How to Get Clients to Open Up Without Scaring Them Off

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“I am not comfortable telling you my family’s history of mental health conditions, it’s embarrassing.”

Though unsurprised by this statement, I was stunned by its disclosure. Actually, I was pleased, because in my clinical experience, I am rarely able to address these feelings since they are not typically shared with me in some cultures. Instead, questions about family mental health history and the longevity of mental health symptoms are usually unanswered or minimized. This underreporting of symptoms in certain cultures to mental health clinicians can be harmful because it impedes proper diagnosis of mental health conditions and treatment aligned with the condition. Since I knew that these feelings interfered with my gathering of information, I changed course to reduce the “embarrassment" that this person endured. Instead, I created an environment that allowed this person to feel at ease with sharing information.

To avoid scaring mental health clients off, my recommendation is for practitioners to focus on building trust, showing empathy, and creating a welcoming, nonjudgmental environment. I decided to use empathy and cultural sensitivity combined with normalizing mental health and psychoeducation. This also allowed me to foster rapport and comfort with this client and this is how I did it:

1. Empathy

You do not need to be of your client's culture to show kindness and concern. It is more important to listen and understand their feelings. What I do is to encourage communication by my verbal and non-verbal expressions. For example, I stop what I am doing (i.e., taking notes) and fully place my focus on the client (i.e., sustained eye contact, nodding, and friendly smile) to convey attentiveness. I actively listen without interrupting or rushing to conclusions. Make sure that you reflect and validate their emotions to show understanding.

2. Cultural Sensitivity

Respect the client’s cultural background and how it may influence their perception of mental health. Tailor your approach to align with their cultural values and beliefs. Do not be afraid to address stigma and barriers because these thoughts do matter in some cultures. Acknowledge and be supportive of societal stigma. Normalize those feelings since they can cause hesitancy about opening up. Remind them of confidentiality to reassure them that their disclosures are private and protected.

3. Normalization of Mental Health

Everyone has a story. If comfortable, share one of yours to help your client understand that their feelings are not isolated. Even as a professional, you can still relate to feelings of apprehension about disclosing personal issues to your own practitioners. This allows you to seem human and relatable to your client. In this same vein, normalize mental health and discuss it as a common and important aspect of well-being. Emphasize that seeking help is a strength, not a weakness, because in some cultures it is considered a deficiency. When appropriate, use examples or anecdotes to demonstrate that others have faced similar challenges. I tend to use real-world examples regularly with clients to assist them with comfort and disclosure.

4. Psychoeducation

You do need to explain the reasons why full disclosure of symptoms and history are necessary components of diagnosis and treatment. Even when we are empathetic and relatable to the client, we still need to stay focused on the outcome. This can be achieved through the psychoeducation that you provide to your clients. Educate your clients about mental health symptoms and treatment options to empower them and reduce fear. Explain the importance of disclosure in tailoring effective treatment plans. In some instances, I taught clients how underreporting does hurt the diagnostic process (i.e., the difference between Attention-Deficit/Hyperactivity Disorder (ADHD) versus Autism Spectrum Disorder).

You may choose to use these strategies and add your own. The point of this post is to provide you with a frame of reference to support your interventions with more resistant clients. You may be asking, how did these strategies work to reduce the "embarrassment?" In this case, the resistance was lessened due to my techniques and the client's supportive family who started working through the apprehension before our meeting. However, I have faced this challenge many times. Since I am already aware that research shows that empathy, active listening, and cultural competence are critical factors in encouraging disclosure and engagement (Norcross & Wampold, 2011; Sue et al., 2009), I know what helps these clients' comfort levels.

By employing these strategies, you too can foster an environment where clients can feel comfortable and supported while discussing their mental health. The supportive environment that you create will allow your clients to remain engaged and benefit from mental health services. Using these strategies will also remind you that, “Cultural competence and personalized care have been shown to improve engagement among diverse client populations” (Sue et al., 2009). Clients may still approach disclosure at their own pace; however, continue to ensure that they will receive support from you when needed. Be patient and keep an empathetic stance, and clients will feel secure enough to open up, ensuring a more effective and supportive experience.