Strategies for Work with Involuntary Clients

Ronald Rooney, Rebecca G. Mirick

• Publisher: Columbia University Press
• Year: 2018
• ISBN:
  9780231544283
• Edition: 3
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Often 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. Practitioners in settings from prisons to emergency rooms to nursing homes to child protection agencies will find themselves with involuntary clients. 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.

While work with involuntary clients is common, it can be challenging, frustrating, and unproductive unless practitioners are well trained for it. This book provides a theoretical framework for understanding the legal, ethical, and practical concerns when working with involuntary clients, offering theory, treatment models, and specific practice strategies influenced by the best available knowledge. Animated by case studies across diverse settings, these resources can be used by practitioners to facilitate collaborative, effective working relationships with involuntary clients.

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 service users, recipients, or clients experience limited choices for accepting service. Those contacts often occur in a context of distrust between service users or clients who are often culturally, racially, or economically different from service 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 practitioners 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 services of another, or a person served by or utilizing the services 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 permission to advise, and, finally, is willing to change in some way (Keith-Lucas 1972). A voluntary client does not experience external pressures to participate in services and is free to select helpers or “fire” them if services 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 services. However, such terms can appear to represent a hollow power if an involuntary service recipient is pressured to accept services. For example, a mental health service recipient commented that he consumed mental health services the way that cockroaches consume poison (Barker and Pack 1996)! Such unwilling recipients have been described as refusers of services (McLeod 2007; Smith et al. 2012). These authors recommend the term “involuntary service user” to describe persons who utilize service under pressure. We will refer to involuntary recipients of service as “involuntary service users” or “involuntary clients,” defining the latter as persons who accept contact with helping professionals under pressure.

Involuntary clients or service 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 service 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 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 services 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 service. 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 services, and family service agencies. Nonvoluntary clients include persons who are not required to participate in a service but are encouraged to do so if such encouragement contains pressure (Altman 2004). Nonvoluntary clients may exert their freedom by refusing to accept services 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 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 service 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 service?
• 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 service?
• 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 would prefer to be elsewhere. In addition, involuntary clients are disproportionately more likely to be members of oppressed groups. The four parts of this definition are examined separately here, and the concept of fate control is introduced.

1. The involuntary transaction is a dynamic exchange of resources (Hasenfeld 1987). It is commonly assumed that since clients want help and agencies wish to provide it, they share a common goal. In fact, the interests of the practitioner and those of the client are determined by their respective systems. Like all living systems, the agency and the client each want to maximize their own resources while minimizing the costs of attaining them. Therefore, a person becomes a client or service user to obtain needed resources and tries to do so with minimal personal costs. The agency, via the worker, engages the client to obtain resources controlled by him or her while minimizing organizational costs. It is this exchange of resources that makes the systems interdependent.

The transaction is dynamic because the involun...