Engaging Individuals Who Don’t Want to Be Seen: Motivational Interviewing and Outreach Strategies

Engaging Individuals Who Don’t Want to Be Seen: Motivational Interviewing and Outreach Strategies

Working with individuals who are unhoused and living with severe mental illness or substance use disorders often means encountering people who avoid traditional services. These individuals may not show up for appointments, resist structured environments, or simply vanish for weeks at a time. Their avoidance isn’t necessarily rooted in defiance—it often stems from survival strategies, trauma, disconnection from systems that have failed them, or the need to protect autonomy.

So how do we, as behavioral health providers, social workers, or case managers, offer support to someone who doesn’t want to be found? This question becomes especially important when the person holds strong goals—such as clearing a legal charge or stabilizing mental health—but struggles with steps like attending appointments or maintaining contact.

Meeting People Where They Are—Literally and Figuratively

Engagement starts with flexibility. Outreach isn’t about waiting in the office for someone to walk through the door. It's about walking through theirs—whatever that may look like. This means identifying common areas they frequent, respecting the environments where they feel safe, and maintaining a consistent presence even if direct contact doesn’t always happen.

Research by Padgett, Henwood, and Tsemberis (2016) in housing-first models shows that consistent, low-barrier contact builds trust over time, especially when not tied to service compliance. Offering practical support—food, hygiene items, or simply showing up with no demand—helps reduce the perception of threat or obligation.

Building Trust Through Consistency and Affirmation

Many individuals who avoid services have had negative experiences with institutions—whether that be jails, hospitals, shelters, or treatment programs. Building trust takes time and depends on your ability to offer predictability and unconditional respect. Celebrating small wins and reinforcing strengths (e.g., navigating the city, caring for pets, using technology) acknowledges a person’s competence and fosters self-efficacy.

In Motivational Interviewing (MI), developed by William R. Miller and Stephen Rollnick, affirmations are key to building rapport and evoking change. These are not compliments, but genuine observations of strengths: “You’ve managed to keep yourself and your dog safe for years—that takes skill.” This creates space for the person to see themselves as capable of change.

Rolling With Resistance and Evoking Motivation

Rather than confronting resistance, MI encourages us to “roll with” it—by joining with the individual’s perspective rather than pushing against it. When someone says, “I don’t want to go to that appointment,” the response might be, “Yeah, I get it—those places can be overwhelming. What’s made it hard in the past?” This invites reflection rather than defensiveness.

When ambivalence is high—wanting change but fearing failure—highlighting discrepancies is often effective. MI uses open-ended questions to draw out personal reasons for change:

• “What makes this goal important to you right now?”

• “What would it look like if things were just a little bit better?”

• “If you could wave a magic wand and fix one thing, what would it be?”

Small steps toward change are more achievable than major commitments. Instead of asking, “Will you go to court next week?” try, “What’s something we could do this week that gets you one step closer to being ready for that?”

Working With Barriers Without Losing the Goal

Sometimes the barriers are practical and real: service animals can’t be left unattended; phones are often dead; laundry or recycling is a higher priority than stabilization. MI helps reframe these challenges as part of the person's reality rather than obstacles to “get over.” Use collaborative planning:

• “Let’s think about how to make space for both—your dog and that appointment.”

• “If we had a plan for your cans, would that make it easier to think about going in?”

The goal is not to remove every barrier overnight, but to co-create a pathway that respects the individual’s priorities and capacities.

Key Takeaways for Providers

• Show up consistently, even without a guarantee of contact. Presence is powerful.

• Affirm autonomy and capability, even in disorganized behavior.

• Use MI to explore ambivalence, not erase it.

• Focus on the person’s goals, not what the system wants from them.

• Celebrate progress, even when it’s just a conversation that didn’t happen last week.

Motivational Interviewing is not a magic wand, but it is a deeply human and evidence-informed approach that honors the person’s right to self-direct while inviting change. For individuals who don’t want to be seen, it helps them feel seen without being cornered.

---

References:
Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.
Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. (2016). Housing First: Ending Homelessness, Transforming Systems, and Changing Lives. Oxford University Press.