IECA Conference Presentation: Alleviating the Perception of Coercion and Eliciting Autonomous Motivation During the Admission Process

On Friday, May 8th, 2015, our founder–Clinton J. Hardy–and Dr. Neal Christensen had the opportunity to present, Alleviating the Perception of Coercion and Eliciting Autonomous Motivation During the Admission Process, at the IECA (Independent Educational Consultants Association) Conference in Baltimore, MD.

We would especially like to express our gratitude to the educational consultants and program representatives who attended the presentation in Baltimore.  For those who were unable to attend, we have included a summary of it for your reference.

Drawing on research and well-established psychological theory, Clinton Hardy and Dr. Christensen addressed the following questions: (a) How do adolescents experience coercion during admission and what effect does this impose on the adolescent and therapeutic process? (b) What can IECs (independent educational consultants), programs, and transport do to alleviate the experience of coercion and foster autonomy (vs. control) during a coerced admission?

In particular, although a diverse range of coercive admission methods exist, how an adolescent subjectively experiences the admission seems to be the most implicative.  In other words, the adolescent’s perception is perhaps more important than the actual admission method employed.  This is not to say that the method of admission does not matter, but rather that how an adolescent experiences the method of coercion, such as a youth transport or parent pressures, can vary depending on various contextual factors embedded within the overall treatment admission process.

Although only a limited amount of coercive treatment research exists in the private residential and wilderness therapy program sectors, other mental health research has uncovered at least three factors that can impact an individual’s (adolescent’s) perception of coercion during admission, namely, admission pressures (including both positive and negative pressures), “voice” (i.e., whether or not the individual was able to express themselves during the process, irrespective of the outcome), and the perceived motivation of others.  For instance, the research suggests that when a coerced (adolescent) person (a) experiences positive (vs. negative) pressures, (b) believes they had the opportunity to express their concerns and thoughts about the treatment decision, and (c) perceive the motivation (and intentions) of others as genuinely sincere, they are in turn more likely to report less coercion (and in some instances no coercion) at the time of admission.  Even in circumstances where negative pressures are experienced, minimal coercion may still be reported if positive pressures were exhausted first.  In essence, whether or not an adolescent (or individual) experiences high coercion seems to have a lot to do with certain underlying processes and the context in which they occur versus the actual method of coercion used per se.

Therapeutic educational consultants and program admission staff should be focused on reducing the experience of coercion for a number of reasons.  Specifically, myriad negative effects have been (empirically and theoretically) linked to the perception of coercion, including but not limited to: negative emotional states (e.g., anger, hostility, fear, resentment), decreased motivation and reduced participation, hindered therapeutic working alliance, psychological reactance (i.e., tendency towards oppositional behavior), decreased satisfaction and adherence to treatment, negative attitudes toward future treatment, and diminished treatment outcomes.

Although these findings have not been specifically cited in the private residential and wilderness program literature–given that no research currently exists–one recent wilderness therapy program study found several implications linked to the perception of negative admission pressures, which is a strong predictor of perceived coercion.  Specifically, in a study that comprised 76-adolescent wilderness program participants, Hardy (2014) reported that the increased perception of negative pressures was significantly associated with four adverse emotional reactions at admission: (a) increased emotional distress (r = .521, < .001), (b) decreased emotional positivity (r = -.363, p < .001), increased emotional hostility (r = .565, p < .001), and (d) increased emotional fear (r = .359, p = .007).   Also of note, Hardy’s investigation reported these effects to remain almost unscathed after accounting for the overall psychological well-being of each adolescent.  That is, contrary to what was anticipated, the mental health symptoms reported by adolescents did not relate with their reports of experiencing increased negative pressures during admission.  This poses the idea that whether or not adolescents experience negative pressures during admission into a wilderness therapy program may have no association with the severity of their mental health.  While this study carried several limitations and was not conclusive, it remains the only study of its kind within the private sector of adolescent residential treatment and wilderness therapy.  Therefore, at minimum, it offers support for further scientific inquiry into the admission process within the adolescent treatment industry, including residential and wilderness treatment programs.

This presentation also examined the different trajectories of change and outcomes associated with controlled (or coerced) and autonomous motivation.  In sum, autonomous motivation is essential to lasting change and successful outcomes.  Autonomous motivation–according to self-determination theory–is attained within the context of therapeutic treatment when an individual (or adolescent) establishes a personal value with the therapeutic process.  Considering this, it seems critical that parents, consultants, programs, and transport make a concerted effort to minimizing and alleviating the perception of coercion or control during all aspects of the admission process.

In closing, a recommended model of best practices was provided for educational consultants and the admission staff of therapeutic residential and wilderness programs.  This model emphasized two themes: (a) fostering volition and (b) the least coercive method of intervention.  This model is outlined below.

Fostering Volition:

  • Minimize Pressure & Control
  • Provide Reasoning
  • Understand & Acknowledge
  • Support Choice
  • Unconditional Positive Regard

Least Coercive Intervention:

  • Process of justification for both use and extent of coercion
  • Determine competency
  • Negotiate
  • Client-centered intervention
  • Exhaust Positive Pressures
  • Facilitate “Voice”
  • Act in Good Faith & Without Bias

Please respond with any questions or comments you may have below.

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