THERAPIST FACTORS
Frequently we are asked what therapist variables
lead to success in recruiting. The following four principles are devoted to such factors.
Principle 16: An important recruitment variable is the
extent to which the
therapist shows interest in the family through hir willing-ness to expend considerable effort in engaging thenz. From our experience, there are a number of therapist
characteristics and atti-tudes that lead to more favorable recruitment
rates. These include the following:
I . The
therapist must be energetic. The recruitment process can be demanding in time and effort. Rather than expecting to sit in his office, the therapist should be willing
to get out into the field and make
home visits.
2.
Enthusiasm for the work is obviously essential.
Sager et al.'26 noted
a reluctance by many of their therapists to work with -poorly motivated- families.
3.
The therapist must be persistent and able to
tolerate rebukes by family members.
4.
Flexibility and lack of rigidity are necessary,
since they allow therapists to adroitly counter family resistance moves.
5.
The therapist must be convinced of the value of his
endeavor and feel that it will be
helpful to the family. This conviction
will be conveyed to clients, and will help to change their negative -set.-
Principle 17: Providing incentives
to therapists for each success-fully recruited case increaser the
rate of success. Early in the life of our project the therapists began
to complain that they were paid to do therapy and the recruitment
effort was demanding an inordinate amount of their time. If this objection had been
allowed to dictate our procedures, we would have been left with an
unacceptably small, select sample, composed of -easy- or highly
motivated families. Thus we were forced to rearrange our priorities and
shift incentives. We did this by making a portion of the therapists'
pay contingent upon successfully recruiting families—a bonus
system. This had the double advantage of (1) reordering therapists'
priorities through tangibly
Principle 18: The program must be structured in a way that does not allow therapists to back down
from enlisting whole families. This is a crucial point. We are convinced that if we had not held firmly to our requirement that the total family—or at least
the IP, both parents, and siblings
living in the home—be involved, the therapists would have settled for less. Without this mandate, we
estimate that one-third of our
families would have arrived incomplete, and treatment would have commenced without one or more important
members. It would have been too easy
to proceed with only the most willing participants.
Vignette 15. Adherence to Principle 18 sometimes had unexpected benefits. In one interesting example (in a case
seen by David B. Heard, PhD) the
recruitment requirement prevented a potential problem from developing in our research and treatment design. The addict in this case was in trouble with the law
(although we did not know it at the
time) and had a court hearing pending. Heard devoted great energy, including seven individual interviews
plus numerous telephone calls, toward getting the IP to agree to engage his
family. As the situation developed,
it appeared that all members except the stepfather would agree to participate (the natural father was de-ceased). However, Heard could not make direct
contact with the stepfather. This
process went on for approximately 21/2 months with no results. Eventually the addict was caught
selling drugs at the treatment center
and was discharged for disciplinary reasons. He defected to another program and soon thereafter went to jail. We later learned from a counselor in that program that
(1) the addict had been facing
serious legal charges for some time, and (2) he had no "stepfather."
The person the addict was trying to bring in as his stepfather was his uncle. Apparently the addict was trying to avoid prison by presenting a case to the judge that he
was motivated to change, had entered a treatment program, and that his effort
was earnest to the point where he
could claim, "See, even my family is involved with me in treatment." However, he
knew that we would
Principle 19: A mechanical approach to recruitment it insuf-ficient to guarantee success—flexibility and skill are crucial if the therapist is to avoid getting deadlocked. While the initial interview procedure described in Chapter 3 can probably be
handled by most experienced clinical
interviewers, recruitment of the whole family is more difficult. The latter demands a certain level of skill in dealing with families—essentially the kind of experience
one gets in per-forming family
therapy. Not only must one be able to show proper empathy and effective joining techniques, but one
must also be able to respond to family
interaction patterns.
The importance of recruiter skill cannot be overestimated.
We do not agree that positive results
are primarily due to "highly moti-vated therapists.- Therapists must be
able to adapt the basic princi-ples of recruitment flexibly and
creatively in order to meet the unique requirements
of each case. Simply -plugging away- is insufficient. As in Vignettes 10 and 11, a skillfull recruiter can
sometimes get results with a minimum
of well-directed effort, much like the judo flip succeeds when direct overpowering will not.
