Motivating Clients to Change
by David S. Prescott

This is a PDF version of chapter 5 of the Safer Society Handbook of Sexual Abuser Assessment and Treatment.

Even the most well-designed treatment program will fall short if clients are not meaningfully engaged in the change process. Chapter 5 of The Safer Society Handbook of Sexual Abuser Assessment and Treatment addresses one of the most challenging aspects of working with individuals who have committed sexual offenses: how to transform reluctant, mandated clients into willing participants who find genuine value in treatment. Drawing on decades of research in correctional treatment, motivational interviewing, and therapeutic alliance, this chapter provides clinicians with practical strategies to build client motivation and reduce treatment attrition.

The Responsivity Principle and Client Motivation

The Risk-Need-Responsivity (RNR) model has guided effective correctional treatment for decades, yet the responsivity principle often receives the least attention. At its core, responsivity involves ensuring that treatment is tailored to each client's individual characteristics, including their motivation to change. Research shows treatment attrition rates of approximately 27 percent, with the clients who would benefit most from treatment (high-risk, high-needs individuals) being the least likely to complete it. This chapter examines what professionals can do to create environments where change becomes possible for these challenging clients.

David Prescott emphasizes that harsh confrontational approaches have been shown to be ineffective, while research indicates that the most effective treatment providers demonstrate warmth, empathy, and directiveness. The chapter challenges clinicians to consider: under what conditions would they use harsh confrontation when it is more effective to guide clients toward confronting themselves?

Motivation and Goal Setting

The phrase "Focus on what to avoid" displayed in red text on a black background, illustrating the concept of avoidance-oriented goals.

People change for reasons they discover within themselves, not because someone else told them to. When goal setting becomes something imposed on a client rather than a shared process, it is far less likely to succeed. The chapter distinguishes between treatment activities (what clients do) and treatment goals (what clients achieve). Too often, programs conflate these concepts, leading clients to view treatment as a series of tasks to complete rather than a path toward recrafting their lives.

Prescott introduces the distinction between avoidance goals ("I don't want any more victims") and approach goals ("I want people to be able to trust me"). Research suggests that pursuing achievable, positive goals offers a greater sense of fulfillment than goals focused on what one hopes to avoid. The chapter provides detailed guidance on recasting avoidance-oriented goals into meaningful approach goals that connect to the client's own motivations for change.

Motivational Interviewing

The chapter provides an overview of motivational interviewing (MI), describing it as a collaborative, goal-oriented style of communication that pays particular attention to the language of change. The four key aspects of MI's underlying spirit are partnership, acceptance, compassion, and evocation. MI is done for or with someone, not on or to them.

The author describes MI's four therapeutic processes: engaging (establishing a working relationship), focusing (developing direction in conversations about change), evoking (eliciting the client's own motivations), and planning (committing to change and formulating action plans). The chapter addresses how modern MI has moved away from the concept of "resistance," replacing it with two more useful concepts: sustain talk (statements favoring the status quo) and discord (relational disagreement between client and therapist). Case examples illustrate how skilled clinicians can work with these dynamics rather than against them.

Feedback-Informed Treatment

An emerging body of research indicates that incorporating formal feedback regarding treatment progress and the therapeutic alliance can double the effectiveness of services, reduce attrition by 50 percent, and decrease deterioration rates by 33 percent. Feedback-informed treatment (FIT) involves administering two brief scales: one measuring the quality of the therapeutic relationship (Session Rating Scale) and another assessing progress (Outcome Rating Scale).

The chapter provides practical guidance on how to introduce these measures to clients in a way that creates a genuine "culture of feedback" where clients feel free to rate their experiences without fear of consequences. When treatment isn't progressing, clinicians can use this feedback to revisit the goals, tasks, and nature of the therapeutic relationship. Just as there are treatments of choice for different populations, there are also relationships of choice that vary from client to client.

Practical Applications for Clinicians

Throughout the chapter, a detailed case example follows "Anthony," a civilly committed individual who has dropped out of multiple treatment programs. The case demonstrates how clinicians can identify approach goals hidden within statements of hopelessness, work collaboratively with clients who distrust the system, and use feedback to adjust treatment approaches. The chapter also addresses therapist self-care, recommending techniques for getting centered before sessions to ensure clinicians approach their work with the mindful, relaxed presence that makes effective treatment possible.

Supporting Prosocial Change

Treatment succeeds when clients make the case for change, not when professionals argue for it. Although clinicians develop expertise over time, only clients are the true experts on what they want from their lives. The style and spirit of motivational interviewing, combined with careful attention to outcomes and alliances through feedback-informed treatment, provide a strong platform for addressing the responsivity principle. These approaches prove an important axiom: the slower you go, the farther you can reach, and the faster you ultimately arrive at your destination.

Chapter 5 equips clinicians with practical, evidence-based strategies for engaging even the most reluctant clients. For professionals working in sexual offense treatment programs, this chapter offers the tools needed to build meaningful therapeutic relationships that support lasting change.

The author covers the following topics:

• • The Responsivity Principle and Motivation

• • Motivation and Goal Setting
    • • Activities Versus Goals
    • • Avoidance Goals Versus Approach Goals

• • Motivational Interviewing
    • • The Evolving Definition of Motivational Interviewing
    • • Motivational Interviewing and Resistance

• • Feedback-Informed Treatment
    • • Soliciting Feedback
    • • Providing Feedback

• • Getting Centered

• • Afterword: What Is Change?

• • Summary and Conclusions

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