Client Adherence: Validation and Therapeutic Strategies
Key Points
- Challenging denial and delusion with acceptance and validation is putting things into dialectical form.
- Explore, validate, and be willing to sit with clients in their distress until they are ready to move along.
- Success needs to be owned by the client to be sustainable over time.
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Transcript
So let’s go over, why don’t clients do what we tell them to do, and kind of what gets in the way of that?
When we talk about adherence or compliance, we talk about feeling bad. And when we feel bad, we don't want to escape, avoid, alter, right? We shift to denial and self-delusion instead of acceptance and change. When we talk about something that can be judgmental, we’d like to put that on a continuum and create that dialectic. So, if we’re talking about denial and self-delusion on one end, what would be on the other end? Well, acceptance and potentially change. So let’s explore that.
Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open, 8, e016982.,Matthews, R. (2018). The value trap. Group Practice Journal, 67(10), 10–13.,Penso, J. (2018). Changing the course of chronic disease. Group Practice Journal, 67(10), 1–5.
When we can explore things on continuums or through dialectics, oftentimes, it takes out that judgment, that feeling bad, that immediate barrier. With this I want clients to understand the cycle that they’re in, what’s currently happening. So then we can see, is it meeting needs? Are those needs getting met by self, other, and environment? Are they getting met short term, midterm, long term? There’s going to be a risk/reward if I’m going to change something. I have to have a reward that is worth me taking a risk. That flies in the face of habit formation or even initial steps toward change.
Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open, 8, e016982.,Matthews, R. (2018). The value trap. Group Practice Journal, 67(10), 10–13.,Penso, J. (2018). Changing the course of chronic disease. Group Practice Journal, 67(10), 1–5.