Court-Ordered versus Voluntary Clients: Problem Differences and Readiness for Change

Many social work clients are more or less coerced into receiving services for a variety of reasons. Some clients are legally mandated by the courts because they have committed criminal offenses related to domestic violence, child abuse, mental disorders, or substance abuse. Court-ordered clients have been labeled by practitioners as resistant, hard to reach, hostile, and un-motivated (Goldstein, 1986; Miller & Rollnick, 1991; Rooney, 1992). They often have the problem defined for them and the treatment imposed on them. Although many practitioners have seen a lack of motivation as unconscious denial and resistance, a more likely explanation in many cases is simply the client's refusal to cooperate with treatment goals or procedures they neither requested nor agreed to (Ewalt, 1982). Despite the profession's implicit faith in the benefits of unwanted treatment, there is little evidence that this approach to therapeutic jurisprudence helps, and there is some reason to believe that it may cause harm (Wexler, 1991b). Given the immensity of social work's investment in working with involuntary clients, court-ordered treatment raises serious questions about treatment ethics and effectiveness. Therapeutic Concerns in Treating the Involuntary Client There are at least two reasons why coercion militates against effective treatment outcomes. First, most treatment models in social work assume a reasonable degree of voluntariness by the client (Behroozi, 1992) and call for a generally positive client-practitioner interaction (Garfield, 1994). Second, oppressed groups are disproportionately represented among court-ordered clients, a fact that threatens to carry social power imbalances into the helping relationship (Pinderhughes, 1989). This situation may account, in part, for the significantly higher dropout rates in clinical settings of members of disadvantaged groups (Sue, Zane, & Young, 1994). It appears that although court-ordered treatment may be a well-intended alternative or complement to punishment, it may undermine the effectiveness and morale of social workers, do little to improve the lot of the offender, and promise unachievable benefits to the general public. Gauging Readiness for Intentional Change Given that voluntariness exists on a continuum, referral source alone cannot adequately gauge "where the client is." Other related constructs need to be examined. The stages of change, grounded in the transtheoretical model of change (Prochaska & DiClemente, 1984), may provide such a link. The Stages of Change Scale (SOCS), developed with a variety of client groups, comprises four stages: (1) precontemplation, in which the client minimizes or denies the problem, sees others as the cause of his or her difficulties, and feels coerced into treatment; (2) contemplation, in which the client is aware of a problem, is considering changing, and has some expectation that therapy may help; (3) action, in which the client begins to take steps to work on the problem; and (4) maintenance, in which the client has already made changes and may have sought treatment to consolidate previous improvements (McConnaughy, DiClemente, Prochaska, & Velicer, 1989). A recent article outlining methods for treating resistant drug abusers noted the serious lack of research in treatment of precontemplators (Barber, 1995). However, some evidence has confirmed that precontemplators are common among samples of people seeking treatment for mental health problems (McConnaughy et al., 1989), alcohol abuse (DiClemente & Hughes, 1990), and a range of other problems including cocaine abuse and juvenile delinquency (Prochaska et al., 1994). Method The study described in this article addressed two main research questions. First, it was hypothesized that respondents in a sample of outpatient mental health clients who were court ordered to treatment would express less concern about their problems than voluntary clients. …