Health Blog

The four C’s of program participation:  Conflict, Compliance, Cooperation, and Correspondence

This post is meant for both treatment providers and for those receiving treatment, as it may serve to define how someone is progressing in a treatment program. This is from anecdotal observation and should not be considered as rigorous research or hardbound truth. This is a blog post and is not in a journal. If this shows up in a paper, I hope your professor reads this blog.

In working in different treatment programs, I have noticed patterns of participation, ranging from willful disobedience, bitter resignation, and clock-watching, to graduating and flourishing. These patterns can reflect a particular stage of change that a program participant is in, from pre-contemplation to contemplation to preparation to action to maintenance. These patterns can exist in many treatment programs.

Here are the styles and some description of each:

Conflict: These program participants have the least amount of interaction with any singular program but may have the most contact with different programs. They may find themselves outside of the program by their choice or by the action of the program to keep the other program participants safe and focused on their treatment. These participants may have hostile and defensive interactions with program staff and peers. They are more likely to leave against staff advice or be asked to leave by staff advice.

Compliance: These program participants attend. Their behavior is such that they reasonably comply with the rules, attend their treatment groups, and fulfill to some degree their more superficial treatment expectations. They may sit in groups, say little, and defer group participation to others. They are more likely to consider “groups” as “classes”, changing the dynamic from intrinsic to extrinsic, with the focus not on personal responsibility but to the group facilitator having the responsibility to incite change in them. They may complete a program, but little, if any, progress can be quantified. They are more likely to come back into a program than those in the next two groups.

Cooperation: These program participants can find some meaning in their program participation. Although they may not be in agreement with every part of the routine or expectations of the program, they have chosen something to which they respond. Progress can be expressed by these participants and seen by the program staff. The participants also seek out other ways to interact with the program, such as helping out with the facility (in some inpatient programs, this may be the case), or asking for feedback from other program staff about various issues. These participants will act and think differently after they have completed the program and their families will be able to see it.

Correspondence: This is the rarest form of participation. It is defined by individuals who have changed their participation in the program and have changed the program itself. Program providers will say about these participants, “This is the reason I do my job.” These participants may also go into a helping field themselves. Their feedback to the program may inform procedure or protocol, as the program providers have grown to trust and value the input from these persons. Their participation is considered more “co-respondent” as both providers and participants have been changed positively as a result of the interaction.

I hope this helps to determine for program providers where someone is on their journey and that it helps increase awareness for participants of what their participation dictates about their likelihood for success.

Justin Westerhof, LMSW
Outpatient Therapist
Leonard Street Counseling Center