What are the Main Barriers to Engagement in Therapy?

When providing therapeutic intervention to a client, it isn’t uncommon to come across some barriers to engagement within therapy sessions.

By understanding and pre-empting these barriers, therapists can plan how to overcome the barriers to prevent a disruption throughout the therapeutic intervention.

We recently conducted a survey called “State of Mind” to get a deeper insight into the therapy sector, including the barriers to engagement therapists face from clients and how they overcome them.

What are the Most Common Barriers to Engagement?

From the survey, we found that the most common barriers to engagement included:

• Professional improvement
• Price
• Parents availability to facilitate children attending sessions
• Lack of understanding of reason for referral
• Lack of trust
• Hesitation and avoidance
• Feel pressured into attending
• Client being uncomfortable in a new environment with strangers
• Client doesn’t believe that they need therapy
• Availability
• Attachment style of client

Out of all these identified barriers to engagement, the most common, with 60% of therapists agreeing, was hesitation and avoidance from clients and that clients don’t believe that they need therapy.

This isn’t surprising given the variety of circumstances that have brought people to therapy, and what expectations they have for the process. They might have sought it out for themselves because they are familiar or curious about the process and believe it can help them with issues that they know they are experiencing.

However, it’s often because they’ve been recommended to seek the support by friends or loved ones or have been signposted by their GP. In this case, the client might not have a clear understanding of how therapy works or what they want out of it.

It’s also very common for someone in their family to have insisted that they get therapy, rather than suggested. In this case, they might be fully dismissive of the process or keen to find a quick fix and then decide it’s helped as much as it’s going to. It’s worse still if the client has arrived at the therapy room because it’s been mandated by the courts or social services. This is, sadly, one of the more common circumstances for therapy to be commissioned.

The therapeutic relationship relies on interpersonal trust, open communication, and emotional congruence. This is difficult to achieve under the best circumstances, and requires a period of building rapport and familiarity, no matter how eager both people are to engage. That’s because therapeutic work inherently involves engaging with deeply uncomfortable and disturbing feelings, something that we naturally avoid unless we’re making a deliberate effort to confront them.

Making that effort to engage despite the discomfort, especially over a long period, often requires a deliberate, genuine desire to work through the issues the client is dealing with, and a willingness to receive the emotional support and guidance of the therapist.

As such, it’s extremely difficult to achieve meaningful results if the client doesn’t have a clear understanding of what they want from therapy or is only complying to achieve somebody else’s intended outcomes for a change in their behaviour because they feel threatened or coerced to attend.

What Techniques, Tools or Strategies are Used to Overcome These Barriers to Engagement?

By identifying these barriers, we also wanted to understand how therapists overcome them. This is what we found:

• Writing letters for regular non attendees
• Rephrasing “therapy” to something else i.e., “special time”
• Reflecting together on non-attendance
• Planning sessions together
• Offering early evening times and weekends
• Offering different locations
• Motivational interviewing style techniques
• “Getting to know you” activities
• Creating a bridge to trust and therapeutic alliance
• Checking in pre and post session

We found that the most common technique therapists use to overcome barriers of engagement within therapy sessions is by creating a bridge to trust and therapeutic alliance.

This can be achieved through effective and reciprocal communication but will often require time and patience on both sides of the clinical relationship. For the therapist, their involvement in building this bridge can also look like addressing any disparities in power dynamic at play in the clinical relationship and affirming or asserting the client’s agency in the process where appropriate and necessary.

Do you face these barriers and use the techniques mentioned, or face other barriers? Our dedicated “State of Mind” page has more information and a link to the survey, where you can have an input into our findings.