Gaining emotional permission

Actually, you really don't have permission to be probing every area of someone's life unless they have
invited you to do that.  Getting clear what they want is empowering to them and it results in their giving
you permission to do your assessment.  Just because they signed your consent for treatment form
doesn't automatically mean they have given emotional permission for you to probe sensitive and painful
areas of their life. When you link the assessment to what is most important to the client that is both
respectful as well as more effective. It also increases client accountability and self-change.
 
Monitor and check at every visit
At every visit, deliberately monitor if your clients are getting what they want.  Check yourself for
whether your work with them is a good fit. We want to "keep them coming back" until they are showing
self-propelled, improved function and outcomes.
 
Always ask- What's working? What's not ?
When working with clients, it really is "all about them" and not you.  When you start with what is
important to them, and stay with what is important to them, the assessment and treatment process falls
into place.  You are simply assessing and collaborating with them on what has worked (and what has not
worked in the past) in getting what they want. Furthermore you are checking in with them on their
experience since your last session with them, whether an individual or a group session.  You are
continually asking: what has worked or not worked in reaching their goals.
 
What's important right now ?
Engage the client by a focus on the treatment contract which can be developed using the What, Why,
How, Where and When.  Identify what is most important to the client at this point in time.  

Explore the “What, Why, How, Where and When” to Develop the Treatment Contract.

We want to develop a truly participatory treatment plan, one most likely to succeed in being followed. First be clear what the client
really wants, not what they’ve been told they need; or what you (perhaps correctly) feel they need to change, or what they think the
clinician wants to hear. Determining what the client wants means going deeper beneath the surface of a rote presenting complaint
like “Depression” or “Brought in by the police”. One method is to ask the “What, Why, How, Where and When”. This explores:
> What a client wants—
> Why the wants are so important to the client & Why now—
> How s/he intends to achieve that goal—
> Where and When s/he is willing to act on the treatment plan.

The police may well have brought in the client, but what the person states is that he wants “to be left alone”. The treatment contract
can genuinely be based on this specific “want”.
Client: “I want to be left alone.” Therapist: “I will help you to be left alone.”
Take the client at his/her word. You can then discuss why people are not leaving the client alone, and what he/she would have to do
differently to get people to leave him alone.
 
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CLIENT CLINICAL ASSESSMENT TREATMENT PLAN
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does client want?
What does client need? >What is the treatment contract?
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Why? What reasons are revealed by the
WHY?> What’s the level of Is it linked to what the client wants?
assessment data?
commitment?
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How will s/he get there? How How will you get him/her to accept the
HOW?> Does the client buy into the link?
quickly? plan?
Where
Where is the appropriate setting for treatment? Referral
WHERE?
will s/he do this? What is indicated by the placement to level of care
criteria?
What
When When?
is the degree of urgency?
WHEN? will this happen? How quickly? How soon? What is the process?
How badly What are realistic expectations?
What are the expectations of the
does s/he want it? What are milestones in the process?
referral?