August 1st, 2011

Therapy with Coerced and Reluctant Clients

Book tackles issue of reluctant clients

“Therapy with Coerced and
Reluctant Clients”
By Stanley L. Brodsky
American Psychological Association
Washington, D.C., 2011

By James K. Luiselli, Ed.D., ABPP,
BCBA-D

How would you describe coerced and reluctant clients? According to psychologist Stanley L. Brodsky, they include children, adolescents and adults who are forced into therapy by schools, employers and the courts. Similarly, patients in psychiatric hospitals may have mandated treatment as a prerequisite to their release. Whatever the conditions, people entering a therapeutic relationship involuntarily pose many challenges for mental health professionals.

Brodsky is a recognized expert in forensic psychology, devoting many years to evaluating and treating prisoners as well as individuals navigating different stages of the criminal justice system. As such, he can and does advise convincingly about coercion and reluctance within psychotherapy. Early in the book he distinguishes between oppositional clients, those reticent about therapy, from coerced clients, who enter therapy “through procedures, forces and events outside their control.” This distinction implicates a person’s motivation as central to understanding and dealing with resistance and negative attitudes towards treatment.

The book lays a solid foundation for comprehending coercive influences in the context of psychotherapy. Not surprisingly, there is a good deal of empirical research on the topic, which Brodsky presents in sufficient detail. He also opines about the effectiveness of coerced treatment with different clinical populations. Readers will find that the author doesn’t waver or write equivocally about what he thinks works best and what should be avoided.

One of Brodsky’s central tenets is that coercion and reluctance must also be attributed to therapists themselves. He provides illustrations of shy, anxious, angry and fearful therapists, noting their characteristics and the impact on conducting therapy with difficult clients. Therapist styles and interactions, in turn, may be governed by the settings in which they practice – that is, they may have little or no choice about whom they treat. This interplay between client and therapist attributes is alluded to frequently throughout the book.

Several chapters are devoted to Brodsky’s admonition to therapists that they “Don’t ask questions.” By this he means avoiding questions that predictably evoke negative reactions from people who don’t want therapy in the first place! He offers many examples, using therapist-client scripts as a teaching medium and builds his case further by suggesting therapy dialogue that can substitute for direct inquiries, namely (a) making statements based on knowledge, (b) articulating observations and transactions, (c) noting therapeutic possibilities and (d) giving clients third-person descriptions and feedback.

While most of his recommendations are reasonable, some need further explication and testing before they can be readily adopted by most practitioners.

“Therapy with Coerced and Reluctant Clients” succeeds in bringing to light an issue that affects nearly every mental health professional. Arguably, it requires honed skills to interact successfully with people who must participate in therapy against their will. Not all of Brodsky’s suggestions are easy to interpret, for example, that therapists adopt a “more directive intervention style with objective self-awareness, constructivism and personal construct therapy as part of the foundation.” And yet, the book does address most issues pragmatically, with a basis in good science and some humor along the way. Thanks to the author’s empirical wisdom and sensibility, this book should appeal to students, therapists in training and many professionals.

James K. Luiselli, Ed.D., ABPP, BCBA-D, is senior vice president, applied research, clinical training and peer review at the May Institute in Norwood, Mass.

By James K Luiselli EdD ABPP BCBA-D

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