Tag Archives: Mandated Treatment

Mandated Treatment

mandated therapyI have been assigned to work with a client who has to attend therapy as part of his probation requirement. How can I build trust with someone who probably doesn’t want to be in treatment?

It is challenging to work with someone who isn’t seeking therapy voluntarily. Therapy is sometimes required as part of probation, a child abuse investigation, or other legal situation. There are complications in developing a therapeutic relationship when treatment is mandated by a third party. This blog contains a few suggestions that will help you work through some of these complications.

First, I recommend that you get clear information at the beginning of treatment about what you will be required to report to the mandating authority. Your client may come with a referral form or blank progress report that will have these instructions, or you may need to ask for his authorization to talk with the mandating authority about their expectations and requirements. If possible, it is best to report general information only, such as dates of attendance, issues discussed and treatment goals. As a therapist, you are not evaluating your client in relation to his legal situation so you cannot advocate for a specific outcome or express an evaluative opinion.

Once you are clear about what the mandating authority requires, you should share this with your client, letting him know what you will share and what you can keep confidential. This conversation is in addition to a discussion of the general limits of confidentiality you have with all clients. By talking openly with him about the reporting requirements, you establish clear and direct communication which is the beginning of a therapeutic relationship.

Second, acknowledge that your client has mixed feelings about being required to attend therapy and talk about the impact the mandate has on his ability to feel open and trusting of you. An example would be “Since coming to therapy is required rather than something you decided on your own, I imagine it will be hard to decide how much you want to talk about with me.” Acknowledging his ambivalence is likely to help him feel more trusting rather than less, and it communicates your ability and willingness to discuss things that are difficult. This should be an ongoing issue for discussion, since he will continue to have questions about trust as the relationship develops.

Third, bring up the possibility that the client may not feel comfortable sharing truthfully with you. He may have other requirements like maintaining sobriety, attending parenting classes, or detaching from conflictual or violent situations and it will be difficult to know whether he is being truthful when he reports complying with those requirements or reaching treatment goals. One way to discuss this is to raise a hypothetical question like “If you had started drinking again, do you think you’d be able to tell me?” In this way, you bring the issue of truthfulness into your relationship without being accusatory. Even if the client assures you he would be able to tell you, raising this question acknowledges the impact of the mandated requirement on his communication and relationship with you. As with the issue of ambivalence, you should raise this periodically as an ongoing issue in the relationship.

I hope you find this helpful in doing therapy with clients whose treatment is mandated. Please email me with comments, questions or suggestions for future blog topics.