The past decade has seen an increasing number of clients mandated into substance abuse treatment by various sources. The criminal justice system increasingly views diversion to substance abuse treatment as a viable alternative to incarceration because of the possibility of rehabilitation, especially for first-time offenders, and as a less costly alternative to imprisonment. The changing public assistance requirements also have led to a growing number of substance-abusing individuals who are mandated into treatment in order for them to receive benefits. Many other individuals are brought to the attention of substance abuse treatment centers through child welfare agencies. Since 1976 child welfare departments across the country have seen an increase of more than 330% in child abuse and neglect reports, and it is estimated that at least two-thirds of the families known to child welfare agencies have substance abuse problems. Clients are also mandated into substance abuse treatment by employers concerned about poor work performances, and many are forced into treatment by their family members. Dr. Shafer uses a practice model that not only elicits the cooperation of clients but also empowers them to take responsibility for finding and enacting their own solutions.
Current Perspectives on Mandated Clients
The language used by clients mandated to substance abuse treatment often mirrors the language of the criminal justice system. Mandated clients often describe the treatment as a matter of “doing time.” They focus on the “release date” and are more concerned with meeting the requirements recommended by the judge, probation officer, child welfare department, public assistance system, the employer, the family, or some other monitoring authority than with the successful completion of clinical goals established by the treatment center. The flip side of this lexicon is the language used by treatment providers to describe the mandated client. Words such as mandated, involuntary, or criminal justice elicit certain preconceived notions in clinicians, such as difficult, resistant, oppositional, or defiant, as well the other commonly used description of clients as “in denial” or as “minimizing the seriousness of the problems.” It is not a big leap to then interact with the client in a manner that conveys the perceived truth of these descriptions. Before long, the client indeed displays many of the signs of being “noncompliant” and having a “bad attitude.”
New Solutions on Mandated Clients
A growing literature is emerging, however, that advocates the need for a better fit between client motivation and provided services. Some therapists, suggest that practitioners pay attention to the positive or prosocial comments or behaviors that clients show and openly praise them. They also emphasize the advisability of challenging or confronting antisocial comments or behaviors—but of doing so cautiously. Other therapists advocate a four-stage process: (1) emphasizing client choice whenever possible, (2) informing clients about what to expect during treatment and their part in it, (3) contracting with clients around goals and treatment procedures, and (4) fostering client participation throughout treatment. These strategies offer a greater degree of choice and control to clients, orient them to the treatment process, and give them a sense of responsibility for success or failure in achieving the treatment goals that they themselves have established.