Counseling Intake Technique: The Question That Creates a Motivated Client

Is there a counseling intake technique that creates a motivated client? For most of us, there is nothing harder than a client who doesn't want to be there. The solution? Listen to my podcast about ending a session with a 3-Point Wrap Up. I'll explain this easy, solution-focused counseling intake technique so you can use it in your next intake session to help your next reluctant client win the battle for initiative.

TCCBB Episode #15 Counseling Intake Technique: The Question That Creates a Motivated Client

How do you increase client motivation?

What we think of as motivation, can also be thought of as initiative. In their classic family therapy text, The Family Crucible (1978), Napier and Whitaker outline two main “battles” between therapists and clients:

The battle for structure and the battle for initiative.

Clients who come to us reluctantly can be difficult to engage in the process. This can lead to a ‘pursuer-distance' dynamic where the counselor feels like they are working harder than the client.

What kinds of clients can be reluctant or lack initiative?

• People who struggle with addiction
• The partner in couple counseling who NOT make the therapy appointment
• An adolescent whose parents are making them go to counseling
• Court mandated clients

We can help these clients win the battle for initiative by using the counseling intake technique of asking the right questions.

What type of therapy helps with motivation?

No one likes to feel like they are broken, or that something is wrong with them, or that their situation is worse than everyone else's.

Many times counselors add to that problem.

Think about it. The simple process of going through an intake assessment with your client and stamping a diagnosis on a treatment plan at the end of the session literally tells a them, “I have decided you have ______problem.”

What do WE do when someone we just met tells us we have a problem?

We get defensive.

On the other hand, guess what happens when we tell clients that they are “normal?”

When we tell them that anyone in their shoes might have acted/reacted in a similar way?

That there is a solution that is easier than they think?

We get buy in.

Insoo Kim Berg and Steve DeShazer, pioneers of the post-modern solution-focused approach, gave us the key: we must collaborate with our reluctant clients to by asking the right questions to co-create solutions.

How do we do that?

The 3-Point Wrap-Up

Helping our clients become motivated isn't as hard as you think.

The question that creates a motivated client can be as simple as “does that resonate with you?”

At the end of the intake assessment you have a LOT of information. But much of it can be boiled down to three problem areas: stress, life cycle stage, and the presenting issue.

The three point wrap up begins by asking your client, “There are three things that are really jumping out at me from your assessment. Is it ok if I share that with you?”

Most of the time (honestly in eighteen years I've never had a client say no), they will say yes.

Score 1 for client in the battle for initiative.

Point #1 Stress

Explain the different types of stress, what stress does to the body (reference the Holmes-Rahe Stress Inventory) and to the ability to problem solve. Validate how hard they have been working to make good decisions in spite of the amount of stress they have been under. Then ask them, “does this resonate with you?” or, if you are talking with a couple, “have you talked about the amount of stress you have been under?”

Point #2 Life Cycle Stage

Explain life cycle stages. Offer data about the most difficult life cycle stages and how transitions and interrupted transitions can be hard on individuals and families. Commend their efforts despite the life cycle stage they are in. Then ask them, “Is this new information for you? or, ‘Does this surprise you?”

Point #3 Presenting Issue

We save this for last because it is likely going to be the area/behavior the reluctant client defends.

Explain the ramifications of______________ (drinking and driving, texting nude pictures to a co-worker, going off their medications, punching a teacher, etc.) and tell them you are willing to work with them, if they like.

You can ask this a couple of ways.

“Does (addressing presenting issue) sound like it might be a good goal for therapy?”

“Does (presenting issue) sound like something you might want to focus on?”

“I'm happy to work with you on (presenting issue) too if you like. Have you ever thought before about changing/stopping/addressing (presenting issue)?

What types of interventions might be appropriate to help the client become more focused or motivated?

We can create a motivated client out of even the most reluctant individuals if we use the 3-point wrap up as our counseling intake technique. The fact is, in many cases, these clients will be coming to you for several sessions. Sometimes these clients can win the battle for initiative and engage in the process if we just ask the right questions.

Blog post by Dr. Kate Walker Ph.D., LPC/LMFT Supervisor

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