I have a proven track record of engaging difficult clients. I got my start by in an agency that said,  “Give us a family which you have no hope that they can change, I will show you what we can do, and we will work that case pro bono.” So, what are strategies for engaging difficult families?

1) Approach them with a mindset that you are no different than them.

Given similar circumstances and resources, you would be in a similar situation making similar decisions. This non-judgmental stance of “people are people” makes the families feel comfortable. However, very often, to separate ourselves from painful situations, we differentiate ourselves from those we work with telling ourselves “we are not like them”. This attitude raises barriers to engagement. We must realize that stepping into it with the clients we serve is a fundamental and much-needed skill all therapist need. Connection is key! By connecting and seeing ourselves in our client we bring their reality closer to our own and will be able to experience some of what they are going through. This also brings the pain of what they are going through closer.

2) Listen to their story.

Show them that you are listening to them by repeating things they said back to them at later times. Provide different interpretations of what they have told you by asking, “when you say (blank) could it be or mean (blank)?” If you hit on the right interpretation it will resonate with them and they will enthusiastically agree.  This not only demonstrates listening, respect and caring, it offers a chance to reframe their situations, so a solution is more readily available. Often being stuck is because the reality as the client sees it cuts them off from solutions. A simple reframe provides an alternative reality that allows them to move because the solution is now an option.

3) Demonstrate you care first.

A co-worker of mine has a mantra she quotes often: “Nobody cares what you know until they know you care!” People want to know you have their best interests in mind before they will make that psychological shift and grant you permission to treat them. We have to demonstrate this caring in order to engage those we treat. I often find this demonstration is done through simple gestures.  For example; once I simply stated to a mother, “ I know you don’t trust me, that is good. You shouldn’t because I have done nothing to earn that trust. I simply ask that you give me some time to earn your trust.” This statement acknowledged what she was feeling but could not express while remaining respectful, dignifying and asking for a reasonable request of time.

4) Provide hope.

We have to demonstrate that we have ideas, skills, and strategies that can be of practical use to those we serve in the here and now. This immediate relief gives families hope that things can improve and will continue to improve over time.

When you put this all together, although simple, the impact is dramatic. I managed a grant that treated families managing domestic abuse who were also chemically dependent. The engagement rate for the first months was below 20% prior to me taking over the grant. Once the staff learned how to implement strategies such as those above with the families, the engagement rate increased to 79%. Staff initially complained about difficulty making their hours. After training, the same staff with the same families were constantly asking for more time and exceeding expectations. Keep in mind the hours per week on this grant was 7-10 hours but routinely after the training staff wanted 15 or more. The evidence-based program I helped to create typically has had an engagement rate hovering around 90% for over a decade and a half with these same types of difficult families. The key to making these simple strategies work is being honest and genuine in how you whole heartedly put them into practice. Only you will know if you are doing so or not. Together I hope we can all positively impact the families in their greatest time of need in a positive meaningful manner.

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Lee "Bob" Smith. MS. LMFT, CCSOTS

AAMFT Approved Supervisor
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