Engagement is a vital part of therapy with clients – getting them interested in interacting with the therapist rather than being a passive recipient of analysis and clarification from a counselling situation. In this paper from over 35 years of client (patient) contact I will examine some of the techniques of engagement using models and exercises to bring out a more interactive experience in therapy.
Although in psychological thought, interactionism, is a well accepted concept such as in the idea of nature and nurture as not two separate concepts, but instead as a dynamic interaction of basic elements that through, a too and fro motion, create a unique outcome that expresses itself through the very being of our character, so we become a thinking, feeling, behaving human being of complex mental states and outcomes. As engagement is seen as a viable learning instrument, in that through situations, we can internalize and process information about the world and ourselves, leading to change and a fusion of self examination and outward understanding to become a new unique person with a changed perspective.
Some clients (patients) have fixation and so reject or refuse to accept change as this would challenge their world view. Security of the ego comes from not accepting alternatives to their comfort zone even when they acknowledge this is leading to poor functioning in everyday situations. It is through active engagement that we (the therapist) can help the client not only make internal mental changes but by using action can fundamentally move forward to a better mental health position. Insight is still the main tool of any well versed therapist – change can only be seen when the client accepts and understands their present position in relation to the past, present and future tenses of personal perception.
The word – stance – is the place is which you start. It is the beginning of engagement the client and therapist must have a clear view of where the client feels they are in relation to interactionism of both other people in their social circle and strangers. How they react to conflict and the situations of others. Do they possess empathy, insight, self-intelligence and the ability to engage at all levels? Intelligence does not mean IQ, but in fact smartness about your world and life challenges. Poor street children in South America can be street smart but not considered high IQ achievers, yet can survive and make money in a very difficult situation of danger and poverty. So self-intelligence is how smart are you about yourself. In engagement we hope to increase this self-intelligence to a new level of understanding.
To clarify what we mean by engagement we should have a definition of its common parlance. Engagement means to interact through an action to affect the outcome of our understanding either in mental change or physical outcomes. If a footballer engages with his teammates in a planned outcome through each playing a particular strategy then the expectations of the team is to win the game – however through these interactions that both succeed and fail – change is inevitable to the next planned play or actions. So in a therapeutic situation this can also apply. As the therapist shows or explains a model of interactive behaviour or understanding – the client can strategize their own position in relation to others and situations that are familiar to them and in doing so can make re-evaluations as to their present position and the position they wish to achieve.
Engagement then means involving the client in active participation in the therapy session in order to effect change that will have positive outcomes and challenge fixated thinking through client acknowledgement of their current position being dysfunctional at best.
My personal preference is always to have a whiteboard in my counselling room. It is a godsend for making lists such as – pros and cons – when talking to a woman considering an abortion for example – the engagement being the client creates the list and actively is participating in making choices. In other instances the whiteboard can act as a catalyst for thought as in a brainstorming session.
In the first session with a client, a model can help the client to outwardly focus on something outside of their internal thought process and so engage the client away from their initial concerns. By focusing on the model the client can concentrate on the whiteboard illustration and so focus on the concept at hand. For example – the, I’m OK – Your OK model of interactionism with others (1. Transactional Analysis E. Berne 1960 – developed by Franklin Ernst 1971) the client at first watches the model being created on the whiteboard by the therapist talking through the concepts and their meanings, at some point the therapist marks a circle on the diagram showing his healthy position while being realistic – the client is then invited to stand and using the whiteboard pen – mark their own perceived position. This engagement enables the client to have a point of reference in which to recognize a need for change and their current fixation on where they are right now. Many clients comment on their past position and so engaging in reflective thought about how they could be back at a healthier outcome if they could move from depression or anxiety for example.
Another example of engagement is in visualization techniques. Here the client is shown several illustrations that have no immediate obvious story, (ambiguous) the client is then asked to comment on the meaning of each picture. This engagement helps the client to project their own situation onto the illustrations. (Usually only 10 illustrations are used for a one hour session). The therapist then tells the client what most people saw and how their answers differed; this then led to some insight about how they personally perceived the world. This engaging process helps many clients to see their prejudices and fixed thinking about other people from their own perspective. (In projection work there is no right or wrong answer). Another projection technique foe interactionism is story telling visualization – here the client closes their eyes and listens to a story told by the therapist – as some point the client is asked to take over the story and make it their own. The initial story from the therapist contains both, visual, emotional and feelings (physical as well as emotional) to help the client experience the narrative. From this type of engagement the client experiences empathetic understanding by trying to engage in their own continued version. Often this technique of engagement creates interesting outcomes such as acknowledged fears, prejudices and insights prevail. One female patient reported upon hearing a story about a lake that she has in fact a fear of water (aquaphobia) which had never come up in therapy. One often used technique is to introduce a familiar stranger at the end of the story for the client to take over. Many clients recognize this person as someone they know and is an important figure in their lives (significant other) again often not reported in therapy as this is mostly is focused on an inward looking perspective. Engagement allowed the therapist to examine why this significant other was so important to the clients psychology.
In engagement of the client in therapy, both client and therapist can interact to create understanding and a point of reference in which to start the movement of mental, physical and emotional well-being. Most counselors training is short and often poorly led, they are given the basics of theory and the technique of listening, clarifying and analysis. Although the last one – analysis – if often a frightening prospect for most new counselors as they fear that making a comment that can be a self projection of their own prejudices. As in the Christian counselor who became angry when a patient wanted to divorce his wife to marry another woman. So most counselors fear engagement as a risk of self exposure of their own mental problems (and many have them) and it is why cognitive behavioural therapy is not popular amongst many counselors because it carries a degree of challenge to the clients faulty thinking or maladaptive perceptions. (Although CBT is very limited in its overall effectiveness, despite its popularity with psychiatry.)
Engagement is an educational approach to therapy in that by illustrating models of theory the client can make use of the simple approach that a model can provide in understanding a complex emotional feeling. It is this simplicity that engages the client in psychological insight and change. By interacting with the therapist, by standing and making models, by taking over narrative the client is engaged in real world change through action. A real life action has far more weight in change effectiveness than thoughtful insight. In other words, I can know it – but when I do it – I understand it.
One of my favourite models is the – I & Me – concept of the secret, private I and the socially created ME. 2. (S F Myler 2003) As in all simple models the client instantly understands the process and engages in active discussion about who he has created for other people and the one who he really is inside. The person (I) he keeps hidden and under control and the ME who if you asked five of his friends to describe him would refer to his social self (ME) as the real person they believe him to be. We can of course over time become the very ME we create but only by the subsuming of our secret I. When drawn and explained on a whiteboard many clients engage in a discussion about how they keep themselves in check when in the company of others. They can open up to allowing the therapist a glimpse into the murky world of the, I that we are all so good at keeping hidden.
Most of these techniques of engagement I developed over many years of client interaction and successful outcomes to difficult cases (3. S F Myler 2017). The therapist must show courage and the ability to engage without barriers to their personal fears. It does take a certain amount of confidence and showmanship to engage successfully in engagement and is not for the faint hearted. Reciprocation is feared by most therapists who have been told in training not to expose their own feelings and views, however it is through reciprocity that clients can build trust in a therapist that is willing to show their own position in models to help the client realize it is OK to be exposed emotionally if the therapist has the confidence to show their own emotional wellbeing or vulnerability. Engagement is an interactive technique that helps the clients be actively engaged in their own therapy and to own the responsibility for the choices they make in life both hidden and observed.