Why We Need to Stop Calling Clients “Non-Compliant”

Written By: David Baker, LPC

I know it’s probably dangerous to quote the title of a song recorded in 1984 by a band called Twisted Sister in a blog about mental health-related topics because 1) it certainly dates me a bit (though I promise you I wasn’t really a Twisted Sister fan in my youth) and 2) as a protest song (and I know you’ve probably heard it and maybe even sung along with it) it makes some pretty strong statements. But I think the title and the sentiment behind the lyrics of the song make a pretty good point about not trying to force people to fit into a box they don’t belong in.

I can already hear you asking “So what does that have to do with non-compliant clients?” My response is: “A lot!” Let me explain. Most of the time when we identify a client as “non-compliant” what we are saying is “They aren’t doing what I or someone else thinks they should be doing.”

For example:

• “They aren’t keeping appointments”
• “They aren’t taking their medicine”
• “They aren’t returning my calls”
• “They aren’t using the skills I’m teaching them”
• “They aren’t getting anything out of the therapy I’m providing”
• Or you fill in the blank

Usually “non-compliance” has more to do with what I think my client’s unmet needs are than with what my client thinks their unmet needs are.

At the risk of giving Twisted Sister more credit than they might deserve for brilliant therapeutic insights, think about these lines in the context of the clients you work with who you think of as “non-compliant”:

“We’ve got the right to choose it/There ain’t no way we’ll lose it/This is our life, this is our song”

and

“We’ll fight the powers that be just/Don’t pick our destiny ’cause/You don’t know us, you don’t belong” 

While these sentiments may be somewhat overstated (and I’m probably stretching these lyrics way beyond their intended purpose…), I think these lines make the point that people have the right to choose their destiny and when this is challenged or disregarded the response is usually to fight or flee from whoever is trying to force us to do something we didn’t choose.

So when your client is “non-compliant” maybe what they’re telling you is there’s something about the help they are getting that they don’t want to “take.” If we are accurately reflecting in treatment the unmet needs our clients have asked us to help them to address, than “non-compliance” is a non-issue as a client can’t be non-compliant with themselves.

I think these lines make the point that people have the right to choose their destiny and when this is challenged or disregarded the response is usually to fight or flee from whoever is trying to force us to do something we didn’t choose.

So, what do we as therapeutic helpers do when we our clients become disengaged from treatment? I think the first and best thing we can do is to listen. Sometimes the listening is easy because our clients are singing as loud as Twisted Sister letting us know that they don’t want what they’re being offered by us – “We’re  not gonna take it!” More often than not though the listening requires a little more skill because the communication isn’t so “in your face.”

In an article on addressing resistance in therapy the following statement was included: “…resistance is a signal that the client views the situation differently.  This requires that [staff] understand the client’s perspective.  This is usually a signal for [staff] to change direction or to listen more carefully” (http://rssw705.tripod.com/id15.html).

The point is in order to better align treatment with the client’s unmet needs we need to make sure we understand our client’s unmet needs. For our clients to stay involved in treatment we need to create the positive motivation for them to stay involved in treatment. If we haven’t asked them why they aren’t engaged, we need to. If we haven’t given them the freedom to have a different point of view than ours and express that point of view, than we need to give it. If we haven’t put ourselves in our client’s shoes as best we can and tried to understand the challenges they are facing from their point of view, than we need to. And we need to be willing to acknowledge that while we may have a lot of experience and education in providing help to other people, our clients are still the experts on their own unmet needs even if they don’t always know it. So we need to make sure that we are developing the skills to hear in all the various ways our clients are expressing those unmet needs and then help our clients tell us how we can assist them to most effectively and positively meet those unmet needs.

And we need to be willing to acknowledge that while we may have a lot of experience and education in providing help to other people, our clients are still the experts on their own unmet needs even if they don’t always know it.

Finally, there will be times when our clients continue to tell us straight up “We’re not gonna take it anymore!” and our response will have to be “OK” because our clients have the right to make that choice. It’s their treatment. Hopefully that will be after we have made every effort we can to listen and have exhausted every possible avenue for creating motivation to access the help we have been trained and want to provide.

Oh and if you’re feeling lost without the word “non-compliance” in your vocabulary, I guarantee you if you put yourself in your client’s shoes and try to see things through their eyes you’ll probably come up with something more positive to use.