What do you do with clients who don't improve?

If you work in a helping role, what do you do with clients who get stuck, who make little or no progress at all?
 
You would think that if you have a motivated and skilled helper, then change would be pretty straight forward. But, of course, we know this is not always the case.
 
The good news is that we know from the research that we do make a difference - helping does help. People who seek professional help are better off than 80% of people with similar concerns who never seek help.
 
But we also know that helping does not always help – some people only improve slightly or do not improve at all despite our best efforts. Yes, we know that the reasons for lack of progress are many. However, one of these reasons is that sometimes we are the problem.
 
One of the very interesting findings from the meta-research is that we need to open to adjusting our approach if there is minimal progress in the early meetings as the progress people achieve in the first 3 to 6 meetings is indicative of the progress that will be achieved 6 to 12 months later.
 
So, everyone in a helping role needs to be paying close attention to the level of progress in the early days of working with people.  One way of doing this is by having an honest conversation with the client, their family members or others who are working with them as to how much progress is taking place towards the agreed goal.
 
You will notice I haven’t simply said use your own judgment as to whether progress is occurring as the research says we are often wrong. We may well be discounting progress that has occurred or think we’re doing a great job when the client is thinking something else.
 
Yes, we know that progress is often one step forward and two steps back and that some people have concerns that are more complex than others. But here, the importance of measuring progress and client satisfaction with the help being received is still valid.
 
Miller and Duncan recommend the use of Outcome Rating Scales to measure progress and Session Rating Scales to make it easier for clients to give helpers feedback. You can gain free examples of these brief and easy-to-complete forms here.
 
Of course, helpers need to make it easy for clients to raise concerns. You can do this by reassuring people that it helps you to know what helps and what doesn’t, making feedback from clients a routine part of what you do, and then, of course, responding positively even to feedback you believe is unfair. 
 
Client feedback can also be written, verbal, non-verbal through their body language, as well as through their behaviour – people not keeping appointments, people not acting on the agreed plan, as well as their behaviour during your meeting with them.
 
Certainly, the lack of progress indicates something needs to change. Here are five options you can consider:

  1. Change your approach. Can you use a different model of helping, focus on a different issue, or use a different mode of intervention – perhaps moving from a talking mode to a visual mode, using illustrations, for example.
     
  2. Change the time of day you work with them. Something as simple as changing the timing can be helpful for some people. Some people, for example, are more receptive in the morning, when they are rested, have eaten or are sober. Sometimes the timing can be helpful for you as well. I used to joke that my clients were better to see me early in the week rather than as the last person on a Friday afternoon.
     
  3. See additional people or see couples separately. It is a wonderful thing when we can bring into the room others who are supportive of change. It certainly does get a very different dynamic going. Other times, it can be more helpful to see parties separately, to better help them empathise with the other or to explore their contribution in a more face-saving way.
     
  4. Organise a medical assessment. For those of us in a position to do so, this can be very helpful as often untreated or poorly medicated conditions may well be getting in the way of progress. I recall many clients who were in a better position to embrace change when appropriate medical treatment has been provided.
     
  5. Change who works with them. It is not a sign of defeat if you refer the client to someone else who can also work with them - it is more a sign of sanity. It is not written down anywhere that we should all work well with all the personalities and concerns that come our way.

    I would often tell my clients that if there is no progress after a period of time, and the changes we make do not produce a better result, then I would be referring them to someone else. If you are concerned about your clients believing you are abandoning them, you might simply involve a new additional person to work with them. Often, a new personality with a new approach can achieve a better result.

What can you do to better measure people’s progress and their satisfaction with the help you are giving?

And, if there is little or no progress, what will you do as a result?


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