How to Engage Clients in Therapy

Both clinicians and clients seek therapy with the hope of a positive experience. This might include reaching specific goals, learning new skills, self-discovery, and growth. A key factor in having a positive experience is client engagement.

While it is a crucial element of therapy, definitions and methods of assessing client engagement are inconsistent (Holdsworth et al., 2014).

In general health care settings, client (or patient) engagement involves collaboration, involvement in treatment, compliance, and adherence (Marzban et al., 2022).

However it is defined or measured, engaging clients in therapy and helping them embrace change is critical for success, retention, and a fulfilling experience.

Before you continue, we thought you might like to download our three Goal Achievement Exercises for free. These detailed, science-based exercises will help you or your clients create actionable goals and master techniques to create lasting behavior change.

How to Engage Clients in Therapy: 6 Key Steps

Connecting with and engaging clients in therapy is often considered a metric of success (Hill et al., 2013). There are a few steps that can make this connection more effective and powerful.

1. Therapeutic alliance

Perhaps the biggest factor for client engagement in psychotherapy is the therapeutic relationship. This is the bond between the client and therapist, which is commonly referred to as rapport (Stubbe, 2018). Building rapport with the client during initial sessions will strengthen this alliance.

This relationship involves empathy, a nonjudgmental attitude, and mutual respect, creating a safe space for clients to openly address concerns, explore issues, and facilitate personal growth and healing (Stubbe, 2018).

2. Collaboration

An important step to client engagement is working with them as a partner rather than creating a barrier of power and authority.

To encourage your clients to feel a sense of ownership in the process, allow them to share responsibility when (Stubbe, 2018):

• Setting goals
• Creating a treatment plan
• Determining the most effective therapeutic approach
• Gauging the timing and frequency of sessions

With this ownership, clients are more invested and value each session more deeply.

3. Empowerment

Encouraging clients to take control of their choices, behaviors, and decisions in the treatment process is the path of empowerment (Peebles, 2020).

When you nurture your clients’ ability to actively participate and make informed decisions, they embrace change and are more engaged in their individual journey of therapy.

Therapists can create empowerment by providing knowledge, teaching skills, and cultivating awareness and confidence to shift from a place of dependency to a partnership — collaboration. Client empowerment has been shown to increase satisfaction, loyalty, and client engagement (Peebles, 2020).

4. Education

A specific part of empowerment is education. Providing clients with psychoeducation on both their condition and treatment options provides more meaning to the process and can enhance client engagement (Coulter, 2012).

Education begins from the very start of treatment. Clients should be informed about confidentiality, your practice and credentials, what they can and can’t do, and details on diagnosis and disorders.

5. Professionalism

Creating a strong therapeutic alliance is important to engage clients, but therapists should also embrace a professional standard to gain respect and trust (Stubbe, 2018).

Professionalism includes being consistent, reliable, attentive, and present in sessions. It takes commitment from both parties to create engagement. Following up on appointments and agreed-upon activities is part of committing to the process.

6. Flexible approach

Therapy is not one-size-fits-all. While many therapists have a specialty, such as EMDR therapy for trauma, having training and experience with various techniques can provide a more individualized experience for your clients. Being flexible in selecting the appropriate technique and modality for treatment will help keep your clients engaged.

Tips for online sessions

Since the start of COVID, online therapy has emerged as an effective way to help clients navigate life, stress, and mental and emotional health disorders. It continues to grow in popularity, but technical issues can often hinder connection and engagement. Here are some helpful tips to make the most of online sessions.

1. Environment

Find a quiet space with favorable lighting and a neutral background. Encourage the client to find a space where they are comfortable that is free of distractions. Both the client and the therapist should turn off devices and consider a white noise machine to eliminate external noise and keep things private.

2. Eye contact and pacing

Make eye contact with the client to build rapport, just as you would during an in-person session by looking at the camera. Facial expressions and tone are powerful tools you can use to connect with the client online. Allow space for the client to respond to questions and learn to be comfortable with some silence, even though it can be more difficult to do virtually, as it feels awkward to pause while online.

3. Consider posture and distance

We often forget that how we sit and our distance from the camera matter in virtual sessions. Posture, how the body is angled, and proximity to the camera affect how a client sees and perceives you. Be open, welcoming, confident, and far enough from the camera that most of your upper body can be seen.

3 Reasons Client Engagement Matters for Therapy Outcomes

There are many obvious reasons why keeping clients engaged in therapy affects treatment outcomes. When we are engaged in life, we get more out of it!

1. Improves client compliance

Engaged clients are more likely to complete homework assignments, participate in sessions, and follow the steps of the treatment plan. Successful outcomes and improvement in wellbeing are the results of compliance (Coulter, 2012).

2. Goal achievement

Empirical evidence consistently demonstrates that a strong therapeutic bond deepens client involvement and leads to better outcomes (Peebles, 2020). Client engagement is a better predictor of goals than use of specific techniques. Shared goals and collaboration are linked to a reduction in stress and improvement in psychological adjustment (Peebles, 2020).

3. Symptom improvement

A study examining the level of client engagement in treatment outcomes for cognitive behavioral therapy (CBT) found that it was a critical component for reducing distressful psychological and emotional symptoms (Glenn et al., 2013).

Client engagement was the biggest predictor for reducing anxiety, depression, and functional disability in the CBT program implemented in this research. Additionally, engaged clients remained in treatment longer and had higher levels of satisfaction with the program (Glenn et al., 2013).

4 Common Barriers & How to Overcome Them

Research has shown that 33% to 46% of clients in community mental health centers discontinue the recommended treatment after starting services (Hull & Broquet, 2007). Aside from general client resistance in therapy, identifying common barriers can help clinicians find practical ways to overcome them.

1. Complex behavioral or medical health needs

Clients with medical conditions such as chronic pain, obesity, diabetes, traumatic brain injuries, or other neurological conditions also report lower levels of compliance and engagement in mental health therapy (Smith et al., 2023). This research shows that the number of health conditions is directly correlated to client resistance.

Reasons for such resistance are not conclusive, but it may be because they feel misunderstood or that getting treatment for mental and emotional health is not seen as a priority or something that can be done in conjunction with treating physical symptoms.

How to overcome: Understand medical conditions

Get educated on specific client conditions, best practices, and treatment options. Understanding clients’ conditions (physical, emotional, and mental) will help therapists meet clients where they are, connect with them, and design a plan that matches specific needs.

2. Unstable and traumatic relationships

Clients with a history of adverse childhood events, trauma, and other forms of abuse are more resistant to therapy (Smith et al., 2023). Lifelong experiences with trauma lead to a mistrust of authority and health care professionals. Creating trusting relationships can be particularly difficult for individuals who have never experienced them.

How to overcome: Use trauma-informed care

For individuals who have experienced traumatic relationships, using trauma-informed care is particularly important. Establishing an environment of safety will help build trust and improve client engagement (Smith et al., 2023).

3. Lack of motivation

Client motivation is a critical factor to their engagement in treatment. Clients who are forced or coerced into therapy by a loved one, court order, etc., are less likely to be engaged in sessions, complete homework, or work toward treatment goals (Smith et al., 2023).

Clients may lack motivation if they do not share in goal setting or feel they have a voice in the treatment process.

How to overcome: Persistence and patience

Be patient with clients, meet them where they are, and don’t give up on them emotionally when there are setbacks, struggles, and failures. If one technique or treatment isn’t working, try using a different modality or approach.

4. Burnout

Therapists are human, and they can experience burnout like any other profession. Engagement depends on the alignment of work and personal attributes. It is cultivated by attitude, behavior, motivation, and worldview (McFarland & Hlubocky, 2021). Engagement in work decreases, and feelings of therapy burnout come when work is driven by fear and necessity and feels inconsequential.

Burnout can result in feelings of anger, frustration, helplessness, and fatigue (Smith et al., 2023). These feelings can be overtly or subtly communicated to clients, which in turn will create feelings of disconnect and distrust, decreasing engagement.

How to overcome: Self-care and boundaries

Implementing a routine of self-care for therapists and setting boundaries with clients and the work environment can help therapists prevent burnout and stay engaged with clients (McFarland & Hlubocky, 2021).

Finding time for personal hobbies, physical activity, social support, and/or relaxation techniques such as yoga and mindfulness is important for clinicians to do on a regular basis.

Helpful Tools for Sustainable Long-Term Engagement

Therapeutic tools can help with long-term client engagement. These include motivational interviewing, collaborative goal setting, and strengths-based techniques.

Motivational interviewing

Motivational interviewing helps clients explore their problems and come to their own conclusions (rather than being told what to do). It asks open-ended questions, affirms effort, and uses reflection and summarization. An example question would be:

“What would your life look like if you didn’t have this problem?”

Collaborative goal setting

When clients are part of the goal-setting process, they may be more likely to invest in it and embrace the change they want. Ask clients, “What matters most to you right now?” And then help them create SMART goals that are specific, measurable, action-oriented, realistic, and time-based.

Strengths-based tools

Focusing on strengths, accomplishments, and successes is much more motivating than focusing on our deficits. Shifting attention from weakness and failure to a focus on character strengths and how these can be used to accomplish goals is a powerful tool for engaging clients in therapy (McFarland & Hlubocky, 2021). Ask clients about past successes or use strengths assessments to get started with this.

5 Engaging Therapeutic Techniques

Along with therapeutic tools, there are some techniques that can help build rapport, engage clients, and create lasting change.

1. Visual aids and props

Metaphors and tangible props can draw clients into therapy, help them open up, and lead to greater insight and understanding (McFarland & Hlubocky, 2021). Using props like a rock to represent stability or a ball of tangled yarn to demonstrate overwhelming thoughts can provide insight.

Use drawings or charts such as an emotion wheel to help clients identify thoughts, feelings, and progress through therapy.

2. Expressive art

Creative techniques such as drawing, creating a collage or vision board, and music or yoga therapy can help clients tap into deeper sensations without words. These techniques can be particularly useful when clients struggle to identify emotions or have difficulty expressing them. Bypassing the analytical brain allows clients to embrace feelings and change, leading to powerful breakthroughs (Coulter, 2012).

3. Movement and environment techniques

Use of the physical environment and movement can help engage clients who feel stuck, restless, or guarded. Things like walk-and-talk therapy and grounding techniques that incorporate texture, sense of smell, or kinesthetic props (sand, water, soil) help regulate the nervous system. These techniques allow clients to take a holistic approach by engaging the mind, body, and environment (McFarland & Hlubocky, 2021).

4. Techniques of play

Strategically using playful techniques in session can build rapport, improve connection, lower emotional defenses, and lead to better engagement (McFarland & Hlubocky, 2021). Some ways to do this include turning goals into games or challenges with mini rewards.

Use card decks with topics or prompts such as “share your favorite childhood memory” to help relieve stress from open-ended questions and heavy therapeutic topics.

5. Techniques for teens

Teens are often resistant to therapy and may find it difficult to open up and engage. This video reviews some specific ways to engage teenage clients in therapy.

How to Enhance Engagement Through Homework

Offering homework exercises between sessions can keep clients engaged in treatment. Clients are individual, and tailoring homework activities to specific preferences is something important to consider.

Worksheets, books, videos, articles, apps, and websites are great ways to assign homework. Tang and Kreindler (2017) divide therapy homework into three types:

1. Psychoeducation consists of activities that educate clients about symptoms, causes, and options for treatment.
2. Self-assessment homework activities help clients monitor moods, emotions, and thoughts between sessions. These include questionnaires, thought records, and progress trackers.
3. Modality-specific homework includes assignments that are specific to client conditions. This might include having a client with depression complete a gratitude journal or engage in behavioral activation techniques between sessions.

Strategic homework assignments can encourage clients to practice skills, learn new techniques, personalize growth, and embrace change.

PositivePsychology.com’s Helpful Resources

There are several resources available at PositivePsychology.com that can help with the topics discussed in this article.

As mentioned, motivational interviewing is a powerful way to engage clients. The article 18 Motivational Interviewing Worksheets, Examples, and Techniques provides worksheets to use with clients to foster motivation and reasons for coming to therapy, particularly for those resisting change.

Additionally, this Motivational Interviewing: Ability Questions worksheet can help elicit client abilities during motivational interviewing by using the DARN acronym.

Our Setting SMART+R Goals worksheet can help clients incorporate rewards when setting goals in therapy.

Is it difficult for your clients resisting change to find goals? Our free Goal Achievement Exercises will help you and your clients create actionable goals to foster everlasting change.

If you find that clients are difficult to engage with, please look at our article 6 Stages of Change: Worksheets for Helping Your Clients. This article provides links to worksheets, introduces six stages of how change is achieved, and explains why change is important.

If you’re looking for more science-based ways to help others reach their goals, this collection contains 17 validated motivation & goals-achievement tools for practitioners. Use them to help others turn their dreams into reality by applying the latest science-based behavioral change techniques.

A Take-Home Message

Client engagement is critical to client success, positive outcomes, and a better experience in psychotherapy and coaching.

Establishing a positive rapport and therapeutic alliance; using collaboration, education, and empowerment; and having a professional yet flexible approach can create a wonderful environment for engagement (Marzban et al., 2022).

Clients who actively engage in the therapeutic process are more open to change and more likely to have meaningful experiences with positive outcomes.

We hope you enjoyed reading this article. Don’t forget to download our three Goal Achievement Exercises for free.

ED: Updated June 2025