Your client seems disengaged in therapy. How can you effectively motivate them to participate?

I think a lot of times when clients seem hesitant to dive in it is related to shame. What is bothering them is something they just don't feel comfortable sharing with you or don't fully trust you enough to be vulnerable. Rather than calling this resistance, as is often the case in the medical model, if instead, therapists encourage their clients to give them feedback about you as a therapist or how the therapist is going. Asking a client what you can do to help the process can sometimes help put them at ease. Furthermore, building trust takes as long as it takes. There is no timeline for this, especially when a client may not have EVER been able to fully trust with someone in order to develop a secure attachment.

Explore what brought them to the therapy in first place. What were they hoping to achieve? What was there expectation from the process. Affirm their determination in returning to sessions.

I would put a big emphasis in the "SEEMS disengaged". Have we asked them directly ? Have we ourselves felt comfortable enough with the client to reflect that sensation ? A lot of the times, our best tool is us and how we feel. If we feel disconnected from the client, asking about it and reflecting on the relationship directly might be the best course of action. The first rule of Motivational Interviewing is to really and truly try to understand what's happening and go from there to create motivation. It's not about what we wish for and how we think it should be achieved. And sometimes, we're not the right fit for someone. That happens and that's okay. Being able to recognize our limit is important as well.

As a trauma specialist, we take the neurobiological treatment approach. If a client is resistant, we teach them to notice the feelings, sensations and emotions that are coming up for them with curiosity, not judgement. This helps the client to remain present in the present moment and become mindfully aware of what is going on in their external environment that could be triggering them and causing the resistance.

I would work with the client on the disengagement itself, since that's an important reality as part of the therapeutic process!

When a client seems to be disengaging, I explore this gently but clearly. I share what I have observed after asking if that is ok. I invite reflection on the process so far, and normalize that there can be many valid reactions to this work. Sometimes clients will share that something I am doing or not doing is a challenge for them. This is great! We get to learn more and explore more, and I always welcome this feedback. Sometimes clients share that they are feeling better, and have ambivalence about continuing. I reinforce that this is their choice, and they have no obligation to me, only to themselves.

Desenvolver a discrepância é uma técnica central na Terapia de Mudança Comportamental e pode ser uma abordagem poderosa para aumentar o engajamento do cliente na terapia. A ideia é ajudar o cliente a perceber a diferença entre sua situação atual e seus objetivos ou valores desejados. Algumas estratégias para desenvolver a discrepância: 1. Explorar Valores e Objetivos 2. Refletir sobre o Impacto Atual 3. Comparar Comportamentos e Metas 4. Facilitar a Reflexão Pessoal 5. Apoiar na Criação de um Plano de Ação 6. Utilizar Reflexão e Reforço 7. Promover a Autoeficácia

Resistance often manifests in 'sustain talk' and a fundamental aim of MI is to redirect the client towards 'change talk' instead of challenging the narrative. I found one of the most helpful tools in that regard is the Importance/Confidence Ruler that addresses a clients readiness to change in a non-confrontational way. The importance side of the ruler will prompt the question, "What makes the importance so high?" and functions as a reminder of the clients motivators for change. The confidence side of the ruler addresses a clients belief in their ability to change. It prompts the question, "What makes your confidence that instead of something LOWER?" The typical answer will be the client's motivation to change.

One thing I learned is to listen attentively, and identify what is working for the client vs what is not working, and meet the client where they are.

Disengagement in therapy is a sign of being hopeless. When a client is not hopeful about continuing therapy, it is because of a lack of belief in self-efficacy. Participants should believe in his/her abilities and skills according to change. As a therapist, we can reinforce and empower self-efficacy by showing past successes to motivate clients to get engaged in therapy.

When planning for change, I encourage my clients to identify their outcome goal—the overarching change they wish to achieve. Once we have a clear vision, we can break it down into actionable steps using SMART or process goals. Since outcome goals can sometimes feel overwhelming, breaking them into manageable, realistic steps can make the journey a little less scary for them. It also provides opportunities to celebrate small accomplishments along the way.

I have found it helpful to lean into the feelings of resistance and collaborate with the client on solutions. Often, it is less about resistance and more about alignment with the goals in therapy. It can be valuable to assess the goals set by clients and give space to make changes that feel more aligned with the clients needs. In short, call it out, lean into it, and give space for change.