Stages of Engagement Framework

Productive engagement can be complex with three phases (Pre-Engagement, Engagement and Contracting).  The chart below presents these phases with corresponding, appropriate interventions to help foster effective communication.


Phase Intervention


Trust vs. Mistrust

Safety Issues

Identify potential patient
Respect personal space
Assess safety
Attempt verbal and non-verbal communication
Offer essential need item(s)
Listen for client language
Establish initial communication, etc.


Trust vs. Mistrust

Dependency Issues

Boundary Issues

Communicate with empathy and authenticity
Learn patient’s language
Actively listen by reflecting person’s words, ideas, values
Identify and reinforce person’s strengths
Provide unconditional regard
Avoid power struggles
Emphasize joining the resistance
Introduce roles, begin and continue healthy boundaries
Establish on-going communication
Identify current life stressors, etc.


Autonomy vs. Shame

Issues of Control

Initiative vs. Guilt

Further define roles and boundaries
Address shame by universalizing human frailty
Review patient’s strengths
Negotiate reachable goals to alleviate life stressors
Explore person’s history around goal setting and achievement
Determine eligibility for resources and services
Further define shared objectives
Review and reinforce current coping strategies,
Seek permission to register/enroll patient for treatment 

Figure 26. Stages of Engagement Framework. Adapted from Levy JS.36