How to Teach Client Responsibility
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Some clients begin therapy without learning healthy boundaries or taking responsibility for their actions. For many, their behaviors are a reflection of the abusive systems they were raised in. Abusive systems teach a skewed perception of responsibility through blame and shame. These circumstances do not take away the need for personal responsibility but offer an understanding to counselors who encounter these behaviors. A part of therapy will be to hold the space, validate these experiences, and teach clients personal responsibility.
Personal responsibility empowers clients to make healthy choices for themselves and others. Teaching client responsibility in the therapy room can help them mirror to others their ability to self-regulate their emotions, control impulses, and make sound decisions. This improves their relationships and connections to others. Clients, who become more responsible, are more effective parents, partners, and work associates.
The Client’s Rights & Responsibilities Form
One of the first forms clients receive when they enter the therapeutic process is a sheet about client rights and responsibilities. This sheet includes what a client’s rights are regarding counseling services and what is expected of the client for therapy to be successful. According to the National Board of Certified Counselors:
In order for your counselor to provide the highest quality of services, it is important that clients:
- Adhere to established schedules. If you must miss an appointment, contact your counselor as soon as possible.
- Pay your bill in accordance with the billing agreements.
- Follow agreed-upon goals and strategies established in sessions.
- Inform your professional counselor of your progress and challenges in meeting your goals.
- Participate fully in each session to help maximize a positive outcome.
- Inform your counselor if you are receiving mental health services from another professional.
- Consider appropriate referrals from your counselor.
- Avoid placing your counselor in ethical dilemmas, such as requesting to become involved in social interactions or to barter for services.
The Importance of Healthy Boundaries
At the first session, clients are given a written form about the client’s rights and responsibilities, informed consent, and other forms pertinent to the treatment process. It is important to verbally discuss the client’s rights and responsibilities listed above, informed consent, and any other forms.
According to the American Counseling Association’s Code of Ethics (2014) A.2. Informed Consent in the Counseling Relationship:
A.2.a. Informed Consent
Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both counselors and clients. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship.
Policies are not enough, counselors need to attend to missed appointments, unpaid bills, and if a client needs to make progress in session. The article, “Maintaining professionalism and compassion: We can do both,” summarizes this well:
Boundaries are not about being nice or mean. They are about providing clarity for the counseling relationship. We see this in Standard A.2., which deals with informed consent in the counseling relationship. Its purpose? To let clients know what to expect in counseling, how to respond in certain instances, what the counselor’s roles and responsibilities are and what the client’s roles and responsibilities are. We fail to protect clients when we don’t institute the boundaries that have been placed around our profession.
Resistance
All clients can become resistant to therapy for a variety of reasons. Clients may view responsibility as a loss of freedom, yet it is through setting boundaries that people experience more freedom. A clear expectation of what will happen decreases anxiety and gives one a sense of certainty in an uncertain world. We cannot control other people, but we can learn to control our responses. This is where our point of power comes from.
Rather than view resistance as a roadblock to counseling, resistance can be utilized as part of the treatment process. With proper awareness and attention, resistance can be seen as transference and utilized for your client’s growth. Transference is an opportunity for the counselor and client to learn about each other and must be discussed within the counseling session. Newman from Cognitive and Behavioral Practice cites,
Clients sometimes work in opposition to their therapists, a phenomenon known as “resistance.” Such behavior is not simply an impediment to treatment, but also a potentially rich source of information about each client. This information can be assessed and utilized to strengthen the therapeutic relationship, help the therapist better understand the ideographic obstacles to change, and devise interventions that may motivate the client toward therapeutic activity and growth.
Promoting Client Autonomy
A part of building client responsibility is working with the principle of autonomy and shared decision-making. When you reinforce for the client their capacity to make conscious decisions, it will help them feel more confident to take responsibility. Forester-Miller, PhD and Thomas E. Davis, PhD (2016) state,
Autonomy is the principle that addresses respect for independence, and self-determination. The essence of this principle is allowing an individual the freedom of choice and action. It addresses the responsibility of the counselor to encourage clients, when appropriate, to make their own decisions and to act on their own values. There are two important considerations in encouraging clients to be autonomous. First, helping clients to understand how their decisions and their values may be received within the context of the society in which they live, and how they may impinge on the rights of others. The second consideration is related to the client’s ability to make sound and rational decisions.
Through shared decision-making, you ensure that your client is not alone in this process; you will help guide them. In session, set aside time to discuss your clients’ decisions and review all the possible risks and benefits of that decision. Ultimately, it is up to the client to decide and face any consequences of that decision.
It can help clients to understand that there is no perfect decision. No matter how much you prepare for a decision, unknowns can lead to a different outcome. The important factor in decision-making is considering as many factors as possible and choosing the best possible result, rather than using impulsive decision-making, which does not involve deliberation.
Ebel et al., 2018 assert that shared decision-making helps clients be responsible for their decisions:
Because the word “shared” doesn’t refer to who makes the decision, but instead to the process by which patients and physicians make those decisions. The proper practice of shared decision-making recognizes that clinicians often play a critical role in educating patients about their treatment alternatives, and in helping patients align their choices with their values. In effect, shared decision-making is assisted decision-making. It also allows for patients to have differing levels of responsibility for the final decision, according to their role preferences, rather than forcing all patients to be responsible for decisions that they wish to delegate to others. In effect, shared decision-making is a process that promotes patients’ relational autonomy.
How to Teach Responsibility without Shaming or Blaming Your Client
Be in the Now – The best teachings come from the therapeutic relationship itself. Counselors naturally model responsibility each time they are attentive, show up, and are ready to do the work of a counselor. Boundaries are best when flexible and taught through compassionate care, in the moment. When clients show instances of responsibility, validate those efforts. Any time clients are not taking personal responsibility, gently confront those instances.
Empathic Confrontation – Empathy validates others, which helps them feel understood and seen. Empathy alone is not enough to teach responsible behaviors. Empathic confrontation is a counseling technique counselors employ to get clients unstuck by addressing their behavior in a gentle but directive manner. Farrell & Shaw state, “Empathic confrontation can be defined as the therapist’s approach to addressing early maladaptive schemas and dysfunctional mode behavior, with empathy for how they developed, balanced by confronting these behaviors as needing to change for the patient to have a healthy life.”
Demonstrate Authenticity- There can be times when counselors are not taking or showing their responsibility, within the therapeutic relationship. Counselors must be self-aware, acknowledge when their words and actions do not match, and discuss that within the therapeutic relationship. If a client notices a counselor’s lack of responsibility and expresses it in session, the counselor must listen openly, validate the client’s experience, and take personal responsibility. Any defensiveness on the part of the counselor will decrease relationship trust and erode any efforts of personal responsibility taught.
When counselors take personal responsibility, it can build a stronger bond of trust. Clients see that counselors are, like themselves, human and imperfect. This supports clients in taking responsibility, learning that they may falter but can make amends.
Use Self-Determination Theory (SDT)- According to self-determination theory, counselors can work to enhance our client’s competence, autonomy and relatedness, which will support their self-responsibility. Legault 2017 notes,
Self-determination theory offers a broad framework for understanding human motivation and personality by defining the psychological nutrients required for optimal motivation, engagement, and well-being. SDT underscores the idea that people’s relationships and social contexts must involve and support their fundamental human needs for autonomy, competence, and relatedness.
Give Rewards Through Positive Praise– Behavioral counselors utilize rewards to encourage behavioral change, such as taking personal responsibility. Scott et al., 2022 states,
Behavior modification is a type of behavior therapy. B.F. Skinner demonstrated that behavior could be shaped through reinforcement and/or punishment. Skinner noted that a reinforcer is a consequence that increases the likelihood of behavior to recur, while punishment is a consequence that decreases the chance. Positive and negative are used in mathematical terms. Positive indicates that something is added, and negative indicates something is subtracted or taken away. Thus, positive reinforcement occurs when a behavior is encouraged by rewards.
One type of reward that can be implemented in therapy is verbal validation and encouragement. Rewards work best when they are closely timed to the behavior. For example, when your client has acted responsibly by paying for the session in full or arriving on time, it is important to acknowledge the action immediately. Clients, who are children, can receive stickers for each task for which they demonstrate age-appropriate responsibility.
Lisa Hutchison, LMHC
Writer & Contributing ExpertLisa Hutchison, LMHC, is a licensed mental health counselor for the Commonwealth of Massachusetts. She works for professionals who want to treat and prevent compassion fatigue. With over 20 years of psychotherapy experience, she helps her clients assert themselves, set boundaries, and increase their coping skills. Her specialty is decreasing stress, anxiety, and depression while increasing realistic methods of self-care for those who help others. Ms. Hutchison’s psychological advice has been featured in Reader’s Digest and the Huffington Post. Her articles have been published in numerous magazines, including Grief Digest and Today’s Caregiver.
Lisa is the bestselling author of I Fill My Cup: A Journal for Compassionate Helpers and a faculty member writer for NetCE. Her latest continuing education unit publication is “Setting Ethical Limits for Caring and Competent Professionals.” She has taught creative writing in colleges and presented on boundaries for the compassionate helper; the use of expressive art to heal grief, anxiety, and depression; inspirational and motivational topics; and creative writing techniques.