Putting Trust Right Out On the Table

Mar 07, 2017

“We are what we pretend too be, so we must be careful what we pretend to be.”

from Mother Night
by Kurt Vonnegut

Putting Trust Right Out On the Table

TISA Description of the Problem: As clinicians we are often asking clients to make changes in their lives, in essence to make promises both to themselves and ourselves, and often to family members as well. Such moments of commitment to keeping ones word may include “promises” with great variation including: the promise to go to an AA meeting, a promise to have their child seen by a child psychiatrist and, in a more intense arena, the commitment to a safety contract or a collaborative safety plan with a client having suicidal ideation. In all of these instances, we are dealing with the art of gauging the intensity of a client’s intention to change – the power of their motivation. A myriad of useful ways to gauge client motivation exist, some more effective than others. In the following provocative tip, Donna Hilbig M.Ed, LPC makes the practical suggestion that perhaps we should simply ask! I think she is on to something.

Tip: When asking clients to make commitments, such as safety contracts, I find that the following two questions – when asked to clients who seem to be well engaged with me – can be useful, often resulting in some intriguing insights, heart-to heart discussion, and a more realistic appraisal of the client’s level of intent.

1. “Are you a person who keeps their word? If not, what should you and I do when we are trying to see if you will do what you say?”

2. “If you sometimes have trouble keeping your word, is there a person with whom you tend to keep your word and who might be able to help us to help you to do so now?”

TISA Follow-up: With clients who are well engaged, sometimes the best approach is the one staring us in the face – just ask directly. The resulting frank discussion can be refreshing, yield a more accurate estimation of the client’s intent, and even (with Donna’s second question) lead to work with collaborative supports such as family members and friends. Many thanks to Donna for a useful set of interviewing tips.

Tip provided by:

Donna Hilbig, M.Ed., LPC
Methodist Healthcare System
Psychiatric Assessment Team
San Antonio, Texas

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