Step 7. Incorporating the C-NIP into Practice

Ayo, a 24-year-old college student of African descent, sought care for his anxiety, depression, and interpersonal trauma. At the end of treatment, Ayo said that he had found the Cooper-Norcross Inventory of Preferences (C-NIP) to be “very helpful” and explained that “it meant that I got to make the decisions on paper, rather than telling a person.”

By this, Ayo meant that it was easier for him to be more open and honest on a form rather than in speech because he was less concerned about hurting the other person’s feelings. Ayo also said that he valued the C-NIP because “there are a lot of questions, and they’re all very specific, which is great because they’re things I probably wouldn’t have thought of.”

Ayo articulated 2 of the 4 principal virtues of any standard measurement. First, measures tend to increase the willingness of respondents to truthfully self-disclose sensitive behaviors. Sometimes, writing provides a channel by which more “personal” ideas and feelings can be expressed. Second, measures allow for a more comprehensive assessment. A client, particularly when anxiously meeting a clinician for the first time, may not be that aware of their strong preferences. By contrast, a measure invites them, as Ayo put it, to think about things that they “wouldn’t have thought about” otherwise.

In addition to these two advantages, the use of measures reduces the likelihood that the clinician’s own foibles and biases will get in the way of an objective assessment of what the client wants. Finally, standardized measures allow the client’s answers to be compared against representative samples so that scaled scores can be produced (e.g., high, average, low). We can therefore obtain a relative sense of the strength of a client’s preferences.

The dialogue with clients about identified strong preferences is a vital part of the process. Remember that assessment results comprise only a starting point for a meaningful exchange about how clients can get the most out of their treatment. In the words of Paulo Friere “Dialogue. . . (is) the way by which we achieve significance as human beings.”

Some examples of how you can deepen the exploratory process follow:

♦ I can see here that you desire quite an emotionally intense therapy. Can you say more about that?

♦ Your responses to the questionnaire indicate that you want me to challenge you. Is that right? What sort of challenge do you think might be helpful?

♦ You’ve said that you are keen to text every day or two. Do you have a sense of why?

It may also prove helpful to inquire into the origins of clients’ preferences. This typically generates more context and meaning for their treatment desires.

Therapist (T): You indicated here that you strongly seek a client-led approach, one with little structure and no homework. Can you tell me more about where that comes from?

Client (C): The first therapist I had I really couldn’t get with. He had the sessions planned out the moment I walked through the door. I didn’t feel like there was much—any space for me to have input into things.

T: So the key thing is feeling that you can have some say in what is going on. Is that right?

C: Yes. To be honest, I didn’t mind the exercises too much, but it was the way that he did it. I felt like I could have been anyone.

T: It sounds like the main issue was about feeling anonymous and the therapy feeling impersonal [(C: Mm]) more than the structure, per se [(C: Yes]).

Subsequent steps present the ways practitioners can, and cannot, accommodate their client’s treatment preferences. Suffice it to say, for now, that exploring and dialoguing about strong likes and dislikes presents a valuable opportunity for you to indicate whether you can, or cannot, accommodate those preferences.

Just because a client asks for something does not mean they get it. Legal, ethical, and legal codes still operate.

It is essential that you do not convey judgement on the client’s therapeutic preferences. We learn nothing from summary judgements; we learn from human empathy. Clients should leave the assessment session feeling that their preferences are respected and valued, whatever they indicate.

Watch the following video of the C-NIP being used:  

Continue to practice asking the 2 questions: What do you strongly dislike or despise in treatment? What do you strongly like or desire? How did you explore the preferences your client shared?