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Working With Involuntary Clients

In representing the interests of children, courts and society generally, social workers are often faced with imposing conditions. Sometimes these conditions also include therapy on unwilling clients. Where this involves drug-related issues (eg. neglect, violence) motivational interviewing has been used to manage client resistance.

However, the first step often required in what is a conflict of interests generated by imposition of the state's will on an unwilling client is conflict resolution. Subsequently, negotiation around the bottom-line of intervention, options and consequences for adherence and non-adherence of intervention options need to be explored.

If indicated, motivational interviewing should be used once the air is cleared, the ground rules are set and the client has experience in participating with negotiation.

The six steps described below and developed by Barber (1991), outline a practical method for negotiated casework with the involuntary client. Notes on dealing with involuntary clients follow the six steps below.

These steps are also available as a PowerPoint presentation @ Managing the Involuntary Client pp
Statutory referral form as Word 6 document also available.

Contents

Six Steps for Dealing With Involuntary Clients

Notes on Dealing With Involuntary Clients

Six Steps For Dealing With
Involuntary Clients

1 Clear the air

 

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Set the stage of negotiation by stating the statutory framework (including any court order) under which casework is being conducted (eg. protection of children, drug-relate offences, domestic violence, self-harm)

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Encourage the client to express their feelings and thoughts about the situation - the worker should use their reflective listening skills at this stage

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Worker express her/his thoughts and feelings about the constraints of the intervention while being respectful of the client

The aim of this step is to begin to deal with the emotional content of 'conflict' and for the worker to make clear their role as negotiator between the court/society/statutory issues and the client.

2 Identify legitimate client interests

 

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Worker inquires about the reasons for client resistance - ie what exactly does the client stand to loose by engaging in the change process or adhering to court orders? Notes are taken for use later.

bulletWorker explains that they will subsequently negotiate a treatment plan which will aim to minimise these negative consequences.

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3 Identify non-negotiable aspects of intervention

 

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Sit side-by-side with the client and go over the basis of the intervention (eg. a court order, child protection allegation, etc)

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Reframe directives to be of interest to both worker and client (eg. rather than, "if you don't cooperate, we will have to take your child from you", "we will be happy when we are reasonably sure that your child is safe and has reasonable opportunities to grow and develop".)

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Client and worker both invited to question aspects of the bottom line and the worker should be prepared to negotiate where appropriate. For example, the worker would need to be specific about what "reasonably sure that your child is safe" means.

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In the case of drug use by a parent, specific connections relating to child protection (such as managing supervision of a young child while intoxicated) should form the basis of the bottom line. (see Risk Assessment for Parental Drug Use)

bulletBy the end of this step, both client and worker have agreed on bottom-line limits of intervention and the client has experienced a process of empowerment in their involvement of interpretation of the statutory issue or court order.
4 Identify negotiable aspects of intervention

 

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Having agreed on the bottom-line, brainstorm a broad range of possible interventions and treatment goals which might meet the bottom line.

bulletWhile step three requires worker and client to be precise and pay attention to detail, step four calls for creativity and imagination. It may even be fun.

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5 Negotiate the case plan

 

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Negotiate a case plan taking into account the legitimate client interest, the bottom-line and the brainstorm of negotiable aspects of intervention. Keeping written notes from the former steps will be helpful here.

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Worker may express her/his legitimate interests (eg. amount of time for the case, availability of transport, etc.) to enable the fairest plan for both client and worker.

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Where there is ambivalence around choosing a particular course, the worker may use a modified motivational interviewing to help with decision making. In this modified version, both worker and client progress through the decisional balance of costs and benefits.

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The main points of an initial plan are drawn up while you are both there.

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Set a short-term goal with the client.

6 Agree on criteria for progress

 

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Determine with client, answers to the following:
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How  will the treatment plan be monitored?

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How will worker and client know that the treatment plan is working

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What will happen if the client fails to comply with one or more of the terms?

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Precisely what is required before Departmental services  are terminated or renegotiated?

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Document agreed criteria for monitoring and contingencies

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Notes on Dealing With Involuntary Clients
The skills most social workers are taught in developing relationships with their clients are based on the humanistic school of unconditional acceptance and self-determination (eg. Egan, 1985). However, where the reason for contact is based on statutory grounds; where the client is not seeking intervention; and where the primary concern relates to a third party (eg. child protection), this non-directive model is generally inappropriate in the first instance.

James Barber (1991) in his acclaimed book Beyond Casework, states;

"Work with involuntary clients must begin with the recognition that the interaction between worker and client is based on conflict rather than cooperation, that social work with involuntary clients is a political, not a therapeutic process involving the socially sanctioned use of power." (p 45)

 

Barber (1991) outlines a process of negotiation which differs from two common approaches:

'Casework by concessions' where the worker is uncomfortable and apologetic about constraints and tries to avoid conflict by 'going with the client'. This can leave both worker and client bitter and resentful when, in the end, the worker still has to carry out statutory obligations - by force.

'Casework by oppression' where the worker uses rigid tactics to force (punish) the client to submit to the worker's authority.

'Casework by negotiation and conflict management' differs from the above two styles offering a model of intervention based on the principles of conflict resolution with the social worker taking on the role of negotiator or conflict manager. This process has three aims:

  1. Maximising self-determination within statutory constraints
  2. Operationalising clinical goals and orders through client involvement
  3. The behaviour of skilled negotiations, models peaceful, conflict resolution

The overall goal of casework by negotiation is an initial development of a working relationship rather than a therapeutic relationship. While a therapeutic relationship may follow, this may not be essential as a working relationship will allow for brokerage of treatment options and supervision of case management.

Where direct therapy by the social worker is indicated, the six steps outlined above will go a long way in developing a solid foundation of an honest relationship based on roles, responsibilities and mutual participation.

Dealing With Involuntary Clients section is an adapted summary from James Barber (1991) "A slight Digression: Casework with Involuntary Clients" in his book Beyond Casework
With Permission  MacMillan Press

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Click here  to download a referral form which could assist in the referral process of statutory clients from statutory agencies to drug specialist agencies. word[1].gif (924 bytes) 16 KB

Related Internet Page

Click here for Insoo Kim Berg's Solution Focused Brief Therapy useful questions to ask involuntary clients  word[1].gif (924 bytes) 32 KB

Click here for the Victorian Eastern Drug & Alcohol Service's,
"An Introduction To Working With Alcohol & Other Drug Issues" (2002). Go to p. 21 for Involuntary Clients section from their manual. 640 KB

 

Other DrugNet Pages in this Subject Heading

Introduction ] Treatment Steps ] Brief Intervention ] Raise the Issue ] Motivational Interviewing ] Intoxication ] Relapse ] Harm Reduction ] Referral ] Withdrawal ] Treatment Options ] [ Involuntary Clients ] Self-help ] 12 Steps AA/NA ] Overdose ] NIDA Publications ] Adolescents ]

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