Engagement...in therapy!

Most people think of the word engagement and automatically start imagining a tiny box, a diamond ring, and someone down on one knee. I think of engagement and start thinking about therapy. Strange, huh? Well, if you think of what the word actually means, it's not too strange. The noun engagement is "the act of engaging or the state of being in engaged." The verb engage is "to occupy the attentions or efforts of (a person or persons)." In my last post I talked about the stigma surrounding mental health issues and treatment. I mentioned some really sad facts about the rates of mental health need and the actual percent of people receiving adequate services for those needs. Part of it has to do with the identification of mental health need, so as a community, being able to spot people in need of mental health services, whether at the disorder-level or just going through a rough patch in life, is extremely important. Another part of the equation is convincing people to go to therapy if they need it. A lot of times, individuals don't recognize their struggles or don't want to admit to them. Other times, issues like stigma make them afraid to seek out treatment even if they know they are having some sort of difficulty. This is where mental health literacy comes in...simply raising awareness as a general public that people have all sorts of issues they're dealing with and understanding that psychological services may help them be more emotionally healthy.

A third facet is the what's called on-going engagement, or active participation in treatment. Sometimes people who end up in therapy just don't want to be there. They might be there because a partner threatens to leave them if they don't get help. They might be a child whose parent is bringing them in. They might be mandated by a court to get counseling. There are all sorts of reasons. Even people who seek therapy on their own may not really feel like they need to be there. Low engagement can manifest as poor attendance, frequently cancelling sessions or no-showing. It might be constantly running late and showing up with only 20 minutes left in the 50 minute session.  It can be lack of compliance with the therapist's suggestions. It might simply be a bad attitude and unwillingness to discuss issues. In the worst case, and altogether not infrequent case, clients simply drop out of treatment.

Whatever the reason and whatever the symptoms of low engagement, as professionals, we have a responsibility to pay attention to those things. As researchers, we have a responsibility to figure out ways to address those issues. Since there are so many people in need of mental health services and so few of them are getting care, let's do the best we can to give the highest quality care possible to those who make it to our clinics.