Authoritative Settings and Involuntary Clients
Abstract and Keywords
Social workers are increasingly working in authoritative settings—that is, settings where they have the power to mandate conformity by the client to the normative and often legal requirements of the organization. Such settings may be residential, such as jails, prisons, and rehabilitation facilities, or community-based organizations that are part of the criminal justice system, the mental health system, the health system, and the child welfare system. The exercise of power derived from the authority vested in the setting’s objectives may and often does alter the total life situation of an individual, such as when a client is compelled to move to supervised care without the client’s consent. Under an outpatient civil commitment order or mental health court supervision, the patient may be told where to live and with whom to associate as well as be required to participate in interactive treatment and to take medication. In authoritative settings, social workers are working with “involuntary” clients—clients who understand, whether or not it is explicitly stated, that the social worker possesses the power to effect unwanted change in their life circumstance. Since the early 1990s, the field has been developing new ideas and skills that are equally useful in working with voluntary and involuntary clients. In the process, social worker authority is now viewed less as a way to gain client compliance and, instead, is understood more as an opportunity to build partnerships with clients that lead to changes that are enduring and more meaningful to clients.
Although social workers sometimes seem reluctant to say it openly, they know that they are in practice because they have been granted the authority to be in practice. This authority comes in part from belonging to a profession that requires social workers to complete a course of formal education and a licensing examination that guarantees they possess the knowledge, skills, and values for effective practice. Their authority also is derived from the settings in which they practice. Although there are social workers in private practice, most practice is in agency settings, continuing to reflect that social work is a profession formed out of the challenges of working in an agency context (Compton, Galaway, & Cournoyer, 2005). The reluctance of social workers to draw attention to their authority is especially prevalent when social workers practice directly with clients. This reluctance occurs because the social workers rightly perceive that doing so can easily risk undermining their wish to build cooperative, supportive, working relationships with their clients and their desire to respect and foster client self-determination. However, the social worker’s failure to acknowledge this authority is often viewed as disingenuous by clients, who recognize the social worker’s position in the organization and the power of their decision making to compel action.
Social workers often draw a distinction between voluntary and involuntary clients. Voluntary clients are those who freely choose to participate in social work services while involuntary clients are those who have been pressured or even forced into services by others who have power over them. The sense of “no choice” with which involuntary clients enter services is especially noticeable with those who have been legally mandated into social and mental health programs. Clients are frequently mandated to receive services in child welfare, probation and delinquency, and mental health settings. The distinction between voluntary and involuntary is in fact too categorical. For example: Are the elderly trying to be admitted to a long-term care facility that their children have chosen for them “voluntary”? Is the prisoner seeking help within the state prison, knowing that this is the desire of his or her administrative officer and thus possibly helpful with potential parole “voluntary”? Is the teenager whose parents think he or she should get help truly “voluntary”? There are many shades between voluntary and involuntary, and many clients are ambivalent about their status. The professional social worker most often faces a continuum of clients from totally voluntary to totally involuntary, with the majority of clients in social welfare, health, and mental health settings being on the reluctant end.
Many professionals believe that having “no choice” renders involuntary clients more resistant, difficult, uncooperative, and even more hostile than voluntary clients (Kadushin, 1997). This assessment has been increasingly alarming to the field because the majority of clients seen by social workers in public agencies either is mandated or is at least involuntary to some degree (Ivanoff, Blythe, & Tripodi, 1994; Rooney, 1992). It is also alarming because the field’s practice models historically were based on the assumption that practitioners work with voluntary clients (Ivanoff et al., 1994). Social workers who have little expertise in engaging and working with involuntary clients or perhaps clients with restricted choices may find themselves reluctantly leaning on their authority as a way to motivate seemingly resistant and unmotivated clients to make use of services. The dearth of effective ways of working with involuntary clients led Hutchison (1987, p. 595) to declare: “If there is to be a place for social work in the social welfare system, the profession must make … an academic commitment to the development of improved practice models for social work with mandated clients.” Perhaps, more strongly stated, the profession must acknowledge its social control function in most practice settings.
Complicating the interaction of the social worker with the involuntary client is that, in authoritative settings, it is typically the social worker who completes the assessment that determines whether the individual meets the qualifications of the court or person that placed the client under the authority of the organization, even though the final responsibility for the commitment may lie with someone else, such as a judge. The social worker determines whether the client qualifies for initial admission to the setting, when and how long that qualification will last, and whether the client may be transferred to a more restrictive setting or released from supervision. As such, the social worker, whether he or she likes it or not, is the agent of social control.
Coercion, that is, the use of force or the power to use force, is believed the opposite of freedom. Nevertheless, most people are coerced each day of their lives and often to their benefit. A basic principle in child rearing and group work is the art of setting limits for children—providing them with a structure within which they can exercise their behavioral experimentation while minimizing their risk of self-harm and harm to others. Several studies show the benefits of such protective—albeit coercive—oversight for adults. For example, in a study of 8,879 patients released from psychiatric inpatient care to outpatient commitment, as opposed to 16,094 released from such care without such protective oversight, those in the former group experienced a 14% lower death rate than those in the latter group and had a 24% reduced risk per day of dying from an injury-related death (Segal & Burgess, 2006a). The former group also used mental health services in a similar fashion to that of the voluntary group (Segal & Burgess, 2006b) Methadone maintenance treatment has been found to be equally as effective for mandated individuals as for voluntary patients and the former actually stay longer in care (Anglin, Brecht, & Maddahian, 1990; Anglin, McGlothlin, & Speckart, 1981; Collins & Allison, 1983; McLellan & Druley, 1977). This was an unexpected result, given that the latter group entered voluntarily in hopes of getting well, while the former was coerced into treatment. It sometimes seems that social workers’ need to always employ or believe to employ “voluntary” care is more about the social worker’s need to be the “good guy” or to feel good about themselves than it is about facing the difficulty of exercising real responsibility for their clients’ outcomes, which is the primary function of authoritative settings.
Toward Different and More Effective Use of Authority: Treatment Methods
Interdisciplinary evidenced-based approaches such as assertive community treatment (ACT) (Olfson, 1990), cognitive behavioral therapy (CBT) (INSERM, 2004), and dialectical behavior therapy (DBT) (Kliem, Kröger, Kossfelder, 2010; Linehan & Dimeff, 2001) have broad applications, especially in an interdisciplinary team approach. These interventions, which are often accompanied by outpatient commitment orders, parole, probation, and court ordered treatment, are well documented in the literature. These interventions use incentives to encourage client involvement as well as focused and intense oversight by the social worker. The latter is particularly true for ACT, an aggressive social work, where the supervision, outreach, support and montoring of client activity in the community may occur around the clock, passed from one team to another within a 24-hour timeframe.
After reviewing related research, Rooney (1992) and Ivanoff et al. (1994) concluded that developing “motivation congruence” between clients and practitioners is key to effective practice with involuntary clients. Improvement in practice applies to both the clients who are legally mandated and the clients who are pressured into services by their school, parents, or an intimate partner. These sources suggest strategies that simultaneously attempt to foster clients’ sense of choice and control while being respectful and straightforward about any nonnegotiable matters, such as those mandated by the court. These strategies include (a) exploring clients’ understandings of their situations to reduce anger, (b) reframing to increase fit between clients’ wishes and outside pressures, (c) using rewards to increase compliance with nonnegotiable requirements, and (d) accepting as worthwhile and useful the client’s goal to get the pressuring agent “off my back and out of my life.” These strategies typically downplay the use of authority to gain compliance with services. For example, confrontations of client perceptions are generally used sparingly and in nondirective forms, while the open confrontation is used only with regard to nonnegotiable matters.
Motivational interviewing and solution-focused interviewing are two recently developed practice models with research support that are increasingly being adopted for work with involuntary clients. Both approaches build cooperative working relationships with clients without relying on confrontation or insisting that clients accept that they have “a problem.”
Motivational interviewing is a client-centered, humanistic approach that allows clients to describe their problem and circumstances and that accepts the client’s viewpoints without direct confrontation. Motivational interviewing, an evidence-based practice (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010), was developed in work with substance abuse clients; numerous clinical trials provide evidence showing its efficacy (Miller & Rollnick, 2012). This form of interviewing makes use of the natural tendency of clients to be ambivalent about embarking on change, realizing that people want to change but have ambivalence about the change process. Ambivalence is believed to be normal human behavior, and motivational interviewing offers strategies for helping clients resolve their ambivalence about change.
Using motivational interviewing, the social worker notes and reflects back to the client anything heard that reflects a discrepancy between the client’s substance use and what the client states is important, such as job performance, relationships to family members, self-concept, and so forth. Discrepancy between clients’ goals and their behavior leads to resolution of the ambivalence by helping clients see the advantages of change. It is an increasing sense of ambivalence about the outcomes of substance use, for example, that is thought to motivate clients to do the work of making real and lasting changes.
Interviewing that uses the techniques of solution-focused brief therapy is built around the belief that clients are people who make choices about future acts, including whether or not they would do something different in an involuntary situation. The research on the effectiveness of solution-focused brief therapy is growing, with more and more studies being added each year, suggesting that this approach achieves evidence-based outcomes (Gingerich & Eisengart, 2000; Kim, 2008; Kim, Smock, McCullom, Trepper, & Franklin, 2010; Franklin, Trepper, Gingerich & McCollum, 2011). Solution-focused interviewing is not problem-specific, but it aims at building client-specific solutions by inviting clients to build visions of what they would like to be different in their futures and to construct ways of making those preferred futures happen. This interviewing is done in the client’s frame of reference and with a “not knowing” posture toward clients, that is, a curious and inquisitive attitude toward the clients’ situation. When this approach is used, the client resistance ceases to be a concern, and work with voluntary and involuntary clients proceeds similarly (De Jong & Berg, 2001; de Shazer, 1984, 1985, 1988). Involuntary clients, similar to voluntary clients, are invited to share their understandings of their situations, while the social worker listens for hints of what is important to the client and what the client may want. Solutions are built in the clients’ context by “not knowingly” asking clients “relationship questions” about how any particular goal or strategy they are shaping may fit with their significant other expectations, and in the case of involuntary clients, the expectations and pressuring persons from authoritative agencies. Social workers do not attempt to shape client solutions, with direction about what to do in their situations, involuntary or voluntary, being left to clients as their responsibility (except in instances where a client demonstrates a clear intent to physically harm self or others). In solution-focused interviewing in authoritative settings, it appears that the most difficulty occurs when the goals and strategy of the client conflict with the goals of the authoritative setting that employs the social worker to help the client achieve. At some point, the social worker may be forced to use the authority vested in his or her position. When this happens, the action may only be acceptable if the client believes that the social worker is attempting to act in the client’s best interests despite the rule enforcement. Listening to and respecting the client’s goals and objectives may help foster such belief in situations where authoritative action is required to set rules and or to follow legal mandates.
Engaging Involuntary Clients
Involuntary clients are unlikely to acknowledge their problems in the same way that a pressuring agent, such as a family member or judge, might perceive them. Likewise, involuntary clients are unlikely to respond to the active benefits of the social worker–client relationship in the same way that a voluntary client would respond. For example, involuntary clients are less likely to respond to warmth, genuineness, and empathy as the primary means of engaging the client (Ivanoff et al., 1994; Kadushin, 1997). Useful guidelines and skills for working with involuntary clients include the following (Berg & Kelly, 2000; De Jong & Berg, 2008):
• Assume that clients probably start by not wanting anything workers might offer.
• Assume that clients have good reasons to think and act as they do.
• Suspend evaluations and agree with the clients’ perceptions that stand behind their cautious, protective stance.
• Listen for who is important and what is important to clients, including when the clients are angry.
• When clients are angry, ask them what else could have been done.
• Listen for and ask for the clients’ understandings of their situations and for what the clients believe to be in their best interests; that is, ask what clients want.
• Use relationship questions (not confrontation or education) to address the clients’ context; for example, “Knowing the court as you do, what is it expecting you to do different?” or “Suppose you did that, what would be different for you?”.
• Respectfully provide information to clients about any nonnegotiable requirements and immediately ask for the clients’ perceptions of these.
• Ask about what clients are able to do and willing to do in their situations.
• Always stay in a “not knowing” posture, that is, formulate questions so that clients are put in the position of telling their social workers about the clients’ perceptions.
Several advances in how to work with involuntary clients have been made since the early 1990s. As these innovations evolve, awareness is growing that working with involuntary and voluntary clients is not as different as once believed. Major practice texts are incorporating knowledge and skills for working with mandated clients (Compton et al., 2005; Hepworth, Rooney, & Larsen, 2002; Sheafor & Horejsi, 2006). Social work literature emphasizes that effective practice results primarily from building partnerships with all clients, both involuntary and voluntary, around what the clients want and from helping the clients work in that direction by building on their strengths and resources; secondarily, the practitioner identifies useful community resources to support the clients’ goals (Compton et al., 2005; Miley, O’Melia, & DuBois, 2007; Saleebey, 2007; Sheafor & Horejsi, 2006). With this reorientation, the authority of the social worker, although used for purposes of social control on behalf of the objectives of the authoritative setting, may also serve as a force to gain client’s compliance serving the client’s self-interest. Authority serves to legitimate the role of social workers as professionals who move alongside their clients as partners, inviting their clients to build more satisfying lives for themselves and their families.
Anglin M. D., Brecht, M. L., & Maddahian, E. (1990). Pre-treatment characteristics and treatment performance of legally coerced versus voluntary methadone maintenance admissions. Criminology, 27, 537–557.Find this resource:
Anglin, M. D., McGlothlin, W. H., & Speckart, G. R. (1981). The effect of parole on methadone patient behavior. American Journal of Drug and Alcohol Abuse, 8, 153–170.Find this resource:
Berg, I. K., & Kelly, S. (2000). Building solutions in child protective services. New York: Norton.Find this resource:
Compton, B. R., Galaway, B., & Cournoyer, B. (2005). Social work processes (7th ed.). Belmont, CA: Thomson Brooks/Cole.Find this resource:
Collins, J. J., & Allison, M. (1983). Legal coercion and retention in drug abuse treatment. Hospital and Community Psychiatry, 34(12), 1145–1149.Find this resource:
De Jong, P., & Berg, I. K. (2001). Co-constructing cooperation with mandated clients. Social Work, 46, 361–374.Find this resource:
De Jong, P., & Berg, I. K. (2008). Interviewing for solutions (3rd ed.). Belmont, CA: Thomson Brooks/Cole.Find this resource:
de Shazer, S. (1984). The death of resistance. Family process, 23, 79–93.Find this resource:
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.Find this resource:
de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.Find this resource:
Franklin, C., Trepper, T., Gingerich, W., & McCollum, E. (Eds.) (2011). Solution-focused brief therapy: A handbook of evidence-based practice. New York: Oxford University Press.Find this resource:
Gingerich, W., & Eisengart, S. (2000). Solution-focused brief therapy: A review of the outcome research. Family Process, 39(4), 477–496.Find this resource:
Hepworth, D. H., Rooney, R. H., & Larsen, J. A. (2002). Direct social work practice: Theory and skills (6th ed.). Pacific Grove, CA: Brooks/Cole.Find this resource:
Hutchison, E. D. (1987). Use of authority in direct social work practice with mandated clients. Social Service Review, 61, 581–598.Find this resource:
Institut national de la santé et de la recherche médicale (INSERM). (2004). Psychotherapy: Three approaches evaluated, PMID 21348158Find this resource:
Ivanoff, A., Blythe, B. J., & Tripodi, T. (1994). Involuntary clients in social work practice: A research-based approach. New York: De Gruyter.Find this resource:
Kadushin, A. (1997). The social work interview (4th ed.). New York: Columbia University Press.Find this resource:
Kim, J. S. (2008). Examining the effectiveness of solution-focused brief therapy: A meta-analysis. Research on Social Work Practice, 18(2), 107–116.Find this resource:
Kim, J. S., Smock, S., McCullom, E., Trepper, E., & Franklin, C. (2010). Is solution-focused brief therapy evidence based? Families in Society, 91(3), 300–306.Find this resource:
Kliem, S., Kröger, C., & Kossfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78, 936–951.Find this resource:
Linehan, M. M., & Dimeff, L. (2001). Dialectical Behavior Therapy in a nutshell, The California Psychologist, 34, 10–13.Find this resource:
Lundahl, B., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. (2010). A meta-analysis of motivational interviewing: Twenty five years of empirical studies, Research on Social Work Practice, 20(2), 137–160.Find this resource:
McLellan, A. T., & Druley, K. A. (1977). A comparative study of response to treatment in court-referred and voluntary drug patients. Hospital and Community Psychiatry, 28, 241–245.Find this resource:
Miley, K. K., O'Melia, M., & DuBois, B. (2007). Generalist social work practice: An empowering approach. Boston: Allyn & Bacon.Find this resource:
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing (3rd ed.). New York: Guilford.Find this resource:
Olfson, M. (1990). Assertive community treatment: An evaluation of the experimental evidence. Hospital and Community Psychiatry, 41, 634–641.Find this resource:
Rooney, R. H. (1992). Strategies for work with involuntary clients. New York: Columbia University Press.Find this resource:
Saleebey, D. (Ed.). (2007). The strengths perspective in social work practice (4th ed.). Boston: Allyn & Bacon.Find this resource:
Segal, S. P., & Burgess, P. M. (2006a). Effect of conditional release from hospitalization on mortality risk. Psychiatric Services, 57, 1607–1613.Find this resource:
Segal, S. P., & Burgess, P. M. (2006b). The utility of extended outpatient civil commitment. International Journal of Law and Psychiatry, 29(6), 525–534.Find this resource:
Sheafor, B. W., & Horejsi, C. R. (2006). Techniques and guidelines for social work practice (7th ed.). Boston: Allyn & Bacon.Find this resource: