Provide Role Induction

As we continue our exploration of client retention and how this can decrease stress for clinicians by increasing the consistency of clients attending treatment, we will be looking at Chapter 3 - Provide Role Induction from the book Premature Termination in Psychotherapy - Strategies for Engaging Clients and Improving Outcomes, written by Joshua K. Swift and Roger P. Greenberg.

Starting therapy can be a daunting and intimidating process for clients.  For novice clients, everything is uncertain.  They may have questions that range from where to sit and how to pay, to what topics are appropriate for discussion in session.  These feelings of anxiety and uncertainty are one potential cost of seeking psychotherapy that, for some clients, may result in a decision to drop out.

For clients with previous psychotherapy experience, some clients begin therapy with certain role expectations in mind.  The term role expectations refers to the client and therapist behaviors that the client believes will be present in treatment.  These may be beliefs about whether the therapist will offer advice or who will be doing most of the talking in the session.  Although they may not have to face uncertainty when starting therapy, clients with preexisting role expectations may also be at risk of dropping out.  Specifically, some of these clients may hold role expectations that are inappropriate for psychotherapy altogether or role expectations that are appropriate but do not fit with the behaviors and expectations of their particular therapist.  When framed as a cost, expectations that are not met may be interpreted as an error or inadequacy in the therapist and/or treatment, and the client may quickly drop out as a result.

Role induction is the process of educating clients about appropriate therapy behaviors early on in treatment.  

Role induction is best accomplished when all three domains are covered:

1. The general behaviors of an ideal client
2. The general behaviors the client can expect from the therapist
3. The specific nature, purpose, and behaviors associated with the particular treatment approach

The general behaviors of an ideal client.

Clients need to know what is expected of them.  The client should be taught that although the therapist plays an important role, progress in therapy is largely dependent on the efforts of the client.  Clients can be instructed to talk openly and honestly about problems, thoughts, and feelings, regardless of how personal or painful they may be.  They can also be encouraged to fully invest and engage in the in-session and out-of-session activities that they and their therapist come up with as part of their treatment.  Finally, clients can also be told that their regular feedback, positive or negative, regarding the therapist, techniques, and therapy progress is strongly desired.

The general behaviors the client can expect from the therapist.

Clients need to know what they can expect from their therapist.  In general, clients should be told that the therapist's primary job is not to solve the problems but to assist the client in the journey of finding solutions.  Communicating this should include whether the therapist or client is going to direct the session, whether the therapist will give advice, ask questions, use challenges, and provide interpretations.  The client also needs to get a sense that he or she can trust the therapist, and that the therapist will be accepting and understanding, not judgemental or condemning, of the client’s problems.  Conveying these later characteristics is often done better through actions than words.

The specific nature, purpose, and behaviors associated with the particular treatment approach.

Clients need to be provided with a credible treatment rationale.  This first includes a theoretically sound causal explanation of the client’s problems and, second, a description of the techniques and procedures that will be used to treat those problems.  A treatment rationale should also include specific details about the appropriate client and therapist behaviors.  In the treatment rationale, a more detailed description of the roles should be provided, such as the content area of the communication or the type of homework that may be assigned.  Understandably, the treatment rationale provided is going to vary depending on the client's problems and the therapist's theoretical approach.  However, the specific details of the rationale are not of consequence as long as they are shared with and make sense to the client.

Tips

• To save time in session, many therapists have used video, audio, and text formats for role induction.  Presentation in one of these formats may seem more official to clients and help them recognize that there is a consensus on the importance of the behaviors and roles that are discussed instead of it simply being based on the opinion of their individual therapist.
• When is the appropriate timing of this procedure?  In general, it is important to start treatment off on the right foot, so it is recommended that it be included early in therapy.  However, the exact timing again depends on the content of the socialization.  Given that the treatment rationale needs to be tailored to the client’s individual presenting concerns, it should wait until the end or after the intake appointment when the therapist has a better conceptualization of the problems.