Cutting-edge Behavioral Healthcare is client-centered …

Accurate identification of the stage of change &/or stage of treatment that any client occupies is foundational to all that happens next! The great tragedy of behavioral healthcare in the United States is the disconnect between a multitude of treatment interventions designed for the action-stage client, and the client who is not yet action-stage ready to change. Although Motivational Interviewing1 has been an available part of the solution to this disconnect for over 30 years, consistent and effective implementation of a service array for less-than-action-stage clients is not yet as commonplace as it needs to be. Much lip service is given to the research finding that the single biggest predictor of a positive behavioral health outcome is the quality of the relationship between helper and service recipient, but how is that connection actually optimized? Engagement skills need to occupy an important place in every change agent’s toolbox, and the teaching and practice mastery of such skills should be a priority for cutting-edge behavioral health organizations. Progress in this direction is informed by the conclusions and recommendations of the Task Force on Evidence-Based Therapy Relationships, representing the research findings of the Society for the Advancement of Psychotherapy and including evidence-based elements as well as practice-based methods of adaptation.2 Many may recognize the relational elements on the following list: Alliance in individual, youth & family therapy; Cohesion in group work; Empathy; Collecting client feedback; Goal consensus; Collaboration; Positive regard; Genuineness; Repairing alliance breaches; Managing countertransference; Expectations; & Attachment style. Many may also have some exposure to available methods of adapting practice in response to the following diverse client features: Reactance level; Preferences; Culture; Spirituality; Stages of Change; & Coping Style. The effective behavioral healthcare provider of the 21st century will feature staff with trained exposure, supervised monitoring and support, and eventual mastery of these domains of knowledge and skill.

1 Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: helping people change and grow. Fourth edition.

2 Norcross, J. C. (2014, June). Conclusions and recommendations of the Interdivisional (APA Divisions 12 & 29) Task Force on Evidence-Based Therapy Relationships. [Web article]. Retrieved from