Engaging hard to engage clients: a Q methodological study involving clinical psychologists

This research uses Q methodology to collate a number of techniques, and to investigate what techniques are used to encourage engagement across a number of clinical psychology specialities. Eleven groups of participants from different clinical specialities were interviewed in order to develop a set of 51 statements reflecting engagement techniques that clinicians felt that they were likely to use with 'hard to engage' clients. Seventy-five participants from a similar range of specialities were then asked to Q sort these statements and provide other demographic information. Forty-four participants returned completed Q sorts which were factor analysed by a tailored program (PQ Method) to investigate how the statements fall into patterns that reflect ways clinicians approach engagement. Varimax rotation produced five factors, four of which were able to be interpreted by participant information and comments. These accounts were taken back to some of the initial participants for 'reflexive correction' (Stainton Rogers, 1995). The four factor patterns are discussed in relation to existing literature and the research questions. These identified factors are: (i) the client focused approach; (ii) the interpersonal professional; (iii) the 'eclectic' or systemic approach; (iv) the expert listener. The implications for training, clinical practice and research are discussed.