of the narrative, the client engages in changing the real world through action. A real life action has much more weight in the effectiveness of the change than a thoughtful vision. In other words, I may know it, but when I do, I understand it.
One of my favorite models is the – I & Me – concept of the secret, private self and the socially created SELF. 2. (SF Myler 2003) As with all simple models, the client instantly understands the process and engages in an active discussion about who they have created for other people and who they really are on the inside. The person (me) that you keep hidden and in check and the ME that if you asked five of their friends to describe it, they would refer to their social self (ME) as the real person they think they are. Of course, over time we can become the same SELF that we created, but only by incorporating our secret self. When drawn and explained on a whiteboard, many clients engage in a discussion about how they keep themselves in check when in the company of others. They can open up to allow the therapist a glimpse into the murky world of the self that we are all so good at keeping hidden.
Summer Commitment:
Most of these engagement techniques I developed over many years of client interaction and successful outcomes in difficult cases (3. SF Myler 2017). The therapist must show courage and the ability to engage without barriers with his personal fears. It takes a certain amount of confidence and showmanship to successfully engage in engagement and it’s not for the faint of heart. Reciprocity is feared by most therapists who have been told in training not to expose their own feelings and views, yet it is through reciprocity that clients can build trust in a therapist who is willing to show their own position in models to help the customer to realize. It is okay to expose herself emotionally if the therapist has the confidence to show her own emotional well-being or vulnerability. Engagement is an interactive technique that helps clients actively participate in their own therapy and take responsibility for the choices they make in life, both hidden and observed.
References:
1. Ernst F. (1971) The OK Corral – TAJ pages 231-240 vol. 1 Chapter 4
2. Myler SF (2003) I & ME – model of the self. (Unpublished)
3. Myler SF (2017) Client notes: from private practice.