I Want Your Help, Not Your Recommendations!

How can therapeutic independent educational consultants and therapeutic programs work with parents who say they want help but resist recommendations? Wanting help only implies having an interest, whereas following recommendations requires engaging in behavior(s). Think of how people may be interested in wanting help to get into better shape or in taking diligent care of their health, yet often do not implement an exercise plan or follow doctors’ advice.

“Readiness for change” is an important organizing concept that overlaps with motivation.

Self-evidently, people in lower states of readiness for change are less likely to follow professionals’ recommendations. (Those that accept recommendations blindly might also have low “readiness” in disguise—sometimes they “just want to get it over with.”) Relatedly, all help-seekers start with some degree of ambivalence because making life changes, no matter how desirable, is disruptive. Assessing readiness for change is also helpful in fine-tuning timing for providing recommendations. Interestingly, asking for help with the highest urgency does not imply a commensurate readiness to act.

Certain variables regarding whether recommendations are followed are unique to the individual in question. Some people do not follow recommendations because they cannot connect the dots. Others well-understand why they should follow recommendations, but lack the requisite focus or frustration tolerance, or cannot abide being told what to do.

Similarly, personality traits such as perfectionism, difficulty showing vulnerability, needing to control the narrative, negative lifestyle issues, the presence of compelling psychological problems, or a “nothing will work” outlook can also affect whether recommendations are followed. Situational factors such as relationship conflicts, financial pressures, or job pressures may also be in play. Sometimes personal and situational issues are obvious, but they can also bubble beneath the surface and require extensive exploration and rapport-building to uncover.

Moreover, recommendations from professionals are made and received in a societal context. In our post-pandemic society, unfortunately, trust in professionals has eroded, leading many people to rely on information from the internet and social media, and “do my own research.” Of course, skepticism regarding professionals does not preclude having unrealistic expectations of them!

Relevance to IECs

Parents who ask for IECs’ help arrive in different states of readiness to act. There are formal “readiness to change” measures, but sometimes all it takes is to ask parents to rate theirs from 1–10. Scores of 7 or lower suggest the need for further attention to the readiness process. Higher scores present an opportunity to reinforce parental commitment to making and following a plan of action.

However, readiness for change can be quite variable—meaning it could be ebbing right before recommendations are provided! Another consideration is that parents may differ in their readiness for change. Therefore, we highly recommend assessing parental readiness for change frequently in the process, both as individuals and together for couples, especially close to decision points. It’s also important to time this feedback to when recommendations seem most likely to be well received. Unfortunately, some parents will demand recommendations ahead of their readiness to receive them.

Red flags suggesting a lack of parental readiness for acting on recommendations include endless negotiating, going from “gung-ho” to “I don’t know” in the blink of an eye, and shooting the messenger, as well as signs of problematic parenting habits like over-accommodating negative behaviors, difficulties setting boundaries, being easily guilt tripped, lack of parent cohesion, or a history of being reinforced for inaction. When such issues are severe, referring out for parent training to support their work with IECs and overcome their “stucks” may be indicated. Similarly, if a parent has personal or situational issues that are blocking progress, a referral for individual therapy may be warranted. Just as a reminder, a few self-guiding questions for IECs to ask themselves before making recommendations that parents are unlikely to follow include: Do these parents really want what they say they want? Do they truly “get it?” Can they do it?

We suspect these are interesting times for IECs. On one hand, there is more need for expert guidance in finding the correct educational or therapeutic pathways for young people, and many parents seem confused about their role and how to balance being both an effective and loving parent. On the other hand, IECs must make recommendations not only in an atmosphere of general distrust of professional expertise, but also against the headwinds of negative stories in the news about the sorts of schools and programs they might recommend. Speaking proactively and straightforwardly with parents about anything they are concerned about based on such stories seems like the best approach.

Statistics are lacking regarding rates of parents following the recommendations of IECs. Without such data, an individual IEC does not know whether the rates of parents following recommendations in their practice are par for the course. Information is also lacking on the reasons parents state for not following the recommendations of IECs. Wouldn’t it be great to have well-designed studies showing that following IECs’ recommendations is associated with better outcomes, like how following doctors’ orders is associated with more successful medical outcomes? We understand, however, that recognizing the importance of conducting such research is increasing.

Finally, absent guiding studies, IECs can do some of their own personal research by keeping a record of rates of parents following or not following their recommendations, and why they think either outcome might have occurred, or if in retrospect there were red flags. Using a checklist to ensure they have spoken with parent(s) about key concepts like readiness for change, dealing with their expectably ambivalent thought patterns, personal and situational barriers potentially impacting their ability to follow recommendations, and the inherent unknowns in taking even well-considered next steps can also be helpful.

No matter what, there will always be parents who will not follow IECs’ recommendations. Even so, the hope is that such parents will at the very least walk away from the consultation experience with more self-awareness and valuable information for taking next steps, if and when they are ready.

By Jonathan Hoffman, PhD, ABPP; Michele Bechor, PhD; Katia Moritz, PhD, ABPP; and Dee Franklin PsyD, LMHC

From the Summer 2024 issue of IECA’s Insights magazine

Sources

APA 2023 Practitioner Pulse Survey (2023). Psychologists reaching their limits as patients present with worsening symptoms year after year. https://www.apa.org/pubs/reports/practitioner/2023-psychologist-reach-limits

DeMille, Steven & Tucker, Anita R. & Gass, Michael A. & Javorski, Steven & VanKanegan, Christie & Talbot, Brett & Karoff, Maggie (2018). “The effectiveness of outdoor behavioral healthcare with struggling adolescents: A comparison group study a contribution for the special issue: Social innovation in child and youth services,” Children and Youth Services Review, Elsevier, vol. 88(C), pages 241-248. DOI: 10.1016/j.childyouth.2018.03.015

Gass, M., Wilson, T., Talbot, B., Tucker, A., Ugianskis, M., & Brennan, N. (2019). The Value of Outdoor Behavioral Healthcare for Adolescent Substance Users with Comorbid Conditions. Substance abuse: research and treatment, 13, 1178221819870768. https://doi.org/10.1177/1178221819870768

Laranjeira, C., Carvalho, D., Valentim, O., Moutinho, L., Morgado, T., Tomás, C., Gomes, J., & Querido, A. (2023). Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis. International journal of environmental research and public health, 20(5), 3869. https://doi.org/10.3390/ijerph20053869

Malik, M., Kumari, S., & Manalai, P. (2020). Treatment nonadherence: An epidemic hidden in plain sight. Psychiatric Times, 37(3), 25-26.

NATSAP: The State of Therapeutic Schools and Programs. (2023). https://natsap.org/page/StateOfTherapeuticPrograms

Pew Research Center. (2023). Americans’ Trust in Scientists, Positive Views of Science Continue to Decline. United States. [Web Archive] Retrieved from the Library of Congress, https://www.loc.gov/item/lcwaN0002821/

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288. https://doi.org/10.1037/h0088437