Strategies for Work with Involuntary Clients, by R. Rooney and R. Mirick (preface and chapter 1)

STRATEGIES FOR WORK WITH INVOLUNTARY CLIENTS THIRD EDITION

RONALD H. ROONEY REBEC C A G. MI R I C K

EDITED BY AND

Preface

This book is about practice with involuntary clients, both those clients required to see a helping practitioner, such as juveniles on probation, and those pressured to “seek help,” such as an alcoholic threatened with desertion by his spouse if he does not get help. “Involuntary practitioners” are also included in the book, which includes those who may be as reluctant to work with involuntary clients as the clients are to work with them. When I (Ron Rooney) began work as a social worker, I intended to work with clients who wanted to work with me, who would be thankful for the insights I gave them, and who would pay my receptionist on the way out. The reality was that few of my clients, either then or later, were excited to work with me and they were often more interested in escaping the clutches of my agency and the law than in gaining an insight into their personalities.

Most of the intervention theory I was taught ignored these clients or considered them exceptions to the rules that apply when working with voluntary clients. When I became an instructor, I continued the tradition of teaching voluntary client methods to students who worked with involuntary clients.

Independent-thinking students would ask, “But how does this apply to the people who don’t want to see you?” and I would improvise answers adapting voluntary methods. This book is written in answer to those students and practitioners working with involuntary clients who strug gle to apply voluntary practice theories to involuntary practice. In fact, I suggest that involuntary clients are the rule in practice rather than the exception.

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Preface The book is written for students, instructors, and practitioners. While probably few students become members of helping professions hoping to work with people who don’t want to work with them, many experience less than voluntary client contact through their field placement and internship experiences. Students should find the book useful in explaining and guiding involuntary practice on its own terms. Such practice often appears to be undertaken as a rite of passage to provide experience and toughness before graduating to work with voluntary clients. Students may also find parallels to their own situations as “involuntary” students: if they wish to graduate, they must take some required courses “for their own good” in addition to choices in elective courses.

The book is also intended for practice methods instructors who wish to add material about involuntary contact to balance sources that assume solely voluntary contact. Instructors teaching courses about social problems and practice settings that often include involuntary clients, such as child welfare, criminal justice, and chemical abuse programs, will also find the book a useful practice supplement.

Finally, the book is written for practitioners who work with involuntary clients. While the book is based in the social work profession, the content is useful to other helping practitioners such as psychologists, psychiatrists, nurses, probation officers, employment counselors, child welfare workers, and youth workers. The book addresses public-agency practitioners with legal mandates, large caseloads, feelings of being unappreciated, overworked, and underpaid, as well as private-agency practitioners who may not recognize that many of their clients are, in fact, involuntary clients.

The book is designed to help both involuntary practitioners and involuntary clients become at least semivoluntary. Guidelines are aimed at providing legal, ethical, and effective intervention. While involuntary clients differ from one another as much as they do from voluntary clients, involuntary clients share the fact that they did not willingly enter contact with the practitioner.

Consequently, the book focuses most extensively on the socialization and contracting phase that tends to be similar for many involuntary clients. Guidelines for interventions after the contracting phase are more tentative, since there is much variation based on the specific problem and setting. The book will help practitioners prepare for involuntary contacts by providing them with realistic role expectations so that they can make clearer decisions about when they must act and when they should not act. The guidelines should lead to less hostile and uncooperative encounters, to more successful contracts, more collaboration between practitioner and client, and less “burnout” on both sides of the involuntary transaction.

Finally, the book reviews the philosophical debate about the conflict between social control and caring roles, and between rehabilitation and criminal justice goals. The issues are reviewed with an aim toward increasing awareness

Preface without proposing to resolve those issues herein. The book is designed to help practitioners currently engaged in the ongoing debate.

Involuntary clients sometimes have fantasies that their practitioners will leave them alone, or forget about “helping” them. Practitioners also fantasize that they can make involuntary clients change if they can just find the right magic to make those clients think differently, or if they exert enough force.

This book supplies neither magic nor force. It will not provide the practitioner with a blueprint for making involuntary clients do what they do not want to do, continue to do it after intervention, and like it. The book does not provide a “laying on of hands” whereby the involuntary client is transformed into a “born again” voluntary client, thankful for insight and eager to modify his or her life patterns. It is not a manual for brainwashing or hypnotizing involuntary clients to bring them to their senses—or to the practitioner’s point of view. Nor will the guidelines eliminate the need for professional judgment in making decisions.

Guidelines are based on available evidence about interventions that can be used legally, ethically, and effectively across involuntary settings and populations. Where that evidence is limited or inconclusive, alternatives are presented to help practitioners make informed choices. The book also draws on the practice literature from different involuntary populations and helping professions and on my case experiences and those of my students. Practice guidelines are frequently illustrated with selections from transcriptions derived from training videotapes, some of which were conducted with actual clients. In all cases, practitioners and clients provided informed consent and client identities are disguised. The book raises questions for further study and suggests ways to test those questions.

The book is aimed at increasing understanding of the involuntary transaction and knowing how to act within it. As practitioners need to be able to explain to themselves and others why they carry out an intervention, part 1 provides a foundation with a conceptual framework for understanding the involuntary transaction and influencing client behavior and attitudes in a legal, ethical, and effective fashion. It draws widely from sources in law, ethics, intervention effectiveness across helping professions and problem areas, and social psychology. Chapters are organized around brief summaries of relevant theory and research.

This third edition of the book revises, condenses, and updates the second edition. Rebecca Mirick joins me as an author and editor of this edition. She has much practice, research, and teaching experience related to involuntary clients in child welfare, outpatient mental health, and the juvenile correction system. Each chapter closes with questions to guide discussion in classes and work groups. Part 3 contains chapters written by contributing authors that cover specific areas, populations, and fields of practice in which involuntary clients are frequently encountered. We have added new chapters related to

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Preface involuntary clients with substance use disorders, with diagnoses of dementia, who are survivors of trauma, and who are seen within the context of behavioral health care.

This book would not have been completed without the support and encouragement of colleagues, students, practitioners, and clients from many settings. The support of Departmental Chair Jim Reinardy from the University of Minnesota School of Social Work was essential. We want to thank our spouses, Glenda Rooney and Seth Mirick, for their patience and support during this process. We want to thank the contributing authors for their persistence and commitment in supporting the completion of this project and Jennifer Perillo of Columbia University Press for her encouragement and inspiration in completing this project. Finally, we want to thank reviewers from Columbia University Press for their helpful comments.

Part I

A Foundation for Work with Involuntary Clients

Helping professionals often assume that their clients want to work with them. Practice with clients who do not seek a helper but rather acquiesce to pressure to seek help requires different assumptions. Practitioners need to know when and why to act with involuntary clients as well as how to work with them. Part 1 lays a foundation for legal, ethical, and effective practice with involuntary clients by providing concepts and assessing empirical evidence about effectiveness. Chapter 1 introduces involuntary practice and work with clients across a continuum of voluntarism. Chapter 2 builds a foundation of legal and ethical principles for involuntary practice. Intervention principles based on evidence of effectiveness are discussed in chapter 3; and principles of behavior and attitude change are found in chapter 4. Chapter 5 puts work with involuntary clients into the context of clients often being members of oppressed groups and presents theoretical frameworks, such as reactance theory, to help assess initial interactions between practitioners and involuntary clients. Chapter 6 adds the lens of trauma-informed care to such work.

Chapter 1

Introduction to Involuntary Practice

Ronald Rooney

Involuntary ser vice users, recipients, or clients experience limited choices for accepting ser vice. Those contacts often occur in a context of distrust between ser vice users or clients who are often culturally, racially, or economically different from ser vice providers and their agencies. This chapter describes work with two types of involuntary clients. Many involuntary clients are legally mandated to see a helper. Others experience pressure that is no less real, but is not legally mandated. As the practitioners who work with involuntary clients are often as reluctant as the clients, I also introduce the concept of the involuntary practitioner and describe the transactions between involuntary clients and practitioners. Since clients can be more or less voluntary at various times or depending on the issues, a continuum of involuntary contact is presented.

The implications for members of an oppressed group are also introduced. The chapter concludes with questions for prac titioners to ask about their work with involuntary clients.

Definition of “Involuntary Client” According to Merriam-Webster Online, a client is “a person who is under the protection of another, one who engages the professional advice or ser vices of another, or a person served by or utilizing the ser vices of a social agency.” The definition best fits the circumstances of a voluntary client who recognizes a problem, is willing to tell someone about it, is willing to give that person

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A Foundation for Work with Involuntary Clients permission to advise, and, finally, is willing to change in some way (KeithLucas 1972). A voluntary client does not experience external pressures to participate in ser vices and is free to select helpers or “fire” them if ser vices are not acceptable.

Some practitioners raise concerns about connotations of the term “client.”

Some maintain that it can imply a relationship with an assessing expert and that the client needs that expert’s advice (McLaughlin 2009). Terms such as “consumer” or “customer” have been used to emphasize the recipient’s power to be a partner and to choose among ser vices. However, such terms can appear to represent a hollow power if an involuntary ser vice recipient is pressured to accept ser vices. For example, a mental health ser vice recipient commented that he consumed mental health ser vices the way that cockroaches consume poison (Barker and Pack 1996)! Such unwilling recipients have been described as refusers of ser vices (McLeod 2007; Smith et al. 2012). These authors recommend the term “involuntary ser vice user” to describe persons who utilize ser vice under pressure. We will refer to involuntary recipients of service as “involuntary ser vice users” or “involuntary clients,” defining the latter as persons who accept contact with helping professionals under pressure.

Involuntary clients or ser vice users are individuals who are forced by those around them, such as parents, spouses, neighbors, and police, to seek assistance from official helpers (Murdach 1980). They also include persons who must deal with helping professionals because they have behaved in ways considered annoying or troublesome to society (Cingolani 1984). Involuntary clients feel pressured to seek or accept contact with a helping professional. The aforementioned definitions contain the term “client” while recognizing constraints on free choice. To retain the use of the term “client,” there must be an effort to engage persons in involuntary circumstances as informed participants in constrained circumstances. Change is not targeted at the person as a whole, but rather at his or her illegal, harmful behavior. A sexual predator may find that there is a nonnegotiable focus on his dangerous, illegal behavior toward others; but he or she can be engaged as a client around other goals, such as how to increase his freedom. If the person in involuntary circumstances has no opportunity to engage in actions to identify and increase self-defined goals, then he or she is an involuntary target rather than a client. The Social Work Code of Ethics provides guidance for ser vice to clients, but no guidance is available for targets (National Association of Social Workers 1999).

Involuntary clients can be subdivided further into legally mandated clients and nonvoluntary clients, according to the source of pressure experienced. Legally mandated clients must work with a helping practitioner as a result of a current or impending legal mandate or court order (Hutchison 1987). Mandated clients comprise the majority of those seen in many public social service settings, human services departments, child welfare, probation and parole, and psychiatric wards. The helping practitioners who work with them come from

Introduction to Involuntary Practice professional fields such as social work, psychology, psychiatry, counseling, marriage and family counseling, nursing, correctional counseling, and chemical dependency training. Many others are paraprofessionals with on-the-job training. Practitioners working in public settings with mandated clients are usually aware of the involuntary nature of their client contact since legal mandates describe practitioner responsibilities and often specify client rights.

In common parlance, all involuntary clients are legally mandated clients.

I suggest that they are not the only ones. Some involuntary clients can be described as “nonvoluntary.”

Nonvoluntary clients have contact with helping professionals through sources other than a legal mandate. For example, a referral from a doctor, a school official, or an employer can represent formal pressure to seek assistance.

Referral from a spouse, partner, or family member represents informal pressure to seek help. Nonvoluntary clients include those who accept services under pressure because valued ser vices are unavailable elsewhere (Slonim-Nevo 1996). For example, though prospective adoptive parents generally might be considered voluntary, the adoptive children they seek are a scarce and valued resource. Hence, they might consider their contact with helpers, such as attending required training to qualify as potential parents, as “jumping through hoops.” Similarly, women who seek refuge in a shelter for victims of domestic violence may voluntarily seek safety from possible abuse, yet chafe at the “package deal” of requirements implicit in the acceptance of the offer of ser vice.

They might prefer relief with no strings attached and object to restrictions against telephone contact with their partners or the requirement to attend groups. Nonvoluntary clients are more difficult to count because they are not defined by a legal status yet may represent the majority of clients seen in public schools, hospitals, outpatient mental health settings, day treatment programs, group homes, shelters, drug and alcohol treatment programs, youth ser vices, and family ser vice agencies. Nonvoluntary clients include persons who are not required to participate in a ser vice but are encouraged to do so if such encouragement contains pressure (Altman 2004). Nonvoluntary clients may exert their freedom by refusing to accept ser vices when their perception of their own needs does not reflect that of the referral source (Barlow et al. 2005).

Informal pressures also come from the referrals of community members who attribute problems to persons whose behavior they consider inappropriate or deviant. For example, persons with dementia may be pressured to work on concerns of family members rather than attend to their own expressed concerns (McGovern 2015).

Nonvoluntary clients are often cited as unable or unwilling to accept responsibility for their problems. For example, service users with substance abuse issues are frequently alleged to deny responsibility for the concerns of others (see chapter 15 in this volume). Voluntary clients are typically identified by

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A Foundation for Work with Involuntary Clients the fact that they have acknowledged their problems and sought help. An attributed problem is one that others say that a client has (Reid 1985). Involuntary clients, both mandated and nonvoluntary, have problems attributed to them that they may or may not acknowledge. For example, many of the clients in my child welfare practice had been found by a court to be abusive or neglectful yet did not acknowledge abuse or neglect as a problem. They did acknowledge, however, that the public child welfare agency was restricting access to their children and were willing to work to regain access. In later chapters, we will explore ways to work with both attributed and acknowledged problems.

Both legally mandated and nonvoluntary clients are involuntary because they feel forced to remain in a helping relationship through physical or legal coercion, the unavailability of attractive alternatives, or both (Thibaut and Kelley 1959). Also, the individual may choose to remain in an involuntary relationship because the cost of leaving it is considered too high. For example, a ser vice user might consider violating his court order yet decide that the costs of an increased sentence are prohibitive. Finally, people are involuntary clients when they believe that they are disadvantaged in the current relationship because better alternatives are available. For example, public school youth who are referred for social skills classes because of disruptive classroom behavior may resent being singled out in this way.

Factors that influencing the level of pressure felt by an involuntary client include the following: • How severe are the consequences if he or she refuses the ser vice?

• How constrained are the client’s choices regarding who might provide help?

• How much input can the client provide in the assistance offered by that helper (Slonim-Nevo 1996)?

• Who initiated the contact: the client or others?

• Does the potential client perceive a need for ser vice?

• Does that potential client experience pressures to make life changes (Burstein 1988)?

• How receptive are helping professionals to the client’s account of circumstances leading to contact?

The Involuntary Transaction Both legally mandated and nonvoluntary clients are participants in an involuntary transaction. An involuntary transaction is a dynamic exchange of resources among clients, practitioners, and agencies occurring in a shifting legal and normative context and power imbalance such that the involuntary client

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ften in their careers, social workers will encounter clients who are either legally required to attend treatment services or are otherwise coerced or pressured into those services.

In an update to this classic text, social workers Ronald H. Rooney and Rebecca G. Mirick explore the best ways to work with unwilling clients. This book provides a theoretical framework for understanding the legal, ethical, and practical concerns, offering theory, treatment models, and specific practice strategies influenced by the best available knowledge to facilitate collaborative, effective working relationships with involuntary clients.

“Hooray! The much-anticipated third edition of Strategies for Work with Involuntary Clients builds on the superb previous editions, adding depth and breadth to a uniquely useful presentation of practice strategies for working with individuals and families. Rooney and Mirick provide insightful guidelines for legal and ethical issues and a new chapter on the ‘involuntary’ practitioner. An invaluable resource for both students and professionals.”

A L E X G I T T E R M A N , University of Connecticut School of Social Work

“In this substantive and helpful collection of essays, the editors and the contributors manage to convey that we can be respectful of a client’s rights while not being too easily put off by understandable resistance. In the end, real change is always in the control of the clients, even those who didn’t have a choice in engaging in the service.”

L AW R E N C E S H U L M A N , SUNY Buffalo

“This comprehensive and accessible text will be plundered for its insightful observations coupled with practical suggestions across a range of service areas. It is timely, as emphasis is shifting from identifying problems/risks to looking at how work can be undertaken with different types of involuntary clients to effect the required change. Best read from cover to cover, this is a genuine candidate for the authoritative guide in this challenging area of work.”

M A R T I N C . C A L D E R , director, Calder Training and Consultancy

“This book helped me define who is involuntary and how to approach a client who is defined that way. It presents cases, data, research, and questions that will shift our way of thinking about clients and therapists who are ‘forced’ to be in treatment.”

E L I Z A B E T H M I S E N E R , University of Southern California

R O N A L D H. R O O N E Y is professor emeritus at the School of Social Work, University of Minnesota, and coauthor of Direct Social Work Practice: Theory and Skills.

R E B E C C A G. M I R I C K is a licensed clinical social worker and assistant professor at Salem State University. Her research focuses on client engagement and resistance, suicide prevention, and work with parents involved with child protective services.

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