The development of a trusting therapeutic alliance with the client is essential to engaging the client in the treatment process and has been linked to both improved client outcomes related to AOD use (e.g., decrease in alcohol use) and mental health (e.g., improvement in depressive symptoms) [117–120]. Engaging clients in treatment can be difficult, particularly at the start of treatment where therapy may be challenging and attachment needs are activated [121]. For example, in clients with personality or psychotic disorders, difficulties engaging may be due to a history of poor relationships with AOD and other health professionals; a bias towards suspiciousness or paranoid interpretation of relationships; or a chaotic lifestyle, making appointment scheduling and engaging in structured work more difficult [122]. Conversely, a positive therapeutic relationship allows clients to modify their maladaptive relational patterns and learn how to form healthy relationships [123]. The following strategies may assist in engaging the client in treatment [115, 121, 123–127].
- Express empathetic, optimistic, non-judgemental, and compassionate attitudes.
- Provide individualised care that includes identified strengths as well as problems.
- Adopt a holistic approach including both recovery-oriented and trauma-informed principles.
- Be flexible yet consistent with appointments.
- Protect confidentiality and privacy.
- Promote client motivation and self-efficacy.
- Work with the client’s current stage of readiness to change (as discussed in Chapter B3).